Many go on taking discredited remedies

CHICAGO — For years, millions of Americans have spent billions of dollars on alternative remedies with unproven effects. Now, rigorous science is starting to test those treatments and mostly finds them lacking.

Last week, major government-funded research indicated that two wildly popular arthritis supplements, glucosamine and chondroitin, did no better than a placebo at relieving mild arthritis pain.

Earlier this month, a study yielded negative results for saw palmetto to treat prostate problems; last July, ditto for echinacea and the common cold. Those followed similar disappointments for St. John's wort to treat major depression, and powdered shark cartilage for some cancers.

Yet despite the U.S. government's multimillion-dollar effort to test products from a little-regulated, $20 billion-a-year industry, the big question is: Do the results really matter when so many consumers swear by these remedies?

"I'll wrestle anybody who says it's no good," Carl Haupt, 79, says of glucosamine and chondroitin, pills he credits with helping him resume mountain hiking, a hobby he quit seven years ago because of arthritis pain.

Haupt spends about $25 a month on the pills. Debilitating pain returned when he quit taking them once, and he said the government's results won't change his mind.

"I wouldn't quit taking it again. I learned my lesson," Haupt said.

Even the researchers themselves, funded by the National Institutes of Health (NIH), say their results don't necessarily mean consumers are pouring their money down the drain.

"If someone tells me this is working for them, I'm not going to tell them not to take it," said Dr. Thomas Schnitzer, a Northwestern University arthritis specialist and co-author of the glucosamine/chondroitin study.

That's partly because the three most recent studies found no real harm; also, in some cases, the results are not completely clear-cut.

For example, although most people taking the arthritis pills in the study got no significant benefit compared with a placebo, the pills seemed to help those with more severe pain. And critics of the echinacea study say different doses might have found a benefit.

Also, studying these herbs and extracts is far more challenging than researching prescription drugs, which are subject to Food and Drug Administration scrutiny. Alternative health products with the same name can have vastly different ingredients and potencies, and research results from one may not apply to others, said Gail Mahady, a botanicals researcher at the University of Illinois at Chicago. She was not involved in the federal studies.

But another important factor is what scientists call the placebo effect, meaning that just thinking you're taking something useful can make you think there's a benefit.

Imaging tests show changes in the brains of placebo users, suggesting that the effect is not just "in your mind," but in the brain, said Dr. Stephen Straus, director of the NIH's National Center for Complementary and Alternative Medicine.

"Their wishful thinking that they're going to get better is harnessing the body's own mechanism for relieving pain," Straus said.

The placebo effect was huge in patients unknowingly taking a placebo in the arthritis study, and it could have overshadowed any potential benefit from the real pills. But it's also likely that the placebo effect contributes to benefits that many people say they get from alternative remedies.

Barrie Cassileth, an alternative-medicine researcher at Memorial Sloan-Kettering Cancer Center in New York, said some products, including echinacea and St. John's wort, can interfere with conventional medicine and should not be considered harmless.

But others, including saw palmetto, are cheaper and have fewer side effects than prescription drugs. "If the results that people swear by work by placebo, who cares?" she asks.

Some data suggest that more than one-third of Americans use alternative medicines.

Ben Pratt, a spokesman for General Nutrition Centers, a national chain of stores selling nutritional supplements, said last summer's negative study didn't affect sales of echinacea.

Some consumers use alternative medicines because of safety concerns about prescription drugs, including reports of heart problems that doomed the once-popular arthritis drug Vioxx. Others mistrust the medical establishment because it bombards them with contradictory studies.

Straus, of the NIH's alternative-medicine center, says his agency will continue research on supplements. "I think that consumers should pay attention — understanding that a single study may not provide the final answer," he said.