Alternative Medicine Debated by Nevada Legislators

As more people turn to alternative practitioners for their medical needs, Nevada needs better regulation of alternative medicine to protect consumers, lawmakers were told Wednesday.

Sen. Mike Schneider, D-Las Vegas, said some doctors can't do alternative therapies because the regulatory structure isn't there. He asked the Senate Commerce and Labor committee to pass five bills affecting alternative medicine.

The main part of Schneider's plan is SB432, which would get rid of the state Board of Homeopathic Medical Examiners and replace it with a board regulating "complementary integrative medicine," or alternative medicine. Schneider said the current board's authority is too narrow in focus.

That bill also changes the makeup and scope of several other state regulatory boards.

SB413 would mandate that insurance companies accept "ABC Codes," a new type of coding system that has more detail about alternative therapies. Using that system would make it easier for practitioners such as chiropractors, massage therapists and homeopathic doctors, said its supporters.

Using ABC codes could make it easier for massage therapists to get respect -- and money -- from insurance companies, said Billie Shea, head of Nevada's Board of Massage Therapy. But she worried that other aspects of Schneider's proposals could over-regulate some massage therapists.

Non-medical massage therapists don't make more than $40,000 or $50,000 annually, and already have to pay for multiple business and professional licenses, she said.

Larry Matheis, director of the Nevada State Medical Association, opposed all the bills. Schneider's approach wouldn't do anything to integrate alternative medicine into the existing health care system, which already is occurring, said Matheis. Rather, it would create a new state bureaucracy that could endanger patient safety, he said.

The existing medical boards offer sufficient regulation while Schneider's plan would allow unlicensed practitioners to get into the medical field, Matheis said.

"That is a dangerous step," said Matheis. "Your responsibility is patient safety, is public safety. If you're going to err, you have to err on that side."

Deborah Klein, representing the Nevada Dietetic Association, said proposed regulations for "medical nutritionists" in SB432 were vague and should be stricken. They would deceive the public into believing that nutritionists are qualified to do what dietitians do, said Klein.

"Basically, anyone can call themselves a nutritionist," said Klein. "However, they do not have the qualifications of a registered dietitian."

Some of the opposition to his bills came from traditional practitioners who "don't want to give anything up," said Schneider.

"The goal is to get more health care to more people are a more reasonable price," he said.

Should NICE evaluate complementary and alternative medicine?

Demand for complementary and alternative medicine is high despite limited evidence. In last week's BMJ, researchers go head to head over whether the National Institute for Health and Clinical Excellence (NICE) should review these therapies.

NICE was set up as an independent body by the UK government in 1999, charged with getting the best from NHS resources. It examines the value of treatments and decides whether they should be used in the NHS.

Around half of general practitioners provide access to complementary and alternative medicine, and two thirds of Scottish general practitioners prescribe herbal or homoeopathic medicines, so a thorough review by NICE would benefit the NHS and patients, argue Professor Linda Franck and colleagues.

Some people within conventional medicine remain deeply convinced that alternative medicine cannot have any possible benefit, but this is all the more reason that these therapies should be rigorously evaluated, they argue.

They believe that failure to evaluate complementary and and alternative therapies also leads to health inequalities because of uneven access and missed opportunities. For example, as complementary therapies are often relatively cheap, if shown to be effective they could save money currently spent on costly drugs.

Complementary and alternative therapies deserve a full evaluation from NICE and, if the evaluation is favourable, they should be adopted either on their own or integrated with conventional medicine, they conclude.

But Professor David Colquhoun argues that NICE cannot afford to re-examine evidence that has shown little benefit.

He points out that NICE already have alternative treatments in several of their reports and, in all these cases, they have found no good evidence for anything more than placebo effects.

And it is not necessary to take the word of sceptics about the lack of evidence. The more honest advocates of complementary and alternative medicine admit it themselves, he adds.

None of this is intended to deny the important role of supportive and palliative care for patients for whom that is the best that can be done, he says. But there is no need to subscribe to the early 19th century pseudoscientific hocus pocus of homoeopathy to treat sick patients sympathetically and holistically.

And there is no need for NICE to spend time and money coming to that conclusion when it has more important things to do, he concludes.

Head To Head: Should NICE Evaluate Complementary And Alternative Medicine?

Demand for complementary and alternative medicine is high despite limited evidence. In this week's BMJ, researchers go head to head over whether the National Institute for Health and Clinical Excellence (NICE) should review these therapies.

NICE was set up as an independent body by the UK government in 1999, charged with getting the best from NHS resources. It examines the value of treatments and decides whether they should be used in the NHS.

Around half of general practitioners provide access to complementary medicine, and two thirds of Scottish general practitioners prescribe herbal or homoeopathic medicines, so a thorough review by NICE would benefit the NHS and patients, argue Professor Linda Franck and colleagues.

Some people within conventional medicine remain deeply convinced that alternative medicine cannot have any possible benefit, but this is all the more reason that these therapies should be rigorously evaluated, they argue.

They believe that failure to evaluate complementary therapies also leads to health inequalities because of uneven access and missed opportunities. For example, as complementary therapies are often relatively cheap, if shown to be effective they could save money currently spent on costly drugs.

Complementary and alternative therapies deserve a full evaluation from NICE and, if the evaluation is favourable, they should be adopted either on their own or integrated with conventional medicine, they conclude.

But Professor David Colquhoun argues that NICE cannot afford to re-examine evidence that has shown little benefit.

He points out that NICE already have alternative treatments in several of their reports and, in all these cases, they have found no good evidence for anything more than placebo effects.

And it is not necessary to take the word of sceptics about the lack of evidence. The more honest advocates of complementary and alternative medicine admit it themselves, he adds.

None of this is intended to deny the important role of supportive and palliative care for patients for whom that is the best that can be done, he says. But there is no need to subscribe to the early 19th century pseudoscientific hocus pocus of homoeopathy to treat sick patients sympathetically and holistically.

And there is no need for NICE to spend time and money coming to that conclusion when it has more important things to do, he concludes.

Garlic

Sutidies have concluded that garlic doesn't lower cholesterol.

But advocates of herbal and nutritional remedies are responding to the news with this advice: Keep eating the onion-like herb because what befouls one's breath may befriend one's health.

Garlic, the longtime folk remedy for various conditions and ailments -- heart disease, cancer and bacterial infections included -- still has sizable support in scientific literature. But anyone using garlic to lower his or her cholesterol might consider seeking an alternative approach.

"I do recommend that people eat garlic, especially through the winter," said Dr. Sharon Plank of the Center for Integrative Medicine at UPMC Shadyside, noting its antibiotic effects. "We tend to see better health in people who eat nutritionally and the Mediterranean diet, which uses garlic and spices."

Previous studies about garlic's impact on cholesterol were mixed, despite many alternative medicine publications suggesting a positive impact on cholesterol.

But a study that appeared yesterday in Archives of Internal Medicine concluded that garlic consumed almost daily for six months had no appreciable effect on cholesterol.

Dr. Christopher Gardner, assistant professor of medicine at Stanford University, told The Associated Press that he and colleagues were initially optimistic that garlic would reduce cholesterol.

Their study included 192 adults about 50 years old who had moderately elevated LDL or bad cholesterol levels. They were assigned to eat an average clove of garlic in raw form, or take garlic pills, six days a week for six months. In the double-blind study, part of the group was given dummy pills.

While more than half of the participants reported bad breath and body odor and some reported flatulence, there were no major side effects from eating garlic. But the study found virtually no effect on cholesterol levels in either group.

Calling the results disappointing, Dr. Gardner said it's still possible garlic might lower cholesterol when eaten in larger doses or by people with severe cholesterol problems. It also might have other characteristics that benefit heart health.

An Archives editorial said "the jury is still out" on whether garlic prevents cardiovascular diseases.

But advocates of herbal and nutritional remedies said people should continue consuming the herb.

Dr. Plank recommends consuming two cloves of raw garlic daily. She questioned whether the study's use of garlic pills, rather than raw garlic, accounts for the lack of impact on cholesterol. She said garlic thins the blood, which benefits heart health.

Other studies have concluded that garlic prevents prostate and gastric cancers, kills bacteria and even can alleviate mosquito bites.

Dr. Shivendra Singh, director of basic research, professor of pharmacology and urology, and leader of the Biochemoprevention Program at the University of Pittsburgh Cancer Institute, has been studying diallyl trisulfate, a chemical found in garlic that kills gastric and prostate cancer cells in dish cultures and animal models without affecting healthy cells.

He said he's developing the chemical as a cancer prevention, and soon will seek U.S. Food and Drug Administration approval to conduct human clinical trials on its safety and effectiveness.

Dr. Singh said research proves garlic consumption has beneficial effects on prostate cancer.

Diallyl trisulfate, he said, is just one of many chemicals in garlic that benefits health. Allicin, the chemical released when garlic is chopped, was purported to be the agent that reduced cholesterol.

Garlic's health benefits have been documented since 1400 B.C. Hippocrates, the famed Greek doctor, advocated its use for abnormal growth, which Dr. Singh said probably referred to cancer. Egyptian and Indian cultures also recommended garlic consumption to solve various ailments including growths.

Dr. Singh, who eats a clove of garlic daily, said the evidence is clear: "In terms of cancer, we know which chemical it is, how it works and how it inhibits cancer in animals."

He recommended eating a clove of garlic a day, which can be chopped, microwaved a brief period or mixed with honey.

Dr. Robert A. Schulman, author of "Solve It With Supplements" that recommends using herbal and nutritional supplements to help prevent and heal more than 100 common health problems, praised garlic, but warned that no herb or nutritional supplement is "a magic bullet."

"Herbs work in concert with other things," Dr. Schulman said. "Eating well, not eating junk food, exercising and getting a lot of sleep will make you live longer."

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