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By DANIEL A. LANG, M.D.
Alternative medicine is defined simply as the use of treatment, particularly drugs, that have not undergone modern scientific scrutiny. Marketed to a believing American public, sold without control for self administration as food supplements and health promotion aids, they have been exempted by Congress from the surveillance of the Food and Drug Administration.
They are aggressively promoted as novel treatments free of the high costs and narrow biases of conventional medical practice. As mixtures of plants and/or animal products, often in poorly controlled proportions, they are touted as natural and spiritual, two characteristics that guarantee strong political support. It is no longer politically correct to challenge the individual’s right to alternative therapies, however unscientific and unproven.
As much as we like to perceive of this view as a new, modern protection of the individual right to choose, in reality, history shows that it is little more than a retreat to 19th century pre-scientific medicine.
The 1800s began with concepts of democratic competition of schools of medical treatment, with little effort at careful clinical evaluation. The contribution of these early practitioners was to look to herbs and other plants that were rooted in folk medicine for some physical effect on patients. They became the fathers of modern American pharmaceutical chemistry by the insistence on identification of active ingredients, purification and chemical modification to reduce harmful side effects and improve clinical efficacy.
The culmination of this view, that drugs must be safe and efficacious, as demonstrated by increasingly rigorous and costly scientific standards, is the FDA program of cautious stepwise evaluation and investigation. Controls such as these are now the worldwide standard for the evaluation of new therapies.
For many proponents of alternative medicine, the choice offered is between natural substances and artificial, manmade chemicals. The idea that all natural products are healthful and harmless ignores the lessons of history in which people died from ingesting foxglove, nightshade, ergot or oleander. That manmade chemicals are to be avoided as dangerous rewrites falsely the medical and scientific history of the last century.
Alternative medicines are generally nothing more than chemicals that occur in nature, whose purity or efficacy are not necessarily controlled or established.
A recent study of Asian patent medicines, sold openly in American health food stores, identified 32 percent of the preparations to be adulterated with potentially toxic amounts of lead, arsenic and mercury, as well as unlabeled pharmaceuticals. Details of that study, conducted by the California Department of Health Services, Food and Drug Branch, are cited in the Sept. 17, 1998 New England Journal of Medicine.
The same issue describes two patients who became seriously ill because of ingestion of a food supplement contaminated with digitalis.
In a third study, an “alternative” unregulated treatment for prostatic cancer, sold as a food supplement, was found to contain significant quantities of estrogens and related substances. In appropriate dosage, estrogenic compounds are employed by medical specialists in some stages of prostatic cancer treatment.
Beyond the ingestion of uncertain amounts of substances of questionable potency and purity lies the cost of using questionable alternative medication as a substitute for standard effective medication.
No one would deny a patient who was beyond conventional treatment access to any modality that might be chosen as a last resort. The patients who went across the border to Mexico to obtain Laetrile in the 1970s comes to mind. On the other hand, the reliance on unproven food supplements and natural products as an alternative to curative surgery, radiation or chemotherapy cannot be justified by either the government or anyone responsible for the health care of other individuals, regardless of professional degree.
In that same Sept. 17 issue of the New England Journal, Dr. Jerome Kassirer, the editor, sums it up:
“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,” he writes. “Testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments.”
Alternative medicine must not become a venerated doctrine that is politically incorrect to challenge.
The issue of concern is the apparent departure from hard-won science and regulation that obligates wide and profitable commercial use of a preparation, labeled as a food or health supplement, before the true scientific or medical effect or value is understood. By allowing or encouraging self-treatment with unproven modalities of care, the patient is allowed to make an unwitting, potentially irreversible mistake, based on little or no information, other than the promises of the promoter.
Dr. Daniel A. Lang is a Beverly Hills physician who has served as medical director of the Healthcare Association of Southern California and National Health Foundation since 1986.
