White House Commission on Complementary and Alternative Medicine Is Biased
The White House Commission on Complementary and Alternative Medicine policy was created by an executive order of President Clinton on March 7, 2000. This was in response to enormous political lobbying, especially by Senators Orrin Hatch and Tom Harkin. The purpose of the Commission is to develop a set of legislative and administrative policy recommendations that will “maximize the delivery of alternative medicine to the public.”
The former president was to appoint nineteen commissioners. It is the view of the editors of the Scientific Review of Alternative Medicine (the only peer-reviewed skeptical journal in the field) that virtually all of the members of the Commission selected thus far are in favor of alternative medicine, and that the Commission is not fairly represented by skeptical medical scientists. Incidentally, it is unclear at this time as to what the new Bush administration will do with the Commission.
The Commission has been holding open public forums throughout the country. I was invited by the Commission to present testimony before it, and I did so on behalf of CSICOP on December 4, 2000, in Washington, D.C. The following are my written responses to questions provided to me beforehand.
Should Complementary Alternative Medicine (CAM) be integrated with conventional medicine and why or why not?
I do not think that it should be integrated. I deplore the efforts to do so. The term “conventional medicine” is a misnomer. What is labeled as “conventional” is modern scientific or evidence-based medicine. Many or most CAM therapies on the other hand are conventional and ancient, such as traditional Chinese medicine, qigong, or spiritual importations from India.
Scientific medicine is a relatively recent development in human history, especially since the nineteenth century, when increased knowledge of physiology and human anatomy was refined. There have been a number of brilliant researchers who have contributed to our understanding, such as Claude Bernard, Louis Pasteur, Robert Koch and Joseph Lister. Theories about the nature and transmission of infectious diseases-such as diphtheria, tuberculosis, malaria, typhoid, tetanus, polio-and the development of vaccines had important roles in immunization. Likewise important were the advances in epidemiology, public health, and sanitation. In the twentieth century endocrinology advanced-with the discovery of insulin, cortisone, and sex hormones. In the field of nutrition, researchers discovered the role of vitamins. There have been significant new diagnostic tools, such as X-ray imagery, CAT scans, mammography, and sonograms, to mention only a few. The great strides in surgery have been impressive, including cardiology, neurosurgery, and organ transplantation. The discovery of antibiotics has made enormous contributions to the cure of infectious disease. We should add to this the discoveries of DNA, biogenetic research, gene therapy, and other innovations on the frontiers of research. All of these achievements have led to the reduction of infant mortality and the extension of life spans. Part of this process was the development, beginning in 1904, of rigorous standards of education in medical schools. Thus we see the remarkable effectiveness of modern scientific medicine-all for the benefit of mankind.
The key factor in evidence-based medicine is that any new diagnostic techniques and therapies be submitted to rigorous, double-blind clinical tests. Unfortunately, CAM therapies, in our view, have not been adequately tested. Too often the claims of their validity have been anecdotal or highly subjective, uncorroborated reports by practitioners and/or their patients, some of these based upon the placebo effect.
Surely, we cannot lump all CAM therapies together and make a blanket indictment. Each has to be examined objectively and impartially. Scientific medicine admits that fallibility and skepticism are parts of its process of inquiry. On the other hand, we should insist that the public be safeguarded against unproven cures, untested therapies, and quackery by practitioners and manufacturers out to make a profit.
Should there be access to and delivery of CAM products and practices? If so, why? If not, why not?
I do not think that there should be universal access and delivery of CAM products and nostrums. This will tend to weaken what is one of the finest health care systems in the world. CAM could undermine the line between genuine science and pseudoscience. Each claim to validity must be tested by impartial, neutral observers-not simply their advocates. If a therapy proves to be effective, then it becomes part of scientific medicine. It is vital, in our view, that this Commission represent not only proponents of CAM, but scientists and physicians who are skeptical of its claims.
If current CAM utilization trends continue, what consumer protection should be implemented?
CAM seems to be growing. I think the public should be protected. The government has an obligation to act against spurious or fraudulent claims. The free market-in selling adulterated goods and questionable services-needs to be monitored. The misuse of taxpayers funds needs to be safeguarded. The great issue is the health and welfare of the American public. Government sponsorship of questionable CAM therapies would be a disservice to the public interest.
What policy recommendations do you have for the Commission?
I would strongly urge as a first step the repeal of the 1994 Dietary Supplement Health and Education Act, which freed herbal medicines and dietary supplements from regulation by the FDA. Prescription drugs are required to be tested. There are no such safeguards for dietary supplements. There are now some 20,000 such supplements-including herbal and homeopathic remedies-on the market. Many of the manufacturers make false and misleading claims. Many have dangerous side effects. Some may have positive results. In any case, the packages should be properly labeled-there should be “truth in labeling.” Those medications deemed to have possible noxious side effects by misuse should require a prescription.
Second, similar regulations should be enacted against other false claims-such as quack cancer cures, crash diets, Chelation therapy, iridology, therapeutic touch, and magnetic therapy. This is particularly important when patients avoid scientific medicine and substitute alternative therapies, believing that since they are offered by the health delivery system, they must be effective. There needs to be peer review, as in scientific medicine, not simply by the practitioners in a field, but by other objective and neutral scientific reviewers.