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.