Wayne B. Jonas and Christine Goertz
Director and Deputy Director of the Samueli Institute for Information Biology (SIIB)
Tuesday, July 12, 2005 3:30 PM
Wayne B. Jonas, director of the nonprofit Samueli Institute for Information Biology (SIIB) in Alexandria, Va., and Christine Goertz , the institute's deputy director, were online on Tuesday, July 12, at 3:30 p.m. ET to discuss the work of the institute, which funds research into alternative medicine.
Washington Post staff writer Sandra G. Boodman reports in Tuesday's article "Probing Edges Of Medicine -- And Reality" (Post, July 12):
"Ask Wayne B. Jonas why the scientific foundation he directs is funding research into the effects of prayer, the use of homeopathy to fight bioterrorism and whether magnetic devices can heal orthopedic injuries, and he offers a straightforward answer: Science is the way to determine whether they work.
"'We're trying to stimulate good-quality research,' said Jonas, a former chief of the Office of Alternative Medicine at the National Institutes of Health (NIH) who directs the nonprofit Samueli Institute for Information Biology (SIIB) in Alexandria. 'There is a good case for looking at these things scientifically, because we don't know a lot about them.'
"But, the 51-year-old board-certified family physician and retired Army doctor adds, "it's difficult to walk the scientific fence" -- dodging criticism from "the hard-core skeptics" who dismiss alternative medicine as quackery and the "hard-core advocates" who accept it uncritically.
"Jonas has headed the institute -- named for its principal benefactor, California philanthropist Susan Samueli -- since its inception in 2001."
A transcript follows.
Herndon, Va.: I'm one of the "skeptics," and want to know what kind of testing procedures you use for these "alternative treatments." My limited experience is that nearly evidence for "alternatives" is anecdotal, and little, if any, testing is done.
Christine Goertz: It is true that there are many unanswered questions about the effectiveness and even safety for many alternative treatments. However, that is slowly changing as there is more interest on the part of scientists to investigate alternative treatments, and more funding available to do so.
Washington D.C.: In homeopathy, it was mentioned that a substance comes from the glass that might be involved. What is that substance?
Christine Goertz: We think it may be silica.
Washington, D.C.: Hello,
Thank you so much for participating in this chat. I am interested in going back to school in order to pursue a career in nutrition. Alternative medicine is always something that has not only interested me, but something I have relied upon in my own health care routines. Nevertheless, I think it is important to get a good grounding in traditional Western medicine. I am no longer young, but I was thinking of pursuing a masters. Do you have any recommendations on the types of programs I might look into?
Wayne B. Jonas: I think that an MPH is a useful type of training to have and allows you to go into medical research and prevention.
Washington, D.C.: Can you explain more about the work the institute does? Is this research different from other research being done into alternative medicine?
Christine Goertz: The Samueli Institute is interested in studying the healing experience of the patient, and how that experience can be maximized. The research we conduct to answer these questions follows might be in the laboratory, in the context of randomized clinical trials, or health services research. We use the same scientific methods that are used to investigate any other medical treatment.
Richmond, Va.: Prevention and detection are to me important and not developed in this country (except may be mammography for woman). Is it part of natural medicine or a priority?
Learning human to listen to their body may help them to, for example, slow down when necessary will be also a natural approach isn't it?
Wayne B. Jonas: Leaning to care for one self with wellness and prevention methods is clearly important, especially as we age. Many complementary approaches suggest this as to some areas of conventional medicine. Self-care is an important part of our Optimal Healing Environments concept that we are investigating.
Wethersfield, Conn.: Is it time for a new paradigm in research studies? The allopathic double-blind study mode looks for statistics, measurements into the third decimal place. With CAM, do a hundred anecdotal successes count for anything? I have had acupuncture treatment with excellent improvement in health. I am not a statistic.
Wayne B. Jonas: Even in conventional medicine we do case reports and observational studies. I have suggested and published about the need for a complete "house of evidence" that includes but is not limited to controlled trials. all medicine, including alternative needs such research approaches.
Arlington, Va.: How does a form of medicine get classified as an alternative medicine, rather than a mainstream medicine (is that the correct term for that?)? Thank you.
Christine Goertz: Very good question. The way it has been done so far is that a group of "experts" gets together and decides what fits in the alternative medicine box. Right now many people use the definition that has been published by the National Center for Complementary and Alternative Medicine at NIH. However, I can tell you that it is not always that easy to categorize specific therapies.
Arlington, Va.: Why is chiropractic care considered alternative?
Christine Goertz: Because the NIH has included chiropractic in their definition of alternative medicine, which is currently the most common definition used.
Alexandria, Va.: Hello, Thank you for answering questions. I have one: It seems that nutrition in our society is considered "alternative."
Never has a (regular) physician inquired into my diet or suggested I might need to change anything. On my own, I've given up refined sugar and caffeine and have never felt better in my life.
Friends who have digestive troubles severe enough to be on medications for IBS, constipation, etc., have never been sent to a nutritionist or for food allergy tests.
A neurosurgeon sucked a tumor out of a friend's skull, without ever inquiring into her diet, which included several cans of Diet soda a day ... a drink with a label warning you to drink at your own risk.
That sort of thing.
Do you think nutrition and diet are at the heart of our health? Why are they virtually ignored (until there's a major, chronic problem that's directly attributable to diet, such as diabetes or heart disease)?
Wayne B. Jonas: Oversight groups including those supported by the government have suggested that nutrition be an important part of medical education. While some schools have done this many have not. Nutrition is clearly part of an optimal healing environment and should be studies and used in medicine more often that it is.
Pleasant Hill, Calif.: Is there scientific evidence that acupuncture helps with infertility?
I read about the one German study where IVF success rates increased with treatment, but I questioned why they did not have a control group that had the needles placed in random places.
Also, if relaxation is the key benefit of acupuncture in regards to infertility, why not just practice meditation and save the expense?
Thanks -- I have yet to get a straight answer on this topic!
Wayne B. Jonas: I would have to look at our files but I think that there has been a recent article on infertility and acupuncture showing improved birth rates. It could very well be that the effect is due to relaxation. Herb Benson of Harvard published a study years ago showing that relaxation techniques also improved fertility rates.
Washington, D.C.: Is there a difference between alternative and complimentary medicine, or do both the terms "alternative" and "complimentary" refer to the same kinds of medicine? Thanks.
Christine Goertz: Generally alternative medicine is used to describe treatments that are used as an alternative to conventional western medicine and complimentary treatments refer to those treatments that are used in addition to conventional western medicine. I have to say that many people use the terms interchangeably however.
San Diego, Calif.: I am interested in the types of research that you fund, e.g., would you fund research being conducted in India? Exploratory research into the effects of meditation on decision-making?
Wayne B. Jonas: We do have a program developing research in India. It is not up and running yet but we hope to investigate some of the traditional Indian practices for their effects on several disease that they use them extensively for.
Arlington, Va.: There has been a lot in the media about anti-depressants and the like lately. I feel that they have a real place in our society and have benefited from them in my past. I would like to know what your thoughts on this type of medication are and if there are any viable alternatives to help people who suffer from chronic major depression.
Wayne B. Jonas: Anti-depressants have an important role in the treatment of depression and other conditions when properly prescribed. There are some supplements that appear to also have anti-depressant effects but the extent of research is less and they should not be substituted for medications with out physician supervision, of course.
Fairfax, Va.: As long as you are subjecting these ideas to verification by the scientific method, I'm happy. It's where 'alternative' medicine shades over into hippy-dippy mysticism where people like me shake our heads and walk away. Discounting the snake-oil salesmen, are most alternative medicine practitioners and researchers willing to submit to rigorous scientific investigation?
Christine Goertz: My experience has been that there are many alternative medicine practitioners who are willing to submit their treatments to rigorous scientific investigation. Many are not. I think that NCCAM has done a very good job of encouraging highly qualified scientists to consider the study of alternative therapies. Many major universities are currently conducting research on alternative therapies. For a list, go to the NCCAM Web site and look under funded research.
Anonymous:: How many kinds of studies are there into alternative medicine?
Christine Goertz: The Cochrane Collaboration Complementary Medicine Field has collected more than 8000 randomized clinical trials on CAM. For more information go to www.cochrane.org.
Rockville, Md.: I am a big fan of homeopathy. My family has been using it for years, and I've seen major, intractable, physical and mental health problems cured by homeopathic treatment. I'd love it if some scientific proof could be found of its effectiveness, but the problem with the clinical trials so far is that they ignore the special way homeopathic remedies work. There is no such thing as one standard homeopathic remedy for a headache or a stuffy nose. The right remedy must be prescribed by a homeopath based on the totality of symptoms. For example, the right remedy for a headache will depend on which side is worse, what time of day it is worse, etc. The wrong remedy can make things worse instead of better. So a test of the same remedy given to fifty different flu patients, for example, is bound to fail.
Have you funded research into homeopathic medicine, or do you plan to? If so, how do you deal with the fact that traditional clinical trials don't really apply in this area of alternative medicine?
Wayne B. Jonas: Yes, we are very aware of the way homeopathy is practiced and the creativity required to do good research on the topic. It can be done however. For example, we have currently funded a study examining if homeopathic effects are due to the remedy or the extensive consultation that it involves. Stay tuned!
Alexandria, Va.: Where can I get good information about the efficacity of alternative therapies, dietary supplements, etc., without having to subscribe to scientific journals?
Christine Goertz: I would recommend the NCCAM Web site. They have a great collection of fact sheets. www.pubmed.gov and Medline Plus can also be very helpful.
Longmont, Colo.: Dr. Jonas, I really appreciate your work, particularly the breadth of approaches included in your 2004 Definitions and Standards essay. As a ThD student in Spiritual Healing (w/Norm Shealy et al), I am beginning to explore the potential of grounded theory for spiritual healing research. My interest in grounded theory arises, in part, from an intriguing essay by James Waldram (U of Saskatch) on "The Efficacy of Traditional Medicine-Current Theoretical and Methodological Issues" (Medical Anthropology Quarterly, Series 2, Volume 14 (2000), pp. 603-625). Waldram argues that anthropologists need to return to the field to discover what participants in the sickness encounter (patients, healers, families, communities) expect of the encounter; and, then, to construct appropriate measures of efficacy based on expectations. I wonder whether you've delved into grounded theory. If so, do you have a particular view of its utility, and/or, are there particular grounded theory studies you'd recommend? I appreciate your reply. And thanx for being available on-line to Post readers.
Wayne B. Jonas: This is a complicated questions but the short answer is that qualitative research, in which grounded theory has a important place in the research house. Anthropologist are currently working with physicians to conduct better qualitative research in medicine. We have recently held a conference looking at some of these techniques which will be posted on our Web site and published in a peer reviewed journal in the fall,
Pittsburgh, Pa.: I understand that a study has been underway to study whether claims that soy, black cohosh, etc. do reduce the symptoms of menopause (hot flashes, night sweats). Has this study concluded and if so, what are the findings? I have a personal interest in the subject -- as a 45 year old who is now experiencing perimenopause, and who would like to avoid any sort of HRT in the future, any natural alternative would be welcome.
Wayne B. Jonas: I think this study is being conducted by Fredi Kronenburg, Ph.D. Director of the Rosenthal Center at Columbia University. You can search for their Web site to see if they have any more information on it.
Washington, D.C.: What are all of the forms of alternative medicine, and how wide reaching is each one (what's the most popular/the least?)?
Christine Goertz: There are more than 400 modalities, at least 12 different alternative medical systems and about 10,000 ways to apply them! Some of the most popular modalities are prayer for your own health, use of herbs, chiropractic, and massage. The best overview of CAM use in the US comes from the 2002 National Health Interview Survey (NHIS). You can get a copy of this report from the NHIS Web site.
Baltimore, Md.: Many patients who use alternative medicine like having control over decision making, but don't take the treatments as seriously, and don't follow any kind of logical plan or dosing of medicines. How do you deal with this?
Wayne B. Jonas: This is a big problem. There are not properly trained guides to help patients go through the confusion. We need good research and education. Start with your doctor. They should be able to find information from the medical literature for you and partner with you in your decisions. If not you may want to look for one that will.
Palm Desert, Calif.: Is there any alternative medicine for hypo (low) thyroid, other than taking synthroid every day for the rest of my life??!!
Wayne B. Jonas: I don't know if any alternative to thyroid supplements if your thyroid is not functioning.
Washington, D.C.: At what point can a line be drawn between "alternative treatments" and "quackery"? Or to use less loaded terminology, are you prepared to label any alternative practices as completely ineffective?
Christine Goertz: The very reason we need to be open-minded enough to investigate CAM is so that we can answer your question in a systematic matter, therapy by therapy, condition by condition. Yes, I am prepared to label some alternative practices as ineffective. Some examples are acupuncture for obesity and homeopathy for prevention of the flu.
Washington, D.C.: Do you foresee alternative medicine expanding in the United States? Around the world?
Wayne B. Jonas: The surveys seem to show the use of alternative medicine is increasing or at least stable for the last several years.
Arlington, Va.: What kind of alternative medicine has been around for the longest amount of time?
Christine Goertz: The use of herbs is probably the oldest.
Anonymous: Are there many other institutes like yours -- that conduct research into alternative medicine -- across the country?
Wayne B. Jonas: The National Center for Complementary and Alternative Medicine at the NIH conducts research alternative medicine. The Fetzer institute does work on mind-body medicine. The Robert Wood Johnson Foundation supports research on healing environments and communities.
Rosslyn, Va.: What do you know about the Noni fruit? I hear it has some amazing healing powers.
Wayne B. Jonas: Sorry. I am not familiar with this fruit.
Sterling, Va.: Are you doing/have you done studies on the efficacy of acupuncture? Have you developed profiles of conditions for which acupuncture is effective versus conditions for which it is not effective? Where could I find scientifically based information about the efficacy of acupuncture? Thank you very much.
Christine Goertz: The NIH conducted a concensus conference on the efficacy of acupuncture in 1997 and concluded that acupuncture was effective in the use of post-operative pain, including dental pain, chemo-induced nausea and vomiting, and post-operative nausea and vomiting. A Cochrane review concluded that acupuncture may be useful for low back pain. A recent study in Annals of Internal Medicine showed that acupuncture is effective in treating knee osteoarthritis.
Washington, D.C.: How varied is your research? Can you explain how you research a form of medicine in more detail?
Wayne B. Jonas: Our research covers a variety of types of research as long at is is high quality. To fully understand any treatment requires clinical studies, laboratory studies, observational studies and qualitative research. I have published several books on doing good research and you can look for them on standard online sources.
Washington, D.C.: There has been a lot in the media about the importance of Omega3s in our diet. Can you tell me what you think their major benefit is? Also, what is the importance of Alkylglcerols? Do they work together? A company called SeaBiotics has a liquid product with both. Have you heard of them? Thanks
Wayne B. Jonas: I am not familiar with Seabiotics or it combination products. Omega 3 fatty acids have been reported in several studies to be beneficial in cardiovascular disease and depression. Several investigators at the NIH on researching this area and I think had a conference on it recently. You may want to check the NIH website [www.nih.gov] and search it.
Christine Goertz: It looks like that is the end of the questions. I would like to thank everyone for participating in this Guest Forum on CAM.
Waldorf, Md.: Is it enough to prove something works for it to be accepted in the mainstream? Or must we also know how it works?
Wayne B. Jonas: Depends on who you ask. More patients and doctors will tell you that if at treatment is proven with good science that is enough. Others will want to know the mechanisms before they will believe it or use it.
Wayne B. Jonas:
Thanks for your great questions.
Wayne Jonas, MD
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