Don't Dismiss These Treatments as Placebos

This post is part of our forum on David H. Freedman's July/August story, "The Triumph of New Age Medicine." Follow the debate here.

David Freedman's article "The Triumph of New-Age Medicine" provides a thoughtful commentary on the complexities and controversies surrounding integrative medicine. At the National Center for Complementary and Alternative Medicine, a component of the National Institutes of Health, our mission is to define, through careful scientific research, the usefulness and safety of complementary and alternative medicine interventions.

As Freedman notes, public investment in this research has generated controversy. Critics note - with some justification - safety concerns, excessive claims, and misleading marketing. They also often argue that treatments lack scientific plausibility; that when tested, they lack merit; or that any benefit can be dismissed as a placebo effect.

But the science is yielding a complex and nuanced picture and suggests that some of these interventions deserve careful investigation. For example, the most common health problem for which people turn to complementary and alternative medicine is chronic pain. Pharmacological approaches to chronic pain management, while important, have well-documented hazards.

Evidence is growing, based on carefully controlled studies, that certain non-pharmacological complementary interventions may be useful adjuncts to conventional care. For example, the pain of osteoarthritis can be lessened by acupuncture; tai chi may be helpful in reducing the pain of fibromyalgia; and massage and manipulative therapies may contribute to the relief of chronic back pain and related functional impairments. Furthermore, evidence from basic research points to ways in which such interventions use the body's own pathways known to be involved in response to pain.

Similar lines of basic and clinical research evidence point to the potential value of meditative approaches in dealing with chronic stress and post-traumatic stress disorder, and in supporting or promoting healthy behavior change. While this research is not yet definitive, further investment in study of such sensible, low-tech complements to conventional treatment is warranted given the scope of these health problems and the limitations of currently available conventional treatments.

Freedman describes how integrative approaches are being offered and studied in a variety of health care settings. In addition, it is noteworthy that more than half the hospices in the United States offer such treatments. Likewise, the departments of Defense and Veterans Affairs have taken a keen interest in incorporating approaches such as meditation, yoga, and massage into treatment and prevention programs aimed at addressing the enormous burdens of post-traumatic stress.

In all of these settings, patients, providers, and policymakers have many unanswered questions: Are these interventions really a useful adjunct to conventional care? If so, who and in what ways do they help? What are the downsides? What are the costs?

As Freedman also notes, research suggests that non-specific effects often make important contributions to the benefits patients may experience. For example, acupuncture involves a complicated interaction - including the stimulus of needles and their placement, expectancy, touch, a soothing environment, and a reassuring, supportive practitioner - that science has yet to disentangle.

Should we dismiss any benefits as mere placebo effects? Or should we explore the possibility, increasingly suggested by the science, that some complementary interventions provide powerful tools for studying the contributions of attention, touch, time, and reassurance, which are now in short supply in our health care system?

At NCCAM, we are exploring the latter. The ultimate goal of NIH research in this area is to develop the objective evidence necessary for patients, practitioners, and policymakers to make informed decisions.

Freedman's article makes fresh and important contributions toward understanding the rationale behind public investment in this research. It also illuminates the fallacy of monolithic generalities - whether positive or negative - about the diverse array of practices that fall under the rubrics of complementary, alternative, or integrative medicine.

The debate continues here./p>