What CAM you do?

Once again, CAM therapies are receiving a nice bashing in the general media. A prominent publication detailing the “failure” of herbal supplements to “cure” arthritis makes for great headlines – but at what cost?

Alternative Remedies Fail Government Tests” roared the AP (via Yahoo! News) on my home page this weekend.

Writer Lindsay Tanner leads with the following:

For years, millions of Americans have spent billions of dollars on alternative remedies with unproven effects. Now, rigorous science is starting to test those treatments and mostly finds them lacking.

This latest in a series of sensationalized attacks on CAM therapies (or rather, on the national funding of CAM therapy research) stems from the publication in the New England Journal of Medicine of the GAIT (Glucosamine/Chondroitin Arthritis Intervention Trial) study. The trial examined the use of glucosamine and chondroitin in the treatment of knee osteoarthritis. Funded by the NCCAM, the NIH’s CAM research arm, the GAIT study is now in a heavy spin cycle as one of several big trials of herbs funded by the US government which have failed – the first of which (on echinacea) I noted previously.

What worries me is not that herbs work or don’t work for arthritis. I’m not sure this study answers that question in any case. What type of arthritis? What type of glucosamine and chondroitin? What dose, what source? Why did a subset of patients benefit above and beyond what was a massive placebo effect (55-60% of those on placebo responded significantly in terms of pain reduction)? What worries me is that many conventional groups and physicians will stop looking. Already, we’ve seen calls to end funding for NCCAM. Yet one of the main findings of both the echinacea and GAIT studies funded by NCAAM is how few harmful effects were noted, especially when compared with conventional medicine therapies (cold medicines and Vioxx, respectively). For those of us who treat children, the analysis of benefit-harm is crucially weighted towards “first do no harm.” Author and lawyer Michael Cohen has published elegant work on the ethical issues in CAM-use decision making. He has created a useful 2×2 table for safety and efficacy decision making which is included in an Annals of Internal Medicine article from 2002. Simply restated, therapies fall somewhere on a safe-unsafe spectrum and on an effective-ineffective spectrum. I encourage you all to read Michael’s work and consider his paradigm in evaluating whether or not to prescribe or use any remedy, CAM or otherwise. It is this even playing ground I seek, nothing more, nothing less.

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