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Jan. 20, 2000 (Washington) -- Even though it's estimated that one-third of the American public used some sort of alternative treatment in 1997, including the comedian Rodney Dangerfield, these therapies still "don't get no respect" from many in the medical mainstream. Many clinicians hesitate to acknowledge even a potential use for alternative and complementary therapies. And now the medical experts are debating the appropriateness of research funding for these relatively new arrivals to the world of traditional medicine.
A case in point is a $1.4 million grant awarded to Nicholas Gonzalez, MD, from the National Center for Complementary and Alternative Medicine (NCCAM) to study the effectiveness of coffee enemas and enzymes in pancreatic cancer patients. NCCAM is a division of the National Institutes of Health. The National Cancer Institute also is underwriting the research. In spite of this backing from prominent agencies, many experts dispute the approach, and a state medical board has sanctioned Gonzalez, a Manhattan cancer specialist.
Victor Herbert, MD, a medical doctor and a lawyer who teaches at New York City's Mount Sinai School of Medicine, testified in court against Gonzalez. Herbert decries the trend to alternative therapies, which he says can't stand up to scientific scrutiny. "Scam sells, science sucks. We all know that," he tells WebMD.
Whether you love them or hate them, it's clear that alternative treatments have friends in high places that have helped them get more and more federal dollars. Since 1992, when the then Office of Alternative Medicine was born, the alternative and complementary therapies research budget has increased from $2 million to $68.7 million this fiscal year. NCCAM's 37% growth rate is the highest of any NIH center or institute.
But NCCAM Director of the Division of Extramural Research, Training, and Review Richard Nahin, PhD, bristles at the suggestion that congressional backers of alternative treatments are twisting the arms of NIH officials to push pet projects -- an idea that was raised in a recent Washington Post story on Gonzalez and his research. "Congress doesn't really interfere with us. They've never told us to study a particular product," he says.
"NIH certainly needed a prod to pay more attention to these therapies," says Peter Reinecke, a legislative aide to Democratic Sen. Tom Harkin of Iowa, one of the strongest advocates of alternative treatments in Congress. But Reinecke also says there was no intention of dictating specific projects.
"The American people are spending billions of dollars a year on [complementary and alternative treatments]. ... Are they worth the money? The American people have a right to know the facts, and it's our job to help generate that new and vital information," says NCCAM's first director Stephen Straus, MD, in a publication from NIH.
Nahin says that his center's standards for awarding grants are even more rigorous than other departments at NIH. "We're not here to advocate any given intervention. We're here to really test these things in as rigorous a way as we can and get out this information, whatever it might be," says Nahin.
Aside from Gonzalez' controversial cancer treatment, NCCAM is funding a number of studies including: acupuncture to relieve osteoarthritis; the botanical Hypericum, or St. John's wort, to treat depression; and another botanical, ginkgo biloba, to prevent dementia or intellectual decline in older people -- a $3-million dollar effort. "For botanicals in general, it's really the combination end product that produces the most efficacious results. It's not necessarily a single compound as you might see in a pharmaceutical," says Nahin.
But Herbert says the difference between a genuine and a bogus alternative can be straightforwardly measured by whether the treatment is safe and effective compared to placebo, and if the benefits outweigh the risks. "To run them through again and again after every test shows that they're worthless is ... not only a waste of money, but it perpetuates the fraud," says Herbert.
Why is it so many are seeking unproven alternative treatments in an era of high-tech medicine? In some cases the benefits may be more emotional than physical. "A lot of people who go through alternative medicine practitioners ... such as cancer patients or HIV patients, don't see that conventional medicine is offering them a cure," says Nahin. The nontraditional approach at least offers hope and is generally less invasive.
Herbert has a more cynical explanation for the growing acceptance of alternatives. "There's money in it. It's lucrative," he says.