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. Eisenberg and the comments I submitted. Despite his enormous conflict-of-interest and continuous overpromotion of “CAM,” he was retained on the proposed committee.
|IOM Description (February 2003): David M. Eisenberg is the Director of the Osher Institute at Harvard Medical School and the Division for Research and Education in Complementary and Integrative Medical Therapies. He is also the Bernard Osher Associate Professor of Medicine at Harvard Medical School. In 1979, under the auspices of the National Academy of Sciences Dr. Eisenberg served as the first US medical exchange student to the People’s Republic of China. In 1993, he was the medical advisor to the PBS Series, “Healing and the Mind” with Bill Moyers. More recently, Dr. Eisenberg has served as an advisor to the National Institutes of Health, the Food and Drug Administration and the Federation of State Medical Boards with regard to complementary and alternative medicine research, education and policy. Dr. Eisenberg has authored numerous scientific articles involving complementary and integrative medical therapies.|
My Comments (Posted on February 23, 2003)
- Eisenberg’s 1993 article on “Unconventional Medicine in the United States” is the most widely cited journal report on “CAM” methods. The article, which was based on a telephone survey concerning 16 types of what he called “unconventional therapy,” concluded:
One in three respondents (34%) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy . . . In 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians. . . .
- Although the report headlined in the media as evidence of increasing public interest in “alternative methods,” the study’s design was extremely poor. extremely poor. The authors defined “unconventional therapies” as “medical intervention not taught widely at U.S. medical schools or generally available at U.S. hospitals.” However, the categories they selected included some approaches that are medically appropriate (self-help groups, for example) and some that may or may not be appropriate, depending on the circumstances (relaxation therapy, biofeedback, hypnosis, massage, and commercial weight-loss clinics). About 30% of the visits were for “relaxation techniques,” 11% for commercial weight-loss clinics, and 5% for self-help groups. The data on practitioner visits included self-use, and the study failed to consider than many people use gynecologists for their primary care. In light of these facts, the estimated expense total and visits comparison were meaningless.
- I personally (face-to-face) have told Eisenberg that his classification was overbroad, and so have other people. But he goes right on promoting the same puffed-up statistics. In 1998, the Journal of the American Medical Association published Eisenberg’s report on another survey that misclassified standard methods as “CAM” and claimed that “CAM” use had risen to 42%. JAMA’s editor, who had well aware of my concern, told me that he had forced Eisenberg to mention that some of the methods were “arguably” not “alternative.” However, this did not influence either the data or Eisenberg’s conclusions. I believe that he misclassifies standard methods as “CAM” in order to foster his economic and political agenda.
- Eisenberg’s annual CME conference at Harvard enables “CAM” advocates to promote what they do (or pretend to do) without facing knowledgeable critics. The March 2003, program for example, includes a “review of the theory, practice, safety, and efficacy of chiropractic and spinal manipulation, massage/body work [and] acupuncture.” You can bet your life that no speaker will discuss how many of their practitioners are engaged in quack practices.
- I have seen no evidence that Eisenberg considers plausibility as a criterion for setting research priorities or that he has ever suggested that any “CAM” method should be discarded as worthless. In a recent paper, he listed 28 “selected consensus reports, clinical trials, and reviews suggesting that CAM therapies may be effective and/or warrant further clinical investigation.” He also listed 11 “selected clinical trials suggesting that CAM therapies may lack efficacy.” There is no list of “selected clinical trials suggesting that CAM therapies should not be supported by government research dollars or should be abandoned.” Nor is there a list of “CAM therapies that should be abandoned because they are irrational. Eisenberg’s “warrant further investigation list” includes “homeopathy as distinct from placebo”; homeopathy for vertigo (dizziness); homeopathy for allergic rhinitis; distant healing; and intercessory prayer.
- The above observations, and many more that I do not have time to write about, provide at least three reasons why Eisenberg should be bumped from the IOM CAM committee:
- Since 1993, he has produced a steady stream of inaccurate and unbalanced information intended to promote “CAM” activities.
- His judgment about research priorities is flawed.
- Since his current professional career depends upon his ability to promote interest in “CAM” methods, he has an enormous economic conflict-of-interest.
This article was revised on January 15, 2005.