When I take a history from a new patient or update her history during a return visit, I always ask her what medications she is currently taking. After she relates her prescription meds, I then inquire about her use of supplements, over-the-counter substances and alternative therapies. And the list is usually long; hence, I read with great interest a “Viewpoint” article that appeared in the May 2 issue of JAMA. It was titled “Studying Complementary and Alternative Therapies”. The author cited statistics from the National Center for Complementary and Alternative Medicine (NCCAM) whose budget is now $1.6 billion. Currently 50% of US residents use some form of alternative medicine and 12% use it for their children.
We are reminded that Hippocrates used leaves from the willow plant to treat headaches and muscle pains; that in the 1800′s the active ingredient of aspirin was isolated, and that quinine from the bark of a cinchona tree was used to treat malaria as early as the 1600′s. Another malaria drug that contains an herb called Artemisia was used by Chinese healers for thousands of years. Clearly these herbs, plants and practices have been important in the development of healing and soothing medications.
The author, however, focuses on some of the expensive studies by the NCCAM that showed failure of efficacy. Apparently $374,000 was spent in an attempt to see if inhaling lemon and lavender scents would promote wound healing (it didn’t), $750,000 to establish whether prayer cures AIDS or hastens recovery from breast reconstruction surgery, $700,000 to investigate whether magnets would treat arthritis, carpal tunnel syndrome or migraine headaches (not proven), and $400,000 to find out if coffee enemas cure pancreatic cancer. (What do you think?) They have also investigated acupuncture and therapeutic touch and, so far, their controlled studies have found that they work no better than placebo. Ah, but “here’s the rub”… Placebos have often been found to alleviate many symptoms and make us feel better. They may “tell” the brain that something is being done and perhaps induce the release of neuromediators that block pain and promote symptom relief.
The author goes on to point out that there are scientists who are avid proponents of the value of negative studies. For example, studies have shown that combination measles-mumps-rubella vaccine does NOT cause autism. But he argues that a negative finding frequently does not change public behavior. There are still many parents who are afraid to vaccinate their children and as a result the rate of pediatric morbidity and mortality from these and other diseases has risen.
When it comes to megavitamins and supplements, there is an ongoing “Why not use it, it won’t hurt” attitude. He points out that several NCCAM-funded studies have shown that garlic does not lower low density lipoprotein cholesterol, ginkgo does not improve memory (I forgot about that one!), St. John’s wort does not treat depression, echinacea and megavitamins do not treat colds. And some studies have shown that megavitamins increase the risk of cancer and heart disease. Vitamins and supplements are not regulated by the FDA. But these negative data do not seem to negatively impact our need to hope that they work. In 2010, the vitamin and supplement industry grossed $28 billion, up from 4.4% the year before. (I am thinking of having a vitamin of some sort named after me, it might provide a great financial legacy for my kids…just kidding!)
I want to quote the conclusion of the article, it was quite amazing: “Because negative studies performed without a sound biological basis have little or no success, it would make sense for the NCCAM to either refrain from funding therapies that border on mysticism such as distance healing, purging, and prayer; redefine it’s mission to include a better understanding of the physiology of the placebo response; or shift it’s resources to other NIH institutes
I think he makes a good point.