ALTERNATIVE MEDICINE: Journal Blasts Untested Treatments
This week's New England Journal of Medicine features several clinical studies that document serious dangers associated with non-standard medical treatments involving herbs and dietary supplements, and a separate editorial unambiguously denounces alternative medicine as "a reversion to irrational approaches to medical practices." The Boston Globe reports that the journal's executive director, Dr. Marcia Angell, who authored the editorial along with editor-in-chief Dr. Jerome Kassirer, said, "'[W]e're not holding alternative medicine to the same standards' of scientific validity as conventional medicine." She added that doctors should "stop patronizing [their] patients" when it comes to alternative therapies: "Don't just shrug it off and say it probably won't hurt you."
Case By Case
The featured articles include:
- An account of two pediatric cancer cases in Alberta, Canada, in which two children opted for herbs and shark cartilage, respectively, to treat their tumors. One child's cancer worsened, the other died (Saltus, 9/17).
- A study of a combination of herbs known as PC-SPES that reduces signs of cancer and decreases levels of testosterone that fuel tumor growth, but also "acts like an estrogen hormone and can pose dangerous side-effects such as blood clots."
- A sampling of 260 Asian herbal remedies by the California Department of Health Sciences which found that one-third were contaminated with heavy metals.
- A case in which a woman ingested a herbal remedy contaminated with "a naturally occurring form of digitalis" and experienced "nausea, vomiting and heart palpitations" (Uhlman, Philadelphia Inquirer, 9/17).
No Free Ride
In the accompanying editorial, Angell and Kassirer cite two factors behind the public's "increased interest in alternative medicine": "the often hurried and impersonal care delivered by conventional physicians," and Congress' exemption of herbal remedies from FDA regulation "[i]n response to a lobbying effort from the multibillion dollar" industry. The editorial concludes: "It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine -- conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work (NEJM, 9/17 issue).
Docs And Industry Reax
In response to the editorial, Dr. Andrew Weil, head of the University of Arizona College of Medicine's Program in Integrative Medicine, said that although "there is a huge and embarrassing gap between what patients are doing and what doctors know ... editorials like this don't help heal the gap." Purdue University's Dr. Varro Tyler, while agreeing that "a problem exists," said "there is also a very responsible segment of the industry and this kind of diatribe really hurts the whole industry" (Boston Globe, 9/17). Annette Dickenson of the Council for Responsible Nutrition, a dietary supplement trade group, said, "The entire editorial is a strange mix of product-related complaints, which we believe can be effectively addressed under the current law, and frustration with the entire practice of alternative medicine, a different topic entirely and one not affected by today's regulations. This shows that the medical community is struggling with the public's desire for alternative roads to better health" (MacPherson, Newark Star-Ledger, 9/17). However, Dickinson admitted "there may need to be (regulations requiring) a separate evaluation, a more formal evaluation, of [the supplements'] efficacy and benefits" if they are marketed for specific purposes (Brown, Washington Post, 9/17).