COMMENTARY

Which Complementary and Alternative Therapies Merit Study?

Paul A. Offit, MD

Disclosures

May 17, 2012

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Hi. My name is Paul Offit. I am speaking to you today from the Vaccine Education Center at the Children's Hospital of Philadelphia. I thought I would talk about a viewpoint piece that appeared in the most recent issue of the Journal of the American Medical Association.[1] It involved studying complementary and alternative medicines, specifically focusing on the National Center for Complementary and Alternative Medicine. This center was born as the Office of Alternative Medicine, in 1992, by the influence of 2 Iowa politicians. One was Tom Harkin, who believed that bee pollen had cured his hay fever. The other was Berkley Bedell, who believed that cow colostrum had cured his Lyme disease. Their notion was that alternative medicines, if studied, would move into the mainstream.

Since the founding in 1992, the National Center for Complementary and Alternative Medicine (NCCAM) has received about $1.6 billion of federal money to study a variety of things. What they have studied has been disappointing. They spent hundreds of thousands of dollars to see whether prayer treated AIDS; to see whether prayer could promote wound healing after breast reconstruction surgery; to see whether coffee enemas could treat pancreatic cancer; to see whether magnets (in mattresses or otherwise) could improve carpal tunnel syndrome, migraines, or arthritis; in addition to whether lemon or lavender scents could improve arthritis. I think the disappointing part of these studies is that they are not based on any biological principle. In fact, they seem to hark back to a much more distant time, before we really understood the pathophysiologic basis of diseases and were able to direct treatments towards them.

You could argue that negative studies are of some value, even when they are not based on any sound biological principle. For example, when Andrew Wakefield claimed that the measles, mumps, and rubella vaccine caused autism, or when there were fears that thimerosal and ethyl mercury-containing preservative in vaccines caused autism, they, too, were not based on any biological principle. But in any case, those negative studies were useful in being able to reassure parents that their concerns or fears about those vaccines were ill founded and that studies showed that vaccines do not cause autism.

One could then argue that these negative studies are of some value, but that does not seem to be true in regard to complementary and alternative medicine. Many studies have shown that megavitamins are not what they are claimed to be. In fact, a number of studies have shown that megavitamins can increase one's risk for heart disease or cancer or shorten a person's life. Studies have shown that chondroitin sulfate and glucosamine do not treat arthritis, or that St. John's wort does not treat depression, or that ginkgo does not improve memory, or that garlic does not lower low-density lipoprotein cholesterol, yet we are still looking at alternative and complementary medicine, a $34 billion-a-year business. I think few people are aware of those studies, so it hasn't really changed behavior.

For these reasons, I think that NCCAM should reevaluate its portfolio. One could argue that just because an alternative medicine does not work better than placebo, that doesn't mean that placebos don't work; or, said another way, that alternative medicines can act as placebos. If NCCAM wants to study the placebo response or the physiologic basis of the placebo response, I think that is of value. But I do think that studies that have bases that, frankly, border on mysticism are not of value. Thank you for your attention.

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