Alternative versus Traditional Medicine:
What's Best for You?
Excerpts from Larry King Live - Aired July 16, 1998
LARRY KING, HOST: Tonight, from Viagra to vitamins. We'll look at America's most pressing health issues and take your phone calls. Our guests are some of the most prominent medical authorities in the country. In Los Angeles, Dr. Andrew Weil, editor of the "Journal of Integrative Medicine" and director of the program in integrative medicine at the University of Arizona; In Boston, Dr. Timothy Johnson, medical editor ABC News; In Columbus, Ohio, Dr. Bernadine Healy, dean of the College of Medicine and Public Health, Ohio State University; In New York, the famed sex therapist, Dr. Ruth Westheimer; And in San Diego, the best-selling author on emotional and spiritual alternatives, Dr. Deepak Chopra.
CHOPRA: I think it's important for people to know that doctors frequently use drugs not selectively. That approximately 80 percent of the drugs that are used in this country are of optional or marginal benefit, which means, if you did nothing about a disease process, it would make no difference whether you use the drug or not. And people have to be really careful. You know, people prescribe antibiotics for viral illness and yet, you know, every doctor knows it doesn't work but they do it.
KING: Let's pick up on that. Pharmaceuticals, Dr. Johnson. How is a pharmaceutical -- let's say Viagra. It's approved. How long did they look at it? Did they check whether Viagra goes with aspirin?
JOHNSON: They tested it in very careful trials on between 4 and 5,000 subjects.
KING: Who may have taken many other medications at the same time?
JOHNSON: They did check for some, not all. That's why whenever it goes into general use we may learn something new, but I have to say that Viagra was as well tested as any other drugs that have been approved.
KING: When I buy a drug, Dr. Healy, do I assume its efficacy?
KING: If it's legal, do I -- can I assume this will work?
HEALY: Yes. One of the things the FDA looks for is efficacy, and I think that's one thing you can be sure of. What we often don't know about are long-term side effects that occur when the drug has been in use for five years, 10 years, and 20 years. We all have to have a faith in that, and we have to monitor it as it's out there in the market. (Editor's Note: If you believe this, I can sell you the Brooklyn Bridge.)
WEIL: I think that pharmaceutical drugs in their place are great. You know, they do things that there may not be natural remedies for. But I would point out that many of the drugs on the market today, I think, are neither safe nor efficacious despite our testing procedures. Yes, there are a lot of worthless drugs out there, there're drugs that are of questionable safety, and even something like Viagra, which works, you know, let's see what happens after a year of use by this many people. You know, a lot of drugs look good near the time of their introduction, and after time passes we become more cautious about them.
KING: Dr. Chopra, do you start with a built-in not belief in the drug or the pharmaceutical industry? Do you start by saying, "This drug -- I'm going to find something better."
CHOPRA: No. I don't. I agree totally with Dr. Weil. Look at Viagra. If you look at the study in the "New England Journal of Medicine," when people receive 25 milligrams of Viagra over 24 weeks, 72 percent responded. What the public is not aware of is that 50 percent responded to a placebo. So why don't we hear about that? Why do we think that Viagra is this magic bullet that is going to solve the problems of 30 million impotent people in this country, which is approximately 1/3 incidentally; it says a lot about our society.
KING: But in the '90s we want overnight cures. We'll get into that, discuss lots of aspects, and take your phone calls with our outstanding panel.
JOHNSON: Well, I disagree with that number. In certain segments it was that high. In other segments it was much lower. And certainly any drug that is approved ought to be better than placebo, and it was in this case, in many cases. So I think it's not a panacea. It probably does have some placebo effect but it also clearly works in men who have had no ability to have erections, so I think we're always talking about drugs in terms of the wise use, not the overuse, but the wise use.
KING: And you disagree with that?
WEIL: But no, I would just point out that the one panacea we really have is a placebo. In any tests we conduct, placebo worked for a significant percentage of people.
KING: So obviously, a lot of it's mental.
WEIL: Well, I think it suggests that there is an element to medicine involving belief that I think doctors are not really trained to use. There's a way in which we can present treatments to patients to maximize this natural healing response. If we could get those responses without giving people chemicals that are toxic so much the better.
KING: Dr. Chopra, we know that Dr. Weil does accept a lot of the medical fraternity things. Do you? Do you accept that people need open-heart surgery and people need kidneys?
CHOPRA: I do sir, I do completely accept all that. But it's easy to dismiss a biological affect by calling it a placebo. If a placebo worked in this instance, and if I'm a scientist, I want to know how does it work? Placebos work in ulcers. Placebos enhance the immune system. If I'm a legitimate scientist, I want to know how these things happen.
KING: Why don't we just make a product called placebo, the wonder product?
CHOPRA: No. We need to understand how you can consciously evoke the healing response from the human pharmacy. In fact, the best drugs that exist today are biologicals. They mirror what's already happening in your body. Your body has a pharmacy that makes...
KING: Every time I ask you, though, you keep saying, "Yes, I accept ethical drugs," and then you knock it.
CHOPRA: I don't knock it. I'm just saying we have to be much more selective than we are. That science is not as scientific as it pretends to be.
KING: Yes. Let's discuss advances, and Dr. Johnson I know you have stated -- you wrote an article, I'll deal with the media in a while -- that we're making tremendous advances in cancer, for instance.
JOHNSON: Well, I have to say, Larry, in my 28 years as a medical journalist covering cancer research, I've never seen or heard such excitement from researchers as I'm hearing now about new ways of treating cancer. In the past we've used blunderbuss approaches: surgery, radiation, chemotherapy. Now we're building on the knowledge, really just gained in the last 10 years, about genetics, and cellular and molecular biology. And so the new approaches to cancer are trying to target very precisely and specifically the cancer cell. And while the devices or the drugs being tested now may not be the ones that eventually work, I really do think that this approach, the more precise genetic approach, is going to pay off in the long run. And that's what researchers are very, very excited about.
KING: Do you salute that, Dr. Chopra?
CHOPRA: I do only partially, because a human being is not just a physical body. Drugs like that will make us superb technicians who will know everything about the human body but perhaps lousy healers who know nothing about the human soul. A human being is a collection of emotions and feelings and desires and instincts and drives you have to address.
KING: What is a scientist looking at cancer do with that, though?
CHOPRA: Well, you have to address the suffering of a cancer patient and not just the cancer itself. You have to integrate the approaches that Dr. Johnson is taking -- talking about, with approaches that look at the human being as a whole.
KING: Don't we all do that, Dr. Weil? Doesn't every good doctor...
CHOPRA: Unfortunately, we don't.
KING: Isn't any doctor, Dr. Weil, supposed to do that?
WEIL: Supposed to, but in fact, they way that many...
KING: Holding hands of the patient, right?
WEIL: Yes, but doctors are really not trained in that, and medical education...
KING: They're not?
WEIL: I don't think so. I think medical education is very limited and leaves out many subjects that are very relevant to promoting healing, including how to talk to patients, how to be with them.
KING: Three doctors could look at three lab results and have three opinions. We'll start -- go all around the horn on this. Dr. Weil, is medicine an art or a science?
WEIL: I think medicine is an art. I think it uses information produced by scientific research. It uses the forms of science, but I think the manner of dealing with the patient is an art form.
JOHNSON: Absolutely, both. If you do only one and ignore totally the other, you're not a good healer. The wise physician or healer has to know when to emphasize the art and when to emphasize the science and how to use them in good combination.
KING: When doctors disagree, Dr. Healy, what do we, the uninformed patient, do?
HEALY: Oh, I think the uninformed patient has to become rapidly informed...
HEALY: ... when they start having disagreement among their doctors, and I absolutely believe in second opinions or third opinions. I believe in reading. I believe in seeking out information from people that you trust. Not all doctors come to the same conclusion. Some may be right; some may be wrong, but usually the patient can figure that one out.
KING: Do you think it's both an art and a science, too?
HEALY: Absolutely. And I think even when we select student to go into medicine, we have to look for students who have that quality of the humanistic side as well as the scientific capability.
CHOPRA: I agree with and panelists that have been talking thus far, completely.
KING: Do you think, Dr. Chopra, there's such a thing as -- a doctor may have been a B student, another doctor an A student, but the B student's going to be a better doctor?
CHOPRA: Absolutely, a better healer, absolutely. Much of the information we get in medical school actually is not even relevant afterwards. It gives us a good background, but a lot of the information is not relevant. And even a C student can sometimes be a better physician, a better healer, a better doctor than an A student...
WEIL: And, in fact, let me tell you a radical innovation that has been done at the University of Arizona Medical School. Our dean instituted a policy of having applicants interviewed by patients, as well as by the usual interviewees. And the patient evaluations have sometimes led to rejection of applicants that had very high grades and scores, because the patient said that they did not come across as good human beings.
HEALY: Well, it's an interesting experiment. I think it would be interesting to principal is right. First and foremost a doctor has to relate and respond and care about the patient.
KING: In the most recent edition of the "New England Journal of Medicine," Dr. Timothy Johnson, up in Boston, wrote a lengthy article, a terrific article on the media, influence of the media in politics. And over all these years, certainly one of the areas that have occurred is vitamins, right? We are vitamin users in America: good or bad, doctor?
JOHNSON: Obviously, we need vitamins, without them we develop vitamin deficiencies. The real question is how much do we need of which vitamins?
JOHNSON: And I am all for the idea of taking a modest amount of extra vitamins, especially the so-called antioxidant vitamins. My worry is that vitamins have become sort of the magic potion or pill of our decade. So I know a lot of people now who are popping vitamins and think they can do anything else they want: they can smoke, they can overeat, they don't have to exercise as long as they're taking vitamins. So we have to be careful not to overly on them.
HEALY: You know, I must say, I think the doctors have been really behind the curve in terms of pushing vitamins and how important they
are. There have been numerous scientific studies that have come along and showed vitamin E and heart disease, vitamin C and heart disease. And I think these are compelling. The data is there. And, in general, you often cannot get the adequate at of vitamins you need from even a balanced diet that's low fat and rich in fruits and vegetables, so I tend to be a supporter of vitamins.
KING: Dr. Weil, are we better informed? Dr. Johnson wrote a terrific article on what the media has done in medicine, especially in the last...
WEIL: I think we're informed. And, by the way, another very potent force that no one has mentioned so far is the Internet. I have met a remarkable number of patients over the past couple of years, who have gotten the answers they needed from the Internet, especially when there was disagreement of physicians. Now, obviously, you have to be careful going there, because the quality of information is very variable. But if you proceed in the right way, there are answers there.
KING: The layperson knows a lot more.
WEIL: Absolutely.
KING: Dr. Chopra, where do you stand on vitamin supplements?
CHOPRA: I would say look up the Internet. If you look up the Internet check the Web site of the National Library of Medicine you'll find at least 12,000 references on vitamins and cancer. And they're good references. They're put out by the National Library of Medicine. You'll find over 10,000 references by the National Library of Medicine on nutrition and cancer. The Internet is a very good place to search and then question your doctor. It's very clear that difficult patients who ask a lot of questions do much better than the so-called compliant or good patients.
KING: Doesn't, generally, one health fanaticism, if it could be called that, lead to another.
WEIL: Yes.
KING: So if you're taking vitamins you suddenly figure you're going exercise. If you exercise you're going to watch your diet, because you feel good.
WEIL: I think that's true. And also I think it's interesting that -- I think years ago you would not heard doctors like Dr. Johnson and Dr. Healy saying what they did about vitamins. There has been a real change in the medical profession's view. You know, they're no longer telling people that it is a waste of money the take splints, or you may as well be dropping them directly in the point.
KING: Dr. Johnson, how about all the herbal products? They got names -- I think they run out of names for herbal products. You go into the health food store and it's more than cornflakes.
JOHNSON: You know, I have to tell you, Larry, in all honestly, I don't even try to keep up with that. I have such a tough time keeping up with my own area of expertise, but I am fascinated by the slow growth and studies behind some of these herbs. And, indeed, one of the herbs I have investigated and I reported on it on "20/20," namely, St. John's Wort, because I think there is a lot of good data supporting its use in mild to moderate depression.
KING: As opposed to taking prozac?
JOHNSON: As opposed, in some cases at least, to taking prozac or any other antidepressant.
HEALY: ... and one of the things that we started when I was at NIH, was an office of alternative medicine. At least, our hope was to have scientific studies or consensus conferences or literature reviews of a lot of these herbs and I think it needs to be done. That doesn't mean they don't have value but I think any patient should beware before they start taking any of these pills, like melatonin, or any of them, without knowing whether or not it's going to work and what the risks are.
WEIL: And I would apply all of that to pharmaceutical drugs as well. But I think we have a problem with the claims by the manufacturers of pharmaceutical drugs.
KING: What does Dr. Johnson think of the holistic drugs?
JOHNSON: Well, I -- my attitude is that we should be open to anything. My attitude toward holistic medicine, herbal medicines is that
we should be open to anything that might help people. I do think, however, that we have to demand of any treatment that is suggested to the public, whether it's traditional medicine or so- called alternative or complimentary medicine -- that it has to be well studied. People deserve good data in terms of their decision making. And I'm a scientist at heart in that regard.
KING: There is assumption, Dr. Chopra, that holistic medicine can't harm you. It may not help you, but it can't harm you.
CHOPRA: No. It can harm you.
KING: It can?
CHOPRA: The herbs can have the opposite effects. One of the problems with getting data about herbs is that the pharmaceutical industry is not interested in getting that data, because many of these herbal combinations act bio-synergistically, and you can't patent them. And you can't patent them, then you can't make money on them and therefore, there is no point in doing any research on them. There are herbs and there are published studies across the world on herbs that work for hyperlypodemia (ph); that work as brain enhancers; that work as anti-hypertensive.
KING: Dr. Healy, we've heard this all our life. That money counts more in medicine than proof of cure? That if the pharmaceutical company can't make money, it isn't going to make the product. That if the study can't make money, it isn't going to do the study.
HEALY: But, you know that's why we have institutions like the NIH. The NIH does a lot of research on drugs, for example, the vitamins. A lot of the credibility that we now have and the faith in the vitamins are because of major studies done by public money, not by pharmaceutical houses. You can't make a lot of money on Vitamin E. Well, those studies were done.
KING: Do you agree with that, Dr. Weil?
WEIL: I would agree, and I think in certain areas, like botanical medicine, which is my field of expertise. We've been left in the dust by other countries, especially by Japan, Germany, which have tremendous programs of research on natural products and I think this is, again, the fall of the educational system. There is essentially no teaching in medical school about botanical medicine.
KING: By the way, in your cardiology field, isn't aspirin now more and more a wonder drug?
HEALY: Absolutely, a phenomenal wonder drug, and stroke, and it also...
WEIL: Aspirin has so many effects on so many different systems of the hat people say if it were a new drug developed today, it would have no chance of FDA approval.
JOHNSON: Money plays a huge role in our health care industry and in our pharmaceutical industry. And I, for one, feel that we've got to face the fact that health care is not a commodity to be traded in the marketplace for as much as you can make, but it's a service that we have to offer so that all of our citizens can afford it. And I think we're facing a real difficult tension in this country over health care form, and profit is going to be one of the big questions that's going to be attacked. WEIL: But these drug prices are so high, in a nutshell, because the markup in the pharmaceutical industry is higher than in almost any other area of commodities in the U.S. market.
JOHNSON: And, of course, they always say that they have to charge these high charge in order to justify research, but they don't give us the figures.
WEIL: They don't give us the breakdown.
JOHNSON: And I'm suspicious, that it's too high.
KING: First, Dr. Chopra: Are we going to cure AIDS?
CHOPRA: I think we are going to cure it in the new generation of drugs looks very promising, but people should also know that there are public studies that show that a good massage will increase natural cell killer activity, will increase the natural... A good massage will increase NK cell activity, will increase natural killer cell count, and will increase the CD-8 (ph) count.
WEIL: I think that we will eventually control it and that inevitably, they are going to lose their effectiveness, because the virus will mutate into resistant strains.
KING: Dr. Johnson, will we get a vaccine?
JOHNSON: I'm quite pessimistic about a vaccine in the immediate future. I think the virus is so clever and diabolical that it can out wit our vaccine attempts. But we've got to keep trying, because that's the only answer worldwide, especially in countries that can't afford treatment.
KING: Because we're being seen live around the world and every country may say this, we only have a couple minutes left. But everyone in the United States has always heard the term, we have the best medicine in the world, do we?
WEIL: I think we have very good medicine. I think it can get a lot better if it broadens its scope and includes a lot of these methods and remedies that consumers want.
KING: Dr. Johnson, do we have the best medicine in the world or how do we measure that?
JOHNSON: For people who can afford it or have good insurance, but we fall short of other countries in providing basic health care to all of our citizens.
HEALY: We have the best medicine in the world and we also provide the intellectual knowledge-base that lifts medicine up for people all around the world.
CHOPRA: At the Chopra Center, we believe that healing involves more than taking a drug. It involves changing the environment, looking at the body, the mind... We have the best drugs in the world. We certainly don't have the best healers in the world.
KING: We don't? CHOPRA: No, sir.
KING: You're saying if you had a serious illness, there's someplace else you might go?
CHOPRA: Well, there are studies that show that, Yes, medicine is a very cultural phenomenon, that you can use the same treatment in different environments and get a different result.
KING: Dr. Andrew Weil, we've always the heard the term, he's the best -- you got to see Dr. Him, in Chicago, he's the best. Is there a best?
WEIL: I think if you're having a procedure done, and you're going to have a bypass operation or -- you want to go to the -- best. The person who has the most experience.
KING: So we do want that?
WEIL: Absolutely.
KING: And would the best sometimes be in countries other than the United States?
WEIL: That is plausible.
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