Healers or Quacks?
Therapies once viewed as fringe are becoming mainstream
Within moments of entering Arlene Olson’s Calgary office, even casual visitors are likely to be seduced by the heady mix of aromas that permeates the softly lit space. Difficult to define but ravishing to sniff, the intermingling scents conjure up visions of summer flowers, freshly peeled fruit or shavings from fragrant woods. Olson, a massage therapist who also offers aromatherapy, says more and more people are discovering that natural fragrances, carefully combined, can have powerful healing and rejuvenating effects. Usually, aromatic oils are massaged into the body, but simple inhalation is also common. Olson notes that nurses in British hospitals use aromatherapy for patients with anxiety and depression, and to make terminal-care patients more comfortable. Her own practice includes clients who use the soothing scents in combination with massage to alleviate pain caused by broken bones or to reduce swelling from varicose veins—or simply to relieve stress. “The oils bring pleasure,” Olson says, “and pleasure reduces pain.”
Like millions of other Canadians, Olson’s clientele are increasingly attracted by unconventional forms of health care. They are experimenting with a huge range of alternatives, from new types of chiropractic and acupuncture for chronic pain, to herbal medicine for conditions that range from menopause to acquired immune deficiency syndrome (AIDS). Only a decade ago, such alternatives were widely viewed as far out on the medical fringe, tainted by allegations of ineffectiveness or, worse, outright quackery. Now, every month seems to bring another book on the subject, while many large drugstores are stocking a wide range of herbal remedies, and holistic health clinics are proliferating across the country. “Conventional medicine is lousy at dealing with chronic illness,” says Zoltán Roña, a Toronto physician whose second book about natural ways to maintain long-term health was published this year. “People are beginning to realize they can keep up conventional treatments for diseases like cancer, while improving their survival rate and quality of life by using natural therapies.”
According to independent surveys, about 20 per cent of Canadians opt for some type of alternative treatment. (Chiropractic leads the way with nine per cent.) Some of these treatments come under provincial health insurance: chiropractic is partially paid for in British Columbia, Alberta, Saskatchewan, Manitoba and Ontario, while some naturopathic services are covered in British Columbia. = Costs range widely, from about $275 an hour for the services of a ^ holistic MD (which may not be covered by the provincial insurance â
plan) to about $25 for a follow-up visit to a chiropractor. In any event, most patients combine their trips to alternative healers with visits to mainstream medical practitioners. In fact, many report high confidence in their MDs, and say they simply want more health-care options. Of those who try unconventional therapies, many also cite a powerful aversion to drugs and invasive techniques such as surgery.
For physicians, the snowballing interest in alternative health care presents a quandary. A small percentage emphasize holistic medicine in their own practices, offering services such as acupuncture and nutritional counselling. The vast majority seem to walk the middle road, acknowledging that patients may feel better if they try such alternatives, as long as they do not abandon conventional treatment. The benefits of alternative medicine are largely psychological, many believe. “The placebo effect
is very powerful,” says Toronto oncologist Robert Buckman, “so it must be doing some good.”
Other doctors, however, argue that alternative health practices could be doing a lot of harm. In virtually every province, medical licensing authorities—which are administered by MDs—are investigating doctors who offer alternative health care and, in some cases, threatening to revoke their licences. The authorities insist that they are protecting public safety, but others say that such explanations are a smoke screen. “This resistance is about maintaining the power of the medical profession,” says William LaValley, a Nova Scotia physician whose practice in the seaside town of Chester was the object of complaints by several doctors. “A small number of doctors who run the profession are trying to restrict choice in health care, and they are not interested in the fact that so many people are getting well and we are saving so much money.”
Tom Mountford, for one, believes that no one has the right to control access to alternative forms of health care. Mountford, a project leader for a Vancouver group that offers support and information for
AIDS patients, learned in 1985 that he was infected with HIV, the virus believed to cause AIDS. He began investigating alternative therapies almost immediately and first tried a homeopathic remedy to treat a tooth infection; the problem disappeared within two days, he claims. Now 48, Mountford credits a range of alternative treatments, from nutritional counselling to acupuncture and herbs, with helping to alleviate the side-effects of AIDS drugs and to control his pain. “It’s a whole new frontier,” he says. “It’s exciting when you see something working.”
Earl Berger, a health-policy consultant who publishes the Toronto-based Canada Health Monitor in conjunction with management consultants Price Waterhouse, says that baby boomers—those veteran trendsetters—are spearheading the move towards alternative medicine. But interest in natural therapies is strong among other age groups as well. “This is a very dissatisfied society,” says Berger. “People are searching for a different way of living, and alternative medicine is part of that search.” Between 25 and 30 per cent of working Canadians report that they have suffered health problems because of stress in the workplace. Many are also convinced that their environment is highly contaminated, and that their health is suffering as a result. For many, Berger says, common sense dictates fewer expensive and uncomfortable medical tests and prescription drugs, and more em-
phasis on diet, relaxation techniques and simpler lifestyles. “People are turning back to the basics, in all kinds of areas, like politics and spirituality,” Berger says. “Medicine is no exception.”
That may be why so many are drawn to traditional ways of healing, which rely mostly on non-invasive, drugless techniques. Chiropractic is celebrating its 100th anniversary this year, an event that will be commemorated with a series of four new Canadian stamps, including one depicting the Port Perry, Ont.-born founder, Daniel David Palmer. Homeopathy, which began in Germany in the late 1700s, was widely practised in North America until the early 20th century, when advances in modern medicine—in particular, the development of antibiotics—drove it off the medical map. Chinese remedies, such as herbs and acupuncture, are many centuries old.
In fact, alternative medicines have never slid into obscurity in Europe and Asia as they did in North America—and now they are coming on even stronger. Members of the British Royal Family, including Prince Charles, are enthusiastic users of homeopathy, and sales of the remedies are shooting up all over Europe: 20 to 25 per cent in the United Kingdom in 1994 over the previous year, and 30 per cent in Greece and Portugal. In France, four out of five herbal remedies are prescribed by doctors, while 77 per cent of pain clinics in Germany use acupuncture. Interest in alternative therapies is also surging in the United States. In 1993, the National Institutes of Health—the leading public institution for medical research—established an Office for the Study of Alternative Medicine, with a budget of $2.7 million. In 1990, spending on alternative remedies by American consumers is estimated to have reached $18.6 billion, more than was spent that year on visits to primary-care physicians (not including hospital visits).
The new treatments present a quandary for doctors
For many patients, the highly personalized attention offered by alternative health practitioners is a powerful draw. An initial consultation often takes more than an hour. The healer may ask dozens of questions, not just about a particular ailment but about problems at work or at home, diet, exercise and environmental influences. The patient may receive a careful physical examination and detailed directions for lifestyle changes. Medical doctors, by comparison, spend an average of seven to 10 minutes with each patient, and it is estimated that three-quarters of office visits to general practitioners end with a prescription for drugs.
Like many Canadians who eventually find themselves using alternative health care, Linda Aspin did not go looking for it. Aspin, 50, and her husband, John, run a small boat-chartering business in Pinette, P.E.I. About four years ago, she began to experience uncomfortable menopausal symptoms, such as sleeplessness and hot flashes. “My doctor slapped an estrogen patch on me and I didn’t think about it,” she recalls. But her doctor found a lump in her breast a few years later, and although it proved to be benign, the scare got her thinking. “I suddenly realized that there was a risk of cancer with the
patch, so I took it off,” Aspin recalls. “But then, it was as though I was being jolted into menopause all at once. I needed help.”
Aspin found a practitioner who uses Chinese remedies, including acupuncture and herbs. Three times a day, she drinks a bitter tea made from the bark and leaves of 14 different plants to help keep her symptoms under control. At a cost of about $50 to $100 a month for the herbs and $50 for an hour-long consultation, the treatment is not cheap, but Aspin says it is worth the peace of mind natural remedies bring. She is not so happy, however, about the reaction of her GP. “He told me I was wasting my money,” she says. “I don’t think he will be the doctor for me in the future.”
In fact, studies of physicians’ attitudes towards alternative thera-
pies reveal a deeply divided profession. Maija Verhoef teaches in the department of community health sciences at the University of Calgary. In a study published in June in the Canadian Family Physician, Verhoef reported that 65 per cent of doctors in Ontario and 44 per cent in Alberta had referred patients to alternative healthcare practitioners, mostly for chiropractic treatments, acupuncture and hypnosis. Doctors remain highly skeptical of a number of other therapies, she says, such as reflexology and herbal medicine. Verhoef noted, however, that physicians vastly underestimate the number of their patients using them. That may be because 70 per cent of people who try such therapies—other than chiropractic— keep their little secret from their physicians for fear of censure. “Some MDs feel that they are in competition with alternative therapists,” Verhoef added. “And they are concerned about liability—what if they make a referral and it doesn’t work? Could they be sued?” Despite such reservations, there are signs that the medical establishment is responding to the public push for more choice in health care. Last year, the British Columbia ministry of health announced that it planned to establish a college of acupuncturists to regulate the field, similar to the provincial college that governs physicians and surgeons. And the British Columbia Medical Association is forming a committee to deal with issues related to alternative medicine. “In Canada, medicine has evolved on a scientific basis, and that is paramount,” says Arun Garg, the India-born physician who chairs the committee. “But we don’t want to be insensitive to other traditions.”
In Alberta, acupuncture is now offered as an option to health professionals at the University of Alberta in Edmonton, and the Alberta Medical Association recently offered its first continuing education course in alternative medicine. Toronto East General Hospital has trained 120 nurses in therapeutic touch, which uses gentle sweeps of the hands and arms just above the skin to promote healing, particularly after surgery. And research on the effectiveness of various alternative treatments is growing, including a $300,000 study examining the use of chiropractic to treat asthma in children. Funded by a con-
sortium of chiropractors based in Los Angeles, the study is jointly supervised by Malcolm Sears, director of the Firestone Regional Chest and Allergy Unit at St. Joseph’s Hospital in Hamilton, and Jeffrey Balón, a chiropractor and family doctor based in Ottawa.
“Many pediatricians believe that chiropractors should not treat children,” Sears says, “and that is exactly why we need this study—we need some objective evidence about whether it works or not.”
For many doctors, that is the crux of the matter. Buckman, who is associate professor at the University of Toronto, a clinician at Sunnybrook Regional Cancer Centre in Toronto and co-author of the 1993 book, Magic or Medicine, and a coming volume, What You Really Need to Know About Cancer, believes that only a handful of alternative remedies have been proven effective: acupuncture for pain, chiropractic for lower back problems and a traditional Chinese remedy made from 12 different herbs for controlling childhood eczema.
But in most cases, he says, the healing apparently experienced by patients of natural therapists—while it may be real—is not due to chemical or mechanical processes; rather, it comes from the psychological benefits of in-depth attention, healthier lifestyles and the considerable power of the placebo effect. “People are frustrated with medical science,” Buckman acknowledges. “When you are sick, you need support, of a person or a system. Mother’s chicken soup works precisely because mother is giving it to you.”
Most physicians are less willing to speak publically about their reservations. Privately, however, many agree with the views of
Morris VanAndel, deputy registrar at the British Columbia College £ of Physicians and Surgeons. Alternative treatments have their place,
he says, but not as a replacement for standard medical procedures. “If someone has cancer,” he says, “and they have tried surgery and radiation first, then they want to try some Mexican hocus-pocus medicine— well, if it’s not actually harmful, then as a treatment of last resort, OK.”
Such views make some patients angry.
Rosario Farro, was diagnosed with breast cancer 18 years ago and underwent a mastectomy. Eight years later, cancer was found in her other breast and Farro submitted to a lumpectomy. But she refused to undergo radiation and chemotherapy, convinced that they would do more harm than good. Instead, she took massive doses of vitamins and minerals under the supervision of a physician interested in holistic health. That was 10 years ago and her health remains good, a fact she credits to the 20 to 25 vitamin and mineral pills she still takes every morning. “The important thing is not to panic,” says Farro. “Read all the information you can, and then take responsibility for your own health. You are the only one who can cure yourself.”
Of course, many questions remain about alternative therapies and the people who practise them. Pamela Speraw offers acupuncture and Chinese herbal remedies in her Halifax clinic. Trained in California, Speraw spent three years earning a diploma in oriental medicine after obtaining an undergraduate degree in psychology and Asian studies. A year of her studies included training in Westernstyle medicine and prescription drugs. Like many natural therapists, Speraw believes that alternative medicine should be much more closely supervised by government. Chiropractic is regulated in all provinces, and acupuncture in Alberta and Quebec, while British Columbia expects to bring in regulations by the end of this year. Naturopathy is subject to provincial law in British Columbia, Manitoba, Ontario and Saskatchewan, but virtually all other types of alternative therapies remain unregulated. And while such well-estab-
Healing, while real, may often be due to psychology
lished groups as homeopaths and massage therapists may have professional associations, most others do not. “That can lead to a lot of unevenness among people who practise natural therapies,” Speraw says, “including doctors or physiotherapists who take quick weekend courses in things like acupuncture.” Consumers also need to know that the effectiveness of many natural remedies remains very much in question. Homeopathy, for instance, uses highly diluted solutions of plants and other substances that proponents say have curative effects for ailments ranging from influenza to gastrointestinal problems. The dilutions, however, are so extreme that even many homeopaths agree there is „ virtually no trace of the active ingredient re| maining in the final remedy. They speculate z that, by shaking the solution, they somehow ^ leave a picture or impression of the ingrediz ent’s molecular structure in the water. But f while some recent studies have shown that homeopathic remedies can have a positive effect, many scientists believe that their main power is psychological.
They take a similarly skeptical view of most so-called miracle cures, generally herbs or other substances that true believers say can alleviate cancer or other diseases. One such Canadian remedy, a herbal mixture called essiac, is sold around the world and has many supporters among naturopaths and doctors who practise holistic medicine. Essiac was first widely used in the 1920s by an Ontario nurse named Renée Caisse. (Essiac is her name spelled backwards.) She sold the recipe, which uses Indian rhubarb, sheepshead sorrel, slippery elm and burdock root, to a Canadian company in 1977, and it is now distributed by Ottawa-based Essiac International. One unit, which includes enough for about a week of treatments, costs $39.95. Most doctors, however, do not believe essiac works. According to a 1989 Health Canada bulletin, a trial carried out by 112 Canadian family practitioners in 1982 found that essiac had no therapeutic effect; the
same result occurred in a 1983 test at the National Cancer Institute in Bethesda, Md.
More problematic are remedies that can do active harm. Liver specialist Graham Woolf, a native Torontonian who is assistant professor of medicine at the University of California at Los Angeles, advises strongly against using any herbal remedies. While most are harmless, he says, some are toxic to the liver. The herb jin bu huan, for example, is sometimes prescribed for inflamed joints and back pain—but can ultimately lead to hepatitis. And in general, many herbs contain contaminants and may be mislabelled, creating problems for doctors trying to halt the damage they may cause. “More than 75 per cent of my patients have taken or are taking herbs,” Woolf says. “What they don’t realize is that the word ‘natural’ does not guarantee that a product is safe.”
There is one point on which doctors and reputable alternative therapists agree: natural therapies should be used in conjunction with, but not instead of, conventional medicine. That is particularly true of life-threatening conditions. In March, 1994, a 12-year-old diabetic girl died in Hull, Que., three days after her mother removed her from daily doses of insulin—on the advice of a naturopath, she v said. Even though Lisanne Manseau deteriorated rapidly, Sylvie
I Fortin said that naturopath Louise Lortie told her to continue the regimen she recommended: cane sugar, pear juice, olive oil massages and salt baths. Partly as a result of Fortin’s allegations, Lortie was charged with 34 counts of illegally practising medicine on Manseau and nine other people by the Quebec College of Physicians and Surgeons, and, if found guilty, faces a fine of up to $40,000. A trial to test those charges was adjourned in March, when Lortie checked herself into a Montreal psychiatric institution, and reconvened last week.
Such cases, fortunately, are rare. And there is little doubt that many alternative remedies have proven themselves to be effective at helping patients with maladies that may not be life-threatening, but which leave doctors perplexed and patients frustrated. Jan McFarland, a Toronto physiotherapist, decided to try a massage technique that is little known in North America after concluding that conventional physiotherapy relied too much on machines. Manual lymph drainage massage was developed in Europe in the 1930s, and uses a series of gentle stroking and rotating motions to stimulate the lymph system. McFarland, who has acted as a consultant to physiotherapists at the Hospital for Sick Children in Toronto, treats pa= tients with lymphoedema (a buildup of fluid in connec5 tive tissues due to surgery, injuries, burns or hereditary defects) and arthritis, among other ailments.
“People are beginning to realize that there are different ways of approaching health,” she says, “and that prevention and healing are as important as treating acute symptoms.”
Nancy Jacklin, a Calgary psychologist, spent years looking for long-term answers to several chronic health problems. Plagued by persistent fatigue as well as yeast and bladder infections, she found that the drugs prescribed by her MD had only a temporary effect: within weeks or months, her symptoms would return. Finally, she tried herbal medicine. Jacklin says the healer’s recommendations have not been easy to follow, but they have worked. For a year, she maintained a strict diet, cutting out wheat, yeast, sugar, fruit and vinegar. She also swallowed up to 70 pills a day, mostly derivatives of natural plant substances. “I’m grateful for Western-style medicine, when it’s needed,” Jacklin says. “But clearly, it can’t deal with everything. My problem is that it refuses to look at the alternatives. ' As support for naluiaí health techniques continues to grow, reputable therapists can at least feel confident that labels like “quack may soon be only a memory.
REBEL WITH A CAUSE
Since he set up his medical practice eight years ago, Dr. William LaValley has been a driving force in the movement to pull holistic health care into the medical mainstream. His clinic in Chester, N.S., the Medical Wellness Centre of the Maritimes, offers electroacupuncture, nutritional and botanical medicine, and homeopathy, as well as conventional medical treatment. The clinic has gained steadily in popularity—LaValley says he has 5,000 patients and a waiting list of hundreds of names. But it has not always been easy for LaValley and his former partner, physician David Baker, now retired. Three years ago, doctors from the provincial body that administers health insurance filed a letter of complaint about his practice with the Provincial Medical Board, which regulates Nova Scotia physicians. The complaint, which was later withdrawn, accused the Wellness Centre of quackery and administering treatment outside the realm of accepted standards. Two other doctors also made complaints about his methods, and although those were later dismissed, LaValley says he is angry about the continued resistance of some doctors to alternative medicine.
Determined to raise the profile of holistic health care, LaValley, 37, last year spearheaded the creation of the complementary medicine section of the Nova Scotia branch of the Canadian Medical Association, a first in North America. But he has not stopped there. The general practitioner, who serves as chairman of the new section,
has appeared on television and radio, and written articles in support of alternative health care. He has also lent his support to a national group called Citizens for Choice in Health Care, which is lobbying the Nova Scotia government to amend the provincial Medical Act to specifically guarantee the right to use alternative medicine. LaValley also believes that Nova Scotia should create a new health services and disciplines act to ensure greater accountability for nonmedical practitioners who offer alternative therapies. “If this doesn’t happen,” he warns, “consumers are the ones who will continue to suffer.” LaValley traces his interest in alternative health care to his graduate work and medical training at the Baylor College of Medicine in Houston. During his studies, he travelled to China to observe the effects of acupuncture on the brain. There, he says, he came to believe that medicine is more than chemistry. “There is an inevitable evolution going on in medicine,” he says, “from biochemistry to biophysics.” As LaValley sees it, alternative therapies promote wellness in cells, organs and body systems— while conventional medicine responds only to disease. He adds, however, that they are complementary—that “we need both for wellness.” p. C.