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Casting a cold eye on hot remedies

Scientists raising new doubts on popular alternative medicines

By Stephen Smith, Globe Staff, 4/20/2002

Every year, Americans spend $27 billion on alternative medicine: potions, pills, and treatments that fly from the shelves of health food stores, supported more by the hopes and expectations of their users than by rigorous scientific research.

But now, backed by millions of dollars from federal agencies, scientists are beginning to hold those treatments to the same kind of scrutiny as conventional drugs, often with disappointing results.

New studies released in the past two weeks show that six popular treatments - including the use of magnets for pain relief and St. John's wort for depression - perform no better than placebos, the equivalent of sugar pills. In fact, the trial of one tree extract, guggul, showed that it aggravated the condition it was supposed to relieve, actually elevating cholesterol levels.

''It's a case of buyer be thoughtful,'' said Dr. Peter M. Wolsko, a Harvard researcher studying magnets.

Scientists evaluating the alternative treatments said the negative findings should not be surprising. It happens with drugs developed by big pharmaceutical companies, too, which is why so few ever make it to market.

Researchers also warn that the quest for truth may prove elusive, demonstrating a fundamental division between the way medicine is practiced and researched in the West and in the rest of the world, where many of the alternative treatments originated.

The research canons of the developed world demand results that can be precisely quantified, often forsaking broader measurements of well-being.

''In the West, we look at complementary medicine in a very reductionist way; we strip a treatment down to its bare constituent parts,'' said Peter White, who researches acupuncture at the University of Southampton in England. ''Maybe we can't do that with complementary medicine. Maybe we need to incorporate some of the holistic nature of complementary medicine into our research.''

The explosion in popularity of acupuncture, magnets, and a constellation of herbal remedies is in many ways a testament to patients' frustration with prescription medications that roil their stomachs and surgeries that require weeks of healing.

But, until recently, most health claims for alternative methods rested on anecdotes and testimonials, rather than hard science. So in the past decade, the federal government has increased its investment in studying alternative medicine, from $2 million to more than $68 million a year.

''It just seems to me that if we're going to start treating people with these sorts of treatments,'' White said, ''we need to know a bit more about them.''

He was among the scientists who spent three days in Boston last week swapping data at the International Scientific Conference on Complementary, Alternative & Integrative Medicine Research. The gathering represented a meeting of two worlds of medicine once viewed as irreconcilable but now trying to learn from each other.

Some of the most important research is unfolding at universities more commonly associated with old-line medicine, Harvard and the University of California at San Francisco.

''I'm very pleased that these scientific games have begun,'' said Dr. David M. Eisenberg, director of Harvard's Osher Institute, which explores alternative medicine. ''Many people thought the game would never be played on a level playing field with real umpires and real players.''

The scientists met just days after publication of a landmark study of St. John's wort showed that the herbal remedy was no better than a dummy pill in modulating the effects of moderately severe depression. In fact, St. John's wort came in third, with patients taking the placebo reporting the greatest reduction in depression, followed by those who took the prescription medication Zoloft.

Two other favorite herbals - kava, touted for its anxiety-abating virtues, and valerian, reputed to ease insomnia. - also failed to outperform a placebo in a study by Dr. Bradly P. Jacobs, medical director of the Osher Center for Integrative Medicine at the University of California at San Francisco.

What was exceptional about Jacobs's study and many others discussed at the Boston meeting was that they hewed to the kind of research standards applied to prescription medicines. The kava and valerian studies were double-blind, meaning that neither the participant nor the researcher knew whether the test subjects were taking the real thing or a fake pill.

''We were surprised with the findings,'' Jacobs said. ''Going into it, I thought these herbs probably would work. Our goal was to really crank up the level of scientific rigor.''

That goal was shared by Dr. Philippe Szapary, a University of Pennsylvania internist who investigated guggul, a resin extract from a thorny tree indigenous to Western India. Earlier studies in other countries had suggested it worked in reducing cholesterol.

After 85 participants completed the study, Szapary concluded that not only was guggul no better than a placebo, but that bad cholesterol - low-density lipoprotein, or LDL - actually rose 4 percent in participants who ingested the tree extract. And four people developed rashes.

Szapary speculated that ethnicity might explain the discrepancy between findings obtained by researchers in South Asia and the data he collected. Perhaps, he said, guggul's ability to lower or raise cholesterol levels is different in different populations.

''But at this point, I wouldn't use it,'' Szapary said. ''Just like in medicine in general, there are things that work and things that don't. We just need to weed out the ones that are beneficial and those that are not.''

Researchers in Boston and Southampton, England, investigated two of the most popular alternative pain treatments, acupuncture and magnets. Each year, Americans spend an estimated $150 million on medical magnets, purported to increase blood flow to body parts hobbled by pain.

At Beth Israel Deaconess Medical Center, Harvard's Wolsko gave arthritis patients knee sleeves, some with magnets, some without. Four hours after first slipping on the knee sleeves, the participants who received magnets reported less pain than the group that received sleeves without magnets. But that difference waned dramatically as the study progressed; after six weeks, the participants who did not have magnets reported more improvement than the magnet group.

''Based on the way people are choosing alternative therapies, I don't think they should expect 75 or 100 percent of all therapies are going to be shown to be efficacious,'' Wolsko said. ''It may be more on the order of 25 or 50 percent, but only time will tell.''

Scientists at the University of Southampton set up a test of acupuncture in which one group of patients received needle treatments, while the other received mock electrical stimulation meant to mimic acupuncture. Both groups reported that their pain eased by about 60 percent, with no statistical difference between the half that received acupuncture and the half that received electrical stimulation alone.

The British researchers hypothesized that the benefit shown by both parts of the study might really reflect the attention devoted to the patients. Twice a week for four weeks, there was someone who listened, compassionately, as they spoke of the ordeal of neck pain, someone who touched them with care, whether it was for an acupuncture session or for a treatment that, objectively, offered no medical benefit.

Ultimately, Southampton's White said, maybe it doesn't matter that much that acupuncture worked no better than the placebo. ''If something empowers patients to feel better and it doesn't hurt them,'' White said, ''then why not use it?''

Stephen Smith can be reached at stsmith@globe.com.