To treat or not to treat: The ethical dilemma of alternative medicine therapies

AIDS and Public Policy Journal

Volumn 14, Issue 3, 1999, Pages 117-131

  Clark, Peter A ^a  

^a GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALTERNATIVE MEDICINE; HEALTH CARE DELIVERY; MEDICAL ETHICS; REVIEW; TREATMENT PLANNING;

LEGAL APPROACH; PROFESSIONAL PATIENT RELATIONSHIP;

ALTRUISM; COMPLEMENTARY THERAPIES; DRUG APPROVAL; ETHICS, MEDICAL; EVIDENCE-BASED MEDICINE; FREEDOM; HIV INFECTIONS; HUMANS; PUBLIC POLICY; SOCIAL JUSTICE; UNITED STATES;

EID: 0033305969     PISSN: 08873852     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (103)

1. W.B. Jonas, "Alternative Medicine - Learning from the Past, Examining the Present, Advancing to the Future," Journal of the American Medical Association 280 (11 November 1998): 1616-7. See also P. Starr, The Social Transformation of American Medicine (San Francisco, Calif.: Harper Collins, 1982), 514; A. Furnham and J. Foley, "The Attitudes, Behaviors and Beliefs of Patients of Conventional vs. Complementary (Alternative) Medicine," Journal of Clinical Psychology 50 (1994): 458-69; and J.A. Astin, "Why Patients Use Alternative Medicine: Results of a National Study," Journal of the American Medical Association 279 (1998): 1548-53.
2. W.B. Jonas, "Alternative Medicine - Learning from the Past, Examining the Present, Advancing to the Future," Journal of the American Medical Association 280 (11 November 1998): 1616-7. See also P. Starr, The Social Transformation of American Medicine (San Francisco, Calif.: Harper Collins, 1982), 514; A. Furnham and J. Foley, "The Attitudes, Behaviors and Beliefs of Patients of Conventional vs. Complementary (Alternative) Medicine," Journal of Clinical Psychology 50 (1994): 458-69; and J.A. Astin, "Why Patients Use Alternative Medicine: Results of a National Study," Journal of the American Medical Association 279 (1998): 1548-53.
3. W.B. Jonas, "Alternative Medicine - Learning from the Past, Examining the Present, Advancing to the Future," Journal of the American Medical Association 280 (11 November 1998): 1616-7. See also P. Starr, The Social Transformation of American Medicine (San Francisco, Calif.: Harper Collins, 1982), 514; A. Furnham and J. Foley, "The Attitudes, Behaviors and Beliefs of Patients of Conventional vs. Complementary (Alternative) Medicine," Journal of Clinical Psychology 50 (1994): 458-69; and J.A. Astin, "Why Patients Use Alternative Medicine: Results of a National Study," Journal of the American Medical Association 279 (1998): 1548-53.
4. W.B. Jonas, "Alternative Medicine - Learning from the Past, Examining the Present, Advancing to the Future," Journal of the American Medical Association 280 (11 November 1998): 1616-7. See also P. Starr, The Social Transformation of American Medicine (San Francisco, Calif.: Harper Collins, 1982), 514; A. Furnham and J. Foley, "The Attitudes, Behaviors and Beliefs of Patients of Conventional vs. Complementary (Alternative) Medicine," Journal of Clinical Psychology 50 (1994): 458-69; and J.A. Astin, "Why Patients Use Alternative Medicine: Results of a National Study," Journal of the American Medical Association 279 (1998): 1548-53.
5. D. Eisenberg et al., "Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use," New England Journal of Medicine 328 (28 January 1993): 246-52, p. 246.
6. D. Eskinazi, "Factors that Shape Alternative Medicine," Journal of the American Medical Association 280 (11 November 1998): 1621-3, p. 1622.
7. D. Eisenberg et al., "Trends in Alternative Medicine Use in the United States, 1990-1997," Journal of the American Medical Association 280 (11 November 1998): 1569-75, p. 1569.
8. J. Udani, "Integrating Alternative Medicine Into Practice," Journal of the American Medical Association 280 (11 November 1998): 1620.
9. Jonas, "Alternative Medicine," see note 1 above, p. 1616.
10. Ibid. See also M.S. Wetzel, D.M. Eisenberg, and T.J. Kaptchuk, "Courses Involving Complementary and Alternative Medicine At U.S. Medical Schools," Journal of the American Medical Association 280 (11 November 1998): 784-7.
11. Ibid. See also M.S. Wetzel, D.M. Eisenberg, and T.J. Kaptchuk, "Courses Involving Complementary and Alternative Medicine At U.S. Medical Schools," Journal of the American Medical Association 280 (11 November 1998): 784-7.
12. D. Studdert et al., "Medical Malpractice Implications of Alternative Medicine," Journal of the American Medical Association 280 (11 November 1998): 1610-5, p. 1610. See also K.R. Pelletier et al., "Current Trends in the Integration and Reimbursement of Complementary and Alternative Medicine by Managed Care, Insurance Carriers, and Hospital Providers," American Journal of Health Promotion 12 (1997): 112-23.
13. D. Studdert et al., "Medical Malpractice Implications of Alternative Medicine," Journal of the American Medical Association 280 (11 November 1998): 1610-5, p. 1610. See also K.R. Pelletier et al., "Current Trends in the Integration and Reimbursement of Complementary and Alternative Medicine by Managed Care, Insurance Carriers, and Hospital Providers," American Journal of Health Promotion 12 (1997): 112-23.
14. Eisenberg, "Trends in Alternative Medicine," see note 4 above, p. 1573.
15. For a more detailed analysis, see S. Goldbeck-Wood et al., "Complementary Medicine Is Booming Worldwide," British Medical Journal 313 (1996): 131-3. See also O. Akerele, "Summary of World Health Organization Guidelines for the Assessment of Herbal Medicine," Herbalgram 28 (1993): 13-6.
16. For a more detailed analysis, see S. Goldbeck-Wood et al., "Complementary Medicine Is Booming Worldwide," British Medical Journal 313 (1996): 131-3. See also O. Akerele, "Summary of World Health Organization Guidelines for the Assessment of Herbal Medicine," Herbalgram 28 (1993): 13-6.
17. L. Lee, "Introducing Herbal Medicine Into Conventional Health Care Settings," Journal of Nurse-Midwifery 44 (May-June 1999): 252-66, p. 254. See also, M. Castleman, The Healing Herbs (Emmaus, Pa.: Rodale Press, 1991); and J. Grunwald, "The European Phytomedicines Market: Figures, Trends, Analyses," Herbalgram 34 (1995): 61-5. Since 1986, the National Cancer Institute's Natural Products Branch has tested 40,000 plant samples, collected from around the world, in the continuous search for cancer and AIDS drugs. Roughly half the drugs sold in the United States are derived from plants, such as digitalis (from purple foxglove) and taxol (from the Pacific yew tree). B. Baker, "Be Smart, Beware: Herbs and Botanicals Can Help But Also Can Harm," AARP Bulletin 40 (May 1999): 15-16, 17, p. 15.
18. L. Lee, "Introducing Herbal Medicine Into Conventional Health Care Settings," Journal of Nurse-Midwifery 44 (May-June 1999): 252-66, p. 254. See also, M. Castleman, The Healing Herbs (Emmaus, Pa.: Rodale Press, 1991); and J. Grunwald, "The European Phytomedicines Market: Figures, Trends, Analyses," Herbalgram 34 (1995): 61-5. Since 1986, the National Cancer Institute's Natural Products Branch has tested 40,000 plant samples, collected from around the world, in the continuous search for cancer and AIDS drugs. Roughly half the drugs sold in the United States are derived from plants, such as digitalis (from purple foxglove) and taxol (from the Pacific yew tree). B. Baker, "Be Smart, Beware: Herbs and Botanicals Can Help But Also Can Harm," AARP Bulletin 40 (May 1999): 15-16, 17, p. 15.
19. L. Lee, "Introducing Herbal Medicine Into Conventional Health Care Settings," Journal of Nurse-Midwifery 44 (May-June 1999): 252-66, p. 254. See also, M. Castleman, The Healing Herbs (Emmaus, Pa.: Rodale Press, 1991); and J. Grunwald, "The European Phytomedicines Market: Figures, Trends, Analyses," Herbalgram 34 (1995): 61-5. Since 1986, the National Cancer Institute's Natural Products Branch has tested 40,000 plant samples, collected from around the world, in the continuous search for cancer and AIDS drugs. Roughly half the drugs sold in the United States are derived from plants, such as digitalis (from purple foxglove) and taxol (from the Pacific yew tree). B. Baker, "Be Smart, Beware: Herbs and Botanicals Can Help But Also Can Harm," AARP Bulletin 40 (May 1999): 15-16, 17, p. 15.
20. L. Lee, "Introducing Herbal Medicine Into Conventional Health Care Settings," Journal of Nurse-Midwifery 44 (May-June 1999): 252-66, p. 254. See also, M. Castleman, The Healing Herbs (Emmaus, Pa.: Rodale Press, 1991); and J. Grunwald, "The European Phytomedicines Market: Figures, Trends, Analyses," Herbalgram 34 (1995): 61-5. Since 1986, the National Cancer Institute's Natural Products Branch has tested 40,000 plant samples, collected from around the world, in the continuous search for cancer and AIDS drugs. Roughly half the drugs sold in the United States are derived from plants, such as digitalis (from purple foxglove) and taxol (from the Pacific yew tree). B. Baker, "Be Smart, Beware: Herbs and Botanicals Can Help But Also Can Harm," AARP Bulletin 40 (May 1999): 15-16, 17, p. 15.
21. It should be noted that all 50 states do provide licensure requirements for chiropractic practice, but only about a half do so for acupuncture and therapeutic massage, and fewer license homeopathy and naturopathy therapists. For a more detailed analysis, see Federation of the State Medical Boards of the United States, Report on Health Care Fraud from the Special Committee on Health Care Fraud (Austin, Tx.: Federation of the State Medical Boards of the United States, 1997).
22. M. Angell and J. Kassirer, "Alternative Medicine - The Risks of Untested and Unregulated Remedies," New England Journal of Medicine (17 September 1998): 839-41, p. 840. See also B. Wittes, "FDA Exemption Sought For Self-Help Medicines," Recorder (7 October 1994): 2; and M.W. Wagner, "Is Homeopathy 'New Science' Or 'New Age'?" Scientific Review of Alternative Medicine 1 (1997): 7-12.
23. M. Angell and J. Kassirer, "Alternative Medicine - The Risks of Untested and Unregulated Remedies," New England Journal of Medicine (17 September 1998): 839-41, p. 840. See also B. Wittes, "FDA Exemption Sought For Self-Help Medicines," Recorder (7 October 1994): 2; and M.W. Wagner, "Is Homeopathy 'New Science' Or 'New Age'?" Scientific Review of Alternative Medicine 1 (1997): 7-12.
24. M. Angell and J. Kassirer, "Alternative Medicine - The Risks of Untested and Unregulated Remedies," New England Journal of Medicine (17 September 1998): 839-41, p. 840. See also B. Wittes, "FDA Exemption Sought For Self-Help Medicines," Recorder (7 October 1994): 2; and M.W. Wagner, "Is Homeopathy 'New Science' Or 'New Age'?" Scientific Review of Alternative Medicine 1 (1997): 7-12.
25. In 1994, the Lancet published a randomized, double-blinded clinical trial that reported that homeopathic preparations were effective in the treatment of allergic asthma. See D.T. Reilly et al., "Is Evidence For Homeopathy Reproducible?" Lancet 344 (1994): 1601-6. Animal studies conducted in Germany and Great Britain have reported that homeopathy can be effective in the treatment of mastitis. See C. Day, "Clinical Trials in Bovine Mastitis," British Homeopathic 75 (1986): 11-4. In addition, in 1991 the British Medical Journal published a meta-analysis of 107 clinical trials of homeopathy; of the 22 best-quality studies, 15 showed positive results in conditions such as hay fever, influenza, migraine headache, trauma, and length of labor. See J. Kleijnen et al., "Clinical Trials of Homeopathy," British Medical Journal 302 (1991): 316-23. See also D. Weerdt, "Herbal Medicines in Migraine Prevention: Randomized Double-Blind Placebo Controlled Trial of Fever-few Preparation," Phytomedicine 3 (1996): 225-30.
26. In 1994, the Lancet published a randomized, double-blinded clinical trial that reported that homeopathic preparations were effective in the treatment of allergic asthma. See D.T. Reilly et al., "Is Evidence For Homeopathy Reproducible?" Lancet 344 (1994): 1601-6. Animal studies conducted in Germany and Great Britain have reported that homeopathy can be effective in the treatment of mastitis. See C. Day, "Clinical Trials in Bovine Mastitis," British Homeopathic 75 (1986): 11-4. In addition, in 1991 the British Medical Journal published a meta-analysis of 107 clinical trials of homeopathy; of the 22 best-quality studies, 15 showed positive results in conditions such as hay fever, influenza, migraine headache, trauma, and length of labor. See J. Kleijnen et al., "Clinical Trials of Homeopathy," British Medical Journal 302 (1991): 316-23. See also D. Weerdt, "Herbal Medicines in Migraine Prevention: Randomized Double-Blind Placebo Controlled Trial of Fever-few Preparation," Phytomedicine 3 (1996): 225-30.
27. In 1994, the Lancet published a randomized, double-blinded clinical trial that reported that homeopathic preparations were effective in the treatment of allergic asthma. See D.T. Reilly et al., "Is Evidence For Homeopathy Reproducible?" Lancet 344 (1994): 1601-6. Animal studies conducted in Germany and Great Britain have reported that homeopathy can be effective in the treatment of mastitis. See C. Day, "Clinical Trials in Bovine Mastitis," British Homeopathic 75 (1986): 11-4. In addition, in 1991 the British Medical Journal published a meta-analysis of 107 clinical trials of homeopathy; of the 22 best-quality studies, 15 showed positive results in conditions such as hay fever, influenza, migraine headache, trauma, and length of labor. See J. Kleijnen et al., "Clinical Trials of Homeopathy," British Medical Journal 302 (1991): 316-23. See also D. Weerdt, "Herbal Medicines in Migraine Prevention: Randomized Double-Blind Placebo Controlled Trial of Fever-few Preparation," Phytomedicine 3 (1996): 225-30.
28. In 1994, the Lancet published a randomized, double-blinded clinical trial that reported that homeopathic preparations were effective in the treatment of allergic asthma. See D.T. Reilly et al., "Is Evidence For Homeopathy Reproducible?" Lancet 344 (1994): 1601-6. Animal studies conducted in Germany and Great Britain have reported that homeopathy can be effective in the treatment of mastitis. See C. Day, "Clinical Trials in Bovine Mastitis," British Homeopathic 75 (1986): 11-4. In addition, in 1991 the British Medical Journal published a meta-analysis of 107 clinical trials of homeopathy; of the 22 best-quality studies, 15 showed positive results in conditions such as hay fever, influenza, migraine headache, trauma, and length of labor. See J. Kleijnen et al., "Clinical Trials of Homeopathy," British Medical Journal 302 (1991): 316-23. See also D. Weerdt, "Herbal Medicines in Migraine Prevention: Randomized Double-Blind Placebo Controlled Trial of Fever-few Preparation," Phytomedicine 3 (1996): 225-30.
29. The 16 therapies used by Eisenberg et al. were relaxation techniques, herbal medicine, therapeutic massage, chiropractic, spiritual healing by others, megavitamins, self-help groups, imagery, commercial diet, folk remedies, lifestyle diet, energy healing, homeopathy, hypnosis, biofeedback, and acupuncture. For a more detailed analysis, see Eisenberg et al., "Trends in Alternative Medicine," see note 4 above, p. 1572.
30. Use was more common among women (48.9 percent) than men (37.8 percent) and less common among African-Americans (33.1 percent) than other racial groups (44.5 percent). People 35 to 49 years of age reported higher rates of use (50.1 percent) than people either older (39.1 percent) or younger (41.8 percent). Use was higher among those with some college education (50.6 percent) than among those with no college education (36.4 percent). It was estimated that the number of visits to alternative medicine practitioners increased dramatically from 427 million in 1990 to 629 million in 1997, and that only 38.5 percent of those who use alternative therapies discussed them with their primary care physicians. Ibid., 1571-3.
31. Ibid., 1573-4.
32. Ibid., 1575. See also E. Ernst, "Harmless Herbs?" American Journal of Medicine 104 (1998): 170-8; P.A. DeSmet, "Health Risks Of Herbal Remedies," Drug Safety 13 (1995): 81-93; P.F. D'Arcy, J.C. McElnay, and P.G. Welling, ed., Mechanisms of Drug Interactions (New York: Springer, 1996), 327-52.
33. Ibid., 1575. See also E. Ernst, "Harmless Herbs?" American Journal of Medicine 104 (1998): 170-8; P.A. DeSmet, "Health Risks Of Herbal Remedies," Drug Safety 13 (1995): 81-93; P.F. D'Arcy, J.C. McElnay, and P.G. Welling, ed., Mechanisms of Drug Interactions (New York: Springer, 1996), 327-52.
34. Ibid., 1575. See also E. Ernst, "Harmless Herbs?" American Journal of Medicine 104 (1998): 170-8; P.A. DeSmet, "Health Risks Of Herbal Remedies," Drug Safety 13 (1995): 81-93; P.F. D'Arcy, J.C. McElnay, and P.G. Welling, ed., Mechanisms of Drug Interactions (New York: Springer, 1996), 327-52.
35. Ibid., 1575. See also E. Ernst, "Harmless Herbs?" American Journal of Medicine 104 (1998): 170-8; P.A. DeSmet, "Health Risks Of Herbal Remedies," Drug Safety 13 (1995): 81-93; P.F. D'Arcy, J.C. McElnay, and P.G. Welling, ed., Mechanisms of Drug Interactions (New York: Springer, 1996), 327-52.
36. L.J. Schneiderman, "Alternative Medicine or Alternatives to Medicine? A Physician's Perspective," Cambridge Quarterly Of Healthcare Ethics 9 (2000): 83-87, p. 88.
37. See note 3 above, p. 1621.
38. Angell and Kassirer, "Alternative Medicine," see note 13 above, p. 839. See also National Institutes of Health, Office of Alternative Medicine, Grant Award and Research Data (Bethesda, Md.: Office of Alternative Medicine, date), see: 〈http://altmed.od.nih.gov/oarn/research/ grants〉. To meet the demand for evidence-based complementary medicine (CM), a CM Field, funded by the National Institutes of Health, Office of Alternative Medicine, was established within the Cochrane Collection in 1996. The goal of the Cochrane Collection is to produce, maintain, and disseminate systematic reviews on all topics in healthcare. The CM field focuses on CM topics. Since the CM Field has been functioning, a great deal of effort has focused on laying the ground-work for reviews by constructing a data base of randomized controlled trials on CM topics. Capturing all relevant trials in MEDLINE has yielded surprising challenges. Assessments of MEDLINE sensitivity have demonstrated that, on average, MEDLINE searches yield only half of all known trials on a given topic, with CM topics usually scoring below average. There are three reasons for this. First, there may be low MEDLINE sensitivity because articles on CM topics appear in journals that are not indexed by MEDLINE; second, the articles are published in journals that are not indexed by an electronic data base; third, studies may exist that have never been fully published in any journal ("gray literature"). Estimates from conventional medicine show that only 50 percent of randomized controlled trials that appear as conference proceedings are ever published. For a more detailed analysis, see J. Ezzo et al., "Investigating Alternative Medicine Therapies in Randomized Controlled Trials," Journal of the American Medical Association 280 (11 November 1998): 1626-30.
39. Angell and Kassirer, "Alternative Medicine," see note 13 above, p. 839. See also National Institutes of Health, Office of Alternative Medicine, Grant Award and Research Data (Bethesda, Md.: Office of Alternative Medicine, date), see: 〈http://altmed.od.nih.gov/oarn/research/ grants〉. To meet the demand for evidence-based complementary medicine (CM), a CM Field, funded by the National Institutes of Health, Office of Alternative Medicine, was established within the Cochrane Collection in 1996. The goal of the Cochrane Collection is to produce, maintain, and disseminate systematic reviews on all topics in healthcare. The CM field focuses on CM topics. Since the CM Field has been functioning, a great deal of effort has focused on laying the ground-work for reviews by constructing a data base of randomized controlled trials on CM topics. Capturing all relevant trials in MEDLINE has yielded surprising challenges. Assessments of MEDLINE sensitivity have demonstrated that, on average, MEDLINE searches yield only half of all known trials on a given topic, with CM topics usually scoring below average. There are three reasons for this. First, there may be low MEDLINE sensitivity because articles on CM topics appear in journals that are not indexed by MEDLINE; second, the articles are published in journals that are not indexed by an electronic data base; third, studies may exist that have never been fully published in any journal ("gray literature"). Estimates from conventional medicine show that only 50 percent of randomized controlled trials that appear as conference proceedings are ever published. For a more detailed analysis, see J. Ezzo et al., "Investigating Alternative Medicine Therapies in Randomized Controlled Trials," Journal of the American Medical Association 280 (11 November 1998): 1626-30.
40. Angell and Kassirer, "Alternative Medicine," see note 13 above, p. 839. See also National Institutes of Health, Office of Alternative Medicine, Grant Award and Research Data (Bethesda, Md.: Office of Alternative Medicine, date), see: 〈http://altmed.od.nih.gov/oarn/research/ grants〉. To meet the demand for evidence-based complementary medicine (CM), a CM Field, funded by the National Institutes of Health, Office of Alternative Medicine, was established within the Cochrane Collection in 1996. The goal of the Cochrane Collection is to produce, maintain, and disseminate systematic reviews on all topics in healthcare. The CM field focuses on CM topics. Since the CM Field has been functioning, a great deal of effort has focused on laying the ground-work for reviews by constructing a data base of randomized controlled trials on CM topics. Capturing all relevant trials in MEDLINE has yielded surprising challenges. Assessments of MEDLINE sensitivity have demonstrated that, on average, MEDLINE searches yield only half of all known trials on a given topic, with CM topics usually scoring below average. There are three reasons for this. First, there may be low MEDLINE sensitivity because articles on CM topics appear in journals that are not indexed by MEDLINE; second, the articles are published in journals that are not indexed by an electronic data base; third, studies may exist that have never been fully published in any journal ("gray literature"). Estimates from conventional medicine show that only 50 percent of randomized controlled trials that appear as conference proceedings are ever published. For a more detailed analysis, see J. Ezzo et al., "Investigating Alternative Medicine Therapies in Randomized Controlled Trials," Journal of the American Medical Association 280 (11 November 1998): 1626-30.
41. For example, an analysis of ginseng products reported that the amount of active ingredient in each pill varied as much as by a factor of 10 among brands that were labeled as containing the same amount. Some brands contained no ginseng at all. Garlic is purported to lower cholesterol, but only certain forms of garlic - raw cloves, fermented garlic, and garlic powder - seem useful. How much garlic it takes to yield benefits and how it is processed is largely unknown. Baker, "Be Smart, Beware," see note 11 above, p. 15.
42. P. Fontanarosa and G. Lundberg, "Alternative Medicine Meets Science," Journal of the American Medical Association 280 (11 November 1998): 1618-9, p. 1618. See also Practice and Policy Guidelines Panel, National Institutes Of Health Office Of Alternative Medicine, "Clinical Practice Guidelines in Complementary and Alternative Medicine: An Analysis of Opportunities and Obstacles," Archives of Family Medicine 257 (1987): 149-54.
43. P. Fontanarosa and G. Lundberg, "Alternative Medicine Meets Science," Journal of the American Medical Association 280 (11 November 1998): 1618-9, p. 1618. See also Practice and Policy Guidelines Panel, National Institutes Of Health Office Of Alternative Medicine, "Clinical Practice Guidelines in Complementary and Alternative Medicine: An Analysis of Opportunities and Obstacles," Archives of Family Medicine 257 (1987): 149-54.
44. See note 3 above, p. 1622. It should be noted that recently in the U.S., naturopathic educational institutions such as Bastyr College in Washington State have begun to conduct herbal research. Bastyr is conducting research on echinacea species, focusing on the effectiveness of echinacea on the frequency and severity of respiratory tract infections. Lee, "Introducing Herbal Medicine," see note 11 above, p. 257. It should also be noted that after it was reported that St. John's wort has had dangerous interactions with other drugs, including drugs used to treat HIV infection, and drugs used to prevent rejection in transplant patients, several studies have been initiated - one by the National Institutes of Health and one by Pfizer Inc. See D. Grady, "Scientists Say Herbs Need More Regulation," New York Times, 3 March 2000, D-4.
45. See note 3 above, p. 1622. It should be noted that recently in the U.S., naturopathic educational institutions such as Bastyr College in Washington State have begun to conduct herbal research. Bastyr is conducting research on echinacea species, focusing on the effectiveness of echinacea on the frequency and severity of respiratory tract infections. Lee, "Introducing Herbal Medicine," see note 11 above, p. 257. It should also be noted that after it was reported that St. John's wort has had dangerous interactions with other drugs, including drugs used to treat HIV infection, and drugs used to prevent rejection in transplant patients, several studies have been initiated - one by the National Institutes of Health and one by Pfizer Inc. See D. Grady, "Scientists Say Herbs Need More Regulation," New York Times, 3 March 2000, D-4.
46. FDA testing can cost hundreds of millions of dollars, and herb manufacturers do not attempt it because their products are generally not patentable and they will never recoup the costs.
47. See note 3 above. Traditional practices from other cultures "follow different diagnostic classifications than biomedicine and the complex substances (e.g., botanical, animal products) they use cannot easily meet the criteria established for essentially pure drugs or even for conventional biologics. However, the FDA recently has begun addressing the issues posed by evaluation of alternative medicine products. Representatives from the FDA actively participated in the organization of two conferences that addressed the special considerations of acupuncture and of botanical medicines" (pp. 1622-3).
48. The 11 November 1998 edition of the Journal of the American Medical Association contains the results of six randomized clinical trials of alternative therapies. Bove and Nilsson reported that chiropractic spinal manipulation is not effective for episodic tension headaches. G. Bove and N. Nilsson, "Spinal Manipulation in the Treatment of Episodic Tension-Type Headache: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1576-79. Cardini and Weixin found that moxibustion (stimulation of an acupuncture point by heat generated from burning a specific herb) is helpful for correction of breech presentation in late pregnancy. F. Cardini and H. Weixin, "Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1580-4. Bensoussan et al. document that a Chinese herbal medicine formulation improves symptoms of irritable bowel syndrome. A. Bensoussan et al., "Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1585-9. Shlay et al. report that acupuncture was no more effective than amitriptyline or placebo for relieving pain due to HIV-related peripheral neuropathy. J.C. Shlay et al., "Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1590-5. Heymsfield et al. determined that Garcinia cambogia, a common compound of commercial weight-loss products, lacks efficacy as an anti-obesity agent. S.B. Heymsfield et al., "Garcinia Cambogia (Hydroxycitric Acid) as a Potential Antiobesity Agent: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1596-600. In a preliminary study, Garfinkel and coworkers report that yoga-based intervention appears to hold promise for relieving some symptoms of carpal tunnel syndrome. See M.S. Garfinkel et al., "Yoga-Based Intervention for Carpal Tunnel Syndrome: A Randomized Trial," Journal of the American Medical Association 280 (11 November 1998): 1601-3. In addition, a systematic review by Wilt and colleagues suggests that saw palmetto extracts improve urologic symptoms in patients with benign prostatic hyperplasia. See T.J. Wilt et al., "Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review," Journal of the American Medical Association 280 (11 November 1998): 1604-9. See also Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, pp. 1618-9.
49. The 11 November 1998 edition of the Journal of the American Medical Association contains the results of six randomized clinical trials of alternative therapies. Bove and Nilsson reported that chiropractic spinal manipulation is not effective for episodic tension headaches. G. Bove and N. Nilsson, "Spinal Manipulation in the Treatment of Episodic Tension-Type Headache: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1576-79. Cardini and Weixin found that moxibustion (stimulation of an acupuncture point by heat generated from burning a specific herb) is helpful for correction of breech presentation in late pregnancy. F. Cardini and H. Weixin, "Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1580-4. Bensoussan et al. document that a Chinese herbal medicine formulation improves symptoms of irritable bowel syndrome. A. Bensoussan et al., "Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1585-9. Shlay et al. report that acupuncture was no more effective than amitriptyline or placebo for relieving pain due to HIV-related peripheral neuropathy. J.C. Shlay et al., "Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1590-5. Heymsfield et al. determined that Garcinia cambogia, a common compound of commercial weight-loss products, lacks efficacy as an anti-obesity agent. S.B. Heymsfield et al., "Garcinia Cambogia (Hydroxycitric Acid) as a Potential Antiobesity Agent: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1596-600. In a preliminary study, Garfinkel and coworkers report that yoga-based intervention appears to hold promise for relieving some symptoms of carpal tunnel syndrome. See M.S. Garfinkel et al., "Yoga-Based Intervention for Carpal Tunnel Syndrome: A Randomized Trial," Journal of the American Medical Association 280 (11 November 1998): 1601-3. In addition, a systematic review by Wilt and colleagues suggests that saw palmetto extracts improve urologic symptoms in patients with benign prostatic hyperplasia. See T.J. Wilt et al., "Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review," Journal of the American Medical Association 280 (11 November 1998): 1604-9. See also Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, pp. 1618-9.
50. The 11 November 1998 edition of the Journal of the American Medical Association contains the results of six randomized clinical trials of alternative therapies. Bove and Nilsson reported that chiropractic spinal manipulation is not effective for episodic tension headaches. G. Bove and N. Nilsson, "Spinal Manipulation in the Treatment of Episodic Tension-Type Headache: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1576-79. Cardini and Weixin found that moxibustion (stimulation of an acupuncture point by heat generated from burning a specific herb) is helpful for correction of breech presentation in late pregnancy. F. Cardini and H. Weixin, "Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1580-4. Bensoussan et al. document that a Chinese herbal medicine formulation improves symptoms of irritable bowel syndrome. A. Bensoussan et al., "Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1585-9. Shlay et al. report that acupuncture was no more effective than amitriptyline or placebo for relieving pain due to HIV-related peripheral neuropathy. J.C. Shlay et al., "Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1590-5. Heymsfield et al. determined that Garcinia cambogia, a common compound of commercial weight-loss products, lacks efficacy as an anti-obesity agent. S.B. Heymsfield et al., "Garcinia Cambogia (Hydroxycitric Acid) as a Potential Antiobesity Agent: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1596-600. In a preliminary study, Garfinkel and coworkers report that yoga-based intervention appears to hold promise for relieving some symptoms of carpal tunnel syndrome. See M.S. Garfinkel et al., "Yoga-Based Intervention for Carpal Tunnel Syndrome: A Randomized Trial," Journal of the American Medical Association 280 (11 November 1998): 1601-3. In addition, a systematic review by Wilt and colleagues suggests that saw palmetto extracts improve urologic symptoms in patients with benign prostatic hyperplasia. See T.J. Wilt et al., "Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review," Journal of the American Medical Association 280 (11 November 1998): 1604-9. See also Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, pp. 1618-9.
51. The 11 November 1998 edition of the Journal of the American Medical Association contains the results of six randomized clinical trials of alternative therapies. Bove and Nilsson reported that chiropractic spinal manipulation is not effective for episodic tension headaches. G. Bove and N. Nilsson, "Spinal Manipulation in the Treatment of Episodic Tension-Type Headache: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1576-79. Cardini and Weixin found that moxibustion (stimulation of an acupuncture point by heat generated from burning a specific herb) is helpful for correction of breech presentation in late pregnancy. F. Cardini and H. Weixin, "Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1580-4. Bensoussan et al. document that a Chinese herbal medicine formulation improves symptoms of irritable bowel syndrome. A. Bensoussan et al., "Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1585-9. Shlay et al. report that acupuncture was no more effective than amitriptyline or placebo for relieving pain due to HIV-related peripheral neuropathy. J.C. Shlay et al., "Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1590-5. Heymsfield et al. determined that Garcinia cambogia, a common compound of commercial weight-loss products, lacks efficacy as an anti-obesity agent. S.B. Heymsfield et al., "Garcinia Cambogia (Hydroxycitric Acid) as a Potential Antiobesity Agent: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1596-600. In a preliminary study, Garfinkel and coworkers report that yoga-based intervention appears to hold promise for relieving some symptoms of carpal tunnel syndrome. See M.S. Garfinkel et al., "Yoga-Based Intervention for Carpal Tunnel Syndrome: A Randomized Trial," Journal of the American Medical Association 280 (11 November 1998): 1601-3. In addition, a systematic review by Wilt and colleagues suggests that saw palmetto extracts improve urologic symptoms in patients with benign prostatic hyperplasia. See T.J. Wilt et al., "Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review," Journal of the American Medical Association 280 (11 November 1998): 1604-9. See also Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, pp. 1618-9.
52. The 11 November 1998 edition of the Journal of the American Medical Association contains the results of six randomized clinical trials of alternative therapies. Bove and Nilsson reported that chiropractic spinal manipulation is not effective for episodic tension headaches. G. Bove and N. Nilsson, "Spinal Manipulation in the Treatment of Episodic Tension-Type Headache: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1576-79. Cardini and Weixin found that moxibustion (stimulation of an acupuncture point by heat generated from burning a specific herb) is helpful for correction of breech presentation in late pregnancy. F. Cardini and H. Weixin, "Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1580-4. Bensoussan et al. document that a Chinese herbal medicine formulation improves symptoms of irritable bowel syndrome. A. Bensoussan et al., "Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1585-9. Shlay et al. report that acupuncture was no more effective than amitriptyline or placebo for relieving pain due to HIV-related peripheral neuropathy. J.C. Shlay et al., "Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1590-5. Heymsfield et al. determined that Garcinia cambogia, a common compound of commercial weight-loss products, lacks efficacy as an anti-obesity agent. S.B. Heymsfield et al., "Garcinia Cambogia (Hydroxycitric Acid) as a Potential Antiobesity Agent: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1596-600. In a preliminary study, Garfinkel and coworkers report that yoga-based intervention appears to hold promise for relieving some symptoms of carpal tunnel syndrome. See M.S. Garfinkel et al., "Yoga-Based Intervention for Carpal Tunnel Syndrome: A Randomized Trial," Journal of the American Medical Association 280 (11 November 1998): 1601-3. In addition, a systematic review by Wilt and colleagues suggests that saw palmetto extracts improve urologic symptoms in patients with benign prostatic hyperplasia. See T.J. Wilt et al., "Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review," Journal of the American Medical Association 280 (11 November 1998): 1604-9. See also Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, pp. 1618-9.
53. The 11 November 1998 edition of the Journal of the American Medical Association contains the results of six randomized clinical trials of alternative therapies. Bove and Nilsson reported that chiropractic spinal manipulation is not effective for episodic tension headaches. G. Bove and N. Nilsson, "Spinal Manipulation in the Treatment of Episodic Tension-Type Headache: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1576-79. Cardini and Weixin found that moxibustion (stimulation of an acupuncture point by heat generated from burning a specific herb) is helpful for correction of breech presentation in late pregnancy. F. Cardini and H. Weixin, "Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1580-4. Bensoussan et al. document that a Chinese herbal medicine formulation improves symptoms of irritable bowel syndrome. A. Bensoussan et al., "Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1585-9. Shlay et al. report that acupuncture was no more effective than amitriptyline or placebo for relieving pain due to HIV-related peripheral neuropathy. J.C. Shlay et al., "Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1590-5. Heymsfield et al. determined that Garcinia cambogia, a common compound of commercial weight-loss products, lacks efficacy as an anti-obesity agent. S.B. Heymsfield et al., "Garcinia Cambogia (Hydroxycitric Acid) as a Potential Antiobesity Agent: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1596-600. In a preliminary study, Garfinkel and coworkers report that yoga-based intervention appears to hold promise for relieving some symptoms of carpal tunnel syndrome. See M.S. Garfinkel et al., "Yoga-Based Intervention for Carpal Tunnel Syndrome: A Randomized Trial," Journal of the American Medical Association 280 (11 November 1998): 1601-3. In addition, a systematic review by Wilt and colleagues suggests that saw palmetto extracts improve urologic symptoms in patients with benign prostatic hyperplasia. See T.J. Wilt et al., "Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review," Journal of the American Medical Association 280 (11 November 1998): 1604-9. See also Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, pp. 1618-9.
54. The 11 November 1998 edition of the Journal of the American Medical Association contains the results of six randomized clinical trials of alternative therapies. Bove and Nilsson reported that chiropractic spinal manipulation is not effective for episodic tension headaches. G. Bove and N. Nilsson, "Spinal Manipulation in the Treatment of Episodic Tension-Type Headache: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1576-79. Cardini and Weixin found that moxibustion (stimulation of an acupuncture point by heat generated from burning a specific herb) is helpful for correction of breech presentation in late pregnancy. F. Cardini and H. Weixin, "Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1580-4. Bensoussan et al. document that a Chinese herbal medicine formulation improves symptoms of irritable bowel syndrome. A. Bensoussan et al., "Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1585-9. Shlay et al. report that acupuncture was no more effective than amitriptyline or placebo for relieving pain due to HIV-related peripheral neuropathy. J.C. Shlay et al., "Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1590-5. Heymsfield et al. determined that Garcinia cambogia, a common compound of commercial weight-loss products, lacks efficacy as an anti-obesity agent. S.B. Heymsfield et al., "Garcinia Cambogia (Hydroxycitric Acid) as a Potential Antiobesity Agent: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1596-600. In a preliminary study, Garfinkel and coworkers report that yoga-based intervention appears to hold promise for relieving some symptoms of carpal tunnel syndrome. See M.S. Garfinkel et al., "Yoga-Based Intervention for Carpal Tunnel Syndrome: A Randomized Trial," Journal of the American Medical Association 280 (11 November 1998): 1601-3. In addition, a systematic review by Wilt and colleagues suggests that saw palmetto extracts improve urologic symptoms in patients with benign prostatic hyperplasia. See T.J. Wilt et al., "Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review," Journal of the American Medical Association 280 (11 November 1998): 1604-9. See also Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, pp. 1618-9.
55. The 11 November 1998 edition of the Journal of the American Medical Association contains the results of six randomized clinical trials of alternative therapies. Bove and Nilsson reported that chiropractic spinal manipulation is not effective for episodic tension headaches. G. Bove and N. Nilsson, "Spinal Manipulation in the Treatment of Episodic Tension-Type Headache: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1576-79. Cardini and Weixin found that moxibustion (stimulation of an acupuncture point by heat generated from burning a specific herb) is helpful for correction of breech presentation in late pregnancy. F. Cardini and H. Weixin, "Moxibustion for Correction of Breech Presentation: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1580-4. Bensoussan et al. document that a Chinese herbal medicine formulation improves symptoms of irritable bowel syndrome. A. Bensoussan et al., "Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1585-9. Shlay et al. report that acupuncture was no more effective than amitriptyline or placebo for relieving pain due to HIV-related peripheral neuropathy. J.C. Shlay et al., "Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1590-5. Heymsfield et al. determined that Garcinia cambogia, a common compound of commercial weight-loss products, lacks efficacy as an anti-obesity agent. S.B. Heymsfield et al., "Garcinia Cambogia (Hydroxycitric Acid) as a Potential Antiobesity Agent: A Randomized Controlled Trial," Journal of the American Medical Association 280 (11 November 1998): 1596-600. In a preliminary study, Garfinkel and coworkers report that yoga-based intervention appears to hold promise for relieving some symptoms of carpal tunnel syndrome. See M.S. Garfinkel et al., "Yoga-Based Intervention for Carpal Tunnel Syndrome: A Randomized Trial," Journal of the American Medical Association 280 (11 November 1998): 1601-3. In addition, a systematic review by Wilt and colleagues suggests that saw palmetto extracts improve urologic symptoms in patients with benign prostatic hyperplasia. See T.J. Wilt et al., "Saw Palmetto Extracts for Treatment of Benign Prostatic Hyperplasia: A Systematic Review," Journal of the American Medical Association 280 (11 November 1998): 1604-9. See also Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, pp. 1618-9.
56. Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, p. 1618.
57. S.G. Stolberg, "For a Very Few Patients, U.S. Provides Free Marijuana," New York Times, 19 March 1999, A-10. See also J.E. Joy, S.J. Watson, and J.A. Benson, Marijuana and Medicine: Assessing the Science Base (Washington, D.C.: Institutes of Medicine, March 1999).
58. S.G. Stolberg, "For a Very Few Patients, U.S. Provides Free Marijuana," New York Times, 19 March 1999, A-10. See also J.E. Joy, S.J. Watson, and J.A. Benson, Marijuana and Medicine: Assessing the Science Base (Washington, D.C.: Institutes of Medicine, March 1999).
59. S.G. Stolberg, "Government Study on Marijuana Sees Medical Benefits," New York Times, 18 March 1999, A-1.
60. The following findings must be made to place a drug on Schedule I: "(1) "the drug . . . has a high potential for abuse; (2) the drug . . . has no currently accepted medical use in treatment in the United States; and (3) there is a lack of accepted safety for use of the drug under medical supervision." Part 1 of Schedule II drugs is identical; the other requirements are "(2) the drug . . . has currently accepted medical use in the United States . . . and (3) abuse of the drug . . . may lead to severe psychological and physical dependence." For a more detailed analysis, see G.J. Annas, "Reefer Madness - The Federal Response to California's Medical-Marijuana Law," New England Journal of Medicine 337 (7 August 1997): 435-9, p. 438.
61. It should be noted that the DEA has rejected proposed protocols accepted by the FDA. "The clinical trial devised by D.I. Abrams et al., has been approved by the FDA (as well as the California Research Advisory Panel, the Institutional Review Board of the University of California, and the scientific advisory board of the San Francisco Community Consortium). Unfortunately, the protocol was rejected by the DEA and the National Institutes of Drug Abuse. Political disingenuity involved in this rejection has frustrated members of Congress. J.M. McParland and P. Pruitt, "Medical Marijuana and Its Use by the Immunocompromised," Alternative Therapies 3 (May 1997): 39-45, pp. 39-40. Five years later, Donald Abrams, MD, of the University of California at San Francisco, finally obtained approval and a $978,000 NIH grant. "Even then, Dr. Abrams said he had to mask his true research interest. Although he wanted to examine the effects of marijuana on the weight loss associated with AIDS, he pitched the study as one that would look at potentially toxic interactions between marijuana and standard AIDS medications. 'We designed a study that would appeal to the group funding the grant'." S. Gay Stolberg, "Restrictions Ease for Studies on Marijuana as Medicine," New York Times, 22 May 1999, A-11.
62. It should be noted that the DEA has rejected proposed protocols accepted by the FDA. "The clinical trial devised by D.I. Abrams et al., has been approved by the FDA (as well as the California Research Advisory Panel, the Institutional Review Board of the University of California, and the scientific advisory board of the San Francisco Community Consortium). Unfortunately, the protocol was rejected by the DEA and the National Institutes of Drug Abuse. Political disingenuity involved in this rejection has frustrated members of Congress. J.M. McParland and P. Pruitt, "Medical Marijuana and Its Use by the Immunocompromised," Alternative Therapies 3 (May 1997): 39-45, pp. 39-40. Five years later, Donald Abrams, MD, of the University of California at San Francisco, finally obtained approval and a $978,000 NIH grant. "Even then, Dr. Abrams said he had to mask his true research interest. Although he wanted to examine the effects of marijuana on the weight loss associated with AIDS, he pitched the study as one that would look at potentially toxic interactions between marijuana and standard AIDS medications. 'We designed a study that would appeal to the group funding the grant'." S. Gay Stolberg, "Restrictions Ease for Studies on Marijuana as Medicine," New York Times, 22 May 1999, A-11.
63. For a more detailed analysis of the medicinal use of marijuana see P.A. Clark, "The Ethics of Medical Marijuana: Government Restrictions vs. Medical Necessity," Journal of Public Health Policy 21 (Spring 2000): 40-60.
64. Angell and Kassirer, "Alternative Medicine," see note 13 above, p. 840. Slifman and her colleagues report a case of digitalis toxicity in a young woman who had ingested a contaminated herbal concoction. See N.R. Slifman et al., "Contamination of Dietary Supplements by Digitalis Ianata," New England Journal of Medicine 339 (17 September 1998): 806-11. Ko reports finding widespread inconsistencies and adulteration in his analysis of Asian patent medicines. See R.J. Ko, "Adulterants in Asian Patent Medicines," New England Journal of Medicine 339 (17 September 1998): 847. L. Vecchio et al., report on a patient who suffered central nervous system depression after ingesting a substance sold in health-food stores as a growth hormone stimulator. See F. LoVecchio, S.C. Curry, and T. Bagnasco, "Butyrolactone-Induced Central Nervous System Depression after Ingestion of Renew Trient, 'A Dietary Supplement'," New England Journal of Medicine 339 (11 September 1998): 847-8. Beigel and coworkers describe the puzzling clinical course of a patient in whom lead poisoning developed after he took an Indian herbal remedy for his diabetes. See Y. Beigel, I. Ostfeld, N. Schoenfeld, "A Leading Question," New England Journal of Medicine 339 (11 September 1998): 827-30.
65. Angell and Kassirer, "Alternative Medicine," see note 13 above, p. 840. Slifman and her colleagues report a case of digitalis toxicity in a young woman who had ingested a contaminated herbal concoction. See N.R. Slifman et al., "Contamination of Dietary Supplements by Digitalis Ianata," New England Journal of Medicine 339 (17 September 1998): 806-11. Ko reports finding widespread inconsistencies and adulteration in his analysis of Asian patent medicines. See R.J. Ko, "Adulterants in Asian Patent Medicines," New England Journal of Medicine 339 (17 September 1998): 847. L. Vecchio et al., report on a patient who suffered central nervous system depression after ingesting a substance sold in health-food stores as a growth hormone stimulator. See F. LoVecchio, S.C. Curry, and T. Bagnasco, "Butyrolactone-Induced Central Nervous System Depression after Ingestion of Renew Trient, 'A Dietary Supplement'," New England Journal of Medicine 339 (11 September 1998): 847-8. Beigel and coworkers describe the puzzling clinical course of a patient in whom lead poisoning developed after he took an Indian herbal remedy for his diabetes. See Y. Beigel, I. Ostfeld, N. Schoenfeld, "A Leading Question," New England Journal of Medicine 339 (11 September 1998): 827-30.
66. Angell and Kassirer, "Alternative Medicine," see note 13 above, p. 840. Slifman and her colleagues report a case of digitalis toxicity in a young woman who had ingested a contaminated herbal concoction. See N.R. Slifman et al., "Contamination of Dietary Supplements by Digitalis Ianata," New England Journal of Medicine 339 (17 September 1998): 806-11. Ko reports finding widespread inconsistencies and adulteration in his analysis of Asian patent medicines. See R.J. Ko, "Adulterants in Asian Patent Medicines," New England Journal of Medicine 339 (17 September 1998): 847. L. Vecchio et al., report on a patient who suffered central nervous system depression after ingesting a substance sold in health-food stores as a growth hormone stimulator. See F. LoVecchio, S.C. Curry, and T. Bagnasco, "Butyrolactone-Induced Central Nervous System Depression after Ingestion of Renew Trient, 'A Dietary Supplement'," New England Journal of Medicine 339 (11 September 1998): 847-8. Beigel and coworkers describe the puzzling clinical course of a patient in whom lead poisoning developed after he took an Indian herbal remedy for his diabetes. See Y. Beigel, I. Ostfeld, N. Schoenfeld, "A Leading Question," New England Journal of Medicine 339 (11 September 1998): 827-30.
67. Angell and Kassirer, "Alternative Medicine," see note 13 above, p. 840. Slifman and her colleagues report a case of digitalis toxicity in a young woman who had ingested a contaminated herbal concoction. See N.R. Slifman
68. Angell and Kassirer, "Alternative Medicine," see note 13 above, p. 840. Slifman and her colleagues report a case of digitalis toxicity in a young woman who had ingested a contaminated herbal concoction. See N.R. Slifman et al., "Contamination of Dietary Supplements by Digitalis Ianata," New England Journal of Medicine 339 (17 September 1998): 806-11. Ko reports finding widespread inconsistencies and adulteration in his analysis of Asian patent medicines. See R.J. Ko, "Adulterants in Asian Patent Medicines," New England Journal of Medicine 339 (17 September 1998): 847. L. Vecchio et al., report on a patient who suffered central nervous system depression after ingesting a substance sold in health-food stores as a growth hormone stimulator. See F. LoVecchio, S.C. Curry, and T. Bagnasco, "Butyrolactone-Induced Central Nervous System Depression after Ingestion of Renew Trient, 'A Dietary Supplement'," New England Journal of Medicine 339 (11 September 1998): 847-8. Beigel and coworkers describe the puzzling clinical course of a patient in whom lead poisoning developed after he took an Indian herbal remedy for his diabetes. See Y. Beigel, I. Ostfeld, N. Schoenfeld, "A Leading Question," New England Journal of Medicine 339 (11 September 1998): 827-30.
69. J. Lazarou, B. Pomeranz, and P. Corey, "Incidence of Adverse Drug Reactions in Hospitalized Patients: A Meta-Analysis of Prospective Studies," Journal of the American Medical Association 279 (15 April 1998): 1200-5.
70. L.A. Love, "The MedWatch Program," Clinical Toxicology 36 (1998): 263-7.
71. Angell and Kassirer, "Alternative Medicine," see note 13 above, p. 841.
72. Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, p. 1618. Those who advocate scientific testing argue that the majority of alternative medicine therapies can be critically assessed by evidence-based research as demonstrated by various studies in Europe. For those not able to be assessed by this method, enhanced research designs, such as randomized clinical trials, can be implemented. "Controlled evaluation of alternative medicine therapies may require its practitioners to undertake a fundamental conceptual shift from a view of patients as requiring individualized treatment that may vary at each session to one in which trial participants are regarded as members of an equivalence class, defined by the diagnosis, who all will be given a standard prescribed treatment." See A. Margolin, S.K. Avants, and H. Kelber, "Investigating Alternative Medicine Therapies in Randomized Controlled Trials," Journal of the American Medical Association 280 (11 November 1998): 1627-8.
73. Fontanarosa and Lundberg, "Alternative Medicine," see note 23 above, p. 1618. Those who advocate scientific testing argue that the majority of alternative medicine therapies can be critically assessed by evidence-based research as demonstrated by various studies in Europe. For those not able to be assessed by this method, enhanced research designs, such as randomized clinical trials, can be implemented. "Controlled evaluation of alternative medicine therapies may require its practitioners to undertake a fundamental conceptual shift from a view of patients as requiring individualized treatment that may vary at each session to one in which trial participants are regarded as members of an equivalence class, defined by the diagnosis, who all will be given a standard prescribed treatment." See A. Margolin, S.K. Avants, and H. Kelber, "Investigating Alternative Medicine Therapies in Randomized Controlled Trials," Journal of the American Medical Association 280 (11 November 1998): 1627-8.
74. Eisenberg et al., in 1997 found that 42 percent of the subjects who reported that they used alternative medicine therapies said they were used to treat existing illnesses, whereas 58 percent were used, at least in part, to prevent future illness or to maintain health and vitality. See note 4 above, p. 1575.
75. It is imperative in this day and age to include as part of every patient's history an inquiry into the use of alternative treatments. This can be done by the physician, in a nonjudgmental way, by inserting such questions into routine inquiries about the patient's life activities such as smoking, alcohol and caffeine intake, exercise, sexual activity, use of unprescribed drugs and vitamins, and so forth. See note 19 above, p. 92.
76. For example, shark cartilage is promoted on its label "to maintain proper bone and joint function," saw palmetto to "promote prostate health," St. John's wort can "help enhance mood," and echinacea "helps maintain immune function." Sources?
77. See note 4 above, p. 1575.
78. There are reputable reference books available here in the U.S., as well as clinical journals and newsletters from Europe. Reputable U.S. references include M.R. Werbach and M.T. Murray, The Healing Power of Herbs and Botanical Influences on Illness (Tarzana, Calif.: Third Line, 1994); D. Hoffman, The Information Sourcebook (Freedom, Calif.: Crossing, 1994); R.F. Weiss, Herbal Medicine (Beaconsfield, England: Beaconsfield, 1991); a major European journal would be the Journal of Herbal Medicine published by the National Institute of Herbal Medicine in the United Kingdom; and the major newsletter is Medical Herbalism, available at 〈http://www.medherb.com〉.
79. There are reputable reference books available here in the U.S., as well as clinical journals and newsletters from Europe. Reputable U.S. references include M.R. Werbach and M.T. Murray, The Healing Power of Herbs and Botanical Influences on Illness (Tarzana, Calif.: Third Line, 1994); D. Hoffman, The Information Sourcebook (Freedom, Calif.: Crossing, 1994); R.F. Weiss, Herbal Medicine (Beaconsfield, England: Beaconsfield, 1991); a major European journal would be the Journal of Herbal Medicine published by the National Institute of Herbal Medicine in the United Kingdom; and the major newsletter is Medical Herbalism, available at 〈http://www.medherb.com〉.
80. There are reputable reference books available here in the U.S., as well as clinical journals and newsletters from Europe. Reputable U.S. references include M.R. Werbach and M.T. Murray, The Healing Power of Herbs and Botanical Influences on Illness (Tarzana, Calif.: Third Line, 1994); D. Hoffman, The Information Sourcebook (Freedom, Calif.: Crossing, 1994); R.F. Weiss, Herbal Medicine (Beaconsfield, England: Beaconsfield, 1991); a major European journal would be the Journal of Herbal Medicine published by the National Institute of Herbal Medicine in the United Kingdom; and the major newsletter is Medical Herbalism, available at 〈http://www.medherb.com〉.
81. I. Sugarman and L. Burk, "Physicians' Ethical Obligations Regarding Alternative Medicine," Journal of the American Medical Association 280 (11 November 1998): 1623-5.
82. S. Fried, "F.D.A. Approval Is Just the First Step," New York Times, 25 April 1998, A-15.
83. Source?
84. For example, conventional antidepressants act on the same neurotransmitters within the central nervous system that St. John's wort does. For a more detailed analysis, see Sugarman and Burk, "Physicians' Ethical Obligations," see note 44 above, p. 1625. Also, a recent study in the New England Journal of Medicine on women with breast cancer who seek alternative therapies like herbs or acupuncture, in addition to standard treatment, reported that they may be unusually worried and depressed and in need of extra help with their fears about the disease. Researchers found that women who began the alternative medicine therapies, when compared with women who did not, reported a worse quality of life, more depression, worse general mental health, and greater fear of recurrence of cancer and less sexual satisfaction. Researchers found these women may have turned to alternative medicine to help cope with their psychosocial distress after surgery. The women reported that they used these treatments as a complement to established medical practices, not as a substitute for them. For a more detailed analysis, see H. Burstein et al., "Use of Alternative Medicine by Women with Early-Stage Breast Cancer," New England Journal of Medicine 340 (3 June 1999): 1733-9.
85. For example, conventional antidepressants act on the same neurotransmitters within the central nervous system that St. John's wort does. For a more detailed analysis, see Sugarman and Burk, "Physicians' Ethical Obligations," see note 44 above, p. 1625. Also, a recent study in the New England Journal of Medicine on women with breast cancer who seek alternative therapies like herbs or acupuncture, in addition to standard treatment, reported that they may be unusually worried and depressed and in need of extra help with their fears about the disease. Researchers found that women who began the alternative medicine therapies, when compared with women who did not, reported a worse quality of life, more depression, worse general mental health, and greater fear of recurrence of cancer and less sexual satisfaction. Researchers found these women may have turned to alternative medicine to help cope with their psychosocial distress after surgery. The women reported that they used these treatments as a complement to established medical practices, not as a substitute for them. For a more detailed analysis, see H. Burstein et al., "Use of Alternative Medicine by Women with Early-Stage Breast Cancer," New England Journal of Medicine 340 (3 June 1999): 1733-9.
86. Sugarman and Burk, see note 44 above, p. 1625.
87. For example, Timothy McAlindon of the Arthritis Center at Boston University School of Medicine conducted an analysis of 15 studies published from 1966 to 1999 and found that the popular dietary supplement glucosamine sulfate was moderately effective against osteoarthritis, and that chondroitin sulfate had a big impact on the ailment. See National News Briefs, "Two Dietary Supplements Supported by Study," New York Times, 15 March 2000, A-19.
88. Sugarman and Burk, see note 44 above, p. 1625.
89. Jonas, "Alternative Medicine," see note 1 above, p. 1616.
90. Angell and Kassirer, "Alternative Medicine," see note 13 above, p. 841.
91. A. Liburd, "The Use of Complementary Therapies in Midwifery in the UK," Journal of Nurse-Midwifery 44 (May-June 1999): 325-9, p. 328.
92. It should be noted that the American Botanical Council and the Herb Research Foundation are non-profit research and educational organizations that provide information to the public, government, and educational institutions about phytotherapy. The American Herb Products Association works with the FDA to publish guidelines for good manufacturing practices for herbal products that are used as dietary supplements. The American Herbalist Guild has initiated the publication of American Herbal Pharmacopoeia Monographs to provide therapeutic and clinical information. Lee, "Introducing Herbal Medicine," see note 11 above, p. 255.
93. Grady, "Scientists Say Herbs Need More Regulation," see note 24 above, p. D-4.
94. For a more detailed analysis, see D. Daly, "Alternative Medicine Courses Taught at United States Medical Schools: An Ongoing List," Journal of Alternative Complementary Medicine 3 (1997): 405-10; F.B. Milan, C. Landau, and D.R. Murphy, "Teaching Residents about Complementary and Alternative Medicine in the United States," Journal of General Internal Medicine 13 (1998): 562-7; and D. Von Behren, "Program in Integrative Medicine Initiates Nation's First Fellowship," in Arizona Health Horizons, ed. D. Von Behren (Tucson, Ariz.: Office of Public Affairs, University of Arizona Health Sciences Center, 1997), 16-7.
95. For a more detailed analysis, see D. Daly, "Alternative Medicine Courses Taught at United States Medical Schools: An Ongoing List," Journal of Alternative Complementary Medicine 3 (1997): 405-10; F.B. Milan, C. Landau, and D.R. Murphy, "Teaching Residents about Complementary and Alternative Medicine in the United States," Journal of General Internal Medicine 13 (1998): 562-7; and D. Von Behren, "Program in Integrative Medicine Initiates Nation's First Fellowship," in Arizona Health Horizons, ed. D. Von Behren (Tucson, Ariz.: Office of Public Affairs, University of Arizona Health Sciences Center, 1997), 16-7.
96. For a more detailed analysis, see D. Daly, "Alternative Medicine Courses Taught at United States Medical Schools: An Ongoing List," Journal of Alternative Complementary Medicine 3 (1997): 405-10; F.B. Milan, C. Landau, and D.R. Murphy, "Teaching Residents about Complementary and Alternative Medicine in the United States," Journal of General Internal Medicine 13 (1998): 562-7; and D. Von Behren, "Program in Integrative Medicine Initiates Nation's First Fellowship," in Arizona Health Horizons, ed. D. Von Behren (Tucson, Ariz.: Office of Public Affairs, University of Arizona Health Sciences Center, 1997), 16-7.
97. An example of on-line services includes the Herbal Information Centre web page, which is an excellent source of information on Materia Medica (it is compared to the Western practitioner's Physicians' Desk Reference). See D. Hoffman and C. Hobbes, The Herbal Information Centre, available at 〈http://www.healthy.net/clinic/therapy/ herbal/herbic/index.htm 〉. Paul Bergner's Medical Herbalism focuses on clinical herbalism with various links on pharmacology and physiology; see Medical Herbalism, available at 〈http:// www.medherb.com〉. See also D. Hoffman, The Information Sourcebook (Freedom, Calif.: Crossing, 1994), which is a comprehensive guide to on-line sites and data base sources. Lee, "Introducing Herbal Medicine," see note 11 above, p. 257.
98. An example of on-line services includes the Herbal Information Centre web page, which is an excellent source of information on Materia Medica (it is compared to the Western practitioner's Physicians' Desk Reference). See D. Hoffman and C. Hobbes, The Herbal Information Centre, available at 〈http://www.healthy.net/clinic/therapy/ herbal/herbic/index.htm 〉. Paul Bergner's Medical Herbalism focuses on clinical herbalism with various links on pharmacology and physiology; see Medical Herbalism, available at 〈http:// www.medherb.com〉. See also D. Hoffman, The Information Sourcebook (Freedom, Calif.: Crossing, 1994), which is a comprehensive guide to on-line sites and data base sources. Lee, "Introducing Herbal Medicine," see note 11 above, p. 257.
99. An example of on-line services includes the Herbal Information Centre web page, which is an excellent source of information on Materia Medica (it is compared to the Western practitioner's Physicians' Desk Reference). See D. Hoffman and C. Hobbes, The Herbal Information Centre, available at 〈http://www.healthy.net/clinic/therapy/ herbal/herbic/index.htm 〉. Paul Bergner's Medical Herbalism focuses on clinical herbalism with various links on pharmacology and physiology; see Medical Herbalism, available at 〈http:// www.medherb.com〉. See also D. Hoffman, The Information Sourcebook (Freedom, Calif.: Crossing, 1994), which is a comprehensive guide to on-line sites and data base sources. Lee, "Introducing Herbal Medicine," see note 11 above, p. 257.
100. An example of on-line services includes the Herbal Information Centre web page, which is an excellent source of information on Materia Medica (it is compared to the Western practitioner's Physicians' Desk Reference). See D. Hoffman and C. Hobbes, The Herbal Information Centre, available at 〈http://www.healthy.net/clinic/therapy/ herbal/herbic/index.htm 〉. Paul Bergner's Medical Herbalism focuses on clinical herbalism with various links on pharmacology and physiology; see Medical Herbalism, available at 〈http:// www.medherb.com〉. See also D. Hoffman, The Information Sourcebook (Freedom, Calif.: Crossing, 1994), which is a comprehensive guide to on-line sites and data base sources. Lee, "Introducing Herbal Medicine," see note 11 above, p. 257.
101. Jonas, "Alternative Medicine," see note 1 above, p. 1617.
102. For a more detailed analysis, see Burstein et al., "Use of Alternative Medicine," see note 46 above, pp. 1733-8, and M.J. Verhoef et al., "Alternative Therapy Use in Neurologic Diseases: Use in Brain Tumor Patients," Neurology 52 (1999): 617-22.
103. For a more detailed analysis, see Burstein et al., "Use of Alternative Medicine," see note 46 above, pp. 1733-8, and M.J. Verhoef et al., "Alternative Therapy Use in Neurologic Diseases: Use in Brain Tumor Patients," Neurology 52 (1999): 617-22.