Complementary Medicine- it Doesn’t Complement and It’s Not Medicine

Offit’s lead editorial in the May issue of JAMA – profound

Paul Offit’s editorial in The Journal of the American Medical Association (JAMA. 2012;307(17):1803-1804.)  goes through the history of the National Center for Complementary and Alternative Medicine(NCCAM) and nicely points out that studies funded by NCCAM have failed to prove that complementary or alternative therapies have any more benefit than placebos.

Offit points out how NCCAM spent $374,000 proving lemon and lavender scents do not promote wound healing, $750,000 to prove that prayer does not cure AIDS, or improve recovery from breast reconstruction; $390,000 to find that ancient Indian remedies do not control type 2 diabetes, $700,000 to find that magnets to not treat arthritis or even carpal tunnel syndrome; and $406,000 to show that coffee enemas do not cure pancreatic cancer.

As much as we would love to find the new treatment that is available in your grocery store, or Ace Hardware, or Starbucks – it just has not been found.

Still, proponents of acupuncture, homeopathy, naturopathy, and even HCG diets, insist they have proof it is always in their own journals, with less than rigorous studies, and never reproduced in major medical journals. But clearly, science is less important to those who take these “treatments” than the potential of placebo effect.

This Month’s art is called “Circus Side show” Appropriate for NCCAM

Offit points out that while many drugs today were originally derived from plants (aspirin, quinine, digitalis, and artemisinin ) – the funding from NCCAM is not about finding the next great herb, isolating the ingredient, and then working out the chemistry. Instead NCCAM seems to be spending money on studies that reasonable people would laugh at, and know that they will lead to no improvement in the health and well being of our citizens.

Projects that funded programs are recruiting for include:

So I went to NCCAM website to see what sorts of programs they are funding and would they be, on the simple sniff test, something that would make sense in an era when we have a limited number of research dollars. Here is what I found:

A Pilot Study of Acupuncture Treatment for Dysphagia:
No study to date has found a use for acupuncture, why they keep looking is beyond me.

Antioxidant Therapy to Reduce Inflammation in Sickle Cell Disease:
Science is clear that most antioxidants are inactive when they leave the stomach, basic chemistry 101, and antioxidants have never been proven beneficial in any disease yet so why we continue to put money into this is proof that Snake Oil Salesmen abound.

Hypnosis for Hot Flashes Among Postmenopausal Women in a Randomized Clinical Trial:
How you randomize for this, do you have non-hypnotized women?
Patient Response to Spinal Manipulation – Pilot Study:
Spinal manipulation again, while massage has proven worth, spinal manipulation never has and it is an embarrassment that we allow chiropractors to be anything more than a historical footnote.
Probiotic Lactobacillus GG (LGG) in Patients with Minimal Hepatic Encephalopathy:
So you get a bunch of bad liver patients together, give them a dose of bacteria that won’t reach the colon and think you have a study. Amazing how probiotics have caught the attention of the public and marketers when we know  they are essentially useless unless done through a fecal transplant via colonoscopy.

Quantification of Outcome Measures for Mind-body Interventions:
How do you quantify the mind? What is mind over matter – and how come it doesn’t work when you have a real issue like an automobile accident or traumatic stab wound to the heart

Sauna Detoxification Study: Pilot Feasibility:
Ok, my ancestors from Norway love Saunas, but they detoxify nothing. Sweat glands in saunas cool people by simple sweat that is sodium chloride- there have never proven to be toxins in any sweat, in spite of what “ancient Chinese medicine” might think

We need regulation for supplements and Alternative Medicines

Better yet, if NCCAM would develop a registry where various herbal supplements that are sold would be noted, and tested to see if there is actually the ingredients that they state are. Then serve as a registry for adverse events, something the FDA is prohibited from doing. Because of the Dietary Supplement Health and Education Act of 1994 the FDA has no role in regulation of these items. But having a registry where reports of adverse events could be noted would be helpful. Manufacturers are not required to submit safety information before marketing “dietary supplements,” so only after multiple adverse events can the FDA act. Since the FDA is prohibited from monitoring and regulating Alternative medicine products, the public is virtually unprotected against supplements and herbs that are unsafe.

The article goes on to show that clear evidence that there is no efficacy or therapeutic value to these supplements does not stop people from buying them. This is further need that those individuals will consume anything with a label of “natural” or “organic” or perhaps endorsed by their guru, be it Mercola, or Dr. Oz, or Dr. Weil.  Regulation to allow these supplements to be tested, standards of manufacturing to avoid contamination, and a registry where health problems from the supplements occur may help protect these individuals from their worst enemy – themselves.

We as physicians, however, have a duty to our patients- a strong ethical duty of beneficence. Some mistake our ethic as “do no harm,” but it is not that. Treatments (medications, surgery) have known side effects and a risk-benefit ratio. Having a side effect does not violate beneficence as they are expected. However, if we prescribe a treatment that we know has no beneficial effect, we violate one of the basic tenants of a physician’s ethics. While government agencies do not have  ethics- physicians do, and I hope the physicians who sit on NCCAM take their ethics seriously.

Dr. Terry Simpson About Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and received his MD. Dr. Simpson, a renowned weight loss surgeon, is a leading advocate of culinary medicine. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.

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Comments

  1. The Doc says

    The government is there for the common welfare – as it states in the first articles of the constitution.
    It is sad how people think that something sold on Walgreens shelves, or GNC, or anywhere should be safe because “the government wouldn’t let it if it wasn’t” or people will claim that “they can’t say it if it wasn’t true.”
    We have a job to do- first as citizens to keep people from harming themselves because they might believe some outrageous claim

  2. says

    Homeopathy is a non-toxic system of western medical science originated in Germany by Dr. Friedrich Samuel Hahnemann (10 April 1755 Germany- 2 July 1843 France). He received his M.D. with honors in conventional medicine from University of Erlangen, Germany on 10 Aug 1779. From Germany (1796) homeopathy spreads to austria (1816) and then to the rest of the europe.
    The birth date of the founder and father of Homeopathy i.e. 10 April every year is celebrated as ‘ World Homeopathy Day ‘ and the week following his birthday i.e. 10-16 April every year is celebrated as ‘ World Homeopathy Awareness Week ‘ all through the world

  3. The Doc says

    It is “non-toxic” because it is so diluted there is no active ingredient in it. Hahnemann’s ideas include that you treat burns with more burns – contrary to all we know. His MD was given at a time when MD’s were a six week course, and far before the reforms from the Flexner report which got rid of silly ideas such as homeopathy. When The state legislature of Michigan tried to force the homeopathy school on the Board of Regents of the University of Michigan Dr. Zina Pitcher wrote:
    ...shall the accumulated results of three thousand years of experience be laid aside, because there has arisen in the world a sect which, by engrafting a medical dogma upon a spurious theology, have built up a system (so-called) and baptized it Homœopathy? Shall the High Priests of this spiritual school be specially commissioned by the Regents of the University of Michigan, to teach the grown up men of this age that the decillionth of a grain of sulphur will, if administered homœopathically, cure seven-tenths of their diseases, whilst in every mouthful of albuminous food they swallow, every hair upon their heads, and every drop of urine distilled from the kidneys, carries into or out of their system as much of that article as would make a body, if incorporated with the required amount of sugar, as large as the planet Saturn?

    Homeopathy holds the belief that even if you dilute the active ingredient to where there is no molecule of it left, that water will somehow remember what is there and have some magic propert. Homeopathy ingredients are sold in over-the-counter stores because they contain no active ingredient, and are essentially sugar pills. That anyone would look to Hahnemann as anything more than a fake or ascribe to the teachings proven false, is testament that people need to be protected from themselves.

  4. Damo says

    Hey doc, did you here about the homeopathist that took his single pill?

    He overdosed!

  5. Lynn says

    I recently decided to try a drugstore brand of homeopathic eye drops for what I thought was viral conjunctivitis. 24 hours later, I was in such pain that luckily an eye doctor saw me right away. I was given prescription antibiotic eye drops with a bit of steroid and improved within hours.
    A friend of mine spent a few months studying Bach flower remedies before opening up a practice in her home. People flock to her for everything from cancer to psychiatric problems and pay for the office visit as well as the remedies. If her children fight, she sprays the air with Bach flower remedies to calm them down. Doctors spend years studying cancer treatments but she claims to have the answer after just a few short months. Of course most of her cancer patients get some other form of treatment as well such as South American chicken blood. She does claim that even if a person gets conventional treatment, her flower remedies will prevent recurrences by eliminating the mental stress that she claims gave them cancer to begin with. To give the devil it’s due, there was some Harvard study correlating cancer to stress.

  6. The Doc says

    We are scratching the surface and yet, flower power – who wouldn’t want that to work. We all have stress – and eventually we will all die from something.

  7. Cinnie Morgan says

    I’ve always liked alternative med in principle, but I agree w you, and have never gone that route. There are lots of really bad docs out there, and I’ve met more than my share. That doesn’t make the huge body of scientific research and the billions (more?) of hours that physicians put into learning less reliable than advice from the modern equivalent of a snake oil salesman.

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