According to one study in the journal by David M. Eisenberg, MD, of the Beth Israel Deaconess Medical Center in Boston, and colleagues, more than $27 billion was spent on alternative therapies in 1997. The estimated number of visits to alternative medicine practitioners increased dramatically, from 427 million in 1990 to 629 million in 1997, exceeding the total number of visits to all primary care physicians in the US that year.

Alternative vs. Complementary
It is absolutely crucial to separate alternative, unproven therapies from complementary therapies, said Barrie Cassileth, PhD, author of The Alternative Medicine Handbook and member of the American Cancer Society Advisory Committee on Alternative Therapies.

Alternative therapies are unproven methods that are generally invasive and harmful and have a major physiologic effect, she said. As many as 10 percent of cancer patients try one of these types of alternative therapies, usually before or after mainstream therapy, she added.

"Avoid any regimen or product that is offered as a cancer cure outside of mainstream medicine," Dr. Cassileth warned.

Complementary therapies, on the other hand, may be very helpful in supporting the patient during conventional therapies, she added, and could include methods such as Tai Chi, massage, mind-body techniques, and counseling. Most of these methods have been around for decades and have data to show they are effective approaches, said Dr. Cassileth. In the past, they would have been referred to as "supportive care." As many as half of cancer patients use complementary methods along with traditional treatments, she said.

Cassileth believes one of the things that boosted sales of alternative therapies, such as megavitamins, herbs, and homeopathic teas, is the 1994 federal law that removed all food supplements from regulation by the US Food and Drug Administration (FDA). These remedies are now available over-the-counter and manufacturers do not have to prove safety, purity, or efficacy. There are no regulations requiring manufacturers to provide any guarantee of what a product contains or does not contain.

While medical proof of the value of some therapies may not exist, their ability to make a patient feel better still has value, said Mary Kaminski, MD, a former practicing oncologist and a chief scientific officer of Novartis Pharmaceuticals Corp.

"My philosophy is as long as the physician knows what the patient is doing, and it is not a financial burden on the patient, and as long as there is no known adverse effect, patients may go ahead and explore," said Dr. Kaminski. "There may not be any positive effect, but for the patient, there is a positive psychological effect. They have to feel empowered and in control of the process."

Alternative Therapy Usage
As many as 83 million or 42.1 percent of the adult population has used at least one alternative therapy, with people aged 35 to 49 years of age reporting the highest use, at 50.1 percent. "In 1997, 42 percent of all alternative therapies used were exclusively attributed to treatment of existing illness, whereas 58 percent were used, at least in part, to prevent future illness from occurring or to maintain health and vitality," wrote Dr. Eisenberg in his study.

"Despite the increasing use of alternative medicine in the United States and throughout the world, most alternative therapies have not been evaluated using rigorously conducted scientific tests of efficacy based on actual rules of evidence," said George D. Lundberg, MD, former editor of JAMA.

Other therapies reported on in this issue include relaxation techniques, herbal medicine, massage therapy, chiropractic care, megavitamins, self-help groups, imagery techniques, commercial diet nutritional supplements, folk remedies, lifestyle diet, energy healing such as magnets, homeopathy, hypnosis, biofeedback, and acupuncture.

Dr. Lundberg concluded, "Until solid evidence is available that demonstrates the safety, efficacy, and effectiveness of specific alternative medicine interventions, uncritical evidence of untested and unproven alternative medicine therapies must stop."