Wrong prescription for alternative medicine The need to study alternative medicine is beyond dispute. But NIH, a stronghold of medical orthodoxy, has amply demonstrated over six years that it's not the place to do it.

November 12, 1998|By Daniel S. Greenberg

WASHINGTON -- Congress has given the orthodox medical establishment $50 million to sort out the claims, mysteries and realities of "alternative medicine." That's the term for a melange of potions and treatments that includes massage and acupuncture, as well as shark's cartilage for cancer and St. John's Wort, a low-octane anti-depressant for sale without prescription.

Unfortunately, the congressional generosity is misbegotten since the money was entrusted to the National Institutes of Health, where the management rates alternative medicine as synonymous with quack medicine. With lesser sums previously imposed on it by Congress, $20 million last year, the guardians of medical orthodoxy at NIH have been pawing at alternative medicine since 1993, with little to show for their efforts.

In fact, squabbles still persist about the definition of alternative medicine, with some proponents preferring to call it "complementary medicine," while others have recently shown interest in calling it "integrative medicine," sometimes in combination with the other terms.

It's important to look at it, the proponents argue, since Americans by the scores of millions are gulping strange potions beyond the reach of the Food and Drug Administration and subjecting themselves to procedures foreign to Western medical practice.

According to a recent issue of the Journal of the American Medical Association that was devoted to alternative medicine, Americans made 629 million visits to "alternative medicine practitioners" in 1997, "thereby exceeding total visits to all U.S. primary care physicians." The alternative healers are said to have taken in $21.2 billion; $12.2 billion of that sum was out of pocket -- which probably signifies a mixture of confidence and desperation among their clients.

The expressed concern in the ranks of orthodox medicine is that reliance on the alternatives might delay or interfere with effective treatments for serious ailments. There's also worry about fraud in the grand snake-oil tradition and well-intentioned but harmful incompetence.

A mainstream scientist is quoted in the JAMA issue as saying, "Why don't we form a center at Harvard for the scientific study of astrology?" Various alternative camps respond that these concerns reflect the turf insecurities of organized medicine, now intensified by the income-cutting rigors of managed care.

The directed purpose of the NIH program is to subject alternative treatments to the same type of scientific examination that supposedly assures the safety and efficacy of mainstream medicine. The moving force behind this effort is Sen. Tom Harkin, an Iowa Democrat, who forced money upon NIH in 1992 for what eventually became a low-level Office of Alternative Medicine.

Hostile to this mandate, the NIH management entombed the office in bureaucratic snarls, to the point where the founding director quit in disgust after two years. His successor, Wayne B. Jonas, a medical officer on detail from the U.S. Army, fared better during a three-year stint.

Dr. Jonas made progress toward getting mainstream scientists and physicians to recognize that whatever their attitude toward alternative medicine, scores of millions of Americans are indulging in it and, therefore, it is desirable to identify what works and what doesn't.

Mr. Harkin struck again this year, elevating the office to the more independent rank of a center in the NIH organizational structure, and raising the budget to $50 million, despite NIH's preference for holding the money level.

In a swan song article in JAMA, Dr. Jonas touched on several characteristics that may account for the popularity of alternative medicine. Based on reports of patient surveys, he notes that the "time spent with each patient by an alternative medicine practitioner usually exceeds that spent by the average conventional physician, and patients are often more satisfied with their interactions with unorthodox than orthodox medical practitioners." He points out that conventional treatments gone awry "are a major cause of death and hospitalization" -- a failing openly acknowledged by orthodox medicine.

The need to study alternative medicine is beyond dispute. But NIH, a stronghold of medical orthodoxy, has amply demonstrated over six years that it's not the place to do it. The new center would be better off as an independent agency, safely insulated from the tender care of the elite skeptics at the National Institutes of Health.

Daniel S. Greenberg is a visiting scholar in the history of science, medicine and technology at Johns Hopkins University. He is writing a book on post-Cold War science politics.

Pub Date: 11/12/98

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