An Herbal Rumble

In alternative medicine, a soothing, low-stress environment is the first rule of good health. But Washington has a way of knocking everyone's chi out of alignment. Two years ago President Clinton set up a commission to recommend a policy on "complementary and alternative medicine" (CAM), a burgeoning field that ranges from the near-mainsteam (chiropractic) to the exotic fringe ("life energy" manipulation).

But when the commission quietly released its final report last month, it asked for more research money and increased government attention, re-igniting some bitter divisions in the health-care community. "We all have a desire for simple and inexpensive solutions," Dr. Yank Coble, president-elect of the American Medical Association, said of the report's findings. "But anything that sounds too good to be true often is." Dr. James Gordon, chair of the commission, said of the backlash, "There were one or two people who said we shouldn't be studying any of these approaches. I'm sorry, but that's not a very scientific attitude." Somebody needs some massage therapy.

As health care gets more expensive and impersonal, Americans are turning to techniques from other cultures. In 1997--the year of the last big study--42 percent of the population used some form of alternative therapy (though a core of true believers, about nine percent, accounted for 75 percent of those visits). Overall they spent $27 billion out-of-pocket, about equal to what Americans spent (not counting reimbursements) on conventional medicine. The National Institutes of Health spends almost $250 million a year studying CAM, and 91 out of 125 surveyed medical schools deal with it in required courses. But the commission's report envisions a vastly expanded role. "Health involves all aspects of life-mind, body spirit and environment--and high-quality health care must support care of the whole person," the report says. That means broad increases in funding for research, more emphasis in medical schools and wider insurance coverage. It's a policy blueprint that could make these practices as common as X-rays.

The first job, though, is to figure out what actually works. "The guidelines should be exactly the same as for conventional medicine," says Gordon, a psychiatrist. "Is it safe, is it effective and can it save us money?" CAM relies heavily on anecdotal claims of effectiveness, so the commission wants funding for rigorous trials, and federal and state agencies to regulate the field. The medical establishment looks warily at those recommendations. "If we're talking about small amounts of money to look at some of these potions people take, I don't have a problem with that," says Dr. Jerome Kassirer of Tufts University, former editor of the New England Journal of Medicine. "If they apply for funding for jewels on the chest or remote healing, that would be completely absurd." Don't hold your breath waiting for movement, though; the White House wouldn't comment directly on the report, and a Department of Health and Human Services spokesperson said it was "premature to make a prediction" about how the it might be put into action.

What the CAMsters want may be impossible in any case. Many alternative therapies don't lend themselves to classical trials. What's a valid placebo for a test of acupuncture? Hard-line defenders of conventional medicine say any practices that can't be formally tested should be disqualified right off, and that the commission was stacked with alternative medicine advocates too credulous to be trusted to make policy recommendations. The broad scope of the report--ranging from basic fitness and nutrition to Native American medicine wheels--troubled even some members of the commission, such as Dr. Joseph Fins, a medical ethicist at New York Presbyterian Hospital. "You do a disservice to the things that have been proven to be safe and effective by clumping them with things that are not," says Fins.

The awkward fact is that after ten years of research the National Center for Complementary and Alternative Medicine at NIH hasn't validated a single practice. Yet a few legislators, led by Iowa Sen. Tom Harkin, continue to push for more studies. All sides agree that ideally there'd be medicine that works, and medicine that doesn't, with no special distinction for "alternative." Separating the good stuff--like better ways of dealing with patients--from the nonsense is the contentious part. Maybe aromatherapy candles would help.