Editorial

State of the Art

The following developments over the past year should be of interest. It has been increasingly obvious that the “alternative medicine” movement has not been generated by public demand. Dr. Gorski’s analysis in this journal a year ago showed interest in “alternative” methods to be much less than claimed—perhaps as little as a quarter of the 34 to 44% so often quoted. The demand has been generated on one hand by ideological movements, and on the other by economic interests. The former include spiritual and religious healing cults, “New Age” consciousness expansion beliefs, and academic movements of cultural relativism and postmodernism. The economic forces include unscientific practitioner guilds such as chiropractic, traditional Chinese medicine and acupuncture, naturopathy, and the vitamin supplement industry. These interests over some fifty years or more have amassed enough power and following to challenge rational science and ethical medicine as the standards for conduct, and to demand and receive acknowledgment by government and other institutions.

The movement has infiltrated major social institutions such as academic medicine, legislative bodies, the press, and granting institutions. The watch-phrase is that “alternative medicine has gone mainstream.” At least that is the claim, even if in reality the movement is not as popular as claimed.

But there are also signs of the movement’s failure. In regard to funding, the good news is that many independent hospital and medical school programs are failing to be supported by volume and payment. The bad news is that private foundation and government money continues to pour into research and clinical programs, thus keeping the programs afloat.

The program at State University of New York at Stony Brook was all but eliminated, partly through objections of the faculty and partly because income could not support the program. Samuel Benjamin, MD, was recruited by the SUNY administration to head its complementary and “alternative” medicine (CAM) program without consultation with the medical school faculty, and in an apparent end run around usual protocol. Benjamin, an Andrew Weil disciple who had had little to no experience in the practice of medicine, received about $330,000 per year for three years. In return, the administration and Benjamin received the wrath of permanent faculty whose department funds were being limited.

The program at the University of Pittsburgh was reduced in scope after its director, Lewis Mehl-Madrona, was either fired or asked to leave after a stormy set of investigations (Mehl-Madrona claims he left voluntarily, but less than a year after he was removed as director). A modified but still active program continues at Pittsburgh under a different director, while the Beth Israel Hospital in New York inexplicably hired Mehl-Madrona as its new program director.

The University of Arizona program of Andrew Weil had several of its positions defunded last year because of economic shortfalls, despite Dr. Weil’s claim that he has waiting lists extending months. The program was rescued by the dean of the medical school, James Dalen, MD, who is also the editor in chief of the AMA journal Archives of Internal Medicine. Dr. Dalen, a supporter of CAM theologies and of Dr. Weil, was apparently able to appropriate $2 million of general university funds for the program by virtue of his position as dean. How long such subsidies will continue or when another collapse will occur remains to be seen.

What any utilization director should recognize is that services of personnel who administer anomalous methods are time consuming and are not going to be profitable in the long run. This will become more and more obvious as time and investigations show the methods to be ineffective, as originally charged.

A recent entry into another arm of the CAM movement is Laurence Rockefeller. Rockefeller funded the alternative medicine program at Sloan-Kettering Cancer Institute in New York to a reported $1 million in startup funds. Following use of the seed money, the program was expected to be self-sustaining. But the program now requires sharing of expenses with more Rockefeller money and the Sloan-Kettering Institute itself. This program, then, is also probably not a self-sustaining one, needing most of its support from sources other than the program’s income.

Rockefeller was reported in a recent New York Times article to be funding the Heffter Institute, devoted to furthering psychedelic research including into LSD and psyloscibin, a hallucinogen from mushrooms. While there is nothing bad about basic and clinical research, and there is plenty to learn about the hallucinatory experience, research so far in the field has been undisciplined, and the memberss of the institute seem to be ideologically involved with the mysticism of the psychedelic experience. Prior research from those associated with the institute was largely devoted to extensive descriptions of the hallucinatory experience, and the its “expanding of consciousness.” There was little short- and long-term objective measurement of results. Descriptions often read like Eastern mysticism tracts, with testimonial and philosophical wanderings. Laurence Rockefeller has not stated why he is interested enough in both the psychedelic movement and the “alternative medicine” movement enough to fund both with millions, but the connections between the two are certainly not coincidental, and Rockefeller is only one of many to see both in similar “mind-expanding” light.

We have listed previously a number of private “alternative medicine” funding organizations, and will from time to time list more and what we know about them. The problem such funding presents to the medical system is similar to that outlined in an article in the January 6, 2001, issue of Science. The author, from the University of Toronto, called such specifically directed funding to spiritual, religious, and other nonscientific research a corruption of the academic process. To call the medical school acceptance of “alternative medicine” grants less than a corruption is to hide from reality.

On the public front, some may have detected a shift in the press’ attitude toward dietary supplements. It seems that there are increasing numbers of reports of herb and supplement toxicity such as from ephedra, and the drug interactions reported from St. John’s wort. Medical commentators such as Dr. Dean Edell have been ratcheting up their warnings about unfounded claims and reported bad reactions. As if they have detected the same public reaction, a group of federal legislators have formed a bipartisan group called the Complementary and Alternative Medicine and Natural Foods Caucus to educate members of the House and Senate on policy and regulatory issues. The leaders of the caucus are Reps. Dan Burton (R, Ind) and Dennis Kucinich (D, Ohio), and Senators Tom Harkin (D, Iowa) and Orrin Hatch (R, Utah). Industry trade groups apparently hope to prevent any legislative amendment to the 1994 Dietary Supplement Health and Education Act (DSHEA). Ordinarily such a move would cause concern among advocates for science and law in the supplement marketplace, but why would those influential and powerful legislators bother to form such a group unless they saw a threat to their partisan positions supporting quackery? It looks to me like a sign of weakening and recognition that the public is becoming wise and may have had enough.

— Wallace Sampson