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Considering the alternatives.

With so many people spending so much money on unconventional medical treatments these days, it's perhaps not surprising that the National Institutes of Health will soon begin looking into the safety and efficacy of alternative therapies under the auspices of its new Office of Alternative Medicine. The OAM was established in response to a congressional mandate in the form of instructions to the NIH to devote $2 million of its annual ($9 billion) budget to assessing the claims of nonorthodox therapies. OAM's director, Dr. Joseph J. Jacobs, seems particularly suited for the post--a conventionally trained pediatrician whose Native American background and work with the Indian Health Service have acquainted him well with alternative healing traditions (New York Times, 16 March 1993).

Given its modest staffing--a deputy director, a program analyst, and a secretary in addition to the director--one of OAM's principal tasks will be to coordinate research through other institutes at the NIH, such as the National Cancer Institute or the National Center for Nursing Research, that have the requisite scientific and clinical expertise to evaluate unconventional therapies. The office will also fund some research directly. Earlier this spring OAM issued its first "request for applications" soliciting proposals for "pilot projects" to identify promising areas of research.

But will scientific data on the efficacy of "nonscientific" treatments make a difference to those who seek out alternative therapies? That depends, in part, on why people go to nonmedical practitioners in the first place. And there are at least two views on offer. In an editorial in the 28 January issue of NEJM, physician Edward Campion suggested that "the simple: [people] want to feel better." Alternative therapies are attractive, he suggests, because among other things access to them is easy compared to conventional medicine, they are generally cheaper, seem not to pose the same risks of iatrogenic injury and illness, and clients believe nonphysician healers will give them more time and attention.

Robert C. Fuller, professor of religious studies at Bradley University in Peoria, Illinois, thinks there may be more to the matter, however. In an article in Second Opinion (July 1992), Fuller suggests that alternative therapies perpetuate religious and metaphysical thinking that since Emerson and the Transcendentalists has been part of "an enduring style of unchurched American religiosity." While clients surely are looking to unconventional therapies for relief of pain, they may also be looking for metaphysical reassurance. "Patients," Fuller notes, "often consult a doctor for more than the remission of their symptoms; they often also seek relief from the fears that have been aroused by their illness, and they seek ways of interpreting the reasons for their having fallen out of favor with the cosmos. By giving patients confidence that they have inwardly reconclied themselves to the ultimate powers upon which life depends, alternative healing groups make possible the restoration of a coherent sense of self."

And efficacy of that sort may be difficult to assess in a randomized, double-blind, controlled clinical trial.
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Title Annotation:alternative medicine
Author:Crigger, Bette-Jane
Publication:The Hastings Center Report
Date:May 1, 1993
Previous Article:Medicine coming of age.
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