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NCAHF Position Statement on White House Commission
on Complementary and Alternative Medicine

Revised March 25, 2002

The White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP) was appointed during the closing days of the Clinton Administration to make recommendations "assuring that public policy maximizes the benefits to Americans of complementary and alternative medicine." The Commission final report recommends expanded federal spending and other policy initiatives that would foster irrational methods.

Background Information

"Complementary and alternative medicine" ("CAM") is an imprecise marketing term that is inherently misleading. "Alternative" methods are loosely described as practices outside of mainstream health care. They lack evidence of safety and effectiveness and are generally not covered by insurance plans. "Complementary medicine" is loosely described as a synthesis of standard and alternative methods that uses the best of both. In truth, there are no "alternatives" to objective evidence of effectiveness and safety. As noted by editors of the top two American medical journals:

There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is 'Eastern' or 'Western,' is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. . . . As believers in science and evidence, we must focus on fundamental issues-namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy." [1]

The IOM Committee's mission aresembles that of the White House Commission on Complementary and Alternative Medicine Policy.

 

"There cannot be two kinds of medicine—conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculation, and testimonials do not substitute for evidence." [2]

Only a small minority of licensed medical practitioners use "CAM" methods. No published data indicate the extent to which "CAM" practitioners use proven therapies or the extent to which they burden patients with medically useless methods. However, there is good reason to believe that most provide substandard care and seek to undermine their patients' confidence in standard care.

NCAHF has examined the background and credentials of WHCCAMP's members. Most are philosophically aligned with the so-called "CAM" movement, and many have an economic interest in this area [3,4]. Few knowledgeable critics are among them.

The WHCCAMP Final Report

In March 2002, the Commission issued a lengthy report recommending across-the-board "integration" of "complementary and alternative medicine (CAM)" into government health agencies and the nation's medical, medical education, and insurance systems. The report is carefully contrived to suggest that CAM is close to the mainstream and that its critics are on the fringe. Just the opposite is true. NCAHF has posted a paragraph-by-paragraph analysis of the report [5].

The WHCAMP report is vague, long, unfocused, and rambling. The Commission's failure to critically analyze CAM reflects the zealotry of its chair and many of its members. Two Commissioners, Joseph Fins, MD, and Tierona Low Dog, MD, issued a clear and concise dissent that was buried in the report as Appendix G. The report was apparently modified at the last minute by Commission Chair James S. Gordon, MD, to try to blunt some of the impact of the dissent. The modifications were made without review by the Commission.

Throughout the report, the Commission implies that "CAM" is a well-defined medical discipline rather than a marketing term used to promote unproven methods. It fails to acknowledge that science-based medicine is already a highly "integrative" process and that all it requires of any therapy is objective scientific evidence that it works. There are no "alternatives" to objective evidence of effectiveness and safety. If such evidence does not exist for a given therapy, scientific medicine does not embrace it. The Commission falsely assumes that "CAM" research is cost-effective and that "CAM" methods have been sufficiently developed to integrate into every aspect of our educational and health-care delivery systems. Its report does not identify a single "CAM" practice that should be considered improper. Moreover, the Commission did not even propose criteria for evaluating "CAM" practices for safety or effectiveness—a major flaw in their work.

Given limited resources to improve health care in our society, diversion of federal spending to study illogical and ill-conceived ideas makes no sense. Many CAM practices and methods are illogical, unsafe, and never likely to be effective, a point made in the dissent by Commissioners Fins and Low Dog. The pathway for funding research has always been based on testing viable hypotheses, not all hypotheses, whether viable or not.

Conclusions

The Commission advocates spending hundreds of millions of taxpayer dollars to promote unscientific beliefs that would include treating cancer with herbal teas and coffee enemas; diagnosing ailments throughout the body by pushing down on the patient's arm; and manipulating supernatural forces to treat serious illnesses. The report implies that anything marketed as "CAM" should be taught in medical schools, included in health plans, and widely incorporated into government policies.

Such recommendations are a perversion of the trust placed in Presidential Commissions, an affront to medical science, and an assault on consumer protection. Without science-based safeguards, any scam artist with a far-fetched idea can open for business and bilk the public. The proper place for unproven and untested methods is in laboratories and clinical research studies, not in large-scale unscientific experiments upon the American people. "CAM" methods that are plausible should be tested with well-designed clinical trials. The rest should be discarded. No method should be marketed, promulgated, or taught without proof that it is safe and effective.

NCAHF believes that this Commission has failed in its mission. For a Commission of professionals with medical and other advanced degrees, its activities apparently lacked scholarship and rigor. Its draft report lacks both value and validity. Instead of seizing an opportunity to critically examine "CAM" theories and practices and making a rational and reasoned report to the President, the Commission blindly advocates policies that are illogical and economically senseless. The value of any possible therapies that may have emerged from careful review and testing has been lost in a tidal wave of enthusiasm for anything merely bearing the label of "CAM."

Recommendation

The National Council Against Health Fraud strongly suggests that the Commission's recommendations be viewed as unsupported and considered accordingly. They should be rejected by President Bush and members of Congress. The recommendations go far beyond any data or findings of the Commission, and also go beyond reason and rationality. Widespread adoption of unproven, disproven, and irrational methods would cost the American public billions of dollars and thousands of human lives. The WHCCAMP recommendations for implementation are premature by any standard, since scientific data do not exist to support them. Medical ethics dictate that before any medical practices are adopted or spread, they should be validated by appropriate scientific studies. Doing less would endanger the public and remove safeguards that have evolved over centuries in the practice of rational and caring medicine.

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References

  1. Fontanarosa PB, Lundberg GD. Alternative medicine meets science. Journal of the American Medical Association 280: 1618-1619, 1998.
  2. Angell M, Kassirer J. Alternative Medicine—The risks of untested and unregulated remedies. New England Journal of Medicine 339:839-841, 1998.
  3. Gorski T. White House Commission stacked against science. Scientific Review of Alternative Medicine (in press).
  4. Sarner L, Rosa L. Commission member sketches. no-whccamp.org, accessed March 4, 2002.
  5. Barrett S, Goski T. Analysis of the Reports of the White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP) NCAHF Web site, March 25-30, 2002.

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This article was revised on March 28, 2002.