Some Thoughts on Alternative Medicine: Past, Present, and Future.

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Some Thoughts on

Alternative Medicine:

Past, Present, and Future

 

Reporting and Commentary © By Peter Barry Chowka

 

(October 15, 2002) - Recently, a reporter contacted me by e-mail. She wrote that

she was working on a story about alternative therapies, based on the news about

a positive study of Lorenzo's Oil, an unconventional treatment for a rare

disease (adrenoleukodystrophy) and the subject of a 1992 Hollywood feature film.

" I wanted to ask you, " she wrote, " if you think it's difficult for a home

therapy such as this one to make it though clinical trials and be proven to

work. . . several people indicate that they feel a war has been declared against

alternative medicine. "

 

A war, indeed. The reporter's beat is science and medical news. And a query like

this one is difficult to resist. During the course of a week or so, she and I

exchanged a lot of e-mails and talked a number of times on the phone. I shared

with her the names of some well-informed, credible, and primary sources and a

lot of general and specific information gleaned from more than two decades of

investigating and writing about alternative medicine.

 

The author (right) during a break in a live national interview by Tom Snyder,

ABC TalkRadio Network, Los Angeles, June 1987; Photo by Kathi Head

 

Although the reporter is widely published, she admitted that she did not have

much experience covering controversies in alternative medicine. I found that

interesting and revealing. A decade or two ago, " controversies in alternative

medicine " was a very frequent topic of mainstream media inquiry. Programs like

ABC News 20/20 and CBS News 60 Minutes and high-profile reporters like Geraldo

Rivera and Tom Snyder routinely did in-depth, provocative reporting on

controversies involving alternative medicine.

 

Have the controversies gone away, then? Not really. They are just off the radar

screen of most reporters.

 

 

 

First Take

 

As I considered the issues, one of the starting points I came up with was the

observation that, the recent widely reported mainstreaming of complementary

alternative medicine (CAM) notwithstanding, few Americans are aware that their

own treatment options - indeed, their most personal medical choices - are

tightly regulated by the government and are seriously limited. Despite all of

the changes and growth in alternative medicine, there remain very little freedom

of therapeutic choice and only a half-hearted commitment to medical pluralism in

this country. At the local level, the clinical practice of primary alternative

medicine is still routinely criminalized.

 

The Access to Medical Treatment Act (AMTA) is a fledgling, and moderate, attempt

at reforming things. It is ironic, however, that it is the U.S. Congress that is

being asked by proponents of the AMTA to start undoing years of bureaucratic

meddling that has resulted in the situation that has made the Access Act

necessary - meddling that was voted into law incrementally by the same

legislative body. It's no surprise that the Access to Medical Treatment Act has

been languishing in Congress since it was first introduced almost a decade ago.

 

The reporter asked me what I thought about the Food and Drug Administration

(FDA) and the signature role that it plays. The modern FDA began in 1930 under

the mandate of the 1906 Federal Food and Drugs Act. Starting with a tiny number

of employees and a limited mandate - primarily to oversee food product labelling

- the FDA has grown into a bureaucratic behemoth with a 2001 budget of $1.6

billion and 9,100 employees. As the New York Times reported on October 8, 2002,

the FDA now has the authority to regulate products that account for 20 percent

of every consumer dollar spent. The agency regulates every aspect of health

care, including routinely restricting Americans' choices and preventing access

to promising, innovative medical treatments.

 

Restrictions of medical freedom and pluralism continue despite - or perhaps

because of - the new context and extraordinary popularity of a segment of

alternative medicine that is allowed to flourish - mostly a safe,

non-threatening kind, involving " integrated " and " complementary " approaches.

Emblematic of the trend are things like the smiling, avuncular face of Dr.

Andrew Weil on the cover of Time magazine, or slick television advertisments for

a national cancer treatment center that hype the use of vitamins and nutrition

(to support the patient's immune system while he/she undergoes conventional

chemotherapy).

 

 

 

Sick Children are Emblematic

 

The issue of children with cancer and other life-threatening illnesses whose

families want to use alternative treatments is particularly vexing. (The

Lorenzo's Oil therapy, which piqued the reporter's interest, is for children.)

The challenges and controversies that can quickly envelop and overwhelm families

whose children are seriously ill bring into sharp focus the current restrictions

on medical choice that affect all Americans.

 

Magazine cover with the author's article on sick children and medical freedom of

choice (1988)

 

Over more than two decades, I have covered a half dozen cases of children with

cancer whose parents - loving, informed, and conscientous - wanted options other

than, or in addition to, chemotherapy and radiation for their sick kids. In each

instance, medical authorities and then the state became involved - limiting

medical choices and in some cases playing legal hardball by threatening the

parents with prosecution for wanting to go beyond mainstream medicine. A child

with terminal cancer is heartbreaking enough - but for the parents to have to

fight both cancer and bureaucrats is more of a challenge than one can imagine.

Parents of sick children today who are interested in accessing alternatives have

told me that their freedom is more restricted than it was two decades ago.

 

As an attorney for one sick child's parents told me in 1979, " It's proper for

courts to determine if parents are competent. It is not proper for the courts to

make medical decisions. "

 

Medical doctors and the state, however, believing they will be backed up by the

courts, generally take an activist and unfavorable view of parents who employ an

alternative therapy for a sick child. A recent, high-profile case involved four

year-old Thomas Navarro, who had medulloblastoma, a form of brain cancer, and

whose family wanted him to be treated by Stanislaw Burzynski, MD, PhD. Alexander

Horwin was another young person with brain cancer whose treatment choices,

according to his parents Michael and Raphaele, were dictated by the FDA's

unresponsive, bureaucratic rules rather than by his parents' best informed

judgments.

 

A touchstone of the medical freedom issue occurred in 1987, when the U.S.

Federal Court of Appeals for New York ruled, in a case involving alternative

cancer clinician Emanuel Revici, MD, that " An informed decision to avoid surgery

and chemotherapy is within the patient's right to determine what to do with his

or her own body. . . We see no reason why a patient should not be allowed to

make an informed decision and go outside currently approved medical methods in

search of an unconventional treatment. " If the intent of this ruling could be

applied to the FDA and other government agencies, the American people's health

would probably be a lot better today.

 

 

 

Starting Points

 

I started my long odyssey of writing about alternative medicine in the 1970s. At

the time, I was covering national politics in Washington, D.C. In 1976, I was

given an assignment by a national magazine to write an article about cancer.

President Nixon had declared an official, bipartisan " War on Cancer " several

years earlier and questions were starting to be raised. When I began looking

into the cancer war, to my surprise I found a situation that was highly

politicized and riddled with conflicts of interest. As I interviewed top people

in the federal health agencies, cancer charities, and academic medicine, I

discovered they were more like politicians than physicians or healers. One door

opened on a dozen others, and after deconstructing medical orthodoxy in a series

of articles I started investigating and writing about promising innovative

alternatives.

 

Cover of magazine with the author's first national article on cancer and

alternative medicine (1977)

 

It's been a long and complex journey of discovery and reporting. Throughout the

twentieth century, alternative medicine remained controversial but that

situation began to change a decade or so ago.

 

Today, alternative medicine has increasingly been " mainstreamed " - it's taught

insome medical schools and has found a well-funded home in the U.S. government.

Officially, the war on alternative medicine has supposedly ended. But at the

grassroots level, as patients will often tell you, it's as hard today as it ever

was to get access to primary alternative therapies. The kind of alternative

medicine that has started to gain legitimacy ( " CAM, " a less threatening term)

entails adjunctive modalities that can be used along side of conventional

treatments while not threatening the hegemony of the conventional medical power

structure and the entrenched economics of the medical/pharmaceutical status quo.

 

A clear look at the cancer field is instructive. The bottom line has long been -

and still is - that more people in this country make a living from cancer than

die from it (annually). And about 600,000 Americans die of cancer every year.

Meanwhile, cancer is about to become the leading cause of death, the average

patient spends six figures to treat his or her disease, and the " five-year

survival rates " for most forms of cancer are only marginally better than they

were three decades ago. What's wrong with this picture? Everything - including

the fact that the politics and economics of cancer may have become more complex

than the science of cancer.

 

History is full of examples of promising innovative therapies arising from

outside of the mainstream - ranging from discoveries in the laboratories of

Nobel Prize winners like Linus Pauling, Ph.D. and Albert Szent-Gyorgyi, MD, PhD,

to the offices of lay healers like Harry Hoxsey (all of these individuals are

long deceased). But no matter where it came from or how credible the proponent,

if an approach was considered by the powers that be to be " unconventional, " it

faced an uphill and usually impossible battle. A kind of medical McCarthyism has

reigned - and once an innovator was blacklisted or relegated to the medical

gulag, he or she faced a daunting road to acceptance or even to getting a fair

hearing. Many credible pioneers have died of old age before their discoveries

were ever recognized, acknowledged, or made widely available.

 

 

 

Looking to the Future

 

During a week or so of regular contact with the reporter, I shared much of the

previous information and observations. I also developed some fresh insights of

my own into the state of alt med today, and some concerns about what lies ahead.

 

It seems promising that alternative medicine has gained a strong foothold, not

only in this country but around the world in widely divergent cultures. An

article on September 17, 2002 in The Age (Australia), titled " Alternative

Medicine Booming, " reported that " Australians are spending more on alternative

therapies than pharmaceuticals, prompting calls for improved regulation of the

complementary medicine industry and some soul-searching by doctors. An Adelaide

University study shows 60 per cent of women and 44 per cent of men use

alternative therapies. "

 

Another article, in the Gulf News (United Arab Emirates), reported, " Public

hospitals [in the UAE] could start offering alternative medicine services to

patients, Sheikh Mohammed bin Saqr Al Qasimi, assistant undersecretary at the

Ministry of Health and director, Sharjah Medical District, said yesterday. 'It

is a possibility, since difficulties in diagnosis or treatment while following

traditional medical methods could possibly be resolved by alternative medicine,

the various branches of which we are now examining and trying to understand,' he

said while opening Ayurvedic Herbal Health Centre's new premises. He indicated

the thrust towards alternative medicine in the UAE is gaining fresh momentum,

pointing out the ministry has established a new department to review the issue

and scrutinise applications on a case-by-case basis. 'The medical authorities

did not recognise these alternative forms, but we are now closely studying them

and granting permission after scrutiny of the documents and facilities,' he

added. "

 

In the United States, the federal government's full scale entry into the field

began in 1991 with legislation passed by the Congress mandating the Office of

Alternative Medicine (OAM) at the National Institutes of Health (NIH). Over the

course of a decade, alternative medicine has been renamed - to complementary

alternative medicine - and given its own burgeoning bureacracy. The OAM started

humbly, with a $2 million a year budget which its first director, Joe Jacobs,

MD, referred to as " homeopathic. " Today, it might be described as metastatic as

spending has grown to over $113 million annually via the National Center for

Complementary and Alternative Medicine (NCCAM), which in 1998 supplanted the

OAM.

 

A 5,600 percent increase in the federal budget for alt med during the course of

one decade is not bad. Another $2-plus million was recently spent by the White

House Commission on Complementary and Alternative Medicine Policy (WHCCAMP),

which took two years to study the field, take testimony from hundreds of

witnesses, and issue a lengthy report that contained more than 100

recommendations for more federal spending, research, integration, and so on.

 

But all of this has not been enough for many proponents of complementary

alternative medicine, who routinely advocate bigger infusions of tax dollars in

order to put their vision of alternative medicine on an even faster track, with

demands that it be included in Medicare, made available free of charge to

" underserved communities, " and otherwise expanded.

 

One might ask what all of the money spent on CAM - probably close to half a

billion dollars since 1992 - and the personnel, conferences, committees,

reports, and meetings have achieved. Part of the answer might lie in a typical,

current case history.

 

In May 2001, the National Cancer Institute (NCI) announced that it would conduct

a review of 714X, a nontoxic Canadian cancer treatment used by many Americans.

There was a buzz about the treatment in April and May of 2001 when the leading

media in Boston exposed an alleged cover-up of promising tests on 714X by a

major conventional cancer research center. Quickly, the U.S. National Cancer

Institute became involved, noting that it had the mechanisms to do a fast track

review of 714X. On May 30, 2001, Jeffrey White, MD, the director of the NCI's

Office of Cancer Complementary and Alternative Medicine, told me, " we ought to

be able to get that review [of 714X cases] done in a month's time [after the

cases were submitted]. " (The cases were submitted in August 2001.) White

continued, " Then we'll have to find out when the next meeting of the CAPCAM -

the Cancer Advisory Panel for Complementary Alternative Medicine - is and get it

[714X] scheduled on the agenda for CAPCAM review. "

 

That next CAPCAM meeting took place on February 25, 2002 and, according to the

official minutes of the meeting, 714X was not discussed. As of this writing,

eight months later, the CAPCAM has yet to meet again.

 

On October 7, 2002, the mother of a cancer patient who used 714X successfully,

and who helped to spearhead the effort in Massachusetts in early 2001 to uncover

and bring to public attention the positive 714X tests, told me, " Nothing has

happened with the NCI and 714X. [My son] just had to sign more permission papers

as they [NCI] are continuing to ask for more information. CERBE [the company in

Canada that produces 714X] is supplying everything that is possible - it seems

as though the NCI is just trying to prolong things. "

 

 

 

A Rare Voice of Dissent

 

An allied area of inquiry is the cancer Establishment's attention - or

inattention - to environmental causes of cancer and primary prevention, and the

myopia of the huge federal agencies and disease-oriented nonprofit groups that

are supposed to be doing something about cancer, heart disease, and other

conditions but that instead put most of their eggs in the treatment basket. It

is the " failure of orthodox medicine " as represented by this status quo that has

provided the inspiration for people to explore alternative options in the first

place.

 

In December 2001, on the thirtieth anniversary of the U.S. War on Cancer, I

spoke with Samuel S. Epstein, MD. A prolific author (including The Politics of

Cancer), recipient of the Right Livelihood Award (the " Alternative Nobel

Prize " ), expert on environmental cancer, emeritus Professor of environmental

medicine at the University of Illinois School of Public Health, and Chairman of

the Cancer Prevention Coalition, Epstein commented on the situation these days

vs. a decade or two ago.

 

" I'd say we're progressing from bad to worse. The fixation of the National

Cancer Institute and the [leading cancer charities] on damage control, mainly

diagnosis and treatment and basic molecular biology to the virtual exclusion of

providing the Congress, the regulatory agencies and the public with a vast body

of information on avoidable causes of cancer, coupled with the escalating

incidence of cancer, coupled with the manipulation of data by the NCI, an effort

to trivialize the incidence and to emphasize misleadingly the plateauing of

mortality rates which has got nothing to do with any efforts of the NCI but

merely reflects the decrease in smoking in men. That, coupled with the fact that

we now have, I think, reasonably persuasive evidence that up to 75 percent of

the increase in cancer rates in recent decades is non-smoking in origin. All of

these factors are merely manifestations of the fact that we have gone from bad

to worse and that as cancer rates continue to escalate the public is being

fooled more and more, Congress is being fooled more and more into believing that

we're winning the losing war against cancer, and the opposite is true. The NCI

budget has now escalated beyond all conceivable proportions. . .I really think

that we're going to see the incidence of cancer escalate still further. And I

really think we're in a major disaster.

 

" We have infinitely more politics and what's more, infinitely more money. Cancer

is now a highly profitable disease. When you read Cancer Letters, which is one

of the very best twice-monthly letters, you find further confirmation that at no

time in history has any disease, and the treatment of any disease, been so

closely tied in with industry interests. And I really believe that we're going

from bad to worse in this whole area because there's no single voice, or there

are very few single voices raised in protest and overwhelming efforts are made

to isolate those voices.

 

" The essence of democracy worldwide is the right to know, of citizens and

consumers, all aspects of information governing their lives, health, welfare,

and national policies with the exception of course of certain issues of national

security. But here we have situations in which the public is provided with no

information on the fact that there are 60 different carcinogens in cosmetics and

toiletries and household products that people use all the time. In foods,

there's no labeling of any kind other than fat and so on and so forth. The

public isn't given information on levels of carcinogens in the air from nearby

chemical industries. And at the same time they're being lulled into a false

sense of security by the media.

 

" The rollover media have an enormous responsibility in what's happening now.

Their gullibility, their lack of independence. . .And there's so little in-depth

reporting. The dynamic trio at the New York Times of Gina Kolata, Jane Brody,

and the other one whose name just escapes me - they roll over with gushing

hyperbolic enthusiasm at all the latest sudden advances in cancer chemotherapy.

For years I've been talking about the dangers and unreliability of mammography,

especially pre-menopausal mammography. It's taken twelve years or so [until]

these questions are now surfacing in the press. So we're really dealing with a

massive rollover of the media, overwhelming industry complicity, major response

of the NCI and the ACS, and with one or two lone voices such as yourself and

however powerful a story you're going to tell. I hate to say, it's going to be

lost in this hyperbolic enthusiasm of 'we're winning the war.' "

 

 

 

 

 

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