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Evaluating Complementary and Alternative Medicine: The Limits of Science and of Scientists

Published online by Cambridge University Press:  01 January 2021

David J. Hufford
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Extract

Science provides the most important set of tools for the evaluation of complementary and alternative medicine (CAM). Nonetheless, there are important limits in science that constrain its ability to evaluate CAM effectively. Some are the limits encountered by science in conventional medical research. Others are peculiar to this controversial topic. The most important limits are not those inherent within the basic methods of science, but rather within the culture of science — the particular ways that scientific knowledge, theory, and method are configured and arrayed rhetorically, and in the social context in which science operates. It is the limitations of scientists as a group of human beings more than science as a set of methods that hamper scientific evaluation of CAM.

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Article
Information
Journal of Law, Medicine & Ethics , Volume 31 , Issue 2 , Summer 2003 , pp. 198 - 212
Copyright
Copyright © American Society of Law, Medicine and Ethics 2003

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References

Hufford, D.J., The Limits of Science in Medicine, presentation at Alternative Medical Systems: Here to Stay, But on What Terms?, Ninth Annual Thomas A. Pitts Memorial Lectureship, Medical University of South Carolina, Charleston, September 13, 2002.Google Scholar
Costello, R.B., ed., American Heritage Dictionary of the English Language, 3rd ed. (Boston: Houghton Mifflin Co., 1997): At 1221.Google Scholar
Schneiderman, L.J., Alternative Medicine or Alternatives to Medicine, presentation at Alternative Medical Systems: Here to Stay, But on What Terms?, Ninth Annual Thomas A. Pins Memorial Lectureship, Medical University of South Carolina, Charleston, September 13, 2002.Google Scholar
Hufford, D.J., “Complementary & Alternative Medicine and Cultural Diversity: Ethics And Epistemology Converge,” in Callahan, D., ed., The Role of Complementary and Alternative Medicine: Accommodating Pluralism (Washington, D.C.: Georgetown University Press, 2002): 15–35, at 24 (quoting Arnold Relman).Google Scholar
Schneiderman, L.J., “Alternative Medicine or Alternatives to Medicine? A Physician's Perspective,” Cambridge Quarterly of Healthcare Ethics, 9 (2000): 83–97.CrossRefGoogle Scholar
Schneiderman, L.J., “Medical Ethics and Alternative Medicine,” Scientific Review of Alternative Medicine, 2, no. 1 (1998): 63–66.Google Scholar
See Schneiderman, , supra note 5, at 95.Google Scholar
See id. at 87.Google Scholar
Fontanarosa, P.B. and Lundberg, G.D., “Alternative Medicine Meets Science,” JAMA, 280 (1998): 1618–19, at 1618.CrossRefGoogle Scholar
Eisenberg, D.M. et al., “Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use,” N. Engl. J. Med., 328, no. 4 (1993): 246–52; Eisenberg, D.M. et al., “Trends in Alternative Medicine Use in the United States, 1990–1997: Results of a Follow-Up National Survey,” JAMA, 280, no. 18 (1998): 1569–75.CrossRefGoogle Scholar
O'Connor, B. et al. (Panel on Definition and Description, CAM Research Conference, April 1995), “Defining and Describing Complementary and Alternative Medicine,” Alternative Therapies, 3, no. 2 (1997): 49–57.Google Scholar
Mowrey, D.B. and Clayson, D.E., “Motion Sickness, Ginger, and Psychophysics,” Lancet, 1, no. 8273 (1982): 655–57.CrossRefGoogle Scholar
Chibnall, J.T., Jeral, J.M. and Cerullo, M.A., “Experiments in Distant Intercessory Prayer: God, Science, and the Lesson of Massah” Archives of Internal Medicine, 161, no. 21 (2001): 2529–36.CrossRefGoogle Scholar
Kuhn, T., The Structure of Scientific Revolutions, 2nd ed. (Chicago: University of Chicago Press, 1970).Google Scholar
Id. at 66–91.Google Scholar
Schneiderman, , supra note 5, at 85.Google Scholar
Id.Google Scholar
See Hufford, supra note 4.Google Scholar
Berthold, H.K., Sudhop, T., and von Bergman, K., “Effect of a Garlic Oil Preparation on Serum Lipoproteins and Cholesterol Metabolism: A Randomized Controlled Trial,” JAMA, 279, no. 23 (1998): 1900–02.CrossRefGoogle Scholar
Curtius, M., “Touting Garlic's Glories. Despite Study, Gilroy's Devotion to Aromatic Crop Is Unshaken,” Los Angeles Times, June 21, 1998, at A3.Google Scholar
The authors concluded that “there is no evidence to recommend garlic therapy for lowering serum lipid levels.” Berthold, Sudhop, and von Bergman, supra note 19, at 1902.Google Scholar
In Berthold and colleagues' response to a critical letter in the next issue of JAMA, they state, “Even though the conclusions of our study apply only to the preparation we used, we believe that convincing evidence of lipid-lowering effects of any garlic preparation is still lacking.” Lawson, L. D., “Effect of Garlic on Serum Lipids” (with reply from Berthold, Sudhop, and von Bergman), JAMA, 280, no. 18 (1998): 1568. Although in the reply by Berthold, Sudhop, and von Bergman they offer brief comments regarding other studies that they feel support their conclusion, and offer a reason for having selected the remedy they used in their study, the fact remains that in their conclusion to their published paper they stated their broad conclusion regarding garlic and serum lipids as if the statement were a reasonable inference from their study. Further, they do not note the steam distillation as a possibly controversial element.CrossRefGoogle Scholar
Schneiderman, , supra note 5, at 85.Google Scholar
Id.Google Scholar
Linde, K. et al., “Are the Clinical Effects of Homeopathy Placebo Effects? A Meta-Analysis of Placebo-Controlled Trials,” Lancet, 350 (1997): 834–43.CrossRefGoogle Scholar
Kleijnen, J., Knipschild, P., and ter Riet, G., “Clinical Trials of Homeopathy,” British Medical Journal, 302 (1991): 316–23.CrossRefGoogle Scholar
Beyerstein, B.L. and Downie, S., “Naturopathy,” Scientific Review of Alternative Medicine, 2, no. 1 (1998): 20–28.Google Scholar
Id. at 24.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id. at n.20, n.25, and n.27.Google Scholar
Vickers, A.J. et al., “Can Acupuncture Have Specific Effects on Health? A Systematic Review of Acupuncture Anti-Emesis Trials,” Journal of the Royal Society of Medicine, 89 (1996): 303–11.CrossRefGoogle Scholar
Id. at 303.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id. at 310.Google Scholar
ter Riet, G., Kleijnen, J., and Knipschild, P., “Acupuncture and Chronic Pain: A Criteria-Based Meta-Analysis,” Journal of Clinical Epidemiology, 43 (1990): 1191–99.CrossRefGoogle Scholar
“NIH Consensus Conference: Acupuncture,” JAMA, 280 (1998): 1518–24.Google Scholar
Rosa, L. et al., “A Close Look at Therapeutic Touch,” JAMA, 279 (1998): 1005–10.CrossRefGoogle Scholar
Turner, J.G., The Effect of Therapeutic Touch on Pain & Anxiety in Bum Patients, grant no. 94020 final report, Tri-Service Nursing Research Program (November 14, 1996), cited in Rosa, et al., supra note 39, at 1007.Google Scholar
Id.Google Scholar
Lorenzo's Oil, produced by Universal City Studios, directed by George Miller, 135 min. (1992), film.Google Scholar
Schneiderman, , supra note 5, at 89.Google Scholar
Rubin, R., “Lorenzo's Oil Brings Hope for the Afflicted: New Findings Support Unorthodox Treatment of Rare Brain Disorder,” USA Today, October 22, 2002, at 1A, 2A.Google Scholar
Id. (quoting Dr. Hugo W. Moser).Google Scholar
Moser, H.W., “Suspended Judgment: Reactions to the Motion Picture ‘Lorenzo's Oil,’” Controlled Clinical Trials, 15 (1994): 161–64.Google Scholar
Id. at 162.Google Scholar
Id. at 163.Google Scholar
Id. at 161.Google Scholar
Moser, H.W., Letter to the Editor, “Lorenzo's Oil and Thrombocytopenia in Patients with Adrenoleukodystrophy,” N. Engl. J. Med., 328, no. 15 (1993): 1126–27.Google Scholar
Id. at 1126.Google Scholar
Schneiderman, , supra note 5, at 92.Google Scholar
Kauffman, J.M., “Alternative Medicine: Watching the Watchdogs at Quackwatch,” Journal of Scientific Exploration, 16 (2002): 312–37.Google Scholar
Id. at 312.Google Scholar
Id. at 321.Google Scholar
Id.Google Scholar
Id.Google Scholar
See, e.g., Chappell, L. T. and Janson, M., “EDTA Chelation Therapy in the Treatment of Vascular Disease,” Journal of Cardiovascular Nursing, 10 (1996): 78–86; Douglas, W.C. Jr., “Chelation Therapy—Better Than Ever!,” Second Opinion, suppl. (March 1995): 1–4, and references therein.CrossRefGoogle Scholar
Sampson, W., “On the National Institute of Drug Abuse Consensus Conference on Acupuncture,” Scientific Review of Alternative Medicine, 2, no. 1 (1998): 54–55.Google Scholar
Moertel, C.G. et al., “A Pharmacologic and Toxicological Study of Amygdalin,” JAMA, 245 (1981): 591–94.CrossRefGoogle Scholar
Schneiderman, , supra note 5, at 91.Google Scholar
Id.Google Scholar
Id.Google Scholar
See Sampson, , supra note 59, at 54–55.Google Scholar
Feyerabend, P., Against Method, rev. ed. (London: Verso, 1988): At 23–24.Google Scholar
Herdman, R.C. et al., Unconventional Cancer Treatments, OTA-H-405 (Washington, D.C.: U.S. Government Printing Office, 1990).Google Scholar
Schneiderman, , supra note 5.Google Scholar
Complementary and Alternative Therapies in the Academic Medical Center, a conference sponsored by the University of Pennsylvania School of Medicine, Philadelphia, November 9–12, 1999.Google Scholar
See Linde, et al., supra note 25.Google Scholar
Murphy, E.A., Skepsis, Dogma, and Belief: Uses and Abuses in Medicine (Baltimore: Johns Hopkins University Press, 1981).Google Scholar
Id. at 157.Google Scholar
Davenas, E. et al., “Human Basophil Degranulation Triggered by Very Dilute Antiserum Against IgE,” Nature, 333 (1988): 816–18.Google Scholar
Maddox, J. et al., “‘High Dilution’ Experiments a Delusion,” Nature, 334 (1988): 287–90.CrossRefGoogle Scholar
Whorton, J.C., “Patient Heal Thyself: Popular Health Reform Movements as Unorthodox Medicine,” in Gevitz, N., ed., Other Healers: Unorthodox Medicine in America (Baltimore: Johns Hopkins University Press, 1988): 52–81, at 60.Google Scholar
Id. at 69.Google Scholar
Burkitt, D.R., Walker, A.R.P., Painter, N. S., “Effect of Dietary Fibre on Stools and Transit-Times, and Its Role in the Causation of Disease,” Lancet, 2 (1972): 1408–12.CrossRefGoogle Scholar
Salmeron, J. et al., “Dietary Fiber, Glycemic Load, and Risk of NIDDM in Women,” JAMA, 277 (1997): 472–77.CrossRefGoogle Scholar
Avorn, J. et al., “Reduction of Bacteriuria and Pyuria After Ingestion of Cranberry Juice,” JAMA, 271 (1994): 751–54.CrossRefGoogle Scholar
Howell, A.B. and Foxman, B., “Cranberry Juice and Adhesion of Antibiotic-Resistant Uropathogens,” JAMA, 287 (2002): 3082–83.Google Scholar
Beers, M.H. and Berkow, R., eds., Merck Manual of Diagnosis and Therapy, (Whitehouse Station, New Jersey: Merck Research Laboratories, 1999): At 1888.Google Scholar
Hilton, E. et al., “Ingestion of Yogurt Containing Lactobacillus acidophilus as Prophylaxis for Candidal Vaginitis,” Annals of Internal Medicine, 116 (1992): 353–57.CrossRefGoogle Scholar
Freed, G. et al., “National Assessment of Physicians' Breastfeeding Knowledge, Attitudes, Training and Experience,” JAMA, 273 (1995): 472–76.CrossRefGoogle Scholar
Id. at 475.Google Scholar
Both of the Eisenberg et al. surveys of CAM use (supra note 10) illustrate this, as do many other surveys. A well-designed poll reported in Newsweek (March 31, 1997) found that 87 percent of Americans believe “that God answers prayers” and that 79 percent of Americans “say God answers prayers for healing someone with an incurable disease.” One can readily obtain a large body of additional survey data supporting this point by visiting Polling the Nations (a subscription database of all sorts of survey data, at <http://www.orspub.com>), and entering “prayer” as the search.),+and+entering+“prayer”+as+the+search.>Google Scholar
Koenig, H.G., McCullough, M.E., and Larson, D.B., Handbook of Religion and Health (Oxford: Oxford University Press, 2001).CrossRefGoogle Scholar
Sloan, R. et al., “Religion, Spirituality & Medicine,” Lancet, 353 (1999): 664–67; Sloan, R. et al., “Should Physicians Prescribe Religious Activities?,” N. Engl. j. Med., 342 (2000): 1913–16.CrossRefGoogle Scholar
Harris, W. et al., “A Randomized, Controlled Trial of the Effects of Remote, Intercessory Prayer on Outcomes in Patients Admitted to the Coronary Care Unit,” Archives of Internal Medicine, 159 (1999): 2273–78; Cha, K.Y., Wirth, D.R., and Lobo, R., “Does Prayer Influence the Success of In Vitro Fertilization-Embryo Transfer? Report of a Masked, Randomized Trial,” Journal of Reproductive Medicine, 46 (2001): 781–87.CrossRefGoogle Scholar
Seldin, D.W., “Presidential Address: The Boundaries of Medicine,” Transactions of the American Association of Physicians, 94 (1981): lxxv-lxxxvi, at lxxxv.Google Scholar