Frequent commenter, anjou, just sent along a link to a MSNBC article by Robert Bazell entitled, “Ignoring the failures of alternative medicine.” The article is subtitled, “The U.S. spends millions testing popular supplements. It’s a futile effort.”
Bazell is chief science and health correspondent for MSNBC. Most striking about Bazell’s article is that the mainstream media has generally remained quiet on criticizing the alternative medicine industry. In contrast, the scientific community has long questioned both the legitimacy of NIH’s alternative medicine-focused center, NCCAM, and their priorities. Bazell’s article represents the first clear critique of these efforts that I have seen in the higher-profile lay press.
His arguments are based on two key theses:
1. US consumers continue to buy supplements despite the repeated lack of efficacy of a great many in clinical trials
2. Medical and media “personalities” are complicit in the propagation of this industry.
I’ve argued in the past that the rush to prove efficacy of dietary supplements in NIH-funded studies often lead to oversights on the quality of the product being used. This would be tantamount to a drug company embarking on a large, Phase 3 clinical trial before doing careful Phase 1 pharmacokinetic studies – a formula for disaster and a waste of money. By setting up trials for failure, one can equally question whether the supplement in question doesn’t work, whether the supplement tested even contained adequate amounts of a bioactive substance, or whether it was simply not dosed at a high enough level. This poor clinical trial design hurts all researchers who are conducting legitimate research on the potential efficacy of naturally-derived substances.
Bazell also takes to task some high-profile alternative medicine advocates with direct financial interests in the products they hawk. This issue was nicely discussed in the Jan/Feb 2006 issue of Nutrition Action Healthletter in an article entitled, “Supplementing Their Income: How Celebrities Turn Trust Into Cash — What You Should Know Before Handing Your Credit Card to Larry King, Dr. Phil or Dr. Andrew Weil” (513KB PDF)”
Bazell follows with a similar argument:
Marketers often sell them under the guise of a mom-and-pop alternative to big pharma. Yet the $29 billion-a-year dietary supplement industry wields such power that it got Congress to pass a law in 1994 that basically frees it to peddle almost anything that doesn’t kill people with claims of medical benefit that need not be proven.
No doubt some of the thousands of products sold as dietary supplements work well, but the industry that sells them has neither motivation nor desire to know which ones work and which don’t.
Neither do many of those who advocate their use, such as the guru of alternative medicine Dr. Andrew Weil.
In the end, all remedies with adequate preliminary data suggestive of their efficacy should be prioritizied and tested fairly and equally, all within the constraints of the current NIH budget. A burden for testing should also fall on this $29 billion industry. But having two sets of rules for drug products and supplement products seems to fuel an industry that appeals partly to mistrust and ideas of government or industrial conspiracy.
I am reminded of an excellent quote from an article co-authored by former editor of New England Journal of Medicine, Dr Marcia Angell, by no means a “pharma-shill” as judged by the content of her book, “The Truth About the Drug Companies”:
“There cannot be two kinds of medicine – conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.”
– Angell M, Kassirer JP, Alternative medicine–the risks of untested and unregulated remedies. N Engl J Med 1998;339:839