E. Straus

[Guest guest]

http://washingtonpost.com/wp-dyn/articles/A34851-2000Mar28.html

Examining the Alternatives

By Okie

Washington Post Staff Writer

Wednesday, March 29, 2000

E. Straus, the man leading the federal government's newly expanded

effort to evaluate alternative medical treatments, once volunteered to rub

an extract of red pepper on his lips three times a day.

It was agony for the sake of science: Straus, a National Institutes of

Health virologist studying chronic herpes infections, wanted to find out

whether a particular chili pepper component impaired the cold sore virus's

ability to spread along nerves.

The outcome? " As far as I was concerned, " said Straus, " it hurt a lot more

than it helped. "

Last October, the career NIH researcher became the first permanent director

of the National Center for Complementary and Alternative Medicine (NCCAM).

With a budget this fiscal year of $68.7 million, the center, established by

Congress, is charged with finding out whether the alternative therapies so

popular with the public really work.

That question has major medical and economic ramifications. Forty-two

percent of Americans used such treatments in 1997, spending an estimated $27

billion. With consumers, alternative practitioners, doctors, dietary

supplement companies and members of Congress all eagerly awaiting scientific

verdicts on alternative therapies, observers say Straus's job requires, if

anything, more political agility than those of other institute directors at

the NIH.

" It's kind of like having one foot on the pier and one in the boat, " said

Spiegel, a psychiatrist who directs Stanford University School of

Medicine's complementary medicine clinic. " If you're really strong, you can

keep it together--but it's really easy to go in the wrong direction. "

Although some colleagues were initially surprised when Straus accepted the

post, the Brooklyn native says he welcomes the challenge of trying to put

alternative medicine on a scientific footing.

" The opportunity would provide me with a greater chance of affecting public

health than anything I had been allowed to do yet at the NIH, " he said.

Straus's career has combined medical practice with rigorous laboratory

research. He has specialized in studying chronic infections, including

hepatitis, herpes, Lyme disease and AIDS. He is credited with discovering

the first inherited autoimmune disorder, a genetic disease in which cells of

the immune system attack body tissues.

But he is best known as an expert on chronic fatigue syndrome (CFS), a

mysterious and controversial condition that produces overwhelming fatigue,

headaches, difficulty concentrating and various other symptoms. Victims are

sometimes so severely affected they can't work or function properly.

Although some researchers had suggested that a virus caused the syndrome,

Straus concluded that while viruses can trigger the illness, they probably

don't produce its long-lasting symptoms. " I don't believe there is a

specific cause, " he said. " I think it results from some final common pathway

of insult. "

For suggesting that psychological factors might contribute to CFS, Straus

took political heat from the patient community, said R. La Montagne,

deputy director of the National Institute of Allergy and Infectious

Diseases.

" He did a marvelous job . . . putting [CFS] on a stronger scientific basis, "

said La Montagne, Straus's former boss. " He's a person of tremendous

integrity and objectivity. "

Straus has outlined ambitious goals for the NCCAM, including the support of

nine specialized alternative medicine research centers around the country

and the funding of a series of large studies to test some of the most

popular therapies. His priorities, he said, are those treatments that show

the greatest promise and those likely to affect the most people.

" We don't want lots of little teeny studies, " he said. " It won't provide the

American public with a definitive answer. "

Already underway are studies of St. 's wort for depression, acupuncture

for arthritis, ginkgo for the dementia of Alzheimer's disease and shark

cartilage for lung cancer. Slated to begin this year or next year are trials

of milk thistle for liver diseases, melatonin and valerian for insomnia, saw

palmetto for benign prostate enlargement and echinacea for colds.

Straus noted that, from the perspective of other NIH institutes, NCCAM's

approach to research is " upside down. " The center will start by testing

treatments in patients rather than first studying " molecules and mice. " But

as a physician who cares for people with chronic illnesses, he said he feels

comfortable with that way of proceeding.

As a doctor, " I developed a very nonjudgmental, empirical approach, " he

said. " If something could be beneficial, if it seemed to be nontoxic and if

my patient could afford it, I'd say, 'Try it. We'll examine this together.'

"

Spiegel said he thinks Straus's research credentials are just what the new

NIH center needs to gain credibility as the arbiter of scientific standards

in alternative medicine.

" He's highly thought of as a medical researcher [and] he's open enough to

complementary treatments that he's willing to take the job, " Spiegel said.

" It's much better at this stage to get that kind of person than to get

somebody who's highly regarded in the complementary world but doesn't know

the science very well. "

Players

E. Straus

Title: Director, National Center for Complementary and Alternative Medicine,

National Institutes of Health.

Age: 53.

Education: Bachelor of science in life sciences, Massachusetts Institute of

Technology; medical degree, Columbia University College of Physicians and

Surgeons; internship and residency in internal medicine, Hospital,

St. Louis; specialty training in infectious diseases, Washington University,

St. Louis.

Previous jobs: Chief of the Laboratory of Clinical Investigation, National

Institute of Allergy and Infectious Diseases (NIAID); other positions at

NIAID.

Family: Married, two daughters and a son.

Hobbies: Reading, woodworking and scuba diving.