NIH and Alternative Medicine

Under the urging of former Congressman Berkley Bedell and Senator Tom Harkin, Congress appropriated two million dollars last year and an additional two million this year for the creation of an Office of Alternative Medicine, under the auspices of the National Institutes of Health (NIH). In June and September, meetings were held near Washington, DC in which both practitioners of Alternative Medicine and the public made recommendations on how the Office should be set up and what it should study. In attendance were representatives from many disciplines, including nutritional therapy, alternative cancer therapy, energy medicine, psychoneuroimmunology, and structural therapies.

Although some individuals involved in the Alternative Medicine movement believe they have been unfairly treated in the past by NIH and other conventional medical institutions, it appeared to most attendees that the attitude of NIH toward the new Office was one of support, rather than sabotage.

A $2 million budget pales in contrast to the multibillion dollar annual NIH budget. Nevertheless, this type of seed money can set some important wheels in motion. Preliminary recommendations from the Office are that some of the funds be used to support “site visits” to clinics where promising treatments are being undertaken. If objective evidence shown that better-than-usual results are being obtained, then recommendations for further study will be made. In addition, individuals or clinics interested in conducting research on various aspects of Alternative Medicine may apply for a $50,000 research grant. Approximately ten such grants will be available in the present fiscal year.

Along with Townsend Letter editor, Jonathan Collin, M.D. and columnist Tori Hudson, N.D., I have been fortunate to be a member of the advisory panel concerned with diet, nutrition and lifestyle. We are in the process of writing a report which describes nutritional medicine and how it can be successfully incorporated into the medical mainstream. Emphasis will be placed on the cost effectiveness of specific treatments, a point which will hopefully catch the eye of a cost-conscious government.

Below are some examples included in the report:

Benign Prostatic Hypertrophy (Prostate enlargement)

Conventional Therapy: Surgery; medication; Proscar

Estimated Annual cost of conventional therapy: $2 billion for surgery (400,000 operations at $5,000 per operation - surgical fees and hospital costs) $1,080,000 for medication (2,000,000 men receiving treatment at $540 per person-year)

Alternative therapy: Oral capsules of an extract of Seronoa repens (saw palmetto berries). Double-blind studies have demonstrated effectiveness. This treatment is commonly used in Europe and costs 60% less than Proscar. Research suggests Seronoa repens is more effective with fewer side effects that Proscar.

Annual cost of therapy: $100-200 (median $150) Estimated annual cost savings with alternative treatment:

Total savings: $2.78 billion per year
$780 million saved by using Seronoa repens instead of Proscar. $2 billion saved by reducing surgical procedures by 50%.

Reference: Campault G, et al. A double-blind trial of an extract of the plant Seronoa repens in benign prostatic hyperplasia. Br J Clin Pharmocol 1984;18:461-462.

Peptic Ulcer

Conventional therapy: Medications: Tagamet, Zantac, Pepcid, Prilosec, Carafate.
Estimated annual cost of conventional therapy: $2 billion for medication

Alternative therapy: Extract of licorice root (deglycyrrhizinated licorice, or DGL). Studies have shown that DGL is as effective as Tagamet or Zantac, in healing peptic ulcers and in preventing recurrences. Side effects are less with DGL than with conventional therapy.

Cost of alternative therapy: Approximately one-third that of standard anti-ulcer drugs.

Estimated annual cost savings with alternative treatment: Approximately two-thirds of $2 billion, or about $1.33 billion.

Recommended study: Large-scale comparative of DGL and standard therapy.

Reference: Glick L. Deglycyrrhizinated liquorice for peptic ulcer. Lancet 1982;2:817.

Atherosclerosis (hardening of the arteries)

Conventional therapy: Medication, coronary artery bypass, balloon angioplasty, carotid artery bypass, femoral artery bypass, amputation.

Estimated annual cost of conventional therapy: $30 billion

Alternative therapies: Dietary modification: Nutritional therapy including vitamin C vitamin E, vitamin B6, magnesium, chromium, carnitine, Coenzyme Q10. These nutrients are often of value in the treatment of angina and congestive heart failure. Chelation therapy - An alternative to bypass surgery and angioplasty. It involves the intravenous infusion of EDTA, a drug which improves arterial blood flow.

Clinical observations and medical journal reports indicate that the need for surgery is eliminated more than half of the time, and the number of prescription medications can be frequently reduced with chelation therapy.

Cost of alternative therapy: Variable, depending on the nature and severity of the condition. However, as an example, the average cost of chelation therapy is around $3,000, compared to more than $30,000 for coronary artery bypass.

Estimated annual cost savings with alternative treatment: Estimates are difficult, but a saving of 30%, or $9 billion annually would be likely if all patients were offered alternative therapy.

Recommended study: Outcome comparison of alternative therapies and conventional therapy.


Acute Myocardial Infarction (heart attack)

Conventional Therapy: Fibrinolytic (“Clot-busting”) drugs such as tissue plasminogen activator (TPA) or streptokinase.

Estimated annual cost of conventional therapy: TPA costs $2,300 per dose, streptokinase $280 per dose. Approximately $500 million to $1 billion spent annually on these drugs.

Alternative therapy: Intravenous magnesium. Controlled studies show that magnesium reduces the death rate from acute myocardial infarction as much as or more than the fibrinolytic drugs and has fewer side effects. Magnesium costs about $5 per dose.

Estimated annual cost savings with alternative treatment: The cost of magnesium is negligible, so approximately $500 million to $1 billion would be saved annually if doctors used magnesium instead of fibrinolytic drugs.

Reference: Sheckter M, Hod H, Marks N, Behar S, Kaplinsky E, et al, Beneficial effect of magnesium sulfate in acute myocardial infarction. Am J Cardiol 1990;66:271-274.

Osteoarthritis

Conventional therapy: Nonsteroidal anti-inflammatory drugs.

Estimated annual cost of conventional therapy: $2-4 billion, including cost of medications and cost of treating complications of the medications (such as peptic ulcer and kidney failure)

Alternative therapy: Niacinamide, an inexpensive B-vitamin, ameliorates osteo- arthritis in at least 50% of cases, and is particularly effective against osteoarthritis of the knees. Side effects are negligible, although occasional monitoring of liver function tests is recommended. Identification and avoidance of allergenic foods. Approximately half of individuals with osteoarthritis will have improvement with specific dietary modifications. Using the above two approaches, at least half of individuals can control osteoarthritis without prescription medication.

Estimated annual cost savings with alternative treatment: Estimates are difficult, but the savings from less prescription medication and from fewer complications of these medications would probably be in excess of $1 billion annually.

Recommended studies: 1) Comparative study between niacinamide and standard anti-inflammatory medications; 2) Outcome study on the effect of food allergy elimination in individuals with osteoarthritis of the knees.

Reference: Kaufman W. Niacinamide therapy for joint mobility. Therapeutic reversal of a common clinical manifestation of the “normal” aging process. Conn State Med J 1953;17:584

Recurrent Ear Infections

Conventional therapy: Antibiotics. Tubes in ears if condition persists

Estimated annual cost of conventional therapy: $650 million (10 million ear infections annually at cost of $50 for office visit and medication and 100,000 children with tubes put in ears at $1,500 per procedure).

Alternative therapy: Allergy elimination diet with individual food challenges to identify allergenic foods. This approach eliminates recurrent ear infections and eliminates the need for tubes in the ears at least 75% of the time.

Estimated annual cost savings with alternative treatment: $487.5 million by reducing the incidence of recurrent ear infections by 75%

Recommended study: Outcome study on the effect of food allergy elimination in children with recurrent otitis media.

Asthma

Conventional therapy: Medications

Estimated annual cost of conventional therapy: At least $10 billion, including doctors’ visits, hospitalizations,medication.

Alternative therapy: Elimination diet with individual food challenges to identify allergenic foods. This approach produces significant improvement in at least 75% of asthmatic children and in about one-third of adults. Nutritional supplements including vitamin C, vitamin B6, magnesium. These supplements often reduce the frequency and severity of asthma attacks.

Estimated cost savings with alternative treatment: At least $3 billion annually in terms of fewer hospitalizations, emergency room visits and doctors’ visits.

Recommended studies: Controlled studies on the effect of a combination of nutrients (vitamin C, B-complex, magnesium) on childhood asthma.

References:

• Rowe, A.H., Young, E.J., Bronchial asthma due to food allergy alone in ninety-five patients. JAMA 1959;169:1158


• Ogle KA, Bullock JD. Children with allergic rhinitis and/or bronchial asthma treated with elimination diet: a five-year follow-up. Ann Allergy 1980;44:273.

• Collipp PJ, Goldzier S III, Weiss N. Soleymani Y, Snyder R. Pyridoxine treatment of childhood bronchial asthma. Ann Allergy 1975;35:93-97.

It is hoped that the Office of Alternative Medicine of NIH will be a catalyst for more widespread dissemination of the type of information presented above and for a shift in research priorities toward evaluation of more cost effective treatment approaches.

Alan R. Gaby, M.D.

Reprint, Townsend Letter for Doctors, February/March, 1993