Vacations with benefits

BEFORE her first trip to the Dead Sea five years ago, 40-year-old Rhonda Dupras didn’t even own a pair of shorts. Suffering from severe psoriasis over her entire body, Dupras normally cloaked herself in long sleeves and long pants, hiding her red, flaky, scaly skin from curious stares and prying questions.

But after three weeks of soaking up the Dead Sea sunshine under a doctor’s care at her health hotel in Israel, Dupras’ skin was tanned, glowing, smooth -- and virtually clear of flakes and patches. She cried like a baby, she says, and promptly bought shorts to celebrate. “I ended up showing off my skin to everyone. I just couldn’t help myself,” she says. Her remission lasted four giddy months. Now she tries to return for more therapy every couple of years.

A trip to the beach might cure many ills -- restless-kids syndrome or overwork ennui, perhaps -- but some vacations can perhaps treat even more serious ailments. Travelers from the U.S. and especially Europe visit certain climates -- the Dead Sea in the Middle East, radioactive mines in Austria and Montana, barren caves in Slovakia, among others -- to treat a panoply of skin, arthritic and immune system diseases.

Tourists in Safaga, Egypt, can opt to be buried up to the neck in warm, black, radioactive sands -- reportedly an excellent treatment for rheumatism. People with psoriasis can travel to Kangal, Turkey, to soak in a pool filled with tiny, toothless “doctor fish” that nibble off dead, flaky skin. And ever since the late-19th century establishment of famed tuberculosis sanitariums in Davos, Switzerland, city dwellers have fled to alpine resorts in search of sunshine, good food and a breath of crisp air.

Known collectively as climatotherapy, or health tourism or bioclimatology, this Mother Nature approach to medical treatment is often met with a degree of skepticism from the American medical establishment. But many European physicians recognize climatotherapy as a legitimate form of complementary medicine.

Still, state-of-the-art randomized controlled trials are relatively rare in the field of climatotherapy. (It’s tough to construct a placebo uranium mine, for instance.) But an accumulating body of research -- some of it tucked away in foreign-language journals -- suggests that some tales of climate-induced miracle treatments may in fact have a scientific basis.

Although any exotic climate can be touted as a potential climatotherapy destination -- Siberian winters for hay fever, anyone? -- some environments have the benefit of active research and on-site medical clinics. Here’s a look at a few well-studied regions.

The Dead Sea

Spa-goers in America might pay top dollar for a soak in mud imported from the Dead Sea, but they miss the most therapeutic part of the Dead Sea experience: the sunlight. As the sea’s salty water evaporates, it leaves behind a mineral cloud hanging over the valley. That haze -- plus the extra 1,300 feet the light needs to travel to reach the lowest point on Earth -- filter out the sun’s damaging short-wavelength UV rays.

The result? A great tan, in part. “It’s fairly difficult to get a sunburn at the Dead Sea,” says Dr. Mark Lebwohl, chairman of the dermatology department at Mount Sinai School of Medicine in New York.

But the appeal extends beyond the cosmetic for psoriasis suffers, whose skin often clears and heals in sunlight. “The light actually stops the rapidly multiplying skin cells in psoriasis,” Lebwohl says. In many environments, raw psoriatic skin often burns before it can heal.

When scientists tried to replicate the beneficial effects of sunlight in the lab with phototherapy, they found that long-wavelength light centered around 311 nanometers was strikingly effective -- which is just about the same spectrum found at the Dead Sea.

This treatment, narrow-band UVB therapy, provides ultraviolet light too intense for some patients to tolerate, Lebwohl says. But Dead Sea dosages of phototherapy might be just right. A 1999 study of 100 patients found that 75% had their psoriasis cleared within four weeks of treatment at the Dead Sea. Of those, about two-thirds stayed clear for four months, 43% were clear for six months, and 10% stayed clear for eight months or more.

Other skin conditions may also benefit from Dead Sea climatotherapy. Studies have been published showing positive effects for patients with vitiligo (patchy unpigmented skin), eczema and mycosis fungoides (a type of skin lymphoma).

But the therapy is not without its risks. One study found more skin sun damage, such as wrinkles and lost elasticity, in psoriasis patients who visit the Dead Sea than in the general population. Skin cancer, however, was roughly the same in the two groups.

Most hotels in the Ein Bokek region of Israel have rooftop solariums, and on-site doctors can recommend personalized climatotherapy regimens. Many visitors spend five to nine hours of the day stretched out on towels, slathered in olive oil and fighting off buzzing flies, Dupras says. Men and women sunbathe in separate areas, usually in the nude, playing Scrabble and swapping stories.

The molecular mechanisms behind the phototherapy effects are not well understood, but researchers think that sunlight might stifle the development of DNA in skin cells and possibly even change the skin’s immune responses.

Insurance plans in many European countries -- Denmark, Germany, Austria, Sweden and Norway, among others -- subsidize some climatotherapy treatments at the Dead Sea. Israeli citizens with psoriasis receive four weeks of government-sponsored treatment at the Dead Sea every year.

Uranium mines

In the late 1940s at a struggling uranium mine in Boulder, Mont., the wife of a mining engineer visited her husband at work and reported that her painful shoulder bursitis cleared up after a single trip down the 85-foot-deep mine shaft. She passed the word along to friends in Los Angeles, and before long people were clamoring for their own health tour of the still-radioactive mine. Mining operations were soon abandoned, and in 1952 the Free Enterprise Radon Health Mine was born as a radon therapy center, continuing today under the care of the original owner’s granddaughter, Patricia Lewis.

Medical associations in the U.S. wrote off the fans of the Montana mine as just “a bunch of nuts out in the sticks,” says Barbra Erickson, an anthropology professor at Cal State Fullerton who has researched the cultural aspects of radon therapy.

But around the same time, miners’ stories of amazing pain relief in Bad Gastein tunnels in the Austrian Alps caught the attention of German and Austrian medical researchers. They ended up building a medical facility on the site, called the Gasteiner Heilstollen (“healing tunnel”).

Today, most of the scientific literature about radon therapy is written in German, and the field is not well known in English-speaking countries, Erickson says. Only a handful of facilities provide radon therapy across the world, either through inhalation or soaks in radon-infused waters, often at the site of old uranium mines.

When uranium decays, it produces radium, which in turn produces radon, a colorless and odorless radioactive gas. Radon is a known carcinogen, blamed for an estimated 15,000 to 22,000 U.S. lung cancer deaths every year. (Smoking-related lung cancer deaths number about 160,000 annually.) The health risks come from breathing in the alpha particles emitted by decaying radon, which can damage delicate lung tissue.

Natural levels of radon in the environment average about 0.4 picocuries per liter of air. The U.S. Environmental Protection Agency recommends that indoor air contain no more than 4 picocuries of radon per liter. The air in the Montana mine reaches about 1,600 picocuries per liter. The Austrian facility clocks in at about 2,200.

It’s clear that radon is toxic. What’s debatable is the dose at which it does harm. The EPA says that exposure is dangerous at any level. Some scientists, however, say that small doses may not be harmful -- and in fact might actually help reduce pain and swelling. The evidence for radon therapy’s lasting effects against diseases such as arthritis and ankylosing spondylitis (arthritis of the spine) is compelling, says Dr. Klaus Trott, an oncology professor at the University College of London.

In 2001, a study of 120 ankylosing spondylitis patients found that radon therapy plus physical therapy reduced pain and the need for painkillers more than physical therapy alone. Effects lasted for up to 10 months after treatment. One theory is that radon’s alpha particles trigger an immunological response when they hit certain immune receptor cells in the skin.

Visitors to Gasteiner Heilstollen consult with medical spa doctors before treatment in the radon tunnels. Temperatures hover at about 105 degrees with 90% humidity, and bathrobed patients lie quietly while doctors periodically measure blood pressure. The Montana mine sports a more rugged, American flavor: Visitors in jeans and jackets pay facility fees on the honor system, decide their own treatments and play cribbage in the 60-degree underground tunnels.

Proponents for radon therapy have done the math and insist that the exposures from standard treatments aren’t as high as they seem. Twelve hours at the Austrian facility spread across one month every two years would increase a person’s radon exposure by about the same amount that sleeping with open windows during that same time would decrease it (because trapped radon in the house can escape outside), Trott says. And because people generally don’t think twice about the risks of sleeping with closed windows, Trott says, they also shouldn’t worry too much about exposure levels in radon therapy. And any health risks apply only to inhaling radon, so facilities that provide soaks in radon-infused waters pose virtually “no risk whatsoever,” Trott says. Some European countries such as Germany and Austria cover the cost of radon therapy, either inhaled or absorbed.

Karst caves

Beneath the Slovakian landscape lie about 5,000 karst caves, formed when seeping water dissolves away soluble bedrock and leaves behind barren caverns and soaring rock formations. But it’s the air, not stalagmites, that intrigues climatotherapy researchers. Karst caves host a very stable air environment: about 45 degrees, up to 100% relative humidity, high electronegative charges, lots of calcium and magnesium particles and a virtual dearth of mold, bacteria, pollen and other allergens.

In the late 1940s, a German doctor found that his wheezy patients who had spent World War II hiding in a karst cave emerged after the war with easier breathing. He began studying how adults with respiratory problems responded to cave air, a treatment known as speleotherapy.

Czechoslovakian scientists followed suit with asthmatic children, and in 1972 the Children’s University Hospital in Banska Bystrica (now in Slovakia) began a formal treatment program at the Bystrianska cave in the Low Tatra mountains. About 350 patients undergo the therapy every year at Bystrianska, says Dr. Svetozar Dluholucky of the hospital’s pediatrics department and president of the speleotherapy group of the International Union of Speleology.

During the recommended 14-day stay, speleotherapy patients practice deep breathing exercises in the cave for up to three hours a day, Dluholucky says. Adults listen to relaxing music and engage in yoga; children have fairy tales and dancing. The Slovakian Ministry of Health recognizes speleotherapy as a standard complementary treatment for respiratory tract diseases and helps cover patients’ expenses.

The effectiveness of speleotherapy is “surprising,” Dluholucky says, especially in asthmatic children. A 2001 study of 110 asthmatic patients found that patients who underwent speleotherapy at Bystrianska had fewer asthma attacks and needed fewer medications up to one year after treatment than patients who stayed in the area but never entered the cave.

In Europe, some clinics also provide speleotherapy in salt or metal mines, but the Bystrianska karst cave is the International Union of Speleology’s gold-standard reference for therapy, Dluholucky says. It’s not clear what mechanisms might lie behind the effects, but some studies suggest that tiny particles in the cave air heal the moist tissue lining the bronchial tubes, which in turns changes the immunological behavior of tissue in the lungs, Dluholucky says.

“Europe has more of an open mind toward complementary and alternative medicine than America does,” says Dr. Gailen Marshall, professor of medicine and pediatrics at the University of Mississippi Medical Center who studies the effects of psychological stress on the immune system. He suspects that some of climatotherapy’s beneficial effects stem from the healing power of vacations. Getting away from everyday stressors not only boosts mood but actually changes the body’s immunological responses, he says.

But a strong “vacation effect” wouldn’t necessarily make climatotherapy any less valuable, Marshall says. If asthmatic patients come back from a vacation in the caves and need only half as many pills and inhalers even for a short while, he says, why is that a bad thing?

“Scientists and clinicians and the public should have an open mind,” Marshall says. Risks and benefits of climatotherapy should be carefully weighed without preconceived notions. “We shouldn’t believe that just because a therapy is ‘natural’ that it’s any better or any worse,” he says. “It should stand the same scrutiny that other medicines do.”