Why Western Physicians Should Test and Discuss Alternative Medicine.

Date: MARCH 24, 1998
Time: 12:00
Tran: 032401NP.217
Type: FEATURE
Head: Alternative Medicines
Sect: News; Domestic
Time: 12:06

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT
BE IN ITS FINAL FORM AND MAY BE UPDATED.

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross.

When you're trying an alternative medical therapy, do you tell your doctor about it? Most people don't. It's been hard to find doctors willing to take alternative therapy seriously, but that's starting to change.

For example, last November a National Institutes of Health panel determined that acupuncture could be effective for certain conditions. And there's a group at Harvard Medical School called the Center for Alternative Medicine Research that's committed to evaluating the effectiveness of alternative therapies, evaluating their financial implications for the health insurance industry, and educating health providers.

My guest David Eisenberg is the director of the center. The center conducted a study in 1990 that found that one in three people use alternative medicine, but three-quarters of those people never mention the alternative therapy to their doctors.

I asked Dr. Eisenberg why he thought that was so.

DR. DAVID EISENBERG, DIRECTOR, BETH ISRAEL CENTER FOR ALTERNATIVE MEDICINE RESEARCH, MEMBER, ALTERNATIVE MEDICINE PROGRAM ADVISORY COUNCIL, NATIONAL INSTITUTE OF HEALTH: We had imagined in the first survey that many people would feel as though their physicians would disapprove.

GROSS: Mm-hmm.

EISENBERG: Or just think less of them if they asked the doctor about coming out with the acupuncture or massage. Many of the therapies historically are not taught in medical school. That's sort of our definition of alternative therapies -- treatments that are not commonly taught in U.S. medical schools and not commonly available in most hospitals.

So, we thought many patients would feel embarrassed. I think data from the initial survey and others suggests that it's not as simple as that; that some patients probably think their physicians are not interested in some of these things or may not understand some of the techniques as they're not trained in them.

I think it's also a question of setting the right atmosphere. Who should ask the question first? Should the physician elicit that information from the patient? Should the patient bring it up? You know, a physician/patient relationship is so much an improvised dance. Who leads and who takes the first step?

From my vantage point, I think physicians should ask. They should ask their patients if they've used or thought about using chiropractic, acupuncture, herbs, massage -- and begin the discussion that way.

GROSS: Let's get to the question of why it's important now to test alternative medical therapies. You made the point that everybody's -- a lot of people are using them one way or another. They're using them anyways. So I guess it's important to have some empirical evidence about how effective they really are?

EISENBERG: Absolutely. You could argue we need to test them because so many people are using them. One issue is safety. Which are safe?

GROSS: Mm-hmm.

EISENBERG: Which of the herbs, vitamins, and supplements, in and of themselves, are routinely safe? And which have some toxicity associated with them? Some herbs -- camamille (ph), sassafras, others can cause liver damage. Which herbs, vitamins and supplements might interact with an individual's prescription medications?

That's a good question. We don't have such a good answer for that, and it's a deep concern of mine and the focus of many of our research projects. Will people -- for instance women who are about to undergo chemotherapy for breast cancer, might there be an interaction between their chemotherapy and the herbs, vitamin supplements or dietary interventions that they're using -- vito-estrogens for example?

GROSS: Some alternative medicines just don't follow a Western scientific model, like acupuncture for instance. You know, Western science doesn't have a way of explaining in any satisfying way how acupuncture would work. So, do alternative therapies lend themselves to being tested by western scientific testing techniques?

EISENBERG: I think they do. Your question raises a fascinating conundrum, and that is: might acupuncture work, as an example, but have nothing to do with the proposed Chinese medical theory -- that is the flow of vital energy of "chi" through these invisible meridians through the body. What if acupuncture works, but doesn't follow the theory? What is homeopathy works, but doesn't necessarily follow the theory prescribed or suggested by Europeans and Americans over the last 100 years?

A scientist, I think, at least a scientist with an open mind, would say, you know, what is the phenomenon, and then let's look at the mechanism. So, some of these things may work, but not necessarily by the theories proposed.

GROSS: That would shake up everything 'cause then the whole -- a whole philosophy of medicine would topple if for instance acupuncture worked, but it had nothing to do with "chi" and energy meridians.

EISENBERG: Well, it certainly would be a challenge to traditional Chinese medical theory, but not necessarily lead to the end of it. I mean, you could argue the reverse; that unless rigorous science is applied to some of the Asian medical systems, they may sociologically die out, because many of the brightest young minds in China at least, where I'm familiar with education, aren't necessarily going into herbal medicine anymore like they did 20 years ago.

So, I think without the application of science, some of these therapies may inadvertently wither.

GROSS: What are your priorities to test first?

EISENBERG: I'm interested in the question of whether and how the licensed alternative therapies like chiropractic, acupuncture, and massage, might be responsibly integrated into health care systems. So, should your HMO cover chiropractic, acupuncture, massage as examples, if you have acute or chronic lower back pain? I think it's a fundamental question that gets at efficacy, safety, credentialing, licensing, cost-effectiveness, ethics. It's such a rich question.

So as an example, we're doing a randomized study right now with the largest HMO in Massachusetts -- Harvard Pilgrim Health Care -- Harvard Vanguard Medical Associates. It's got about 1.5 million members here.

And in this pilot study, people with acute lower back pain are offered entry into an experiment where some are randomized to get their usual care, and the others are randomized to a group that gets a choice of expanded benefits; that is, they can choose between seeing an acupuncturist or a chiropractor or a massage therapist, or receive usual care if they're not interested in any of these things.

And if they choose one of those three licensed practices, they're referred within 48 hours and they're treated. And for their acute lower back pain, they get 10 sessions -- up to 10 sessions paid for as part of the experiment.

Now, in this experiment we're really testing a lot of fundamental questions. If you offer licensed alternative medical care in your city, and people who are button-collared conservatives want to choose, what will they choose? Will Bostonians choose chiropractic, acupuncture, and massage if it's offered, to an elite, credentialed group of practitioners who have met very serious standards and are willing to follow clear guidelines? So, that's question number one.

Number two, what's it going to do to outcome? Do people get better if these therapies are made available and paid for, either partially or totally? And then the next question is: what does it do to costs? And if you're running an insurance company or a Fortune 500 company where back pain is costing an enormous amount of your productivity and budget and some of the performance of your better workers, it's a good question.

GROSS: I think that it's interesting that you're choosing lower back pain as one of the areas that you're studying. And I say that because in my experience, back doctors, you know, or orthopedists are among the doctors who strike me, anyways, as being most removed and most resistant to alternative therapies.

You can -- you know, in my experience, you can go to a doctor and complain about lower back pain, and you know, if you're not ready to perform surgery, they'll kind of throw up their hands and say: "well, there's really nothing we can do." You know, take anti-inflammatories and maybe here's a few exercises on this xerox sheet.

When yet, I mean -- we know a lot about relaxation techniques. We know a lot about how, you know, improving your posture and your movement can help lower back pain and so on. And I know a lot of back -- back doctors doesn't even seem to look at how you walk or sit to see if that might be figuring into the discomfort that you're having.

EISENBERG: I think you're right. There is a lot of resistance. You asked me before about "why now" -- why it's important. I think there has been this resistance within the conventional medical establishment, some of which is very sound to me. I mean, there's not enough good science here. We don't have enough evidence that acupuncture works for lower back pain; or massage in a controlled randomized trial does better than nothing or physical therapy. We just don't have our hands around the science.

So, I understand some of the conservatism. There is also the fact that in some instances there have been reported adverse effects with some of the therapies -- spinal manipulation of the neck can, rarely, cause problems.

But that skepticism and resistance aside, there's sort of a philosophical resistance, too. These are therapies which we do not learn about in medical school; which we do not understand or necessarily accept the theories of. They are alien to us. They are not ours. They're not from our camp.

So there is sort of this psychological or professional distancing, if you will. It is other -- I don't know about it. And there's sort of a natural tendency to at least push that which is not like you away. So, I think that that's also understandable.

GROSS: Would you like to see, for instance, the treatment of back pain get to the point where perhaps the first person you see is a medical doctor, and if you don't need surgery; if it doesn't require that level of intervention; and if, you know, pills aren't the answer, that that doctor might refer you to an alternative therapy or work in conjunction with a chiropractor or somebody who teaches posture techniques, to help you improve? In other words, so that there'd be some -- not -- not an either/or sense -- you either do the mainstream thing or you do the alternative thing -- but that these guys can work together?

EISENBERG: Right. Well I think you have very aptly and accurately described a piece of medical care in the future; that is, integrated teams of open-minded, rigorously thinking, conventional and alternative therapists who work together.

You know, another project mentioned in our list of projects from the center at Beth Israel-Deaconess Medical Center in Harvard is the notion of creating a demonstration unit just like the one you described. In short, imagine going to Fortune 500 companies and saying: "look, send us your employees with back pain of six or eight weeks who are out of work now and receiving workers compensation." We know historically that the odds of those people returning to work are small -- maybe as small as 25 percent over the next year.

So the notion here is: what if we, in the belly of a conservative teaching hospital at Harvard Medical School, created an integrated unit that had in it a hand-picked group of orthopedists, rheumatologists, physical therapists, nurse-specialists -- all of whom are really as skilled as one can be in the art and science of conventional medicine, who are also very eager to learn with and from colleagues who they can respect representing the professions of chiropractic, massage, acupuncture, mind-body, mindfulness, meditation therapy, and exercise prescription -- that is exercise physiologists who actually could hold the hand of a patient and teach them how to use these machines, not just say "get thee to a gym."

The notion is to create such an integrated team, but really to focus on the word "team." That is, the notion that every member knows when to pass and knows when they are less helpful than another member. And forging that team is very challenging and has never been done, I think, satisfactorally, in conventional and alternative medicine for muscular-skeletal disease.

The analogy I'm very fond of is that primary care, which is now a term we're all familiar with, emerged in the '70s just as I was coming of age as a medical doctor myself. And at that time, the notion that a physician and a nurse practitioner and a mental health provider needed to work as a primary care team, in concert, with candor and honesty and mutual respect, was probably at least odd, if not radical, thinking to many practitioners.

Now, it is of course the standard of care. It is the way we deliver care and in fact that team is really the gatekeeper.

GROSS: My guest is Dr. David Eisenberg, director of the Center for Alternative Medicine Research at the Harvard Medical School's Beth Israel-Deaconess Medical Center. We'll talk more after a break.

This is FRESH AIR.

If you're just joining us, my guest is Dr. David Eisenberg. He directs the Center for Alternative Medicine Research at Beth Israel-Deaconess Hospital, which is affiliated with Harvard Medical School, and it was established in 1995 to evaluate the safety, efficacy, and cost-effectiveness of alternative medical therapy.

I believe one of the studies that you're very actively involved in yourself is studying cancer patients. What particularly are you looking for?

EISENBERG: At this point, we're still trying to create an appropriate agenda.

GROSS: Mm-hmm.

EISENBERG: I am -- I'm less interested in sort of looking for the magic bullet -- "does (unintelligible) cartilage work? Or, does a particular diet cause remission?" -- than I am, quite honestly, in creating useful information for patients who, you know, with a cancer diagnosis are dropped into a forest without a map; don't know where to go.

So I'm interested at this point in collecting as much information as we can to advise cancer patients on what to use and what to avoid; how to talk to a clinician about the judicious choice of diet, vitamins, herbs, supplements, when to use acupuncture, who is credentialed, who's not -- that kind of thing.

Because I think patients now are really in need of advice and other unpublished work that we're working on right now suggests that people with cancer want this advice from people in white coats -- their doctors and their nurses. They'd prefer, you know, a consultation unit in a hospital to looking at it on an Internet screen from somebody who is a self-proclaimed advocate.

GROSS: Now, critics of alternative medicine sometimes say that: "well sure, it sometimes gets good results, but it's not because the alternative therapy works; it's because of the placebo effect -- a person believes it's going to work, therefore they do experience some amount of feeling better."

What's your response to that?

EISENBERG: I think this is one of the richest areas of research in science. If we, in retrospect, had devoted as much attention and resource to the question of the effect of mind on physiology or body as we did to developing the Manhattan Project, who knows where biology would be right now.

You know, in answer to the question: is this all placebo? You know, I turn the question around and say: Does the herb, the bill or the needle work because of the herb, the bill, the needle or the belief in the herb, the bill, or the needle? And it's not an easy answer, which is why we need the best scientists, supported by government, to look at this question.

But answers may come in different stripes. For instance, some of these therapies work regardless of belief. Some of the herbs have active ingredients. Acupuncture changes pain thresholds, I'm quite sure, regardless of your belief. It also works in animals. Some of these therapies may have a lot to do with belief expectation, and sort of that -- the mystery and magic between a healer and a healee -- a patient. You know, does that belief really infuse a change in their physiology?

And then there's the large gray area, which is where I as a primary care internist by training, was most attracted to this field -- the question of: to what extent does a patient's belief, positively or negatively in a therapy, impact the effect of that therapy? I mean, that question is as appropriate for surgery or chemotherapy as it is the use of St. John's wort. How does the mind impact the body and to what extent? It's just a wonderful question, and that's where the NIH support in alternative medicine and the skepticism about placebo, I think feed research in conventional medicine very nicely.

GROSS: Last fall, a panel convened by the National Institute of Health concluded that acupuncture is effective in treating certain nausea and vomiting -- nausea and vomiting caused by cancer chemotherapy; by surgical anesthesia; by pregnancy. They also found that acupuncture was effective for treating pain following dental surgery and they found that it may be effective, though it's -- there's less evidence for it -- in stroke rehabilitation, headache, menstrual cramps, tennis elbow, lower back pain, carpal-tunnel syndrome, and asthma.

What impact have you seen that panel's conclusions have so far on the medical profession and on the insurance industry?

EISENBERG: It has always fascinated me, and my associate director is a fellow named Ted Capchuck (ph) who's an expert in acupuncture and Oriental medicine. He and I are always struck by the fact that when one of the major TV networks has a story on alternative medicine, they invariably focus in on somebody with needles -- usually in their face.

And if you look at the New England Journal article we published in '93, acupuncture is way down on the list -- so far below chiropractic, massage, relaxation, and herbs -- that it's sort of not just apples and oranges, but apples and frogs in terms of frequency. It is just so few use that as compared to the others.

And yet, that -- the few are still millions and millions of visits. So it is just interesting that societally, this is what has captivated us. I mean, my own experience -- my own odyssey began with a story written by James Reston, the op/ed editor of the New York Times, who in '71 got acupuncture for his appendectomy. He wrote a tongue-in-cheek obituary to his appendix in the New York Times.

And that has captivated the scientific community. So, acupuncture has been on the front burner as sort of the interesting topic for 20, 25 years.

GROSS: How much to you think the insurance industry is going to determine what is considered a legit therapy and what isn't? And I ask this because I think it was one of your patients who defined alternative therapies as the kind of therapies you have to pay for out of your own pocket 'cause no insurance company's is going to reimburse you.

EISENBERG: Yeah, you're referring to a comment by a patient with cancer who said: "with all due respect, Dr. Eisenberg, my definition is quite simple: it's the therapies which I've used for chronic lymphoma for 20 years which by and large I paid for out of pocket, with cash, and never felt comfortable discussing with my physicians."

GROSS: Right. Now, you know, a lot of alternative therapies require a lot of visits 'cause they're more about a process than just the action of taking a pill or the act of getting cut open by a surgeon.

So if you're taking acupuncture, chances are you're going for a lot of sessions and then you're going for tune-ups every few months. Likewise, a lot of chiropractors like to see you on a fairly regular basis. And so for an insurance company, that might seem pretty prohibitive, even if it is an effective therapy for the person who's in pain.

EISENBERG: That's exactly why we need research with health service researchers and economists. I mean, there's nothing magical about arbitrarily deciding to see somebody in followup every week for 52 weeks. That's arbitrary.

What if, though research, we determine through our studies at Beth Israel-Deaconess and Harvard that if people are going to respond to acupuncture, they're going to respond in four or six or eight sessions over six or eight weeks? Or, what if we determine that if somebody really is going to benefit from chiropractic for low back pain, there is a range of visits within which you're going to see an effect?

And in fact, clinically that's really what often happens. A patient says to the acupuncturist or chiropractor: "please, give me some sense as to how many visits it's going to take before you, the acupuncturist, and I the person with back pain or elbow pain know this is going to work and how much is it going to cost me?" And that's not usually an indefinite, vague discussion. It's usually fairly concrete. That's why we need good science to figure that out.

GROSS: Dr. David Eisenberg directs the Center for Alternative Medicine at Harvard Medical School's Beth Israel-Deaconess Medical Center. He'll be back in the second half of the show.

I'm Terry Gross and this is FRESH AIR.

This is FRESH AIR. I'm Terry Gross.

Back with Dr. David Eisenberg, director of the Center for Alternative Medicine at Harvard Medical School's Beth Israel-Deaconess Medical Center. He hopes that the best of alternative medicine will eventually be integrated into the mainstream health care system. His center is evaluating the effectiveness and the costs of alternative therapies.

You were the first American student to go to China to study acupuncture after the Cultural Revolution. And I'm wondering if that was the first time you were exposed in a long-term, detailed way to an alternative medicine?

EISENBERG: I got interested in this area in the early '70s as then-President Nixon and Secretary Kissinger were opening up Beijing and China. I studied Chinese in college, really because I was fascinated by traditional Chinese medical texts that basically said prevention is always superior to intervention and that the mind mattered; that one's psyche and spirit impacted one's physical health.

So as a naive 17-year-old Harvard College freshman I studied Chinese, figuring I'll study both. But as events unfolded and China did open up, I had a chance at Harvard Medical School in my first year of medical school to go to Taiwan. So the short answer to your question is that well before I traveled to mainland China, I spent a summer in Taiwan.

And the pivotal event for me, apart from observing Chinese healers and faith healers in Taoist and different temples, was a massage I had. A blind massage therapist walked the streets near my small apartment. And my roommates, who were Chinese brothers, said to me that if I heard this particular bell, it meant that this blind massage therapist was outside, and if you heard the bell and you wanted a massage, you could call him up.

Which I did once, and for a few dollars he came up and worked on my body. And this man spoke not a word of Mandarin. He spoke the native dialect and I couldn't communicate with him verbally. But in a matter of seconds, he just so totally relaxed my body and humbled me into understanding that he knew more with his fingers than I probably ever would with many of my books for a long time.

That -- that experience really compelled me to want to go back to China and look at many other medicinal interventions in mainland China. And about a year or two later, Carter asked for the first exchange scholars and I applied to the Academy of Sciences and Harvard Medical School, and particularly the Dean Dan Feddeman (ph) -- dean for students -- encouraged me to go. So, that's how it started -- with a blind massage therapist.

And I might add that in Asia, children who are blind are often trained in massage to give them a valuable career. And, they're very much respected.

GROSS: Did you try to lead the person's hands to the place that you were having pain?

EISENBERG: Not at all, and I was at the time much thinner, stronger, healthier, a marathon runner, and I felt in tip-top condition. And he turned me into jello in a matter of seconds, and found points that I never knew were sensitive. And really just melted my body. It was as though his hands had a particular gift, a talent, a radar that I just could not fathom.

GROSS: Well, let's apply this to the work that you're doing now. What are some ways you are either testing massage at your center or that you would like to?

EISENBERG: Well, massage therapy...

GROSS: ... examine it in the future -- yeah.

EISENBERG: Massage therapy is included in all of our back pain studies, for instance, but you know, a pet project of mine and one which is not driven so much by a financial bottom line, but by the sense of compassion and desire to help people.

I would love, for instance, to see a project for people who have terminal cancer and who are admitted to the hospital. And you know, it's so tragic that as people are dying, they are perceiving themselves to be abandoned by family, by physicians, by nurses. We don't go in the room as often. Everything shuts down.

And it is the abandonment more than necessarily the pain or fear of death that I think is so devastating for everybody. Wouldn't it be nice if in a conventional setting or in hospice, people who had pain, who were dying of cancer were given a massage by a gifted, licensed, hospice-trained massage therapist? And moreover, if family members were trained in massage?

I mean, when words fail, there is still touch.

GROSS: But if it doesn't officially extend your life or heal you, insurance companies might not be willing to pay for it -- if it just makes you feel better while you're alive, that might not count.

EISENBERG: Well, I mean -- but isn't that sort of how you describe psychotherapy? I mean, you know, but they do pay for some of that.

GROSS: Right.

EISENBERG: Not always because of the bottom line, but because it's the right thing. It improves quality. And you know, whose bottom line? Let's say insurance doesn't cover it, but does that mean hospitals shouldn't make it available in a responsible way to people who could afford the $50 or $100? So, not all of the studies should or need be predicated by a financial bottom line.

GROSS: How come you didn't decide to become an acupuncturist yourself? Or a massage therapist?

EISENBERG: Yeah, I think it's too difficult. I mean, I -- I learned in China that people study for five to 10 years to become an herbalist; or five to 10 years of medical school and subsequent training to become an acupuncturist. And I was never good enough at putting the needles in or at diagnosing a pulse in Chinese medicine or looking at a tongue diagnosis.

So, I consider myself a dilletante -- somebody with a superficial understanding which is sufficient to speak to that community, but clearly not sufficient to practice.

GROSS: You mentioned tongue analysis, which is one of the ways of diagnosing a problem in acupuncture. Did you ever observe an acupuncturist treating a patient who through a tongue analysis arrived at the same conclusion that you arrived at through just, you know, watching the patient and hearing them talk about their symptoms?

EISENBERG: No, but that's for a technical reason. Chinese diagnoses have no bearing on conventional Western diagnoses. If somebody looks at a patient who has pneumococcal pneumonia -- standard pneumonia in the West -- their diagnosis in Chinese, based on pulse and tongue diagnosis, isn't pneumonia. That's not in the Chinese books. The diagnosis might be something like "insufficiency of vital energy in the lung or the spleen."

So when you ask me about a confluence of diagnoses, it doesn't happen 'cause the Chinese diagnoses are just so different from Western diagnoses.

GROSS: If you were seeing an acupuncturist in the United States, how would you begin to determine whether they were really qualified to treat you? Whether they had studied enough and knew enough and were good at it?

EISENBERG: I think you have again put your finger on such an important issue: how do we as a society address the issue of credentialing? Acupuncture is credentialed in 20-odd or close to 30 -- is licensed in 20 to 30 states. It's also registered in other states. I don't have the exact numbers before me. They're in the publications I've mentioned in the Annals of Internal Medicine.

But the issue is: how does one determine? Well fortunately, state boards of registration in medicine often are responsible for that task. The problem there is the credentialing standards vary from state to state. And I think again, societally we must over the next decade work with the various professional groups -- chiropractic, acupuncture, massage, homeopathy, naturopathy -- to develop national standards. Chiropractic is the only one of that group that does have national standards.

But if we could develop them in parallel to and sort of mimicking the kinds of credentialing standards we've created for physicians and nurses, with reciprocity and national examinations and certification that really is understood to mean something; that is consistent -- I think people will be a lot safer 'cause they'll know they're going to somebody who really has all the epaulets in place to do their job.

GROSS: Are there any instances yet where alternative therapies are being taught at American medical schools?

EISENBERG: We have taught a course about alternative medicine at Harvard Medical School for the past four years, through the Department of Medicine. We also have annually provided a continuing medical education course to physicians, nurses, and health professionals. We did a survey with educators from Harvard on how many medical schools throughout the U.S. teach courses about alternative medicine, and it turns out in this year that the number is just more than half -- about 64 out of 125.

But in answer to your question: do they teach students how to do these things? I think the answer is "no." And I think until more is known about them or until we can provide adequate training, they can't. The one exception is a fellowship program that Andrew Weil and the University of Arizona have put together, which is for people who are fully trained -- that is, they're already family docs or internists or gynecologists -- who want to now take an advanced fellowship for two or three years to learn about herbs, vitamins, massage, manipulation of the spine et cetera. That's the first of its kind.

That would actually give them sufficient information to know about these therapies; able to -- be able to perform some of them, but more importantly serve as a liaison to the community of professionals -- acupuncturists, chiropractors -- around them. That's really the front edge there. But I think we will develop training programs at Harvard and elsewhere that will enable specialists to really speak both languages. That's my hope and I think patients want that, demand it, need it, and we need to provide that education.

GROSS: Is there a country that you consider to be state-of-the-art now, in its integration of mainstream and alternative medicine?

LAUGHTER

EISENBERG: China has been using alternative medicine for three or four thousand years. I don't know if it's state-of-the-art. I think the Europeans use a lot more of what we call alternative medicine and don't always view it as "alternative." Herbs, massage for instance, are commonplace, as is acupuncture in Germany, France, the United Kingdom. And there's less of a pejorative attached to them by the conventional medical establishment.

I'd argue that we have the most skeptical medical community, and understandably so. So, perhaps we're state-of-the-art because we're trying to make sense of it.

GROSS: But when you say "I know that China has used traditional therapies for a long time" -- but do they actually integrate Western medicine in with it? Or do you just have a choice and it's all one or all the other?

EISENBERG: Yes, they do integrate it. And in the leading hospitals throughout the country, there are actually departments called "departments of integrative medicine." In the series I did with Bill Moyers, "Healing and the Mind," we taped in China. And although it never made it to the final film, we spent a day with the director of such a department, who really was trained in both Chinese medicine and Western medicine. And he looked at a patient from two frames of reference, and could tell us which patients were better off with herbs and which were better off with antibiotics. And such places do exist.

It would be nice to develop them in the Western world, in our most conservative and scientifically based medical institutions. And I think in the future, there will be departments of integrative care led by people who really are dual-trained and don't carry a lot of bias.

GROSS: Well, I want to thank you very much for talking with us.

EISENBERG: It's a great pleasure, Terry. Thank you.

GROSS: Dr. David Eisenberg is the director of the Center for Alternative Medicine at Harvard Medical School's Beth Israel-Deaconess Medical Center. His center is not equipped to handle consumer questions and doesn't make referrals.

Dr. Eisenberg recommends that you try the information line at the National Institutes of Health's Alternative Medicine Clearinghouse. That number is 1-888-644-6226. That's 1-888-644-6226.

Coming up, our film critic John Powers on the Academy Awards.

This is FRESH AIR.

Dateline: Terry Gross, Philadelphia
Guest: David Eisenberg
High: Dr. David Eisenberg is director of the Beth Israel Center for Alternative Medicine Research. He is also a member of the National Institute of Health's Alternative Medicine Program Advisory Council. He'll discuss the Center's research on the use of alternative therapies, such as chiropractic, acupuncture, massage, and homeopathy.
Spec: Health and Medicine; Culture; Education; Alternative Medicines
Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Alternative Medicines
Show: FRESH AIR
Date: MARCH 24, 1998
Time: 12:00
Tran: 032402NP.217
Type: FEATURE
Head: Oscar Winners
Sect: News; Domestic
Time: 12:45

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT
BE IN ITS FINAL FORM AND MAY BE UPDATED.

TERRY GROSS, HOST: Part of the ritual surrounding the Academy Awards is talking about them the day after. So, we called our film critic John Powers to get his reactions to last night's broadcast.

I asked him what "Titanic's" big victory -- 11 awards -- says about the state of Hollywood.

JOHN POWERS, FRESH AIR COMMENTATOR: Well I think the interesting thing about Titanic's sweep is that there are a whole bunch of things that it was bound to win, because it was so impressive at the craft level. But I think that probably what really is going on is that people love this kind of idea of Hollywood -- the huge dramatic scope of the enterprise; the fact that it made a billion dollars -- made it very hard for Hollywood to turn it down.

And there was really the -- the real problem was that of the other films that were good, they somehow didn't quite seem like Oscar winners to the Academy. So that I think -- I know that if you asked people what they likes most -- the liked "The Full Monty" most. I know if you asked them what they thought was probably the best movie, they thought it was "L.A. Confidential." But somehow, L.A. Confidential didn't have the cultural resonance for people to somehow be the Oscar winner. And The Full Monty was a small little British film.

Whereas Titanic is one of the great event movies in the history of movies, and it's almost impossible for Hollywood to turn that down. What's scary in it is that we're now going to pay for this, Terry, over the...

GROSS: Well, I know. I had a sinking feeling all night last night that now I'm going to be paying for this victory with all these special effects films that I don't want to see.

POWERS: Yes, because even though James Cameron has a kind of Captain Ahab-jerk side, he actually does know how to spend $200 million in a movie. The real problem is there are going to be lots of these younger people who now will worship the fact that he pushed through his vision...

LAUGHTER

... and what they will say -- and they will say it -- is that, you know, if James Cameron could have $200 million, why won't you trust me with the $200 million? -- which is the way Hollywood has always worked.

GROSS: You know, screenwriters always complain that the screenplay is in a way the most underrated contribution in a movie. And everybody -- even people who liked Titanic -- complain about how bad the screenplay was. And so, gosh, it's just kind of scary that a movie in which nobody seemed to like the screenplay, won so many awards, as if, well, that just really didn't matter very much.

POWERS: Yes, it -- well, it -- I mean, you could partly say that it wasn't really a screenplay film. And there is some -- there is some truth to that. But it is kind of -- it is kind of creepy, when you compare Titanic to something like "All About Eve," which -- you know, which shared with Titanic the record for the most nominations. What was interesting that -- is a lot of the nominations that All About Eve won were very -- were the kind of classier nominations.

You know, there were lots of people for acting; the screenplay was up. Whereas in Titanic, most of the awards were the kind of craft kind, rather than the awards for screenplay or skillful performances and all the rest. So the "effects" side of Titanic is extraordinarily strong.

Having said that, I must say it's stunning to me that "Good Will Hunting" would be voted the best screenplay of the last year. It's -- I mean, it's a very conventional piece of work that, you know, that is kind of "Rocky" in a kind of way -- Rocky with hugs. It's strangely anti-intellectual. It's a film about basically someone who's either Mozart or Einstein. And -- but it's not about his intelligence. It's finally about his emotional problems.

And you know, I think that what happened in this case is that the Academy got swept up in the great story of Ben Afleck (ph) and Matt Damon.

GROSS: Were there any choices that you heartily agreed with?

POWERS: (unintelligible) that I heartily -- I thought -- probably I thought that, you know, the best-adapted screenplay for L.A. Confidential, I heartily agreed with. And I thought that probably that was the strongest single category of the entire competition.

I thought between "The Sweet Hereafter" and L.A. Confidential and "Wing of the Dove" -- and there were a couple others -- every single one of those things was good. But by comparison, I thought that almost every single original screenplay wasn't very good, which might say something about the state of screenplays, that finally people have to adapt because they've kind of lost the storytelling ability.

GROSS: Well, what do you think was the best original screenplay of the year, you know, regardless of what the Academy Award nominees were?

POWERS: Well I think that the -- you know, some of the original -- interesting original ones -- I think "Chasing Amy" was an original -- was a good original screenplay. I thought the little film "The Daytrippers" was good. Actually, The Full Monty was a very skillful...

GROSS: Well, can we get in "Boogie Nights"?

POWERS: Yes, and Boogie Nights was an extremely good -- I mean, I thought of that -- of the ones on the list last night, Boogie Nights was far and away the most interesting original screenplay. You know, taking on the difficult subject; not pushing it in obvious directions; writing a kind of character that people don't normally see on the screen; and making them interesting.

I think it -- the fact that Burt Reynolds didn't win is one of those revealing moments about two things. I think on the one hand that Hollywood will always go for the slightly safer film in voting, which is one reason why Robin Williams won over Burt Reynolds.

And I think the other thing that happened in this particular case was that Reynolds, who has made Hollywood a lot of money over the years, hasn't done it recently. Whereas Robin Williams has made a lot of people in that audience a lot of money, and he's a very popular figure.

And Hollywood's memory keeps getting shorter and shorter. Ten or 15 years ago, Gloria Stuart would have won that Oscar. You know, last year when Lauren Bacall lost to Juliet Binoche (ph), she was the same kind of thing; that Hollywood now is less sentimental about -- than it used to be -- at least about genuflecting to its old idols.

There are current idols that it loves. I mean, last night was, you know, there was more worship of Jack Nicholson at that event last night than I have seen of anybody in years and years and years. The number of jokes about how hip he is, how sharp he is; the good-natured way in which he took them; the amount of fun he was obviously having in winning.

It was -- when you read in the, you know, in all the kind of articles in weekly news magazines about the return of the "swingers" phase, it's clear that there's something about Jack Nicholson's hipster style that is very much in tune with current Hollywood again.

GROSS: What do you think of Jack Nicholson and Helen Hunt winning Best Actor and Actress awards?

POWERS: Well I probably wouldn't have given those awards to those people. I think in lots of ways that, you know, Nicholson was trying hard in that film, but that his -- I never quite believed his character. I realize that much of America disagrees with me. Perhaps even you disagree with me, but I thought that probably it was a -- it wasn't -- it was probably the weakest of the five performances that was up for Best Actor.

But he is the most beloved figure of all of them.

GROSS: And Helen Hunt?

POWERS: Helen Hunt's -- well, it was a very weak category. I think -- I guess I always still get a little bit of a whiff of sitcom from her, but I thought that it was -- that given -- that it wasn't at all surprising. She was in the most popular film of all the -- of the competitors. And it was -- really, it was a very weak category. I mean, I think several of the supporting actors roles were stronger in fact.

GROSS: I really enjoyed her performance in As Good As It Gets, but I really thought Julianne Moore is -- was so deserving. I mean, she's such a fine actress and she's proved that in so many different kinds of movies.

POWERS: Oh, yes. No, I think that it's -- that in terms of like showing different kinds of emotional range, you know Julianne Moore is just so much a better actress than Helen Hunt that -- I don't even mean that as an insult to Helen Hunt.

Julianne Moore is just clearly one of the very best screen actresses there is. She gave a really wonderful performance, and she somehow got lost along the way. I mean, she would have been my vote for Best Supporting Actress. I think she was better than Kim Bassinger.

GROSS: My guest is our film critic John Powers. We'll talk more about the Academy Awards after a break.

This is FRESH AIR.

We're talking with our film critic John Powers about last night's Academy Awards broadcast.

Was there any moment last night where you felt: "ah yes, this is what moviemaking is really about. I feel good."

POWERS: No.

LAUGHTER

There was no such moment. I mean, what struck me was that -- was how unhappy James Cameron seemed to be considering how happy he was saying he was. You know, when he won the Best Director Oscar, he got up and said: "I don't know about you, but I'm having fun." Yet, if you'd watched him all evening, he hadn't been having fun.

You know, when Billy Crystal was making jokes about his stuff, you could see him struggling a little bit to smile and be a good sport. The whole Titanic juggernaut didn't seem very happy. There was the kind of ritual kissing of the ring by each of the technical people who won their award.

LAUGHTER

And then, you know, when Cameron shrieked "I'm king of the world" after winning -- after winning the thing for Best Director, I actually got a telephone call from one of my friends who noticed that "I'm king of the world" is very similar to the thing that James Cagney says at the end of the movie "White Heat" when he says: "top of the world, Ma." And he's standing on a sort of gas factory -- he says "top of the world, Ma," and then he explodes into flames.

And my friend was saying that if only Cameron could have exploded into flames, that that would have been satisfying because there was something not happy about him. There's a kind of quality he exudes like the sullen teenager who still is somehow trying to get people -- "I told you so; I told you so." And he didn't seem joyous in the way that, you know, Jack Nicholson actually seemed really happy to be up there.

GROSS: Well obviously, I -- I can't let you leave without making at least one fashion comment for the evening. Is there anything you would like to say?

POWERS: Well, there were no truly outrageous costumes last night -- in the -- on the fashion front. You know, certain people, you know, looked very, very good. Ashley Judd looked good. And what was interesting was when she presented her award, she had a real kind of Southern ease and graciousness in talking. You could tell that she had that kind of country music background where they really know how to do this stuff.

I mean, I guess I was most shocked by how bad Madonna looked. Those arms of hers, which seem to have been taken from some Olympic champion, looked very weird in relation to that -- that kind of S&M black dress that she was wearing. So, I've never seen her look quite so strange. There was that sort of slight hint of drag queen about her, which is not really something I'd ever associated with her before.

GROSS: I thought Helen Hunt looked distressingly gaunt.

POWERS: Yes, she did. She's -- it's actually -- it's actually kind of disturbing to see -- to see someone who's up there winning, looking slightly anorexic. In contrast, I thought, you know, Kim Bassinger looked very, very good and she -- I think she's one of those people who now looks more beautiful than she did when she was younger. There was always something slightly overripe about her, and you know, she had the kind of look of someone who you always feared had been brought to Hollywood for sex by evil producers.

LAUGHTER

GROSS: Oh, you have a way with words, John.

LAUGHTER

POWERS: But I think people know what I mean. She -- and she'd always seemed slightly bruised and overripe. But -- you know, but now she actually has sort of settled into her beauty, and you know, seemed extraordinarily calm and peaceful. And you know, somehow I think has managed to rise above kind of years and years of bad press, as kind of a classic selfish Hollywood bimbo.

GROSS: I liked seeing Martin Scorsese at the Academy Awards, and I've come to think of him as, you know, America's foremost film professor, 'cause a lot of the work that he's been doing lately has been teaching people about movies.

POWERS: Well actually I love -- I've loved -- actually love listening to Martin Scorsese talk. I mean, he's a wonderful speaker and you know he knows how to speak. And unlike most of the people who were talking last night, he actually knew what he was talking about; that not only did he know the work of Stanley Donen, he knew why it was important and he genuinely loved it.

And probably my favorite little biff in that -- in the Oscar ceremony was Scorsese talking, 'cause he's a wonderful talker, and explaining something that people ought to know. And at the same time, Donen's little thing with the soft shoe was actually very, very charming.

And you know, to sort of see the difference between that and I think a lot of what was going on with Titanic is very instructive about where the film -- movies have gone over the years. Because if you just look at a Stanley Donen film and compare the clips from that to any clip you choose from Titanic, you can see how the movie business has changed.

GROSS: Well John, thanks for talking with us about the Oscars.

POWERS: Oh, sure thing.

GROSS: John Powers is FRESH AIR's film critic and film critic for Vogue.

I'm Terry Gross.

Dateline: John Powers; Terry Gross, Philadelphia
Guest:
High: Film critic John Powers comments on the Academy Award winners.
Spec: Movie Industry; Culture; The Oscars; Kim Bassinger
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End-Story: Oscar Winners
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