Cures or `Quackery'?
How Senator Harkin shaped federal research on alternative medicine
Cassileth says she has tried in vain to point out at the advisory council meetings that clinical trials are the only way to know for sure if a treatment does anything. She points out three fundamental flaws in taking a clinic's apparent success rate at face value. First, many people who go to alternative clinics do not even have the disease for which they are being "treated." Second, "most people with serious illnesses who seek unproven methods have already received conventional care." Finally, most people who use unproven methods have minor problems such as temporary backaches, colds, allergies and headaches that will go away no matter what therapy, if any, is used. "Unless you compare people with the same problem who don't get the treatment, you never know" if the treatment actually is responsible for the patient's improvement, says Cassileth. "That's the comparison they're so afraid of."
Beyond all this, it also is not even clear that the OAM has fulfilled its charge of seriously evaluating promising alternatives. The office has awarded $4.8 million in grants to date; eight grants, totaling $1.9 million, were made with other NIH institutes to fund relatively straightforward clinical studies, but most of the grants--42 to date--have been made for "exploratory pilot projects" of $30,000 apiece. A review of the grants reveals many vague studies unlikely to yield conclusive results. A study of ayurvedic medicine, the traditional medicine of India, divided patients into three groups: One group received a one-time "risk assessment"; one received information on aerobic exercise, low-fat diets and relaxation; and the third received instruction on yoga, "primordial sound meditation" and ayurvedic dietary principles. The study is to follow the patients' cholesterol, blood pressure and general health status for a year. But with only 30 patients in each group, the study's director, Dr. David Simon of the Center for Mind-Body Medicine in San Diego, maintains that even if no significant differences emerge among the groups, that doesn't discredit ayurvedic medicine--it may just mean the sample size is too small.
"Pray-ers." Another one of the $30,000 studies seemingly unlikely to yield definitive results, conducted at the University of New Mexico, has looked at "intercessory prayer" to treat drug addiction. A group of "pray-ers" from the Albuquerque religious community agreed to pray for drug addicts in the experimental group at least once a week; the success rate of the prayed-for was to be compared with that of the not-prayed-for. (To safeguard patient confidentiality, the pray-ers were given only the first names of patients. But then to make sure the Almighty did not become confused as to which "Jim" was being referred to--the experimental-group Jim or the control-group Jim--the pray-ers were also provided with the patient identification numbers for the intended recipients of their prayers.) The principal investigator, Dr. Scott Walker, did not respond to requests for the results of this study.
Critics of the OAM are hopeful that with last November's election, the scheduled rotation of several of the Harkinites off the advisory council and the arrival on July 1 of a new director of the office, Dr. Wayne Jonas, a researcher at the Walter Reed Army Institute of Research, the office may yet get back on track. "I think it was something very well intended," says Jacobs, "but politicians and has-been politicians can't seem to leave well enough alone."