Alternative methods, dose of tradition; Oversight: As head of an NIH office, Dr. Stephen Straus is determined to shine the cold light of science on medical self-care.

THE BALTIMORE SUN

Unlike most Americans, Dr. Stephen Straus does not spend a cent on alternative medicine.

Twenty-three years as a scientist in the labs at the National Institutes of Health have left him skeptical of mysterious palliatives, fabulous marketing claims and the power of suggestion.

He is so conventional that he includes his one regular daily ritual -- downing a single multivitamin and an aspirin -- among the wild assortment of "alternative" treatments ascribed to by legions of believers.

For the first time in its controversial history, the alternative medicine headquarters at NIH has one of its own at the helm, a confident scientist and a New Yorker who questions commercial markets, unexamined toxic properties, flimsy clinical studies and the vulnerability of an American public smitten by a bug to accept even the most peculiar trends in self-care.

Managing controversy and conflict is likely to be part of the job.

But for a 53-year-old physician whose greatest impact has been on discrete public health issues such as herpes and chronic fatigue, the opportunity to influence one of the most contentious debates in contemporary medicine -- the validity of alternative medicines -- seemed too good to pass up. The job places him among the vanguard, and he appears pleased to be there.

"It's an extraordinary opportunity," Straus said recently. "Right now there is this huge knowledge vacuum.

"And in the absence of information, people are led by anecdote and rumor and TV and articles they read from magazines at the supermarket. It's driven by the marketplace and not by science. We have to change that."

In his first few months on the job, modest portents of what will likely become a routine diet of provocative news have touched his doorstep.

In March, The Journal of the American Medical Association published a study questioning the ability of magnets to reduce back pain. At Duke University recently, researchers at a national symposium evaluated herbal remedies, warning of dangers of unregulated herbs and bemoaning markets flooded with "junk products." Last month, a University of Maryland team reported false labeling claims in a variety of glucosamine products.

When he heard news of an NIH study in February pointing out the potentially harmful effects of mixing St. John's wort with AIDS medication, his response was impassioned.

"St. John's wort sold $6 billion worldwide last year," he said. "There is not a prescription drug on the planet that has sold $6 billion in a year. I don't think there's one that sold $3 billion.

"This is a big business, and people are investing a lot of money capturing shares of that market. Now I want to see an investment in research capturing the data."

Forceful declarations such as this might seem odd from a virologist who, until now, conducted science cautiously alongside geneticists and pathologists. For years, he spent his days tracking cellular diversions of a latent herpes virus or directing microscopic detective work on the elusive Epstein-Barr virus.

With a vision of rigorous science, increasing internal support for his center and a budget steadily expanding to $68 million, Straus seems prepared to be the voice of reason in an often maligned but enormously popular field of medicine.

"Over time the skeptics and advocates will see we can be trusted," he said. "If something works, I'll be out there in front of the microphone saying, 'This is the first definitive proof.'

"And if it doesn't work, I'm going to be at the microphone saying, 'We have definitive proof.' You can't satisfy everybody that way. But the American public will benefit."

Straus is not a wild advocate, but the conservative physician has won over many alternative practitioners, the iconoclasts fervently endorsing herbs and meditation and acupuncture whom he will scrutinize and likely challenge as the first major studies of alternative therapies are completed over the next few years.

"Dr. Straus may not be the cheerleader of alternative medicine today, but he may be tomorrow," said Marilyn Schlitz, a parapsychology researcher at the Institute of Noetic Sciences in Sausalito, Calif., who serves on the center's advisory council.

"He's willing to embrace some initiatives that are remarkably bold."

Since his appointment in October, the virologist has impressed people such as Schlitz, whose interests range from shamanistic mysticism to telepathic healing. Larry Dossey, best-selling author of New Age works such as "Recovering the Soul" and "Reinventing Medicine," cheers Straus' emergence as a sign that NIH is willing to take alternative medicine seriously.

"From what I can tell, Dr. Straus is open and eager and highly qualified. He won't let the cynics shut them down," said Dossey, a member of an advisory board that helped shape an agenda for the original Office of Alternative Medicine in 1992.

Straus has earned their respect by broadening the scope of the center and challenging mainstream critics who discount the public's keen interest in everything alternative -- from herbal medicines to chiropractic practices.

In January, he bowled over several doubting members of the center's advisory board -- half of whom practice alternative medicine in such areas as massage, na

jv0 turopathy and hypnosis -- by announcing an innovative five-year plan that included:

The first international study of traditional medicines, including ancient Chinese and American Indian methods, within native communities.

The first program at NIH for the study of botanicals, which will sort through more than 1,500 medicinal herbs for evaluation.

A "frontier research" program that strikes down notions of traditionally acceptable targets of NIH study by investigating unusual therapies, such as telepathic healing, that are on the far fringes of medical practice.

He has gone further in public statements by challenging conventional physicians and researchers who refuse to accept the shift of accepted alternative therapies into common practice.

"Acupuncture doesn't count [as alternative] any more," he said before a crowd in Boston last month at the first of a series of national town meetings he will lead around the country. "Herbs don't count. They're mainstream now."

The job might seem to be scripted for strife, but Straus and his staff have experience standing up to fierce public criticism with advocacy groups.

The center, begun by political mandate as an office at NIH almost 10 years ago, was born in controversy. The first director quit after less than two years, complaining of an abrasive advisory council and meddling congressmen.

Starting with a meager $2 million budget, the office struggled to jump-start any research and, according to observers, faced hostility and resistance within the NIH, where alternative medicine was disdained as an amateur field unworthy of inquiry.

Internal divisions, embarrassing publicity and widespread disorganization in the office led NIH to choose an officer from the Walter Reed Army Institute of Research to take over the office in 1995. Dr. Wayne Jonas, a physician schooled in homeopathy, was assigned to a three-year tour of duty with orders to repair the damage and whip the office into shape.

While the office flailed in the backwaters of NIH, Straus was having his own problems in an emerging public health battle over chronic fatigue syndrome.

In the late 1980s, widespread reports of an illness with the disparaging label "yuppie flu" and, later, chronic fatigue syndrome, emerged in the news. Through his research, Straus became one of the nation's most prominent sources of expertise.

Over the years, he could never pinpoint a source of infection or determine how it spread. When he suggested that the illness stemmed in part from psychological factors and that most often the sufferers were women, many patient advocates were furious.

They characterized Straus as a close-minded, stonewalling bureaucrat, accusing him of sexism, arrogance and mishandling a significant public health issue.

News of his appointment as director of NCCAM surprised those same critics, who have long complained that Straus has been inaccessible, short on tact and unwilling to consider research outside NIH that challenged his conclusions.

Although he no longer conducts CFS research and those conflicts are behind him, Straus bristles when questioned about the controversy.

He brushes aside the subject: "It's not my position to rationalize the opinion everyone else has of me," he said.

His handling of the chronic fatigue syndrome issue impressed members of the NIH search committee when they looked for someone to replace Jonas.

"One has to be very good at dealing with potentially contentious issues" as director of the alternative medicine center, said Dr. Stephen Katz, director of the National Institute of Arthritis, Musculoskeletal and Skin Diseases, who called the search committee.

"Having an outstanding scientist who is empathetic and yet has dealt with contentious issues is a very good thing for us."

Whatever happens next, he says, depends entirely on the fruits of science.

"Over time, the skeptics and advocates are both going to see we call some 'yea' and we call some 'nay,'" he said. "And in every case we've worked hard, designed it well, done a good job and called the data for what it is."

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