Young

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Bulletin of the History of Medicine 72.2 (1998) 279-298

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The Development of the Office of Alternative Medicine in the National

Institutes of Health, 1991-1996

James Harvey Young

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In 1991 the Senate Appropriations Committee responsible for funding the

National Institutes of Health (NIH) declared itself "not satisfied that the

conventional medical community as symbolized at the NIH has fully explored

the potential that exists in unconventional medical practices." 1 "Many

routine and effective medical procedures now considered commonplace," like

cancer radiation therapy, had once been "considered . . . quackery"; to

"more adequately explore these unconventional medical practices," the

Committee directed the NIH to set up within the Director's Office "an

advisory panel to screen and select the procedures for investigation and to

recommend a research program to fully test the most promising unconventional

medical practices." 2 This "advisory panel" became the Office of Alternative

Medicine (OAM). Thus government was brought in a new and very direct way

into a growing national health-care conflict between the forces of

establishment biomedicine and the [End Page 279] diverse ranks of

alternative medicine, the latter gaining increased acceptance and usage by

the American public. In determining whether this trend promoted or

jeopardized the public health, the actions of the Office of Alternative

Medicine (OAM) might well be decisive. Factors underlying its legislative

creation justified skepticism about the scientific standards that would be

applied in the Office's future role.

The prime mover of this edict was Appropriations Committee chair Thomas R.

Harkin, a Democrat from Iowa, in his second Senate term after having served

four terms in the House. Harkin had been urged to take this legislative step

by two constituents, Berkley Bedell and Frank Wiewel. 3 Bedell, a former

member of the House, believed that two crises in his own health had

benefited from the use of unconventional medicine: colostrum derived from

the milk of a Minnesota cow, he held, had cured his Lyme disease; and 714-X,

derived from camphor in Quebec by Gaston Naessens, had prevented recurrence

of his prostate cancer after surgery. Bedell, giving evidence of his Lyme

disease recovery at a Senate committee hearing, observed: "Unfortunately,

Little Miss Muffet is not available to testify that the curds and whey which

she was eating are safe." 4 Wiewel had long been a vigorous champion of

immunoaugmentative therapy for cancer, scorned by orthodox specialists; made

in the Bahamas, this mixture of blood sera was finally barred from import by

the Food and Drug Administration. Wiewel then began operating from his home

in Otho, Iowa, an agency called People Against Cancer, a referral service

for cancer treatments that orthodox medicine considered questionable. 5

Harkin, having lost two sisters to cancer, was susceptible to an interest in

alternative therapies. 6 Soon after sponsoring the law that launched the

Office of Alternative Medicine, Harkin himself became a true believer in

[End Page 280] an unorthodox "cure." On Capitol Hill, Bedell introduced the

senator to Royden Brown of Arizona, promoter of High Desert bee pollen

capsules. Harkin suffered from allergies; persuaded by Brown to take 250 bee

pollen capsules within five days, he rejoiced that his allergies had

disappeared. 7 The senator did not know at the time that Brown had recently

paid a $200,000 settlement under a consent agreement with the Federal Trade

Commission, promising to cease disguising television infomercials as

objective information programs and to stop including in his scripts dozens

of false therapeutic claims for his capsules. These promotions also averred

that "the risen Jesus Christ, when he came back to Earth," had consumed bee

pollen; a more recent customer, Brown's infomercial declared, was Ronald

Reagan. 8 Brown later wrote Hillary Clinton, warning that her husband should

begin dosing with bee pollen lest he develop fatal throat cancer. 9

The Congressional injunction to create the new Office upset NIH leadership,

though they could not publicly admit it. After resigning as director,

Bernadine Healy revealed that she had deemed the project to link qualified

research scientists with true believers in therapies like homeopathy and

magnets, in order to conduct experiments, as foreshadowing nothing but

disaster. "We had no choice," Dr. Healy observed: the agency could not

refuse a mandate from the Congress. 10

Other scientists shared Dr. Healy's private doubts. The new venture, one of

them said, would resemble an Office of Astrology. 11 Some, however, welcomed

the OAM as a way of speeding the acceptance of novel but useful approaches.

Among them was Dean Ornish, who had run clinical trials, with financial

support from an initially reluctant NIH, establishing that heart damage

could be reversed by lifestyle changes, especially diet. The creation of the

Office, Ornish exulted, was "like the Berlin wall coming down." 12 Even

those skeptical of the entire alternative [End Page 281] enterprise saw the

possibility of good in a new government office that would test, disprove,

and publicize false claims. 13

NIH officials launched the new Office with an acting director and an ad hoc

panel of twenty members. 14 Influence on the selection process from Senator

Harkin's office may be presumed, for Bedell and Wiewel became panel members,

as did leading advocates of major elements of alternative medicine:

acupuncture, energy medicine, homeopathy, Ayurvedic medicine, and several

varieties of alternative cancer therapy. Deepak Chopra and Bernard Siegel,

authors of best-selling alternative books, were included. A number of

qualified researchers sympathetic to alternative approaches represented the

medical establishment, including Barrie Cassileth, an expert scholar of the

sociology and psychology of medical practice. Some severe critics of

quackery were consulted and considered for panel membership but were not

selected. 15

The panel convened in June 1992, sponsored by the NIH Office of the

Associate Director for Science Policy and Legislation. Its head, Jay

Moskowitz, referred to "many great discoveries" that had been "based on

theories . . . ridiculed early in their use," and added that the National

Cancer Institute had studied many "natural products--such as taxol--to

combat cancer"; 16 the new Office intended to use part of its funds to aid

alternative practitioners to "develop methodologies so that their results .

. . [were] interpretable and analyzable." 17 The panel, noted acting

director Stephen Groft, would identify the issues to be confronted and then

help set up an official advisory council. Discussion followed as to which

unconventional practices offered the most hopeful prospects for verifiable

results, and the proper methods for evaluation. When some panelists

recommended double-blind clinical trials, others challenged this approach.

"Let's get real," objected Frank Wiewel, "this is an ingrained bureaucracy.

We've got to break the bureaucracy of the past and establish a new order. .

. . The general view of the medical establishment is we're losing the war on

cancer and AIDS. The people who have survived unconventional treatment merit

immediate attention" to learn [End Page 282] the secret of their success. 18

Thus, at the OAM's origin, began a policy debate destined to expand and grow

more bitter.

This panel meeting had a large audience assembled through a public

invitation, and some hundred members spoke in the open forum. They offered

testimonials for such therapeutic approaches as homeopathy, ozone infusion,

the Naessens "cure" that Bedell believed in, and the much-disputed cancer

treatment using antineoplastons being administered in Houston by Polish

immigrant physician Stanislaw Burzynski. Pervading the discussion was "an

undercurrent of anger and distrust" of orthodox science. 19 Some

practitioners had been afraid to come and testify, it was alleged, for fear

of losing their licenses. Michael Culbert, an ardent champion of the

banished cancer drug Laetrile, rebuked the Food and Drug Administration for

clearing the market of such safe products, thus securing "obscene profits"

for the pharmaceutical monopoly. 20 Some testifiers told the press that the

meeting had "legitimized" unconventional medicine. 21

Three months later, in September 1992, the Office of Alternative Medicine

sponsored a larger workshop in Chantilly, Virginia, to "develop a baseline

of information on the state of alternative medicine." 22 Again, the

invitation permitted all who wished to come, and the presentations covered a

wide scope. An editorial review board, chaired by Brian M. Berman of the

University of Maryland School of Medicine, then supervised the structuring

of the information presented, leading to governmental publication three

years later of a hefty volume entitled Alternative Medicine: Expanding

Medical Horizons. The practices discussed included mind-body interventions,

bioelectromagnetic applications, alternative systems of medical practice,

pharmacological and biological treatments, herbal medicine, and diet and

nutrition. The gamut ran from acupuncture to yoga, all discussed in a

respectful editorial tone, although the foreword cautioned that the

"document does not reflect endorsement of these therapies . . . by the NIH,

the U.S. Public Health Service, or the U.S. Department of Health and Human

Services"; rather, the work was intended "for the purpose of furthering the

dialogue between the alternative-complementary [End Page 283] medicine

communities and the biomedical research establishment." 23 One critic called

the report "an uncritical catalog of virtually every dubious and unproven

treatment method of the past 100 years." 24 Another termed it "surely the

most credulous document ever offered in the name of medical science." 25

After a deliberate search, the NIH in October 1992 appointed a director for

the Office of Alternative Medicine. His background, a journalist observed,

seemed "custom-tailored for the job." 26 Joseph Jacobs was the son of a

Mohawk mother and a part-Cherokee father. He and his siblings had been

treated by their mother with herbs and healing ceremonies, as well as with

orthodox medicines, as they were growing up. "I remember an herb called

turtle socks," he once remarked, "something used for children with a fever."

27 Jacobs attended college at Columbia University, then medical school at

Yale, followed by further training at Dartmouth. To repay governmental help

with the expenses of his medical education, he went with his wife, a Yale

student of Chinese calligraphy, to serve for three years as a pediatrician

in the Indian Health Service near Gallup, New Mexico. There he gained

respect for the Navajo medicine men who worked in collaboration with the

physicians of Western medicine in ways he deemed helpful. Jacobs returned

east and secured an M.B.A. in health administration from the Wharton School

of the University of Pennsylvania; he worked for the Public Health Service

in Rockville, Maryland, and then for the Aetna Life Insurance Company in

Hartford as medical director of research and program development, before

assuming the challenging new position in Bethesda. He possessed "an

easy-going sense of humor" 28 and "a way of disarming the surly and

reassuring the dubious." 29

Jacobs had faith that the broad realm of alternative medicine would yield

products and practices of great benefit. "Traditional methods of healing in

other cultures," he observed, "do represent several thousand years of trial

and error, and they are being used by a majority of the world's population.

It's technological arrogance on our part to fail to [End Page 284] recognize

this." 30 Moreover, there were contemporary clues, like the dedication to

massage in the sports field, and the satisfaction that many people suffering

from back pain received from chiropractors. Homeopathy's theory gave Jacobs

pause, but if something worked, even if the mode of action could not be

explained and ran counter to prevailing theories, you had to accept that a

causal relation existed, even if you did not understand its mechanism. Even

crystal therapy, he said, he "wouldn't rule . . . out completely." 31 Jacobs

held high hopes for the OAM's mission: "We may help promote a revolution in

thinking among practitioners and researchers. It's a bold new venture, sort

of like being on the starship Enterprise. We're going where no one has gone

before." 32

The route to discovery, however, required the use of the most capable

science: "I'm not going to be able to wave a magic wand over a particular

alternative practice and declare it valid or invalid. I think my job is

clear: to support research. And once we get results we will publish them for

other people to see." 33 The question posed was not merely whether the

tested treatments cured or not: "One of the bottom lines we want to look

at," Jacobs asserted, "is: 'Do they make someone's life a little better?'"

34 While believing that alternative therapies might require testing regimens

that differed from those used for drugs with a single active ingredient,

Jacobs planned to place his main trust in the prevailing research methods of

orthodox science, grants to be awarded after careful peer review, and

research centers to be established at prestigious medical schools. 35

This approach did not please members of the ad hoc and then the permanent

advisory committee who had sold the OAM concept to Senator Harkin. What

Bedell, Wiewel, and their like-minded colleagues favored were quick field

studies that would validate alternative treatments. 36 Jacobs accepted the

concept of such studies, in an exploratory sense, so long as they were

carefully carried out and checked for accuracy of data. His deliberations

and safeguards seemed excessive to Harkin's allies and they protested to the

senator, who conveyed the message to NIH. Jacobs stood his ground, arguing

that politics should not replace the scientific [End Page 285] method. One

of the first field trials scheduled would investigate Royden Brown's bee

pollen capsules. Jacobs himself went to Arizona to discuss with Brown the

plans for a test. It was agreed that a professor at the University of Texas

Medical Center at Tyler would prepare the protocol to govern a double-blind

placebo-controlled study using patients with pollen-sensitive asthma and hay

fever. Later, when Harkin convened a hearing before his subcommittee to

inquire why field studies were not proceeding more rapidly, Jacobs provided

a countertestimonial to Harkin's praise of Brown's product: "When I was

there," Jacobs told the senator, "I was suffering really bad from allergies.

. . . I took his therapy and became nauseous and almost vomited. . . . I

tried the bee pollen. It did not work for me." 37

From another direction, critics worried that the OAM would turn into a haven

for quacks. "It could be true," Jacobs replied, "if we didn't apply rigorous

scientific evaluation to the various therapies. Yes, there are plenty of

charlatans out there. Some may test us. Some may even engage us and try to

enhance their marketability just by their association with NIH, no matter

what we conclude." 38 This, indeed, was happening, even on the part of

members of the advisory committee, leading to warnings from NIH officialdom.

39 Jacobs trusted that the OAM would at least take away from quacks "the

Galileo ploy," the boast that in the future their now-derided products would

be recognized as miracle medicines. 40

Amidst such tensions, the work of the OAM gradually got under way. The

publication of an article in the N. Engl. J. Med. in January 1993 focused

national attention on the object of the Office's concern. The Harvard

authors, led by David Eisenberg (a member of the OAM's policy committee),

surprised the nation's medical community by reporting how prominent a role

alternative medicine played in Americans' health-care choices: one out of

three Americans in 1990 had resorted to unconventional therapies. The total

medical bill came to nearly $14 billion, about 30 percent of it covered by

insurance. Those who consulted alternative practitioners averaged nineteen

visits during the year; indeed, the total visits to alternative therapists

outnumbered visits to primary care physicians by 425 million to 388 million.

41 Such therapies, proclaimed a New [End Page 286] York practitioner, "are

now as American as mom and apple pie." 42 Commentators like Stephen Barrett

thought that the survey's authors had overstated their case: the categories

chosen included approaches that were already widely accepted in mainline

medicine, such as self-help groups, relaxation therapy, exercise,

biofeedback, hypnosis, massage, and commercial weight-loss clinics. 43

The report increased the already widespread public discussion about the

scope and merit of alternative medicine and the reasons for its expanding

popularity. Its domain encompassed a very long, amorphous spectrum--ranging

from procedures already tested and respectable, through sects of the

nineteenth century such as homeopathy (now regaining energy), through

imports of ancient Oriental systems from China and India, to indubitable

domestic quackery whose promoters sought to crowd under a canopy gaining in

notoriety, and even in respect. 44

A great many Americans came to regard alternative medicine as more congenial

than mainstream scientific medicine. Such converts found much to condemn in

conventional medicine. Physicians seemed too hurried, brusque, and

uncommunicative, as well as too rich, privileged, and arrogant. 45 Their

perspective was too "reductionist," seeking a single disease-causing factor

instead of considering a patient's overall condition. 46 And their track

record was spotty: the war on cancer had not been [End Page 287] won, nor

had AIDS, arthritis, and back pain been conquered. 47 "There is an erosion,"

said Dr. Jacobs, "of the power of the high priest of medicine." 48

Disillusioned, many citizens said to themselves: "I'm an informed consumer.

I'll find something." 49 In their search they did not have far to look. The

desire to take greater charge of one's own health had deep roots in the past

of the nation. Nineteenth-century feminists considered health reform an

important element of the women's rights movement, and this perspective has

gained new vigor in recent decades. 50 Our Bodies, Ourselves, published in

1971, favored holistic health. 51 That title would also fit a book for males

of the boomer generation with their assertive desire to control their

destiny: as boomers have aged, they have become increasingly obsessed with

health, with keeping young, thin, vigorous, and disease-free. 52

The broader culture nudged men and women in the alternative direction.

Hollywood and Madison Avenue portrayed the ideal image: "energy-packed,

physically perfect, and pain-free." 53 Moreover, alternative promoters have

always been "good at selling themselves." 54 A quarter of nonfiction

hardback bestsellers concern self-care and fitness, a high proportion of

them espousing alternative approaches. 55 Such "wide-eyed enthusiasm" also

pervades the considerable attention given the alternative theme on TV talk

shows and in magazines, newsletters, and movies. 56 [End Page 288] There has

been a massive amount of frank advertising in infomercials and direct mail,

by long-distance phone, and more recently on the internet, 57 and the

ability to make a sound judgment in complex fields may be doubted in a

nation in which about half the adults cannot write a letter or calculate a

bus trip from a printed schedule. 58 When fear enters in, as with cancer and

AIDS, even the best educated and the most well-to-do are not exempt from

resorting to alternative options. 59

What has appealed to converts to alternative medicine is the closer

relationship to practitioners, who spend eight times as much time with them

as do mainstream physicians. 60 Also, the procedures are cheaper, simpler,

and more open to the patient's own participation, and they are pitched as

less risky and more natural. They also explicitly address mental, emotional,

and spiritual, as well as physical, components of humanity. Moreover,

age-old factors, the placebo effect and the healing power of nature, are

still at work--bringing relief to many patients, renewing the post hoc, ergo

propter hoc fallacy, and confirming the patient's faith in the practitioner.

Alternative practitioners and vendors make bold therapeutic promises, most

of which remain untested with scientific rigor. 61

To launch such tests was Dr. Jacobs's mission. Alternative medicine, to be

sure, was not an absolutely fresh theme at the NIH: the Institutes had spent

$13 million studying unconventional treatments and had projects under way

investigating acupuncture, transcendental meditation, and Navajo herbs and

healing ceremonies. 62 Jacobs would seek to avoid duplication while

maintaining close liaison. A considerable portion of the OAM's first-year

appropriation was given to the National Cancer Institute (NCI) to support

its study, begun in 1991, of Dr. Burzynski's antineoplastons, although in

1995 this project was halted when the NCI [End Page 289] and Burzynski could

not agree on a definition of new patients to be added to the study group. 63

With the initial budget of $2 million--which Jacobs joked was "a homeopathic

level of funding" 64 --the OAM held its initial competition for one-year

grants. Standard NIH peer review procedures were followed in evaluating 425

proposals, and 30 awards of about $30,000 each were made. The recipients

represented major universities across the nation. The diseases involved

included AIDS, asthma, cancer, cystic fibrosis, depression, and

Parkinsonism. Treatment methods ran a broad gamut, including acupuncture,

Ayurveda, electrochemical current, guided imagery, homeopathy, hypnosis,

macrobiotic diet, massage, music therapy, t'ai chi, and intercessory prayer.

Jacobs's central plan for a network of university centers to perform

sophisticated research on aspects of alternative medicine was thwarted by

the Harkin allies on the advisory council. 66 Only two such centers received

initial approval: at Bastyr University, a naturopathic institution in

Seattle, to assess unconventional therapies for AIDS; and at the University

of Minnesota Medical School, to focus on alternative treatments for

substance abuse.

Jacobs, in turn, remained cautious about proceeding with field

investigations. He thought that his opponents, unable to distinguish good

science from anecdote and wishful thinking, intended to bring dubious

products swiftly to the marketplace. 67 Senator Harkin at his hearing sided

with his council allies, Bedell and Wiewel, and threatened to use "the power

of the purse" unless planned studies were speeded up. 68 Jacobs's opponents

also thwarted his desire to place on the advisory council a member of the

American Cancer Society's Committee on Questionable Methods of Cancer

Management. 69 The director's foes kept up their carping criticism. Wiewel

opined: "The office is not only supposed to look at alternatives, but to

look at them in innovative ways, and this is [End Page 290] where we hit a

snag with Dr. Jacobs." 70 The director also failed, his enemies said, at

administering his office. The bitterness of controversy and the sense of

frustration broke Jacobs's will to fight, and he resigned his office,

leaving the OAM in September 1994 after a tenure of less than two years. 71

As he departed to return to his former home, he quipped: "I prefer the ticks

of Connecticut to the politics of Washington." 72

The Los Angeles Times editorialized, anticipating that valuable results

would yet come from the scientific evaluation of alternative medicine, but

regretting the pressures that had resulted in Jacobs's resignation.

"However, there are dangers," the writer warned: "Alternative medicine has

provided fertile ground for all manner of snake-oil salesmen and other scam

artists who prey on the desperate and gullible. . . . There is a crying need

for an agency like the NIH to separate the wheat from the chaff." 73

Nonetheless, observed another journalist, "it will require all but a

magician of a new director to resolve" the conflict between mainstream

scientists and the most determined champions of unconventional medicine. 74

In January 1995, four months after Dr. Jacobs's departure, NIH director

Harold Varmus announced the appointment of a successor, Dr. Wayne B. Jonas,

who assumed his duties in July. "His background and experience," noted Ruth

Kirschstein, the NIH deputy director, made him "the ideal candidate." 75

While still in medical school at Bowman Gray, Jonas had begun experimenting

with alternative remedies. "I was looking for solutions to help patient

problems that I didn't have tools necessarily to help," he explained. 76 As

an Army officer managing a general hospital in Dexheim, Germany, Jonas

became persuaded of homeopathy's efficacy in primary care practice.

Returning to America, he worked as a consultant in health promotion policy

for the Army surgeon general's office, then directed the Medical Research

Fellowship [End Page 291] at Walter Reed Army Institute of Research. His

special concern became research methodology as applied to both conventional

and alternative medicine areas. He had a faculty appointment at the

Uniformed Services University of the Health Sciences, where he codirected an

alternative medicine seminar. Dr. Jonas had become involved with the Office

of Alternative Medicine at its first formal meeting, speaking on research

techniques; later, he chaired a conference on research methodology in

alternative medicine and contributed on that topic to the Chantilly

conference volume. He came to his new responsibilities convinced of their

importance: "It is no longer possible to look at . . . [alternative

medicine] as a medical side issue," he remarked; "these practices have

become part of an overall strategy that patients use." 77 Research in the

field must be "scientifically rigorous and contextually sensitive," 78 yet

variant approaches must be developed to address some of "our most burdensome

and difficult problems in medicine." 79 Such research, he believed, would

separate the good from the bad in a complex environment. And he was firmly

persuaded that "fringe ideas" held the promise of containing new kinds of

knowledge that could transform science.

Determined, articulate, and managerial, Dr. Jonas promptly reorganized the

Office into six functional sections, concerned with intramural training,

evaluation of research, sponsorship of extramural research, provision of

technical support for research, dissemination of information to the public,

and maintenance of liaison with concerned organizations in the nation and

throughout the world. 80 Dr. Kirschstein, Jonas's NIH superior, asserted:

"The OAM has a sense of activity and stability for the first time." 81 The

staff doubled in size, and the Congress, with Republicans taking charge of

committees in 1995, continued expanding the Office's budget to reach nearly

$12 million for fiscal 1997. 82

Jonas's tendencies lay more in the direction of Jacobs's preferences than

toward the desires of Harkin's allies. The controversial Field

Investigations Program received a new name: the Research Development and

[End Page 292] Investigation Program; its projects, all "stalled for various

reasons," were "essentially starting over and . . . [would] have to undergo

screening and evaluation." 83 The bee pollen capsule investigation, as of

late 1996, was still on hold. Jonas asserted that his Office did not intend

to test "every unlikely claim": probably more than 90 percent would be

"screened out as low priority" and not evaluated. 84

In October 1995 the OAM took a major step toward effectuating Dr. Jacobs's

cherished goal of supporting research groups in alternative medicine at

major universities when eight such centers were funded, four of them in

collaboration with other parts of NIH. 85 The grants were for three years,

the first to be devoted to assessing the state of knowledge in the special

area of the grant and to defining top priority research opportunities, which

would be undertaken in the second and third years. The Kessler Institute for

Rehabilitation of the University of Medicine and Dentistry of New Jersey

would investigate alternative techniques used to rehabilitate victims of

stroke, brain injury, and spinal cord injury. At the Columbia University

College of Physicians and Surgeons, alternative methods to alleviate a wide

range of women's health problems would be explored. At the University of

Maryland School of Medicine, a wide range of modalities for treating

pain--including bioelectromagnetics and mind-body control--were to be

studied. At the Harvard Medical School, initial attention would concentrate

on low-back pain and coronary artery disease. At the University of Virginia

School of Nursing, the problem would be management of acute and chronic

pain, especially from cancer, with particular attention to psychosocial

factors. The University of California, Davis, would investigate asthma and

allergy treatment. Stanford researchers would seek alternative therapies to

prevent or manage disability and frailty and to enhance quality of life

among the elderly. At the Texas Health Science Center in Houston,

researchers sought to evaluate therapies for cancer prevention and

treatment. Seventy-eight percent of the inquiries being made by the public

to the Office of Alternative Medicine related to cancer, and in 1994 an NIH

report had named specific alternative approaches to cancer as high

priorities for [End Page 293] research and evaluation. 86 The Texas list for

possible study contained well-known unorthodox treatments with questionable

reputations in the ranks of the orthodox: antineoplastons, cartilage

products, immunoaugmentative therapy (IAT), 714-X. Even Harry Hoxsey's

therapy, long since driven from use in the United States by Food and Drug

Administration action, was mentioned. 87 The Hoxsey method--as well as IAT

and antineoplastons--was also considered worthy of new study by the

alternative medicine subsection of the American Public Health Association.

Although research centers had been established at only ten institutions,

many other medical schools had begun to show an interest in alternative

medicine, introducing courses and launching research. By mid-1996, some

thirty medical schools had such courses. 89

While the OAM's sponsored research was still in an early phase, the Office

continued busy on other fronts. With a cue from Congress, its staff sought

to broaden the agency's name, adding the more diplomatic word

"Complementary," with its cooperative tone, to the word "Alternative," with

its flavor of conflict. 90 Officials worked with the National Library of

Medicine to get new terms added to the indexes of its databases:

acupressure, health food, imagery, meditation, therapeutic touch. 91 OAM

expanded its contacts with organizations across the nation and around the

world. 92 Its staff answered a thousand telephone inquiries a month and

issued fact sheets on such pertinent topics as Biofeedback, Shark Cartilage,

and HIV/AIDS and Alternative Therapies. 93

A significant aspect of the OAM's activity was participating in conferences,

most sponsored by the Office itself. Some of these sought to educate

proponents of alternative therapies in the requirements of sophisticated

research. 94 Others, like a January 1997 meeting between [End Page 294]

staffers from the OAM and the Centers for Disease Control and Prevention

(CDC), sought to broaden mutual understanding. 95 Two assemblies, jointly

sponsored with the Food and Drug Administration (FDA), dealt with botanicals

and the standards that must be met to enter them into the FDA's approval

system. 96 Two technology assessment conferences sought to evaluate specific

therapeutic methodologies. One of them, also cosponsored by the FDA, dealt

with acupuncture and resulted in the FDA's reclassifying acupuncture needles

from "investigational use" to general use when employed by qualified

practitioners. 97 An NIH Consensus Development Conference on Acupuncture was

scheduled for November 1997. 98 The other technology assessment conference

considered the "Integration of Behavioral and Relaxation Approaches into the

Treatment of Chronic Pain and Insomnia." At its conclusion, a three-member

summarizing panel gave a qualified endorsement to the use of meditation,

hypnosis, and biofeedback in conjunction with conventional medical care. 99

In December 1996 the OAM held a conference on placebos and nocebos. 100

Granted that OAM-sponsored researches are still in their early stages, could

any other positive accomplishments be reported? In a speech Dr. Jonas cited

recent evidence of the merit of certain botanicals: ginkgo for treating

dementia due to circulation problems; saw palmetto for treating benign

prostate hypertrophy; St. John's Wort (Hypericum ) for treating depression.

101 Dr. Robert Temple of the FDA, now on the OAM's advisory council, sees

the greatest expectation for useful discovery in the area of botanicals. 102

A recipient of a preliminary grant published a paper demonstrating [End Page

295] the value of acupuncture in reducing pain during dental surgery, and a

second grantee told the advisory council of his pilot study indicating

acupuncture's value as adjunctive therapy for osteoarthritis of the knee.

103 A third grantee reported one of the yoga techniques as beneficial in

treating obsessive-compulsive disorders, and other examples could be cited,

but there has been continuing criticism that the Office of Alternative

Medicine has not established a record of greater accomplishment--that,

indeed, its key mission may prove illusory, especially establishing the

therapeutic usefulness of major alternative systems like Ayurvedic medicine,

ancient Chinese medicine, and homeopathy.

Mainline scientists have criticized both the method by which the OAM decided

upon grants and the nature of the grants awarded. The University of Virginia

center's proposal, for example, involving the presumed therapeutic power of

magnets, a reporter wrote, "has drawn guffaws from leading scientists." 104

An author in Scientific American considered it inappropriate for Dr. Jonas,

while directing an office making scientific judgments about alternative

approaches, to write a book in collaboration with a member of his advisory

committee, Jennifer Jacobs of the University of Washington, entitled Healing

with Homeopathy: The Complete Guide. The book is described on the jacket as

"The Natural Way to Promote Recovery and Restore Health"; it is a work

infused with the "emotional depth and passion" of a true believer. 105

Panelists at the American Association for the Advancement of Science

convention in February 1997, at a session on "Alternative Medicine in a

Scientific World," sought to expose weaknesses in research allegedly

demonstrating the utility of various alternative approaches. 106

As Congress began to consider appropriations for the 1998 fiscal year, the

chairman of the House Labor, HHS and Education Appropriations Subcommittee,

John F. Porter of Illinois, received stern letters from some [End Page 296]

of the nation's leading physicists suggesting that funds for the Office of

Alternative Medicine be terminated. Professor Allan Bromley of Yale,

president of the American Physical Society, declared: "The OAM has emerged

as an undiscriminating advocate of unconventional medicine. It has bestowed

the considerable prestige of the NIH on a variety of highly dubious

practices, some of which clearly violate the laws of physics and more nearly

resemble witchcraft than medicine." 107 Despite such criticism, however,

Senator Harkin was proposing an expansion in funds bestowed upon the OAM.

On theoretical grounds, the entire mission of the Office of Alternative

Medicine had already been condemned as misguided-- "Buying Snake Oil with

Tax Dollars," in the words of two scientists. 108 Another analyst, Jack

Raso, had found inherent in the systems and methods of alternative medicine

not objective science but "implicit or overt supernatural premises," 109 a

"vital force," 110 a "nonmaterial, divine, or personalized form of energy"

111 beyond the reach of physics and thus irrelevant to scientific health

care. A logician at the University of Delaware, Douglas Stalker, had argued

that alternative therapies flunk the rules of evidence so outrageously that

they do not even warrant testing in a clinical trial format. "The Congress,"

he concluded, "should find something better to do with its money." 112

It is not likely that Congress will listen to Stalker's or to Bromley's

advice. More likely, it will enact a law it has been considering since 1994

that would make the dispensing of unproven therapies, granted the

practitioner and the patient agree, even more unrestrained. 113 The resort

to alternative approaches continues to grow rapidly, aided by expanding

media attention, by increasing insurance and HMO coverage, and by laws

requiring coverage in various states, led by the state of Washington. 114

[End Page 297] Alternative over-the-counter products also are booming, their

episodes of threat to health increasingly worrisome. 115 Whether sound

science can master the challenge of hazardous alternatives and reveal what

utility they may possess looms as a major public health challenge of the new

millennium.

James Harvey Young, Candler Professor of American Social History Emeritus at

Emory University, resides at 272 Heaton Park Drive, Decatur, Georgia

30030-1027 (e-mail: jyoun02@emory.edu). His research has focused on the

history of food and drug regulation and of health quackery in America. His

books include The Toadstool Millionaires (1961), The Medical Messiahs

(1967), Pure Food (1989), and American Health Quackery (1992).

Notes

Some of the material in this article has appeared in James Harvey Young,

"Health Fraud: A Hardy Perennial," J. Policy Hist., 1997, 9 (1): 117-40,

permission of The Pennsylvania State University Press. A shorter version was

presented at the seventieth annual meeting of the American Association for

the History of Medicine in Williamsburg, Va., 4 April 1997.

1. "OAM Legislative History," Seventh Meeting of the Alternative Medicine

Program Advisory Council, Office of Alternative Medicine, National

Institutes of Health (Bethesda, Md.: Office of Alternative Medicine, 1996),

p. 41. The charter for the Office was established in Section 404E of the NIH

Revitalization Act of 1991.

2. Ibid.

3. Margaret Mason, "Health Quest," Washington Post, 26 June 1992, p. D5;

Stephen Budiansky, "Cures or 'Quackery'?" US News and World Report, 17 July

1995, pp. 48-51.

4. Alternative Medicine, Hearing before a Subcommittee of the Committee on

Appropriations, United States Senate, 103d Cong., 1st sess., 24 June 1993

(Washington, D.C.: Government Printing Office, 1993), p. 95, quotation on p.

103; see also pp. 102-7; David Brown, "A New Look at Alternative Therapies,"

Washington Post, Health, 23 June 1992, p. 8; Mary Beth Regan, "Will a Cup of

Cow's Whey Keep the Doctor Away?" Business Week, 12 December 1994, p. 96;

Budiansky, "Cures or 'Quackery'?" (n. 3).

5. Budiansky, "Cures or 'Quackery'?" (n. 3); Eliot Marshall, "The Politics

of Alternative Medicine," Science, 1994, 265: 2000-2; Frank Wiewel,

"Alternative Medicine Warrants Study," Des Moines Register, 21 December

1994, p. 10; James Harvey Young, American Health Quackery (Princeton:

Princeton University Press, 1992), p. 244; Kathleen Canavan, "First OAM

Council Meeting Highlights Acrimony," U.S. Medicine, October 1994, pp. 6-7.

6 . Kenneth Silber, "Alternative Medicine Agency Can't Bridge Gap,"

Washington Times, 8 December 1994, pp. A10 and A11.

7. Budiansky, "Cures or 'Quackery'?" (n. 3); Alternative Medicine (Hearing)

(n. 4), pp.

2-4.

8 . CC Pollen Company, Docket C-3419, 16 March 1992, Federal Trade

Commission; Paragraph 23,310, CC Pollen Co. et al., Consent order to cease

and desist, File No. 902 3145, announced 30 December 1992; Commerce Clearing

House, Trade Regulation Reporter, 13th ed., 291 A, 1 December 1993, pp. 22,

985-86.

9. Chris Frampton, "Alternative Medicine Gets Official Study," Wall Street

Journal, 2 August 1993, p. B7C.

10. Bernadine Healy cited in Gina Kolata, "In Quests Outside Mainstream,

Medical Projects Rewrite Policy," New York Times, 18 June 1996, p. A14; see

also p. A1.

11. Silber, "Alternative Medicine Agency" (n. 6).

12. Daniel Glick, "New Age Meets Hippocrates," Newsweek, 3 July 1992, p. 58.

13. Ibid.

14 . NIH, "Ad Hoc Panel on Unconventional Medical Problems, June 17-18,

1992," author's collection; Jim Bryant, "NIH Panel Reviews 'Unconventional'

Medical Practices," NIH Record, 7 July 1992, 44: 1, 6; Naomi Freundlich, "A

Cardiac Crusader Heads for Main Street," Business Week, 29 November 1993,

pp. 90, 94.

15. Stephen Barrett and Victor Herbert, The Vitamin Pushers: How the "Health

Food" Industry is Selling America on a Bill of Goods (Amherst, N.Y.:

Prometheus Books, 1994), p. 371.

16. Bryant, "NIH Panel" (n. 14), p. 1.

17. Ibid., p. 6.

18. Ibid.

19. Brown, "New Look" (n. 4), p. 8; see also Mason, "Health Quest" (n. 3).

20. Brown, "New Look" (n. 4), p. 8.

21 . Stephen Barrett, "'Alternative' Therapy, Buzzword for the '90s,"

Nutrition Forum, 1993, 10: 1-3.

22 . Alternative Medicine: Expanding Medical Horizons, A Report to the

National Institutes of Health on Alternative Medical Systems and Practices

in the United States (Washington, D.C.: Government Printing Office, [1995]),

p. vii.

23. Ibid.

24. Budiansky, "Cures or 'Quackery'?" (n. 3), p. 50.

25. Robert L. Park, "The Danger of Voodoo Science," New York Times, 9 July

1995, p. 15.

26. Natalie Angier, "Where the Unorthodox Gets a Hearing at N.I.H.," New

York Times, 16 March 1993, pp. C1 and C2, quotation on p. C1. Jacobs's

career is sketched also in Marilyn Achirov and Linda Kramer, "Medicine Man,"

People, 12 April 1993, 39: 95-97; and in Diana McLellan, "Medicine Man,"

Washingtonian, May 1993, 23: 46-47, 124-25.

27. McLellan, "Medicine Man" (n. 26), p. 47.

28. Silber, "Alternative Medicine Agency" (n. 6), p. A10.

29. Angier, "Where the Unorthodox" (n. 26), p. C1.

30. Paul Trachtman, "NIH Looks at the Implausible and the Inexplicable,"

Smithsonian, September 1994, 25: 121.

31. McLellan, "Medicine Man" (n. 26), p. 124.

32. Anastasia Toufexis, "Dr. Jacobs' Alternative Mission," Time, 1 March

1993, pp. 43-44.

33. Trachtman, "NIH Looks" (n. 30), p. 117.

34. Achirov and Kramer, "Medicine Man" (n. 26), pp. 95-96.

35 . McLellan, "Medicine Man" (n. 26); Toufexis, "Dr. Jacobs' Alternative

Mission" (n. 32); Trachtman, "NIH Looks" (n. 30), p. 117.

36. Alternative Medicine (Hearing) (n. 4), pp. 102-7; Trachtman, "NIH Looks"

(n. 30), p. 117; Silber, "Alternative Medicine Agency" (n. 6).

37. Alternative Medicine (Hearing) (n. 4), pp. 116-17, quotation on p. 134.

38. McLellan, "Medicine Man" (n. 26), p. 125.

39. Budiansky, "Cures or 'Quackery'?" (n. 3); open letter by William Jarvis

of The National Council Against Health Fraud, Inc., 1993, author's

collection.

40. Silber, "Alternative Medicine Agency" (n. 6), p. A10.

41 . David M. Eisenberg et al., "Unconventional Medicines in the United

States--Prevalence, Cost, and Pattern of Use," N. Engl. J. Med., 1993, 328:

246-52.

42. Ralph White quoted in Beth Baker, "New Medicine: Healing or Hoax?" AARP

Bull., March 1993, 34: 2, 9, quotation on p. 2.

43. Barrett, "'Alternative' Therapy" (n. 21).

44 . "Alternative Medicine: The Facts," Consumer Rep., January 1994, 59:

51-54; Norman Gevitz, ed., Other Healers: Unorthodox Medicine in America

(Baltimore: Johns Hopkins University Press, 1988); Andrew Stanway,

Alternative Medicine: A Guide to Natural Therapies (London: Bloomsbury

Books, 1980); Douglas Stalker and Clark Glymour, eds., Examining Holistic

Medicine (Buffalo: Prometheus Books, 1985); Jack Raso, "Alternative"

Healthcare: A Comprehensive Guide: Natural Medicine, "Hands-On" Healing,

Spiritualism, Occultism, and Much More (Amherst, N.Y.: Prometheus Books,

1994); Kurt Butler, A Consumer's Guide to "Alternative Medicine": A Close

Look at Homeopathy, Acupuncture, Faith-Healing, and Other Unconventional

Treatments (Amherst, N.Y.: Prometheus Books, 1992); Barrett, "'Alternative'

Therapy" (n. 21).

45. Achirov and Kramer, "Medicine Man" (n. 26); "Alternative Medicine," CQ

Researcher, 31 January 1992, pp. 73-96; Gina Kolata, "On Fringes of Health

Care, Untested Therapies Thrive," New York Times, 17 June 1996, pp. A1 and

C11; Baker, "New Medicine" (n. 42).

46. Silber, "Alternative Medicine Agency" (n. 6); Barrie R. Cassileth and

Christopher C. Chapman, "Alternative and Complementary Cancer Therapies,"

Cancer, 15 March 1996, 77: 1026-34.

47 . "Offbeat Therapies Go to Washington," editorial, Los Angeles Times

(Washington Edition), 17 October 1994, p. A10; Steve Salerno, "Alternative

Medicine," Amer. Legion, April 1994, pp. 22-24, 57-60.

48. Jacobs cited in Baker, "New Medicine" (n. 42), p. 2.

49. Anne Rochell, "Uncommon Cures," Atlanta Journal/Atlanta Constitution, 19

November 1994, p. E1.

50 . Naomi Rogers, "Women and Sectarian Medicine," and Susan E. Cayleff,

"Self-Help and the Patent Medicine Business," in Women, Health, and Medicine

in America, ed. Rima Apple (New York: Garland, 1990), pp. 281-310, 311-36.

51. Boston Women's Health Course Collective, Our Bodies, Ourselves: A Course

by and for Women (Boston: New England Free Press, 1971).

52 . "Alternative Medicine," CQ Researcher (n. 45); Kolata, "Fringes of

Health Care" (n. 45); Edward W. Campion, "Why Unconventional Medicine?" N.

Engl. J. Med., 1993, 328: 282-83; Suzanne Hamlin, "Health Letters Scratch

Out a Niche," New York Times, 9 August 1995, pp. C1 and C2.

53. Campion, "Why Unconventional Medicine?" (n. 52), p. 283.

54. John Renner quoted in Rochell, "Uncommon Cures" (n. 49), p. E1.

55 . Michael D. Hinds, "Coping with Self-Help Books," New York Times, 16

January 1988, p. 33.

56. "Mind Over Malady," Time, 1 March 1993, p. 44; Sharon Begley, "Helping

Docs Mind the Body," Newsweek, 8 March 1993, p. 61; Hamlin, "Health Letters"

(n. 52).

57. James E. Tierney, testimony, in U. S. House Select Committee on Aging,

Quackery: A $10 Billion Scandal, Hearings before the Subcommittee on Health

and Long-Term Care of the Select Committee on Aging, 98th Cong., 2d sess.,

1984, 178; Anthony Ramirez, "A Crackdown on Phone Marketing," New York

Times, 10 February 1995, pp. D1 and D2; Edward Baig, "The Medical Hot Line

in Your PC," Business Week, 20 February 1995, pp. 101-2.

58. William Celis III, "Study Says Half of Adults in U.S. Lack Reading and

Math Abilities," New York Times, 9 September 1993, p. A1.

59 . Barrie R. Cassileth et al., "Contemporary Unorthodox Treatments in

Cancer Medicine," Ann. Intern. Med., 1984, 101: 105-12; Young, American

Health Quackery (n. 5), p. 257.

60. "Alternative Medicine," CQ Researcher (n. 45).

61. Trachtman, "NIH Looks" (n. 30); Glick, "New Age" (n. 12); Campion, "Why

Unconventional Medicine?" (n. 52); Baker, "New Medicine" (n. 42).

62 . McLellan, "Medicine Man" (n. 26); Toufexis, "Dr. Jacobs' Alternative

Mission" (n. 32); Regan, "Will a Cup" (n. 4); Rochell, "Uncommon Cures" (n.

49).

63. Alternative Medicine (Hearing) (n. 4), pp. 108, 135; National Cancer

Institute, "NCI-Sponsored Clinical Trials of Antineoplastons," Cancer Web,

1996.

64. Trachtman, "NIH Looks" (n. 30), pp. 110-23, quotation on p. 121.

65. NIH OAM Grant Recipients, 6 October 1993, author's collection; Silber,

"Alternative Medicine Agency" (n. 6).

66. Alternative Medicine (Hearing) (n. 4), pp. 7-12; Marshall, "Politics"

(n. 5); Silber, "Alternative Medicine Agency" (n. 6).

67 . Natalie Angier, "U.S. Head of Alternative Medicine Quits," New York

Times, 1 August 1994, p. 11; Silber, "Alternative Medicine Agency" (n. 6).

68. Alternative Medicine (Hearing) (n. 4), p. 110. See also Regan, "Will a

Cup" (n. 4).

69 . Jack Raso, "The Three Faces of Medical Unreason," Nutrition Forum,

September/October 1994, 11: 43.

70. Angier, "U.S. Head" (n. 67), p. 11.

71. Ibid.; Budiansky, "Cures or 'Quackery'?" (n. 3); Marshall, "Politics"

(n. 5); Silber, "Alternative Medicine Agency" (n. 6).

72. Angier, "U.S. Head" (n. 67), p. 11.

73. "Offbeat Therapies Go to Washington" (n. 47), p. A10.

74. Angier, "U.S. Head" (n. 67), p. 11.

75. NIH News release, 15 January 1995, author's collection. See also "OAM

Director Outlines Office Mission and Accomplishments," Complementary and

Alternative Medicine at the NIH, December 1995, 2: 1, 4-5. Biographical

information can be found in Office of Alternative Medicine, "Wayne B. Jonas,

M.D., Biographical Sketch," author's collection; Gary Stix, "Profile: Wayne

B. Jonas," Sci. Amer., 1996, 275: 52, 56; Charles Marwick, "Complementary

Medicine Congress Draws a Crowd," JAMA, 1995, 274: 106-7.

76. Dr. Wayne B. Jonas, interview by author, 8 October 1996, NIH Historical

Office, National Institutes of Health, Bethesda, Maryland.

77. Cited in M. A. J. McKenna, "Conference Highlights Alternative Medicine's

Growing Legitimacy," Atlanta Journal/Atlanta Constitution, 31 March 1995, p.

A9.

78. Wayne B. Jonas, "Remarks to the D.C. Science Writers Association," 2

November 1995, p. 5, author's collection.

79 . Ibid., p. 10. See also Stix, "Profile" (n. 75); Wayne B. Jonas,

"Researching Alternative Medicine," Nature Med., August 1997, 3: 824-27.

80. Jonas, "Remarks" (n. 78).

81 . "AM Advisory Council Meets New OAM Staff and Reviews Progress,"

Complementary and Alternative Medicine at the NIH, December 1995, 2: 1, 6-7,

quotation on p. 6.

82 . Jonas, "Remarks" (n. 78); Kolata, "In Quests" (n. 10); "OAM Budget

Update," Complementary and Alternative Medicine at the NIH, January 1997, 4:

83. "AM Advisory Council" (n. 81), p. 7.

84. Wayne B. Jonas, "U.S. Health Agency Isn't Pushing Alternative Medicine,"

New York Times, 9 January 1996, p. 30.

85. "OAM Funds Eight Research Centers to Evaluate Alternative Treatments,"

Complementary and Alternative Medicine at the NIH, December 1995, 2: 2, 8;

Michael Villaire, "OAM Sets Goals for Eight New Centers; Centers Provide

Initial Details," Alternative Therapies, March 1996, 2: 20, 22, 90; "OAM

Research Center Summaries," Seventh Meeting (n. 1), pp. 93-127.

86. Jennifer M. King, "Alternative Medicine Goes Intramural," NIH Catalyst,

July-August 1996, 4: 5-6; Villaire, "OAM Sets Goals" (n. 85).

87. James Harvey Young, The Medical Messiahs: A Social History of Health

Quackery in Twentieth-Century America (Princeton: Princeton University

Press, 1967, 1992), pp. 360-89.

88 . Alternative and Complementary Health Practices Spig Newsl., American

Public Health Association, Fall 1996, p. 4.

89 . Ellen Hughes, "Understanding Alternative Medicine: Implications for

Clinical Practice," in Common Problems in Primary Care: An Evidence-Based

Approach for the Managed Care Era (San Francisco: American College of

Physicians, 1996), pp. 175-98.

90. Summary Minutes, Seventh Meeting (n. 1), p. 12.

91. Database and Evaluation, ibid., p. 15.

92 . Wayne B. Jonas, "General Overview," 9 February 1996, author's

collection.

93. King, "Alternative Medicine" (n. 86).

94. A typical conference was "Examining Research Assumptions in Alternative

Medical Systems," 11-13 July 1994.

95. "Complementary and Alternative Medicine--Evaluation and Surveillance,"

Atlanta, Ga., 9 January 1997.

96. Jonas, interview by author (n. 76); Dr. Freddie Ann Hoffman, interview

by author, 16 October 1996, author's notes; and Dr. Robert Temple, interview

by author, 17 October 1996, author's notes.

97. The transactions of the technology assessment workshop on acupuncture,

21-22 April 1994, were published in the Spring 1996 issue of vol. 2 of J.

Alternative and Complementary Med. See also FDA Talk Paper, T96-21, 1 April

1996, author's collection.

98. OAM News and Events Calendar, 1997.

99 . "NIH Panel Endorses Alternative Therapies for Chronic Pain and

Insomnia," Complementary and Alternative Medicine at the NIH, December 1995,

2: 3, 9; NIH Technology Assessment Panel on Integration of Behavioral and

Relaxation Approaches into the Treatment of Chronic Pain and Insomnia,

"Integration of Behavioral and Relaxation Approaches into the Treatment of

Chronic Pain and Insomnia," JAMA, 1996, 276: 313-18. The conference dates

were 16-18 October 1995.

100 . "OAM Sponsors Placebo and Nocebo Conference," Complementary and

Alternative Med. NIH, January 1997, 4: 3.

101. Jonas, "Remarks" (n. 78).

102. Temple, interview by author (n. 96).

103. "AM Advisory Council" (n. 81), p. 7; Summary Minutes, Seventh Meeting

(n. 1), p. 17. Results of some of the other early research are cited in

Research Grants, Office of Alternative Medicine, on the Internet,

http://altmed.od.nih.gov/oam/cgi-bin/research/form.cgi and are mentioned in

M. A. J. McKenna, "Unusual Prescriptions," Atlanta Journal/Atlanta

Constitution, 11 May 1997, p. C6, and in Jonas, "Researching Alternative

Medicine" (n. 79).

104. Kolata, "In Quests" (n. 10). Kolata's criticisms of alternative trends

were countered in Anne H. Coulter, "Alternative & Complementary Therapies

Presents an Objective Response to a Recent New York Times Series That

Disparages Alternative Medicine," Alternative & Complementary Therapies,

July/August 1996, 2: 253-58.

105. Stix, "Profile" (n. 75); Wayne B. Jonas and Jennifer Jacobs, Healing

with Homeopathy: The Complete Guide (New York: Warner Books, 1996).

106. Tapes of American Association for the Advancement of Science session on

"Alternative Medicine in a Scientific World," 14 February 1997.

107. "Scientists Campaign against NIH Alternative Medicine Office," Cancer

Letter, 11 July 1997, pp. 6-7, quotation on p. 6; Lois R. Ember,

"Alternative Medicine Slammed," Chem. Engin. News, 4 August 1997, 75: 26-27.

108 . Robert L. Park and Ursula Goodenough, "Buying Snake Oil with Tax

Dollars," New York Times, 3 January 1996, p. A11.

109. Raso, "Three Faces" (n. 69), p. 43.

110. Ibid., p. 45.

111. Ibid.

112. Douglas F. Stalker, "Evidence and Alternative Medicine," Mount Sinai J.

Med., 1995, 62: 132-43, quotation on p. 143.

113. Barrett and Herbert, Vitamin Pushers (n. 15), pp. 435-36.

114 . Robin Marantz Henig, "Medicine's New Age," Civilization, April/May

1997, 4: 42-49; "Alternative Medicine: Hope or Hype?," ABC Turning Point, 26

September 1996; Geoffrey Cowley, "Going Mainstream," Newsweek, 26 June 1995,

pp. 56-57; John Weeks, Operational Issues in Incorporating Complementary and

Alternative Therapies and Providers in Benefit Plans and Managed Care

Organizations (Seattle: Integration Strategies for Natural Healthcare,

1996); Seattle King County Department of Health, Final Report: Plan For

Natural Medicine Clinic, April 1995; Heath Foster, "Officials Back

Alternative Clinic," The News Tribune, Tacoma, Washington, 26 January 1996,

p. A1; Peter Jennings, ABC News, 31 January 1997; Clifford J. Levy, "Bill

Requires Insurers to Pay Chiropractors," New York Times, 19 June 1996, pp.

B1 and B5.

115. "Homeopathy: Much Ado About Nothing?" Consumer Rep., 1994, 59: 201-6;

Stewart Toy, "Take Two Eyes of Newt and Call Me in the Morning," Business

Week, 28 March 1994, pp. 144, 146; Dan McGraw, "Flu Symptoms? Try Duck?" US

News and World Report, 17 February 1997, pp. 51-52; Megan Rosenfeld,

"Tropical Noni, A Tonic Boom," Washington Post, 7 August 1997, p. A1.

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