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Ridgely Ochs
Recent Columns 
Alternative Medicine Report: Is It for Learning or Burning?
Apr 2, 2002
 
AFTER TWO YEARS and $2 million, the White House Commission on Alternative and
Complementary Medicine Policy released its report last week, and it's probably no
surprise it has stirred up as much dust as alternative medicine itself has.

Dr. Stephen Barrett, who runs the "Quackwatch" Web site and has been a vitriolic critic
of the commission, called the report a "complete scam" and "intellectually dishonest."
Asked what should be done with it, he replied: "It should be burned."

Two of the 20 commissioners filed a separate statement to Health and Human Services
Secretary Tommy Thompson, criticizing the underlying "advocacy tone" of the report,
which is based, they said, on a presumption that "most 'CAM' [complementary and
alternative medicine] interventions will be proven to be safe and effective."

But in a letter published last Tuesday in The Washington Post, the head of the
commission, Dr. James Gordon, a psychiatrist and director of the Center for Mind-Body
Medicine in Washington, D.C., defended the report, saying it reflected "emphasis on the
need to scientifically investigate complementary and alternative therapies to find out if
they are safe and effective and cost-effective."

Aside from the controversy, it's unclear what impact the report will have - although
Gordon said he hopes it will lead to congressional hearings. In March 2000
then-President Bill Clinton mandated the commission, composed of mainstream doctors,
nurses and alternative practitioners, to develop recommendations to help lawmakers and
administrators make policy that "maximizes the benefits" of complementary and
alternative medicine. But that was in another administration and time.

"Circumstances are very different now. We were at peace then, and we had a surplus
budget, and there was no such thing as bioterrorism," said Dr. Joseph Fins, director of
ethics at New York Presbyterian Hospital in Manhattan and one of the commissioners
who sent a separate letter to Thompson.

If the report has less impact than hoped for, it won't be for lack of trying. For 18
months the commission held town meetings around the country that included the
testimony of more than 700 groups or individuals, and it read more than 1,000 written
submissions. The result is an inch-thick document that Gordon calls "a road map for
taking the next steps to determine ... what we know and what we don't know about
the benefits and hazards" of complementary and alternative medicine. The
recommendations call for:

Allocating more funds for research.

Creating an office within HHS to coordinate complementary and alternative medicine
research and activities.

Educating conventional health professionals in complementary medicine and educating
alternative practitioners in conventional health care

Making accurate information about complementary and alternative medicine available and
ensuring that products are safe.

Improving access to alternative practitioners and ensuring they are accountable to the
public.

Broadening insurance coverage for those practices shown to be safe and effective.

Looking at complementary medicine in promoting wellness.

But the dissenters said, despite last-minute changes, the report still reflects a
pro-complementary medicine mind-set that isn't based on much science.

"Part of the problem is that it was a commission of advocates, myself included," said
Dr. Tieraona Low Dog of Corrales, N.M., who along with Fins sent the dissenting letter.
As a result, the commission wouldn't take a stand about which alternative therapies
have a growing body of science behind them and those that were unproven, possibly
unsafe or downright fraudulent, said Low Dog, an expert in herbs.

"To not take a stand on some of these things that are quackery is just nonsense," she
said. "Some of our most vulnerable populations believe ... and are spending money, and
they're just chasing rainbows."

Fins agreed. "We should try to identify those things that are promising, and the key
element is objectivity and science, not partisanship and advocacy," he said.

He also faulted the report for its vagueness. "We felt there was an intentional lack of
clarity," Fins said. For instance, he said he worried that the proposal about training
primary care doctors and alternative practitioners fuzzied the line between the two and
could be used as a "back door" to having alternative practitioners considered equivalent
to primary care doctors.

Fins and Low Dog said Gordon tried to lessen the advocacy tone and made late
changes in the document; in fact, Fins said, the entire commission did not sign off on
all the later changes. But the changes were not enough to satisfy their concerns.

Another commissioner, Dr. Dean Ornish, president of the Preventive Medicine Research
Institute in California, said he also had had concerns but that Gordon made changes to
satisfy him. Yet, the lack of hard evidence about many therapies is still an issue.

"I think the report is more of a road map for down the road than for right now," he
said. "When you look at the evidence, there's not that much that's been shown
scientifically yet to be effective."

Copyright ¨Ï 2002, Newsday, Inc.

..................................................
*2000³â 12¿ù 15ÀÏ °Ô½Ã±Û

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1) Should CAM be integrated with conventional medicine and why or
why not?

I do not think that it should be integrated. I deplore the efforts to do
so. The term "conventional medicine" is as a misnomer. What is labeled
as "conventional" is modern scientific or evidence-based medicine. Many
or most CAM therapies on the other hand are "conventional" and
ancient, such as traditional Chinese medicine, Qigong, or spiritual
importations from India.

Scientific medicine is a relatively recent development in human history,
especially since the nineteenth century, when increased knowledge of
physiology and human anatomy was refined. There have been a number
of brilliant researchers who have contributed to our understanding, such
as Claude Bernard, Louis Pasteur, Robert Koch, and Joseph Lister.
Theories about the nature and transmission of infectious diseases, such
as diphtheria, tuberculosis, malaria, typhoid, tetanus, polio, and the
development of vaccines had important roles in immunization. Likewise
important were the advances in epidemiology, public health, and
sanitation. In the twentieth century endocrinology advanced--with the
discovery of insulin, cortisone, and sex hormones. In the field of
nutrition researchers discovered the role of vitamins. There have been
significant new diagnostic tools, such as X-ray imagery, CT scans,
mammography, and sonograms, to mention only a few. The great
strides in surgery have been impressive, including cardiology,
neurosurgery, and organ transplantation. The discovery of antibiotics
has made enormous contributions to the cure of infectious disease. We
should add to this the discoveries of DNA, biogenetic research, gene
therapy, and other innovations on the frontiers of research. All of these
achievements have led to the reduction of infant mortality and the
extension of life spans. As part of this process was the development,
beginning in 1904, of rigorous standards of medical eduction in medical
schools. Thus we see the remarkable effectiveness of modern scientific
medicine--all for the benefit of humankind.

They key factor in evidence-based medicine is that any new diagnostic
techniques and therapies be submitted to rigorous double-blind clinical
tests. Unfortunately, CAM therapies, in our view, have not been
adequately tested. Too often the claims of their validity have been
anecdotal or highly subjective uncorroborated reports by practitioners
and/or their patients, some of these based upon the placebo effect.

Surely, we cannot lump all CAM therapies together and make a blatant
indictment. Each has to be examined objectively and impartially.
Scientific medicine admits that fallibility and skepticism is part of its
process of inquiry. On the other hand, we should insist that the public
be safeguarded against unproven cures, untested therapies, quackery by
practitioners and manufacturers out to make a profit.

2) Should there be access to and delivery of CAM products and
practices? If so, why? If not, why not?

I do not think that there should be universal access and delivery of
CAM products and nostrums. This will tend to weaken what is one of
the finest health-care systems in the world based on scientific testing.
CAM could undermine the line between genuine and pseudoscience.
Each claim to validity must be tested by impartial neutral observers not
simply their advocates. If a therapy proves to be effective, then it
becomes part of scientific medicine. It is vital, in our view, that this
Commission represent not simply proponents of CAM, but scientists and
physicians who are skeptical of its claims.

3) If current CAM utilization trends continue, what consumer protection
should be implemented?

CAM seems to be growing. I think the public should be protected. The
government has an obligation to act against spurious or fraudulent
claims. The free market--in selling adulterated goods and questionable
services--needs to be monitored. The misuse of taxpayers funds needs
to be safeguarded. The great issue is the health and welfare of the
American public. Government sponsorship of questionable CAM
therapies would be a disservice to the public interest.

4) What policy recommendations do you have for the Commission?

I would strongly urge as a first step the repeal of the 1994 Dietary
Supplement Health and Education Act, which freed herbal medicines
and dietary supplements from regulation by the FDA. Prescription drugs
are required to be tested. There are no such safeguards for dietary
supplements. There are now some 20,000 such supplements--including
herbal and homeopathic remedies--on the market. Many of the
manufacturers make false and misleading claims. Many have dangerous
side effects. Some may have positive results.  In any case, the
packages should be properly labeled--there should be "truth in
labeling." Those deemed to have possible noxious side effects by
misuse should require a prescription.

Second, similar regulations should be enacted against other false
claims--such as quack cancer cures, crash diets, Chelaton therapy,
iridology, therapeutic touch, and magnetic therapy. This is particularly
the case where patients avoid scientific medicine and substitute
alternative therapies, believing that since they are offered by the
health-delivery system, they must be effective. There needs to be peer
review, as in scientific medicine, but not simply by the practitioners in
a field, but by other objective and neutral scientific reviewers.

Paul Kurtz, Chairman, Committee for the Scientific  Investigation of
Claim of the Paranormal; Publisher, The Scientific Reveiw of
Alternative Medicine.
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