Where is the line on natural remedies?

As a breast cancer specialist, Dr. Barbara Bowers uses a whole arsenal of alternative treatments to help her patients -- acupuncture, green tea extract, vitamins, meditation and yoga, to name a few.

But she calls them complementary therapies for a reason. She almost always uses them alongside the powerful chemotherapy drugs traditionally used to fight cancer -- not instead of them. She believes, from sad experience, that without modern medicine 13-year-old Daniel Hauser -- the boy at the center of a New Ulm, Minn., court battle over refusing conventional treatment -- will most likely die from his cancer.

"Complementary medicine has its place," said Bowers, who practices at Fairview Southdale Hospital in Edina, Minn. "But I have never had someone miraculously cured from adjunctive therapy. I wish I had."

In the past decade, alternative medicine has made dramatic inroads at hospitals and clinics. It has grown into a multibillion-dollar business, and acupuncturists, massage therapists and reflexologists are often as much a part of a medical team as doctors and nurses. Insurers now cover therapies once viewed as ineffective and even outlandish.

But for the most part, medical experts say, such treatments should be used in conjunction with standard treatments such as chemotherapy and radiation that have proven efficacy.

"We don't believe it's an either or, we believe it's a both," said Lori Knutson, executive director of the Penny George Institute for Health and Healing at Abbott Northwestern Hospital in Minneapolis.

Last week, a judge in New Ulm faced a decision in a court case that pitted Daniel Hauser's family against his own doctors. The 13-year-old and his family argued they have the right to reject chemotherapy, based on their religious beliefs in natural medicine. In January, the boy was found to have Hodgkin's lymphoma and had one round of chemotherapy at Children's Hospitals and Clinics of Minnesota. When he did not return for additional treatments, his doctors reported him to child protection, and the Brown County attorney asked the judge to order Daniel into treatment.

Doctors who testified at a hearing said that with chemo and radiation, the boy has a 90 percent chance of surviving. Without it, they said, he will almost certainly die within five years.

On Friday, Brown County District Judge John Rodenberg ruled that Daniel must get medical treatment to save his life -- unless it's not too late -- and the judge gave Daniel's parents until May 19 to get an updated chest X-ray for their son and select an oncologist.

By coincidence, some of the world's top experts in alternative medicine were in Minneapolis last week for the North American Research Conference on Complementary and Integrative Medicine. They said the choice is seldom simple.

Marja Verhoef, who studies complementary medicine at the University of Calgary in Alberta, says research has shown that some methods, such as acupuncture or meditation, can help patients fight cancer or cope with the side effects of treatment. But she worries that patients may not be so discriminating.

"People have strong feelings about (this) and they're not always based on real evidence," Verhoef said. "Sometimes it's hard arguing with beliefs."

Spirituality is a strong component of many complementary practices, experts said. But they can sometimes be a barrier to the use of Western medicine, especially among immigrant groups, said Dr. Greg Plotnikoff, medical director of the Penny George institute.

"My approach is never to fight belief, but to work with it," he said. That experience leads him to believe that the Hausers are driven less by religion than by their fervent desire to protect their son from a bad experience. "I'm not convinced that this is a deeply held religious belief, but rather wishful thinking," he said.

Didier Allexandre, another researcher, said he, too, believes the science of complementary medicine is promising. At the Cleveland Clinic, he is studying whether Reiki massage can help men with prostate cancer reduce pain and speed recovery after surgery. But that's not a substitute for conventional medicine, he said, and the danger is that people can find something on the Internet and treat it as scientific truth. "There's so much junk out there that some people sometimes get ideas that are completely wrong," he said.

Often, cancer patients turn to alternative medicine only as "a last act of desperation," said Raymond Obomsawin, a scientific adviser for the National Aboriginal Health Organization in Ontario. But he said he understands why some would refuse conventional medicine. "The issue is freedom of choice," he said. "People need to be given that freedom."

At the conference, several natural-health practitioners said they would respect such a decision, but they don't see it as an either-or proposition. "I think it's quite simple," said Dr. Rhoda Lee, of Birmingham, England. "You look at what your best options are. That does not exclude anything."

David Brule, a natural health practitioner from Toronto, said he knows of alternative treatments for cancer, but if it were his child, "I would still go the conventional route," he said. Typically, he said, he uses holistic methods to treat the side effects of chemotherapy, not the cancer itself.

Todd Ferguson, a naturopathic doctor in Moorhead, Minn., says natural therapies, such as dietary supplements, can help cancer patients cope with chemotherapy and radiation. "Those treatments are very hard on people, and they get very run down," he said. "We're helping them ... make life more livable."

The Hausers' decision to refuse treatment is rare, but not unheard of, Bowers said. Their story reminded her of a patient she had in 1979 _ also a teenage boy with Hodgkin's lymphoma. His parents decided to forgo chemotherapy and take him to Mexico for vitamins and other alternative treatments. They spent tens of thousands of dollars, but after a year-and-a-half, he died under Bowers' care.

"It was so sad," she said. "He was potentially curable when he was first seen. But they were afraid of the chemotherapy and the side effects."

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