Herbal Supplement Dangers: Do You Know What You're Taking?
BOBBIE BATTISTA, HOST: How safe are your diet pills?</s>DR. DAVID KESSLER, YALE UNIVERSITY: We now have for the first time evidence that certain herbs result in human cancers.</s>BATTISTA: Belgium researchers say the Chinese herb aristolochia can cause kidney failure and cancer. The herb is associated with some weight-loss pills and skin treatments. And it is just one of the natural or herbal treatments known to have dangerous side-effects.</s>KESSLER: Unfortunately harm has to occur before FDA can regulate a dietary supplements. The bulk of the products they sell are not the problem. How do you know? What are the quality controls?</s>BATTISTA: Is it time for the government to take control? or will you trust that salesperson behind the herb counter with your health and maybe even your life? Good afternoon, everyone, and welcome to TALKBACK LIVE. Just because the label reads natural or herbal doesn't mean that it is good for you. Even if it is, how do you know how much to take or what happens if you mix them with medications? There is some question whether you can even believe the labels attached to the thousands of supplements in other products sold in health food stores. Let's find out more now about possible health hazards associated with so-called "health" drugs. Joining us first today, CNN medical correspondent Dr. Steve Salvatore. Steve, that new study in the "New England Journal of Medicine" that came out infers that there is a connection between this Chinese herb and cancer. What is that story all about?</s>DR. STEVE SALVATORE, CNN MEDICAL CORRESPONDENT: Well, basically, what happened is, researchers in Belgium looked at the biopsy samples of about 39 people who had known kidney damage from the Chinese herb, and when they look at those tissue samples, they found 18 of those people had some form of cancer. And that was a very alarming finding, although not so surprising to the researchers, because there had been some anecdotal cases listed before in the literature.</s>BATTISTA: So was it the herb itself that was at fault or was it the preparation of it in this particular diet treatment?</s>SALVATORE: Well, they believe that it is from the herb itself, and there's lots of, it is difficult to always nail these things down, but in these tissue samples, they did find aristolochia present, and it was also found that the higher concentration, the greater the risk of developing the cancer. So they think they have a pretty strong link here.</s>BATTISTA: Is this an herb that's been around for a long time, and I guess what I'm asking is, why didn't no one know of this link before now?</s>SALVATORE: Well, there had been some previous studies that showed that there were problems in rats and laboratory animals, and like I said, there were some anecdotal cases, but part of this whole problem is a policing of this entire industry, and also getting the information out to the public, and getting people to care. It is a very, very big problem. A lot of people don't think that these products can be dangerous, they think it is natural and it is an herb, and it can't hurt me.</s>BATTISTA: Steve, you are going to be staying with us here for most of the hour. I want to bring in two other guests to the conversation here, if we can get those up on the screen. Joining us now is Dr. Isadore Rosenfeld. He is the distinguished professor of clinical medicine at the Weill Cornell Medical Center. He is also a longtime government adviser on health matters and he is the author of "Dr. Rosenfeld's Guide to Alternative Medicine." Also with us John Cordaro, president and chief executive officer of the Council for Responsible Nutrition. Welcome to both of you. And Dr. Rosenfeld, let me start with you because we kind of said it at the top of the show, just because it says "natural" or "herbal," we make the mistake sometimes of assuming that something is safe; and that's wrong correct?</s>DR. ISADORE ROSENFELD, "DR. ROSENFELD'S GUIDE TO ALTERNATIVE MEDICINE": That is absolutely wrong. I mean, that is absolutely right. Herbs have the same potential for toxicity as prescription medicine. As a matter of fact, 125 or more of the prescription drugs that I write for my patients are derived from herbs, and the herbs that you get in the health food store that have not been checked, that have not been approved by the FDA, that your doctor knows nothing about, has the same potential for toxicity as prescription drugs.</s>BATTISTA: What would you take -- is there, I mean, is there anything that you think is safe out there, any supplement or herb?</s>ROSENFELD: Some herbs have been tested. I'm not opposed to herbs. I'm opposed to getting herbs sold by a salesman at a health food store who doesn't know anything about my condition, who isn't a physician, who doesn't know any pharmacology, but is there to sell me drugs. Now, there are some drugs that have been tested. I think, for example, ginkgo biloba is useful for cognition, memory in older people. I think that echinacea is useful in treating respiratory viruses. I think that saw palmetto is useful in controlling the symptoms of an enlarged prostate. I think that St. John's Wort, taken alone, and not with any other medication, is a useful anti-depressant for mild cases. But these are all substances that have been studied appropriately, reported in respectable journals, with double-blinded studies, and they have found to be safe when used properly and effective. That cannot be said for the great majority of the herbs that you buy either in Chinatown somewhere or even in a health food store.</s>BATTISTA: Well, John, outside of those that have been studied, how do we know exactly what we are getting when we buy an herb or a supplement, and how do we know that we are using it properly or taking the proper dosage, et cetera?</s>JOHN CORDARO, COUNCIL FOR RESPONSIBLE NUTRITION: Well, let's get the basic material fact correct. All dietary supplements, including herbs and botanicals, are ostensibly regulated by the U.S. Food and Drug Administration and the 50 state food and drug administrations across the country. These products are regulated as far safety, as far as claims in labeling statements, and as far as the quality control that goes into the production of these products. A consumer needs to read the label and follow the directions on the label to be assured that they are using the product properly.</s>BATTISTA: Dr. Rosenfeld, I was not under the impression that they were regulated by</s>FDA. ROSENFELD: They are not, in fact, regulated by the</s>FDA. CORDARO: That is just wrong, Dr. Rosenfeld.</s>ROSENFELD: Well, that is broad enough for me. They are not regulated with regard to dosage, to efficacy, to safety, to standardization. Now, there are some products that are made in the United States by reputable manufacturers who have been in business for some time that you can depend on. But many of the products that you find over-the-counter, in health food stores, and in Chinatowns are toxic. I think, for example, if you buy an herb, a natural herb has many, many different constitutes, and you don't know which one is going to give you any trouble. And I recommend to all my patients, if they do go for an herb, to get an extract, rather than the whole, you know, shebang.</s>BATTISTA: John, you know what, can I just say something, I think we need some perspective here, in other words, how much of this herb or this supplement do you have to take in order to place it in the danger zone? I mean, how common is a dangerous interaction?</s>ROSENFELD: And who tells you how much to take?</s>CORDARO: I think we have to make a basic distinction here between the fact that all dietary supplements are vigorously regulated, and what kind of enforcement might be taking place, as well as some of these, what I would call, back-alley kinds of operations that Dr. Rosenfeld may be referring to. The reality is, and I think Dr. Rosenfeld was on the right direction when he listed several of the major herbal products that are scientifically sound, and backed by clinical studies, and he mentioned the large number of responsible companies. Unfortunately, what happens is that with the handful of bad actors that might exist, that tends to be the lead story, and the major responsible companies don't get the attention that they should. The second issue is that FDA does have the regulatory authority and simply needs to take strong enforcement action. Let's stay with the issue that's before us today, which is one of the herbal products that Dr. Salvatore referred to, and that is aristolochia. The dietary supplement industry well recognized that this is a toxic herb, it should not be used by consumers, it should not be marketed as a dietary supplement, and the associations have sent alerts to its members well before the Food and Drug Administration advised us to do so. Now, we believe that Dishea (ph) is a responsible, that is the Dietary Supplement Health and Education Act, is responsible framework for regulating these product and we believe that the industry is responsible in self-regulating in these ways.</s>BATTISTA: Let me get Steve back in the conversation here, because you spoke -- I think you spoke recently with David Kessler who used to head up the FDA. Did you talk about this?</s>SALVATORE: Yes, we did. And here's the problem, Bobbie, is there are some manufacturers that are part of Dr. Cordaro's organization, and they do heed those warnings. I mean, when I prepared this story for CNN, I got that warning that they did send out to their associations. But at the same time, when I spoke with Dr. Kessler, he told me, as he was writing the editorial for the "New England Journal" article, he was able to get this substance over the Internet. The problem is that not everybody's on board here; not every company that's manufacturing this stuff is responsible, and consumers can't necessarily tell the difference between who's responsible and who's not.</s>ROSENFELD: Could I just...</s>CORDARO: I'm not aware...</s>ROSENFELD: Could I just -- could I just interject for a minute?</s>CORDARO: I'm not aware of any new regulations that would prevent that kind of thing from happening, and if either of you are, I would be welcome to discussing it.</s>ROSENFELD: Well, just let me ask you, what kind of FDA regulation are you talking about, when this is a toxic product that's been -- presumably causes cancer, causes renal failure, certainly in rats and probably in human beings? What is the nature of the FDA regulations that you are saying are so effective when you can still go and buy it anywhere in the United States?</s>CORDARO: You ask a good question. And I hope I can give you a good answer.</s>ROSENFELD: I hope so, too.</s>CORDARO: There are two parts -- there are two parts to the answer. The first part is that when Congress passed the Dietary Supplement Health and Education Act, it grandfathered all dietary supplements that were safe and marketed in the United States as of October, 1994. Aristolochia acids were not on the grandfathered list, so that they should not be marketed as dietary supplements. If a new ingredient is to come on the market, a manufacturer is required to provide FDA 75 days advance notice and information of the safety of these -- of this new ingredient before they can market the ingredient. Now, that's the mechanism that's in place. I can't deny...</s>ROSENFELD: And an -- and an ineffective one.</s>CORDARO: Well, the only...</s>ROSENFELD: And an ineffective one.</s>BATTISTA: Then we are talking about enforcement.</s>ROSENFELD: Bobbie...</s>BATTISTA: But, I've got to take a quick break. Hold on just a second here. I'm pushing the break. And when we come back, we'll also talk about the doctor/patient relationship. That may have a lot to do with getting everybody on the same page. And as we go to break we invite -- we should mention that we invited the FDA to participate in this discussion today; however, it declined our invitation to appear or to provide a written statement. Meanwhile, you can take part in our on-line viewer vote at cnn.com/talkback. Today's question is: Should the FDA regulate herbal supplements? We'll be back in just a moment.</s>BATTISTA: The Dietary Supplement Health and Education Act of 1994 prohibits food supplement manufacturers from making claims to treat or cure any specific condition or disease. Under this legislation, products are considered generally safe, unless proved otherwise. We are back. And I want to go to Susan quickly in the audience, because, Susan, you were telling us earlier that you advise doctors about herbal and supplement treatments.</s>SUSAN: That's correct. Doctors come to me and ask what herbs would be best for patients that they have who are not responding well to conventional treatments, or what supplements are best for patients that they have who need support, pre-surgery, post-surgery or even during chemotherapy. There are many times when herbal support is now recognized by physicians as being not only helpful, but so valuable to the patients, the patient's well-being, and to the patient's health.</s>BATTISTA: Dr. Rosenfeld is there enough communication between patients and doctors on what it is that the patients -- for example, in other words, I'm not sure that doctors ask enough questions about whether or not their patients are taking herbal supplements, or -- and I think patients are reluctant to admit that they are to their doctors.</s>ROSENFELD: Well, several problems here. First of all, patients often don't tell their doctors they are taking an herb because they figure it's a natural substance and not a medication, and therefore, is no business of their doctor's. The second problem is that most doctors don't know anything about herbs. So even if we encourage patients, listen, tell your doctor what you are taking, tell your doctor if you are taking ginkgo, or ginseng, or even ginger, so that he can guide you. The truth is that most doctors can't, and that is one of the reasons that we, at Cornell, have set up and, along with many other medical schools, departments of integrative complimentary medicines to teach our students what there is to know about these herbs so that they can communicate intelligently with their patients. I just want to make one comment on Mr. Cordaro's last statement that -- and listen to this, that all the herbs prior to 1994 were grandfathered. Now, in my view, that represents probably most of the herbal supplements that are around, and they are grandfathered. Let me tell you this, grandfathered mean that they are not subject to the same regulation as new herbs. And let me tell you this: I don't know of any single physician in my entire group of kotary (ph) friends who is not furious at the fact that the FDA does not have more power to police the production and efficacy of these herbs. he thinks it is a result of a great lobbying movement by the food industry.</s>BATTISTA: I was going to say, why doesn't it?</s>ROSENFELD: Because of, I think, I think because of the lobbying efforts of this industry that got Congress to pass what I consider to be a ludicrous and dangerous law.</s>CORDARO: Well, Dr. Rosenfeld, as a Cornell -- as a graduate of graduate school at Cornell University, I would like to complement my alma mater in being in the forefront of setting up such a center as you mentioned, and I think one of the things that I learned at Cornell is that it's important that consumers have access to products and access to information. I would agree on the two concerns that you raise about the doctor-patient relationship and I would add a third one in the area of information. One segment of our society that can be held accountable for what they tell their consumers is the dietary supplement industry manufacturers. There should be a public-private partnership between the medical community and health care professionals and the dietary supplement industry in providing accurate, truthful and non-misleading information. I think we have to understand that we are going through a major change in our society in terms of how the consumers value their health, their lifestyle and hopefully their longevity. And I think that if we breakdown some of these barriers that exist between the old way things have been done and search for new ways, I think that consumers will be better served.</s>BATTISTA: Could there not be -- at least be some sort of central database, Steve, for all this information, whether it's, you know -- whether the FDA is behind it or the federal government or whatever, but a central database where you can get all the information that you need about these herbs and supplements?</s>SALVATORE: Well, you would think that, that would make the most sense. I think we have a couple of problems here. The FDA feels very frustrated. They feel that the burden of proof is upon them and things are backyards. Normally, with drugs they are tested first, and then put out to the public, but with the way things are set up with dietary supplements, stuff is sent out to the public and then if there's a problem they can regulate it. That's the first problem. The FDA is very frustrated. The second problem is that you have a bunch of manufacturers, not all -- and I'm clarifying -- not all, who it's not in their interest to necessarily have to go through all of this process, a lot of quality controls and rigorous testing. Right now, there are many companies out there making a lot of money making whatever they want. This is a $15 billion-a-year industry and, trust me, that has a lot of influence on Congress.</s>BATTISTA: And I guess there isn't much incentive for these companies to do a whole lot of research on these supplements.</s>SALVATORE: Of course. Once -- right now it is so difficult to pin down a particular herb as causing a problem, you don't have any great quality testing going on. People could be turning up with cancer in your neighborhood right now and they might not even be attributing it to a certain herb they took or something they took. So we don't know.</s>BATTISTA: Got to take a break here. As we do, a comment from Joe Yancy (ph), who's -- you are also in the -- well, you're in the whole foods business.</s>JOE: Whole Foods Market, yes. Oh, I'm speaking now? Thank you. I work with Whole Foods Market, which is the largest retailer for natural foods in the U.S., and speaking just for our company, we have stringent guidelines that follow the federal guidelines as to what we can say and what we cannot say. We cannot treat conditions and we cannot diagnose, and as a company we keep that policy very -- make that policy very stringent and -- so I can only speak for our company, I don't know if other companies are doing it, but perhaps that's what we need to do, like John said, is to enforce the laws that are currently on the books.</s>BATTISTA: All right, we'll take a break and continue here in two minutes.</s>BATTISTA: We are back. And joining us now is Kathleen Areingdale, co-owner of The Herb Shop & Natural Health Center here in Atlanta. Kathleen, thank you for coming down.</s>KATHLEEN AREINGDALE, HERBAL RETAILER: Thanks for the invitation.</s>BATTISTA: We kind of brought you in just to represent the retail division of this, because I'm sure a lot of people are curious, you know, how much do you know about the products that you sell in your herb shop.</s>AREINGDALE: Well, that is very important nowadays for a lot of people to understand, that the herbs are very powerful and do have their chemistry, and they are going to react in the body and you have to know what is going to happen especially if it's mixed with medications, and in particular we train very hard and on a constant basis to know exactly what we are offering the public.</s>BATTISTA: Where do you get this training, I mean, do you take courses, or just books, or what?</s>AREINGDALE: Well, there aren't many courses that are being offered. I am, for example, taking long-distance courses to learn about herbalism and even a naturapathic (ph) degree. But also, a lot of the companies that you can get your products from, if they're reputable sources, will offer training about their products, and we find that, that is very helpful. It's very helpful when you have a company that you can count on as far as information about their own products, where they have different testings that they submit the herbs to, so that they don't just put whatever in a capsule.</s>BATTISTA: And you are asking us to trust you?</s>AREINGDALE: Well, I actually ask the company if I can trust them first. I have found in these five years that I have been now working with all the herbal companies out there, you get a very big load of information, people -- everyday, a new company offering herbs for you to retail, and I will have a lot of questions for them, and sometimes I even get someone to hang up the phone on me because they just can't take it anymore.</s>BATTISTA: Do you also know about things like -- you know, drug interactions, like if the person is taking prescription drug and this particular dietary supplement could interact badly with that?</s>AREINGDALE: Well, there's a lot of information of very many herbs that interact with drugs. But there is also PDR, or desk reference that you can use for the interaction with over-the-counter drugs. With prescription drugs, then I will call the company who has a team of doctors, scientists, pharmacognisists, who are pharmacists that specialize in herbalism, and they will be able to determine, you know, if there's an interaction. And we also advise people to ask their doctors. Unfortunately, the doctor sometimes doesn't offer any help, doesn't know about herbs.</s>BATTISTA: That's right. So it seems like a lot of this -- and I'll direct this to the doctors and John as well, that a lot of the burden is on the consumer. I mean, they're the ones that have to ask the questions. They're the ones that have to, you know, ask their doctor, and that, I guess, is the cause for concern.</s>SALVATORE: Bobbie, there is a standard that has to be done before you could know if something is safe, if something is effective and all of the side effects. Medicine has established a well-accepted form of research, a double blind, randomized, placebo-controlled types of studies. Many of these products have not even been subject to any of these tests. So how can anybody make an informed decision when there's not enough information out there. Add to the fact that these are people who don't have a medical degree, consumers, trying to make a decision about their health based on something they're going to take that may or may not be pure. I just think it's a risky proposition unless something is tested adequately. As we stated before, some of the other things, echinacea, ginkgo, things like that, but otherwise, it can be a risky proposition. If you want to take that risk, it's up to you.</s>CORDARO: Bobbie, I would like to address the quality issue, because I think that I probably am in closer agreement with my colleagues than may be expected. The council for responsible nutrition, which represents over 100 of the leading manufacturers of dietary supplements was the pioneer in developing good manufacturing practice standards and quality standards for our members. We established these in the mid 1980s, about 1985, and our members have been following these on a voluntary basis. When the Dietary Supplement Health and Education Act was passed, it gave FDA the authority to establish these on a regulated basis. The Council for Responsible Nutrition and four other trade associations came together and submitted a petition to FDA in 1996. And we basically said, we believe that almost all manufacturers of dietary supplements are following GNPs and quality standards, and within our associations, we can police that. But for those that are outside of our membership or who might choose to be irresponsible, we believe we need a federal regulation. We've been waiting for the Food and Drug Administration to take this action for four years. The burden now should be on the FDA to take the action and then to take enforcement action. That's where the problem is, with FDA, not with the dietary supplement industry.</s>BATTISTA: I've got to take another break at this time. Still ahead, actor James Coburn and the magic cure. We'll be back in just a moment.</s>BATTISTA: Welcome back. Let he ask our guests, and I'll start with John, why you think so many Americans these days are going outside the confines of traditional medicine?</s>CORDARO: I believe that Dr. Rosenfeld put his finger on it, and number one is that there is an unfortunate loss of faith that has taken place in the medical community, and I think part of that is because with the explosion of information that consumers have available, whether it's by reading or watching television, they're learning more and more about the science that's unfolding, and if the doctors are not able to keep their patient updated with that, then the patient is going to go elsewhere. I think that underlying one of our comments is that there needs to be better training in the medical community to understand what's happening and to be able to effectively dialogue with patients.</s>BATTISTA: Let me -- I'll tell you one person who did go outside of the confines of traditional treatment, on the phone with us now. He is Academy Award-winning actor James Coburn. Mr. Coburn, gosh, can I call you Jim?</s>JAMES COBURN, ACTOR: Yes, sure.</s>BATTISTA: OK. You had absolutely crippling arthritis.</s>COBURN: That's right.</s>BATTISTA: And you found a holistic cure actually for this. Tell us what happened.</s>COBURN: Well, my doctor is named Dr. Ronald Laws (ph). He wrote a book on MSM, but before he wrote that book, he gave me some, and so I've been taking it for like three years and my arthritis is in total remission as far as I know. The remnants of the RA has left my hand a little twisted and my arm, but there's no pain. And the problem with American Medical Association, and the FDA and the pharmaceutical companies, they are all in cahoots. They want to make money selling stuff that they sell, and as far as herbal medicines have gone, I don't know anybody that's been hurt by then, but I know millions have been killed by those pharmaceuticals that they sell. And they say, oh well, well, that doesn't hurt anybody. Come on.</s>BATTISTA: Did you try traditional...</s>COBURN: They're trained in sickness, not in health. That's the problem. If they were trained in how to keep people healthy rather, you know. dealing with them when they're sick. It's like the mechanic. He says, well, let's put some new sparkplugs in now, or I'm going to tear your car down.</s>BATTISTA: Did you -- let me ask you first, did you try traditional medical treatments for your arthritis?</s>COBURN: Oh, yes, absolutely. They don't know anything about it. They don't know anything about it, And they claim that do and all of these -- everybody, you know, giving money to the Arthritis Association. I don't know where that money goes because nothing's changed in the arthritical, you know, the medial approach to arthritis, but MSM works, and I've given it to hundreds of people, and I'm getting letters from everybody saying thank you very much for something that really works, because they've tried, too, and you know, because it's an inexpensive compound. It doesn't, you know -- it costs $30 dollars a pound or something.</s>BATTISTA: Dr. Rosenfeld, do you know about this MSM?</s>ROSENFELD: Well, yes, of course. This -- here's the problem.</s>COBURN: There is no problem with it, man. I -- listen, have you ever tried MSM?</s>ROSENFELD: I don't need it.</s>COBURN: No, I know you don't need it, but you're patients do.</s>ROSENFELD: If you would just...</s>COBURN: ... you know what it is, you are no expert of it.</s>ROSENFELD: I know exactly...</s>COBURN: All you can do is say, well, there hasn't been enough information brought in by it.</s>ROSENFELD: All right.</s>BATTISTA: Does it...</s>COBURN: Well, I know because...</s>BATTISTA: Let me -- OK, hold on, hold on, hold on.</s>ROSENFELD: In response -- now...</s>COBURN: I am the expert on it. I have taken it for two years...</s>BATTISTA: Hang on just a second.</s>COBURN: ... three years...</s>BATTISTA: Hold on, let me have Dr. Rosenfeld answer the question. Let me have him answer this question first.</s>ROSENFELD: Here is the problem, we have Mr. James Coburn, a distinguished artist prescribing MSM to hundreds of people presumably whom he's never seen or examined, who doesn't know -- he doesn't know what else they are taking and he is now practicing herbal medicine.</s>COBURN: No, I am not practicing herbal medicine.</s>ROSENFELD: This is -- just a minute, Mr. Coburn.</s>COBURN: I am just giving out information...</s>ROSENFELD: Mr. Coburn...</s>COBURN: ... that the doctors aren't doing.</s>ROSENFELD: Mr. Coburn, give me the courtesy of hearing me out.</s>COBURN: I have heard the story before, Doctor, and it doesn't make any sense at all.</s>ROSENFELD: I understand. Mr. Coburn, I'm not going to watch...</s>COBURN: You think that I'm practicing medicine -- I wish I could practice medicine, because I would give people...</s>BATTISTA: I think we can all understand James Coburn's frustration, because traditional medicine clearly failed him.</s>ROSENFELD: But understand my frustration in not being able to speak.</s>BATTISTA: I am with you and I am trying to help you out with that.</s>ROSENFELD: I will -- I'm telling -- I know. I'm going to tell...</s>BATTISTA: So -- right. But the -- I think the frustration is that it wasn't a regular doctor who recommended to him to try this holistic approach.</s>ROSENFELD: Look, it may...</s>COBURN: It was. It was a Dr. Lawrence, he is not only a regular doctor...</s>ROSENFELD: Shall I go home?</s>COBURN: ... he is a genius, is what he is.</s>BATTISTA: But that doesn't normally happen, right, OK?</s>COBURN: He's a neurologist...</s>BATTISTA: Right, but that doesn't normally happen?</s>ROSENFELD: There are very few geniuses, Mr. Coburn.</s>COBURN: Normally, it does not happen, because he has made his life practice...</s>ROSENFELD: Should we all go home and let Mr. Coburn finish this program, or can we have a word or two?</s>COBURN: Well, if you have anything important to say, say it.</s>ROSENFELD: Yes, well, you certainly have a lot to say.</s>BATTISTA: OK, well, let's...</s>ROSENFELD: Now, look, I have...</s>COBURN: Yes, well, it doesn't sound like you have anything important to say, it's the same old trash we've been hearing for the last 20 years.</s>ROSENFELD: Are you finished, Mr. Coburn?</s>SALVATORE: Bobbie, Bobbie...</s>COBURN: Not yet, but go ahead.</s>BATTISTA: Let me have Dr. Rosenfeld get his say here.</s>ROSENFELD: Mr. Coburn, your doctor should also have given you with MSM a course in manners.</s>COBURN: Well, my course in manners has to do...</s>ROSENFELD: Now, I have nothing against MSM. It may very well be that MSM is affective in certain forms of arthritis of which Mr. Coburn apparently had one. What I am saying is that when a product such as this comes on the market, instead of Mr. Coburn and his genius doctor prescribing it, it ought to be the subject of a study by a scientific group who will decide which patients could benefit from it...</s>COBURN: Yes, that's all trash.</s>ROSENFELD: ... in what dosage, for how long.</s>COBURN: No, that is all...</s>ROSENFELD: Mr. Coburn, let me finish.</s>COBURN: This stuff has been around since 1938, there has been over 150 studies done on it...</s>ROSENFELD: And none of them have proven anything.</s>COBURN: ... and all of them have proved affective. All of them have proven to me and anybody else.</s>ROSENFELD: Now, Mr. Coburn is a difficult guest, because he doesn't understand...</s>BATTISTA: Well, you know, we have to take...</s>ROSENFELD: ... the ethics and the -- of television broadcasting.</s>CORDARO: Bobbie, Bobbie...</s>BATTISTA: I have to take a break here, but I -- the problem here is that, you know, men of science want to -- they want to know why it works and the rest of us, you know, are more concerned with whatever works, and we will talk about it more when we come back in just a second.</s>BATTISTA: Before we hit the break, both Steve and John were trying to get in here, so we have about a minute or so. Steve, go ahead -- or John.</s>SALVATORE: Yes...</s>CORDARO: OK.</s>SALVATORE: Well, Bobbie, I am very familiar with MSM and I actually did a show with Mr. Coburn before on "LARRY KING" and MSM -- the problem with MSM is just that it hasn't been adequately studied, no one here is saying that MSM does not work, please don't misunderstand. All we are saying is that it has not been put to the standard of the medical community and we want people to put this compound to that test. And of course doctors would be thrilled if there was a new cure for arthritis, there is no conspiracy. It's absurd to think that there is one. So, all we are asking is that these herbal products, things like MSM and other things, be tested for safety advocacy and so people don't get sick from them, that is all, very simple.</s>BATTISTA: And, John, quickly.</s>CORDARO: Well, I quickly wanted to make practically the same point. A difference between Mr. Coburn's First Amendment rights to say what he wants to say versus a manufacturer, if a manufacturer wants to make that type of claim, they need to be able to substantiate it, and I think that that's the basic point.</s>BATTISTA: I have to take another break, and we will hear the response from James Coburn when we get back.</s>BATTISTA: I've got about 30 seconds left -- or a minute left. So I'm going to give 30 seconds to Dr. Rosenfeld and 30 seconds to James Coburn. So, Dr. Rosenfeld, you go first, and basically what I really want to know is whether these two areas can be integrated successfully: traditional and alternative.</s>ROSENFELD: They can be and they are being. The fact is that people are living longer. There are degenerative diseases, like arthritis, that medicine has not been able to solve. People are, therefore, going looking for alternatives. That's fine. All I'm saying is that these alternatives should be studied and tested for safety and effectiveness before they are made available to the general public.</s>BATTISTA: And James Coburn? Last word to you.</s>COBURN: Well, all I am seeing -- see that -- these two gentleman are traditional medical people, of course. And that -- they need that kind of confidence. I'm sure if they gave their patients MSM under a controlled experiment of their own, they may have some results that they could talk positively about. Until that happens, you know, they're going to continue this same old rote that comes down from the pharmaceutical companies and the</s>FDA. BATTISTA: All right, James Coburn, thank you very much for joining us. Dr. Isadore Rosenfeld, thank you. John Cordaro, Dr. Steve Salvatore, thank you. And Kathleen, appreciate you coming down as well. That's all the time we have. We'll see you again tomorrow for more TALKBACK LIVE.