Alternative Health Panel Under Attack

This section is compiled by Frank M. Painter, D.C.
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By Judy Packer-Tursman
Special to The Washington Post
Tuesday, March 19, 2002; Page HE01

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Critics Contend White House Report Favors Bad Science

Within days, Health and Human Services Secretary Tommy Thompson is expected to unveil a package of recommendations for maximizing the potential -- and mitigating the perils -- of unconventional medicine.

The report urges federal officials to spend more money on research into complementary and alternative medicine (CAM), better educate and regulate practitioners of these therapies, publicize the risks of certain CAM treatments and expand insurance coverage to make CAM affordable to more Americans.

The recommendations are the work of the White House Commission on Complementary and Alternative Medicine Policy, whose 20 highly credentialed members included medical doctors, acupuncturists, a chiropractor, a naturopathic doctor, two nurses and a dentist.

An esteemed group? Perhaps President Bill Clinton thought so when he appointed the panel two years ago. But critics of the commission feel otherwise. In September, a dozen academic psychologists called for the commission to be dissolved and charged that its chairman, Washington psychiatrist James Gordon, "has been a longstanding and highly partial advocate for untested and unsubstantiated medical practices."

The commission's findings have been challenged even from within. On March 11, the day the panel sent its final report to Thompson, two commission members filed a separate view, according to a source familiar with the commission's work.

The dissenters objected that the report didn't acknowledge the limitations of unproven CAM interventions, didn't set research priorities and failed to define which CAM practices and products lack scientific credibility and are demonstrably unsafe, said the source, who declined to be identified. The pair were also said to have criticized the inclusion of spirituality as a CAM modality, insisting that neither mainstream nor unconventional medicine can claim prayer as a treatment technique.

The source identified the dissenters as Joseph J. Fins, director of medical ethics at New York-Presbyterian Hospital's Cornell Campus, and Tieraona Low Dog, an expert in botanical medicine who is based in Albuquerque. Low Dog could not be reached for comment. Fins would say only that he and Low Dog had sent a statement to Thompson "just to clarify our position."

Commission member Dean Ornish, a prominent proponent of using diet to control heart disease, said he also "had some reservations" about the report and had considered writing a separate statement. But he says he stayed with the majority because Gordon and Stephen Groft, the panel's executive director, "incorporated each and every one of those concerns" into the report's introduction. He said the same invitation had been extended to Fins and Low Dog.

Ornish, a clinical professor of medicine at the University of California at San Francisco, said he argued that rigorous initial research was needed to show the safety and efficacy of the many unproven CAM therapies, followed by demonstration projects to determine their cost-effectiveness. Only after such studies have been done, he said, would it be appropriate to discuss such issues as insurance reimbursement and licensing for therapies that have been shown to have value.

"It is premature to advocate wide implementation of CAM modalities yet unproven," Ornish said.

This Is About Science

The psychologists who went public in September focused much of their criticism on Gordon, a psychiatrist who directs the Center for Mind-Body Medicine in the District. In a letter to Surgeon General David Satcher, they claimed that Gordon has supported therapists who take seriously the claims of patients who believe they were abducted by aliens and collaborated long ago with the Bhagwan Shree Rajneesh, a cult leader who was deported from the United States in 1985 after followers tainted salad bars in Oregon with salmonella, sickening more than 750 people.

The psychologists dismiss most of the White House panel's other members as "unscientific practitioners, dietary supplement entrepreneurs, and CAM-supporting academics" who favor "an expanded bureaucracy that will further the special interests of ideologues and profiteers" without advancing scientific knowledge or protecting consumers.

Stephen Barrett, a retired psychiatrist known for posting blistering refutations about alternative therapies on his "Quackwatch" Web site, said he wants the Bush administration to reject the commission's recommendations because they "would promote unscientific practices and waste countless millions of taxpayer dollars."

Gordon said he is dismayed by such criticism. But rather than address the charges, he said, the commission's final report should speak for itself.

"I would say [critics] should read the report and comment on the report," Gordon said. "Let's have a discussion on the merits [of the document]. Let's not engage in unsubstantiated ad hominem attacks. This is about science. This is about dialogues."

Gordon said the commission easily agreed on the need for more research dollars to determine whether alternatives are safe and effective. But he acknowledged differences of opinion on regulatory issues and the licensing of unconventional practitioners. He said some members wanted strict regulation to ensure public safety, while others stressed freedom of practice; ultimately, the panel decided it could not say what was the best way to regulate alternative practitioners.

Report's Fate Is Uncertain

Stephen E. Straus a medical doctor who directs the National Center for Complementary and Alternative Medicine (NCCAM), said it is not surprising that feelings about the report are intense.

"CAM has evolved as a parallel health care option for Americans," Straus said. "It is rooted in a different set of traditions and built upon different levels of evidence than contemporary biomedicine. As its popularity has grown, members of the mainstream community have voiced concerns as to whether CAM approaches are as safe and effective as claimed. Advocates of CAM believe longstanding use of an approach and the responses to them of individual patients is all the evidence that is needed. Thus, there is a substantial difference in philosophy and a corresponding tension between groups."

It remains to be seen how much weight the Bush administration will give to a report from a group convened by its Democratic predecessor. Bill Hall, a spokesman for the Department of Health and Human Services (HHS), said the department will consider the panel's suggestions.

Sen. Tom Harkin, D-Iowa, the moving force in Congress behind the commission's creation, continues to voice support for the effort. "I'm hopeful the commission's recommendations will help move toward the day that Americans can get the best of both traditional medicine and complementary medicine," he said. "Public policy has not kept up with consumers or the science in this area. People are spending record sums out of their own pockets for complementary health care and they have a right to expect good and reliable information and continued access."

A spokesman for Sen. Arlen Specter, R-Pa., ranking member of the appropriations subcommittee that funds HHS activities, said, "Clearly [alternative medicine] is of interest" on Capitol Hill. Indeed, Congress has approved a steadily rising stream of research funding for NCCAM in recent years. According to a spokeswoman for NCCAM, the annual investment in CAM research in that center and other parts of the National Institutes of Health is slightly more than $200 million.

Judy Packer-Tursman is editor of Alternative Medicine Research Report (AMRR), a newsletter whose editorial advisory board offers guidance to conventional clinicians on scientific studies of CAM therapies. AMRR board member Xiaoming Tian, a member of the newsletter's advisory group, served on the White House commission.

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