While pharmaceutical companies spend millions on research and churn out countless new drugs, alternative therapies—which rarely involve profit-boosting patents—have often come under fire in the media for lacking scientific support. But more than a third of U.S. residents report using some form of complementary and alternative medicine therapy, which could mean Chinese herbs, massage therapy, meditation, acupuncture and other alternative modalities, according to the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health. With shoppers' budgets tightening, they are increasingly likely to turn to alternative therapies. Will the research supporting these therapies keep up with demand?
Where the money is
The New York Times recently published an article claiming the federal government is working hard to improve the depth and breadth of CAM research, interviewing Dr. Josephine Briggs, director of NCCAM. NCCAM operates a $122 million annual budget, second only to the National Cancer Institute in the NIH Institute's $300 million budget. That sounds like a lot of money until stacked against NIH's full investment into medical research: more than $28 billion.
Research into CAM therapies can be driven by many things. "Ultimately, our mission is to fund rigorous research into CAM therapies and build an evidence base regarding what CAM therapies may be effective and safe and for what conditions," says a spokesperson for NCCAM, who asked that NFM quote the agency only.
State of the research
NCCAM's budget has been flat for the last five years, with the number of research projects funded during that time averaging about 300 a year. "NCCAM studies a broad range of therapies, from biologically based to mind/body-based interventions," says the NCCAM spokesperson. "Biologically based therapies, such as dietary supplements, represent the area of most research."
Steven Dentali, Ph.D., chief science officer for the American Herbal Products Association, says the government agency appears to be getting back to basics, focusing on fundamental research rather than large, expensive clinical trials. One problem, he explains, is that the large studies don't work well with the mechanisms of the botanicals they study, dooming them to failure.
"You don't want to take a shot in the dark with what you think it might be doing. You should know the mechanisms by which these are working first," Dentali says. "I think there is not enough evidence to justify a large clinical trial right now."
For instance, recent news headlines cast doubt on Ginkgo biloba as a treatment for dementia and Alzheimer's disease based on a large clinical study with more than 3,000 participants. Results of a randomized trial showed no beneficial effect in subjects with normal cognition or in those with mild cognitive impairment, according to the findings published in the Nov. 19 issue of the Journal of the American Medical Association. Dentali says the failure points to the need for creating a foundation for research before spending the money for a large clinical trial that might not actually be examining the botanical's active mechanism.
John Finnell, N.D., Lac, a newly minted naturopathic doctor out of Bastyr University in Washington, whose research has focused on echinacea and mushroom extracts, says one of the more important developments for CAM clinical studies in recent years has been the partnerships between CAM-based research centers and conventional medical schools.
"The money may be a bit flat, but what's been building over the past few years is a more competitive landscape of trained researchers who are refining their skills and refining research collaborations, and the research is improving," Finnell explains. "The designs of the study and the questions that they're asking are becoming more relevant to complementary and alternative medicine."
For instance, NCCAM provides long-term grants for what it calls Developmental Centers for Research on CAM that combine the technical know-how of conventional biomedical centers with the expertise of CAM practitioners. One Developmental Center pairs the University of Minnesota with Bastyr to explore the biological basis of the effects of mushroom extracts on the immune system's response to tumors.
"The challenge here is that a lot of this stuff has never been done before and nobody knows how to study it. They're studying how to study it, and that's another big aspect with what's going on," Finnell says. "Most medical schools are beginning to develop CAM programs. … Medical-school students are more interested in CAM."
The American Medical Student Association, reputedly the largest independent association of physicians-in-training in the United States, received a five-year grant from NCCAM to develop a curriculum for conventional medical schools that recently ended. "The students in AMSA have always identified humanistic medicine and integrative medicine as very important to them," says Joan Hedgecock, principal investigator for the project and associate director of the AMSA Foundation.
There is discontent among students with current medical training, which they view as impersonal, Hedgecock notes. "They want to get back to patient-centered care," she says.
Six medical schools eventually adopted the new curriculum, incorporating it into their regular education courses. For example, acupuncture may have been taught in a physiology course or herbal medicine in a pharmacology class.
"It was important for the school rather than to offer a separate course, to integrate this into what they're currently doing. That's the whole point: We want it to be part of medicine, not a separate thing," Hedgecock says.
Peter Rejcek is a Denver-based freelance writer.
Natural Foods Merchandiser volume XXX/number 1/p. 28-29