Merrell teaches herbal medicine at Columbia and is the director of Beth Israel's Center for Health and Healing, which aims to combine alternative and conventional medicine. He also serves on the state's complementary-medicine board and debates the so-called quack-busters on panels. He credits the National Institutes of Health for funding an office of alternative medicine ten years ago. Merrell also says the aids crisis, which drove desperate patients toward unconventional medicine, gave conventional doctors a new respect for alternative cures.
"There was almost nothing infectious-disease specialists could do to help them in the beginning," he says. "Their patients were coming to them doing these wild things, and the specialists saw that some of them were working, against all the odds. They became less antagonistic after that."
Merrell and his colleagues face another obstacle in their quest for legitimacy: The FDA doesn't regulate the supplements industry. Five years ago, Congress passed legislation sponsored by Senator Orrin Hatch -- who represents Utah, home to the largest number of supplement producers in the country -- that essentially forbade the FDA from treating supplements as drugs and applying to them the same stringent testing measures. The result is that many companies -- hoping to cash in on a $12 billion market -- are now labeling their products as supplements willy-nilly, with no standards.
"This is a huge business ripe for fraud," says Merrell. He and the other doctors interviewed for this story who treat patients with supplements say they study the companies and select those they know to be supplying clean and genuine products. Merrell says he recommends supplements from companies that show they have independent lab testing.
Dr. Raymond Chang, a Hong Kong-born cancer specialist, personally visits herb farms in China; he compares his knowledge of medicinal herbs to that of an oenophile's knowledge of wine. A rumpled 41-year-old who got his Western medical training at Brown University after years of apprenticeship to Chinese masters of herbal and acupuncture treatment, Chang operates his Meridian Medical Group on 30th Street off Park Avenue South almost exclusively for the seriously ill, or what he calls "difficult cases," cancers and infertility. An oncologist by training, he is an attending physician at Cornell. His clinic offers his services and also those of an acupuncturist and a Tibetan-medicine practitioner. His patients come from around the world -- some of them, he confides, so important the entire clinic is shut down to the public when they fly in for a consultation.
"There are some things Chinese medicine can help -- fertility, for example -- but kidney stones will not be helped by acupuncture," Chang says. "Some alternative M.D.'s will tell patients not to get chemotherapy. Our determination is based on whatever is best for the patient."
Chang says he "reluctantly" got into Western medicine because his family wanted him to. At first, he was dazzled by Western science: "In the classroom, you do not realize the limits. In terms of pharmacology, physiology, biochemistry, it all works out. But in a clinical setting, when you see patients, you find lots of cases where Western medicine cannot identify what is wrong."
Just five years ago, he was actually reprimanded for discussing herbal treatments at Memorial Sloan-Kettering, where he was then an associate clinical staff member. Now most medical schools offer courses in complementary medicine; Chang teaches one at Cornell. Yet Chang isn't entirely happy about the new acceptance. He worries that the enthusiasm is just a fad auguring rampant commercialism and, ultimately, a bad name for the kind of medicine he practices. "I am keeping a low profile," he says. "This overhype will come back to hurt alternative medicine. The questionable quality of the products will invite skepticism from doctors. It will turn out it doesn't work for certain conditions, and patients will be disappointed."
Frank Lipman, an M.D. from South Africa, is the acupuncturist of choice for aids patients. He, too, reputedly has a client list of famous people -- whom he indignantly declines to name. His interest in nontraditional medicine began in Africa, where he was intrigued by herbal medicine and homeopathy. In the U.S., he started studying acupuncture during his residency in the South Bronx, and eventually he did a psychiatry rotation at an acupuncture clinic there. In 1987, he got his New York acupuncture license. He now runs his own clinic on Fifth Avenue. Patients are charged $325 for an initial consultation and $125 for subsequent visits. Insurance usually covers these sessions.