Herbal medicine, acupuncture, and massage therapy: there was a time not too long ago when these things were dismissed by medical professionals in the United States as charlatanism. Today, though, more and more U.S. medical schools are incorporating so-called "complementary alternative medicine" into their curricula, and the trend is being both praised and criticized.
On a recent Wednesday evening, more than 100 physicians from around the country gathered at Columbia University Medical Center for a 5-day continuing education conference. "Are there any specific questions about patients with HIV disease before we sort of wind up here," the moderator asked as the session drew to a close. The discussion had been about whether HIV patients should be given dried Echinacea, a flower that is indigenous to North America and is believed by many to stimulate the immune system. "We have 2 clinical trials on HIV with Echinacea," a physician in the audience offered. "With an antiviral agent, so the patient was on medication. But it actually showed that those patients fared better."
For the last 10 years, Columbia has been hosting an annual conference on "Botanical Medicine in Modern Clinical Practice." It is organized by the university's Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine. Founded in 1993, the center was among the first of its kind at a major American medical school. "The dean at the time at Columbia was a psychiatrist by training and had seen how psychiatry had gone from sort of being on the outside, wasn't really considered 'real medicine,' to [being an accepted discipline,]" says Dr. Fredi Kronenberg, who directs the center. "[He felt] that complementary medicine was kind of following a similar pathway. And [he] really believed that these things should be studied and should be studied at a place like Columbia."
Today, 95 U.S. medical schools, out of a total of 125, offer coursework in complementary alternative medicine. In most cases, the information is incorporated into classes that focus on more widely used western methods, but Fredi Kronenberg says it is important for doctors to be familiar with non-western approaches to health and healing, as well. "Most consumers are using these things based on their own experience, word-of-mouth, their friends' experience," she says. "Many people would like to talk to their doctors about this, and have their doctors be conversant, at least, so that they can know whether this might truly complement what their physicians are doing. Or maybe it would interact negatively with a drug they're being given."
The popularity of treatments like herbal supplements and massage therapy has skyrocketed in recent years. A 2002 survey by the National Institutes of Health found that as many as a third of all American adults have tried some kind of alternative therapy. The U.S. Congress has given the NIH an annual budget of more than $100-million to study the safety and efficacy of these therapies, ranging from acupuncture to spirituality.
But it is all a waste of money, according to critics like Robert Baratz, a physician who heads the National Council Against Health Fraud. "This is taxpayer money for what? Studies of remote prayer, to see if people praying in one city can affect the outcome of disease in another city," he says. "There is no such thing as complementary alternative medicine. It is a marketing term that has been coined by essentially those who are promoting what used to be called 'snake oil.'"
Dr. Baratz points to the case of Megan Wilson, 16, who recently died of an asthma attack while under the care of a so-called "naturopathic physician." Naturopathy uses herbal remedies, rather than prescription drugs like the ones that probably could have saved Megan's life.
Fredi Kronenberg of Columbia University acknowledges that there have been a lot of mistakes - and even fraud -- in the field of alternative medicine. But she says that is why it is important for medical schools to study alternative methods and push for professional standards. Dr. Kronenberg also denies that centers like the one she directs are promoting health fraud or, in Robert Baratz's words, "snake oil."
"I think if we're promoting anything here at Columbia, we're promoting the rigorous scientific evaluation of various complementary therapies," she says. "We're promoting the development of quality information. We're trying to promote and advocate for the government to regulate herbal products better, so that they're better quality, so we can tease out? what if this doesn't work because it's a bad product? Versus what doesn't work [simply] because it doesn't work?"
And the government cannot adequately regulate the alternative medicine industry, Dr. Kronenberg says, without the appropriate research.