The Best Alternative Medicine

"Alternative medicine needs an ‘evidence-based’ middle ground for the public and for practitioners. The research and wise counsel from Dr. Kenneth Pelletier, in The Best Alternative Medicine, provides us all with an inspired framework for integrating conventional and alternative medicine."

—John W. Farquhar, M.D., Professor of Medicine and Director, Stanford Wellness Center, Stanford University School of Medicine

"In The Best Alternative Medicine Dr. Pelletier gives us the most up-to-date and authoritative information on which therapies work and which don’t. Concise, readable, invaluable."

—James S. Gordon, M.D., Director, Center for Mind-Body Medicine, Washington, D.C.; author, Manifesto for a New Medicine

It’s so-o-o wonderful that we’ve finally moved beyond the old knee-jerk head-butting between pro—and anti—alternative medicine forces and can now engage in rational discussions of what works, what does not, and who decides. Dr. Pelletier is an important change-agent in this process. His book is necessary reading for all concerned.

—Tom Ferguson, M.D., Adjunct Associate Professor of Consumer Health Informatics, University of Texas Health Science Center

The real future of medicine is the integration of the best of evidence-based conventional and alternative therapies. Dr. Pelletier’s book is a landmark contribution to the medicine we want and the medicine we need.

—Michael Lerner, President, Commonweal; author, Choices in Healing

"Dr. Kenneth Pelletier’s The Best Alternative Medicine brings the global field of healing into focus by offering empirical wisdom in a wilderness of wishful thinking. With an open-minded, appreciative analysis of complementary approaches to wellness, Pelletier ultimately reveals that there is no alternative to medicine—only methods that work and those that do not. An essential reference, it may well become a classic."

—Dan Millman, Author of Everyday Enlightenment, and Body/Mind Mastery

Dr. Pelletier tells us not only ‘what works’ and ‘what does not’ but all the ‘maybes’ as well, the gray areas where most of the important questions about alternative medicine reside right now. This book gives readers the essential information to make decisions about the ‘maybes’ that affect their health.

—Walter M. Bortz, II, M.D., Palo Alto Medical Foundation

"All good medicine is the result of a marriage between an open mind and a generous heart grounded in the principles of rigorous science. The Best Alternative Medicine is good medicine and it delivers exactly what it promises."

—Christiane Northrup, M.D., author, Women’s Bodies, Women’s Wisdom

"When traveling to a new land, it helps to have an authoritative guidebook written by an experienced and professional traveler. The Best Alternative Medicine is just such a guide for those venturing into the land of complementary and alternative medicine. It points out the highlights, great sites to visit, and, importantly, how to avoid pitfalls (and rip-offs). Don’t leave home without it!"

—David Sobel, M.D., M.P.H., Director of Patient Education, Kaiser Permanente Northern California; author, Mind & Body Health Handbook

THE BEST ALTERNATIVE MEDICINE

Dr. Kenneth R. Pelletier

Introduction by Dr. Andrew Weil

Copyright © 2000 by Dr. Kenneth R. Pelletier, Inc.

All rights reserved, including the right of reproduction in whole or in part in any form.

First Fireside Edition 2002

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The Library of Congress has cataloged the Simon & Schuster edition as follows:

Pelletier, Kenneth R.

     The best alternative medicine : What works? What does not?/

  Kenneth R. Pelletier ; introduction by Andrew Weil.

       p.   cm.

     Includes bibliographical references and index.

     1. Alternative medicine.  I. Title.

  R733.P45   2000

  615′.5—dc21                     99-26629

                                CIP

ISBN 0-684-84207-6

     0-7432-0027-6 (Pbk)

eISBN 9-781-4391-2895-4

NOTE TO READERS

This publication contains the opinions and ideas of its author. It is intended to provide helpful and informative material on the subjects addressed in the publication. It is sold with the understanding that the author and publisher are not engaged in rendering medical, health, or any other kind of personal professional services in the book. The reader should consult his or her medical, health or other competent professional before adopting any of the suggestions in this book or drawing inferences from it.

The author and publisher specifically disclaim all responsibility for any liability, loss or risk, personal or otherwise, which is incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this book.

ACKNOWLEDGMENTS

From the cover of Time magazine to the innovative research funded by the National Institutes of Health, there is a virtual explosion of recent interest in complementary, alternative, and integrative medicine. Rather like any overnight phenomenon, this area of research and clinical practice has been in gestation for decades in the United States and hundreds of years in indigenous healing traditions in every nation on earth. Conducting my research and writing this book would not have been possible without the genius, dedication, research and clinical funding, encouragement, and enduring friendship of so many colleagues over these last twenty-five years. Each person named here has made a major, significant contribution in sorting through the complexities of complementary and alternative medicine and integrating demonstrably effective interventions into conventional health care.

Acknowledging these individuals has given me the opportunity to reflect upon each person and their unique contributions and abiding perseverance. Although this enumeration is incomplete, it is surely heartfelt. First of all I would like to thank my longtime friend and colleague Dr. Andrew T. Weil for his forward to this book; I am truly honored by his reflections. From the onset I thank my colleagues at the Stanford University School of Medicine, including Dr. John W. Farquhar, Dr. William L. Haskell, Dr. Stephen P. Fortmann, Dr. John A. Astin, Dr. James F. Fries, Dr. David Spiegel, Dr. Christopher Gardner, Dr. Marcia Stefanick, Dr. Wes Alles, Dr. Abby King, Dr. C. Barr Taylor, Dr. Walter Bortz, Dr. Gene Spiller, Professor Alain Enthoven, Dr. Jeffrey Croke, Dr. Halsted Holman, Chris Scott, and Peter Van Etten, president and CEO of the UCSF/Stanford Health System. Paralleling the work of my Stanford colleagues are the individuals who made the writing and preparation of this book possible: Ms. Cindy Wood, Ms. Lauri Young, Ms. Adeline Hwang, Ms. Sandra Stahl, and Ms. Ellen DiNucci. For their consummate editing and writing skills, I am indeed indebted to both Ms. Kathy Goss and Cameron Stauth in the sculpting of the final manuscript.

Most important, I wish to thank Frederic W. Hills of Simon & Schuster for more encouragement, patience, and mentoring than I could have imagined. Also, a thanks to his able assistant, Ms. Priscilla Holmes for her work on the manuscript. At ICM, I want to thank my representatives, Ms. Lisa R. Bankoff and Ms. Suzanne Gluck, for securing such a renowned editor and publishing house.

Research requires funding, and that difficult task attains Herculean proportions in new areas such as complementary and integrative alternative medicine. For their vision and courage of commitment, I would like to acknowledge the National Institutes of Health, National Center for Complementary and Alternative Medicine (NCCAM), with particular respect for Dr. Wayne B. Jonas, Dr. Richard L. Nahin, Dr. Geoffrey Cheung, Dr. Carole Hudgings, and Dr. William Harlan. In the funding of the NCCAM, there are the pioneering efforts of Senator Tom Harkin, Senator Orrin Hatch, and Dr. Joe Jacobs. Funding from the NIH-NCCATA has allowed the creation of the Complementary and Alternative Medicine Program at Stanford (CAMPS).

Additional funding and support has permitted CAMPS to undertake further innovative research and establish a clinic, thanks to the generosity of the Fetzer Institute with Dr. Jeremy Waletzky and Robert F. Lehman, the Nathan Cummings Foundation with Charles Harpen and Ms. Andrea Kydd, Michael S. Currier, the Fresno Foundation with Ed Rontell, Colby and Lani Jones, Larry Biehl, and E. Lewis Reid.

Additionally, Michael Murphy, George Leonard, and Steve Donovan and the board of directors of the Esalen Institute generously donated to CAMPS the Esalen Archive of over twelve thousand hard-copy articles from an Esalen program funded by Laurance S. Rockefeller. Research funding has also been provided by Dr. Albert R. Martin and Ms. Bobbi Kimball of Blue Shield of California; Jay M. Gellert, Dr. Arthur M. Southam, and Dr. Antonio P. Legoretta of Health Net/FHS; Bain J. Farris of Anthem Blue Cross/Blue Shield; Dr. Des Cummings, Jr., of the Florida Hospital/Disney/Celebration collaboration; and the participating companies of the Stanford Corporate Health Program, including AT&T, American Airlines, ARCO, Anthem Blue Cross/Blue Shield, Bank of America, Health Net (FHS), Disney, IBM, Kaiser Permanente, Levi Strauss, Merck, Mercer, Motorola, San Mateo county, Rite Aid/PCS, Shaklee/Yamanouchi, United Behavioral Health, Medstat, and Xerox.

For each chapter of this book and for research projects in various domains, a number of professional experts provided literature searches and reviews, critiques of draft materials, and a wealth of knowledge, wisdom, and critical assessment of these complex areas of clinical and research knowledge. Within the areas of mind/body medicine, a particular acknowledgment goes to Dr. John A. Astin, Dr. Frederic Luskin, Ms. Katie Newell, and Dr. John Kabat-Zinn; in chiropractic, Dr. William Meeker; for acupuncture, Dr. Joseph M. Helms, Dr. Brian Berman, and Dr. Yuan-Chi Lin; nutrition and dietary supplements, Dr. Pamela M. Peeke, Dr. Christopher Gardner, and the late Dr. James H. Whittam; European herbals, Mark Blumenthal and Dr. Ted Kaptchuk; traditional Chinese medicine, Dr. Miki Shima and Dr. Subhuti Dharmananda; Ayurvedic, Dr. Shri K. Mishra; homeopathy, Dr. Jennifer Jacobs, Dr. Roger Morrison, and Dana Ullman; naturopathy, Dr. Carlo Calabrese; within the area of spirituality, Dr. Dick Tibbits and Dr. Larry Dossey; and for the insurance coverage of CAM, John Weeks and Ms. Ariane Marie. Individually and collectively, these scholars and clinicians contributed their best insights and critical orientation to those complex areas and I am hopeful that the results are a modest reflection of their dedication. Whatever insights reside in these chapters is due to their knowledge. Whatever deficiencies remain are solely due to my limitations.

With the funding of ten collaborative research centers, the NIH National Center in complementary and Alternative Medicine (NCCAM) has enabled a core group of researchers to meet, work together, and engage in the critique and mutual development of an array of increasingly sophisticated research. Details of these centers are included throughout the book and many of these colleagues have already been acknowledged, or will be in the final section of this introduction. For now, I wish to thank the following Center colleagues for many exciting and productive meetings: Dr. Leanna J. Standish, Dr. Brian M. Berman, Dr. Fredi Kronenberg, Dr. Thomas J. Kiresuk, Dr. William L. Meeker, Dr. Samuel C. Shiflett, Dr. Judith Stern, Dr. M. Eric Gershwin, Dr. Guy S. Parcel, Dr. Mary Ann Richardson, Dr. Steven F. Bolling, Dr. Sarah Warber, Dr. Nancy Schoenberger, Dr. Betsy B. Singh, Dr. Ann Gill Taylor, Ms. Christine Wade, Dr. Fayez K. Gishan, and Dr. Andrew Weil.

As I was writing this book, my wife, Elizabeth, was thrown from one of her horses and sustained severe injuries. While conventional medicine provided excellent diagnostics, it offered virtually nothing in terms of treatment. Fortunately, a skilled group of alternative medicine practitioners combined and coordinated their skills in a model of true health care that resulted in a full and complete recovery. For their insight, dedication, extraordinary professional skills, and loving care, we want to extend a heartfelt personal acknowledgement to Ms. Pat Scott, Ms. Diana Herold, Ms. Rhonda Hackett, Dr. Roger Morrison, Dr. Miki Shima, and Dr. Harry D. Friedman, who are among the true healers of our time.

Finally, let me conclude with an anecdote that Jane Goodall recounted to open a lecture at the State of the World Forum in the fall of 1996. Standing before a plenary of world leaders, she acknowledged her colleagues by noting a Texas aphorism: When you see a turtle at the top of a telephone pole, you know it did not get there by itself! For over twenty-five years, the field of complementary and alternative medicine has been painstakingly built upon the vision, courage, tenacity, and analytic skills of true pioneers.

Although this recitation of their names is incomplete, it is with deep honor, respect, and admiration that I am proud to acknowledge these individuals as colleagues, friends, and mentors: Dr. Andrew T. Weil, Dr. David Eisenberg, Dr. Herbert Benson, Dr. Hans Selye, Dr. C. Norman Shealey, Dr. Jonas Salk, Dr. Tom Ferguson, Norman Cousins, John E. Fetzer, Dr. Tracy Gaudette, Ms. Sue Fleischman, Dr. Richard Friedman, Dr. Redford B. Williams, Jach Pursel, Dr. Dean Ornish, Dr. Shirley Brown, Ram Dass, Jerry Green, Dr. Michael Carlston, Dr. Joan Borysenko, Dr. Michael Lerner, Roger S. Greaves, Dr. Rachel Naomi Remen, Dr. Martin L. Rossman, George Vithoulkas, Dr. Paul J. Rosch, Dr. Claude Rossel, Dr. Ray H. Rosenman, Dr. Steven E. Locke, Dr. Chandra Patel, Dr. Deepak Chopra, Dr. David Sobel, Dr. James S. Gordon, Ms. Joan L. Schleicher, Dr. Emmett E. Miller, Dr. Daniel Goleman, Dr. Judith Orloff, Dr. Irving Oyle, John Robbins, Dr. Bernie S. Siegel, Dr. Robert E. Kowalski, Dr. William Regelson, Dr. Bill Goldman, Dr. Anton Jayasuriya, Dr. Sadja Greenwood, Dr. Samuel Benjamin, Dr. W. Ross Adley, Dr. Robert O. Becker, Dr. David E. Bresler, Dr. Jeffrey Bland, Dr. Harry B. Demopoulos, Dr. Ken Dychtwald, Dr. Anthony E. Elite, Dr. Joel Elkes, Dr. Harry D. Friedman, Jack Schwarz, Dr. Jessie C. Gruman, Dr. Malik Hasan, Dr. W. Brugh Joy, Dr. Richard A. Lippin, Dr. Gay Luce, Dr. George Solomon, Dr. Alvin R. Tarlov, Dr. Art Ulene, Dr. Donald M. Vickery, Ms. Faye Wattleton, Dr. David Watts, Arthur M. Young, Ms. Deborah Szekely, and Brendan O’Regan.

Each of these individuals has touched and inspired me as well as many, many others, and each of them personifies the vision of keeping your eye on the distant horizon while mapping your course one measured step at a time.

For Elizabeth

She is my North, my South, my East and West

My working week and my Sunday rest

My moon, my midnight, my talk, my song

I thought that love would last

for ever and a day

I was not wrong.

RESPECTFUL PARAPHRASE OF

W. H. AUDEN

CONTENTS

Acknowledgments

Introduction by Andrew Weil, M.D.

PART I

MAJOR AREAS OF TREATMENT

Chapter 1: Think Horses, Not Zebras

Chapter 2: Sound Mind, Sound Body: MindBody Medicine Comes of Age

Chapter 3: Food for Thought: Dietary Supplements, Phytonutrients, and Hormones

Chapter 4: Traditional Chinese Medicine: Three Thousand Years of Evolution

Chapter 5: Acupuncture: From Yellow Emperor to Magnetic Resonance Imaging (MRI)

Chapter 6: Western Herbal Medicine: Nature’s Green Pharmacy

Chapter 7: Naturopathic Medicine: Do No Harm

Chapter 8: Homeopathy: Like Cures Like

Chapter 9: Chiropractic: Thigh Bone Connected to the Knee Bone

Chapter 10: Ayurvedic Medicine and Yoga: From Buddha to the Millennium

Chapter 11: Spirituality and Healing: As Above … So Below

Chapter 12: CAM Insurance: Who Pays How Much to Whom for What

Chapter 13: We’re Not in Kansas Anymore: Toward an Integrative Medicine

PART II

CAM THERAPIES FOR SPECIFIC CONDITIONS

• General Precautions

• Acne

• AIDS

• Alcoholism

• Allergies

• Alzheimer’s Disease

• Anxiety

• Arthritis

• Asthma

• Atherosclerosis

• Attention Deficit Disorder

• Bedwetting (see Enuresis)

• Birth Defects

• Bronchitis

• Bruises

• Buzzing in the Ears (see Tinnitus)

• Cancer

• Cardiovascular (Heart) Disease and Cholesterol

• Carpal Tunnel Syndrome

• Cervical Spondylitis

• Chronic Fatigue

• Cirrhosis and Alcoholic Liver Disease

• Colds/Flu

• Colic

• Constipation

• Dementia and/or Memory Loss

• Dental Craniomandibular Disorder

• Depression

• Diabetes

• Diarrhea

• Diverticulitis

• Dyslexia

• Ear Infection (see Otitis Media)

• Eczema

• Enuresis

• Epilepsy

• Eye Disorders

• Fibromyalgia

• Gastrointestinal (Stomach and Intestinal Disturbances)

• Hay Fever

• Headaches

• Heart Conditions

• High Blood Pressure

• Impotence

• Infertility

• Insomnia

• Irritable Bowel Syndrome (IBS)

• Ischemia

• Kidney Stones

• Liver Disease

• Lupus

• Memory Disorders

• Ménière’s Disease

• Menstrual Symptoms, Menopause, and PMS

• Mononucleosis

• Nausea

• Obesity

• Osteoporosis

• Otitis Media

• Pain

• Parkinson’s Disease

• Prostate or Prostatic Hypertrophy (Prostate Enlargement)

• Psoriasis

• Respiratory Problems

• Schizophrenia

• Sciatica

• Scleroderma

• Sexual Dysfunction

• Sinusitis

• Sprains

• Substance Abuse

• Tendinitis

• Thyroid Dysfunction

• Tinnitus

• Tonsillitis

• Tuberculosis

• Ulcers

• Vaginitis

• Varicose Veins

• Vertigo

• Yeast Infections (see Vaginitis)

Bibliography

Index

THE BEST ALTERNATIVE MEDICINE

INTRODUCTION

Alternative medicine is now the fastest-growing sector of American health care. Despite continuing objections from the rearguard of the scientific establishment, many forward-looking doctors have begun to recognize the virtues of complementary medicine. As for the American consumer, millions are voting with their feet and their pocketbooks for treatments other than those conventional physicians are trained to provide. Alternative medicine is clearly moving into the mainstream. Moreover, what is happening in this country is happening around the world. In fact, some countries—notably Germany and China—are far ahead of us in recognizing the validity of alternative therapies and working to integrate them with conventional, Western medicine. In the United States, the National Institutes of Health has created the National Center for Complementary and Alternative Medicine (NCCAM) to study complementary and alternative medicine. Also, a special presidential commission was established in 1999 to study this subject. Clearly, this movement is not a fad but rather a global sociocultural trend with deep historical and intellectual roots.

In the United States the change began in the 1960s with loss of blind faith in technology. Up to that time our culture was captivated by a technological dream, the belief that science and technology would do away with all human ills, including poverty, illiteracy, disease, and, possibly, even death. Science and technology revolutionized medicine at the end of the nineteenth century, and throughout the first half of the twentieth century enabled us to make great strides in understanding human biology and intervening in cases of illness. Then in the 1960s came the realization that technology creates as many problems as it solves. In medicine, the created problem is expense—expense that has become unbearable as the new millennium approaches. All over the world health care systems are breaking down as the cost of standard medicine continues to increase.

The logical American response to this economic breakdown has been a corporate takeover of health care institutions by people whose only interest is getting what profit they can from a sinking system. This is managed care, and it is making the lives of many people—doctors and patients alike—miserable. Physicians resent their loss of autonomy and inability to practice medicine in the way they imagined it to be when they were idealistic students. Patients are increasingly angry about the impersonality of managed care and the lack of time they get to spend with physicians. This frustration is surely an immediate reason that so many of them are seeking alternatives.

But there are other, deeper reasons for the growing popularity of the ideas and practices described in this book. When medicine embraced technology hundreds of years ago, it turned its back on nature and on all of the simple, inexpensive ways of influencing health and disease that previous generations used, many of which are still current in other cultures. It also lost touch with the most basic precepts of its own historical tradition. After all, Hippocrates enjoined physicians first to do no harm and also to revere the healing power of nature. People all over the world are increasingly concerned about the harm inflicted by modern, technological medicine, especially adverse reactions to pharmaceutical drugs that are now so common. In deciding what to put into their bodies, they are more inclined to pay attention to the wisdom of nature and be wary of all that is artificial. They are also fascinated by mind/body interactions, interested in spirituality, and disillusioned with medicine that looks at human beings as physical bodies only.

I first met Ken Pelletier at a conference on holistic medicine in 1974. The holistic medical movement of those days was an early sign of the discontent that was building, although in the absence of the current economic crisis in medicine, it was easy for most physicians and medical administrators to ignore it or regard it as a fringe movement of little significance. However, both Ken Pelletier and I saw it differently and understood it to be the seed of something of great importance. Three years later, Ken published his landmark book, Mind as Healer, Mind as Slayer, which defined the emerging field of mind/body medicine, now a central focus of alternative medicine, and one that has great potential to challenge the underlying assumptions of the conventional system. It is also the alternative field backed by the greatest amount of research demonstrating efficacy in the largest number of conditions. Always drawing on mainstream science, Ken Pelletier’s work continues to create the foundation for our understanding and applications of mind/body medicine.

Another major thrust of his work has been health promotion and disease management through the Stanford Corporate Health Program at the Stanford University School of Medicine, which aims to educate the purchasers of medical care about creative solutions for the unchecked rise in costs of benefits. One approach that Dr. Pelletier advocates is the management of disease as well as the promotion of wellness through attention to lifestyle. Another is the thoughtful integration of alternative therapies with conventional ones, relying on basic research as well as research in clinical and cost outcomes to make sure integration proceeds wisely toward an integrative medicine.

I am a strong advocate of integrative medicine, because I see it as the way of the future that will bring medicine back into balance, restoring its connection with nature, refocusing it on health and healing rather than on disease, and thus satisfying the needs of consumers. At the University of Arizona College of Medicine in Tucson I direct a new Program in Integrative Medicine, the first of its kind, which is now training physicians and developing new models of medical education. A number of other leading medical schools, Stanford among them, have indicated intentions of moving in this direction. Most patients who come to our clinic, like most patients going to alternative providers in general, are paying out-of-pocket. This limits the availability of integrative medicine to the affluent, and if it does not escape that limitation, it will not have the influence necessary to correct the course of medicine. If integrative medicine cannot be incorporated into the reality of managed care, it will remain a curiosity rather than a mainstream trend.

For many years I have regarded Ken Pelletier’s pioneering work, and especially this book, to be essential to the development of the kind of medicine I would like to see. In these pages he dispassionately and objectively explains what treatments are actually effective, based on the best and most up-to-date domestic and international research on all the major areas of complementary and alternative medicine. In addition to his evaluations of the major therapies, he offers research-based recommendations for specific conditions and diseases. This is information that the consumer can trust, and it will be invaluable to educators, to physicians in practice, to insurers, to administrators and purchasers of health plans as well. It is an important work that will greatly further the movement toward a sound integrative medicine.

Andrew Weil, M.D.

Director, Program in Integrative Medicine

Clinical Professor of Internal Medicine

University of Arizona School of Medicine

When Health is absent,

wisdom cannot reveal itself,

art cannot become manifest,

strength cannot be exerted,

wealth becomes useless,

and reason is powerless.

HEROPHILUS

300 B.C

I manifest for thee those hundred

thousand, thousand

shapes,

that clothe my mystery;

I show thee all my semblances

infinite,

rich,

divine,

my changeful lives,

my countless

forms.

BHAGAVAD GITA

PART I

MAJOR AREAS OF TREATMENT

CHAPTER 1

THINK HORSES, NOT ZEBRAS

Throughout recorded history, every culture has had its own alternative medicines, from tropical Tahiti, Eskimos in the Arctic, American Indians, Mayans, and Gypsies to groups and sects throughout the ancient and modern world. Scientists reported in 1998 that the Ice Man discovered in 1991 at the foot of a retreating glacier where he had been buried for 5,300 years had used natural remedies. Since he had been dried by Alpine winds and then encased in ice, his body and belongings had been remarkably well preserved. Examination of his intestines noted eggs of Trichuris trichiuria, or whipworm, which is a parasite that causes abdominal pain and anemia. Researchers are quite certain that the Ice Man used a botanical product to treat this infection, since among his belongings they found two walnut-sized lumps tied to leather thongs. Analysis revealed them to be the fruit of Piptoporous botulinis, a plant containing oils that are toxic to parasites, as well as very strong laxative compounds that would cause expulsion of the dead and dying parasites and their eggs. In addition, he had what appeared to be several tattoos on his body. These were made by cutting into the skin with a sharp object, filling the incisions with herbs, and then cauterizing the wounds. Further investigation indicated that most of the lesions were situated over joints that had been damaged by arthritis. In addition to herbal medicine, the investigator speculated that he might have used these tattoos as a form of localized therapy for relief of muscle and joint pain. Surely, many forms of alternative medicine have been extant for thousands of years.

It is a humbling experience to thoughtfully examine the complex array of medical systems that CAM comprises. Certainly, this matrix of cultures, philosophies, traditions, and techniques is as subtle and complex as a rainbow.

Today, every medical student is taught the old aphorism, Think horses, not zebras. It is an admonition to pay attention to what is evident about the patient, and to rule out obvious, common conditions before reaching a diagnosis of a rare condition.

This time-honored rule is profoundly valuable in evaluating the best possible treatments for the most common health problems that our society now faces.

Currently, the United States, and much of the rest of the world, is experiencing an epidemic of chronic and degenerative illnesses, such as cardiovascular disease, cancer, diabetes, arthritis, and depression. Very often, these illnesses are the result of obvious, common lifestyle risks, such as smoking, overeating, or being too sedentary. Frequently, such illnesses can be prevented, arrested, and even reversed when individuals stop making these lifestyle mistakes and rebuild their health with various conventional as well as alternative, complementary, or integrative therapies.

Research indicates that many forms of complementary and alternative medicine, or CAM, are exceptionally effective at preventing and quelling the widespread chronic diseases that now plague much of the world. However, effective CAM therapies are often so deceptively simple that they may be overlooked. In effect, medical researchers and clinicians are failing to think horses, not zebras. They are overlooking the obvious: Lifestyle factors cause a great many chronic diseases, and complementary and alternative medicine can have a powerfully positive impact upon those diseases.

However, proponents and practitioners of CAM frequently make an equally egregious intellectual error. They often tend to believe that virtually any form of CAM is superior to any form of conventional medicine. Some advocates of alternative medicine seem to adopt CAM as a veritable religion, and fail to see that CAM, like conventional medicine, has many limitations, and can also be reductionistic, as well as harmful, if used improperly.

This book challenges the polarized, dogmatic thinking that often surrounds the conflict between conventional medicine and CAM. Both of these medical traditions need to be evaluated objectively, using the best research available. Perhaps surprisingly, many conventional medical practices lack any real scientific basis. A 1990 report from the United States Office of Technology Assessment of the United States Congress concluded that upwards of 80 percent of conventional medicine lacked an adequate basis in research. During 1991, Dr. Richard Smith, editor of the British Medical Journal, examined twenty-one common medical practices and concluded that the evidence for seventeen out of twenty-one was poor to none in an editorial commentary on the necessity of research-based medicine. Most recently a review by Jeanette Ezzo and Dr. Brian M. Berman of the University of Maryland was undertaken under the auspices of the international Cochrane Collaboration that focuses on evidence-based medicine for both conventional and alternative medicine. Based on 159 reviews of conventional medical practices, the reviewers found that only 20.8 percent evidenced a positive effect on the treated group over the control group. For the vast majority of the conventional medical practices, the evidence ranged from 6.9 percent demonstrating harm to 24.5 percent resulting in no effect at all.

To avoid a double standard, all therapeutic interventions should be held to the same rigorous standards of evidence-based medicine. Essentially, the purpose of the book will be to rigorously evaluate the most common forms of CAM, based on the best scientific research, and to shed light upon: (1) What works; (2) What doesn’t work; and (3) What is in the works. It is very important to underscore that negative findings on what does not work will be very limited, out of necessity. This is due to the fact that negative research findings are not frequently published. Emphasis throughout will be predominantly on what CAM therapies work for which conditions, and for whom, based on the best available research evidence today.

Groucho Marx once quipped, Be open-minded, but not so open-minded that your brains fall out. In the evaluation of complementary and alternative medicine, it often seems as if some clinicians’ and researchers’ brains have fallen out. No other area of medical research generates such acrimonious and often unenlightening debate as does the area of complementary and alternative medicine. Debate over this subject is highly polarized, and highly politicized. In fact, both advocates and critics of CAM may decry this book’s attempt to hold to a middle ground, and to sort fact from fiction. On every controversial issue, we hear accusations from one side or the other that the sky is falling. These extreme positions create mass confusion on vital issues, such as chemical and pesticide hazards, food additives, cancer therapy, silicone breast implants, and even on issues as mundane as the value of high-roughage cereals. There is a shortage of fact and a plethora of opinion.

As the debate rages on, however, we remain in the midst of an epidemic of inadequately treated chronic illness. Heart disease remains the major cause of disability and death, despite decades of major advances in treatment. Sixty million Americans have hypertension, forty million suffer from arthritis, and twenty-three million have chronic migraine headaches. A million Americans each year are diagnosed with cancer. Almost 40 percent, or nearly every other person you know, will eventually develop this terrifying disease. On the increase is the prevalence of asthma, multiple sclerosis, chronic fatigue, immune deficiency syndrome, HIV, and a host of other debilitating conditions. Compounding this dire litany is the fact that more than forty million Americans—the total population of thirteen states—have no medical insurance!

Nevertheless, treatments do exist that are extremely effective at preventing and ameliorating these maladies. Many of these therapies are deceptively simple.

For a moment, reflect on a breakthrough intervention now being supported by decades of research from the National Institutes of Health. This breakthrough has been acknowledged by the American Medical Association and the United States Surgeon General. It has the documented effect of reducing virtually all forms of illness. It helps patients prevent or recover from high blood pressure, diabetes, osteoporosis, breast cancer, arthritis, and chronic pain. It improves mental function, sleep, weight loss, and muscle mass, and extends life expectancy. Miracle drug? New product of advanced genetic engineering? Discovered in an arcane Chinese medical text? None of the above. It is … exercise! Exercise is more important for health than most of the more exotic forms of CAM, and a great many forms of conventional medicine. Think horses, not zebras.

In fact, many CAM modalities, including various forms of exercise, stress reduction, and optimal nutrition, have been embraced by conventional medicine in recent years.

Despite this growing collaboration, the atmosphere of the debate surrounding CAM is still often strident, shrill, and short of fact. In Choices in Unconventional Cancer Therapies, Dr. Michael Lerner states, Critics have characteristically dismissed the alternative therapies as quackery … and have worked systematically and often effectively to … disbar or ‘defrock’ physicians, researchers and attorneys. Practitioners have faced legal prosecution, lengthy trials with high legal expenses, suspension or loss of their licenses to practice medicine, and sometimes jail terms…. Opposing the Quack Busters is a coalition of proponents of alternative cancer therapies…. While some members of the coalition are moderate in tone, others use harsh language and tactics. Opponents of alternative therapies have been seriously compared to Nazis. Conventional therapies such as surgery, radiotherapy, and chemotherapy are denounced as ‘cut, burn, and poison….’ While for many years the Quack Buster coalition held the advantage in this vociferous conflict, a significant shift in the balance of societal forces has occurred in the last 10 years, so that conditions are now somewhat more favorable to the proponents of alternative therapies. Between the strident and polarized opinions is a vast middle ground where the issue of what does and does not work needs to be addressed by scientific research and clinical judgment, not by uninformed diatribes from both extremes.

One result of this vitriolic polarization is that patients, starkly aware that many conventional doctors disapprove of complementary and alternative medicine, often hide their use of CAM interventions from their conventional physicians. In the classic 1993 study of alternative medicine by Dr. David Eisenberg of the Harvard Medical School, less than 40 percent of patients who used alternative medicine told their doctors. In certain instances, this can have disastrous results, since some CAM modalities, such as use of certain herbal supplements, may interact negatively with medications.

What is needed in the ongoing debate over complementary and alternative medicine are more constructive yet critical voices similar to that of Dr. Wallace Sampson of the National Council for Reliable Health Information. Recently, Dr. Sampson founded a new journal entitled The Scientific Review of Alternative Medicine, which interjects a healthy note of skepticism into the alternative medicine debate. Through the NCRHI, such publications provide an invaluable service by sorting fact from fantasy through rigorous science and evidence-based medicine.

This book is intended to build such an evidence-based foundation.

WHAT IS CAM?

According to Dr. David Eisenberg of the Harvard Medical School, a widespread, accepted definition of CAM, which was used in his 1993 and 1997 studies, is Those practices explicitly used for medical intervention, health promotion, or disease prevention which are not routinely taught at United States medical schools, nor routinely underwritten by third party payers within the existing United States health care system. Because medical schools and insurance companies are gradually accepting various CAM modalities, the practices included in this definition are constantly being revised.

In March of 1997, the National Center for Complementary and Alternative Medicine (NCCAM) formulated another definition: CAM includes those medical systems, interventions, applications, theories or claims that are currently not part of the dominant (conventional) biomedical system. Classification of a practice as CAM may change, depending upon changing attitudes, scientific data, and experience. Given the rapidly evolving nature of CAM, this operational definition will be used throughout this book.

For this book, we will examine the following CAM modalities: Mind-Body medicine; dietary supplements, phyto- or plant-based nutrients, and hormones; traditional Chinese medicine; acupuncture; European herbals; naturopathy; homeopathy; chiropractic; Ayurvedic medicine; as well as spirituality and healing. These are currently the most predominant forms of CAM used by the largest number of people in the United States and abroad, according to several national and international surveys.

Many areas of alternative medicine are not addressed in this book, which predominantly focuses on those that are most common, according to national surveys. Bear in mind that the Office of Alternative Medicine has identified over six hundred specific terms describing an array of CAM practices. It is simply impossible in the confines of this book to address them all, including areas such as chelation, aromatherapy, multitudinous varieties of meditation, applications of bioelectromagnetic fields, and other promising areas of research and clinical practice. No matter what area is addressed, the right approach by a clinician or individual is one of well-informed, cautious involvement.

Research indicates that these various forms of CAM are now extremely popular in America, accounting for approximately 425 million visits to providers in 1990. It is important to note that this number exceeded the total number of visits to all United States primary care physicians for the same year, at only 330 million office contacts. Repeating his classic 1990 survey, Dr. David M. Eisenberg and his colleagues at the Harvard Medical School found that this number of visits increased by 47 percent from 1990 to 1997 for a total of 629 million visits. This 47 percent increase is in striking contrast to a much smaller increase in the number of primary care visits in 1997, to only 386 million. Generally, patients seek out CAM therapies mostly for prevention, and second for chronic, ongoing conditions, rather than life-threatening illnesses.

A 1998 national survey by Dr. John A. Astin of the Stanford University School of Medicine determined the general type of individual who uses CAM. Compared to the general population, CAM patients are better educated, have more health problems, have a greater belief in the healing power of the mind and spirit, had a transformational experience that changed their worldview, and participate more in environmentalism, feminism, esoteric spiritualism, and personal growth psychology. CAM patients tend most often to have the following health problems: back pain, obesity, anxiety, depression, insomnia, and chronic pain. They report that their primary reason for using CAM is that it relieves their symptoms better than conventional medicine. Most significant, the patients who use CAM do not express any greater dissatisfaction with conventional care than patients who do not use CAM! Only 5 percent of them rely primarily upon CAM. It was only this 5 percent that expressed greater dissatisfaction with conventional care.

Satisfaction of CAM patients with conventional care strongly suggests that there is, indeed, a fertile middle ground for patients and practitioners who wish to use both CAM and conventional care.

AN EXPLOSION OF INTEREST IN CAM

Amid the heated debate over CAM, one fact is certain: Consumers are not waiting for scientific experts to tell them that it is acceptable to use CAM. Pharmacies throughout the United States are experiencing a huge surge in the demand for alternative remedies. This is now the fastest growing segment of the over-the-counter market. From 1991 to 1996, this market doubled, to over $3.77 billion. It is projected to reach more than $6.5 billion by 2001, for an average growth rate of 12.5 percent.

Furthermore, in a 1996 study by Landmark Healthcare, over 70 percent of HMOs reported an increased request for CAM by their enrollees. Modalities most in demand were acupuncture (requested by 56 percent of patients), chiropractic (45 percent), massage (25 percent), acupressure and biofeedback (21 percent each), hypnotherapy (8 percent), and reflexology (4 percent). Perhaps even more telling is that 38 percent of the HMOs believed that offering alternative medicine would increase their enrollment.

A central reason that CAM is vaulting in popularity is simply that the general public demands the benefits of such CAM therapies. One of the most important and insightful articles in this regard was published in the Journal of the American Medical Association by Dr. J. Michael McGinnis, former director of the U.S. Office of Health Promotion and Disease Prevention, and Dr. William H. Foege, director of the Centers for Disease Control in Atlanta. Their 1993 article cited the usual Ten Leading Causes of Death in 1990, ranging from heart disease and cancer at the top to chronic liver disease and HIV infections at the bottom. These mortality statistics and supposed causes are so ubiquitously cited that they belie a more fundamental issue.

Upon closer examination, McGinnis and Foege contend that this familiar dire litany of mortality consists not of the actual causes of death but of the terminal diseases cited in a pathologist’s report or autopsy. In fact, the actual causes from most impact to least are: tobacco (which caused approximately 400,000 deaths in 1990), diet and inactivity patterns, alcohol, certain infections, toxic agents, firearms, sexual behavior, motor vehicles, and finally, drug use, which was responsible for 20,000 deaths in 1990. This listing of the ten actual causes contributed to 1,060,000 deaths, or approximately 60 percent of all deaths in 1990.

From the somewhat different perspective of the benefits and liabilities of managed care, Dr. David Blumenthal succinctly stated this issue in the New England Journal of Medicine, noting that In 1991, the Harvard Medical Practice Study showed that adverse events occur in 4% of hospitalizations, that 14% of these events are fatal, and that as many people are dying from preventable causes each year in the United States as would die if three jumbo jets crashed every two days. Translated into terms of aviation disasters, it is obvious that such incidents would not be tolerated, and immediate remedial actions would be undertaken. What is evident from such