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From The April 1999 Issue of Nutrition Science News
Doctor's Insight
A Look at JAMA's Special Issue on Alternative Medicine
By Richard N. Podell, M.D.
Sen. Daniel Patrick Moynihan of New York once remarked, "There are two distinct kinds of issues—issues of fact and issues of politics." By publishing 80 articles about alternative medicine in their 10 leading journals, the American Medical Association (AMA) added modestly to the facts pertaining to alternative medicine research. But the political implications of their publication were much more important. The AMA escorted through the front door important issues formerly left to shiver outside.
This month I'll guide you through several articles that appeared in Journal of the American Medical Association (JAMA), the AMA's flagship publication.
The most quoted article will probably be the updated telephone survey, conducted by David Eisenberg, M.D., of alternative medicine use in the United States.1 From 1990 to 1997 the number of people seeking any of 16 alternative therapies increased from 33.8 percent of the population to 42.1 percent. Herbal medicine use increased to an estimated 12.1 percent, up from 2.5 percent in 1990. About 5.5 percent of people took megavitamins in 1997, up from 2.4 percent in 1990.
Positive Studies
TCM for Irritable Bowel Syndrome: Traditional Chinese Medicine (TCM) was put to the test by an Australian research team that referred 116 patients with irritable bowel syndrome for either an individualized prescription of Chinese herbs as recommended by a TCM practitioner, a standardized 26-herb formulation from Mei Yu Imports of Sydney, Australia, or placebo.2
Both the standardized and the individualized treatments worked better than placebo. However, individualized prescriptions were no better than the standard herb mix. In fact, to a nonsignificant degree, the standardized treatment did better.
Yoga Helps Carpal Tunnel Syndrome: Researchers at the University of Pennsylvania in Philadelphia assigned 250 patients with carpal tunnel syndrome to two groups. One group did a series of yoga strengthening, stretching and balancing exercises while the other group's wrists were immobilized with a splint, considered a passive, control treatment.3 Both groups improved during the eight-week study. However, the actively treated yoga patients were rewarded with less pain and better grip strength than the passively treated controls.
Burning Herbs Turn Breech Babies: The third positive study
showed that moxibustion—burning herbs to stimulate acupuncture points—caused breech-presentation-term fetuses to turn themselves around for a normal head-first delivery.4 Researchers from Jiangxi's Women's Hospital in Nanchang, China, conducted the
randomized trial of 260 women with breech babies in their 33rd week of pregnancy. Half the women received moxibustion stimulation with mugwort (Artemesia vulgaris) at the outer corner of the fifth toenail. The treatment was repeated once or twice daily for a week.
Homeopathy Heals Vertigo: Potentially the most revolutionary study of all appeared in JAMA's
sister publication, the Archives of Otolaryngology—Head & Neck Surgery.5 This research showed that the homeopathic-style remedy Vertigoheel®, from Heel Inc. of Albuquerque, N.M., was as effective as
a standard prescription drug—betahistine hydrochloride—for treating vertigo-induced dizziness. Vertigoheel ingredients include the classical homeopathic remedies Cocculus indicus, Conium maculatum and Ambra grisea,
in the 4X to 6X potency range. The down side of this study was that no placebo was used for comparison.
| The information, plus the attention garnered from publication, can only benefit alternative medicine. |
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Saw Palmetto for BPH: In addition to the aforementioned original research, JAMA published one scholarly review.6 This was a meta-analysis of 18 randomized control trials involving nearly 3,000 men. Although the authors were concerned about the short duration of the studies, the variability in their design, differences in use of phytotherapeutic preparations and outcome reports, the evidence suggested that saw palmetto (Serenoa repens) improved both urologic symptoms and urine flow measures in the treatment of benign prostatic hypertrophy (BPH). Its effects were similar to those of finasteride, the pharmaceutical drug commonly prescribed for BPH, and also had fewer side effects.
Negative Studies
Taking on Tension Headaches: A Danish study randomized 75 patients with frequent tension-type headaches (TTH), which account for more than 66 percent of all headache episodes. One group received massage plus chiropractic manipulation, and the control group received massage plus placebo laser treatment.7 Both groups improved, but chiropractic manipulation per se seemed to make no difference.
Easing Painful Nerve Damage: A U.S. study addressed the difficult issue of pain from HIV-related nerve damage.8 More than 200 patients were randomized to receive acupuncture directed to either therapeutic or nontherapeutic points. Another 100 or more patients received either amitriptyline, an antidepressant medicine commonly used for neuropathic pain, or placebo.
Unfortunately, neither acupuncture nor amitriptyline was more effective than placebo. While disappointing, these results support the power of the placebo effect: About one-fifth of all patients felt "a lot" of relief, and nearly half rated their benefit as "moderate."
Herbal Weight-Loss Aid: Obesity researchers at New York's St. Luke's Hospital gave 135 patients on high-fiber, low-fat diets either 1,000 mg Garcinia cambogia (hydroxycitric acid) 30 minutes before each meal, or placebo. The group taking placebo lost more weight on average than did those taking the herb, although the difference was not statistically significant.9
Views from the Other Side
The editorials in JAMA's special issue are definitely well worth reading. One, by Wayne Jonas, M.D., director of the NIH's Office of Alternative Medicine, Bethesda, Md., addresses the risks of making alternative medicine too conventional:
"Most alternative medicine systems carefully attend to the illness and suffering that accompanies all disease... These elements are easily lost in the subspecialization, technology and economics of modern medicine. Conventional medicine must develop a better language for managing illness and suffering or lose this essential message that alternative medicine provides.
"Is the current trend toward 'integrated' medicine a deluded temptation that will turn out to be a nightmare of unscientific
practices? Or will these newfound tools of scientific medicine be used to look deeper into the processes of healing for their utility in treating disease and alleviating suffering?
"Alternative medicine is ... here to stay. It is no longer an option to ignore it or treat it as something outside the normal processes of science and medicine. The challenge is to move forward carefully, using both reason and wisdom, as we attempt to separate the pearls from the mud."10
George Lundberg, M.D., now former editor-in-chief, wrote with JAMA's senior editor, Phil Fontanarosa, M.D., a piece purporting that alternative medicine advocates oppose good scientific research:
"There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproved medicines, for which scientific evidence is lacking... However, some advocates of alternative medicine argue that many alternative therapies cannot be subjected to the standard scientific methods and thus, instead must rely on anecdotes, beliefs, theories, testimonials and opinions to support their effectiveness and justify continued use... Most alternative therapies have not been evaluated using rigorously conducted scientific tests of efficacy based on accepted rules of evidence."11
On a brighter note, JAMA mentioned that the Office of Alternative Medicine was elevated to the National Center for Complementary and Alternative Medicine and its annual budget increased from $20 million in 1998 to $50 million in 1999. In time, the Center will enable additional, rigorous research to be conducted on the myriad alternative therapies. The studies recently published in JAMA and its sister publications are all worthwhile. Whether the results were negative or positive, the research helped define each therapy's use. Ultimately, that information, plus the attention garnered from publication, can, in the long run, only benefit alternative medicine.
Richard N. Podell, M.D., M.P.H., is director of the Podell Medical Center in New Providence, N.J.
References
1. Eisenberg D. Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998;280:1569-75.
2. Bensoussan A, et al. Treatment of irritable bowel syndrome with Chinese herbal medicine. JAMA 1998;280:1585-9.
3. Garfinkel M, et al. Yoga-based intervention for carpal tunnel syndrome. JAMA 1998;280:1601-3.
4. Cardini F, Weixin H. Moxibustion for correction of breech presentation. JAMA 1998;280:1580-4.
5. Weiser M, et al. Homeopathic vs. conventional treatment of vertigo: a randomized double-blind controlled clinical study. Arch Otolaryngology—Head & Neck Surgery 1998;124:879-85.
6. Wilt T, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia. JAMA 1998;124:1610-5.
7. Bove G, Nilsson N. Spinal manipulation in the treatment of episodic tension-type headache. JAMA 1998;280:1576-9.
8. Schlay J, et al. Acupuncture and amitriptyline for pain due to HIV-related peripheral neuropathy. JAMA 1998;280:1590-5.
9. Heymsfield S, et al. Garcinia combogia (hydroxycitric acid) as a potential antiobesity agent. JAMA 1998; 280:1596-1600.
10. Jonas W. Alternative medicine—learning from the past,
examining the present, advancing the future. JAMA 1998; 280:1616-7.
11. Fontanarosa P, Lundberg G. Alternative medicine meets science. JAMA 1998;280:1618-9.
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