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To the Editor:
The New England Journal of Medicine articles and editorial
on complementary and alternative medicine (September 17, 1998),
reveal a bias and a misunderstanding of both conventional
and complementary medicine, especially the use of dietary
supplements and the role of the FDA in regulating their safety.
The FDA has ample power to regulate dietary supplements for
safety, and full authority to remove from the market any product
that is mislabeled, contaminated, or in any way dangerous.
The claim that complementary medicines have no scientific
basis reveals an ignorance of a significant body of scientific
knowledge. Although there are many treatments that do not
have as much research as we would like, this is true of both
conventional and complementary medicine. Conventional practice
routinely includes treatments that are not well documented.
Some reliable estimates suggest that as much as 85 percent
of medicine as it is actually practiced is not based on adequate
science. This is not always "bad" but a reflection
that medicine is still an art. We use as much science as we
can, but we should not be under the misimpression that conventional
medicine is all science based. Antibiotics are routinely overused
(for examples, for ear infections and colds). There are millions
of serious adverse reactions to drugs every year, and heart
bypass surgery has been shown by science to be of no benefit
for the vast majority of patients, and (as reported in June
in the New England Journal!) is often recommended for "non-medical
incentives!" Every day we learn that something we are
doing routinely in medicine is either not beneficial or actually
does more harm than good. This is what Dr. Angell calls "scientific"
medicine.
It is curious that the articles relied so heavily on anecdotal
reports to show the supposed dangers of complementary practices,
while antagonists are quick to point out that anecdotal reports
are inadequate to support the value of such therapies. Fortunately,
there is much science behind most dietary supplements and
herbs, and other alternatives to drugs and surgery, and their
safety record is astoundingly good, especially when compared
with prescription medications and surgery.
The public is demanding these treatments (to Dr. Angell's
apparent dismay) because they are dissatisfied with what their
doctors are offering, or cognizant of the real risks associated
with drugs and surgery. Dr. David Eisenberg's alternative
medicine article in the New England Journal of Medicine a
few years ago pointed out that it is the highly educated who
seek out alternative treatments. Maybe they know something
to which we should pay attention.
drjanson@drjanson.com
November
through May: 386-409-7747
June
through October: 603-878-2256
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