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New England Journal dose another 'hit job' on alternative medicine.

The New England Journal of Medicine, one of the most respected medical journals in the world, has a long history of publishing biased and unfair editorials that denigrate "alternative medicine." The most recent example is an article titled, "What's the Alternative? The Worldwide Web of Integrative Medicine." (1) The editorialist, an oncologist from Australia, described an example of apparently unscrupulous behavior by an apparent charlatan, and then took the liberty of inappropriately attempting to define alternative medicine by this example.

The story was of a woman in her 30s who was given a free blood test at an "integrative medicine exhibition." The blood test, which was touted as being capable of diagnosing cancer, came back positive (circulating tumor cells were supposedly seen in her blood), and the woman was told that she had advanced non-small-cell lung cancer. She was referred to an "integrative health expert" who, based on the blood test, recommended a series of intravenous vitamin C treatments, at a cost of $6000, which had to be paid up front. She then consulted an oncologist (the editorialist). After a PET scan of the lungs came back negative, the oncologist informed the patient that she does not have cancer, and that the blood is not a valid diagnostic test for cancer. However, the patient was not sure whom to believe and, fearing for her future, she requested that the oncologist continue to follow her.

It would certainly appear that diagnosing advanced cancer based solely on an unproven blood test, and prescribing an expensive and unproven treatment without first recommending a referral to an oncologist, smacks of gross incompetence or fraud. However, one could also find many examples of incompetence and fraud in conventional medicine. It is just as illegitimate to equate the entire field of alternative medicine with one of its worst examples of bad behavior as it would be to equate the entire field of conventional medicine with one of its worst examples of bad behavior. Nevertheless, the editorialist used this story as a springboard for launching a series of diatribes against alternative medicine in general.

"At one time, the worst offense one encountered was someone prescribing a few herbs to a desperate patient who'd exhausted all other means of treatment." This statement comes from a member of a profession that routinely prescribes some of the most toxic and expensive drugs on the planet, all too often despite limited evidence of treatment effectiveness. (2) One might therefore reasonably question upon what authority the editorialist labels the prescription of a few herbs an "offense."

"The practitioners never write directly to oncologists and refuse to be accountable for their actions." To the contrary, at least in the US, naturopaths and other alternative practitioners who manage cancer patients routinely work in conjunction with oncologists, and generally defer to the oncologist's opinion on issues such as the use of antioxidants during courses of chemotherapy.

"Alternative therapies need meet no burden of proof except a patient's gullibility." While such a statement would apply to all fraudulent therapies, it is an egregious misrepresentation of alternative medicine

"Oncologists generally avoid even mentioning alternative therapies, lest a whiff of interest in it contaminate their integrity." Does this statement imply that any oncologist who searches for additional ways to improve patient outcomes lacks integrity? Regarding the issue of integrity in oncology, I am reminded of a letter to the editor of a conventional medical journal some 25 years ago. The writer admitted that, for a certain type of cancer, no chemotherapy regimen had been demonstrated to be effective. However, the writer suggested that patients with that type of cancer be offered chemotherapy anyway, or else they might go elsewhere and seek alternative treatments. (2)

The vast majority of alternative practitioners are responsible people who provide safe and effective treatments. What is irresponsible is to make blanket generalizations about a diverse field of health care based on a single example of misconduct. This is not the first time that the editors of the New England Journal of Medicine have allowed the publication of a "hit job" against alternative medicine. In contrast, I have never seen an editorial in that journal arguing that all of conventional medicine is horrible because some doctor made a lot of money from unnecessary surgery or from some other unscrupulous activity. The fact that the Journal allows inappropriate diatribes against alternative medicine, but not against conventional medicine, reveals its bias.

Notes

(1.) Srivastava R. What's the alternative? The worldwide web of integrative medicine. N Engl J Med. 2012;366:783-785.

(2.) Oye RK, Shapiro MF. Reporting results from chemotherapy trials. Does response make a difference in patient survival? JAMA. 1984;252:2722-2725.

Alan R. Gaby, MD
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Author:Gaby, Alan R.
Publication:Townsend Letter
Article Type:Editorial
Geographic Code:1USA
Date:Jun 1, 2012
Words:781
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