Conventional Medicine Faces the Alternative

Photo by Patrick Ladapo Joseph Ladapo

The arm’s-length relationship conventional medicine has maintained with complementary and alternative medicine (CAM) is under siege. Frequently citing the lack of scientific evidence as grounds for dismissal, conventional medicine’s argument against CAM is increasingly being undermined as more government-funded research explores the safety and efficacy of alternative treatments. As the results trickle in and effective alternative therapies are separated from the less effective, the ball will be in conventional medicine’s court: will it adapt to the growing scientific understanding?

Never before in the history of modern medicine have so many Americans turned to complementary and alternative medical treatments. These therapies are diverse and include herbalism, meditation, acupuncture, yoga, and megavitamin supplementation, among others. According to a recent survey conducted by the National Institutes of Health, more than one in three adults avail themselves of these therapies. Together, they fuel a thriving $27 billion industry. Less diverse are the reasons patients stray from the mainstream: most see CAM as a positive augmenter of conventional treatment or feel that conventional medicine will not help alleviate their health problems.

The Standard Argument
Historically, the response within medical circles has generally ranged from healthy skepticism to outright disdain. Medicine’s “party line” position was perhaps best exemplified in a 1998 editorial in The New England Journal of Medicine. Marcia Angell, an HMS senior lecturer on social medicine, and Jerome Kassirer, an HMS lecturer on medicine at Brigham and Women’s Hospital, both former editors of the NEJM, wrote that alternative medicine “has not been scientifically tested and its advocates largely deny the need for such testing…. There cannot be two kinds of medicine.”

This argument, espoused long before Angell and Kassirer’s rendition, spurred the establishment of the Office of Alternative Medicine in 1992 and the National Center for Complementary and Alternative Medicine (NCCAM) six years later, both within the NIH. This center has actively reshaped the landscape of our medical understanding of complementary and alternative healing, by funding research studies nationwide, including research at Harvard.

Most recently, the NEJM published findings of an NCCAM-funded study on the efficacy and safety of two widely used dietary supplements, glucosamine and chondroitin, for the treatment of osteoarthritis of the knee. In a carefully controlled trial, researchers found that the two supplements were generally no better than placebo pills at relieving mild arthritic pain. Yet patients with more severe pain did show marked improvement.

Though the results were widely interpreted by the media as arguing against CAM, some arrived at a different conclusion. In an editorial published in the same Feb. 23, 2006 issue, Marc Hochberg, of the University of Maryland School of Medicine, cited other investigations that yielded more encouraging results and lamented the researchers’ use of glucosamine hydrochloride instead of glucosamine sulfate, a preparation with a more storied history of efficacy. Like all research, this study is a piece of a larger puzzle of understanding.

Ready or Not
But as the pieces fall into place and scientific understanding moves toward consensus, will the medical body politic follow? Or will conventional medicine maintain its arm’s-length relationship, undeterred by evidence? If medicine is to live up to its ideals, it seems it must evolve and embrace this knowledge with the same alacrity it shows for other advances.

While medicine ponders its response, some are not waiting for an answer. Michael Turner (HMS ’05), a physical medicine and rehabilitation resident at the Mayo Clinic, has chosen to launch a health website that integrates conventional medicine and research-backed complementary and alternative treatments with an underlying theme of religious spirituality and wellness. The therapeutic information he shares with patients in the clinic and on the site is buttressed by scientific references; the treatments, whether alternative or conventional, pass medical muster.

Turner believes that a comprehensive approach to wellness “promotes health and keeps [patients] out of the medical system.” When working with cardiac patients, for example, he recommends omega-3 fatty acid–rich fish oil, in addition to a standard medical regimen. The supplement can “be demonstratively as effective as some of the more expensive medications,” Turner said, and its accessible nature “empowers patients to self-care
and responsibility.”

Conventional medicine, rooted in the scientific method, is now being challenged by complementary and alternative therapies—on its own terms. As our understanding of what works and what doesn’t continues to broaden, medicine will be forced to either embrace the advances or turn its back on therapies whose effectiveness has been demonstrated by its own rigorous methods.

—Joseph Ladapo is a Harvard medical student and a PhD student in health policy.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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