A Statement in Defense of Scientific Medicine
from the Council for Scientific Medicine
IN RECENT YEARS A WIDE RANGE OF UNCONVENTIONAL THERAPIES HAS appeared on the public scene. These are offered as “alternative” or “complementary” to mainstream medicine. And they include everything from herbal medicines, homeopathy, and aromatherapy to the use of acupuncture, therapeutic touch, prayer at a distance, faith healing, chelation therapy, and “miraculous” cancer cures.
We, the undersigned, believe that the need for objective, scientific critiques of the claims of “alternative” or nonconventional medicine has never been greater. This conclusion seems inescapable because . . .
- There is a lack of readily available, reliable information about the efficacy of such treatments. This impairs people’s free choice and increases risks to their health. The potential harm is incalculable but appears to be growing. The trend is abetted by those who promote unproven treatments, especially those who are naïve, greedy, or unscrupulous.
- The media all too often dote on controversial and false claims but unfortunately provide few careful, critical examinations of them, usually preferring to titillate, pander, or entertain. Often what the public hears is anecdotal testimony of people allegedly cured, not the results of scientific research. Many best-selling books promote the power of such alleged healings, but they hardly pass the scrutiny of peer review.
- Several new journals devoted exclusively to “alternative” medicine have appeared recently, but they merely advocate unconventional treatments and rarely assess them objectively.
- Both the public and some medical professionals seem unaware that credible, scientific assessments of many “alternative” medicine claims already exist—and that new evaluations based on available information are possible.
- There is a critical need to test new claims before they are marketed to the public.
We therefore welcome the founding of the Scientific Review of Alternative Medicine—the first peer-reviewed journal dedicated entirely to the scientific, rational evaluations of unconventional health claims.
Its purpose is to apply the best tools of science and reason to determine the validity of hypotheses and the effectiveness of treatments. It will dismiss no claim a priori, but consider it on its merits. It will reject no claim because it fits, or fails to fit, some paradigm. It will, using scientific methods and reasonable criteria, seek justified answers to two questions: “Is it true?” and “Does this treatment work?” It will call for double-blind controlled trials of “alternative” therapies.
We believe that the launching of the Scientific Review of Alternative Medicine is now imperative. We therefore call for physicians, scientists, health practitioners, and citizens everywhere to join us in supporting this important venture to advance scientific medicine and to expand the benefits of people’s free and informed choice.
Why a New Alternative Medicine Journal?
Wallace Sampson, MD, Editor
SEVERAL NEW ENGLISH-LANGUAGE "ALTERNATIVE MEDICINE" JOURNALS HAVE recently appeared; they include three American and one British. They were organized for the publication of articles on "alternative and/or complementary" medicine (ACM). Several others have been in publication for years. At least one of the new journals claims that its articles are peer-reviewed.
Why were they formed? For the most part, medical editors do not look favorably on articles and theories that are outside the borders of science and objective reality. Articles supportive of acupuncture, chiropractic, and homeopathy often do not fulfill criteria for good science.
Usual publication criteria are simple in principle but difficult to carry out, as any researcher can testify. The work should be done openly, with colleagues, observers, and commentators having access to all notes and data. Breaks in protocol must be recorded. Patients should be randomized and stratified, and blinding should be appropriate to the experiment. Data collection should be standard. Human experimentation must have the subjects' informed consent with approval by a human-subjects committee or institutional review board. The data should be analyzed by standard statistical techniques and presented in an understandable manner. Conclusions must be derived accurately from the data analysis. Finally, the more revolutionary or unusual the outcome, the more stringent the reviews and the critiques should be.
Few alternative medicine articles are found in standard medical journals because they have not met these criteria. Anomalous methods have not been accepted in the realm of scientific medicine. The new alternative journals now provide a forum and a resource for such articles. Disaffected commentators can now find their articles published after tying their imaginations to long tethers and following trails of thought less encumbered by brambles of rigorous methodology. (Proponents of ACM have also often bypassed science and have gained legitimacy through legislative action.)
FOR LACK OF A JOURNAL
So we find a need for a journal devoted to the rational analysis of those articles and of the "alternative" system. The arrival of the alternative movement requires it. Proponents are calling for a different set of evaluation techniques to include, or even be defined by, patient satisfaction. This journal will be devoted to the standard rational analysis of the claims.
The perception of alternative medicine's increased popularity, whether factual or not, has led to a flurry of press reports, books, television programs, and talk shows. Feelings pro and con run high. Reporters and producers have told me that the media regard critical analysis as dry and old hat. Unfortunately for science, the media's bias is often to favor what's new and to present the "establishment" in a negative light. At the same time, concerned people and their concerned relatives often find a dearth of solid information on anomalous medical methods. Most books and articles are written by or about supporters and practitioners of the methods. Two days before writing this, I was called by a woman who was concerned about a relative living who claimed to have multiple chemical sensitivities (MCS). He had bought and sold three cars in a short period of time because he felt he was allergic to something in each car, could not hold a job, and seemed depressed yet would not admit to it. The woman had kept a Boston Globe article on MCS from the previous year that quoted me as stating that most MCS was a form of somatization—a form of reaction to depression. (I was actually quoting others.) She called after her searches through public libraries came up with nothing other than comments supportive of the existence of multiple chemical sensitivities. Although there have been good articles on the subject showing its relationship to depression and somatiform illness, her only reference was the Globe article.
We know where reliable information on ACM is. It is published sporadically in regular medical journals such as the Journal of the American Medical Association (Laetrile, Burton clinic, Burzynski antineoplastons, coffee enemas), the New England Journal of Medicine (manipulative therapy, candidiasis, anomalous cancer methods), the Canadian Medical Association Journal and Archives of Internal Medicine (sornatiform illness), and Annals of Surgery (chelation therapy). But these articles are sporadic and not easily found.
(The information is also published in organs of the Committee for the Scientific Investigation of Claims of the Paranormal, the National Council Against Health Fraud, and the American Council on Science and Health. These include, respectively, Skeptical Inquirer, NCAHF Newsletter, and Priorities. Other newsletters that have reported accurately on controversial issues include David Zimmerman's Probe, Healthline, and Nutrition Forum, and Paul Goldberg's Cancer Letter. All these publications have relatively limited circulation.)
The point is that there has been no truly scientific, peer-reviewed journal specializing in ACM.
WHAT THE REVIEW OFFERS
The Scientific Review of Alternative Medicine will contain four categories of articles. Most common will be review articles of various anomalous ACM subjects, methods, and books. (These articles will be grouped under the headings of “Analysis” and “Book Reviews.”)
Second will be original trials attempting to validate or to challenge published trials or unsubstantiated claims (grouped under "Research"). These works will probably be few at first, but we hope to publish more as the field becomes more popular and as funding for such projects increases. (We would, for example, pub¬lish work funded by the Office of Alternative Medicine.) We intend to publish works with controversial results and to provide relevant critiques.
Third will be critical reviews of specific articles published elsewhere (also grouped under "Analysis"). Such critiques have in the past been usually relegated to letters columns. The reviews here will be in-depth analyses, comparing the claims to present knowledge from valid science.
Fourth will be invited essays by scientists and commentators from other fields ("Commentary"). Principles for critical analysis can be derived from other fields, especially psychology and physics. By publishing essays that explain more general scientific laws and lines of thought, we hope to encourage readers to apply those principles directly in their own clinical research and thinking.
The intended audience of the Scientific Review of Alternative Medicine will be physicians, scientists, other educated adults, and inquiring students. Some background in biochemistry, physics, or general medicine will be helpful in understanding some articles. But the editors intend that the articles be approachable. Technical information and explanations will be expanded wherever possible.
The Review will bring into one journal a collection of reference articles containing material that represents valid criticism in medicine and other health sciences. It will, we believe, help fill the gap in scientific information in a field that could-for better or worse-have an enormous impact on the practice of medicine and people's lives.