"Hey, doc…will pine bark extract help my child's hyperactivity?…Or, "doc, will physical therapy improve my child's low muscle tone?". I am confronted almost daily with questions like these for which there are no answers. As a pediatrician who cares for children with neurodevelopmental problems, I can't help but feel frustration and anger. These simple questions should have simple answers. But, as a society, we have failed to press for answers to key questions about the effectiveness of new and established treatments for developmental disorders and other chronic conditions.
Parents are not surprised when I express caution (and sometimes cynicism) about new "alternative" treatments. But there are also many well-established developmental therapies that lack good scientific evidence for their effectiveness. "Doctor, how dare you suggest that physical therapy may not help my child with abnormal muscle tone!"…"Heresy!"
Every parent wants the safest, most effective treatment for their child with a developmental disability, and many standard treatments have limitations and drawbacks. Because there is an undeniable appeal to therapies that are "new", "different", and "more natural", families are increasingly turning to alternative models and providers of health care and healing for these answers. Unfortunately, too many families are gambling on "alternative" therapies and foregoing established treatments with demonstrated efficacy. This should not be the case.
No one should oppose the development of innovative therapies. Without them, there would be no medical progress. I simply urge that all interventions, new and old, be evaluated in an objective, methodologically rigorous way. We, the public, should expect no less. Without reliable clinical data, informed, meaningful comparisons between competing treatment approaches are impossible. Families should not have to make their treatment decisions in a virtual research vacuum.
Research is clearly the key. Traditionally, clinical research precedes the introduction of new treatment approaches. Before a new prescription medicine is approved by the FDA, it must be shown to be effective and relatively safe. New medications and surgical techniques are then repeatedly compared in methodologically rigorous studies, with clinicians adopting those treatment approaches shown to be superior. Although there have been missteps over the years, this process has led to the development, identification, and clinical application of increasingly effective treatments.
This Old World order, though somewhat Darwinian and paternalistic in nature, is now being threatened by the well-intentioned forces of "alternative" or "complimentary" medicine. As a physician who accepts the scientific model yet also recognizes that some alternative therapies will undoubtedly be proven superior to conventional therapies, I am concerned that new treatment approaches are being promoted in a "Madison Avenue", "free market" cyber-wired world and then embraced with little or no scientific research to support them.
If families are rejecting some of what traditional medicine has to offer, physicians and the medical establishment are partly responsible. There has historically been little interest and even less money directed to investigating alternative therapies. Although patients are always encouraged to turn to their physician for sage counsel regarding alternative treatments, most doctors lack the objective information needed to respond. Physicians and scientists, however, are not alone to blame, and remedies must come from many quarters.
Research: With much fanfare, the National Institute of Health established the Office for Alternative Medicine in the early 1990's. Now titled the National Center for Complimentary and Alternative Medicine, this program receives much less than 1% of the total monies administered by the NIH. Unfortunately, this is an egregious example of the federal government doing "too little, too late". Funding for the NCCAM should be increased at least tenfold. It is not in our national interest to pursue ineffective treatments or forego effective therapies. Undoubtedly, billions of dollars are being spent on conventional and alternative therapies with limited or no proven value. Society does not need expensive placebos.
