[These developments are dealt with in greater detail in the 32 page "1996
Update" to the Equinox Press edition of The
Cancer Industry.]
It is a time for big changes at the Office
of Alternative Medicine (OAM).
On May 17, 1994 Secretary of Health and Human Services Donna Shalala,
PhD sent letters to 18 individuals asking them to serve as members of the
first Alternative Medicine Program Advisory Council (AMPAC) of the
National Institutes of Health. These individuals include not just medical
practitioners, but activists who have been outspoken in trying to keep the
office to the direction charted by Sen. Tom Harkin in 1991. These patient
advocates include: Berkley Bedell (4 year term), Gar Hildenbrand (2 year
term), Ralph W. Moss, PhD, (3 year term) and Frank Wiewel (1 year term).
Sources at OAM insist that all 18 appointments are still subject to review
and are not final at this time. The Cancer Chronicles will publish
the entire official list as soon as it is made available.
At around the same time as the appointments were announced, Joe Jacobs,
MD, director of the OAM, informed many colleagues that he was resigning,
probably in September. This has not been officially announced, either,
but candidates are already putting in applications for Jacob's post.
The appointment of the 18-person advisory council, which replaces the
26-person Ad Hoc Advisory Board, had been the subject of much anticipation.
The Ad Hoc board held its last meeting in July, 1993. Since that time, OAM
has been without any consistent input from the community. Communication
has been mainly informal, or through a few panels and subcommittees, such
as the Editorial Board, which (under the leadership of Brian Berman, MD
and David Larson, MD) is preparing a massive report on the state of unconventional
medicine.
BIG JOB FOR AMPAC
The appointment of the new AMPAC board and, sooner or later, a new director,
opens up the prospect of greater coordination and cooperation with OAM.
One of the big issues that AMPAC will have to confront is what sort of clinical
research OAM should carry out. The cancer activists have led the fight
for field (or patient outcomes) research into the work of real-life
alternative practitioners, and will continue to do so. NIHs tendency has
been to concentrate alternative research (and OAM's money) into academic
"centers of excellence," in the belief that only big-name universities
can win sufficient prestige to gain medical acceptance. In line with
that philosophy, OAM (without any board input) gave out 30 grants of $30,000
each, mostly to academics.
It also decided this spring to set aside $1.8 million (more than half
its budget) to fund four non-governmental intermediary "exploratory
centers," to "see which AM modalities are safe, effective, and
appropriate for general patient care in America," according to the
OAM's in-house newsletter, AM.
The purpose of these centers is to develop a multidisciplinary research
focus in one of three areas: (a) cancer, (b) pain, or (c) another condition
or symptom that has a broad impact on health in America. How this is implemented,
and what research does not get done because of this focus, is the main issue.At
the same time, the idea of actual field research into alternative medicine
has been deftly shunted aside.
For example, OAM held a one-day workshop on June 6 devoted to issues
of "study design, patient selection, and data collection in clinical
research involving cancer." By and large, the conference ignored the
whole issue of field trials, and in particular the proposed investigations
of the cancer treatments of Emanuel Revici, MD; Stanislaw Burzynski, MD,
PhD (antineoplastons); and Charles Simone, MD (shark cartilage).
A trial of antineoplastons has been initiated at Memorial Sloan-Kettering and
the Mayo Clinic, but few if any patients have been enrolled. Following
OAM recommendations, the 96-year-old Revici is compiling data on past
cases, but there is no prospective study using OAM funding. The Simone
study of shark cartilage is on hold. Thus, little is being done to settle
the question of whether such treatments really work in alleviating the
enormous burden of suffering from cancer.
