Wednesday, March 5, 1997
"Exploring Alternative and Complementary Medicine": A Summary*

Introduction - Debu Tripathy, M.D.

Dr. Tripathy introduced the topic by talking about how alternative medicine is comprised of many areas and covers many diverse interests. In conventional medicine it is difficult to make decisions and understand the various treatments, in alternative medicine it is that much more difficult. Dr. Tripathy would like to know how women make decisions about whether to use alternative medicine, the criteria upon which women base these decisions, and what their values, preferences, problems and biases are regarding alternative medicine.

Women's Concerns about Alternative Medicine

• Many women diagnosed with breast cancer get to a point where they will do anything and everything to heal or recover. Since all therapies, conventional and alternative, are "a bet," many women try to increase their odds by trying many different therapies.

• The Cancer Support and Education Center, in Menlo Park, has an excellent program that consists of visualization, meditation, pain control, body awareness, motivational strategies, nutrition, energy building and group sharing. The group meets one day a week from 9:30am - 4:30pm for 10 weeks. The program is expensive, $1600 for the 10 week session, but it can be repeated if the patient would like. The Cancer Support and Education Center can be reached at (415) 327-6166.

• Several attendees stated that they do not know how to integrate supplements into their diet. They don't know which supplements to use, how much they should use and how this should change during and after their various treatments.

• Dr. Tripathy replied that there has been no research done on supplements that are used during conventional treatments. In addition, using anti-oxidants during chemotherapy can be harmful because it can interfere with the chemotherapy.

• The attendees would like to see a panel of alternative medicine specialists available to answer all their questions.

*This is an attempt to capture the topics and general ideas discussed at the February 5th meeting. Every effort was made to represent the statements and opinions as accurately as possible. Any misrepresentation or omission of the discussion was entirely unintentional.

Registry at UCSF

• At UCSF, Dr. Tripathy has developed a Registry to Study Traditional Chinese Medicine with The College of Traditional Medicine. The cohort study will track patients' use of alternative treatments and how they integrate these therapies into their conventional treatments. Women will be asked to complete a questionnaire and symptom index every few months.

• The registry will not be able to isolate specific treatments that work or do not work, but eventually it will be able to identify trends, benefits and side effects in large populations. It will collect information on people who have used the same Chinese treatments and on patients who are not using any alternative treatment to make general comparisons.

• The trends identified in the registry will be the basis of research questions.

• UCSF has joined with California Pacific Medical Center (CPMC) to study the effects of an intensive intervention for women who have been diagnosed with breast cancer. The intervention will include nutritional changes, group therapy, individual therapy, dance therapy, yoga and meditation.

• There is also an Integrative Medicine program that is working with Dr. Dean Ornish of the Preventive Medicine Research Institute. Dr. Ornish has developed a program that has been shown to reverse heart disease and he is trying to apply the same concepts to prostrate cancer.

Barriers to Making Alternative Medicine Mainstream

• Few studies have been done using alternative medicine. Although there is much anecdotal evidence in support of alternative therapies, physicians are taught to look for scientific proof and are critical of evidence that is not scientifically based.

• Dr. Elisabeth Targ is a psychiatrist who wrote a grant to the Department of Defense trying to get funding for psychic, distant healers. Although her grant received a score in the top 5 percentile (meaning it was one of the best grants reviewed), the Department of Defense would not fund it because it did not have a scientific base.

• Not only are studies not being funded, but patients are not even given the information about alternative medicine. One patient referred to the lack of information as a "blackout in medicine."

• It is important to use data that already exists. China has begun to run clinical trials with the herbs they have been using for thousands of years. Unfortunately, their data is hard to interpret because they do not have long term outcomes yet.

• Dr. Tripathy would like to see medicine and science at least question alternative methods. No one can possibly know the true benefit of these methods until they are tested in a methodological manner.

• Women want their physicians to be more open about their options. Many patients feel that their doctors are cynical or negative about using alternative medicine. Some women wonder if this is because the physicians feel threatened or are being protective over their patients and the treatments they recommend.

• Dr. Andy Kneier, a psychologist, thinks that the reason alternative medicine is not mentioned is because it is threatening to traditional medicine.

• Dr. Nancy Valente, a medical oncologist, said she personally is afraid to talk to her patients about things she does not know about. She is more comfortable discussing the things taught to her in her training.

• Dr. Laura Esserman, a surgical oncologist, thinks there are a lot of open minded doctors who do not know or do not have the time to research these issues and others who do not continue learning once they have been trained. Patients need to communicate the importance of these issues to their doctors.

• Medicine needs to be changed across the board starting with medical schools. Medical students should be taught about alternative medicine and techniques and how to access more information for their patients.

• Doctors also need to treat the person as a "whole" as opposed to treating just the "part" that is their specialty. Doctors of different specialties also need to communicate to one another. One woman told a story about having feet pain which was only relieved once a dentist identified that she had metals in her mouth that needed to be removed.

• Finding the inner balance in a person is the basic premise of Chinese medicine. Western doctors would not know what to "do" with a patient who came to them well. There needs to be a better interface between sickness and health in Western medicine.

• Patients can have a lot of impact by communicating these things to their physicians.

• Many clinical trials are underwritten by biotechnical or pharmaceutical corporations. The trend towards exploring alternative medicine and patients turning away from standard drug treatments are threatening to these industries.

• This also poses a problem in terms of who will pay to study alternative medicine. The federal government and, specifically, the National Institute of Health (NIH) and the National Cancer Institute (NCI) have not paid for any clinical trials studying alternative medicine. Pharmaceutical companies will not pay for this research unless they can market natural herbs. In order to market herbs, the herbs need to be approved by the Food and Drug Administration (FDA). With FDA approval comes the processing, heating and sterilizing of the herbs which may cause them to lose their potency.

• The problem with not getting FDA approval is that the consumer can not always be sure what she is buying. One woman stopped using Chinese herbs because her herbalist could not translate the herbs into English.

• Part of the problem is that the U.S. would like to regulate all medicine. Even though alternative medicine is highly scientific, knowing the right doses and treatments for each individual is an art that can not be standardized.

• Women should work with reputable and knowledgeable herbalists. Even though California has rigorous quality controls, there are always people who get around licensing.

• It is also important to work with people who are knowledgeable about Western medicine so the treatments can work together and not cause additional harm. Knowledgeable practitioners can adjust doses according to a patient's specific treatment.