New Life for Old Remedies

BALTIMORE —  When Dr. Brian Berman first saw him two years ago, the man’s face was paralyzed by pain.

The 54-year-old cameraman suffered from trigeminal neuralgia, a condition that produces severe facial pain. He had found some relief through anesthetic nerve blocks and narcotic painkillers--but at a terrible price. He couldn’t sleep, couldn’t concentrate and was often depressed.

Berman decided to try something unconventional--indeed, something that many physicians once might have ridiculed: He prescribed belladonna, derived from a plant in the poisonous nightshade family. Within six months--using that drug and a second, causticum, made from a mineral--the pain receded by two-thirds, Berman said.

Today it is kept under control through such homeopathic drugs, supplemented by over-the-counter medications.

Berman, 45, a family medicine physician in Baltimore, began to combine “alternative” therapies with conventional treatments early in his practice.

“I had great training for acute-care problems, but I didn’t have a lot of the answers for chronic conditions,” he said. “I started to look for other ways.”

Now many other doctors are beginning to do the same thing. They have discovered that integrating the unconventional with the mainstream not only can provide relief but also can do so with fewer side effects and without more invasive procedures, such as surgery.

Bolstered by mounting scientific evidence, some approaches once considered radical or “alternative” are beginning to be viewed as “complementary.”

Not all of the disciplines work for everyone. But as long as patients don’t put their lives in jeopardy by rejecting established therapies, many physicians--even those most resistant to alternative medicine--now seem willing to take a second look.

Dr. Nancy Dickey is a family practice physician who chairs the board of trustees of the American Medical Assn., a conservative doctors’ organization long skeptical of alternative approaches. She reflected the new attitude when she acknowledged: “If I had a patient who said, ‘I quit using codeine since I started doing acupuncture,’ I’d say, ‘Terrific.’ ”

According to the World Health Organization, 65% to 80% of the world’s health care services can be classified as alternative--although the preferred term outside the United States is “traditional,” since most of these approaches derive from ancient practices.

“These become complementary, alternative or unconventional when used in Western countries,” said Dr. Wayne B. Jonas, director of the National Institutes of Health office of alternative medicine, which Congress established in 1992 to focus more scientific scrutiny on the field. “Even in countries where modern Western biomedicine dominates, the public makes extensive use of unconventional practices.”

A 1990 study indicated that one in three Americans saw an alternative health care practitioner--ranging from osteopaths to acupuncturists--that year. More than 80% used them in conjunction with conventional medicine, according to the NIH.

It may be that Americans are turning to nonconventional medicine in record numbers because it represents “a simpler approach to healing than the high-tech medicine of the 20th century,” said Dr. Thomas L. Delbanco, chief of general internal medicine at Boston’s Beth Israel Hospital.

Seek ‘Good Old Days’

“People yearn for the ‘good old days’ when doctors spent more time listening to their patients than ordering complicated tests and procedures,” Delbanco said. “This . . . is a response to modern life, where everything, including health care, often seems rushed and impersonal.”

If so, doctors are beginning to listen. Jonas estimates that more than 50% of “conventional” physicians in the United States use or refer patients to these treatments. And medical schools are beginning to add training in alternative therapies to their curricula.

In addition, insurance companies, health maintenance organizations and other health plans have begun to cover alternative treatments, in part because they often cost less than standard procedures and also because customers want them.

“Consumers themselves are driving the change, and many of them are physicians who are themselves consumers,” said Dr. James Gordon, chairman of the program advisory council of NIH’s office on alternative medicine. “I’ve certainly seen physicians change because they had a health problem that was not helped by conventional therapy.”

Doctor a Believer

Gordon was one. A psychiatrist long interested in the therapeutic effects of alternative approaches, he became a believer after he seriously injured his lower back and was helped by an osteopath, who focuses on the musculoskeletal system’s relationship to the body.

The most widely used alternative medicines--including homeopathy, acupuncture, Chinese herbs and mind-body approaches such as meditation and yoga--have long histories.

The NIH’s Jonas points out that a new drug’s average “half-life,” or period of peak use, is about 20 years. Homeopathy has been around, unchanged, for almost 200 years; acupuncture for more than 2,000 years; prayer and spiritualism for at least 20,000 years. And “if one believes reports of monkeys using plant products to regulate their menstrual cycles,” he said, “herbalism, probably the oldest, has been around for greater than 200,000 years.”

Homeopathy, which originated in Europe in the early 1800s, is based on the idea of “like cures like.” It involves treating a disease by giving highly diluted preparations of substances that actually cause the same symptoms.

Berman notes that similar treatments exist in conventional medicine, such as the drug digitalis, which controls heart irregularities when given in small doses and causes them when given in large ones.

Attests to Success

In homeopathy, “the medication is so diluted that there are no molecules left,” Berman said, repeating a criticism voiced by skeptics for years. “So how can you have an action? I don’t know. But I’ve seen it work.”

There is more scientific understanding of acupuncture, which is derived from traditional Chinese medicine and used for pain control and other disorders. It involves the use of whisper-thin needles inserted into the skin at specific points. Stimulating these points alters chemical neurotransmitters in the body.

Ginny Burnham, a 52-year-old Baltimore nurse, came to Berman more than a year ago when she could no longer tolerate the side effects of painkillers given to treat fibromyalgia, a joint, muscle and nerve disorder.

Dr. Lixing Lao, who studied traditional Chinese medicine at Shanghai University, works with Berman and practices acupuncture and traditional Chinese herbal medicine. He put Burnham on a schedule of acupuncture, homeopathy and Chinese herbs.

Eventually she was able to wean herself away from the drugs.

“I didn’t want to come,” Burnham said. “I’m married to a physician, and I’m a nurse. I was skeptical. I was afraid of needles. But now I’m a real believer. It’s helped me a great deal.”

Similarly, Sandra Powell, 52, a former ballet dancer and teacher from Derwood, Md., sought relief from the severe symptoms of menopause, including as many as 15 hot flashes an hour.

“I thought I was going to go out of my mind,” she said.

Acupuncture treatments reduced the incidents to one an hour, “and then they went to nothing,” she said.

After about six treatments, acupuncture also helped unlock a “frozen” shoulder.

“By God, everything started to turn around,” said Powell, who makes the 60-mile round trip once a week for treatment. “I just wish he [Lao] were closer.”

Acceptance Predicted

Berman predicts it will take another decade for society to undergo a major transformation in the way it views alternative therapies. It will happen after enough scientific evidence accumulates to support these largely anecdotal success stories.

“From my perspective, we’re not talking about conventional vs. complementary, but effective vs. noneffective,” Berman said. “That is what will take us away from this we versus them attitude.”

The NIH has funded about 90 alternative medicine studies at a total cost of $13 million. In addition, its office of alternative medicine is supporting 10 new specialty research centers--Berman’s at the University of Maryland is among them--at a cost of about $850,000 each. Their mandate is to study alternative therapies in such areas as chronic pain, stroke, cancer, addictions, AIDS, asthma and women’s health.

Despite the growing willingness of many doctors to turn to alternative therapies, there is a certain amount of resistance to immediately suggesting them.

“In the United States, [conventional] biomedicine has had much more power to define what health care is than anyplace in the world,” Gordon said. “Part of it is political. Part of it is the fact that there has been a centralization of power in the hands of physicians that has not been the case in most other countries. Part of it has been the teaching that these are all folk beliefs, a less-evolved form of medicine, and that we have more useful tools.

“When you have a specific cause and a specific treatment, and it works, that’s very neat and appealing. It’s been very easy for people to think we will always find the appropriate treatment for all the illnesses we have.”

The U.S. Food and Drug Administration regulates homeopathic medicines--there is an established registry, or pharmacopeia, of recognized homeopathic drugs--and many can be obtained only by prescription.

But other products, such as nutritional supplements and some herbs, are unregulated. With those substances, the FDA often can act only after harm has occurred.

In 1994, for example, the Annals of Internal Medicine reported that a Chinese herbal product, Jin Bu Huan, marketed as a natural pain reliever and sedative, had caused liver damage in some people.

“If something doesn’t do any harm, I don’t have a problem with it,” said the AMA’s Dickey. “But there is very little science to tell us what’s good and what’s bad. I’d feel better if we could collect scientific information about what works and works well. We need something more than stories of patients who were magically cured.”

Dickey warns against abandoning proven therapies against infectious diseases or cancers in favor of alternatives.

“If patients can find relief through acupuncture or meditation, I’m all for it,” she said. “I just don’t want to see anybody with a cancer go through a half-dozen alternative therapies first, and by then it’s too late to intervene.”

But some practitioners insist that all too often it’s the other way around.

Gordon, director of the Center for Mind-Body Medicine in Washington and a professor at the Georgetown University School of Medicine, tells the story of a 35-year-old woman with severe rheumatoid arthritis. Her condition was so bad that she could not unscrew a jar of baby food or lift her children. She was on high doses of medicine and wanted to stop so she could have another baby. Her pediatrician, who had heard Gordon deliver a talk, suggested she see him.

“She had no particular interest in alternative therapies. She just knew she couldn’t get pregnant while she was on these drugs,” Gordon recalled.

Uses Diet, Herbs

Under his care, she fasted for a week, then gave up milk, sugar, wheat, red meat and corn. He sent her to a yoga teacher and recommended regular massage.

“I gave her Chinese herbs and did acupuncture,” he said. “I talked to her about the stresses in her life.”

Within four months, the swelling disappeared, the pain decreased and she was off all her medications, he said. After 10 months of treatment, she became pregnant.

“She had no problems during her pregnancy,” Gordon said. “The baby is now about 6 months old, and she’s still taking no medication at all.”

In Gordon’s case, he said his back injury was so bad, “I was bent almost double.”

He consulted an orthopedic surgeon, who prescribed muscle relaxants and recommended he stay in bed with a heating pad. Later, he performed back exercises. Nothing helped.

In frustration, he sought help from a local osteopath. His first back “adjustment” did not work.

In desperation, he called Dr. Shyam Singha, a London osteopath and practitioner of Chinese traditional medicine whom he had met earlier.

Halts Medication

Singha ordered Gordon to stop taking medication and start taking hot baths with Epsom salts followed by cold showers. He told him to eat nothing but pineapple for a week.

“I thought the transatlantic phone had gone bad,” Gordon recalled.

But Singha said pineapple contains malic acid, which affects the lungs and the colon. In Chinese medicine, the lungs and the colon are the “mother” of the kidney and the bladder, which “are connected to the back,” Singha told him.

Gordon followed the unorthodox regimen.

At the end of the week, his mouth was full of sores. He had a fever of 103 and felt terrible.

He called Singha again, who told him to coat the pineapple with honey and not to worry about how sick he felt. In Chinese medicine, “a chronic disease must be made acute before it can be healed,” he said.

As a psychiatrist, Gordon saw a certain logic. After all, “one often has to relive painful traumatic experiences” in order to heal emotionally. Why couldn’t the body work the same way?

At the end of the week, Gordon returned to the local osteopath for another back “adjustment,” and this time it held.

“All I can tell you is it cured me,” he said. “It did the trick.”