NEWS AND COMMENT AAAS Session Provides Glimpse at Science-end of Alternative Medicine Issues, Research KENDRICK FRAZIER doing its best to sift through all kinds of ing that the grants and awards issued by claims for nuggets of scientific and ther- NCCAM and its predecessor Office of The more scientific end of the spectrum apeutic value. Alternative Medicine have produced no of alternative medicine got a hearing at "Our role is to stimulate and support useful information (see story on next the annual meeting of the American the best scientific modalities," he told page). He didn't quibble with the con- Association for the Advancement of the media. Some of the therapies clusion but again emphasized that larger Science (AAAS) in Boston in February. NCCAM studies "may hold germs of studies will be necessary to get definitive Generally the kind of wacky and ques- truth." Some, he said, "will be proven results. "If something [turns out to be] tionable stuff that critics and skeptics of safe and effective, some unsafe and inef- ineffective, I have no need to fund fur- alternative medicine focus on was fective." He said the agency seeks to pro- ther studies of that topic," he said. nowhere to be seen, and in both the vide the public guidance to sort through In his presentation introducing the February 17 session and in a news brief- "folklore and rumor." symposium on Sunday morning, Straus ing for science reporters the day before, In the news conference the media again offered numerous cautions. He presenters described real scientific were about equally divided between spoke of the strong influence of people's investigations and had all the right cau- those interested in the scientific presen- beliefs, the unintended consequences tionary words about fringier topics. tations to be given and those interested of such things as botanical and drug The half-day session was titled "The in grilling Straus about the controversies interactions, "studies that provide Science Underlying Complementary over the scientific value of NCCAM and important cautionary tales" (such as and Alternative Medicine." It was orga- alternative medicine in general. DiBella multitherapy, which claimed nized by Stephen E. Straus, Director of Isn't NCCAM a highly political 10,000 successful patients, whereas sub- the National Center for Comple- agency, influenced by the views of the sequent studies showed "zero evidence mentary and Alternative Medicine politicians who helped set it up and of remissions"), and important issues of (NCCAM) within the National Insti- continue to support it with ever mind/body medicine. tutes of Health; Donald Krogstan of increasing funding? "Complementary But he maintained that good science Tulane University; and Sondra Schlesin- and alternative medicine is popular," could be done in the field. "Our speak- ger of the Washington University School Straus pointed out. The strong political ers today will tell you that it's not all a of Medicine. support NCCAM enjoys is helping it bunch of nonsense. There is interesting Straus, a physician, has the task of move forward, he said. "It provides the and exciting science to do." trying to bring good science to wherewithal to separate the wheat from In answer to questions from the NCCAM while not offending those the chaff." audience, Straus said, "I believe that influential congressional advocates of What would it take to say all of it the American people are not stupid." alternative and untested therapies who (alternative medicine] "is bunk?" he was He said they seek good information, provide a strong political and funding asked. "Our job is not debunking," he but the problem is that if reliable infor- base for the center, whose annual budget said, but only finding out what works mation is not provided, it is human for extramural research now exceeds and what doesn't. "In the U.S. people nature for people to "attach to anec- $100 million. Most observers say he is a can take things without proof [of effi- dotes." Said Straus: "We at least can master at this. [See also "Bioterrorism cacy]," he said. "We can sit back and rail provide the public with better informa- and the NCCAM: The Selling of about this or we can try to set out and tion to make those decisions. We want Complementary and Alternative Medi- find" what the facts are. to elevate the dialogue. We want to get cine," by Kimball C. Atwood IV, M.D., He openly acknowledged that it out of the streets and get it into the SKEPTICAL INQUIRER, March/April NCCAM's studies haven't yet produced hospitals and laboratories." 2002.) At die meeting and the news any significant results one way or anodier, * a * briefing, Straus certainly said all the but he maintained that larger studies now right words for his audiences of scien- under way are likelier to do so. As for the rest of the symposium, there tists, physicians, and at times skeptical He was asked directly about a new were some interesting reports: science journalists. He offered up the study just published in the Scientific Jonathan Davidson (Duke Universi- image of a taxpayer-funded agency Review of Alternative Medicine conclud- ty Department of Psychiatry) provided a SKEPTICAL INQUIRER May/June 2002 5 NEWS AND COMMENT critical analysis of previous studies of the analgesia is mediated by the body's the awards have not produced useful efficacy of St. John's Wort (hypericum) endogenous opioid systems. "In other information. on major depression. Sales of St. John's words, the appropriate context and The study is published in The Wort are now four times those of expectation is capable of triggering the Scientific Review of Alternative Medicine Prozac. There is, he said, "a little evi- release of endogenous opioids in the (5[4]:205-207, 2001) by Saul Green, a dence that St. John's Wort helps the sea- brain," leading to relief of pain. "We now former professor of biochemistry at sonal blues, or SAD" (seasonal affective know that placebos induce the release of Sloan-Kettering Cancer Institute. disorder). But the study that really got endogenous opioids in painful condi- Congressional advocates of alterna- the herb's sale going was the so-called tions and of endogenous dopamine in tive medicine caused OAM to be estab- Linde study in 1996, an analysis of motor disorders, like Parkinson's disease," lished in 1992 within the National twenty-three randomized trials. It said Benedetti. "Both endogenous opi- Institutes of Health, supposedly to carry claimed a response in treating depres- oids and dopamine appear to be released out rigorous evaluation of "alternative" sion of 55 percent—equivalent to that as neurotransmitters at the level of spe- medical treatment methods and to of prescription agents—compared with cific neurochemical pathways, rather determine their effectiveness. With 22 percent for a placebo. than as systemic modulators/hormones." some intense political support, congres- • David Spiegel (Stanford University sional appropriations for OAM and its "However," said Davidson, "there successor NCCAM have increased were limitations" to the Linde study, in- School of Medicine) described studies using positron emission tomography yearly. Its research funding now stands cluding small sample sizes and lack of at $105 million this fiscal year. long-term follow-up. He also finds "a (PET) scans of the brain to reveal effects number of things puzzling" about the of hypnosis on color vision. The PET Green, a noted critic of alternative study, including a smaller-than-expected scan examined blood flow of "highly medicine, downloaded from the placebo effect (30 to 50 percent is typical hypnotizable" patients during hypnotic NCCAM Web site records of grants and in depression). "It's not quite clear to me states and showed that blood flow awards and tabulated them. He also examined published reports of the inves- how you would get these results," he said. increased when the hypnotized patient believed he was looking at colors, tigations, although he found these to Post-Linde (since 1997) studies of regardless whether the pattern exhibited exist in small numbers. hypericum with large samples have had was in color or in gray scale. The hyp- Among his findings: "Many publica- some "disappointingly low" results, with notic illusion of color induced blood tions were found to be repetitions of odds of getting better with the treatment flow change consistent with observing previously performed research, reviews, at 2.1, "a more realistic" finding com- color. "The subjective experience of and commentaries—the latter two not pared with Linde's 5.5, but still suggestive color alteration in hypnosis was associ- requiring large grants to perform. "of some small effect," Davidson said. ated with activation and deactivation of Many projects seem to be devoted to Davidson had hoped to present at the color processing regions of the brain," implausible methods. No clearly posi- symposium results of his own NIH- said Spiegel. "This provides evidence tive or negative findings have been sponsored study aimed at testing the effi- that hypnotic alteration of perception reported for any method, yet many cacy and safety of hypericum in major changes perceptual experience and not reports call for continuing research." depressive disorder. It's a multicenter, merely reports of that experience." Green says most of the people who double-blind, placebo-controlled trial of were appointed to the OAM advisory hypericum extract. He described the Kendrick Frazier is Editor of the committees were strong advocates of study protocol, which he considers "a SKEPTICAL INQUIRER. alternative medicine, and many of them kind of model for studies of depression," were reappointed to the NCCAM advi- but said the report is still in peer review sory committees. in a major journal. "I hope to be able to Study Finds NCCAM The trend continues, he says.