Maverick medicine: Since Western medics discovered the benefits of acupuncture and other Chinese healing methods, lawmakers have had a tough time fitting it all into the traditional model.

Consider Rhett Bergeron, a Louisiana-trained physician who now practices in Georgia, as an uncomfortable symbol in the growing battle between traditional medicine and those who agitate for alternatives.

Young and energetic, Bergeron graduated from Louisiana State University's medical school in 1992 before starting a family practice in the southern part of the state.

In a region where certain cancers are among the highest in the nation (indeed, the stretch of factories and refineries lining the Mississippi River between Baton Rouge and New Orleans is known as "cancer alley"), Bergeron soon became frustrated over the low success rates he witnessed with traditional ways of treating cancer.

"There were so many cases in which we just couldn't reverse someone's disease process," Bergeron later explained as he recounted his journey into the land of complementary and alternative medicines, known to its practitioners as CAM.

Increasingly, he began to study and eventually use treatments and therapies that included nutrients, herbal remedies, and aloe vera and cesium-packed supplements.

And in the process he became a hero to area patients who admired the physician's eclectic, creative approach, otherwise known as "integrative medicine."

Integrative medicine, for Bergeron, works particularly well because, as a licensed physician, he is allowed to freely mix the latest alternative products and practices with more traditional approaches to battle diseases like cancer.

But even physicians like Bergeron have been affected by the lack of comprehensive federal and state laws governing CAM. Alternative products can be dangerous, but there's no regulation of the industry This fall, during hearings before the U.S. Senate Committee on Aging, Bergeron's name was linked with T-Up, which both federal and state investigators say is a sham product that fails to live up to its billing as a cure for cancer and AIDS, among other diseases. Although no one has accused Bergeron of doing anything wrong, he was listed as a doctor who was using T-Up. Bergeron says he does not remember sending anyone T-Up, and believes the product is "dangerous." T-Up's distributor, Allen J. Hoffman, a Maryland doctor, has been indicted by state authorities on 20 counts of trying to sell and distribute an unapproved new drug and making claims for it that could not be verified.

During the Senate committee hearings, lawmakers heard from a variety of watchdog groups and law enforcement officials, all of whom emphasized that the danger to American consumers who use unregulated and unapproved alternative products and practices has never been greater, primarily because the interest in and use of alternatives has never been stronger.

"This apparently innocent freedom-of-choice movement, which appears to bring the free market to health care, is a major danger," said Dr. Robert Baratz, executive director of the National Council Against Health Fraud. "Neo-snake-oil sales people have begun to undermine the foundation of our excellent system of care. They have begun to succeed at substituting pseudo-science for science, anecdote for evidence and nonsense for substance."

But for the proponents of alternative medicines, such talk is a smoke screen, an excuse, they say, put forward by the traditional medical establishment to deny them their right to choose whatever kind of medical product or treatment they like.

Not surprisingly, the question of whether and how to regulate alternative practices and procedures is frequently an angry one, usually evolving into a debate about what the word freedom really means in the world's greatest democracy.

"The basic point is a simple one--people who are the consumers of alternative products and practices are trying to take responsibility for their own health and well-being," says Jim Turner, executive director of a group called Citizens for Health, which advocates not only CAM, but the state licensing of its practitioners.

"And that means," continues Turner, "having the freedom to make your own choices."

For Barbara Safriet, associate dean at Yale University Law School, the debate, in raw form, is one of semantics.

"By defining alternative medicine and practices as 'alternative,' you have also designated what you're doing as the norm and what the others are doing as something that is a little off-beat. And right off, that categorization is incorrect," she says.

"Some nationally organized physicians' groups have also called nurse practioners 'non-physician providers,'" she says. "And that's like calling me a 'non-astronaut.' It is accurate, but meaningless. It does not tell you anything about me."

DEBATE CREATES MINEFIELD

And for Texas Senator Mike Moncreif, the issues and heat surrounding the CAM debate--semantics aside--represent nothing less than a minefield over which state lawmakers everywhere should be wary to travel.

"How should state legislatures approach something like this?" asks Moncrief, who is the chairman of the Texas Senate's Health and Human Services committee and a national expert on the issue.

"You are talking about the freedom of people on the one hand to have their own say in their medical care," he continues. "But on the other hand, there is the danger of just allowing everything to go unchecked, of not overseeing or regulating these different practices and products in the name of freedom, which could he a very dangerous thing for consumers."

A number of states have passed laws regulating various aspects of the CAM industry: 21 states have defined massage practice not as an adult service subject to periodic raids from the local police, but as a therapy, the practitioners of which have received licenses from a state board of examiners.

Alaska, Colorado, Georgia, New York, North Carolina, Oregon, Oklahoma, South Dakota and Washington have passed what is generally referred to as "medical freedom legislation," which in essence declares that there are two kinds of practitioners who are legally authorized to prevent, treat and even cure diseases--physicians and naturopaths.

ACUPUNCTURE STARTS THE TREND

The greatest CAM advances have been seen with the practice of acupuncture, which became a household word in 1971 after two U.S. scientists visited then-closed mainland China to observe the surgical removal, under acupuncture anesthesia, of a woman's ovarian cyst.

President Richard Nixon's historic visit to China the following year unfolded many of that country's hidden wonders, including its surprisingly advanced medical techniques, which relied more on herbal therapies and mind-body techniques. And when New York Times columnist James Reston, as part of the White House press corps in China, fell ill and had to have an emergency appendectomy via acupuncture, that ancient technique--reported days later on the front page of the paper--received its greatest exposure to date in the United States.

"That really ushered in the age of acupuncture," says Turner. "Suddenly across the country people were asking about it. All kinds of people--many of whom were Asians--began to practice it."

But the acupuncture explosion underlined a curious anomaly in state laws regarding alternative practices and products: In general only licensed physicians were authorized to perform acupuncture. But most of those physicians knew little about it. Those trained in acupuncture, oftentimes in other countries, were prohibited from practicing in the states.

"That was when the states first began to take a second look at their medical practice acts," says Turner, "and decided that special licenses could be granted for people who were trained in acupuncture, which would allow them to practice legally."

As of today, nearly 30 states--including New York, Texas and California--have passed what is generally referred to as acupuncture practice acts. CAM advocates believe the treatment will probably be legally available in every state by the end of this decade.

MILLIONS SEEK ALTERNATIVES

That millions of Americans seek and support other alternative practices and products for their health care--long a principal arguing point for CAM supporters--was finally recognized with the advent of the Internet. More than 30 million people in the United States will seek information and products on alternatives between the beginning of 2001 and its end, according to an interim policy report released in September by the White House Commission on Complementary and Alternative Medicine Policy.

"I really haven't been surprised much by the interest," says Steve Groft, executive director of the commission. "In 1991, I was the first director of alternative medicine at the National Institutes of Health. Even that far back I could see how many people were interested in the alternatives. This is something that has been going on in our country for a rather long time."

Under the large CAM umbrella--as defined by the commission--is acupuncture, chiropractic, massage therapy, dietary and herbal supplements, energy healing, and such mind-body techniques as yoga and meditation.

"You can walk into any health store in the country and see what's going on," says Groft. "People are talking about and buying all kinds of alternative treatments and interventions. It is very clear that millions of people have decided to take the care of their health into their own hands, beyond their physicians. And that is a trend that is only going to increase.

But law enforcement officials and, yes, even the much-maligned traditional medical establishment worry that such interests are perhaps inevitably being exploited by unscrupulous manufacturers and profiteers, who will say anything good about their product just to get it sold.

"We're not doing enough to eliminate the snake-oil salesmen operating in the 21st century, targeting seniors," charged U.S. Senator John Breaux of Louisiana, chairman of the Senate Committee on Aging, during the September hearings.

Breaux specifically pointed to a publication called The Journal of Longevity, which, he said, ran feature stories and ads boasting the wonders of herbal supplements in preventing heart attacks and enhancing sexual performance.

But that same publication, continued Breaux, was owned by a man who also sells the products-under the name of several different companies-featured in the magazine.

"This is what we worry about, and what I think the states are worried about, too," says Mark Gahart, assistant director in health care with the General Accounting Office in Washington, D.C. "It is clear that many of the various alternative products and practices out there are fraudulent or make claims they cannot possibly satisfy. They appear and disappear from time to time, but no one can be certain what kind of damage they create."

And the sheer proliferation of such products, adds Gahart, makes it "very difficult for government at any level to get hard information on what is being used and, of that group, what is dangerous."

CLAMPING DOWN ON FRAUD

What is clear, contends Moncrief, is that the manufacturers of such products "must be prohibited at all costs from making claims that are not true. When this happens, it preys on people, many suffering with terminal illnesses. It's a terrible thing, and we have to do whatever we can to stop or at least reduce it."

What is not clear is how the states can simultaneously support alternative products and practices via such measures as the various medical freedom bills, while also trying to clamp down on fraudulent promises and claims surrounding products that fail to live up to their billing.

"The specific goal of protecting the public's health and safety will obviously remain the states' overarching concern," contends Safriet, who says that licensing alternative therapies and products may be the only way for the states to go.

Such licensing, says Safriet, actually has its roots in a time-honored tradition in the states that has seen various medical practice acts expanded through the decades to make way for chiropractors, nurses, veterinarians and others.

If the public interest in a certain product or therapy is great, then its advocates have only to petition their legislatures, Safriet says. "That's how it's done. And the legislators are just going to have to decide who will and who will not be licensed."

CAM supporters, meanwhile, have frequently complained that the deck in some legislatures has been stacked against them. They say that the traditional medical establishment, as personified by the American Medical Association, has done all it can to block medical freedom legislation because it legitimizes CAM.

The AMA, however, has steadfastly maintained that because it is a professional organization representing the interests of doctors, its only interest in the debate is to make certain that doctors are not left vulnerable through the use of a product or therapy that is not licensed.

The AMA does not actively lobby at the state level, but makes AMA research and information on certain health issues available to state lawmakers.

The AMA approach, says CAM advocate Turner, reflects perhaps the one certain area of consensus between supporters of alternatives and the medical establishment. "Doctors can easily become the subject of these various false claims acts, and the state medical boards can land on them like a ton of bricks."

Although Bergeron's standing with the Louisiana State Board of Examiners is good, he clearly sees the challenge of alternative care as one that confronts both patients and physicians.

"Health care providers should also be able to help patients with therapies they consider to be helpful as long as the therapy is not intended to take their life," Bergeron says.

Perhaps even more radical, from the viewpoint of many of his contemporaries, Bergeron believes patients should even be free to decide their own treatment "with or without the help of a clinician."

"The ultimate freedom and responsibility," adds Bergeron, "should be given to individuals."

For Groft, such compelling statements only underline the seriousness of the issue: "We all have to proceed very carefully, at every level of government. This is, unfortunately, not an issue that anyone can solve quickly or easily. But my fondest hope is that we can work with the states in the hope of coming up with some answers."

Garry Boulard, a free-lance writer from New Orleans, is a frequent contributor to State Legislatures magazine.

RELATED ARTICLE: When herbs are harmful

Consumer interest in a wide menu of complementary and alternative medicine practices and products appears to be riding a permanent high. Those handsomely packaged herbal medicines promising everything from vigor to peace of mind appear to be enjoying the greatest popularity of all.

More than 60 million Americans-spending up to $2.5 billion annually-regularly use one or even a handful of such products, usually without bothering to tell their physician.

And that's where the trouble begins.

Although many of the herbal solutions, doctors agree, are harmless, some can be very dangerous, particularly if mixed with regularly prescribed medicines or taken before surgery.

According to a study released last summer by Dr. Jonathon Moss, an anesthesiologist at the University of Chicago, herbal treatments oftentimes interfere with natural bodily functions-and that, in rare cases, can lead to death.

Moss's study, which was conducted with a team of scientists from the Tang Center for Herbal Medicine Research at the University of Chicago, concluded that garlic, ginseng and gingko biloba-all of which help to thin blood-can contribute to internal bleeding both during and after surgery.

Other herbal remedy worries include valerian and kava kava, both used as a form of tranquilizer, which also tend to prolong the effects of anesthesia; and ephedra, most often used as a weight-loss tool, which has been known to disrupt patient blood pressure and heart rates during surgery.

"Surveys show about one-third of patients coming in for surgery will be taking herbs," Moss told a reporter this summer after the findings of his study appeared in the Journal of the American Medical Association. "There is a reluctance among many of our patients to tell us about them because they consider them merely as nutritional substances without interfering with biological activity."

The University of Chicago study comes on the heels of a separate report issued last year by a team of Belgian researchers, which subsequently appeared in the New England Journal of Medicine.

That report indicated that the Chinese herb Aristolochia fangchi, used in America for weight loss, can damage kidneys and may cause several different forms of cancer.

Last year the Food and Drug Administration announced it was halting the importation of all herbs in the family.

"The biggest worry we have is the amount of misinformation that's out there," says Steven Croft, executive director of the White House Commission on Complementary and Alternative Medicine Policy.

"Is there enough information out there right now for the public to make an informed decision?" asks Croft. "And also is there adequate information for the consensual health care practitioner to provide and understand what is going on with these interventions and to counsel their patients?"

Croft says he does not believe-generally speaking-that either the medical establishment or the alternative medicine industry can currently respond positively to such questions. "But this is one of the most important things we have to explore: how to get reliable information out there for the public, for everyone, to learn from."

Until more information is available, the researchers for the JAMA study suggest that no one should take an herbal supplement at least two weeks before an operation.

Although such safeguards may greatly reduce the risk many herbal remedies pose for patients, Moss, in an interview with ABC, admitted that some risk will still occur, simply because so many physicians remain unfamiliar with the herbal medicine world.

"We haven't been trained in herbal medication," he said. "We come to this by virtue of the fact that our patients often take them."

WHAT WORKS? WHAT DOESN'T?

One of the most compelling arguments for regulating the complementary and alternative medicines industry, say its advocates, is that consumers will have a better handle on what products work and which ones don't even come close.

Mindy Green, founder of the American Herbalists Guild, has maintained that one of the dangers facing consumers is not just buying a product with phony claims, but purchasing a legitimate herbal remedy and using it improperly.

Herbalists who are members of Green's guild must submit three letters of reference from other licensed herbalists and have at least four years of professional experience. Once registered with the guild, they, in turn, are listed on Green's Web site, www.healthy.net/herbalists, and made available to the public to answer questions on how specific herbs work and should be used.

Both physicians and alternative medicine practitioners say the bible of the business is a thick directory called PDR for Herbal Medicines, which is modeled on the successful Physicians' Desk Reference series, described as an "unofficial, but indispensable guide to prescription drugs."

The PDR for Herbal Medicines not only catalogs herbal usage, but also possible side effects, proper dosages, and the effects of mixing herbal supplements with prescription drugs.

Other alternative medicine scholars have mentioned two encyclopedia series that they say have become increasingly popular: The Encyclopedia of Natural Medicine by Michael Murray and Joseph Pizzorno, two doctors of nutrition; and The Alternative Health Medicine Encyclopedia by James E. Marti and Andrea Hine.

Consumer Reports recently surveyed more than 46,000 readers, out of whom 16,000 said they regularly use alternative health practices, and noted that while many tried alternative therapies and products with the help of their physician, "nearly half tried new remedies on their own."

As a service to their readers, the magazine then listed the results of research on several of the most popular herbal products, and provided a report card on each.

Garlic, for example, has been proved to reduce cholesterol, but can cause mild abdominal discomfort.

The leaf extract echinacea, used to increase the immune process, cannot stop a cold from coming on, but may be able to reduce its duration.

Ginkgo biloba, used to stave off mental decline after a ministroke can also interact adversely with blood-thinning medications.

St. John's Wort is an effective treatment for mild depression, but could be dangerous if mixed with prescription drugs.

The lack of a single clearinghouse or source of information on which herbal solutions are the most effective for treating specific problems underlines the wisdom, says Jim Turner, executive director of Citizens for Health, of patients consulting with a physician whenever they are considering an alternative product.

"We like the idea of letting your doctor know everything you are doing," says Turner. "That's ideally bringing the best of both worlds together."

And according to the Consumer Reports survey, which was conducted in early 2000, the incidence of a physician approving an herbal solution appears to be on the increase: "When readers felt comfortable enough to tell their doctors about their alternative choices-and 60 percent did-most doctors expressed approval (55 percent) or at least neutrality (40 percent). Only 5 percent of the group said that their doctor disapproved," the magazine said.

Says Turner: "There are more and more younger doctors in the field every day, and they don't necessarily feel as negative about alternative solutions as perhaps their elders did. That's why we think it is not only a good idea to work with your physician, but that your physician today might be much more amenable to an alternative solution in the first place."