Notes
This article was originally submitted to the CAM Educational Project of the Program on Integrative Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, September 2001. It was updated in 2003 to reflect recent developments in anti-CAM activities in North Carolina.
Natural Medicine Marginalized as CAM?
As the term “Complementary and Alternative Medicine” (CAM) becomes a household word in government and academic texts, it is worthwhile to reexamine its significance. “Complementary” and “alternative” imply a juxtaposition to “mainstream” medicine that is questionable for a variety of reasons. The term distorts the real role a diverse group of traditional ethnic and innovative therapies, lumped together under the term CAM, play in the lives of a majority of the world’s population. The term obscures the long-standing exclusion of these treatments by the medical and pharmaceutical power structure from the practice of medicine, which, until a few years ago, labeled (libeled?) these therapies “quackery” and “health fraud”. Today it continues to marginalize them by relegating them to a fictitious category of Complementary and Alternative Medicine, invoking scientific arguments to rationalize this exclusion while avoiding any reference to economic motives. This robs legitimate, but unorthodox, medical paradigms of their rightful place within medical science, and may even be harmful to people’s health.
Millions in Africa, Russia, China, India, Central and South America, Europe, Australia, Canada and the United States claim to benefit from homeopathy, acupuncture, ayurveda, herbalism, nature cures, and many other approaches as their main or only method of health care. Most people in those countries neither perceive these therapies as an alternative nor as complementary to “mainstream” medicine. Considering that far more people are treated with “CAM” therapies worldwide than by “Western” medicine, it is a mystery, to say the least, that the definition of the term CAM has not been more widely questioned.
According to an article in the 1999 Bulletin of the World Health Organization, during attempts to study the prevalence of “CAM” in the “developing” world, surveys failed to meet the selection criteria[1]. This is partly due to the fact that “users of traditional therapies in developing countries would almost certainly have different characteristics (than those in the industrialized world)”[2]. The author of the article concludes, “The prevalence and use of CAM is likely to vary according to factors that are not fully understood. The available data are both contradictory and unreliable.” To eliminate these uncertainties he recommends that future studies deal with “named therapies rather than CAM in general.”[3] Could the reason for these uncertainties lie in the murky definition of CAM itself?
Even in the industrialized world, where most studies on the prevalence of CAM were conducted[4], there are difficulties with the definition. According to recent surveys, many middle class families in the United States, Europe, and Australia, rely on homeopathy, chiropractic or naturopathy, for some or most of their health care, and/or without informing their regular doctors of this fact[5]. Undoubtedly some of these patients would prefer to think of “mainstream medicine” as the “exception” or “alternative”, complementing their chosen “main” health care modalities. Obviously, here again, the words “alternative” and “complementary” are meaningful only in reference to the mainstream (western; industrial; “scientific”) medicine.
Isn’t CAM really Mainstream Medicine?
The truth is, the “dictocrats” of a global government, academic, media and business conglomerate[6], also known as the “medical-industrial” complex, that has marginalized unorthodox medical therapies for nearly a century, prefer the term CAM. They welcome the juxtaposition because of a vested interest in maintaining a perception of commercial medicine as “mainstream”, and anything that does not fit in that category as CAM.
Bureaucracies such as the National Institute of Health (NIH) and the World Health Organization (WHO) propagate the gospel of “scientific” mainstream medicine and its “unscientific” CAM counterpart, even though most of the world is still trying to figure out what the term CAM really means. Meanwhile, a rapidly growing utilization rate of alternative therapies by well-educated patients in industrialized countries, exceeding in some places the 50% mark[7], begs the question, which medical system really is “mainstream”.
The term CAM also belies the autonomous contributions some of these “non-mainstream” healing approaches made to the evolution of medicine. What is most disconcerting about the term is that it reflects a dishonest, even patricidal, attitude contemporary medicine has taken towards its own roots. For nearly a century, medical textbooks have consistently ignored the role homeopathy and naturopathy played in medical and pharmacological innovation.
You will never find a mainstream medical text saying “in the early nineteenth century, when mainstream doctors practiced “blood-letting” and passed out poisonous doses or mercury and arsenic”, that homeopaths introduced small, non-toxic doses of Digitalis (Hahnemann, 1828) and Nitroglycerin (the homeopathic remedy Glonoinum; Sobrero, 1847) to treat heart disease[8]. Homeopaths prevented rabies with Lyssinum, a medicine made from the saliva of the rabid dog (Hering, 1833) and anthrax with Anthracinum, made from the spleen of affected sheep (Lux, 1833) – more than fifty years before allopathic medicine claimed to have “invented” these therapies[9].
Many homeopathic and eclectic remedies were later absorbed into allopathic medicine. As recently as 1940, the Merck Manual still listed a large number of homeopathic and eclectic medicines in its Materia Medica section. However, once the chemical industry had advanced to the point it could synthetically produce substances previously derived from medicinal herbs, herbalism, naturopathy and homeopathy were relegated to the scrap heap of “unscientific and unproven” methods. The trend in medicine is to ignore its historical roots and pretend that only man-made therapeutics prescribed on the basis of a biochemical theory can be safe or effective. This trend echoes an evolution of medicine from an innocent and honest effort to heal the sick, into an industrial behemoth motivated by profit at any cost, even at the expense of truth.
There can be no doubt about it – the single common denominator connecting therapies as diverse as acupuncture, homeopathy, chiropractic, herbalism, osteopathy, massage therapies, and naturopathy, is that they do not utilize manufactured pharmaceuticals. The only meaningful definition of CAM is therefore – any therapy not using pharmaceuticals.
No Profit In “Alternative Medicine”
Why do today’s mainstream medical therapies make exclusive use of manufactured drugs, even though many herbal and natural “alternative” drugs are available? The answer: Since natural equivalents have been around for centuries, how could they be patented and marketed at a profit?[10] Self-sufficient and knowledgeable patients could harvest or cultivate these drugs themselves and consequently would not need to buy their synthetic equivalents at a far higher price. Can an industry serious about expanding its profits ever be tolerant of the notion that its products may be unnecessary for a segment of the population?
After years of depicting these therapies as frauds or “cults”, mainstream medical literature, following a trend of increasing popularity, now refers to any healing modality that uses natural, non-chemical drugs as “CAM” therapies. However, the subliminal message, conveyed to medical students, doctors, and medical professors, remains: CAM is everything “unproven” and “unscientific”. A naturopath may prescribe an extract of the thyroid of the sheep, while the conventional doctor relies on Synthroid, yet somehow the academic world and the media portray the naturopath as “unscientific”.
Medical journal editorial boards dictate the academic (and general public’s) perception of the scientific rank of therapies and the research conducted on these therapies. Science watchdog organizations, such as American Council for Science and Health (ACSH) and the American Association for the Advancement of Science (AAAS) apparently have considerable influence on editorial decisions of medical journals[11]. According to investigator P. Joseph Lisa, ACSH was funded and controlled in part by the chemical and pharmaceutical industry through corporations such as the Pharmaceutical Advertising Council (PAC)[12].
Anti-Quackery Campaign
According to Lisa, in the past, these organizations have collaborated with government and administrative agencies, such as the FDA, in conducting an “anti-quackery campaign” “investigating” or threatening alternative practitioners. Other PAC-funded groups like National Council Against Health Fraud (NCAHF) and Committee for the Scientific Investigation of Claims for the Paranormal (CSICOP) routinely attack the scientific status of alternative medicine[13]. “CSICOP’s viewpoint dominates the treatment of paranormal claims in nearly all elite, opinion-shaping publications, including Science (the journal of the AAAS), the New York Review of Books, and Time magazine, and in mass-circulation periodicals such as Reader’s Digest and Parade”, concludes the British investigative journalist Martin Walker[14].
Professional “quackbuster” Stephen Barrett, MD, vice president of NCAHF and board member of CSICOP, and advisory board member of the ACSH, and a retired psychiatrist, has an anti-CAM site called www.quackwatch.com , where he discredits all medical therapies that avoid pharmaceuticals, as “unscientific” and “fraudulent”. In an angry letter to a review of Lisa’s Book, “Assault on Medical Freedom”, Barrett boasted that he had successfully sued and gotten a judgment to remove some twenty pages of Lisa’s book. Apparently the quackbusters have infinite wealth to draw on to sue anyone who disagrees with them or exposes their sordid activities.
Barrett does not disclose his ties to the pharmaceutical industry or the fact that he is not even licensed as a medical doctor. In a telephone conversation with myself, Joe Lisa confirmed that Barrett’s organization convinced a judge that the word “shrink” he had used to describe Barrett was libelous, and he had to replace it with the term “psychiatrist”. However, all substantive documentation of the smear campaign conducted by the Pharmaceutical Advertising Council against Complementary and Alternative Healers and Businesses remains intact.
Barrett and other board members of these “independent”, “non-profit” organizations funded by the pharmaceutical industry, such as James “the Magician” Randi appear as “experts” on radio and TV and write articles in medical journals critical of CAM. For example, Barry L. Beyerstein, who published a derogatory article on CAM titled “Alternative Medicine and Common Errors in Reasoning” in the journal Academic Medicine[15], is on the board of the NCAHF, a fellow and member of the executive committee of CSICOP and on the Board of Scientific and Policy Advisors of the ACSH. Neither Dr. Beyerstein, nor Academic Medicine, chose to reveal these affiliations or their financial ties to the pharmaceutical and chemical industries.
The purpose of the whole charade is presumably to steer medical professionals and the general public away from alternative medicine. These allegations are, of course, difficult to prove. No scientific research has been conducted to see if a study’s chance of success to be published in a prestigious medical journal is directly proportionate to its potential benefits to the marketing efforts of a drug. If it were, would the financial backers of these journals permit them to be published? There is currently no system of checks and balances in place that would prevent medical research from becoming corrupted by economic interests.
Financial Ties to Commercial Interests
According to a recent Associated Press article, financial and economic ties between researchers, editorial boards, and industry are commonplace[16]. “Drug companies routinely pay medical doctors to conduct human studies on the safety and efficacy of new drugs and medical equipment.”[17] Currently there are no regulations that require researchers to disclose any financial interests or other ties they may have to the institutions funding their research. Recent recommendations drafted by the nation’s top medical schools to set conflict-of-interest guidelines requiring researchers to disclose their financial interests[18] will not likely change the fact that financial and economic forces drive mainstream medical research. This trend has affected its quality and reliability.
For example, in 1999 drug maker Wyeth-Ayerst Laboratories, a division of American Home Products Corp., commissioned ghost-writers to manufacture ten medical articles promoting a combination of Wyeth drugs called Fen-Phen as a treatment for obesity. Two of the articles actually got published in peer-reviewed journals. After Fen-Phen was pulled from the market for permanently damaging peoples’ heart valves, lawyers for injured victims discovered that Wyeth had edited the articles to not only play down, but occasionally delete descriptions of side effects caused by the drug. Prominent scientists put their names on these articles in return for fees as small as $1000 to $1500 – and journal editors published the articles as if they represented independent scientific inquiry. Wyeth could then cite these “independent” studies to convince doctors to prescribe Fen-Phen[19].
In 1996, Sheldon Krimsky of Tufts University examined 789 articles published by 1105 researchers in 14 leading life science and biomedical journals. In 34% of the articles, at least one of the chief authors had an identifiable financial interest connected to the research. None of these financial interests were disclosed in the journals. Krimsky said the 34% figure was probably an underestimate because he couldn’t check stock ownership or corporate consulting fees paid to researchers[20].
In 1994 and 1995 researchers at the Massachusetts General Hospital surveyed more than 3000 academic scientists and found that 64% of them had financial ties to commercial interests. They reported in the Journal of the American Medical Association (JAMA), that 20% of the 3000 researchers admitted that they had delayed publication of research results for more than 6 months, to obtain patents and to “slow the dissemination of undesired results.” “Sometimes if you accept a grant from a company, you have to include a proviso that you won’t distribute anything except with its OK. It has a negative impact on science,” says Nobel-prize-winning biochemist Paul Berg[21]. In 1999 Drummond Rennie, then editor of JAMA, said private funding of medical research was causing “a race to the ethical bottom…. The behavior of universities and scientists is sad, shocking, and frightening.” He continued, “They are seduced by industry funding, and frightened that if they don’t go along with these gag orders, the money will go to less rigorous institutions.”[22]
Research on alternative healing modalities is often discriminated against a priori, because it does not fit the predominant scientific paradigm. In 1988, the editor of Nature magazine, Sir John Maddox, vilified and attacked Jaques Benveniste’s study as “unscientific” that found effects in vitro of ultra-molecular dilutions, similar to those used in some forms of homeopathic treatment[23]. The editor of Nature had chosen to publish the study along with an elaborate editorial, cautioning that the results would potentially challenge the currently held paradigm. Benveniste’s results corroborated certain aspects of homeopathy that, for over a century, had been used by proponents of allopathic medicine to attack homeopathy on scientific grounds.
However, shortly after the publication of the article, the editor, along with magician and founding member of CSICOP, James Randi, and NIH scientist and professional science “ghost buster” Walter Stewart, visited Benveniste’s lab, presumably to perform a “scientific exorcism”. After observing the Benveniste team for about a day, the self-styled “experts” declared months of careful experiments and statistical analysis “fraudulent”. This peculiar act and publicity stunt resulted in the loss of the researcher’s laboratory, his funding and his reputation. The Benveniste affair is a perfect illustration of the bias and superstition among scientists against anything unorthodox.
Another case in point is the North Carolina Medical Society’s campaign against alternative medicine. This trade group, along with its stooges on the North Carolina Medical Board, long enlisted the help of “big guns” from the “quackbuster groups”. The Board boasts that it is the oldest Medical Board in the country. By law, the North Carolina Medical Society provides a majority of the Board’s members, and can therefore control its policies. Walter Stewart, whose pro-industry zeal extends beyond science “ghost-busting”, appeared on the radio talk show “People’s Pharmacy”, two weeks before the North Carolina legislature voted on the Medical Board’s power to revoke a doctor’s license for practicing an alternative therapy.
Three years prior, the NC’s Supreme Court had sided with the Medical Board against George Guess, MD, whose license the Board had revoked for practicing an “non-standard and non-prevailing form of medicine”, namely homeopathy. After an on-the-air call questioning Stewart’s role in the Benveniste investigation, Stewart boasted that he had successfully exposed Benveniste’s research as a fraud. During the show he repeatedly referred to homeopathy as a “cult”. Apparently his role in the “Nature” publicity stunt led him also to the erroneous conclusion that he had successfully debunked homeopathy. The moderator of the show, Joe Graedon, who had in the past in his syndicated columns called homeopathy “mumbo-jumbo”, quickly cut the caller off when the caller challenged Stewart’s assertions.
The show featured the homeopathy story along with a woman crying bitterly about having been victimized by a “medical fraud” in the form of an experimental (allopathic) harmful drug prescribed by a licensed physician. This had nothing to do with alternative medicine, but the implied subliminal message to the public was presumably that if the Board can’t discipline a doctor for using unorthodox treatments, you could also be harmed by other “fraudulent” medical treatments such as homeopathy.
At the time, the Chapel Hill, NC “public” radio station that produced the show allegedly had an announcement that it was “made possible” by funds from Glaxo, now Glaxo Smith Kline – a pharmaceutical company with offices in the nearby Research Triangle Park – but neither the hosts nor the station revealed their apparent intentions to influence the legislature decision. Nevertheless, in spite of Stewart’s best efforts to discredit homeopathy, the North Carolina legislature signed into law a bill restricting the powers of the Medical Board to punish doctors for practicing an alternative form of medicine.
Unfortunately, this law has not prevented the North Carolina Medical Board from investigating other CAM practitioners. In 2002, the Board targeted more than half a dozen MDs who practiced an alternative form of treatment, as well as several unlicensed CAM professionals, including homeopaths and Ayurvedic Doctors. This action seemed to follow a resolution by the Federation of State Medical Boards aiming at tightening guidelines on CAM practitioners for all State Medical Boards. Several of the practitioners who were investigated had even contributed to the education of over a hundred medical students as part of the Program on Integrative Medicine at UNC, Chapel Hill.
Was this renewed attack by the oldest Medical Board in the country designed to prevent North Carolina doctors and medical students from finding out about alternative therapies? Was it a sign of a new strategy by the Aesculapian behemoth to curb the growing Health Freedom Movement, after the states of Minnesota, Rhode Island and California had passed legislation allowing the free practice of alternative therapies (as of 2016, ten other states have passed similar legislation including Idaho, Oklahoma, Louisiana, New Mexico, Arizona, Colorado and Nevada). If nothing else, the Board’s action has strengthened these practitioners’ resolve. In 2003, activists introduced no less than 9 bills to change North Carolina’s anti-CAM medical licensing laws.
In March, 2001, the results of a new study conducted by Professor Madeleine Ennis and a team of European scientists using a consortium of four independent European laboratories were published in the minor journal Inflammation Research[24] The multicenter study confirmed Benveniste’s original findings. Hardly any mainstream medical journal ever took notice.
Why the silence regarding evidence that marks a revolutionary breakthrough in medical science and confirms what Samuel Hahnemann, one of the Founding Fathers of modern medicine, the man whose name was later eliminated from medical text books, postulated more than two hundred years ago? Can this dead silence be explained by the fact that this breakthrough calls into question a big part of the biochemical paradigm underlying conventional drug therapies? Are the editors afraid of the financial consequences of such a paradigm shift? Or is it that the academic spin-doctors couldn’t care less about shifts in scientific paradigms because, in actuality, their predominant paradigm is about share prices and stock options?
In an article in one of the few papers that covered the story, The Guardian, Lionel Milgrom comments, “one thing seems for certain. Either Benveniste will now be brought in from the cold, or professor Ennis and the rest of the scientists involved in the pan-European experiment could be joining him there.”[25] If the latter is what honest researchers, who do not have financial backing from the pharmaceutical industry, can expect, we can understand, why relatively few are willing to risk their necks conducting studies about CAM therapies. As of this writing, Jaques Benveniste remains “out in the cold” (unfortunately, as of 2016, this is still the case).
Conclusions
Vast bodies of empirical knowledge and their therapeutic applications, recently re-classified as CAM, have been almost completely marginalized. It can only be concluded that mainstream medical research and publications are doing this because CAM does not utilize or promote their synthetic, patentable drugs. The extent to which this occurs is surpassed only by the rigor with which mainstream medicine rationalizes this exclusion. They consistently invoke “scientific reasons”, while steering perfectly clear of references to economic factors. The paucity of public commentary and research on this remarkable circumstance in the current dark ages of medicine will likely prove a fascinating subject of future investigations into the history of medical science and commercial-industrial culture.
Nevertheless, glimmers of light occasionally appear on the drug-free therapies horizon, possibly indicating that a different attitude is finding its way into medical publications. Recently the New England Journal of Medicine published a review by James Spencer Malpas, M.D., D.Phil., of St. Bartholomew’s Hospital in London, that found conventional chemotherapy was no more effective than no treatment at all. This article also praised the positive effects of the “alternative” Gerson Dietary Therapy and juicing regimen in the treatment of cancer[26]. If such reports on positive results continue to be published in major peer-review journals, some day perhaps, the question may dawn on researchers as to whether the intentional exclusion from scientific investigation of drugless therapies and the paradigms they are based on, might represent a de facto measurable threat to health and life.
What if you added environmental health consequences from pharmaceutical drugs to the equation? There is mounting evidence that waste products from the medical and pharmaceutical industry have irreversibly infiltrated drinking water, rivers, oceans, animal and plant life, and food. The long-term health effects are only beginning to be understood[27]. Or could it be possible that these effects may be entirely welcome by the profiteers of the drug manufacturers and their bettors? The more poisoning, the more people need treatment, the more money for them. When you consider these factors, are the words of health freedom advocate Tim Bolen on the activities of the professional detractors of CAM really so extreme? “No studies have ever been conducted to determine the level of suffering, and death, inflicted on Americans because of the activities of these conspirators.”
Like drugs, evidence can be manufactured. Make no mistake about it – the evidence for conventional drug treatment has been, at least in part, manufactured. It is true that so far funding for research on healing methods that do not use manufactured drugs has been minimal. That fact has led many in academic medicine to harbor the notion that lack of research on the efficacy of a therapy means lack of efficacy.
Let us hope that some day this obvious and common error in reasoning will be replaced by a rational and intelligent attitude towards all methods of healing. Whether or not formal studies have been conducted on homeopathy, acupuncture, naturopathy, herbalism, chiropractic, ayurveda and many other unorthodox healing systems, their real status is neither alternative nor complementary to industrial drug therapies. In the final analysis, after you subtract economic factors, allow for corruption, bias and superstition, and when you figure in their historical impact on medical science, including centuries of documented evidence of efficacy, and the place they have in people’s lives today, the truth is, so-called “CAM” therapies are simply good medicine.
References
[1] Ernst, E. Prevalence of use of complementary and alternative medicine: a systematic review, Bulletin if the World Health Organization, 2000, 78 (2), p. 255
[2] Ibid., p. 255
[3] Ibid., p. 256
[4] Ibid., p. 254
[5] Eisenberg, D. et al. Trends on alternative medicine use in the United States, 1990-1997. Journal of the American Medical Association, 1998, 280, 1569-75
[6] Garrison, Omar V., The Dictocrat’s Attack on Health Foods and Vitamins, ARC Books, New York, 1970
[7] Ernst, E., op. cit., p. 255
[8] Hering, Constantine, Guiding Symptoms of the Homeopathic Materia Medica, 1865, Vol. V., p. 100; 407
[9] Ibid., Vol. I, pp. 334; Vol. VII., p. 159
[10] Patent life in the United States for pharmaceuticals is seventeen years.
[11] Walker, Martin J., Dirty Medicine: Science, Big Business and the Assault on Natural Health Care, Slingshot Publications, England, 1994, p. 54
[12] Lisa, P. Joseph, The Assault on Medical Freedom, Hampton Roads, Publishing Company, Norfolk Virginia, 1994, p.126
[13] Walker, M., op.cit., p. 55
[14] Ibid., p 55
[15] Beyerstein BL. Alternative Medicine and common errors of reasoning. Acad Med 2001; 76: 230-237
[16] Article, MS-NBC, Medical schools seek end to conflicts: Researchers would have to disclose financial interests. Associated Press, Boston, Feb 10, 2001
[17] Ibid.
[18] Ibid
[19] Rampton S and Stauber J, Trust us: How Industry and Science gambles with your future. New York, Tarcher/Putnam, 2001. ISBN 1-58542-059-X. http://www.prwatch.org/cgi/spin.cgi . p. 211
[20] Ibid. p. 213
[21] Ibid. p. 215
[22] Ibid. p. 217
[23] Davenas, E. et al. Human basophil degranulation triggered by very dilute antiserum against IgE. Nature, Vol. 333, No. 6176, pp 816-818, June 30, 1998
[24] Belon, P., Inhibition of human basophil degranulation by successive histamine dilutions: Results of a European multi-centre trial. Inflamm. res. 48: pp 17-18
[25] Article. Thanks for the memory: Experiments have backed what was once a scientific ‘heresy’, says Lionel Milgrom. Lionel Milgrom. Guardian, Thursday March 15, 2001
[26] Article. James Spencer Malpas. New England Journal of Medicine. December 12, 2002
[27] Article. Science News 153 [12]:187, 21 March 1998
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