SPECIAL REPORTS Bioterrorism and the NCCAM The Selling of 'Complementary and '

The recent bioterrorism threat has attracted renewed attention to the myriad pseudoscientific claims that permeate "complementary and alternative medicine. " Past history predicts that there will he continued pressure far the National Center for Complementary and Alternative Medicine (NCCAM) to fund studies of claims that can already be dismissed on the basis of established knowledge.

KIMBALL C. ATWOOD IV, M.D.

hanks to the threat of bioterror- "alternative medicine." Republican Dan and smallpox. According to the AP ism, Dr. Stephen E. Straus, Burton battled to legalize the dangerous report quoted on CNN.com, Rep. director of the National Center quack cancer "cure" laetrile in his home Burton opined that since there are only T state of Indiana in the 1970s. He is called 15 million doses of smallpox for Complementary and Alternative Medicine (NCCAM), may be on the "'s best friend in Congress" by available, the government should be verge of shedding his naivete about the Stephen Barrett, M.D., the creator of the pursuing "alternative" remedies. "We're real purpose of the organization that he award-winning Quackwatch Web site facing a terrorism threat now," he said. runs. At a hearing of the House and the vice-president of the National Rep. Burton suggested that the lack Government Reform Committee on Council Against Health Fraud of government interest in "alternative" November 10, 2001, Dr. Straus warned (NCAHF). Although laetrile remained proposals might be due to a conspiracy against the use of "alternative" remedies outlawed in the U.S., Rep. Burton has between the FDA and the pharmaceuti- for the prevention or treatment of continued to support other dangerous cal industry. Queried Burton, "unless it's anthrax or other diseases of bioterror- and absurd cancer treatments, such as brought to you by a pharmaceutical ism. He pointed out that there is no evi- die "anti-neoplastons" of Stanislaw Bur- company, you don't take action?" A rep- dence supporting the use of such reme- zynski and the regimen of coffee enemas, resentative of the FDA replied that any- dies, and that they may interfere with hundreds of daily "dietary supplement" one may apply for drug approval, but the effectiveness of proven measures pills, and hair analyses of Nicholas that no applications for "alternative" (Associated Press 2001). Dr. Straus is a Gonzalez. Burton also supports passage substances had been made. Dr. Straus, virologist, and his statements were con- of the Access to Medical Treatment Act, for his part, said that he would be sistent with the views of any reasonable, an annually defeated bill that would per- "open" to funding research on "natural scientifically trained . mit quacks to prey upon unsuspecting remedies" for the agents of bioterrorism. What Dr. Straus may not have appre- consumers without having to worry He would be wise to do just that if he ciated is that die chairman of the com- about legal interference. Most recendy hopes to keep his job; but should he? mittee to which he addressed his remarks Rep. Burton showed how rabid his inten- The OAM Legacy is not pleased by rational evaluations of tions are by falsely accusing another NCAHF board member. Dr. Tim Straus began his tenure as the sixth (but Dr. Atwood is an anesthesiologist at the Gorski, of having misrepresented his cre- only third full-time) director of the Newton-Wellesley Hospital in Newton, dentials following Dr. Gorski's incisive NCCAM two years ago, when the name Massachusetts, and Clinical Assistant testimony at die Senate Hearing on Anti- of die organization had just changed Professor at Tufts University School of Aging Quackery on September 10. The from the "Office of Alternative Medicine. He is a Contributing Editor of the details of that event are available at the Medicine." The OAM had been estab- Scientific Review of Alternative Medicine, Quackwatch Web site (Barrett 2001a; lished in 1991 not because of any scien- and represented the Massachusetts Medical Burton 2001; Gorski 2001). tific or medical need, but because of the Society at the Massachusetts Special Rep. Burton was disturbed, at the sectarian leanings of Iowa Senator Tom Commission on Complementary and bioterrorism hearing, to learn that nei- Harkin, who was convinced diat his hay Alternative Medical Practitioners from ther the NCCAM nor the FDA is test- fever had been cured by bee pollen. The October 2000 to January 2002. ing "alternative" remedies for anthrax first full-time director was Joseph

1 6 March/April 2002 SKEPTICAL INQUIRER Jacobs, M.D., like Straus a nonideo- animals infected with anthrax, ground up, is recommended in virtually every logue with an ingenuous enthusiasm for and diluted in alcohol to well beyond the naturopathic treatise. The 1994 edition "alternative medicine." Jacobs's tenure point at which any trace of die original of the Journal of Naturopathic Medicine was short precisely for that reason. As preparation remains. According to the (the "official publication of the reported in Science magazine in 1994, article mis works like a vaccine and is American Association of Naturopathic Senator Harkin drummed Jacobs out of utterly safe. Nevertheless, Ullman recom- "), as reviewed by Stephen the office after only a year, once it mends that its use be limited to high-risk Barrett, promotes homeopathic became clear that Jacobs felt that the persons such as postal workers. "nosodes" as safer and more effective role of the OAM was to subject aberrant Ullman is well known and respected than real (Barrett 2001b). methods to rational scrutiny (Marshall in CAM circles. According to the Web Many naturopaths consider themselves 1994). Harkin would apparently have site Integrative Medicine: the Worldwide to be "specialists" in homeopathy. preferred that these methods simply be Authority on Integrative Care, "Mr. These naturopaths are by no means declared valid and integrated into com- Ullman is a member of the advisory the only advocates for homeopathy who mon practice. In an article in The New council of the Alternative Medicine have the ear of Dr. Straus. On the Republic in 1996, Dr. Jacobs was quoted Center at Columbia University's College NCCAM Cancer Advisory Panel is as saying, "it's pathetic. They were so of Physicians and Surgeons [and] a for- Ralph Moss, whose Cancer Chronicles naive about science. I wouldn't trust mer consultant to the World Health newsletter has suggested that homeopa- anything coming out of the OAM as Organization" (Integrative Medicine thy and many other unlikely trearments long as the Harkinites are micromanag- 2001). A visit to the Web site of can cure cancer (Moss 1995). Across ing it" (Satel and Taranto 19%). Columbia's Rosenthal Center for town the White House Commission on The next full-time director of the Complementary and Alternative Complementary and Alternative Medi- OAM was Wayne Jonas, M.D., a Medicine confirms that Ullman's Web cine Policy (WHCCAMP) includes believer in homeopathy, an absurd eigh- site, Homeopathic Educational Services, Pizzorno (the co-editor of the naturopa- teenth century "healing system" that has is recommended, as is another link in thy textbook), Dr. Jonas, and a host of been known to be at odds wim the fun- which "(d)ozens of full-text articles and other magical thinkers headed by the damentals of chemistry and biology excerpts from books by Dana Ullman are chairman, psychiatrist James Gordon. since shortly after its introduction. available" (Rosenthal Center 2001). Such Dr. Gordon is best known for his belief Homeopaths maintain that "like cures is the topsy-turvy world of pseudomedi- in alien abductions and his contention like" (hence the name): thus the "cure" cine and its startling patrons. that schizophrenia is a rational response for a disease is a substance that produces to an irrational world (Gorski and Curry similar symptoms when given to a NCCAM and Advisors 2001).' The rosters of all of these panels healthy person. An example is die use of Dr. Straus can assume that there will be have been examined by Dr. Gorski and onion for the common cold. Medical pressure for the NCCAM to investigate consumer health activist E. Patrick historians, anthropologists, and psychol- Ullman's ridiculous claim. In addition Curry, who found few critical thinkers ogists recognize this as a variation of the to the advocacy of legislators such as among the lot. Their findings are avail- "doctrine of signatures," a prescientific Harkin and Burton and the legacy of able for public review at the myth common to the folklore of many Dr. Jonas, ilicic aic sevcial influential Quackwatch Web site is part of Gorski's cultures. I Ioniecpathy doesn't leave it at NCCAM advisors who can be expected rebuttal to Rep. Burton's misrepresenra that, however. The curative agent must to agree with Ullman. On the National tion charges (Gorski 2001). be "potentized" by a series of dilutions Advisory Council, for example, are three and "succussions," such that not even a "naturopathic doctors." is Is Dedicated CAM Research molecule of the original substance an eclectic assortment of implausible Justified? remains in the "remedy." Thus the "alternative" claims, one of which is Straus revealed his na't'vetd regarding patient is given a sugar pill, or possibly a homeopathy. Homeopathy is taught, the truth of the NCCAM shortly after small quantity of water or alcohol. uncritically, in all four naturopathic his tenure began. It was the case then, Homeopathy offers the very sort of schools. Ullman's Web site is listed as a and still is, that not a single Comple- "alternative remedy" that Rep. Burton "recommended Web site" by the mentary and Alternative Medicine might imagine could solve the bioterror- National College of Naturopathic (CAM) claim had been shown to be ism problem. Zealous homeopath Dana Medicine in Portland, Oregon (NCNM either useful or useless by studies spon- Ullman, quoted in a recent article for 2001). Homeopathy is promoted in the sored by the OAM/NCCAM. Unbow- Utne Reader Online, recommends home- Textbook of Natural Medicine (Pizzorno ed in an article for Academic Medicine, opathic "nosodes" to prevent anthrax and Murray 1999), the only general Straus parroted several common mis- (Garsombke 2001). These consist of farm textbook of the field of naturopathy, and conceptions about CAM: inflated

SKEPTICAL INQUIRER March/April 2002 17 figures of public demand; the confu- intentioned investigators, including Straus's Cancer Advisory Panel, was still sion of popularity with validity; the Straus, to the erroneous conclusion that advocating laetrile as an effective treat- notion that many CAM claims have "further studies are needed." This is the ment for cancer during the 1990s and already been proven "safe and effec- current status of research into homeopa- accused the Mayo Clinic, because of its tive," so that it's necessary to "over- thy and many other CAM claims, and it competent 1982 study that showed come the reluctance of conventional can therefore be predicted that the silli- laetrile to be ineffective (Moertel et al. physicians to consider" them; that ness will persist indefinitely. The 1982), of being "fraudulent" (Moss long-used botanical products, ignored NCCAM, for example, currently funds 1993). The OAM itself can reasonably by the pharmaceutical industry, are whimsical homeopathic "research" by be viewed, at least in part, as a legacy of likely to yield powerful new therapies; former director Jonas.' the paranoid, far-right laetrile move- that some accepted modern treatments Wallace Sampson, M.D., die editor of ment of the 1970s. This was led by the that were "once regarded as radical," the Scientific Review of Alternative Committee for Freedom of Choice in such as radiation therapy, are analogous Medicine, answered all of Dr. Strauss Cancer Therapy (now known as the to methods such as ; that points in a letter to Academic Medicine Committee for Freedom of Choice in time constraints on the "privileged (Sampson 2001b), but Strauss subsequent Medicine), every one of whose found- physician-patient relationship" caused reply revealed that he had failed to under- ing members was also a member of the by managed care somehow justify the stand Sampsons arguments (Straus 2001). John Birch Society (Wilson 2000).'The promotion of implausible and Indeed, Straus betrayed another miscon- NCCAM, due to pressure from ideo- unproven methods; that "a more ception about CAM when he suggested logues such as Moss and Burton patient-centered and less paternalistic mat if research shows a method to be use- (Stokstad 2000), is even now funding approach should be stressed," again less, demand for it will be reduced studies of Kelly-Gonzalez therapy, an 1 somehow justifying CAM; and more markedly; thus, presumably, even skepucs absurd cancer treatment whose history (Strauss 2000). should favor CAM research. This is naive, closely parallels that of laetrile itself Dr. Straus also demonstrated his because advocates are not dissuaded by sci- (Wilson 2000; Barrett and Herbert innocence of the realities of CAM by ence. A short list of CAM claims that have 2001; Green 1998). Is it possible that his glowing review of a speech by already been convincingly shown to be Straus is unaware of these associations? Andrew Weil, whose irrational views of worthless, both as a matter of established The Selling of CAM medicine and science are well docu- knowledge and as a matter of studies per- mented (Relman 1998). Straus wrote, formed, includes: iridology, applied kinesi- It seems clear that the real purpose of "few would argue against the wisdom" ology, craniosacral therapy, homeopadiy, the NCCAM is a political one: to pro- of Weil's call to "train young physicians the subluxation theory, vita- mote "complementary and alternative" about CAM," apparently failing to min C for prevention of the common methods despite a lack of credibility or, appreciate that Weil would have this cold, echinacea for same, guided imagery, at the very least, prior to substantial sci- training performed by advocates, not hair analysis for most purposes, magnets entific validation. WHCCAMP Chair- skeptics. Even now, the vast majority of for arthritis pain, , "distant heal- man (and former NCCAM adviser) medical school CAM courses are not ing," Therapeutic Touch, chelation ther- James Gordon recently admitted as critical of the implausible claims that apy for atherosclerosis, and acupuncture much in a remarkably frank statement they teach (Sampson 2001a). for all but one or two specific indications. for The Scientist: "The reason there is as much interest in complementary medi- Notably absent from Straus's essay All of these methods are alive and thriving, cine as there is, is not because of the sci- was a theme absent from almost all expo- and by funding research into several of ence. The moving force has been us" sitions favoring CAM research: consider- them the NCCAM is contributing to (Bunk 2001). In the same article ations of "prior probability." That is, their perpetuation. Gordon proclaimed his impatience for most CAM methods are at odds with Straus offered laetrile as an example legitimate biomedical investigations: established science (also known as facts: of a treatment whose public demand homeopathy is a perfect example), such "abated markedly only after competent [Gordon] argues that the reductive study of isolated therapies is too slow that no experimental data can validate studies showed it to be ineffective." and is irrelevant because CAM treat- them. There is no point in studying such There is no evidence that this is true. ments are administered in combina- methods, since the results will either be Laetrile is still offered in clinics just tion. Research must be conducted on negative (if all studies are rigorous) or across the border in Mexico, and was integrated approaches, as well as on equivocal (if some studies are sloppy or available via the Internet as recently as a treatments that are individualized, fraudulent). Either of these outcomes is year ago, when the FDA shut down the such as Chinese herbs prepared for a particular patients needs. "This is consistent with "zero" prior probability, vendor (Lewis 2001). The aforemen- crucial," he insists. "This may repre- but the latter outcome leads many well- tioned Ralph Moss, a member of sent one of the most profound

1 8 Match/Apr.l 2002 SKEPTICAL INQUIRER shirts. . . . We're talking about a fun- grams and "integrative medicine centers," which with Science. Baltimore: Johns Hopkins damental sea change in the way we would seem to be purring the can before the horse. University Press. look at medicine and health care." 4. CAM advocacy may once have been a largely Inrcgrativc Medicine: The Worldwide Authority on t-wing phenomenon, bur no more. If Columbia (Bunk 2001) Integrative Care. 2001. Who We Are: Advisory University and homeopadis make strange bedfel- Board. Accessed 11/01 at: www.onemedi- lows, so do ex-hippies (e.g., Gordon and Weil) and Never mind that plenty of rational, evi- cinc.com/AboutUs/Advisors.asp. ex-Birchers. The traditional anti-intetlectualism of Lewis, Carol. 2001. Online laerrile vendor ordered dence-based therapies are "administered the right has recendy been joined by a similar senti- to shut down. FDA Consumer. March-April. in combination," and virtually all are ment from rhe left. This has been no less rruc in Accessed 11/01 at: www.quackwatch.com/02 medicine (Sampson 1998) than in die academy (see. ConsumerProreciion/FDAActions/valc.html. "individualized for a particular patients for example, Gross and Levin 1994). Marshall, E. 1994. The politics of altcrnarive med- needs." This "sea change," an example of icine. Science 265: 2000-2002. die "special pleading" fallacy, is nothing References Moertel, C.G., T.R. Fleming, J. Rubin, L.K. more or less than the selling of CAM. Kvols, G. Sarna. R. Koch. V.E. Currie, C.W. Associated Press. 2001. Feds: Alternative remedies Young, S.E. Jones, and J.P. Davignon. 1982. A The annual budget of the OAM/ no cure for anthrax. CNN.com/HEALTH clinical trial of amygdalin (Laetrile) in the NCCAM has grown from $2 million at Nov. 15. Accessed 11/01 at: www.cnn.com/ treatment of human cancer. New England 2001 /HEALTH/conditions/11 /15/anihrax.alt Journal of Medicine (Jan 28) 306(4): 201-6. its inception to $90 million in 2001. This crnative.ap/index.html. Moss, R.W 1993. Advisors meet April 1-2: Teams may be a small fraction of the total NIH Barrett, Stephen. 2001a. Furdier comments on Dr. from OAM visit docs in Houston and cast. budget of over $10 billion, but it certainly Gorski's credentials. Quackwatch. Accessed Cancer Chronicles # 1 5 . (April). Accessed 11/01 at: www.ralphmoss.com/html/team.shtml. begs the question of how such funds 11/01 at: www.quackwatch.com/01Quackcry RclatedTopics/Hcaring/gorski3.html. . 1995. Homeopathy and cancer. Cancer might be better spent. One tiiinks of pro- . 2001b. A close look at naturopathy. Chronicles #29. (Sept). Accessed 11/01 at: viding protease inhibitors to poor AIDS Quackwatch. Accessed 11/01 at: www.quack- www.ralphmoss.com/html/homeopathy.shtmI. victims, or feeding starving Afghanis. Or, warch.com/01 QuackcryRelatedTopics/Naturo NCNM Page of Recommended Web sites. 2001. parhy/naturopathy.html. Homeopathy. Accessed 11/01 at: www.ncnm. perhaps, expanding the pool of vaccines Barren, Stephen, and Victor Herbert. 2001. edu/internet.htm#homeopaihy. for .millrax and smallpox. Questionable cancer therapies. Quackwatch. Pizzorno, Joseph E., and Michael T Murray, eds. Accessed 11/01 ar: www.quackwatch.com 1999. Textbook of Natural Medicine. London: Notes /01 Quackery RclarcdTopics/cancer.html. Churchill Livingstone. Bunk, Steve. 2001. Mainstreaming CAM. The Relman, Arnold S. 1998. A trip to Stonesville. The 1. Ironically. Dr. Gordon was also once a fol- Scientist 15(24):1. Accessed 12/01 at: www. New Republic (Dec 14). Accessed 11/01 at: lower of rhe violent Indian guru Bhagwan Shree thescientist.com/yr2001 /dec/bunk_p 10_0112 www.thenewrepublic.com/archivc/1298/1214 Rajneesh, whose cult attempted to take control of I0.html. 98/relmanI21498.html. the town of Antelope. Oregon in 1984. In an act Burton. Dan. 2001. Written Submission by Dan Rosenthal Center for Complementary and of bioterrorism, cult members placed salmonella Burton (R-IN). United States Senate Special Altcrnarive Medicine. 2001. Homeopathy Re- in salad bars of area restaurants, causing at least Committee on Aging. Hearing on Swindlers, sources. Accessed 11/01 at: cpmcnet.colum- 750 people to become ill (Gorski 2001; Torok et Hucksters, and Snake Oil Salesmen: The bia.edu/depi/rosenthal/Homeopathy.html. al. 1997). Hype and Hope of Marketing Anti-Aging Sampson, Wallace. 1998. On being a critic. 2. Here is an example of "patient-centered" Producers to Seniors. September 10. Scientific Review of Alternative Medicine care according to Konrad Kail, one of the natur- Quackwatch. Accessed 11/01 at: www.quack- (Spring/Summer) 2(1): 4-5. opaths on the National Advisory Council for watch.com/01 Quackery RclatcdTopics/Heari . 2001 a. The need for educational tcform Complementary and Alternative Medicine: "'If I ng/burton.html. in teaching about alternative theiapies. see a patient who has pain in his arms because his Garsombke, Kate. 2001. Alternative remedies for Academic Medicine (March) 76(3): 248-250. neck is out of alignment.' Dr. Kail says, 'I explain anthrax: Homeopathy provides options. Utne . 2001b. Dancing with a dream: The folly to them that we can do spinal adjustments, Reader Online (31 Oct). Accessed 11/01 at: of pursuing alternative medicine. Academic acupuncture, homeopathy, or we can do all three. www.utne.co m/bSocicry.tmp]?command=sear Medicine (April) 76(4): 301-303. Then 1 wait lor their choice.'" Quoted in Morton, ch&db=dArticle.db&cqhcadlinedara=Homeo Satel, bally, and James laranto. 1996. 1 he alterna- M.. and M. Morton. Naturopathic Medicine. pathic%20Rcmcdies%20for%20Anthra>:. tive medicine scam: Bogus bee poilea. The Healthworld Online. Accessed 11/01 at: Gorski, Tim. 2001. A Written Response to the New Republic (8 & 15 Jan.). pp. 24-26. www.healthy.net/asp/templates/article.aspfPageTy Statement of the Honorable Dan Burton (R- Stokstad, Erik. 2000. Stephen Straus's impossible pe=Anicle8cID=508. IN), Chairman, House Committee on job. Science (June 2) 288: 1568-1570. 3. Among the oilier boondoggles that the Government Reform. United States Senate Straus. Stephen E. 2000. Complementary and NCCAM funds are a study of "meridians": Special Committee on Aging. Hearing on altcrnarive medicine: Challenges and opportu- acupuncture tor shortness of breath in cancer Swindlers, Hucksters and Snake Oil Salesmen: nities for American medicine. Academic patients: acupuncture for hypertension; acupunc- The Hype and Hope of Marketing Anti-Aging Medicine (June) 75(6): 572-573. ture for HIV positive drug abusers; acupuncture Products to Seniors. September 10. . 2001. In reply. Academic Medicine (April) and "moxa" for chronic diarrhea in HIV patienrs; Quackwatch. Accessed 11/01 at: www.quack- 76(4): 303. watch.com/01 QuackeryRclatedTopics/ "healing (non) touch" for neonates; osteopathic Torok, T h o m a s J., Robert V. Tauxe, Robert P Wise, Hearing/gorski2.html. manipulation for chronic obstructive pulmonary John R. Livengood, Robert Sokolow. Steven disease; several srudies that assume die validity of Gorski. Tim. and E. Patrick Curry. 2001. White Mauvais, Kristin A. Birkness, Michael R. Skeels. the "subluxation" theory; and several "distant (psy- House commission stacked against science. John M. Horan. and Laurence R. Foster. 1997. chic) healing" studies (see: http://nccam.nih.gov/ Scientific Review of Alternative Medicine A large community ourbreak of salmonellosis rescarch/grams/rfb/fyOl.htm). One of die gram (Winter) 5(0:7-8. caused by inicnuonal conramination of restau- recipienrs for "distant healing" is a naturopath who Green. Saul. 1998. Nicholas Gonzalez rrearment for rant salad bars, journal of the American Medical is also a member of die NCCAM advisory council. cancer Gland extracts, coffee enemas, vitamin Association (August 6) 278: 389-395. Anodier is Elisabeth Targ, about whom Martin megadoses, and diets. Scientific Review of Gardner has recendy written in SI (March/April Wilson, Benjamin. 2000. The rise and tdl of Alternative Medicine (Fall/Winter) 2(2): 25-30. 2001). There are also multiple grants for die estab- laetrile. Quackwatch. Accessed 11/01 at: lishment and maintenance of CAM training pro- Gross, Paul R., and Norman Levin. 1994. Higher http://www.quackwatch.eom/01 QuackeryRela Superstition: The Academic Ltfi and its Quarrels tedTopics/Canccr/lact rile.html.

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