Is the AMA Getting Paranoid?

Recent Report of the Council on Scientific Affairs Suggests AMA's Growing Concern regarding "Alternative Medicine"

Editor's note: Please accept my apology for the length of this article, but the information presented here is too important to condense any further.

Ever wonder why chiropractic and many other so-called "alternative" forms of health care are becoming so popular? Well, you're not alone. It appears the American Medical Association is wondering too. In fact, their Council on Scientific Affairs has developed a report (CSA Report 10-I-96) that you'll find interesting reading.

The Executive Summary of this report demonstrates the AMA's underlying concern:

"The terms 'alternative medicine,' 'complementary medicine,' or 'unconventional medicine' refer to diagnostic methods, treatments and therapies that appear not to conform to standard medical practice, or are not generally taught at accredited medical schools. The scope of alternative medicine is broad, with widespread use among the American public of a long list of treatments and practices, such as acupuncture, homeopathy, relaxation techniques, and herbal remedies. This report will help clarify and categorize the alternative medical systems most often used, create a context to assess their utility (or lack thereof), and discuss how physicians and the medical establishment might deal with the issues surrounding these unconventional measures in health and healing."

Rather than examining each form of care objectively, this report regurgitates the same old tired rhetoric that the chiropractic profession (and every other "alternative" health care profession) is well accustomed to. To what end?

The report begins with John Renner, MD, a board member of the National Council Against Health Fraud (NCAHF), presenting a "set of definitions that are useful in understanding the continuum of alternative therapies, treatments and devices." The definitions, or categories ("Proven," "Experimental," "Untested," "Folklore," "Quakery") leave little room for any form of alternative care to be acceptably rated.

The council's report continues with a review of the "Theories of Alternative Medicine." The bias is completely exposed in the review of osteopathic theory vs. the review of chiropractic theory. The review of chiropractic theory just happens to reference the book The Health Robbers by Steven Barrett, MD, another board member of the National Council Against Health Fraud. Dr. Barrett's jaundiced views of chiropractic proffered in his book are referenced five times within a short, three-paragraph description of chiropractic theory.

Anyone remotely familiar with the actions of the NCAHF will recognize their historic disdain for all forms of "alternative" health care. Involving the NCAHF in an effort to understand alternative forms of health care is tantamount to involving Rush Limbaugh in a review of President Clinton's accomplishments in office.

The council's report then begins a long litany of criticisms of the attention, acceptance and success that "alternative medicine" has gained. It begins by questioning the Office of Alternative Medicine (OAM) established by the National Institutes of Health (NIH):

"Critics of the OAM wonder why the NIH is putting its imprimatur on some of the more questionable alternative techniques, pointing out that doing so allows practitioners of such therapy to cloak themselves in legitimacy by such an association, claiming (often correctly) that their methods are 'under study' at OAM."

Next follows the alarming realization that:

"In a national survey, at least one-third of persons claimed to have used at least one alternative therapy in the past year and one-third of these persons saw a provider of alternative medical therapy. Among those using an unconventional healer, 83% also saw a medical doctor for the same condition, but nearly 75% of them did not report the use of alternative care to their traditional physician. The survey data estimated that in 1990 the out-of-pocket cost of unconventional therapy in the U.S. including the cost of herbal medicines and health food/nutrition therapy, exceeded $10 billion. Another $3 billion of these costs were borne by third-party payers. The total estimated cost, $13.7 billion, exceeds the out-of-pocket cost of hospital care in the U.S. in 1990 ($12.8 billion) and is about half of all the out-of-pocket expenses to physician services ($23.5 billion). The authors suggest that the total number of annual visits to alternative practitioners may exceed those to primary care physicians.

But it appears that individual MDs are interested in referring patients for alternative care, and some are learning them firsthand:

"A regional survey of family physicians in the Chesapeake Bay area showed that over 70% were interested in training in such practices as herbal medicine, prayer therapy, acupressure, vegetarian and megavitamin diet therapy, acupuncture, and biofeedback. The results of this study, however, are curious in that 26% of respondents claim to have had training in chiropractic methods, 22% in acupuncture, and nearly 10% report training in traditional Oriental or Native American medicine.

"In a national survey of referral patterns by board-certified family physicians and internist, 94% indicated willingness to refer for at least one alternative therapy, 90% for at least two, 85% at least three, 77% at least four, and 66% at least five such modalities. The list of therapies for which these physicians expressed a willingness to refer patients included: relaxation techniques (86%); biofeedback (85%); therapeutic massage (66%); hypnosis (63%); acupuncture (56%); and meditation (54%). By contrast, 47% said they would refer for chiropractic, 24% for "spiritual" healing, 15% for homeopathy, 14% for energy healing, and 6% would refer for megavitamin or herbal therapy."

Even the medical schools are taking a serious look at alternative forms of care:

"In an unpublished survey of all 125 U.S. medical schools, Sampson has found that just over 50 schools offer elective, for-credit courses on alternative therapy, and 18 other schools offer lecture series or seminars on the subject. His survey reveals that most are being given by 'supporters or proponents of alternative methods,' and that the 'scientific view' is offered in only 7 courses."

But political medicine stills wants to see the move towards chiropractic as a political event rather than a popular event. They wish to believe that chiropractic is effective politically, rather than clinically:

"Political decisions allow licensing of alternative practitioners such as chiropractic and naturopathic 'physicians' without any scientific basis for accreditation of their schools or the methods used by their practitioners. Congress has recently dismantled its own scientific oversight section, the Office of Technology Assessment. Political pressure from the health food and vitamin supplement industry has hampered the FDA's ability to monitor their products, and legislative proposals have been advanced to allow such products to be covered by food stamps--in effect, paying for pills instead of food. There is, indeed, reason for concern.

"Given the growing interest in alternative medicine by the public, accurate, even-handed education about alternative medicine is vital for both the public as well as for physicians, who should be familiar with unconventional therapies and be able to advise patients on their use. Sound, good quality research is needed to determine the potential benefits and avoid the risks inherent in unconventional therapy."

Given this background one might expect the recommendations are very predictable:

Recommendations

"The Council on Scientific Affairs recommends that the following statements be adopted as policy, and that the remainder of the report be filed:

1. There is very little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies.


2. Physicians should routinely inquire about the use of alternative or unconventional therapy by their patients, and educate themselves and their patients about the state of scientific knowledge with regard to alternative therapy that may be used or contemplated.


3. Courses offered by medical schools on alternative medicine should present the scientific view of unconventional theories, treatments, and practice as well as the potential therapeutic utility, safely, and efficacy of these modalities.


4. Patients who choose alternative therapies should be educated as to the hazards that might result from postponing or stopping conventional medical treatment.

This report is currently a draft document that was sent back to committee for revision to be presented at the next AMA convention this June. One can only hope that there is someone among the AMA's House of Delegates that knows the difference between information and propaganda. If not, this report is sure to be adopted and released.

Until political medicine is willing to take a fresh look at other forms of care, this exercise will be pointless. A first step would be to use terms that are less condescending and less self-centered. Chiropractic is NOT "alternative medicine," anymore than allopathy is "alternative chiropractic." And DCs won't accept any labels that suggest such.

The words "unconventional," "alternative," "complementary" are not acceptable. Unless medicine is willing to honestly rate its own "therapies, treatments and devices," any kind of an efficacy rating system is just another weapon to discourage the utilization of other forms of care. And using the NCAHF as a resource to developing a report about "alternative medicine" is an obvious tipoff that the report is extremely biased and therefor unworthy of serious consideration.

It is time for political medicine to wake up and smell the coffee. Chiropractic and other nonmedical forms of health care exist because they offer the public what they want and need. And there is nothing the AMA can do about that but accept it.

Donald M. Petersen Jr., BS, HCD(hc), FICC(h)
Editor/Publisher of Dynamic Chiropractic
E-mail: Don@DCMedia.com