Peter Chowka on March 26, 2001

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

James Gordon, MD, White House Commission Chairman: Next, we'll hear from Peter Chowka.

Peter Chowka: Thank you, Dr. Gordon. Commission members, ladies and gentlemen:

The Internet is helping to advance a long overdue revolution in medicine. It's become the fastest-growing, most vital tool ever for self-education. People all over now have instant access to unprecedented amounts of information. They also have the potential for meaningful interaction with other people and with professionals to an extent previously unimagined. We know that a majority of people who go online are looking for personal health information. There is finally the potential for real reform and a sense of empowerment in making personal health choices.

I bring a much broader perspective to this field than an affiliation with one publication or Web site and that's the basis for my comments today. For over two decades, I have been reporting about alternative medicine as a journalist and a medical-political analyst, covering both clinical and political developments. I've worked on documentary films; in radio and television; I've lectured; and I've written over 1,000 articles for magazines and newsletters. Since 1994 I've worked extensively with the Internet.

I've also worked with or provided testimony to a number of government entities including the U.S. Senate Nutrition Subcommittee in the late 1970s; the Office of Technology Assessment in the late 1980s; and the Office of Alternative Medicine in the early 1990s. I therefore have a reasonable understanding of news reporting and how the media work, what the public is interested in in terms of CAM, and both the potential and the limitations of the federal government's role in the field.

Many people disparage the government's involvement in medicine and the role of government in general. For example, Camille Paglia's comments in Salon.com on March 21: "Government has become a fat, lazy behemoth, spawning parasitic bureaucracies resistant to reform."

From what I've seen, I believe that the people working on behalf of CAM for the government are sincere. And I appreciate the opportunity to offer some thoughts on the subject of today's hearing in the spirit of both open dialogue and reality.

Health care today has become unbelievably complex. Medicine is now the nation's biggest business, and it's heavily influenced by politics and economics. Within that context, alternative medicine, despite its successes and well-documented utilization, is still a relatively weak player on a playing field that remains un-level. It continues to suffer from decades of prejudice.

Nineteen years ago, the late Dr. Linus Pauling told me that - in his view - change in medicine was coming from the bottom up, not from the top down. Well, today, change is being hastened by the synergy of alt med and the Internet, resulting in a new critical mass of thought, the outcomes of which cannot be predicted.

I've always felt that, before individuals can make fully informed medical choices, they need to have information about - or understand some of the context of - the structure, the politics, and the economics of modern medicine.

The Internet is providing that information. At the same time, the Internet is becoming invaluable clinically - primarily, to date, as a complement - a partner - to offline information and traditional contact with professionals.

Every major poll or study has found that the Internet is playing an increasingly important role in people's health education - and that individuals are indeed taking more control. A Roper survey from last week (March 21) [Americans take health care into their own hands] found "Americans rely more on themselves than on physicians when feeling under the weather. Following an emerging trend toward self-reliance, Americans say they are increasingly comfortable managing their own health care needs."

Looking pragmatically and realistically at the question of "What could the government do in this area of online CAM information?," some people think: Maybe the government shouldn't do anything! It should get out of the way of the private sector!

But that's unrealistic. Especially since the government has been mandated by the Congress to do something. And it's already doing a lot.

When one looks at the government's existing efforts in this area, there's unquestionably value - but there's a lot that's disorganized and boring and in my opinion largely valueless. There's tokenism. There's also a lot of needless complexity. For example, try searching the keywords "alternative medicine" at the FDA's Web site and see what you come up with.

So, my first recommendation is simplicity - as a reflection of traditional medicine itself and the art of healing. "Simplicity". . .along with a commitment to a citizen's self-education, autonomy, privacy, choice, and ultimate empowerment - all of which I hope we can agree are traditional ideals of American democracy. Start with the needs of the public and go from there.

I recognize the legal and ethical implications and the caution the government must exercise in order to avoid the appearance of endorsing or recommending particular therapies or approaches, especially since most of them remain "unproven" according to mainstream scientific criteria. The government is currently involved in an increasingly well-funded and lengthy process of identifying and evaluating some promising alternative therapies - many of them complementary or adjunctive in nature. It's a process that will take years - decades - and will probably never end. When those studies are published, it may indeed be valuable to have them and they will contribute to the information on the Internet.

Still, I don't think we have to wait for years for the data and the studies to come in. And data and studies are often not definitive anyway.

In the meantime, in the interests of keeping things simple, we can encourage the government to make information on CAM more readily available. Models exist: Natural HealthLine, a non-commercial newsletter and information Web site; other sites, especially ones of a content-driven, primarily non-commercial nature. The National Library of Medicine's MedlinePlus site (medlineplus.gov) is one of the better ones - but in the medical news area, it currently includes only Reuters articles. I think it's preferable to link to as many outside news stories and primary sources relating to CAM as possible.

I like the motto of the Fox News Channel: "We report, you decide." This could be amended to "We link, you decide."

I like the transcripts of meetings at the White House Commission on Complementary Alternative Medicine Policy site.

The House Committee on Government Reform, chaired by Rep. Dan Burton (R-IN), has a useful Web site. The Committee has held important hearings on alternative cancer, medical freedom of choice, and vaccinations. The written testimony is online.

The University of Texas at Houston's late program on alternative cancer had the beginnings of a valuable Web resource - but it's funding has ended."

There is an emerging consensus at the highest levels that medical information empowers people. For example, the Institute of Medicine's March 1 report A New Health System for the 21st Century. Included among the ten "rules" the IOM recommends is this one:

"The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them. The health system should be able to accommodate differences in patient preferences and encourage shared decision-making."

Specifically, the government might help to fund the creation of one or more portals to collect and organize offsite information relevant to CAM - and then link to it. It could be the portal of portals. With information on where to go for more information. A high priority should be providing links to relevant medical journal articles as they are published and the latest news stories. There are at least several score - if not several hundred - news reports every day now that have relevance to people interested in CAM.

Information, free flow, without prejudice, from a variety of points of view, including information that questions and challenges alt med practices.

One might ask, Isn't this recommendation a prescription for chaos? I don't think so. Considering the online information explosion, Jason Epstein offers this analysis in "The Coming Revolution" in the New York Review of Books last Nov. 2:

"The World Wide Web will destroy the filters that have traditionally separated publishable work from the surrounding chaos. But the profound human instinct by which people have always created order, distinguished value, and sustained markets amid multitudinous babble will create new filters. Distinguished and useful websites will prevail over inferior competitors and readers will find their way to desirable goods as they have always done. New technologies alter the forms of production but they do not annihilate human nature."

In closing, I'd like to summarize my recommendations to the commission:

• More resources should be given immediately to expanding the government's Web sites devoted to CAM.
  
  

• The sites can provide abundant resources without making specific recommendations. They could help to organize and link to the plethora of information that already exists - not only pro-alt med sources, but skeptical ones, as well. Let the American people have access to all of the information and then they can better decide what's best for them.
  
  

• The government can play a supportive role in helping to overcome the limitations with health info on the Web. On Jan. 15, 2001 a report by the Detwiler Group of Fort Wayne, Indiana "detail[ed] shortcomings of e-health sites." According to the report, "While Internet sites provide a convenient source of healthcare information, not all of their content is timely or accessible."

In summary: It would be helpful if the government's CAM programs could better implement the intention of Congress a decade ago to disseminate CAM information to the public by moving more proactively and aggressively into a leadership position with alt med online.

Thank you.

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