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Scientific American

What’s the Harm?

published December 2003 | Comments Off
Alternative medicine is not everything to gain and nothing to lose
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After being poked, scanned, drugged and radiated, your doc tells you nothing more can be done to cure what ails you. Why not try an alternative healing modality? What’s the harm?

I started thinking about this question in 1991, when my normally intelligent mother presented to a psychiatrist symptoms of cognitive confusion, emotional instability and memory loss. Within an hour it was determined that she was depressed. I didn’t buy it. My mom was acting strangely, not depressed. I requested a second opinion from a neurologist.

A CT scan revealed an orange-size meningioma tumor. After its removal, my mom was back to her bright and cheery self — such a remarkably recuperative and pliable organ is the brain. Unfortunately, within a year my mom had two new tumors in her brain. Three more rounds of this cycle of surgical removal and tumor return, plus two doses of gamma knife radiation (pinpoint-accurate beams that destroy cancer cells), finally led to the dreaded prognosis: there was nothing more to be done.

What is a skeptic to do? An ideological commitment to science is one thing, but this was my mom! I turned to the literature, and with the help of our brilliant and humane oncologist, Avrum Bluming, determined that my mom should try an experimental treatment, mifepristone, a synthetic antiprogestin better known as RU-486, the “morning after” contraception drug. A smallsample study suggested that it might retard the growth of tumors. It didn’t work for my mom. She was dying. There was nothing to lose in trying alternative cancer treatments, right? Wrong.

The choice is not between scientific medicine that doesn’t work and alternative medicine that might work. Instead there is only scientific medicine that has been tested and everything else (“alternative” or “complementary” medicine) that has not been tested. A few reliable authorities test and review the evidence for some of the claims — notably Stephen Barrett’s Quackwatch, William Jarvis’s National Council Against Health Fraud, and Wallace Sampson’s journal The Scientific Review of Alternative Medicine.

Most alternatives, however, slip under the scientific peer review radar. This is why it is alarming that, according to the American Medical Association, the number of visits to alternative practitioners exceeds visits to traditional medical doctors; the amount of money spent on herbal medicines and nutrition therapy accounts for more than half of all out-of-pocket expenses to physicians; and, most disturbingly, 60 percent of patients who undergo alternative treatments do not report that information to their physician — a serious, and even potentially fatal, problem if herbs and medicines are inappropriately mixed.

For example, the September 17 issue of the Journal of the American Medical Association reported the results of a study on St. John’s wort. The herb, derived from a blooming Hypericum perforatum plant and hugely popular as an alternative elixir (to the tune of millions of dollars annually), can significantly impair the effectiveness of dozens of medications, including those used to treat high blood pressure, cardiac arrhythmias, high cholesterol, cancer, pain and depression. The study’s authors show that St. John’s wort affects the liver enzyme cytochrome P450 3A4, essential to metabolizing at least half of all prescription drugs, thereby speeding up the breakdown process and shortchanging patients of their lifesaving medications.

But there is a deeper problem with the use of alternatives whose benefits have not been proved. All of us are limited to a few score years in which to enjoy meaningful life and love. Time is precious and fleeting. Given the choice of spending the next couple months schlepping my mother around the country on a wild goose chase versus spending the time together, my dad and I decided on the latter. She died a few months later, on September 2, 2000, three years ago to the day I penned this column.

Medicine is miraculous, but in the end, life ultimately turns on the love of the people who matter most. It is for those relationships, especially, that we should apply the ancient medical principle Primum non nocere — first, do no harm.

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