JAMA Embraces Alternative Medicine

The Journal of The American Medical Association has finally admitted it can no longer resist the appeal of alternative medicine.

After decades of opposition and neglect, mainstream medicine is now beginning to recognize the value of such alternative fields as nutrition, acupuncture and biofeedback.

A watershed event in this move towards recognition of alternative medicine was a Dec. 17, 1997, editorial in the Journal of the American Medical Association (JAMA), which stated that the American Medical Association had ranked alternative medicine among the top three subjects (of 86) for its journals to address in 1998 (see accompanying reprint of this editorial).

JAMA declared that it would be publishing two coordinated theme issues on alternative medicine late in 1998, and that it would be publishing papers of this type more frequently in other issues as well. According to the editorial:

"We invite authors...to submit original manuscripts on topics pertaining to complementary and alternative medicine for consideration for publication in JAMA or in one of the AMA Archives journals.... High quality research studies (especially randomized clinical trials) that evaluate the efficacy, safety, outcomes, and cost-effectiveness of complementary and alternative medicine interventions are of particular interest."

The editorial made it clear that JAMA's newfound interest in alternative medicine has been spurred by the burgeoning interest in the field by the public and increasing interest on the part of a growing minority of physicians. JAMA's editorial took the following position:

"Despite increasing public interest and worldwide use of complementary and alternative therapies, high quality scientific evidence that clearly establishes the effectiveness (or lack thereof) of these interventions is lacking."

JAMA Has It Backwards

This position is contrary to the facts. While it is likely that the primary motivating factor in JAMA's current interest in these therapies is exploding public, physician and media interest in alternative therapies, it is decidedly not true that scientific evidence for the role of nutrition and dietary supplements in preventing and treating diseases is lacking. On the contrary, it is the explosion of scientific papers on nutrition and dietary supplements that has driven the media and public interest in these fields.

The volume of this evidence is so enormous that we at the Life Extension Foundation cannot keep up with it. We are constantly bringing you new evidence in our publications and on our web site (www.lifeextension.com) that nutrition and specific nutrients can help to prevent and treat diseases. Yet, what we bring you is just a fraction of the evidence being published in eminent peer-reviewed journals. In fact, some of this evidence has appeared in JAMA.

The fact that JAMA is pretending that the evidence for alternative medicine is weak is a sign that their attitude about it is less than sincere. If the history of medicine teaches us anything, it is that the establishment is neither fair nor just about new developments in medicine. The usual pattern is first to attack new findings and the scientists who make new discoveries, and then, when the evidence for these discoveries becomes overwhelming, to attempt to take credit for them. It usually goes from "It's totally worthless," to "Perhaps there's some merit in it," to "It was our idea in the first place."

Right now, JAMA (and the medical establishment) is in the second phase of this process. It won't be long before they'll be claiming that mainstream scientists and physicians deserve the credit for discoveries that were made by people outside the mainstream. The good thing about this process is that, in the near future, much of what is now considered "alternative" medicine will become part of medicine per se, as it should be. The bad thing is that the establishment will attempt to deprive many scientists and physicians of their rightful place in history for their discoveries. As the leading proponent of integrative medicine, the Foundation will do everything in our power to keep the record straight and honest.

The Greatest Risk Of An Establishment Takeover

The greatest risk of an establishment takeover of alternative medicine is government and corporate control of dietary supplements, leading to a progressive loss of health freedom and escalating prices for nutrient products. The history of medicine also teaches us that the move for this type of control takes place as soon as the powers at large recognize the value of a new therapeutic approach.

The signs of an establishment takeover regarding the dietary supplement industry are already apparent. You've been reading about them in the pages of Life Extension magazine, in our articles about the international threat of Codex, and the move domestically to regulate herbs as over-the-counter drugs. You've also been reading about the Foundation's efforts to stop this movement cold, and the recent success, spearheaded by John Hammell, in removing Codex harmonization language for dietary supplements from the FDA Reform Act.

Right now, the best thing you can do is to help push Rep. Ron Paul's Consumer Health Free Speech Act (HR 2868) through Congress. Passage of this bill will exempt dietary supplements from the definition of "drug" in the Food, Drug & Cosmetic Act, which will effectively tie the hands of the forces pushing to curtail your health freedom. A letter that you can use to ask your representatives in Congress to co-sponsor this bill is included after this article.

Please Co-Sponsor The consumer Health Free Speech Act (H.R. 2868)

The Vindication Of Dr. McCully Continues A good example of the fact that the emerging scientific evidence for the health benefits of nutrition and dietary supplements is the driving force behind their exploding popularity is the story on ABC-TV's 20/20 on Dec. 18, 1997, about Dr. Kilmer McCully's theory that elevated homocysteine levels are a major cause of heart attacks and strokes . The ABC story made it clear that Dr. McCully had discovered solid scientific evidence for this hypothesis 30 years ago, that he had been attacked and discriminated against by the medical establishment for many years, and that he is only now being vindicated because of a spate of new studies showing that McCully was right all along. It's good to see Dr. McCully finally getting credit for his discovery, but it's likely that it was only media attention sparked by our coverage of Dr. McCully's research in the July and November (cover story) 1997 issues of Life Extension magazine, and Dr. McCully's own book, The Homocysteine Revolution, that is leading to the establishment of Dr. McCully's rightful place in medical history. You can be sure that, if it had been left up to the medical establishment to bestow honors on Dr. McCully, it would have been much tougher sledding for him. Again, as usual, the Life Extension Foundation was in the forefront of the fray. Not only did we give full recognition to Dr. McCully before the mainstream media, we were right on top of his discovery from the beginning, starting with the first full year of our existence (1981). Throughout our 18 years of existence, we've been publishing scientific findings about the value of lowering homocysteine levels. It is only one of the many breakthroughs that we've brought to the attention of our members long before the public, the media or the medical establishment.

Reprinted frrom JAMA, Dec 17, 1997, Vol 278, No. 23

Call for Papers for the Annual Coordinated Theme Issues of the AMA Journals

From acupuncture to aromatherapy, from homeopathy to hypnosis, and from relaxation therapy to reflexology, numerous practices that are termed complementary, alternative, unconventional, or integrative medicine have become increasingly prevalent and popular. Even though many of these therapies encompass diverse modalities and philosophies that usually are considered outside the realm of mainstream allopathic medicine, the use of complementary medicine interventions, visits to alternative medicine practitioners, and expenditures for these therapies are substantial. In the United States, the estimated 425 million visits to unconventional medicine practitioners in 1990 exceeded the number of visits to primary care physicians and the use of unconventional therapy generated expenditures estimated at $14 billion.1 Complementary therapies are used by 20% to 50% of the population in many European countries2 and by 48% of the population in Australia.3

Despite increasing public interest and worldwide use of complementary and alternative therapies, high-quality scientific evidence that clearly establishes the effectiveness (or lack thereof) of these interventions is lacking.4,5

Consequently, many physicians traditionally have viewed alternative medicine in general, and most practices contained therein, with skepticism and mistrust.

However, recent developments indicate changing attitudes toward these unconventional therapies, and demonstrate increasing recognition of the need to critically investigate the safety and efficacy of complementary and alternative medicine practices and to determine how some of these therapies could be integrated into clinical practice to improve patient care. For instance, the U.S. National Institutes of Health (NIH) spends approximately $40 million per year on research related to complementary and alternative medicine (largely involving dietary manipulation and behavioral medicine),6 and the NIH Office of Alternative Medicine, which was established in 1992, is now under consideration to have its status upgraded to a full-fledged national center (for complementary and alternative medicine research).7 In their review of published surveys, Ernst and colleagues8 found that, on average, physicians perceive complementary medical therapies (such as acupuncture or manipulation) as moderately effective. Berman et al.9 reported that more than half of family physicians they surveyed considered alternative medicine interventions (including diet and exercise, biofeedback, hypnotherapy, and massage therapy) to represent "legitimate medical practices." At least 34 U.S. medical schools have been reported to have started or are developing courses on alternative medical practices in their medical education programs.10 New biomedical journals devoted to the scientific evaluation of unconventional health claims also have been launched.11

Given the burgeoning interest in alternative medicine among the general public, patients, physicians, academic medical centers, and health care payers, the JAMA editorial board and senior staff and the editors of the American Medical Association (AMA) Archives journals, using our annual modified Delphi process, ranked alternative medicine among the top three subjects (of 86) for our journals to address in the coming year. (Last year, the editorial board ranked alternative medicine 68th of 73 subjects.) Moreover, in a recent survey,12 JAMA physician readers identified alternative medicine as the seventh (of 73) most important topic for publication in [JAMA]. Considering that complementary and alternative medical therapies have the potential to involve patients of physicians in virtually all specialties, the editors of the AMA scientific journals have selected complementary and alternative medicine as the subject for coordinated theme issues to be published late in 1998.

The format for the concurrent theme issues on complementary, alternative, unconventional, and integrative medicine will be similar to theme issues on "Quality of Care" (November 1997) and "Managed Care" (October 1996), in which the AMA scientific journals devoted all or many of their pages, as merited after editorial evaluation and peer review, to a common topic. The 1998 coordinated theme issues will provide a unique, multidisciplinary forum for the publication of original research studies and scholarly articles that present new scientific information and innovative ideas on complementary and alternative medicine to the medical and scientific community. By stimulating research and giving emphasis to this topic, we hope to promote widespread attention in the medical literature and the lay media, foster education among health care professionals, and increase knowledge among patients and the public.

We invite authors from the United States and from other nations, especially authors from countries with an extensive history of non-Western, nonallopathic practice (e.g., studies of acupuncture from China), to submit original manuscripts on topics pertaining to complementary and alternative medicine for consideration for publication in JAMA or in one of the AMA Archives journals. The manuscript may be a report of original research, a review article, an opinion piece, or in the format of any of the other regular features of one of the AMA scientific journals. High-quality research studies (especially randomized clinical trials) that evaluate the efficacy, safety, outcomes, and cost-effectiveness of complementary and alternative medicine interventions are of particular interest. Manuscripts that assess the integration of complementary medical therapies into conventional clinical practice and papers that examine alternative medicine from the perspective of patients, health care organizations, or academic medical centers also are welcome.

The editors of the AMA scientific journals look forward to receiving manuscripts for consideration for publication in the coordinated theme issue on complementary, alternative, and integrative medicine. Submitted manuscripts are subject to our usual rigorous editorial evaluation and peer review, and advance acceptance for any paper cannot be guaranteed. Articles accepted for publication by JAMA or by one of the AMA Archives journals but not included in the theme issues will be published in other issues of these journals. Authors should consult the Instructions for Authors for JAMA13 or the appropriate Archives journal for guidelines on manuscript preparation and submission. Manuscripts received by April 1, 1998, will have the best chance of acceptance for the coordinated theme issues. Phil B. Fontanarosa, M.D. George D. Lundberg, M.D.

REFERENCES

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4. Practice and Policy Guidelines Panel, National Institutes of Health Office of Alternative Medicine. "Clinical practice guidelines in complementary and alternative medicine." Arch Fam Med. 1997,6.149-154.
5. Linde K, Clausius N, Ramirez G, et al. "Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials." Lancet. 1997;350: 834-843.
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12. Lundberg GD, Paul M, Fritz H. "A comparison of the opinions of recognized experts and ordinary readers as to what topics a general medical journal should address." Presented at The International Congress on Biomedical Peer Review and Global Communications; September 20, 1997; Prague, Czech Republic.
13. Instructions for authors. JAMA 1997;278:68 76.