Natural cures: herbs are huge, but do they work?

Leading a national wave of interest in alternative medicine. Angelenos are popping pills, sucking on homeopathic medicines, putting on patches and brewing exotic herbs like never before - all in the belief that natural remedies give them a better shot at good health than traditional treatments

Retailers and manufacturers are riding the wave with even more enthusiasm - many of them posting huge jumps in sales over the past several years alone. Newspapers, magazines and scores of new Internet sites, meanwhile, breathlessly report on the latest herb or homeopathic remedy that offers a potential pathway to well-being.

But amid the current frenzy, one question looms: Do these things actually work?

The short answer - that no one really knows - is hardly reassuring.

Despite their increasing popularity, few homeopathic or herbal therapies have been tested in the same rigorous, double-blind fashion demanded of mainstream pharmaceuticals. Such an absence of concrete evidence makes some in the mainstream medical community apprehensive. While many doctors concede that herbal and botanical remedies can have a powerful placebo effect - providing a psychological boost in the healing process that's hard to dismiss - only a minority of physicians hold much stock in the substances' actual curative powers.

"The issue for most physicians in he United States is that we are taught in the scientific method to test an idea and say, yes it works or no it doesn't," said Dr. Samuel Solish, president of the Pasadena Medical Society and a board member of the Los Angeles County Medical Association. "These things may have great effects and may be very positive, but we will never know until they are put through scientific scrutiny."

Compounding the problem is a virtual absence of regulatory oversight. Unlike drugs, dietary supplements and herbs are not regulated by the U.S. Food and Drug Administration. They are not peer-reviewed by scientific panels; nor are they required to go through clinical trials and the lengthy FDA approval process to get on the market.

All told, the deliberative, methodical pace required by normal scientific inquiry is utterly at odds with the Gold Rush mentality that currently characterizes the natural remedies industry.

In 1997, consumers in California and Hawaii spent some $2.8 billion on vitamins, herbs, dietary supplements and the like - more than 25 percent of the $10.4 billion spent on such products nationwide, according to Natural Foods Merchandiser, a trade publication.

That's just the substances themselves. Factor in alternative treatments - such as massage, chiropractic, hypnosis, acupuncture and other therapies - and Americans spent an estimated $27 billion in 1997, according to a 1998 survey by Harvard Medical School. More than one in four Americans sampled alternative treatments in 1997, the study found - a 47 percent increase from 1990.

The Harvard report revealed some disturbing findings, as well.

Fewer than 40 percent of patients bothered to disclose their use of alternative therapies to their physicians. The study also found that in 1997, 15 million Americans took prescription medications and herbal remedies simultaneously - raising the possibility of unintended side effects due to interactions between the substances.

Glenn Braunstein, an internist and endocrinologist who serves as chairman of medicine at Cedars Sinai Medical Center, said a growing percentage of his patients has begun to see holistic practitioners on the side. "There is tremendous utilitization out there by patients," he said. "We need to study these modalities."

Cedars is one of a handful of mainstream research hospitals taking a step in that direction. In launching its Integrative Medicine Program, the hospital is looking to integrate alternative approaches - ranging from herbs, supplements and vitamins to acupuncture, yoga and massage - with traditional Western medicine, according to Dr. Mary Hardy, an internist who serves as the program's medical director. The center also will conduct clinical trials on the efficacy of alternative treatments.

Since opening late last year, the program's clinic has since seen more than 100 patients seeking treatment for everything from chronic muscle and back pain to diabetes, liver problems and the effects of chemotherapy.

"Most patients are not using (alternative) therapies as substitutes" for Wester-style care, she said. "They are using it as an adjunct. People don't see this as an 'either or' situation. They see it as a 'and-plus.'"

Hardy insists that alternative remedies and therapies can be a powerful healing tool when used carefully and in conjunction with traditional medical care. But she admits that "there is very little actual data on this stuff."

Indeed, while the number of scientific studies into alternatives cures is growing, it has hardly kept pace with the staggering amount of new products being launched. More than 1,100 new brands of vitamins, supplements and minerals were introduced in 1997, compared with just 327 new product launches in 1991, according to Marketing Intelligence Service Ltd. in Naples, N.Y.

The scientific research, meanwhile, remains as anecdotal as the word-of-mouth hype that has led millions of Americans to begin popping herbal tablets at the first sign of the sniffles.

Some alternative-care advocates say the recent research is encouraging.

A 1997 Australian study found that 64 percent of patients with irritable bowel syndrome reported improvement after being treated with traditional Chinese herbs. The condition, a pattern of symptoms that includes episodes of abdominal pain, diarrhea and excessive gas, affects as much as 20 percent of the population. And a 1998 study by German researchers found that the over-the-counter homeopathic medicine Oscillococcinum was effective in short-circuiting the flue.

At the same time, another German study found that the allegedly cold-fighting herb echinacea - the nation's most popular herbal remedy, with sales of $270 million in 1997 - had no significant impact on the number, duration or severity of colds. And extracts of Garcinia cambogia, an ingredient in more than 30 dietary supplements marketed for weight loss, were found to have no effectiveness whatsoever in a study by Columbia University researchers.

The spottiness of the current research leaves health insurers highly skeptical. While all of California's major managed care companies offer some form of alternative care, ranging from chiropractic treatment to acupuncture, members have to pay a surcharge on top of their regular premiums. Only a handful have added herbal and other alternative remedies to their drug formularies.

"It is time to look at these practices and see how we can bring them to our membership in a safe and efficient way," said Kathleen Baffone, product development specialist for Health Net, which is in the process of getting licensed by the state to offer acupuncture and herbal medicine. "But there will have to be a lot more scientific data and research before we fully cover alternative therapies."

A Glossary of Terms

Alternative remedies tend to fall into one of three categories: homeopathic medicine, herbal medicine and vitamin supplements. Here are the definitions of those alternative remedy classes, as well as some of the most common substances in each class.

Homeopathic Medicine

A class of drugs that are extremely diluted extracts of naturally occurring plant, animal or mineral substances. The homeopathic approach was devised two centuries ago by a German physician named Samuel Hahnemann. Today, it's a multi-million-dollar industry that is recognized and regulated by the Food and Drug Administration.

Common homeopathic remedies:

Oscillococcinum - A pill derived from a duck virus. Commonly used in very diluted form to treat symptoms of the flue virus. It is also prescribed to treat the symptoms of other viral conditions.

Arnica - Treatment (available in pill or cream form) derived from a plant and said to stimulate healing responses in the body. It is commonly prescribed for open wounds, bruises and other trauma the body may incur during a fall, car accident or other traumatic incident.

Calms Forte - An extraction of minerals derived from animal an vegetable products. Commonly prescribed as a sleep aid or relaxant.

Herbal Medicine

Originating in China thousands of years ago, this term refers to a set of techniques and methods used in combination with acupuncture, acupressure, qigong and oriental massage. The method focuses on diagnosing disturbances in "qi," or vital energy, in a person's body. The remedies are all natural herbs, none of which are synthesized like drugs used to treat patients in traditional Western medicine. There are about 500 herbs used in herbal medicine, and they can be dispensed in pill, tea or raw plant form.

Common herbal remedies:

Ginkgo Biloba - Derived from an Asian ornamental tree, this herb is said to facilitate the flow of blood through the circulatory system. The drug is commonly used to treat memory loss in elderly patients.

Ginseng - Actually a derivative of the root of the ginseng plant, it is used as a tonic to help the body's system adapt to stress.

Garlic - A versatile herb credited with being able to fight infection, aid in keeping high blood pressure under control, assist digestion, and perform other health benefits.

Kava Kava - Derived from the root of the kava kava plant, it is said to calm people's stress level. It is billed as a natural alternative to the drug Prozac.

Vitamin Supplements

High-dosage versions are regularly used in alternative medicine as part of a preventative care regimen. There is no consensus as to what specific dosage constitutes a "megavitamin," and wide potency variations exist between different brands.

Common vitamins:

Vitamin C - Taken in pill form, it is used to prevent the common cold or to promote general health.

Vitamin E - Taken in pill form or used topically to cure wounds and promote health. It also is commonly used as an antioxidant.

Calcium - Taken in pill form, it is commonly used by women to prevent osteoporosis, a disease that leads to a loss of bone density.

Iron - Taken in pill form, it is commonly used by women to promote health and alleviate anemia.

Compiled by Jessica Toledano