In February 2003, the Institute of Medicine (IOM) announced that it was assembling a committee to identify major scientific and policy issues in “complementary and alternative medicine” (“CAM”) research, regulation, training, credentialing and “integration with conventional medicine.” As part of this process, it posted the names of 15 appointees and asked for public comment about their suitability. Here are IOM’s biographical sketch of Dr. Berman and the comments I submitted. Despite his financial conflict-of-interest and continuous overpromotion of “CAM,” he was retained on the proposed committee.
|IOM Description (February 2003): Brian Berman is Professor of Family Medicine and director of the University of Maryland School of Medicine Center for Integrative Medicine. Trained in family medicine and pain management as well as complementary medical approaches such as acupuncture, Dr. Berman has dedicated his career to evaluating the efficacy, safety and cost-effectiveness of complementary and alternative medicine. In 1991 he founded the first U.S. academic medical center-based program for complementary medicine. He is principal investigator (P.I.) of a National Institutes of Health (NIH) specialized center grant for the study of complementary medicine in the treatment of arthritis and related disorders and P.I. or co-P.I. on a number of large NIH and Department of Defense-funded clinical trials on modalities such as acupuncture and mind/body therapies The results of his research and of systematic reviews he has conducted of the literature in complementary medicine have been published in journals such as Pain, Rheumatology, Annals of Internal Medicine and the Journal of Family Practice. Dr. Berman chaired the ad hoc advisory committee to the NIH Office of Alternative Medicine when it opened in 1992, as well as the report to the NIH on alternative medicine. Subsequently, he served on their advisory committee for 6 years. Dr. Berman also helped found and now serves as field coordinator for the complementary medicine field of the Cochrane Collaboration, an international organization dedicated to evaluating all medical practices, and is chair of the Consortium of Academic Health Centers for Integrative Medicine.|
My Comments (Posted on February 23, 2003)
- The mission of the Consortium of Academic Health Centers for Integrative Medicine, which has eleven institutional members, is to transform health care by “moving the boundaries of the existing field of medicine to include the wisdom inherent in healing the ‘whole person’—mind, body and spirit.” This statement implies that the concept of treating the whole person is something new. In reality, good doctors have always done this.
- Berman co-chaired the editorial review board and wrote the preface for Alternative Medicine: Expanding Medical Horizons, a book in which he stated: “This report establishes a baseline of information on alternative medicine, which may be used to direct future research and policy discussions. . . . . Ultimately it may provide the foundation for the development of a whole new system of medicine.” The report was written entirely by “CAM” proponents who did not criticize any theory or method they discussed or examine whether the relevant practitioners have training or judgment that adequately prepares them to see patients. (Most do not.) The report was so bad that the National Institute of Health added a warning that it did not reflect NIH endorsement and that many of the therapies had not been subject to rigorous scientific investigation or been approved by the FDA. The NIH also cautioned readers not to seek the therapies without consultation with a licensed physician.
- Berman’s enthusiasm about this report shows ignorance of the subject matter, willingness to promote “CAM” without regard for its shortcomings, or both. I don’t believe that anyone who thinks that a one-sided document provides a basis for “future research and policy discussions” belongs on an IOM committee that advises on research and policy.
- The book’s homeopathy section, which Berman co-authored, shows extremely poor scientific judgment. Homeopathy is based on the nonsensical idea that if large amounts of a substance can cause symptoms, tiny amounts of that substance can cure diseases that have such symptoms. Homeopaths also believe that their most potent remedies are products so dilute that no molecules of the original substance are present. This idea is absurd. Yet Berman recommends that research be performed to (a) search for “homeopathic medicine’s mechanism of action,” (b) evaluate the effectiveness of homeopathic products; (c) update century-old studies in which people record what happens after being given various substances, and (d) “determine whether incorporating homeopathy into the national health care system would significantly reduce health care costs.” However: (a) homeopathic remedies are derived from more than 1,500 ingredients; (b) each ingredient may be used in several different concentrations; (c) individual substances are claimed to be effective against dozens or even hundreds of symptoms or conditions; and (d) many homeopaths contend that each person has one or more substances that work for that person. Thus a research program that would “evaluate” both ingredients and clinical outcomes would require millions of studies that would cost countless billions of dollars. The scientific view about “CAM” research is that plausibility should play a major role in determining research priorities. Studies of methods that are unlikely to yield useful findings deserve low or no priority.
- The book’s conclusion provides a futher example of Berman’s bias and tendency to mislead. Noting that health care costs can be lowered with preventive measures, it states that “alternative systems may have much to offer” because “homeopathic and naturopathic physicians, for example, strongly advise their patients about diet and other lifestyle choices as a matter of routine care.” It also states that “many conventional physicians do not routinely give such advice until a patient has become chronically ill.” This statement fails to mention (a) many homeopaths and the majority of naturopaths routinely advise patients not be be immunized; (b) the preventive advice given by naturopaths usually includes a wide array of unnecessary and costly dietary supplement bizarre advice about “detoxification”; (c) homeopathic “remedies” have not been proven effective for treating any health problem; and (d) no published study has ever shown that homeopaths or naturopaths are more likely than medical doctors to give appropriate preventive or therapeutic advice.
- The Center for Integrative Medicine’s Web site contains a mixture of helpful and misleading information. Its Complementary Medicine Field Systematic Reviews and Protocols is a handy index to more than 100 list of Cochrane Collaboration documents, most of which are well-reasoned. But its Consumer Resources in Complementary Medicine on the Internet is another story. This document, which. is intended “to help aid patients and consumers who are considering CAM treatments,” links to government agency “fact sheets” on a few “CAM” topics and lists several Cochrane Cochrane Systematic Reviews. However, its list of “CAM Directories” includes 11 sites that provide untrustworthy information, and its “CAM Associations” list contains 16 proponent organizations, all of which are untrustworthy. The best sources of appropriately critical information about “CAM” methods are not listed.
- Berman frequently refers to a 1995 article he co-authored as evidence that family physicians are not only interested in learning about “alternative medicine” therapies but are either offering them or are making referrals to alternative practitioners. The article stated:
Questionnaires were distributed at three separate conferences of family physicians with 180 physicians responding. More than 70 to 90 percent of the physicians considered complementary medical therapies, such as diet and exercise, behavioral medicine, counseling and psychotherapy, and hypnotherapy, to be legitimate medical practices. A majority had referred patients to nonphysicians for these therapies or used some of them in their own practices. Homeopathy, Native American medicine, and traditional Oriental medicine were not favored as legitimate medical practice.
- Diet, exercise, counseling, psychotherapy, and hypnotherapy are mainstream practices, It appears to me that the authors classified them as “alternative” therapies in order to inflate their findings. Neither the focus of the meetings nor the methods used to recruit survey participants were identified in the paper or supplied by Berman in response to my letter to the editor that was subsequently published. But the most peculiar thing about the survey is that 27.2% of responders said they practiced chiropractic. I suspect that 27.2% of the people who took the survey were chiropractors and that the survey did not reflect what family physicians were doing. Berman is well aware of my concern about this but has never responded. Instead, he keeps citing this study to promote the idea that medical schools should teach more about “CAM” subjects.
- There are at least three reasons why I believe that Berman should be disqualified from being on the IOM committee:
- His primary professional activity depends upon his ability to promote “CAM” education and practice.
- He has a major economic interest in the outcome of the report.
- His publications present an overly positive view of “CAM.”
This article was revised on January 15, 2005.