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Alternative Medicine: more hype than hope?

In 1992, Congress established The Office of Alternative Medicine to facilitate the scientific evaluation of therapies that could improve health and well being, but was usually not included in the educational curriculum or training of physicians. Implicit in its mandate was the need to serve as a clearinghouse for all such approaches, rather than investigating or endorsing a select few. But how can "Alternative" Medicine be defined? What would be included under this vague heading? What criteria could be utilized to determine where the limited funds available should be spent to get the greatest return?

Nobody seemed to have the answer to these questions. "Alternative" suggests something that is being substituted for conventional treatment. But "Complementary" and "Integrative" Medicine had become increasingly popular synonyms, implying that such nontraditional approaches should be used together with FDA approved drugs and procedures. "Holistic" or "Wholistic" embraced both concepts, but placed more of an emphasis on the importance of mind/body relationships, and the need to address emotional and spiritual needs in treatment. "Questionable," "unorthodox," "natural," "New Age," "unconventional" and "unproven" were frequently used substitutes, but each has a different connotation.

"Alternative Medicine" was considered by some to be a meaningless term, if not an oxymoron. Critics pointed out there might be "alternatives" to medicine, but not alternative medicine, since once something has been proven efficacious, it simply becomes medicine. As one emphasized, "There is no alternative medicine. There is only medicine that works and medicine that doesn't work."

Is Supplementation Superior To Substitution?

In 1999, because of confusion and controversy over terminology, Congress changed the title from Office of Alternative Medicine (OAM) to National Center for Complementary and Alternative Medicine (NCCAM). CAM was defined as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine." Complementary therapies supplemented or enhanced the benefits of traditional medicine whereas alternative therapies were more likely to be substitutes that replaced them. NCCAM classified all of these as falling under one or more for the following five domains:

Alternative Medical Systems: Includes 19th century homeopathy, osteopathy, chiropractic and naturopathy, as well as ancient Indian (Ayurvedic) medicine (yoga, meditation, massage, diet and herbs) and Oriental (Chinese) medicine (acupuncture, qigong, herbal medicine, exercise and breathing techniques). There are also other Asian, Pacific Island and Native American modalities that are still practiced.

Mind-Body Interventions: Examples include meditation, guided imagery prayer, dance, music and art therapy, hypnosis, prayer and mental healing, and other mind-body techniques and practices such as Hatha yoga, cognitive behavioral therapy and support groups.

Biologically Based Therapies: Herbal therapies, macrobiotic and other special diets, megavitamin or orthomolecular therapy, procaine, EDTA and chelating compounds, shark cartilage, aromatherapy, apitherapy and other specific biological treatments such as immunoaugmentive therapy, antineoplastins and Coley's toxin for cancer.

Manipulative Body-Based Methods: Includes massage (Swedish, lymphatic, neuromuscular, reflexology), bodywork (Rolfing, polarity and cranio-sacral therapy), as well as postural programs that focus on relationships between the musculoskeletal system and body movement (Alexander Technique, Trager Approach and Feldenkrais Method)

Energy Therapies: Some energy medicine practitioners believe an invisible life force (Qi, ch'i, prana) flows through and surrounds the body in a biofield. Illness occurs when this force becomes blocked or imbalanced. The goal of therapy is to correct this blockage by applying pressure or manipulation. This can be accomplished by placing the hands in or through energy fields using techniques such as Qigong (Chinese), Reiki (Japanese) or therapeutic touch (U.S.) In addition to these biofield effects, there are bioelectromagnetic therapies that utilize magnets, pulsed electromagnetic fields, electrotherapy, as well as low level laser light, ultrasound or heat generating devices.

Federal funding has skyrocketed over the past two decades. OAM's budget was $2 million/year when it began in 1992 and 1993, jumped to $50 million in 1999 with the advent of NCCAM, and has been around $130 million/year in recent years. This does not include an additional $100 million/year in research from other NIH divisions like the National Cancer Institute, which has its own CAM research program. But how do you decide which research studies should be funded and how much should be allocated to each? What criteria should be used? The fact of the matter is that NCCAM has failed so miserably in this regard that there are requests for it to be abolished. It spent $374,000 to find that inhaling lemon and lavender scents does not promote wound healing, $750,000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery, $390, 000 to find that ancient Indian remedies do not control type-2 diabetes and $700,000 to confirm that magnets are not effective in treating carpal tunnel syndrome.

Those Who Forget The Mistakes Of History Are Doomed To Repeat Them

The Office of Alternative Medicine was established due to the efforts of Senator Tom Harkin and Representative Berkley Bedell, who convinced their colleagues that there was a vast and rich treasure trove of natural remedies waiting to be discovered. Hippocrates found that leaves from the willow plant could reduce headache and muscle pain, which led to the discovery of aspirin, quinine to treat malaria came from the bark of the cinchona tree, and a tea brewed from the fox glove plant relieved dropsy because it contained digitalis. It seemed reasonable that others would soon be found.

Americans pay close to $40 billion/year on unapproved products and services, with the largest share going to supplements that promise to bolster immune system defenses, retard aging, improve memory, reduce stress, lose weight, etc. What consumers and health professionals want to know is how can you tell if a product is effective and safe? The answer is that you can't. Since the FDA does not regulate these supplements, the manufacturer can claim anything as long as it is not for the cure or diagnosis of a specific disease. In addition, there is no guarantee that the contents of the container bear any relationship to what is stated on the label. In some instances, random testing has shown an almost complete absence of the active ingredient. Legislation has been repeatedly proposed to mandate accurate supplement labeling and insure safe manufacturing processes similar to regulations in other countries, but has been successfully blocked by powerful vested interests.

In the decades following the Civil War, Americans obtained patent medicines from advertisements in Sears Roebuck, Montgomery Ward and other catalogues or from traveling medicine shows, where hucksters sold their homemade concoctions out of the back of a wagon. Many of these magic potions not only contained liberal amounts of alcohol, but also morphine, opium, cocaine and/or heroin, all of which were inexpensive and widely available. There is little doubt they were effective in treating pain and improving mood, but there were concerns about addiction, especially in infants and children given excess amounts for colic or teething. Coca-Cola was originally developed in 1886 as a patent medicine containing cocaine to treat morphine addiction, dyspepsia, neurasthenia, headache, and impotence. After it became a popular bottled drink, the amount of cocaine was steadily reduced, but it was not until 1929 that Coca-Cola became cocaine free.

After the turn of the century, there was a public uproar about dangerous patent medicines as well as all sorts of worthless magnetic apparel and electrotherapy devices that promised to cure everything from baldness to cancer. The practice of medicine had deteriorated to such a degree due to the lack of standards that the AMA hired Abraham Flexner, a distinguished educator, to evaluate the situation and make suggestions. He personally visited each of the 155 medical colleges and found that many were small trade schools owned by one or more doctors to make a profit. They had no college or university affiliation, the Faculty consisted of local part time doctors whose own training was minimal, a degree was typically awarded after only two years of study that did not include any laboratory work or dissection, and regulation of the medical profession by state governments was minimal or nonexistent. There was no control over patent medicines containing narcotics or medical devices claiming to cure almost anything.

Things changed dramatically after the 1910 publication of the highly critical Flexner report. At least one third of medical schools were shut down immediately and many others that could not conform to the new recommended criteria closed shortly thereafter. In 1910, only 16 out of the 155 medical schools required applicants to have completed two or more years of university education before admission but, by 1920, 92 percent of U.S. medical schools required this, and all had a four-year course that included anatomical dissection and laboratory training. Because there was no scientific basis to support electrotherapy, it was now excluded by law from the practice of medicine.

What Does The Future Hold For Complementary And Alternative Approaches?

It is therefore not difficult to understand why CAM is viewed with skepticism or why it is difficult to fund such research. NCCAM has squandered close to $3 billion on studies of echinacea for colds, Ginkgo biloba for memory loss, glucosamine and chondroitin for arthritis, black cohosh for menopausal hot flashes, saw palmetto for prostate problems, shark cartilage for cancer etc., etc, - with not one positive result. The fact that sales of these supplements are still going strong is a testament to the power of the placebo effect, slick advertising, and concerns about the side effects of prescription medications.

Despite all these drawbacks, some CAM modalities have proven so effective that they are now considered mainstream. For example, hyperbaric oxygen therapy is now approved by the FDA for no less than 13 conditions, and is the treatment of choice for some. Osteopathy, the manipulation of bones and joints, was developed by Dr. Andrew Taylor Still, who suspected that many common complaints were due to disruption of the body's skeletal alignment and balance. He also promoted treating the whole patient rather than just the disease and emphasized the importance of preventive medicine. In 1892, Dr. Still opened the first school of osteopathic medicine in Kirksville Missouri, and although the emphasis was initially on learning various manipulative techniques, the curriculum was extended to include all the courses and training provided by medical schools. There are now 30 U.S. institutions that grant the DO degree and graduates enjoy the same rights and privileges of MDs in all 50 states as well as the Armed Services. They are referred to as osteopathic physicians, whereas DOs trained elsewhere are called osteopaths and are licensed only to perform manipulative techniques. In 1896, Daniel Palmer opened the Palmer School of Magnetic Cure in Davenport, Iowa, which also emphasized the laying on of hands, massage, and manipulation and later became the Palmer College of Chiropractic. It is still flourishing at its original location, as well as campuses in California and Florida along with 16 other facilities in the U.S. that can confer a DC degree after four years of training in anatomy, physiology, orthopedics, and other subjects required of physicians. Chiropractic and acupuncture are considered to be mainstream medicine in some parts of the world and are being increasingly accepted and reimbursed by fiscal intermediaries here.

Perhaps the most impressive gains have been made in unorthodox treatments for cancer such as antineoplastons, a gene targeted approach developed by Dr. Stanislaw Burzynzki. After decades of trying to shut him down and take away his license, the FDA and National Cancer Institute have finally admitted antineoplastons are the only known cure for brainstem glioblastoma and are effective in other malignancies. Doctors may soon be prescribing frequencies rather than pushing pills to treat liver cancer and metastatic disease based on a new approach by Dr. Boris Pasche and colleagues. Treatment, which is painless, has no side effects, is superior to chemotherapy, and is administered at home while the patient reads or watches TV for an hour.

Deep brain stimulation for Parkinson's disease has produced dramatic results in many patients, relieves other types of tremors, and is being investigated for the treatment of depression and Alzheimer's. See also the operating room of the future, in which surgical procedures like hysterectomy will be replaced by non invasive therapies that will allow the patient to return home and immediately resume normal activities. These and other breakthrough advances will be discussed in the forthcoming book Bioelectromagnetic and Subtle Energy Medicine. *a


EP (Exceptional Parent) Magazine is publishing, first in this Annual Healthcare Issue and in the coming months, a series of articles on Alternative Medicine that will cover bioelectromagnetic therapy, chiropractic, hyperbaric oxygen therapy, acupuncture, and several others. EP (Exceptional Parent) Magazine has a responsibility to report on both conventional and alternative therapies for a variety of developmental disabilities. The inclusion of any particular treatment is not an endorsement of the efficacy of the modality but merely presented for educational and informational purposes. We have always been proponents of the following axioms: discuss with your managing physician and healthcare team any therapies you are considering before undertaking them; acquire and study the evidence that supports any treatment, make informed decisions and carefully evaluate the benefits of the treatment using accepted metrics that can be tracked, weighed and compared.



Paul J. Rosch, MD, FACP is Chairman of the Board The American Institute of Stress, Yonkers, New York, and Clinical Professor of Medicine and Psychiatry, New York Medical College, Valhalla, New York. He is also honorary vice president of the International Stress Management Association, a diplomate of the National Board of Medical Examiners, an emeritus member of the Endocrine Society and the Bioelectromagnetics Society, and Fellow of the American College of Physicians and the Royal Society of Medicine, among other organizations. Dr. Rosch is the recipient of many awards, including the Outstanding Physician's Award of the New York State Medical Society (1979), the I. M. Sechenov Award of the Russian Academy of Medical Sciences (1993), and the Innovation Award (2003) from the International Society for the Study of Subtle Energies and Energy Medicine. He received his post graduate medical training at John Hopkins Hospital and Walter Reed Army Hospital and Institute of Research and is the author of numerous professional publications.
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Author:Rosch, Paul J.
Publication:The Exceptional Parent
Geographic Code:1USA
Date:Aug 1, 2013
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