SECOND NIH CONFERENCE:
A MAJOR BREAKTHROUGH
From The Cancer Chronicles #13
© December 1992 by Ralph W. Moss, Ph.D.
[This was the historic "Chantilly" meeting of the OAM, which led to the so-called "Chantilly Report."]
It was medical history in the making.
On Monday, 9/14 , the National Institutes of Health convened a 3-day public meeting of its ofÞce of alternative medicine* at the posh WestÞelds International Conference Center in Chantilly, VA. The NIH invited over 100 practitioners and defenders of alternative medicine to discuss the future of such topics as ethnomedicine, natural products, pharmacological treatments and nutrition/life style changes.
There also were broad discussions of methodology, information dissemination and the peer review process‹three days of intense idea sharing and debate. Each panel had one or two co-chairs and Brian Berman, MD, a Baltimore pain specialist, was appointed by NIH to chair the overall conclave. (Ralph W. Moss, PhD, editor of this newsletter, and Frank Wiewel, head of People Against Cancer, co-chaired the Pharmacological and Biological Treatment Panel.)
The meetings began on Monday afternoon, with a presentation by Dr. Jay Moskowitz, deputy director for science and public policy of the NIH itself. He spoke about the "tomato effect," which is the situation in which well-established scientiÞc "facts" (e.g., that tomatoes are poisonous), turn out to be fallacious. Moskowitz said there were "opportunities for rewarding breakthroughs" in exploring alternatives and declared, "The alternative and established communities are converging."
On Wednesday afternoon, the various co-chairs presented a wrap up to the plenary session. Among the participants there was a consensus that the meeting had gone very well indeed and that alternative medicine was now on the medical map.
Although it is true the new ofÞce was demanded by Congress, it would not be such a promising development without the leadership of two able government ofÞcials. Stephen Groft, DPharm is, the Acting Director of the OfÞce. As he was at the June  meeting, Dr. Groft proved a fair and hardworking facilitator.
The other ofÞcial is Jay Moskowitz. At every turn, Dr. Moskowitz has shown an understanding of the complex issues involved in not just evaluating but integrating alternative therapies into the framework of the medical establishment. He has worked creatively to make the meetings‹and this whole process‹a success.
Two other people are responsible for setting this whole remarkable development in motion. The Þrst is former Congressman Berkley Bedell (D-IA), whose historic contribution was warmly acknowledged by a standing ovation from participants at the plenary session. Without Berkley¹s catalytic activity, none of this would be taking place. And behind it all is, of course, Sen. Tom Harkin (D-IA). In this year of Congress-bashing, Sen. Harkin has demonstrated wise political leadership by demanding that NIH carry out the OfÞce of Technology Assessment recommendations and take alternatives seriously.
Sen. Harkin and his Appropriations committee provided $2 million in 1992 to support the evaluation of alternatives. But most observers expected NIH to interpret this charge narrowly. Instead, NIH director Bernadine Healy, MD and those under her have expanded on this directive. Of great practical as well as symbolic importance is the fact that this ofÞce exists within the ofÞce of the NIH Director herself.
"We have begun the process of providing a thorough and thoughtful consideration of all the issues surrounding unconventional medical practices," Healy has said. While the alternative movement has certainly earned the right to be skeptical of all government pronouncements, Healy¹s actions so far bear out that ambitious claim.
"During the last few years," she continued, "there has been increasing recognition and use of unconventional medical practices for the diagnosis and treatment of various diseases or conditions, including cancer, arthritis, anxiety and depression ....We intend through this structural process to learn more about these areas."
This is a strikingly non-judgmental recognition of alternative treatments as a promising area for study. It may not seem like much, but in fact such fairness has almost never been heard from any top leader of the orthodox medical community. It is also a direct challenge to those forces, both within and outside NIH, who see this ofÞce as a mere bump in the road for the Juggernaut of conventional medicine. Such people think they can continue to marginalize all alternative approaches. As they see the tide shifting, they are bound to Þght furiously against these new developments.
The American Medical Association, which seems undaunted by its conspiracy conviction in Wilks v. AMA (1990), has stepped up attacks on alternative practitioners, such as S. R. Burzynski. The medical Goliath is Þghting a losing battle, but can do much damage nonetheless.
Particularly signiÞcant is NIH¹s statement: "Not all alternative medical practices are amenable to traditional scientiÞc evaluation, and some may require development of new methods to evaluate their efÞcacy and safety."
Behind these mild-seeming words lies a revolutionary concept. It means that the double-blind, placebo-controlled clinical trial, the so-called Golden Mean of clinical research, is no longer the obligatory way of assessing alternative therapies. The demand for double-blind studies, impossible or impractical in many cases, has often been used to bludgeon advocates of alternative approaches.
Now NIH is saying alternative approaches can be validated using alternative tools such as research into treatment outcome.
There is so much good news coming out of Bethesda that it is tempting to focus only on the bright side. Nevertheless, there are signiÞcant problems that remain, which could derail the whole process.
Who will be chosen for the all-important Standing Advisory Committee [i.e. AMPAC]? The impetus for this whole ofÞce came out of the political struggle waged by People Against Cancer, The Cancer Chronicles and others, and will rise or fall accordingly. The outside advisors must be dynamic and proven political leaders in addition to possessing knowledge of alternative medicine. Such choices are in the interest of NIH, too, because when the inevitable crunch comes, we will need political leaders to mobilize public opinion and convince Congress to maintain and expand this ofÞce.
Will the future witness a vigorous development of the excellent start at NIH? Or will it turn into a clever attempt to co-opt and eventually destroy the challenge of alternative medicine? This is the great and still unanswered question before our movement. We ardently prefer the Þrst interpretation, and are working energetically towards this outcome. But the choice of the Advisors will give us a reliable reading of where we are really heading.
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