Complementary medicine under scrutiny

LONDON Harvard Medical School is to create a new research centre to evaluate rigorously complementary and integrative medical treatments. It will be funded by a $10 million grant from the Bernard Osher Foundation and headed by associate professor David Eisenberg. Like the National Center for Complementary and Alternative Medicine at the NIH and the Osher Center for Integrative Medicine at UCSF, both established within the past three years, the new centre signals a growing interest in subjecting complementary therapies to scientific scrutiny.Eisenberg and colleagues have reported (JAMA 1998, 280:1569-1575) that in the US in 1997, the estimated total number of visits to alternative medicine practitioners exceeded the estimated total number of visits to all primary care physicians. In addition, they estimated a total of $27 billion out-of-pocket expenditures relating to alternative therapies during 1997, which was comparable to the projected out-of-pocket expenditures for all US physician-rendered services in that year. In the UK, about 40% of general practices currently offer access to complementary medicine. To offer better protection to consumers, the UK's House of Lords science and technology committee called in December 2000 for tighter regulation of herbal medicines and the creation of centres of excellence for complementary medicine.Although there is some good clinical evidence for a few dozen herbal treatments — including St John's wort (Hypericum perforatum) for depression, echinacea for respiratory infections and ginkgo for dementia — the bulk of herbal treatments have yet to be tested through large-scale randomized placebo controlled clinical trials.But the emphasis is shifting. The number of randomized trials of complementary treatments has roughly doubled in the past five years and, although many of these studies involve small numbers of patients and are of questionable methodological quality, there are some high-quality systematic reviews of complementary medicine (the Cochrane Library now includes nearly 50) and they provide a reliable basis for making healthcare decisions. For example, Andrew Vickers of the Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center, mentions (BMJ 2000, 321:683-686) a Cochrane systematic review of St John's wort for mild to moderate depression that included 27 trials with a total of more than 2000 participants. The review found that St John's wort was superior to placebo and equivalent to tricyclic antidepressants but had fewer adverse effects. Although not all questions have been answered, particularly those of safety, the review does provide a basis for making treatment decisions.Another Cochrane review mentioned by Vickers examined the effects of Saw palmetto (Serenoa repens) on benign prostatic hyperplasia. Eighteen studies with a total sample size of nearly 3000 patients were included. Clear benefits were shown for urinary symptoms and peak urine flow. Other recent, high quality systematic reviews have found acupuncture to be effective for pain and nausea but not for helping smokers to quit. Given the increasing amount of data available in some areas of complementary medicine, Vickers believes that "research is shifting from efficacy trials to more pragmatic studies." He stresses the importance of evidence-based medicine in complementary and alternative medicine in a recent Debate in BioMed Central (BMC Complementary and Alternative Medicine 2001, 1:1). In the US, the National Center for Complementary and Alternative Medicine at the NIH has a $68m (£45m) budget and supports a large number of trials and research centres. In Germany, a centre for research into complementary medicine at the Technische Universitat in Munich has produced a series of important systematic reviews. And in the UK, the National Health Service recently funded two trials of acupuncture for treating chronic pain. Edzard Ernst of Exeter University, the UK's only professor of complementary medicine, welcomes the strong focus on research. "It is time to stop relying on anecdote and enthusiasts," he says. "We want to make research in complementary medicine a top priority."The new centre at Harvard Medical School will join several other units for research into complementary medicine that are based at conventional research institutions in the US, such as the University of Maryland, Columbia University, and Memorial Sloan-Kettering Cancer Center. According to Vickers, these institutions provide the practical and intellectual infrastructure essential for high-quality research. "For example, a phase I trial of a botanical cancer treatment planned at Memorial Sloan-Kettering has been developed by a team that includes experts in complementary medicine research, a statistician who is an expert in developing novel designs for phase I studies, an expert in assessing quality of life, and senior oncologists with extensive experience in clinical research. The researchers have access to a large number of patients who are receiving the highest standard of care. These basic prerequisites for conducting high quality research into complementary medicine would not have been in place several years ago."

Complementary medicine under scrutiny

The establishment of a new research centre for complementary medicine at Harvard Medical School signals a growing interest in subjecting complementary therapies to scientific scrutiny.

Interested in reading more?

Become a Member of