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More About the Evidence in Evidence-Based Integrative Medicine Programs

Marcus, Donald M. MD; McCullough, Laurence PhD

doi: 10.1097/ACM.0b013e3181c8f234
Letters to the Editor

Professor of medicine and immunology emeritus, Baylor College of Medicine, Houston, Texas;

Professor, Center for Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.(McCullough)

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In Reply:

Drs. Briggs and Killen point out that the program announcement for the education grants did not state that “there was strong evidence supporting the efficacy of some complementary and alternative therapies.” Our comment about the premise of the NCCAM educational program concerned the popular belief about the efficacy of alternative therapies; it was not a citation of the program announcement.

Schnyer et al cite a number of publications and reviews that support the efficacy of traditional acupuncture for a variety of conditions. Recent studies that found no important clinical difference between traditional and nontraditional (sham) acupuncture for relief of pain challenge the conceptual basis of traditional acupuncture. Clinical studies that lack sham acupuncture controls, and that do not ensure blinding of the subjects and evaluators, are uninterpretable.

Lawson and Kreitzer state that that their Botanical Medicines module was fully updated in 2008. Our article was submitted for publication in September 2008. When we reviewed the Ginkgo biloba module in June 2008, it contained eight references and the latest was dated 2004. On October 12, 2009 the module contained 11 references, including some from 2007 and 2008. The possible adverse events were described as “extremely rare,” and no mention was made of serious problems caused by bleeding. Similarly, in June 2008 there were five references in the black cohosh module, none later than 2003. On October 12, 2009 there were 11 references, including some from 2008 and 2009. Possible adverse events included “mild GI upset,” but no mention was made of reports of hepatotoxicity and liver failure. Independently funded, negative clinical trials for both botanicals were not cited in the updated references. The botanical modules, and others on the Web site, are obviously uncritical and exhibit a positive bias.

Haramati and Elder, Gaster and Schneeweiss, and Sierpina and Perlman claim that we presented a biased and inaccurate analysis of their curricula that did not take into account other information that was not accessible online. We assumed that the educational material on their public Web sites would be representative of their evaluation of the efficacy and safety of alternative therapies. Meeker and Goertz and all the other letters' authors, except Briggs and Killen, accuse us of bias and poor scholarship. Rather than engage in invective, we invite readers to examine the factual record that we presented and to reach their own conclusions.

One hundred years ago the Flexner Report brought about reforms that made science and scholarship the basis of medical education in the United States. Advances in science resulted in remarkable progress in our understanding of human physiology and disease. Advocacy of unproven and implausible alternative therapies is a regression to the pre-Flexner era. It is an educational failure that needs to be acknowledged and rectified.

Donald M. Marcus, MD

Professor of medicine and immunology emeritus, Baylor College of Medicine, Houston, Texas;

Laurence McCullough, PhD

Professor, Center for Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.

© 2010 Association of American Medical Colleges