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Boom in Alternative Medicine Is Found

Health: Studies say four in 10 American adults turned to such therapies last year. But definition is called flawed.


More Americans than ever are becoming connoisseurs--and purchasers--of alternative medical therapies, even preferring to see alternative practitioners over their primary care doctors, according to a survey and several accompanying studies in today's Journal of the American Medical Assn.

Four in 10 adults used alternative therapies last year, creating a $21.2-billion industry, according to new data collected by Dr. David M. Eisenberg of Beth Israel Deaconess Medical Center in Boston.

Between 1990 and 1997, visits to alternative practitioners jumped about 47%. Over that period, Americans logged about 629 million trips to alternative providers, compared with 386 million visits to primary care doctors.

The findings of six studies presented in the special JAMA issue range from evidence that burning an herb over a pregnant woman's foot may correct a breech presentation to research showing that spinal manipulation doesn't alleviate tension headaches.

The overarching message of the issue, said senior editor Phil B. Fontanarosa, is that: "The time is over to simply accept or discourage alternative therapies. Both alternative and conventional therapies have to undergo rigorous scientific scrutiny."

Eisenberg's telephone survey of 2,055 adults updates his 1990 survey that showed that about one-third of Americans used one or more alternative treatments, including acupuncture, megavitamins, herbs or chiropractic. His current estimate of 60 million adult users of alternative therapies is significantly higher than many previous estimates.

Eisenberg's findings echo those reported by The Times in a four-part series on alternative medicine earlier this year. Eisenberg also found that Western U.S. residents, women, Caucasians and college-educated individuals are more favorably inclined toward alternative therapies.

However, as with his earlier poll, some experts criticized Eisenberg for not narrowing his definition of alternative medicine enough--especially by including diet, nutrition and folk remedies. People who eat chicken soup to ease cold symptoms might describe that as an alternative therapy, said Dr. John Renner, the director of an anti-medical fraud group in Independence, Mo.

Eisenberg's "definition of alternative medicine is seriously flawed," Renner said.

The studies in JAMA yield a mixed bag of treatments and outcomes. Chiropractic manipulation, among the most popular alternative treatments, was not effective against a type of tension headache, according to a Danish study.

Chiropractors say spinal manipulation can reduce the pain of "episodic" tension headache, defined as two to 15 tension headaches per month. But in the new study, 36 men and women with the disorder who got eight spinal manipulations and light massages over four weeks felt no more improvement than a similar group of 34 people getting only light massages.

Woodland Hills chiropractor Michael Spagnoli of the Trillium Sports Medicine Clinic said the study may be misleading because practitioners offer a range of treatments for a given disorder, from posture counseling to nutrition. It's "ridiculous," he said, to try to reduce the approach to "cookbook medicine."

In an unexpected positive finding, however, researchers found that moxibustion, a traditional Chinese therapy to alter the breech presentation of a fetus before birth, was successful. In moxibustion, a herb commonly known as mugwort is burned near an acupuncture point outside of the mother's fifth toenail.

Italian doctor Francesco Cardini studied two groups of first-time mothers in China, all of whom had breech presentations in the 33rd week of pregnancy. After the 35th week, 75.4% of the women who had been exposed to the burning herb had experienced a correction of the breech presentation while 47.7% of the babies in the untreated group had turned into the correct head-down position.

The researchers suggest that the technique, which is highly regarded in China, might work because the herbs have an effect on maternal blood chemicals that cause excessive fetal movements and lead the baby to rotate.

Indeed, the fastest-growing part of the alternative medicine movement is herbal remedies, with Americans' use jumping nearly fourfold from 1990 to 1997, according to Eisenberg and co-workers.

Yet rigorous scientific evidence for many herbal treatments remains hard to come by, researchers say. To help fill the evidence gap, the AMA journal includes three studies of ingested herbal remedies.

An analysis of studies on saw palmetto extract--made from the tree's dried berries--found that it eased the symptoms of enlarged prostate as well as a new prescription medication.

Combining the data from 18 previously published studies involving 2,939 men, the researchers found that compared with men taking a placebo, or dummy pill, those who received the herbal remedy were twice as likely to experience improved urological function.

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