The pain and swelling lessened somewhat, and Pettit, a lawyer, returned for repeat sessions—partly, she admits, because they were so soothing: "It's a very pleasant experience. You lie down, they put a nice warm lamp on you, you fall asleep for half an hour, nice music." But she knew the acupuncture was treating the symptoms, not the cause, and she would ultimately face knee replacement. "I still think it gives some pain relief when there's a flare-up," she said last month, "but I've given up. I'm having replacement surgery in April."
Varied results. Disconcertingly, some of acupuncture's claimed successes seem related to the nationality of study authors. A 1998 analysis of 252 published trials found that 51 of the 52 studies conducted by researchers from Asian countries, where acupuncture is uncontroversial, were positive—a 98 percent success rate. Only 53 percent of the trials run by U.S. investigators showed success, and the rate plummeted to 30 percent in studies involving Canadian, Australian, and New Zealand researchers.
Herbals and dietary supplements are getting considerable attention from researchers, and they're employed at Maryland's integrative medicine center and the Osher Center for Integrative Medicine at the University of California-San Francisco, among other academic hospitals. The effectiveness of most herbal remedies and supplements is largely an open question, and there are issues of toxicity, side effects, and interaction with other medications. Actual dosages in off-the-shelf herbal medications and supplements often are far different from those shown on the label, and the pills may be tainted with heavy metals such as lead and mercury. Yet many of today's powerful medications, among them aspirin, statins, and anticancer drugs, were originally unearthed from trees, fungi, and other natural sources. NCI-backed CAM projects include a test of a six-herb combination, used in traditional Chinese medicine, for its ability to prevent lung cancer, and addition of mistletoe extract to chemotherapy to treat solid tumors.
Yoga, a physical activity, has understandable benefits for cancer patients, in whom it helps restore strength and flexibility to muscles weakened by treatment. Alicia Chin has been taking a weekly yoga class for cancer patients at the Osher Center. "Yoga reteaches the muscles how to work, and it makes me feel good," says Chin, a 46-year-old San Franciscan. She had a lumpectomy and had two lymph glands removed last March, followed by radiation, and now is enrolled in a clinical trial of a new chemotherapy regimen. "You get all these drugs pumped into you, you don't want to do anything," says Chin, a paralegal. She still doesn't have the strength to reach up and paint a ceiling, as she puts it, "but it really makes a difference."
Most CAM therapies remain relatively untested, and the majority of academic centers tiptoe around those that seem especially shaky. "We should always insist on a high standard," says Brent Bauer, director of the Mayo Clinic's complementary and integrative medicine program. CAM therapies for cancer patients at Memorial Sloan-Kettering "have to be rational, and they have to be evidence-based," says Barrie Cassileth, chief of the integrative medicine service and coauthor of the Alternative Medicine Handbook for physicians and other caregivers. Homeopathy is "absurd," she says. "It's like a religion." Nor does she put much faith in energy healing: "Manipulating someone's energy field is nonsense." And while acupuncture is offered at Sloan-Kettering, "we don't do it thinking we're stimulating a vital force—we know we are releasing substances from the brain that make people feel better."
Why not try? Still, some academic hospitals give patients access to highly controversial therapies. Thomas Jefferson University Hospital in Philadelphia and Maryland's integrative medicine center, for example, provide homeopathic services. And patients at Oregon Health and Science University Hospital in Portland and the University of Pittsburgh Medical Center can see a naturopath, generally a non-M.D. who advocates nonmedical aids such as proper nutrition, colonic irrigation (a polite term for enemas), and special water baths to stay healthy without drugs or surgery.