Shark cartilage, coffee enemas, high-intensity light, and energy field manipulation: Complementary and alternative medicine has its curiosities and, of course, its doubters. Cancer biologist Saul Green, retired from Memorial Sloan-Kettering Cancer Center and now scientific editor of Scientific Review of Alternative Medicine, says political pressure, not scientific merit, generates funding for the National Center for Complementary and Alternative Medicine (NCCAM)--expected to exceed $113 million (US) in 2003. An estimated 42% of the US population used at least one of a set of common CAM therapies in 1997--a significant increase from a study in 1990.1 Further, consumers spent upwards of $21 billion on professional CAM services, with more than half of those costs coming out-of-pocket (not covered by medical insurance). A two-year study initiated in October by the Institute of Medicine will further determine public consumption.
NCCAM director Stephen E. Straus says that public expenditures in the tens of billions justify applying rigorous science to prove or debunk such remedies. Since NCCAM's 1992 inception as the Office of Alternative Medicine (OAM), that mandate has yet to be met, says Green. In 2001, he reported that no OAM-funded researcher has ever published results that confirm or negate claims of efficacy.2 "The only thing that has come of this work is the conclusion in each of these papers: 'The results are interesting. Further research is necessary.'" Recently, Duke University researchers did publish negative results on St. John's wort3 in an NCCAM-funded study; Green admits that it does represent rigorous science.
Support from the scientific community is growing, says Straus. At least 45 NCCAM-initiated studies from 1999 through 2002 received additional funding from other NIH institutes. Green maintains that those NIH siblings were pressured by Congressional money-handlers, most notably Sen. Tom Harkin (D-Iowa). Harkin, whom Green terms "a true believer," started the OAM with $2 million after treating his own allergies with bee pollen. A supporter of biomedicine in general, Harkin was also involved in the push to double the NIH budget by 2003.
Congress appropriated $52 million to the OAM from 1992 to 1998, and gave NCCAM another $50 million in 1999. The 2002 budget exceeded $104 million. Some of the approximately 70 treatments being clinically evaluated, such as guided imagery and massage therapy, first appeared on grants in 1993. "The National Center for Complementary and Alternative Medicine is a boondoggle of support without end," says Green. Enough is enough, he declares; public demand should not trump good science. "You don't need $100 million in 10 years to come up with a question mark."
Brendan A. Maher can be contacted at email@example.com.
1. D.M. Eisenberg et al., "Trends in alternative medicine use in the United States, 1990-1997," Journal of the American Medical Association (JAMA), 280:1569-75, 1998.
2. S. Green, "Stated goals and grants of the Office of Alternative Medicine and the National Center for Complementary and Alternative Medicine," Scientific Review of Alternative Medicine, 5:205-7, 2001.
3. J.R.T. Davidson et al., "Effect of Hypericum perforatum (St. John's wort) in major depressive disorder--A randomized controlled trial," JAMA, 287:1807-14, 2002.