Complementary and Alternative Medicine in the United States

Stephen Barrett, MD

Disclosures

October 18, 2005

By the Institute of Medicine Committee on the Use of Complementary and Alternative Medicine by the American Public
National Academies Press
Copyright 2005
357 pages
ISBN: 0-309-09270-1$47.95 hardcover

Until recently, the prevailing scientific view has been that (1) health-related methods that are plausible should be tested with well-designed clinical trials; (2) the rest should be discarded; and (3) no method should be marketed, promulgated, or taught without proof that it is safe and effective.

Two events during the 1990s changed the above situation. One was the creation of a National Institutes of Health (NIH) entity whose actual purpose was to promote pseudoscientific methods. Since that time, hundreds of millions of dollars have been wasted on useless research, and scores of medical schools have established courses that promote quack methods.[1] The other event was the passage of the Dietary Supplement and Health Education Act (DSHEA), which greatly reduced the US Food and Drug Administration's (FDA's) ability to stop the marketing of herbs, dietary supplements, and other nondrug products that are unsafe or promoted with misleading claims.[2]

The combined effect of these 2 events and the development of the Internet have led to the greatest explosion of quackery that the world has ever seen. However, the "q" word has nearly vanished from the American scene and has been replaced by euphemistic slogans, such as "complementary and alternative medicine" (CAM).

In 2002, the NIH National Center for Complementary and Alternative Medicine (NCCAM) commissioned the Institute of Medicine (IOM) to investigate the use of "CAM therapies" by the American public, identify the major issues related to CAM research, and develop frameworks to guide future CAM research. The NCCAM also asked the IOM to explore things, such as "the shortage of highly skilled practitioners who are able to participate in scientific inquiry that meets NIH guidelines" and the incorporation of "successful approaches" into health professions education.

The project was deliberately crafted to avoid critiquing the methods themselves, listing those for which research would be a waste of money, or examining the quality of CAM teaching in medical schools.

The report's preface states that its authors "began with the question what do patients and health professionals need to know to make good decisions about the use of health care interventions, including CAM?" To me, the answer is very simple: accurate information. Methods that are plausible should be tested with well-designed clinical trials. The rest should be discarded. Despite all the alleged experts involved in its preparation, the IOM report does not contain a single word of criticism against methods that are sufficiently irrational to be discarded now. Instead, it makes broad, sweeping generalizations and attempts to set an agenda for the widespread adoption of "CAM" research and teaching.

This does not surprise me because the 17-person committee that was appointed to write it included at least 9 members with a financial conflict of interest, 5 of whom have received multiple grants from the NCCAM. At least 6 of the members either espouse, directly promote, or engage in pseudoscientific practices and had previously overstated CAM's value or promise.[3] Even worse, knowledgeable critics were excluded from membership on the committee, and the report's administrators did not permit testimony or invite review by anyone who might embarrass them by demanding that the report include appropriate criticism.

Most medical school teaching about CAM promotes its unscientific theories and practices. A survey of CAM curricula in 1995-1997 showed that only 4 of 56 course offerings were oriented toward criticism.[4] But instead of noting this problem, the committee merely recommended that more be taught.

CAM cannot be meaningfully defined because it is a marketing term that quackery proponents use as they please to make themselves sound respectable. But instead of recognizing this, the IOM committee adopted one of the many meaningless definitions and included a glossary of brief descriptions of about 120 methods derived from proponent claims. Enough is already known about 70% of these items to conclude that they should be discarded. (Palmistry, crystal therapy, trepanation, iridology, and various methods alleged to the manipulation of nonmaterial forces are stellar examples that deserve extinction.) However, the report does not criticize them or advise that they deserve no NIH research support.

In short, this is not a scientific report. It fulfilled self-serving questions asked by the sponsoring agency (NCCAM). It avoided the scientific questions that one expects the National Academies to address. It was prepared by a combination of individuals with economic conflicts of interest, ideologic devotion to the methods at issue, and a small number of academics who lack experience in detecting pseudoscience and misrepresentation. The report's only redeeming feature is its acknowledgment that the dietary supplement market is a mess. However, instead of concluding that the FDA cannot protect consumers unless DSHEA is repealed and the FDA is given powerful new tools, the committee made vague suggestions for "strengthening" it.

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