A Walk on the Wild Side of Allopathic Medicine: Going Ballistic Instead of Holistic

Item (October 8, 1998): The New England Journal of Medicine publishes a study by Balon, Aker et al., that concludes: "The addition of chiropractic spinal manipulation to usual medical care for four months had no effect on the control of childhood asthma." This statement is based upon the failure of active intervention and manipulation patient groups in a clinical trial to be differentiated in both measurements of quality of life (including nighttime symptoms) and airway function.¹

However, the same authors had already concluded 17 months earlier² that with nighttime symptoms there was a significant difference between the same two patient groups at the highly robust null probability level of p<0.001. This discrepancy was not mentioned by the authors in their NEJM paper.

 

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Item (January 7, 1999): The Massachusetts College of Pharmacy awards an honorary doctorate to Dr. Andrew Weil, director of the program of integrative medicine at the University of Arizona and champion of alternatives to standard pharmaceutical and surgical practices in orthodox medicine.

However, Dr. Jerome Kassirer, editor-in-chief of the New England Journal of Medicine, states that the college's decision to honor Weil inappropriately legitimizes Weil's points of view. At the same time, Dr. Arnold Reiman, the journal's editor-in-chief emeritus, writes a scathing critique of Dr. Weil in a cover story to the December 14 issue of The New Republic, arguing that Weil's assertion that traditional and alternative treatments can be used in conjunction with each other is invalid.³

 

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Item (January 15, 1999): E. Ratcliffe Anderson, the new executive vice president of the AMA, fires George Lundberg, editor-in-chief of the Journal of the American Medical Association. The reason ostensibly is Dr. Lundberg's choosing to print an article on the sexual opinions of college students during President Clinton's impeachment hearings in Congress. The smart money suggests instead a variety of other reasons, including Dr. Lundberg's intense interest in alternative medicine, culminating in an issue of JAMA devoted to the subject in November.

 

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Item (February 19, 1999): Aided by liberal negative commentary by Montreal-based pediatric practititioner and McGill instructor Murray Katz, MD, opponents to the affiliation of Canadian Memorial Chiropractic College and York University in Toronto appear to have succeeded in delaying or overturning a plan to make chiropractors members of the pure and applied science faculty at York. A fallback plan calls for creating either an independent entity at York or a facility which includes all health-related disciplines.⁴ The subject became a topic of intense interest in a new journal which appears to have a decidedly anti-alternative medicine agenda.⁵

 

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Item (March 4, 1999): Meeting on practically the same dates as David Eisenberg's fifth annual continuing education course on alternative medicine in Boston, a conference which appears to have been presented as an alternative to alternative medicine (read: an attempt to debunk the validity of alternative medicine) is held at the Warwick Hotel in Philadelphia. The sponsors of this conference (the Scientific Review of Alternative Medicine and the Committee for the Scientific Investigation of Claims of the Paranormal) do give the purpose of this gathering away. Speakers at this meeting include: Stephen Barrett (the board chairman of Quackwatch, Inc., and board member of the National Council Against Health Fraud); George Lundberg (former editor-in-chief of the Journal of the American Medical Association); and William Jarvis (executive director of the National Council against Health Fraud). The keynote speaker is none other than Marcia Angell, executive editor of the New England Journal of Medicine.

 

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How are these news items linked? For starters, they confirm an intense and bitter reaction from some parties against the practice of alternative medicine. For another, they suggest a strong editorial interest on the part of the New England Journal of Medicine in damaging the credibility of alternative medicine. Many of these attitudes have surfaced as blatantly biased statements in the NEJM time and time again. I have had to hammer these bobbing prairie dogs repeatedly with several refutations printed in this space over the past few months.^6-8 These sentiments regarding recent and dubious material that has appeared in the NEJM are unfortunately not mine alone.^9,10

Most likely, many of these issues are economically driven. On the one hand, we have seen how the number of visits to alternative medicine providers has risen nearly 50% from 1990 to 1997. During the same period, visits to traditional primary care physicians remained relatively constant at just under 390 million calls per year. Within this same time, estimated expenditures for alternative medicine professional services have increased over 45% to a conservative estimate at $21.2 billion in 1997.¹¹

Caught by the pressures of managed care and the failure of its recent abortive plan to endorse Sunbeam products, the AMA in particular must regard these trends as a threat in light of its own sinking financial, membership and credibility bases. It is no strenuous mental exercise to figure out why attacks from this organization, like those hits on Top 40 radio, just keep coming.

The take-home lesson here is that properly executed cost analyses of health care services plus a proper accounting of all indirect costs (including iatrogenic events and malpractice) will become more and more a dominant issue in research. FCER is committed to seeing that such areas receive adequate attention in the months ahead during this unquestionably turbulent era in providing health care services.

References

1. Balon J, Aker PD, Crowther ER, Danielson C, Cox PG, O'Shaughnessy D, Walker C, Goldsmith CH, Duku E, Sears MR. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. New England Journal of Medicine 1998;339(15):1013-1020.
2. Balon J, Aker P, Crowther E, Cox G, Danielson C, O'Shaughnessy D, Walker C, Duku E, Goldsmith C, Sears M. A randomized controlled trial of chiropractic spinal manipulation in children with chronic asthma. American Thoracic Society Convention, San Francisco, CA, May 21, 1997.
3. Miller L. Alternative Dr. Weil to be honored. Associated Press, January 7, 1999.
4. Kondro W. Planned chiropractic merger riles faculty. Science 1999;283(5405):1099.
5. DeRobertis MM. Chiropractic goes to university. The Scientific Review of Alternative Medicine 1998;2(2):49-55.
6. Rosner AL. FCER forum: the backlash against alternative medicine. Dynamic Chiropractic November 2, 1998;16(23).
7. Rosner AL. FCER forum: scratching where it itches: core issues in chiropractic research. Dynamic Chiropractic January 1, 1999;17(1).
8. Rosner AL. FCER forum: one-dimensional chiropractic: thinking outside of the box. Dynamic Chiropractic February 22, 1999;17(4).
9. Chapman-Smith, D. Back pain, science, politics and money. The Chiropractic Report 1998;12(6).
10. Dossey L. On double-blinds and double standards: a response to the recent New England journal editorial. Alternative Therapies in Health and Medicine 1998;4(6):18-20
11. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, van Rompay M, Kessler RC. Trends in alternative medicine use in the United States, 1990-1997. Journal of the American Medical Association 1998;280(18):1569-1575.