Doctors Biased Against Alternative Complementary Medicine

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Alzheimer's

Dr.'s bias towards vitamins

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Academic Physicians Have Been Biased Against Vitamins, Nutritional Supplements, Herbs and Alternative Medicine

Description: Many physicians in the American medical establishment dismiss claims for the usefulness of vitamin supplements as hype. But that denunciation may be based on bias rather than on solid scientific evidence, say two commentators from the University of Texas Medical Branch at Galveston (UTMB).

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Walk into any convenience or herbal remedy store. Facing you are rows of vitamins and supplements for increasing vitality, sexual vigor, mental activity, you name it. Many medical investigators dismiss these "cures" as hype. But that denunciation may be based on bias rather than on solid scientific evidence, say medical commentators Drs. James S. Goodwin and Michael R. Tangum.

In an article to be published Nov. 9 in the Archives of Internal Medicine, Goodwin, director of geriatric medicine and professor of preventive medicine and community health at the University of Texas Medical Branch at Galveston (UTMB), and Tangum, an internal medicine resident at Legacy Hospital in Portland, Oregon, note that throughout the 20th century, American academics have selectively ignored possible evidence supporting the use of vitamin supplements while uncritically accepting evidence against them.

The article is part of a focus that American Medical Association journals are putting on alternative medicine during the week of Nov. 9. The pair's conclusions are based on an analysis of consecutive editions of two prominent medical textbooks published between 1950 and 1992. Those textbooks, the authors say, demonstrate the scornful tone that the American medical establishment often employs in discussions of vitamin supplements. Such a contemptuous tone, they note, is absent from discussions of most other medical controversies.

The authors are not apologists for megavitamins, they say. Nor does their treatise promote any particular micronutrient supplement as being effective. But vitamin supplements, the authors say, initially met with resistance in part because they didn't fit with the prevailing biomedical paradigms, particularly the germ theory. And similar factors may color the response of academic medicine to any 'alternative treatment.'

"Part of the resistance stems from the fact that the potential benefits of micronutrients were advanced by 'outsiders' who took their message directly to the public," says Goodwin in the paper. That same resistance probably prompted the ridicule conferred to Nobel prize-winning Linus Pauling, who was considered "the chemist who intruded into clinical matters" after he became a leading proponent of using massive doses of vitamin C to prevent upper respiratory infections.

"Ideally, issues such as the theory underlying the treatment or the guild to which the proponents of the treatment belong should be irrelevant to the fundamental questions of efficacy, toxicity and cost," Goodwin writes. "The history of the response of academic medicine to micronutrient supplementation suggests that we have not attained that ideal."

'Alternative' Medicine Becoming Mainstream, UF Study Finds

GAINESVILLE---Traditional medical providers may have a reputation for shunning alternative therapies, but health-care teachers are getting massages, learning relaxation techniques and trying other unconventional treatments at about the same rate as the general population, University of Florida researchers report.

In a written survey of physicians, nurses, dentists and other health professionals on UF's faculty, 52 percent of the 764 respondents said they had tried an alternative treatment. An earlier survey found the same percentage of Florida residents had done so. The results, published as a letter in this week's issue of The Journal of the American Medical Association (11/11/98), add to the growing evidence that so- called "alternative" medicine is rapidly heading into the mainstream. "With this survey, we've learned that health science faculty are pretty much like anyone else when it comes to their own health," said Dr. Allen Neims, a professor of pharmacology and former dean of UF's College of Medicine. "This is significant, because they are the role models and teachers of the next generation of health-care professionals." Neims authored the letter with Mary Ann Burg and Shae Kosch in the College of Medicine's department of community health and family medicine, and Eleanor Stoller of Case Western Reserve University.

"I think physicians now know that their patients are using massage and dietary supplements and that they're going to chiropractors," Burg said. "So physicians have to figure out how to deal with a group of techniques they probably don't have any training in and which to date have little scientific evidence to demonstrate their effectiveness." About half of U.S. medical schools, including UF, offer elective courses on alternative therapies, Neims said. "There is a tremendous amount of individuality in how integrative treatments are presented to students by the faculty," Neims said. "Some include quite a bit of information and others are quite resistant to it, seeing it as a step backwards scientifically. While there is room for both views within the college, I hope this study gives people a little more sense of permission to teach these things. Teaching about them does not have to be an endorsement." One hurdle in integrating alternative therapies into mainstream medicine is that mainstream and alternative practitioners have different ideas about what causes health problems, Burg said. "In traditional Chinese medicine, which includes acupuncture and herbal therapy, they think in terms of 'chi,' which is a kind of life force, a body energy," Burg said. "There is some research showing that acupuncture does a good job relieving pain and other problems, but there is no logical explanation within Western medicine for that."

In a written questionnaire mailed to 1,300 UF health faculty members, 32 percent of those who responded said they had used massage, 24 percent relaxation techniques, 23 percent dietary supplements and 16 percent chiropractic. Less than 10 percent of the faculty reported using herbs, acupuncture, hypnosis, homeopathic remedies or biofeedback. Women faculty members were significantly more likely than men to have tried alternative therapies. Faculty from the colleges of Health Professions and Nursing were the highest users of alternative medicine -- at 76 and 74 percent, respectively. Of College of Medicine respondents, 52 percent had used alternative medicine.

"Nurses have been doing a lot more research on alternative medicine for a much longer time than people in the other health professions," Burg said. "Nursing traditionally has been a holistic, patient-oriented profession, which fits in well with the culture of a many alternative therapies."

Neims noted that like the American population in general, health faculty are turning to nontraditional measures to maximize health, not to replace traditional, Western medicine. Many people are exploring new forms of treatment because they fit well with their philosophy of a mind-body connection. They also are seeking a personal relationship that may be difficult to forge in the typical physician office. "If you regularly see a massage therapist or chiropractor, that can turn into a deep relationship with healing qualities of its own," Neims said. "One of the things I hope results from this interest in integrative medicine is that we all reaffirm that the relationship between patient and physician is very, very important."

Contact: Victoria White vickiwhite@xtalwind.net
352-344-2738, University of Florida