A proposal to elevate the National Institutes of Health's Office of Alternative Medicine (OAM) into an institute fell short during the appropriations process, but a 60 percent increase in funding represents a victory of sorts for the office. The $8-million boost proposed by a conference committee would raise OAM's current $12-million budget to $20 million for FY1998.
The conference committee's decision was a surprise considering earlier requests. The House and the Clinton administration both sought cuts in the office's funding, down to $7.5 million for 1998; the Senate requested a slight funding increase, to $13 million. If OAM had been elevated to an NIH institute, it could have received a $200-million annual budget.
The OAM's status sparked a debate during an October 9 Senate hearing over who should have granting authority for studies of unconventional therapies-skeptical scientists or alternative medicine proponents. Critics say that therapies investigated by OAM should undergo the same scientific rigors as conventional therapies, but supporters contend that mainstream scientists don't always cooperate. Both sides agree that such practice warrants a closer look, since according to some estimates, more than a third of Americans use some form of alternative medicine.
Sen. Tom Harkin (D-Iowa) formed OAM in 1992 by adding a $2 million item into a Health and Human Services appropriations bill. The office's budget-and profile-has grown every year and, as it has grown, has attracted increasing controversy. OAM studies cover a broad range of practices, from the benefits of meditation to outcomes of "touch therapy," in which practitioners don't actually touch the patient but purport to manipulate invisible energy fields inches away from patients' bodies that only they can detect.
GRANTING AUTHORITY: James Gordon of Georgetown's Center for Mind-Body Medicine wants more granting autonomy for OAM.
Harkin contends that the anti-OAM sentiment within NIH starts at the top, with Harold E. Varmus, NIH director. Varmus asked for lower levels of funding for the office in two consecutive years, even though NIH's funding level has increased each year. "What kind of signal does that send about how important this is?" asked Harkin, who credits unconventional therapies for curing his allergies and easing a relative's pain.
Varmus has said that he does not think the field needs a separate institute. Two different cultures-conventional and alternative-now provide health care to the public, he told Stanford Medical School graduates this summer during a commencement speech. "Ours has the scientific record of accomplishment, but the other is acquiring enormous public support-even getting the credit for many preventative, behavioral, and low-tech methods that mainstream medical science introduced and validated."
STATUS QUO: Robert Rich, dean for research at Baylor College of Medicine, thinks OAM should remain an office, not an institute.
Sen. Bill Frist (R-Tenn.), the subcommittee chairman who also is a surgeon and researcher, agrees. At the hearing, he hypothetically stated that a review board of 12 acupuncture practitioners would be more likely to give a green light to acupuncture studies than a board of physicians-even if the study had a flawed design. "There's a fear that the peer review there won't be as rigorous as at other institutes," he noted.
OAM's first director, Joseph J. Jacobs, tells The Scientist that he also opposes elevating the office to an institute because such a move would only add to administrative costs and further politicize the office. Jacobs, now the medical director for Vermont's state department of corrections and its Medicaid program, resigned after two years at OAM because of pressure from congressional staffers who wanted him to fund what he thought was poorly designed research. For example, he opposed funding the Bastyr School of Naturopathic Medicine in Seattle. The site, which has since been funded through a $1 million OAM grant, has been one of the most criticized because it merely asks HIV-positive subjects what forms of alternative therapies they use without questioning if or how they work and without accounting for conventional therapies the subjects also use.
Jacobs believes alternative medicine should be subject to the same kinds of clinical trials as conventional medicine. "It adds credibility to the research," he maintains. Proponents of isolating alternative medicine actually are doing the field a disservice because skeptical mainstream scientists will continue to say that many studies in alternative medicine lack sound methodology, he says. Proponents like Harkin also defend questionable studies on an emotional rather than a logical basis. "He's very inflammatory in his remarks," Jacobs adds.
HIGHER STANDARDS: Carnegie Institution's Maxine Singer contends that OAM research is held to lower standards than other NIH research.
CLINICAL TRIALS: Stanford biochemist Paul Berg says alternative medicine should undergo clinical trials, not simple, observational ones.
VOCAL OPPONENT: OAM should be eliminated because of poor research designs, states Maryland's Robert Park.
ALTERNATIVE PRACTITIONER: OAM's director Wayne Jonas practices homeopathy, which many of the office's detractors say runs contrary to science.
Had OAM studies been following stringent research protocols with falsifiable hypotheses, they quickly would have shown that such practices simply don't work, Park says. "They've been exempted from real scientific research."