Alternative medicine gets battered by a dull object

It was inevitable that the proponents of toximolecular medicine would find a new Terminator to take the place of the late Victor Herbert. They can take comfort that Dr. Wallace Sampson's alternative-medicine-bashing message, though not as skillfully articulated as that of Dr. Herbert, is almost as nasty. Moreover, they might take pride in the fact that Sampson's training as an oncologist makes him uniquely qualified to flagellate such modalities as nutritional therapy, herbs, acupuncture, homeopathy, and whatever else annoys the medical-pharmaceutical-hospital complex.

Sampson's emergence from relative obscurity in the field of natural-medicine-flogging was occasioned by an invitation to write an editorial on herbal therapies in the New England Journal of Medicine (NEJM). The editorial, titled "Studying Herbal Remedies," (1) accompanied a study showing that echinacea does not reduce the severity of colds in healthy young people who voluntarily snort rhinovirus into their nose. One would have expected a scholarly editorial to address such issues as generalizability (do the negative results apply to people with weaker immune systems who acquire colds in the normal way, as opposed to inhaling virus from a test tube), dosage (the American Botanical Council has said that the study used too low a dose of echinacea), and differences in various echinacea preparations (the study used a preparation that is not commercially available). Instead, Sampson used his invitation as a platform from which to perform a broad-spectrum mugging of everything with which he disagrees. He argued that it was a waste of taxpayer's money to have studied such an "implausible" and "absurd" treatment as echinacea in the first place; that proponents of natural medicine make "irrational proposals" and engage in "erroneous thinking"; and that alternative medicine is an "errant social-medical trend." He went on to denigrate our ancestors (the same crowd that brought us acupuncture, foxglove, milk thistle, and licorice root) as people who "had no concept of disease states or their causes, nor could they distinguish medicinal effects from the natural course of an illness."

Sampson summarily dismissed more than 200 clinical trials of echinacea as "industry funded," and then chastised that same industry for not performing a larger, more definitive trial. Considering that echinacea is unpatentable and largely priced as a commodity, his demand that echinacea manufacturers foot the bill for such a trial was tantamount to the Wizard of Oz demanding that Dorothy bring him the broomstick of the Wicked Witch of the West.

Sampson also misrepresented the findings from a Cochrane Review of echinacea, (2) claiming that it showed "positive and negative results distributed around the zero-effect line." In fact, the authors of the Cochrane Review stated: "Overall, the results suggested that some Echinacea preparations may be better than placebo" and that "The majority of the available studies report positive results."

Sampson then characterized advocates of natural medicine as people who "often dismiss disproof." This portrayal was in reference to a statement made by a group of investigators that some echinacea preparations may be effective for the treatment of colds, even though a particular product was not effective in children. Of course, the statement Sampson criticized is well supported by the bulk of the echinacea literature; and even if it were not, similar qualifying comments are made all the time in medical journals in reference to conventional therapies. Moreover, a man who summarily dismissed more than 200 echinacea trials and misrepresented the Cochrane reviews, is certainly in no position to criticize investigators who made qualifying comments about a single study.

The world would little note nor long remember Sampson's distorted view of natural medicine, were it not for the worldwide publicity bestowed on him by the editors of NEJM. The editors were flagrantly biased in their choice of editorialist, and clearly lacking in shame when they agreed to publish his submission. When was the last time an NEJM editorial used a negative drug study to argue that no one should take, or even perform scientific research on, pharmaceutical products?

Alan R. Gaby, MD

1. Sampson W. Studying herbal remedies. N Engl J Med 2005;353:337-339.

2. Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. Cochrane Database of Syst Rev 2000;2:CD000530.

Addendum: I submitted a letter to the NEJM regarding the Sampson editorial, and they politely rejected it, due to "lack of space."

In an editorial in the August/September issue of the Townsend Letter I expressed concern about potential adverse effects that might occur with the routine use of megadose iodine therapy. In the following issue, Drs. Abraham and Brownstein wrote a rebuttal. My comments regarding that rebuttal can be found at townsendletter.com.