Body, mind, and Chinese medicine

What are the research issues in alternative medicine? Why isn't more research being done?

The issue isn't that complementary alternative and integrative medicine has been disproven, but that very little research in the last decade has been done to prove or disprove its efficacy or its cost effectiveness. We have so few studies that have been done to a level of excellence that they can authoritatively and definitively tell us, this does work, this doesn't.

I think the impatience on the part of the American public is totally understandable. Many of these therapies have been around or are available off the shelves now and people rightfully ask themselves and their doctors in white coats and nurses and pharmacists, does it work, yes or not? We don't have the information yet. So I understand the impatience.

But the researcher in me, not the clinician or the human being says, now wait a second, some things take time...Things don't grow well when they're terribly rushed. The same is true for large clinical trials. Often the first thing that has to happen with a large clinical trial is asking the right question. Does gingko do anything to change the mental competence of people with dementia? Important question. Does acupuncture, chiropractic, massage and having those therapies available to people in our workforce change the course of acute low back pain or chronic low back pain for people on assembly lines? Good questions. To do those studies often takes five, six, seven, ten years.

The reason it takes so long is as follows. A pilot study could prove that people would enter an experiment and that you could collect information. It might take you two or three years to convince the federal government or a foundation or yourself to do the study and get twenty people in the study. So you might have to write a proposal, get approval from your hospital and the institutional review board, get funding for it. Let's say that that takes two years. Then we have to do the pilot study and prove to those who are skeptical that you can do the experiment and that from that experiment you can design a larger experiment to answer more definitively whether it works, yes or no. Let's say that takes two years.

Then you have to reapply and get funding for the larger experiment, which in the case of a back pain trial might be two or three million dollars. You might have to go to the National Institutes of Health or other parts of the government and say, I now want two and a half million dollars to do this properly. By the way, I and my colleagues and my statistician and the acupuncturists and the chiropractors are not making a dime on this, we're just salaried clinicians as part of a research venture, but it's going to cost two and a half million dollars. That might take two years.

Then you have to recruit the patients...It took us over two years to recruit four hundred and fifty patients [for our back pain study]. It'll take us another year to carefully analyze the data. We will finish our analyses, submit it for publication, and it will probably take another year before it's published because it will go through multiple [revisions] and the constructive criticism by our thoughtful colleagues who say, convince me. Then it's published.... It's taking nine years, seven years, that's how long it sometimes takes.

Does the evidence show that complementary and alternative medicine work?
Let's put it a different way. Would you consider exercise, diet, lowering of cholesterol and stress management to be conventional therapies for heart disease or alternative therapies for heart disease? When I went through internal medicine training in the early 1980s, the notion that one could stabilize or reverse cardiovascular disease through diet, exercise and stress management was deemed as fairly preposterous. There's an example of where over twenty years the evidence showed that lifestyle mattered. That what you ate mattered. That folate mattered. That stress management mattered. This has morphed from a very alternative vantage point first made popular by Dean Ornish in the late 1970s to now part of conventional academic cardiology.

So we have to put these things into a historical perspective. Some things that are deemed alternative, complementary, unproven today, when passed through the prism of science, will come out the other side as evidence-based, helpful therapies that will become conventional. And then they will disappear into the mainstream of conventional medical care. That's the natural flow of things in clinical medicine.

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