Does Complementary-Alternative Medicine
Opinion By Alan R. Gaby, MD
Recent media reports have focused on multiple government-funded studies conducted by the National Center for Complementary and Alternative Medicine (NCCAM) in recent years, which found that certain herbal remedies and nutritional supplements were not more effective than a placebo for specific health conditions. Based on these results, many reports have made a case against natural medicine as a whole, while at the same time expressing concerns about product regulation, bias, and so on. But while some may find it reasonable to draw such conclusions from this group of studies, taking such a narrow a view ignores important points to the contrary and does a disservice to millions of people seeking safe and effective complements or alternatives to drugs and surgery.
The latest study does not equal the last word
While it is important to take all well-designed research into consideration, scientific methodology does not view a single study as the final answer to any research question. As is usually the case in medical research, even highly effective treatments produce negative results in some situations, but those studies must be considered in the context of the entire body of research.
By looking only at NCCAM’s studies, people who view them as proof that natural treatments are ineffective are not taking into account thousands of studies published during the past several decades that have found benefit from vitamins, minerals, and herbs for a wide range of conditions, including depression, migraines, osteoarthritis, osteoporosis, heart disease, acne, eczema, infections, peptic ulcers, diabetes, gingivitis, attention deficit-hyperactivity disorder, fatigue, and prostate enlargement.
Much of this research has been published in reputable, peer-reviewed journals that lead the scientific conversation on treatments of every major disease, such as the Journal of the American Medical Association, The New England Journal of Medicine, The Lancet, Journal of Nutrition, American Journal of Cardiology, Journal of Clinical Endocrinology and Metabolism, Annals of Internal Medicine, Journal of Urology, and the British Medical Journal.
When interpreting results: details matter
The recent media reports cited a NCCAM study in which St. John’s wort was not more effective than a placebo in treating depression. However, those reports failed to mention that in the same study the drug sertraline (sold under brand names such as Zoloft and Lustral) was also no more effective than the placebo. As in any analysis, close inspection reveals nuance that requires consideration. For example, numerous double-blind trials have found that extracts of St. John’s wort are more effective than a placebo in the treatment of mild-to-moderate depression. In comparison trials, St. John’s wort was at least as effective as fluoxetine (Prozac) and sertraline, while causing fewer side effects. Since neither St. John’s wort nor sertraline was effective in the NCCAM study, it is likely that many of the participants in that study were treatment-resistant, and would therefore not be expected to benefit from any treatment.
Another negative study mentioned in media reports examined the effect of glucosamine and chondroitin sulfate for people with osteoarthritis of the knees. At least ten studies have shown that glucosamine in the form of glucosamine sulfate is beneficial for osteoarthritis, whereas glucosamine in the form of glucosamine hydrochloride is of questionable efficacy. Even though the government-funded study used glucosamine hydrochloride, the results were not entirely negative. Glucosamine and chondroitin produced a statistically nonsignificant benefit in the study group as a whole, and a statistically significant improvement in patients who had moderate-to-severe pain.
These are just two of many more examples where attention to detail makes wholesale dismissal of a treatment inappropriate, despite the bottom-line results.
It’s worth it to get educated
In light of negative research on any remedy, some people will prudently choose to err on the side of caution and avoid certain treatments completely, especially people who do not have tools to learn more about potential risks or effectiveness. But in many cases, wholesale rejection can be as damaging as blindly subscribing to natural treatments as universally “good” without taking the time to do any personal investigation.
Particularly in the current economic crunch, which has made healthcare costs of rising concern, it is increasingly important that consumers seek trustworthy, informed sources of answers to their health questions. Discussing options with healthcare specialists and using scientifically referenced resources like Healthnotes from Aisle7 will serve people interested in protecting and optimizing their health. In the end, the more information people have to work with, the better their chances are to live a healthy life.
June 18, 2009
An expert in nutritional therapies, Chief Medical Editor
Alan R. Gaby, MD, is a former professor at Bastyr University of Natural Health Sciences, where he served as the Endowed Professor of Nutrition. He is past-president of the American Holistic Medical Association and gave expert testimony to the White House Commission on Complementary and Alternative Medicine on the cost-effectiveness of nutritional supplements. Dr. Gaby has conducted nutritional seminars for physicians and has collected over 30,000 scientific papers related to the field of nutritional and natural medicine. In addition to editing and contributing to The Natural Pharmacy (Three Rivers Press, 1999), and the A–Z Guide to Drug-Herb-Vitamin Interactions (Three Rivers Press, 1999), Dr. Gaby has authored Preventing and Reversing Osteoporosis (Prima Lifestyles, 1995) and B6: The Natural Healer (Keats, 1987) and coauthored The Patient's Book of Natural Healing (Prima, 1999).
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