Covering Alternative Medicine

As a veteran reporter whose first thought when approaching scientific, medical and health claims is to ask those behind the claims to "show me the evidence," I've long been cautious about many practices that fall under the rubric of "alternative medicine." It's especially easy to do that when you're based in a place like Southern California, legendary for self-styled healers and doctors working outside the medical mainstream.

And yet, after reporting from here for more than 14 years, it's become increasingly clear to me that no journalist should dismiss alternative medicine out-of-hand. That's because it includes a broad range of practices, many of which have demonstrated value way beyond the placebo effect.

In writing about health and access to health care, I've also learned that an increasing number of Americans use alternative health approaches, for varying reasons, often when dissatisfied with traditional, Western medicine. Some turn to these therapies as a substitute for traditional care because they lack health insurance, others others because they've grown up in cultures reliant on ethnic or folk remedies, and others because they're dissatisfied with traditional Western medicine.

Because of the growing interest, any reporter, producer or editor covering health care should become familiar with three broad categories of non-traditional medicine:

1. Alternative medicine offers therapies outside the traditional, Western medical system.

2. Complementary medicine uses alternative methods as part of an overall Western-style approach, such as by incorporating acupuncture, yoga or massage into cancer care.

3. Integrative medicine offers the full range of therapies from traditional and alternative systems, with consideration of how they interact.

Health reporters are often called upon to evaluate the newsworthiness of developments in alternative, complementary and integrative medicine. Typically, these hit the radar screen either because the technique or approach has been shown to be effective, or because there's strong evidence that it's quackery, says Dr. Mary Hardy, M.D., an integrative medicine specialist in Los Angeles.

Consumers are always looking for guidance on distinguishing substance from hype, especially when they're bombarded by promotions for effortless weight-loss methods, or the purported benefits of antioxidant drinks containing noni, goji berries or acai berry. Journalists often play their most important role by telling the cautionary tale, such as warning consumers about potentially dangerous interactions between "natural" dietary supplements and prescription drugs, as I did in a package of stories I wrote in 2000 while a reporter at the Los Angeles Times.

The task of sorting it all out becomes all the harder because evidence for health claims in non-traditional medicine often does not rise to the gold-standard -- randomized, controlled clinical trials (those in which participants are randomly assigned either to an experimental group or to a comparison group) published in major peer-reviewed journals.

"There isn't the same depth of research, and there never will be," says Hardy, medical director of the Simms/Mann-UCLA Center for Integrative Oncology, who has long studied herbs and dietary supplements and often recommends them to appropriate patients. She says safety margins for herbal remedies, especially those used for thousands of years, are better than for prescription drugs. "It's very uncommon that any herb with traditional knowledge behind it will be as toxic as a new drug."

Claims about alternative, complementary and integrative medicine often are built on anecdotal evidence. But that's not the same as demonstrating their effectiveness through rigorous science. Even so, Hardy believes that safety margins for herbal remedies, especially those used for thousands of years, are better than for prescription drugs. "It's very uncommon that any herb with traditional knowledge behind it will be as toxic as a new drug," she says.

When she's trying to evaluate such claims of an alternative remedy's effectiveness, Hardy wants study authors or those making the claims to provide multiple cases of good responses. She also wants to see a rationale for the treatment that is either consistent with the principles of alternative medicine practices, such as traditional Chinese medicine, or explainable through principles of Western medicine.

As an example, she cited research that found the herb ginkgo biloba relieved symptoms of lymphedema - the accumulation of fluid in the arm or hand after breast cancer surgery. Ginkgo contains lots of flavonoids, compounds known to maintain the elasticity and strength of small vessels. Therefore, within Western medical concepts make, it 's reasonable to assume that ginkgo might be able to open up small channels where lymphatic fluid pools. A Chinese medicine practitioner might offer the rationale that lymphedema is a stagnation of blood and qi (the vital energy force that controls body and mind), and that gingko might help because it's a powerful mobilizer of qi.

But most journalists don't do that kind of analysis, making it crucial to find experts who can help.

Three excellent places to start are the Office of Dietary Supplements within the Office of the Director of the National Institutes of Health in Bethesda, Md., the National Center for Complementary and Alternative Medicine at the NIH, and the Office of Cancer Complementary and Alternative Medicine at the National Cancer Institute.

Also, consider contacting The Consortium of Academic Health Centers for Integrative Medicine, which includes 41 top U.S. and Canadian medical schools with integrative medicine programs. The consortium's web site lists member institutions by state, and also provides lists of conditions for which integrative medicine approaches are used.

Integrative medicine is particularly useful in treating chronic diseases like diabetes, coronary artery disease and pain, which are all can be influenced by such lifestyle factors, such as diet and exercise. With the aging of the Baby Boomers, integrative approaches are likely to generate rafts of stories in coming years. It's already happening: just think about how often you hear that regular exercise and a diet rich in antioxidant- packed fruits and vegetables and plant-based proteins (rather than proteins high in saturated fats) may prevent cancer and heart disease.

In cancer care, there's increasing evidence that hands-on alternative approaches, such as specialized massage therapy, can ease certain symptoms and treatment complications.

Stories waiting to be told

A particularly rich area for storytelling is the emerging field of mind-body medicine. Recent studies have explored the effects of hypnosis and relaxation therapy on a host of maladies. A study in the June 2008 issue of the American Journal of Gastroenterology reported that hypnosis may ease the inflammation associated with colitis, an autoimmune disorder of the gut lining.

A sharp journalist looking for story ideas about integrative medicine might want to explore past, current and planned clinical trials. They easily can be tracked down through the federal government's clinical trials web site, which provides specifics as well as contacts for federally sponsored and privately sponsored studies. For example, a search for "mindfulness meditation" yields a list of ongoing and completed trials evaluating its usefulness in reducing back pain, stress among cardiac heart patients, post-traumatic stress disorder among veterans, and insomnia. Similarly, it's easy to find trials evaluating how the practices of yoga and tai chi may reduce pain or improve bone health.

Finally, there are terrific stories to be told about instances where modern science has validated (or debunked) ethnic or folk medicine practices. For example, honey has long been applied as a dressing for skin infections. Today, honey's antibacterial properties are being harnessed to treat antibiotic-resistant infections and diabetic wounds. Leptospermum honey, made from the pollen of the manuka bush in New Zealand and the jellybush of Australia, has particularly strong germ-killing power. A New Jersey company, Derma Sciences Inc., has been selling its Medihoney Manuka dressings for use on wounds and burns, including those of Iraqi burn victims.

As alternative, complementary and integrative medicine practices become more widely available in this country, journalists can play an important role in subjecting them to the kind of close scrutiny that, in turn, can help consumers make more informed choices about their health care.

Jane E. Allen is a Los Angeles-based health and medical writer.