Scrutinizing Alternative Paths to Health : Medicine: Do acupuncture, herbs, massage therapy, meditation and hands-on healing really work? The National Institutes of Health hopes to find out through a new office that will put them to the test.
As do many HIV-positive people, Elena Monica does all she can to maintain her health and avoid the disease’s symptoms.
She sees a conventional medical doctor who checks her blood and advises her. But she also undergoes oxygen therapy, an unproven remedy that involves intramuscular injections of pure liquid oxygen. And she practices chiqong , a form of Chinese meditation.
“Most people (with HIV) have to take some sort of action to get themselves healthier,” says Monica, 27, a Los Angeles actress. “And unless you’re unconscious, it’s hard to avoid alternative medicine in this town.”
Since learning a year ago that she had contracted HIV (the virus that causes AIDS), Monica says she has felt fine and suffered no symptoms. (It’s not uncommon for people to remain symptom-free for years after being diagnosed.)
The problem with her therapy--and with most unconventional medical practices--is that no one can say for certain whether they really work.
That may change.
In an action some call historic, the National Institutes of Health this year opened a small office to study the many alternative practices and therapies flourishing in the United States.
The office for the study of unconventional medical practices--the name is tentative--will put such therapies as acupuncture, herb medicine, massage therapy, meditation and hands-on healing to the kind of scientific scrutiny applied in conventional medicine.
The project is loaded with promise--and with problems.
Among the latter: how to ease the tensions between alternative therapists and conventional medical doctors and promote cooperation and how to test therapies that, practitioners say, are often based on a complicated blend of mind, body and spirituality.
“One of the questions I’ve raised is: What should we call this office? Unconventional? Alternative? Complementary?” says Dr. Jay Moskowitz, associate director for scientific policy at NIH. “Since we are doing this to bring two communities together, unconventional and conventional medicine, I want them both to be comfortable with the name.”
The NIH, which funds the majority of the nation’s medical research, responded to a congressional mandate to research alternative medicine. Alternative health advocates lobbied Sen. Tom Harkin of Iowa, head of the Senate Appropriations Committee, to increase federal funding for studies on alternative medicine. Congress eventually mandated NIH to open the office with a budget this year of $2 million (the agency’s overall budget is $8.9 billion).
Public hearings to plan the office were held in June. And, earlier this month, an ad hoc committee began developing its first projects.
“There was some anxiety about whether our effort is for real,” Moskowitz says. “We are serious about this. More and more people are asking the question: In addition to conventional medicine, is there an adjunct? Can we supplement this practice with something else? That is what we will look at.”
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Although some alternative practitioners are suspicious, most welcome the government’s involvement.
“I think that this is a new era,” says Frank Wiewel, founder of an alternative health association called People Against Cancer.
“I believe this is about the changing face of American medicine. For example, we cannot afford to lose 600,000 of our citizens to cancer every year. We must look at new directions. And this is what this office is about. This office is going to look very seriously in a scientific way at whether or not these alternatives offer promise.”
Says Eve Campanelli, a homeopathic practitioner in Beverly Hills: “It’s mind-boggling. It’s very exciting. It’s about time.”
Dr. Deepak Chopra, the leading U.S. proponent of an ancient Hindu system of medicine called Ayurveda and a former practitioner of conventional medicine, also believes it’s time to explore the legitimacy of alternative medicine:
“It’s an opening up within the mainstream medical Establishment of ideas that have been considered alternative. The younger generation of American doctors feel it’s time to look at alternatives to traditional Western medicine.”
There is also growing recognition that many forms of alternative medicine address two weaknesses in conventional medicine: It is often less expensive because it shuns invasive therapies and high-technology equipment, and it emphasizes prevention.
“Holistic health care costs less,” says Steve Gorman, president of the Calabasas-based Alliance for Alternatives in Healthcare. “If you can prevent back surgery with 20 treatments of acupuncture, that’s a lot less expensive.”
And in the quest to learn more about prevention, more conventional doctors have come across alternative therapies, he says: “I think a lot of (mainstream physicians) are having more favorable experiences with alternative health care. A lot of people who have practiced conventional medicine all their lives have stumbled upon some aspect of alternative medicine that they find helpful.”
Moreover, the American public has grown increasingly dissatisfied with therapies that don’t work, cause severe side effects or make them feel powerless, Wiewel says. Nearly 30% of respondents to a 1991 poll for Time magazine and CNN said they had tried some form of alternative medicine and 84% of that group said they would do so again.
“We know now that surgery, chemotherapy and radiation are effective for only small numbers of people with cancer. They have not affected cancer rates,” Wiewel says. “We really have an opportunity here to see if there aren’t some other things that people want, therapies that don’t make them sick, therapies that will help.”
Americans are particularly interested in natural remedies, like vitamins or herbs, to replace expensive and highly toxic drugs, Gorman says: “There is recognition of the ineffectiveness of a lot of prescription drugs. I think people would like a more natural way of doing things.”
Elena Monica, for instance, is not interested in AZT or in other traditional drugs used to treat HIV infection because they can cause side effects. Pure oxygen therapy is nontoxic, she says. Monica’s physician has said her T-cell count, a measure of her immune system’s ability to fight the infection, is high enough that she has no need for AZT. (A number of studies have endorsed AZT as a means of boosting the immune system in HIV-infected people.)
The doctor is not concerned about Monica’s use of unproven therapies as long as they are nontoxic, she says. Still, Monica welcomes government inspection of unproven remedies to evaluate their safety and efficacy: “The bottom line with me is that I’ve seen results. But since so many people have a hard time with new ideas, if getting ‘approval’ raises their consciousness, that’s fine.”
Mainstream medical doctors and NIH officials view the new office’s value somewhat differently. They think it may help reduce quackery and the dangerous, unproven and misleading medical therapies to which many Americans are exposed.
“It will help in the removal of practices where there is no (proof),” Moskowitz says. “If the results of our studies are negative, I think the practitioners and patients will look at those results and make a decision. And we have to make sure the data from these studies are disseminated as quickly as possible.”
The office for the study of unconventional medicine will be only the first step if alternative medical practices are to gain broad U.S. acceptance, experts say.
Because of its small budget, the office will focus first on some already promising alternative therapies, like acupuncture. Many alternative therapies will be judged for their efficacy against heart disease, cancer or AIDS, Wiewel says, and diet and nutrition therapy will be a priority.
“I think we’re going to see a lot of study into dietary programs,” he says. “This will encompass things like nutritional supplements, which, I think, offer great promise.”
The office will also look at chronic conditions that conventional medicine has not had much success treating, Chopra says, such as migraine headaches, menstrual disorders and ulcers. One early study may involve alternative therapies for pain control, including acupuncture.
“That will immediately give people an idea that these things can really work,” he says.
Each therapy will be studied for safety and medical and cost effectiveness.
Many alternative medicine proponents, however, are concerned that study methods for conventional medicine will not work for alternative therapies. In conventional Western medicine, studies are often designed with two groups of people, one group that undergoes the therapy and a comparison group that receives either no therapy or a placebo. Often, neither doctor nor patient knows which group a patient is in. Such testing ensures that a single variable can be studied without bias.
But many forms of alternative medicine consist of multiple variables, such as an herb, plus meditation, plus the mind-set that the body can heal itself, says Campanelli, author of a holistic health book, “Feeling Very Much Better.”
“How do you document this stuff? I’m concerned about that,” she says. “There are other factors involved other than what we can see and what we can touch. Patients will ask me, ‘Why did this go away? Was it because I meditated? Or was it because I drank carrot juice? Or was it the herbs?’ I tell them I don’t know.”
The new office’s small staff will help doctors and scientists design studies that address this dilemma, Moskowitz says: “Just because there have been historical barriers that unconventional medicine has faced in the past, it doesn’t mean there aren’t new ways of moving forward. I have asked them to be innovative and creative in thinking of new ways of approaching these studies.”
There will be little money available for long-term, large prevention studies, such as looking at whether a certain vitamin or herb reduces cancer risk.
But the mere existence of the office will have a trickle-down effect, Chopra says. He predicts that many more medical schools will establish departments of alternative medicine. And, he says, other branches of the NIH and private funding sources may also take an interest in alternative therapies:
“The very fact that the government is willing to fund things like meditation, herbs, acupuncture, message therapy is going to open up a whole range of possibilities in medicine.”
