"$2.5 Billion Spent, No Alternative Cures Found"

"$2.5 billion Spent, No Alternative Cures Found" screams an MSNBC headline from a few months ago. "Big, government-funded studies show most work no better than placebos..." it continues.

Actually, the line that gets to me is not these, but this, "Many of the studies that have been funded I would not have funded because they seem irrational and foolish -- studies on distant healing by prayer and energy healing, studies that are based on precepts and ideas that are contrary to what is known in terms of human physiology and disease."

Are these the words of a skeptic? A conservative conventional medicine doc? No -- they come to us from Barrie Cassileth, integrative medicine chief at Memorial Sloan-Kettering Cancer Center in New York.

Doing studies based on precepts and ideas that are contrary to what is known is exactly what scientific exploration and discovery is all about. When germ theory was originally proposed, it was considered irrational. The existence of prions, the agents that are now known to cause mad cow disease, were once thought to be physiologically impossible. Examples abound.

In my line of work, I often hear scientists designate certain topics or areas of interest as inherently "unscientific." My response is that there are no "unscientific" topics, only unscientific methods.

What I do agree with is that much research funding has been spent, perhaps wasted, on poorly designed studies, or those in which even successful achievement of the aims would have marginal significance for improving understanding, reducing suffering, or improving health -- both in and out of the complementary and alternative medicine domain.

But, my primary critique of the portfolio of government funding for complementary and alternative medicine and mind-body therapies is that the focus has almost exclusively been on forcing what are most often holistic, individualized treatments into a pharmaceutical research paradigm which requires randomization, blinding, placebo controls, standardization of treatment and dose, extraction of active ingredients, etc. and most results are based on averages and overall effects. This is not by any means to say there should not be randomized controlled trials to assess the efficacy of interventions -- there should be. But it is very likely that many methods other than RCTs should be used to assess the effectiveness of complementary and mind-body approaches to health and well-being -- and the portfolio historically has been dominated by an almost obsessive focus on RCTs with interventions like herbs and other supplements, acupuncture and spinal manipulation, all treated as though they were new "drugs" being developed.

More complex treatments are likely going to be needed for more complex illnesses. We need to work on our spirit of innovation, adventure, and discovery and to use an overused phrase, start thinking outside of the box about how to find out if, why, and how these more complex treatments work for some people, sometimes, and others work for other people at other times. And those of us who study mind-body and complementary approaches need to step up our own creativity and discipline so that we meet acceptable standards of scientific conduct, while also developing innovative ways to study topics that don't lend themselves particularly well to the current state of our scientific evolution.

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