Quacks and Flacks

The pitfalls of seeking a scientific foundation for alternative medicine.

Chris Mooney from the June 2003 issue

(Page 2 of 4)

If Eisenberg was aware of this, it didn't stop him from traveling to China with Bill Moyers for his 1993 television series Healing and the Mind, which depicted the activities of Qi Gong masters with little warning that they may be mere manipulators. Psychologist Barry Beyerstein and Dr. Wallace Sampson, editor of The Scientific Review of Alternative Medicine, have written of Eisenberg's role in Moyers' series: "[He] continued to embrace the therapeutic effects of [traditional Chinese medicine] as enthusiastically as he had back in his student days when he accepted as real the kind of 'external Qi' that others have exposed as magic tricks."

Critical Defect

Will Eisenberg's complementary and alternative medicine program at Harvard succeed in setting research into exotic and nontraditional medical methods on a firm scientific foundation? There's certainly a great deal riding on the endeavor. Bernard Osher, a wealthy San Francisco philanthropist who co-founded Golden West Financial, gave Harvard a $10 million grant in the spring of 2001 to found Eisenberg's center.

"Integrative medicine's time has come," Osher proclaimed at a celebratory reception for the institute. Osher has created a similar program at the University of California�San Francisco; the two Osher centers now collaborate on conferences.

In one sense, Harvard's Osher Institute is just another in a long line of CAM programs at leading medical schools (including an earlier Eisenberg-run center at the Beth Israel Deaconess Medical Center, a Harvard teaching hospital). One of the oldest, Columbia University's Rosenthal Center for Complementary and Alternative Medicine, was established back in 1993; shortly afterward Dr. Andrew Weil founded the Program in Integrative Medicine at the University of Arizona. According to the Rosenthal Center, there are now well over 100 university courses, programs, and institutes in CAM. Yet Harvard's new Osher Institute is distinguished both by virtue of being at Harvard and by its generous funding.

Of course, no one will know which aspects of CAM really work and which don't unless medical schools help separate the wheat from the chaff. But already there are complaints about the research output from both the Osher Institute and Eisenberg's previous center (which was established in 1994). "They've now had a fair amount of money and a fair amount of time to get something done," says Relman, the former editor of The New England Journal of Medicine. "Most of what they publish is opinion and philosophy and speculation and surveys, and not much in the way of objective science."

Federman, Harvard Medical School's senior dean, has been charged with overseeing the growth of the university's CAM division. He admits little research has been conducted thus far at the Osher Institute but says that's mainly because things are still getting off the ground. Eisenberg himself, notes Federman, is not a doctor who's particularly well known for his background in clinical research. Rather, he's charged with a leadership role; research itself will be overseen by a board of senior medical scientists who will review proposals.

But when it comes to CAM, the difficulty of such a research agenda is that the subject excites extreme emotion from both skeptics and believers. In the relatively uncharted area of CAM research, the believers often wind up being the people designing the trials. "There are too few people in this field doing experiments without caring much how they come out," says Dr. Tom Delbanco, chief of the Division of General Medicine at the Beth Israel Deaconess Medical Center, who mentored Eisenberg and was a co-author of his famous 1993 New England Journal of Medicine paper. "Most of the people in the field are trying to prove something they believe in, rather than engaging in research with a truly open mind."

Some of Eisenberg's colleagues have expressed views that suggest a personal investment in CAM. One of his associates at the Osher Institute is an attorney and CAM legal expert named Michael H. Cohen, who attended meetings of the Massachusetts commission in Eisenberg's absence. Cohen's presence was controversial, with some panelists objecting to his appearing to represent the Department of Public Health despite his lack of a medical background. In an article on his personal Web site, Cohen decries a "delusional matrix of medico-legal reality" and argues that biomedicine -- i.e., Western scientific medicine -- "by and large perpetuates a delusional sense that a human being is only material." Cohen also criticizes biomedicine's "tendency to relegate valid, numinous encounters to the realm of psychological dysfunction or unprovable mysticism" and commends "near-death experiences" and "encounters with angels" for bringing humans closer to "that which is Supreme at the edge of consciousness."

Such arguments go far beyond a measured scientific approach to CAM in favor of a philosophical re-examination of the foundations of science itself. Cohen's writings demonstrate a hostility to conventional medicine and appeal to "other ways of knowing," both tendencies that Eisenberg himself warns against in his annual Harvard Medical School course, summarizing an article in Academic Medicine by the aforementioned Barry Beyerstein titled "Alternative Medicine and Common Errors of Reasoning." Eisenberg declines my request to address this seeming contradiction.

Another of Eisenberg's close associates at Harvard is Ted J. Kaptchuk, an acupuncturist and traditional Chinese medicine expert. Kaptchuk holds an overseas degree as a doctor of Oriental medicine. But according to a letter from Eisenberg to Dr. Carl Bartecchi of the University of Colorado Health Sciences Center, Kaptchuk is also a consultant for the Kan Herb Company, which sells a formula guide he created that includes such herbal products as "Women's Rhythm" and "Arouse Vigor." In other words, Kaptchuk has a financial stake in CAM. To his credit, Kaptchuk disclosed this fact in a recent article authored with Eisenberg for the Annals of Internal Medicine.

Healing Impaired

All of these tensions within Harvard's program -- between belief and research, between expectation and investigation -- seem to have exploded during the proceedings of the Massachusetts commission that weighed in on the legitimacy of naturopathy. Established by the legislature in 2000, the Special Commission on Complementary and Alternative Medical Practitioners was chaired by Bill Wood, director of the Massachusetts Division of Professional Licensure. The polarization, animosity, and accusations generated by the commission's work suggest how narrow a tightrope Harvard's new Osher Institute is trying to walk.

Despite its name, the commission ended up focusing on whether practitioners of naturopathy should be licensed in Massachusetts (as they are in 11 other states). Eisenberg represented the Massachusetts Department of Public Health on the commission; the other two medical doctors serving on the panel were the aforementioned Arnold Relman (representing the Massachusetts Board of Registration in Medicine) and Kimball Atwood, a Harvard Medical School graduate and anesthesiologist (representing the Massachusetts Medical Society).

Other members included six state legislators and the presidents of the Massachusetts Society of Naturopathic Physicians and the New England School of Acupuncture. When he resigned in protest, Relman objected that not enough time and attention had been devoted to the scientific aspects of the inquiry and that "there were several alternative medicine people on the commission who clearly had a terrible conflict [of interest]." He wanted to disassociate himself completely from the majority report recommending licensure.