Newsweek's Misleading Report
on "Alternative Medicine"
William M. London, Ed.D., M.P.H.
In its December 2, 2002 issue, Newsweek published an ill-conceived special report on "The Science of Alternative Medicine." In his "Editor's Desk" column, Mark Whitaker wrote: "We're proud to be working with Harvard Health Publications and its editor in chief, Dr. Anthony Komaroff, to bring you the best wisdom that our team of veteran health journalists and Harvard's experts have to offer." Unfortunately, the best wisdom they offer is packaged with propaganda promoting false notions about so-called complementary and alternative medicine (sCAM). Here are some of the problems with Newsweek's reporting.
- The notion of "the science of alternative medicine" falsely implies that a meaningful category of healthcare called "alternative medicine" exists and is scientifically based. But in common usage, the term "alternative medicine" is a euphemism used by enthusiasts and profiteers to give the appearance of legitimacy to methods promoted with scientifically implausible, invalidated, or nonvalidated claims.
- An introduction to the report includes the false generalization that "'complementary' and 'alternative' therapies haven't been the subject of rigorous scientific testing-until now." However, many methods that have been promoted as being "complementary" and "alternative" have been tested rigorously and not been shown to add to health outcomes when combined with proven methods or substitute for proven methods. For example, in rigorous tests, megavitamin C and laetrile have failed as cancer treatments.
- Geoffrey Cowley, one of Newsweek's reporters, refers to acupuncture as credible. But reviews of clinical studies of acupuncture do not support claims that acupuncture is effective for a wide variety of conditions. Beneficial effects have been reported for some types of acupuncture in treating symptoms such as pain and nausea. However, these effects may result from distraction, expectation, suggestion, conditioning, and characteristics of the client-practitioner relationship rather than anything special about acupuncture. Acupuncture has not been proven to alter the course of any disease.
- Cowley refers to chiropractic as credible. But chiropractic has nonsensical central tenets about how the nervous system affects health, and has conflicting factions offering various dubious technique systems. Since 1895, when chiropractic was dreamt up by self-described grocer and "magnetic healer" D.D. Palmer, chiropractors have made no significant scientific contribution to healthcare and many of them have tried to undermine consumers' confidence in rational healthcare and public-health protections.
- Cowley notes: "So after dismissing CAM therapies as quackery for the better part of a century, the medical establishment now finds itself racing to evaluate them." The term "medical establishment" is an abstraction. Use of the term in this context makes an overgeneralization about interest in evaluating sCAM therapies. Many physicians and scientists do recognize that the promotion of nonvalidated or invalidated sCAM treatments for financial gain is quackery. They would prefer research dollars to be allocated according to scientific promise rather than political agendas. Although many hospitals and research institutions are carrying out research on sCAM treatments, much of this has to do with the money trail. Large amounts of funding became available when legislation spearheaded by nostrum enthusiast Senator Tom Harkin (D-Iowa) forced the National Instutute's of Health to create an Office of Unconventional Medicine, which evolved into the National Center for Complementary and Alternative Medicine (NCCAM). However, after spending more than $110 million on research, NCCAM has issued no recommendations for or against the use of any sCAM treatment.
- Cowley cites the survey data published by Eisenberg and colleagues in 1993 as showing that 34% of U.S. adults had received at least one "unconventional" therapy in 1990. But critics note that the percentage was greatly inflated because the survey included use of self-help groups, exercise, prayer, and other activities that should not be considered "CAM."  Publicity about the study raised interest by consumers in dubious herbal and other sCAM products (as reflected in a 1997 follow-up survey), which in turn was used to justify the NCCAM boondoggle.
- Cowley quotes NCCAM head Dr. Stephen Straus: "We want to test therapies that have a plausible basis and address some unmet need." Cowley fails to point out that many of the studies funded so far do not have a plausible basis. The biggest of these is a $30 million NCCAM/NHLBI allocation to support a trial of chelation therapy for heart disease. Chelation's avid following and the study are mentioned in a Newsweek sidebar without mentioning chelation's implausibility  for this purpose.
- Cowley suggests that nation's insurers are biased against "holistic" care. But the real "bias" of nation's insurers is against losing money. Unfortunately, some insurers offer of dubious treatments that they think will attract subscribers. Many plans charge an extra fee or merely enable subscribers to obtain discounts from designated practitioners. And Cowley fails to recognize that good doctors have always considered patients as whole beings and that "holistic" is a dangerous banner under which practitioners of nonscientific methods rally.
- Another reporter, Anne Underwood, wrote about traditional Chinese medicine (TCM) practitioner Nan Lu examining her tongue and "pulses"—one for each organ of her body—to diagnose "energy leak" from her heart and then recommend acupuncture, qigong (described misleadingly as Chinese yoga), meditation, dietary modifications, and herbal remedies containing green orange peel, sour-date seed and licorice root along with dozens of exotic ingredients. She describes Lu's activities as sounding unscientific to "the Western mind." She fails to acknowledge that Lu's activities also sound unscientific to real scientists in Asia. TCM tongue and pulse examination lack validity and a rational basis for making diagnoses and recommending treatments. The diagnosis of "energy leak" in TCM is subjective and has no scientific basis. Modern physics recognizes energy as a material entity, as signified by Einstein's famous equation E=mc2, and explained by quantum theory. Energy is not an immaterial spirit as suggested by promoters of TCM and many other sCAM practices.
- Underwood suggests that acupuncture relieves pain by boosting the body's own opiates called endorphins. But some studies have shown that blocking endorphin receptors using an opiate antagonist does not reverse pain relief following acupuncture. Besides, it is not necessary to apply needles to specific points, as in acupuncture, to release endorphins. The release can be stimulated without needles.
- Underwood cites one study presented at a conference in China suggesting that acupuncture with low-level electrical stimulation can reduce drug cravings and the relapse rate among heroin addicts. But she does not mention that reviews of studies of acupuncture treatment for addiction have not supported claims that acupuncture improves addiction treatment outcomes. And running electrical current through tissues isn't "acupuncture."
- Underwood claims that "Chinese medications tend to have fewer side effects than Western pharmaceuticals" and that "Western medicine is riskier." She provides an unsound argument for this generalization. She writes that a 1996 survey of the most populous Australian states found one adverse event from both herbs and acupuncture for every eight to nine months of a doctor's full-time practice, or one problem per 633 consultations. She compares this survey data with the results of a study published in JAMA in 1998 that used a totally different methodology: a meta-analysis of prospective studies. The authors of the 1998 paper estimated (not "found" as Underwood writes) that more than 100,000 drug reactions occurred among patients in U.S. hospitals in a single year. It is not reasonable to draw conclusions about the relative risks of all prescription drug treatments versus all herbal treatments by comparing adverse event data from hospitalized patients (who are often in weakened and uncertain conditions) with data on patients who visit doctors. The authors of the meta-analysis caution that their "results must be viewed with circumspection because of heterogeneity among studies [in their analyses] and small biases in the samples." Underwood's comparison is also faulty because it only considers adverse events following treatments and not benefits offered by the treatments. She does not consider what widespread adulteration of Chinese herbal treatments with synthetic drugs indicates about what developers of these products think their herbs have to offer in terms of benefits. (Other potential adulterants and contaminants of herbal products include botanicals, microorganisms, microbial toxins, pesticides, fumigation agents, and toxic metals.) And, as reported in the journal Science, "According to a 1999 survey by the Hong Kong government, only 22% of outpatient medical consultations in the city were provided by Chinese medicine practitioners. Officials think the percentage is even lower, and they believe that safety concerns are driving people away from TCM."  Herbal products are prone to misbranding because of difficulties in correctly identifying plant species, chemical variations within plant species, lack of standardization, additions of chemicals, and intentional substitution of one plant for another. Some traditional Chinese herbs have been found to contain aristolochic acid which has been linked to kidney destruction and urinary tract cancers. In June 2002, Health Canada warned consumers not to take seven products marketed as traditional Chinese Medicines because they were found to contain undeclared prescription drugs. In January 2003, the Director-General of Health for New Zealand warned consumers to stop taking eleven traditional Chinese medicines sold as herbal remedies after investigation and testing revealed they contain prescription medicines and toxic substances.
- Underwood discusses the increasing demand of Westerners for Chinese medicine services without mentioning the increasing demand of people in China for modern medicine . Underwood offers a testimonial about a research scientist who said she had "serious dizzy spells" after suffering from West Nile virus. The scientist said treatment from "Western specialists" did not make her spells go away, but her dizziness, allergies, and chronic shoulder problem were "gone" after an acupuncturist diagnosed "stagnant liver qi" and administered acupuncture and herbal remedies. Underwood quotes the scientist as saying: "This doesn't make sense, but there's something there." Underwood concludes: "If Chinese medicine can help complications of West Nile virus, can it work for insomnia? The jury is out, but I'm optimistic." Underwood's unjustified conclusion about Chinese medicine and her failure to explain to readers why testimonials are unreliable as evidence of a treatment's efficacy is egregious journalism.
- In her brief article about Ginkgo biloba-based treatments, Mary Carmichael suggests correctly that the verdict isn't in yet regarding whether it works to sustain memory abilities into old age. She also points out that "mental exercise is still the best way to stay sharp." But then she recommends: "So try a supplement, but remember: memorizing the names of all those chemicals [mixed with Ginkgo biloba in commercial formulas] may fortify your brain more than the chemicals themselves." It is imprudent for consumers to spend money on products of unknown benefit, but Carmichael encourages them to gamble on ginkgo anyway. Her advice defies the ethical principle of nonmaleficence, i.e., first, do no harm. She fails to mention that ginkgo taken orally occasionally causes headache, nausea, gastric symptoms, diarrhea, or allergic skin reactions and may be associated with seizures, cerebral hemorrhages, and other adverse reactions . Her article included no mention of ConsumerLab.com's finding that nearly one quarter of thirty brands of Ginkgo biloba extract products tested did not appear to contain what the label promised.
- David Noonan's article on various methods promoted as "complementary and alternative medicine" or "CAM" for children mentions a three-year NIH-funded study of acupuncture treatment of cerebral palsy in which some patients showed improvements in some areas of functioning and others did not. Although Noonan provides no description of the study design, including whether the study included a control group, he describes the investigator, Burris Duncan, as "a member of a small but growing cadre of researchers who are subjecting pediatric CAM therapies to the rigors of traditional, randomized, controlled clinical trials." Rigorous studies should give clear answers, but Noonan quotes Duncan as saying: "[The subjects] all changed in different ways so it's very difficult to know what to make of this." Noonan raises additional questions about the rigor of Duncan's work by writing: "Determined not to raise false hopes, Duncan says the only thing he knows for certain is that more research is needed, and he plans to continue his work." Noonan also mentions that Duncan conducted the study because he was impressed with what he observed in China of acupuncture and other treatments of cerebral palsy. Although Noonan's article includes Duncan's subjective impressions, it does not address the superstitious basis for acupuncture treatment, the implausibility of acupuncture having special benefits for children with cerebral palsy, and the importance of focusing scientific resources on testing plausible rather than implausible treatments.
- Noonan is mistaken when he describes studies underway to determine the effectiveness of treatments as osteopathic manipulation in preventing ear infections as "serious science." It's implausible that osteopathic manipulation prevents ear infections. NIH's funding of implausible treatments reflects serious politics, not serious science.
- Noonan's placement of the word "But" in the following passage misleads readers by making an anecdote seem more informative than the evidence from well-designed studies: "While some research suggests an association between dairy and wheezing in children, more studies are needed. But the regimen worked for Grant Janz, who has now gone more than two months without wheezing." Of course, if Grant stopped wheezing for two months, it does not mean that his regimen [of no dairy] "worked."
- A sidebar to Noonan's article recommends the book Healthy Child, Whole Child by Stuart Ditchek, MD, Russell Greenfield, MD, and Lynn Murray Willeford. The authors are all disciples of "integrative medicine" guru Andrew Weil, MD, who wrote the book's foreword. As Weil has done previously, the authors mischaracterize regular medicine as "conventional" or "allopathic" and then suggest that (a) its "don't just stand there, do something attitude" makes it excellent for medical and surgical emergencies; (b) it may be less useful for chronic conditions and (c) it may be unnecessarily aggressive in situations where time or a more gentle approach may be equally effective. [p. 5] It doesn't appear that the authors actually believe in this characterization of medicine; otherwise, why would they prudently recommend childhood vaccinations? And, apparently, the authors themselves have that "don't just stand there, do something attitude," especially in treating self-limited conditions. They write: "In most cases, the therapies we recommend have at least some supportive research evidence and always have anecdotal evidence of efficacy." But it's easy to come up with cheery anecdotes for just about any nostrum. And it's easy to meet the lenient standard of "at least some supportive research evidence" by citing poorly designed, mostly irrelevant, or anomalous research studies providing far less than extraordinary evidence for extraordinary hypotheses. A molehill of supportive evidence would meet the authors' standard even when a mountain of conflicting scientific evidence and knowledge is available. Based on preliminary findings and/or anecdotes, the authors are quick to jump to conclusions that treatments work: "If a potentially effective therapy is safe and relatively inexpensive, we don't feel a need to wait for further research to explain how it works—it's enough for us to know that it works." [p. 167]. Thus, they recommend various dubious treatments including: (a) cranial osteopathy for ear infections, headaches, sinus or respiratory problems, learning disabilities, and attention deficit disorder; (b) homeopathic products to treat sore throats, colds, and other self-limiting conditions; and (c) acupuncture for acute sinusitis. The title of their chapter on traditional Chinese medicine is an example of the "everybody says so" fallacy: "A Billion People Can't Be Wrong." If a billion people rely on anecdotes to conclude that a treatment has therapeutic value, then they can be just as wrong as Ditchek, Greenfield, and Willeford. Regarding so-called "energy medicine" methods, they write: "We have seen promising anecdotal or research evidence for some of them and others are simply too wacky for us to consider." [p. 250] Among the "energy medicine" methods that are not too wacky for them to consider are "therapeutic touch" and "external qi gong." The authors fail to mention published critiques of these methods. The closest the authors come to addressing the irrationality of "energy medicine" is: "We're on somewhat shaky ground scientifically when we talk about energy medicine because we are talking about subtle energies that cannot be measured by currently available scientific instruments." [p. 248-249] But even this statement is misleading. The qualifiers "somewhat" and "currently available" don't belong in the sentence. And it's simply wrong to describe imaginary energies as "subtle."
- The sidebar includes Ditchek and Greenfield's recommendation to give echinacea along with vitamin C to children with colds. It is true that Echinacea purpurea extracts have been demonstrated to have significant immune system actions. However, it is not clear that taking such extracts provides relief for people with colds . And retail echinacea products are often misbranded . Vitamin C supplementation has been found to reduce the severity and duration of colds slightly, at best. Spending on such remedies reflects the "don't just stand there, do something attitude" that Ditchek and Greenfield criticize.
- Another book the sidebar recommends is The Holistic Pediatrician by Kathi J. Kemper, MD, MPH. Kemper's book is, for the most part, a useful resource for parents. The vast majority of healthcare methods recommended in the book are rational and fit right in the medical mainstream. The book also provides prudent warnings to consumers about herbal products available to consumers in the United States. And Kemper does not rely on anecdotes as evidence. The main problem with the book is that Kemper embraces studies finding various "CAM" treatments as effective without considering whether the results make sense, are clinically significant, or are attributable to research design problems. For example, she cites a paper by Jennifer Jacobs and her colleagues in support of her suggestion to consider seeing a homeopathic practitioner to administer homeopathic remedies (which probably contain none of the supposedly active ingredients) for childhood diarrhea. But, as pointed out in a published critique, the study showed no clinically significant benefits of homeopathic treatment, no benefits were demonstrated for most measured outcome variables, different homeopathic products were used on different subjects, and the subjects did not have diarrhea severe enough for treatment, rather than monitoring, to be indicated. Based on similarly shaky evidence, Kemper, suggests trying: (a) "therapeutic touch" for burns or fever; (b) visiting a TCM practitioner who can recommend an herbal tea for eczema treatment; (c) homeopathic remedies containing "pulsatilla" to treat ear infections (followed, if the infections don't clear up in 24 hours, by seeing a physician); and (d) acupuncture treatment for allergies, asthma, bedwetting, headache prevention, and nausea/vomiting. According to a description of Kemper in the second edition of the book, she was recruited in 1998 by Harvard Medical School to become the first director of the Center for Holistic Pediatric Education and Research. In his foreword to the second edition of Kemper's book, her colleague Herbert Benson, MD, President of the Mind-Body Medical Institute wrote: "On the other hand, hucksterism and quackery are alive and well. Con men manipulate millions via mass media and the Internet; and it takes a physician experienced in both traditional and alternative medicine to keep perspective in the face of sales tactics appealing to nature, forgotten mysteries, and forbidden fruits." [p. xi] Benson is mistaken. "Alternative medicine" is a mere marketing label promoted as if it were a medical speciality. Consumers need the perspectives of experts in healthy skepticism.
- In a mostly balanced and reasonable accompanying article about the placebo effect, Harvard Medical School faculty members Ted Kaptchuk, David Eisenberg, and Anthony Komaroff seem to falsely imply that skeptics have little reason to doubt therapeutic claims made for methods promoted as CAM. After describing the placebo effect as "the healing that occurs not because of a particular drug or treatment but because of the expectations, beliefs or hopes embedded in the encounter between a patient and a clinician," they state: "Skeptics often dismiss responses to complementary and alternative therapies as 'mere' placebo effects. And, until recently, experts have paid the placebo effect only grudging respect, some insisting that people who experience it must have simply misperceived either their illness or their recovery." However, careful skeptics do not quickly turn to the placebo effect as an explanation for apparent positive changes following so-called complementary and alternative medicine (sCAM) treatment. And they don't jump to the conclusion that such changes are "responses" to sCAM. Moreover, unlike Kaptchuk and his colleagues, they recognize that it is reasonable to not minimize either the plausibility or prevalence of patients misperceiving their health status. People who recover from serious illnesses after using sCAM methods in combination with science-based methods often jump to the conclusion that the seemingly more exotic and passionately promoted sCAM methods deserve most of the credit. Patients and caregivers misperceive illnesses and recovery due to a variety of other factors including misdiagnoses, unduly pessimistic prognoses, failure to recognize variations in the natural course of diseases, psychological needs, and the presence of euphoria-inducing chemicals in some sCAM treatments. Unlike many sCAM practitioners, skeptics also appreciate how easy it is to misperceive potentially dangerous treatments as safe, particularly when effects develop over time, occur infrequently, or might be confused with complications of disease. As noted in a recent review article: "If an herb caused an adverse reaction in 1 in 1000 users, a traditional healer would have to treat 4800 patients with that herb (i.e., 1 new patient every single working day for more than 18 years) to have a 95 percent chance of observing the reaction in more than 1 user." 
The word "alternative" may suggest "adequacy for some purpose" and/or "compulsion to choose."  But irrational and dubious methods are not adequate for their intended purpose, and consumers should not feel compelled to choose them. Instead of attempting a special report on "The Science of Alternative Medicine," Newsweek should have served its readers well by providing an exposé of "Pseudoscience Promoted as Alternative Medicine." As Drs. Marcia Angell and Jerome Kassirer noted in a 1998 editorial in The New England Journal of Medicine: "There cannot be two kinds of medicine—conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work." 
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Dr. London, a former president of the National Council Against Health Fraud, is associate professor and chair of the Department of General Studies in the College of Science and Health of Charles R. Drew University of Medicine and Science in Los Angeles, California. This article was modified from a 2-part series in the Council's newsletter.
This page was revised on October 17, 2006.