[Congressional Record Volume 141, Number 98 (Thursday, June 15, 1995)]
[Senate]
[Pages S8519-S8521]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                          ALTERNATIVE MEDICINE

 Mr. HARKIN. Mr. President, on March 2, I was honored to 
participate in a press conference on a report to the National 
Institutes of Health on Alternative Medicine: Expanding Medical 
Horizons. The report, which was prepared by an editorial committee 
chaired by Dr. Brian Berman and Dr. David Larson, represented more than 
two years of work by more than two hundred practitioners of alternative 
medicine. It is my sincere hope that the NIH carefully read this 
document and use some of its recommendations as the basis for a long-
term strategic plan for the NIH's Office of Alternative Medicine (OAM).
  For my colleagues' review, I am attaching the opening remarks of Dr. 
James Gordon. Dr. Gordon, a Clinical Professor in the Departments of 
Psychiatry and Family Medicine at Georgetown Medical School as well as 
the Chair of the Advisory Council of the Office of Alternative 
Medicine, presents an excellent overview of various kinds of 
alternative therapies now being used by America's health consumers 
along with a cogent justification for the expansion of NIH-sponsored 
investigations into those therapies. I have also included the short 
introductory remarks I made at the March 2 press conference. I ask that 
these remarks be printed in the Record.
  The remarks follow:

  Alternative Medicine: A Report to The National Institutes of Health

                  [Statement by James S. Gordon, M.D.]

       Welcome to the press conference on the Report to the 
     National Institutes of Health on Alternative Medicine. This 
     is a very happy and fulfilling occasion for us. For the last 
     two and a half years the efforts and good will of more than 
     two hundred people have gone into creating this Report.
       I'm James S. Gordon, M.D.--a psychiatrist who uses a number 
     of alternative therapeutic approaches in his medical 
     practice. I'm a Clinical Professor in the Departments of 
     Psychiatry and Family Medicine at Georgetown Medical School; 
     Director of the Center for Mind-Body Medicine here in 
     Washington; and Co-Chair of the section on Mind-Body 
     Interventions of this report. I'm going to be the moderator 
     for today as we discuss this Report and its origins, and 
     present it to the National Institutes of Health.
       I'll begin with an overview of the field and set the 
     context for the development of this Report. I'll then 
     introduce Senator Tom Harkin. Afterwards Brian Berman, M.D. 
     and David Larson, M.D.--the Chair and Co-Chair of the 
     Editorial Board of this Report--will speak briefly
      on the contents of this Report. Drs. Berman and Larson will 
     present the Report to Alan Trachtenberg, M.D., the Acting 
     Director of the Office of Alternative Medicine. Then, I'll 
     introduce the Editorial Board and several other 
     contributing writers, and we'll be available to discuss 
     the Report and answer your questions on it.
       I'd like to begin by giving you some background on the 
     Report and putting it in the context of the field of 
     alternative medicine. Let's start with the name ``alternative 
     medicine.'' Alternative comes from the word ``other,'' and, 
     indeed, this is the other medicine or, more accurately, the 
     other medicines--the ones that are not taught in our medical 
     schools or ordinarily practiced in our hospitals or clinics.
       This use of this term is of recent origin. Over the last 
     two decades, it is one of several that has been created to 
     apply to new developments in medicine. Others include 
     ``humanistic medicine;'' ``holistic'' or ``wholistic'' 
     medicine; ``mind-body medicine;'' and ``complementary 
     medicine.'' Holistic medicine refers to an understanding of 
     the whole person in his or her total environment and the wide 
     range of both conventional and alternative treatments that 
     comprise the whole or comprehensive approach. Humanistic 
     medicine emphasizes the interaction between those who come 
     for help and those who offer it. Mind-body medicine suggests 
     the importance of the two-way connection between mind and 
     body and their integrity. Complementary medicine--the term of 
     choice in Europe--implies a mutually enhancing effect between 
     conventional medicine and other approaches. [[Page S8520]] 
       Alternative medicine does indeed emphasize other practices. 
     It calls attention deliberately to what is not, or not yet, 
     conventional. It is a way for medicine and our society to 
     observe and evaluate what is new or unfamiliar--to hold it at 
     arm's length while deciding whether and how it may be used 
     and integrated into our larger practice.
       The emphasis on alternative medicine emerges now as part of 
     the ongoing development of our medical system and practice. 
     Thirty-five years ago the great microbiologist Rene Dubos 
     suggested that we had begun to approach the limits of modern 
     biomedicine, the surgical and pharmacological treatment of 
     discrete disease entities. We still appreciate the great 
     power of this approach in curing infections and treating 
     acute, life-threatening illnesses, but we have also begun to 
     see how difficult it is to use these methods to treat a 
     variety of kinds of chronic illnesses. And we have begun to 
     become painfully aware of the side effects and overuse of 
     once promising therapies. During these last two decades both 
     patients and physicians have also become increasingly 
     impatient with the kind of care that they have been receiving 
     and offering. They feel a lack of participation and 
     partnership. According to polls taken by Gallup and the 
     A.M.A. itself, there is a sense of alienation on both sides.
       During this time, too, the world has become smaller and 
     more intimate. We've become increasingly aware of the healing 
     traditions of other cultures, and of approaches that have 
     been ignored, neglected, marginalized, or scorned within our 
     own culture. Finally, all of us have become acutely sensitive 
     to the enormous financial
      drain that health care and our medical system are putting on 
     our government and all of us. Health care required four 
     percent of the Gross National Product when Dubos was 
     writing in the 1950's. Now, it is almost fifteen percent. 
     These forces have set the stage for a new approach and new 
     techniques that have propelled alternative medicine to the 
     front of many of our minds, and to a significant place in 
     the on-going health care debate.
       With an appreciation and experience of the potential of 
     some of these new therapies, a sensitivity to the wisdom of 
     traditional approaches, and a weather eye on financial 
     realities, Senator Tom Harkin drew up legislation to create 
     the Office of Alternative Medicine three and a half years 
     ago. He and the Health Appropriations Sub-Committee gave that 
     Office a mandate to study these alternative approaches; to 
     find out which ones were most useful; and to make the 
     information widely available.
       This Report is one of the Office's first and most 
     significant projects. It had its genesis in Chantilly, 
     Virginia in 1992, when more than two hundred people--among 
     them some of the most experienced and best known researchers 
     and clinicians--gathered to begin to assess the state of the 
     art. This effort was requested and supported, then and now, 
     by the Office of the Director of NIH and by the Principal 
     Deputy Directors--initially, Dr. Jay Moskowitz and, more 
     recently, Dr. Ruth Kirschstein.
       At that conference and since, participants divided into 
     groups to work on the thirteen major sections that are 
     covered in this Report. Later, as members of the smaller 
     Editorial Board (most of whom are here today), they began to 
     shape its overall structure, content and tone. Each of these 
     sections are worked on by its own writers and editors. Then, 
     the Editorial Board re-evaluated, discussed, debated, and re-
     wrote each section.
       Each section has its different emphasis and tone. The one 
     on mind-body medicine highlights the range of what we know 
     about the mind's capacity to affect the body--the power of 
     hypnosis, meditation, biofeedback and visual imagery. It 
     provides thoroughgoing documentation of their efficacy and 
     suggests now easily these approaches can and should be 
     integrated into every aspect of medical care. The section on 
     bioelectro-magnetism emphasizes the theoretical promise of 
     this field and its possible role in explaining the underlying 
     mechanisms of many alternative approaches, including 
     acupuncture, homeopathy and laying on of hands. The section 
     on pharmacological and biological therapeutics, by contrast, 
     records the vital importance of studying therapies that are 
     already widely used for such life-threatening conditions as 
     cancer and AIDS--but have never received any critical 
     attention.
       In virtually all of the sections there are also common 
     themes. To begin with we see the sometimes surprising number 
     of authoritative articles. There are literally thousands of 
     articles in peer reviewed journals on biofeedback, hypnosis 
     and visualization. And there are also hundreds on herbal 
     therapies, acupuncture, and homeopathy. We see as we read 
     through the Report how deep the historical use of these 
     practices is. Foods like ginger, onions and
      garlic which we are just beginning to validate 
     scientifically have been used therapeutically for 
     thousands of years. The same is true of spinal 
     manipulation, herbal and mind-body therapies. We learn 
     also how widely used these approaches are. In 1990, a 
     third of the people in this country were using alternative 
     medicines. It is likely that the number now is far higher. 
     Worldwide, according to the World Health Organization, 80% 
     of all people use these ``alternatives'' as their primary 
     care.
       We see, too, how cost effective these approaches can be. To 
     cite several examples: (1) A study done at the Harvard 
     Community Health Plan showed that six weeks of behavioral 
     medicine teaching, including meditation, enabled patients to 
     record savings of $171.00 each in the six months following 
     the treatment. (2) A program of diet, mind-body therapies, 
     yoga, exercise and group support, designed by Dean Ornish and 
     his colleagues of the Preventive Medicine Research Institute, 
     has been shown to reverse coronary heart disease in patients 
     who would otherwise have had coronary by-pass surgery. This 
     program costs approximately $5,000 for its one year--in 
     contrast to the $40,000-$60,000 for each by-pass surgery. (3) 
     At the University of Miami, Tiffany Field's use of several 
     minutes of gentle massage several times a day to treat low 
     birth weight babies not only helped the babies to gain 47 
     percent more weight per day in the hospital, but enabled them 
     to leave the hospital six days sooner, at a savings of $3,000 
     per child.
       Taken as a whole then, this Report is a unique compilation 
     of authoritative information. It is also a remarkable 
     bibliographical resource for those who wish to learn more--to 
     prepare them to undertake research, select treatments or 
     participate in their own care. Finally, it is a guidebook for 
     the Office of Alternative Medicine--a map to help the Office 
     to develop new directions in research and to undertake 
     specific studies. It suggests new research methodologies and 
     new programs of research training which need to be developed. 
     It offers suggestions for new ways to collect and disseminate 
     information; improve peer review; and enlarge and expand 
     collaboration between conventional and non-conventional 
     researchers and practitioners. It explores possible new links 
     between the Office of Alternative Medicine and the rest of 
     NIH, and between the OAM and the general public.
       In the Report, there are a number of creative tensions--
     tensions that reflect the diversity of the medical enterprise 
     and our own experience as people trained in conventional 
     science and medicine, and interested in alternative medicine. 
     I want to acknowledge these tensions because they give life 
     and excitement to the Report.
       Among them are tensions between conventional practitioners 
     and researchers who have been outside the mainstream; between 
     those applying conventional research methodologies to
      unconventional therapeutic methods and those searching for 
     new, perhaps more appropriate, methodologies; between 
     respect for the integrity of traditional healing systems 
     and a need to study their effectiveness in a way that 
     conventionally trained scientists and clinicians can 
     appreciate; between the requirements of scientific 
     precision and the need for easy, popular accessibility; 
     between the hope for encyclopedic inclusion and the need 
     for careful selection; between the demands of activists 
     desperate for answers to desperate public health 
     problems--among them AIDS, cancer, cardiovascular 
     disease--and the requirements of rigorous, definitive 
     research; between the huge number of tasks to be 
     accomplished and the, so far, very small amounts of money 
     ($5 million dollars out of NIH's total budget of $10 
     billion dollars) available to these tasks.
       I hope and believe we are on our way to resolving these 
     tensions in favor of our own greater understanding and the 
     greater understanding and progress of the field as a whole.
       This Report is a compilation of much of the best that is 
     known and thought about alternative medicine. It is 
     comprehensive and authoritative. It has many and varied 
     recommendations for future directions for NIH. And, there is 
     more as well.
       All of us who have worked on it see this Report as an arrow 
     towards the future as well as a progress report and a summing 
     up. In the end, alternative medicine becomes most important 
     as it helps, in the words of the subtitle of our Report, ``To 
     expand medical horizons.'' Our goal is then to create a more 
     comprehensive, responsive, humane and cost-effective system 
     and practice of medicine and health care.
       We are concerned with establishing a way of understanding 
     and practicing which balances the power of definitive 
     treatment with the authority of self care; which is both open 
     to and critical about new approaches; which respects and 
     enjoys the interplay of modern science and perennial wisdom.
       Finally, then, this is a Report which goes beyond the 
     opposition of either/or, conventional or alternative. It is a 
     Report based on the concept of both/and, it is, we hope, a 
     step on the way to a healing synthesis and a new synthesis of 
     health care and medical practice--one which includes and is 
     greater and more valuable than either its conventional or 
     alternative halves.
   Statement of Senator Harkin Alternative Medicine Press Conference

       I want to commend Dr. Brian Berman and Dr. David Larson for 
     their leadership in preparation of this report, Alternative 
     Medicine: Expanding Medical Horizons, as well as the other 
     members of the Editorial Committee present here today.
       In October 1991, Congress provided $2 million to establish 
     the Office of Alternative Medicine at the National Institutes 
     of Health for two main reasons. First, to seriously 
     investigate the potential of alternative medical practices; 
     and second, to break down the bias in medical research 
     against review of worthy treatments not now in the mainstream 
     of conventional medicine.
       Before this Office's creation, the NIH and the medical 
     establishment failed to accept the important of alternative 
     medicine. But the American people had already voted their 
     [[Page S8521]] support for alternative therapies with their 
     pocketbooks.
       In 1990 alone, the New England Journal of Medicine found 
     that Americans spent nearly $14 billion on alternative 
     therapies, and made more visits to alternative practitioners 
     than they did to primary care doctors.
       American consumers are turning to these therapies because 
     they're a less expensive and more prevention-based 
     alternative to conventional treatments. And they're investing 
     their dollars and their hopes without hard scientific 
     evidence of the effectiveness--or ineffectiveness--of these 
     alternative treatments. The American people have a right to 
     know whether these alternative treatments are effective! 
     That's why the Office of Alternative Medicine was created in 
     the first place * * * to begin evaluating the efficacy, 
     safety and potential cost effectiveness of alternative 
     medical therapies. This is a health issue and a consumer 
     issue, and the American people deserve nothing less!
       Admittedly, since its creation three years ago, the Office 
     has gotten off to a slow start. That's due to the continued 
     skepticism of the medical establishment as well as the 
     office's own mismanagement and lack of planning. It's for 
     this reason that I'm so encouraged by the document being 
     presented today to the NIH. This report, which represents 
     more than 2 years of work by more than 200 practitioners and 
     researchers of alternative medicine, should serve as the 
     basis for a long-term strategic plan for the Office of 
     Alternative Medicine.
       It's my sincere hope that the NIH will carefully read this 
     document and use some of its recommendations to put the 
     office back on track, to begin operating efficiently and 
     expand its investigations of alternative therapies.
     

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