Quacks and flacks: the pitfalls of seeking a scientific foundation for alternative medicine

Reason, June, 2003 by Chris Mooney

IN 1979, SHORTLY after the United States established diplomatic relations with the People's Republic of China, a young Harvard Medical School student named David Eisenberg became the first American in decades to visit the country on a medical exchange program. As a Harvard undergraduate, Eisenberg had been fascinated by Chinese history and culture. Now he found the opportunity to learn about traditional Chinese medicine in Beijing exotic and intoxicating. In a sense, it was the logical next step after ransacking Harvard's libraries for information on Chinese medicine and studying under Harvard's John King Fairbank, known as "the dean of American Chinese scholars.

In China, Eisenberg not only enjoyed great massages, practiced Tai Chi, and became something of an ascetic; he also carefully studied the healing arts of acupuncture and Chinese herbal therapy. In the early 1980s, Eisenberg would return to the country with a group of Western doctors, including his Harvard colleague Herbert Benson, to examine scientifically "the most fundamental and baffling element of Chinese medicine--Qi, the concept of 'vital energy."'

Thus began a medical career that, given the state of mainstream Western medicine at the time, might have seemed unimaginable or even impossible. Yet more than two decades later, Eisenberg is arguably the nation's premier academic doctor involved in the growing field of research into complementary and alternative medicine (CAM)--sometimes also called "integrative medicine." In 2001 Eisenberg was named director of Harvard's new multimillion-dollar Osher Institute for Research and Education in Complementary and Integrative Medical Therapies. At a time when CAM programs are proliferating at the nation's top medical schools, Eisenberg now heads the flagship academic research institute devoted to this area. If traditional and complementary and alternative medicine can truly become "integrated" in a university setting, then Eisenberg will be the person to do it.

With CAM's increased prominence at Harvard, however, has come controversy. Skeptics have been watching the medical school and its affiliated hospitals closely for any sign that unproven CAM techniques are being vouched for as scientifically valid or otherwise promoted to the public. They've found several. For example, InteliHealth--a subsidiary of Aetna that draws upon Harvard Medical School's expertise to provide online consumer medical information--was recently caught referring patients to practitioners of homeopathy (a water-based therapy whose key premise, that solutions become more powerful through dilution, violates fundamental laws of physics and chemistry). The offending content was quickly revised--and made much less promotional--by the Harvard faculty.

Far more contentious is a controversy involving Eisenberg's actions outside the context of Harvard Medical School. From 2000 to 2001, Eisenberg represented the Massachusetts Department of Public Health on a state commission charged with examining whether naturopaths, a group of alternative healers, should be licensed by the state as legitimate health practitioners. Regardless of one's position on the licensure of caregivers in general, the commission's experience shines a light on how CAM may eventually be legitimated. The commission members clashed heatedly over their work, eventually producing rival reports in January 2002. Afterward, fellow doctors serving on the commission accused Eisenberg of behaving in an equivocating and unscientific manner. As one complained to Harvard Medical School Senior Dean Daniel Federman, Eisenberg was "notably silent when the other two physicians characterized naturopathic claims as baseless and dangerous."

Eisenberg responded to written questions for this article with a brief statement of medical principles, asserting for example that "members of the Harvard faculty involved with the [Osher Institute] are neither advocates for or against the use of complementary and integrative medical therapies. Rather, they are advocates for the rigorous scientific evaluation of these therapies." In the end, Eisenberg did not sign either of the commission's rival reports, pro or con. But a majority of members, including two CAM practitioners and the Department of Public Health's Nancy Ridley (who appeared in Eisenberg's stead as the process wound down), endorsed the licensure of naturopaths. None was an M.D.

Two doctors and one Massachusetts state representative, on the other hand, signed a scathing minority report that rebuked the majority for disregarding scientific evidence about the potential dangers of naturopathic medicine. Signatory Dr. Peter Madras, chairman of the Massachusetts Board of Registration in Medicine, says of the commission meetings, "We were back in a proceeding that must have emulated the Tennessee courthouse at the time of the Scopes trial." Dr. Arnold Relman, professor emeritus at Harvard Medical School and the editor for 14 years of The New England Journal of Medicine, resigned from the commission in protest and was replaced by Madras. "It was stacked against the M.D.s on that commission from the word go," he says. "And David Eisenberg would not stand with us."