BMJ 2002;324:870 ( 13 April )
Charles Marwick Washington, DC
Complementary medical treatments such as acupuncture, massage, and herbal and nutritional treatments must be evaluated with the same standards of quality, rigour, and ethics as conventional treatments, states the US Commission on Complementary and Alternative Medicine.
"First class scientific research is crucial to helping people—and those who care for them—make the wisest healthcare decisions," said Dr James Gordon, the commission's chairman.
The commission, established two years ago by President Bill Clinton, was charged with making legislative and administrative recommendations to help develop public policies that would maximise the benefits, if any, of complementary medicine. It issued its report at the end of March.
The report notes an emerging dialogue between complementary and conventional medicine and recommends that efforts be made to strengthen it. It calls for integrating complementary practices and products that have been proved to be safe and effective into conventional health care and recommends increased funding for research into these treatments.
The report recommends the creation of a central coordinating office to oversee all activities relating to alternative medicine in the Department of Health and Human Services. Declining to make specific comments, a spokesman for the department said the panel's report "would be considered."
There is some backing for complementary medicine in Congress, which mandated a centre at the National Institutes of Health for supporting studies into such treatments. Senator Tom Harkin, a Democrat from Iowa, is one supporter. Commenting on the commission's report, he said that if its recommendations were implemented they would help people get the best of both traditional and complementary medical practices.
Other recommendations by the commission are directed at the education of practitioners, the dissemination of information on complementary medicine, and reimbursement for proven treatments. A particular concern was the need to inform the public of adverse events associated with complementary products. It cites dietary supplements as one example. In 2000, says the report, $17bn (£12bn; €19bn) was spent by more than 158 million Americans on these agents, yet they are not given the same rigorous testing and control as prescription drugs.
The report was hardly issued before critics attacked it. For example, the National Council Against Health Fraud said it was pointless to spend more money on areas that were unlikely to yield any benefit and that the report failed to distinguish between approaches "for which there is some scientific evidence and those that stretch the realm of logic or are demonstrably unsafe."
Responding, Dr Gordon said that the commission's job was not to evaluate specific treatments. He pointed out that increasing numbers of Americans have begun to look to complementary medicine for their health care. "Our report," he said, "highlights the opportunities for evaluating the ways that are safe and effective."
The report can be accessed at: http://www.whccamp.hhs.gov