The National Institutes of Health, the country's pocketbook fo biomedical research and long a stern protector of the most rigorous brand of science, is about to start venturing into the softer realm of alternative medicine. Some researchers hail the initiative as visionary, but others liken it to governance by horoscope.
In the next few weeks, the institutes' new Office of Alternative Medicine will begin seeking proposals from researchers who want to explore the merits of therapies outside mainstream healing.
These could include homeopathy, herbal medicine, electromagnetism to heal bones and soothe arthritis, mind-body control techniques like visualization and guided imagery, and touch therapy, which is akin to the tradition of laying on of hands.
The office was established last year under pressure from the congressional subcommittee that finances the institutes. The idea was that fresh approaches were needed to treat chronic, degenerative diseases like cancer, AIDS, arthritis, autoimmune disorders or other illnesses for which standard medicine often has no remedy.
Now the office has a permanent director, Dr. Joe Jacobs, a Yale-trained pediatrician whose mother was a Mohawk and who was exposed as a child and later in his work as a physician on a Navajo reservation to the alternative therapies practiced by medicine men.
Dr. Jacobs and outside advisers are completing a statement of the office's mission, and at the end of this month they will ask researchers to apply for grants for studies that will seek to confirm or debunk unorthodox therapies that may be widely used but that often lack hard scientific data to support them.
"I describe my role as the captain of the Starship Enterprise," Dr. Jacobs said. "We're looking for new things, in a sort of an entrepreneurial activity. The purpose of our office is to look at those things on the fringe and give them a rigorous review."
The reaction to the office among the biomedical community, both mainstream and alternative, has been a complicated mixture of praise and damnation. Those who favor the office say it could help validate folk remedies that people have sworn by for hundreds if not thousands of years, focusing on when the therapies are most useful and how they work in the body.
They said alternative therapies often are much less invasive than conventional medical approaches like surgery or radiation and are thus often far less expensive -- an important consideration in a time of exploding health care costs.
"I think it's a great idea that the NIH is going to do this, and I support them 110 percent," said Dr. Halstead R. Holman, a professor of medicine at the Stanford University School of Medicine. "It's unfortunate that a lot of these therapies are viewed as alternative, because it puts a stamp of craziness on things that are potentially valid."
But Dr. Avram Goldstein, a professor emeritus of pharmacology at Stanford, said of the office: "What's it going to be under? The Office of Astrology?"
Dr. Goldstein, who has studied how music can stimulate the brain to produce endorphins, the body's natural opiates, said that while he well appreciated the importance of the mind in healing the body, he was nonetheless skeptical of many alternative therapies.
Some researchers said the creation of the new office was particularly galling in an era when the health institutes' budget has tightened so sharply that all but the top 14 percent of applications are rejected.
The first year's allotment for the study of unconventional practices is $2 million, a fraction of the NIH's overall budget of $10.3 billion for fiscal 1993, and it will cover about 10 projects.
But some worry that if the office grows in influence, it may siphon money from mainstream science. The call for grant proposals is so broad and is open to such a wide spectrum of specialists, from statisticians to anthropologists, that some researchers worry it could be a casting call for quacks.
It is not yet clear how the new office will judge the merits of proposals. Dr. Jacobs insisted that the grants would be given rigorous review, but he admitted he still had to determine how the review experts would be chosen and how high standards would be ensured in fields where there was little scientific foundation to build upon.
"I think this is an appalling way to do research, and it's a terrible waste of money," said Dr. R. Michael Blaese of the National Cancer Institute in Bethesda, Md. "It's clearly a response to congressional pressure. If this were an ideal world with unlimited resources, sure, studying unconventional things would be fine. But there are so many good, well-founded scientifically sound proposals that are not getting funded."
The force behind the new office is Sen. Tom Harkin, D-Iowa, chairman of the appropriations subcommittee that finances health research, who was impressed by the vivid testimony of friends and colleagues in support of unconventional medicine.
The movement also has been helped by advocates for AIDS patients, who have claimed that such techniques as mental imaging and relaxation therapies can help bolster the immune system and keep courage high.