One organization that is seeking to bring more science to nonmedical therapies is the National Institutes of Health (NIH). The NIH has just awarded nearly $16 million in grants to a pair of research centers in Oregon. The grants, which were announced last month, will be used to establish specialized centers in collaboration with local schools and practitioners of chiropractic, acupuncture, naturopathic medicine and other forms of disease prevention and treatment.
The Kaiser Center for Health Research and Oregon Health Sciences University, both located in Portland, will act as the hubs for the new research programs and will each receive about $8 million over the next five years. Schools collaborating on both grants include Western States Chiropractic College, the Oregon College of Oriental Medicine, the Portland Veterans Affairs Medical Center, the OHSU School of Dentistry and the Linus Pauling Institute at Oregon State University.
"I think it's going to really move forward the integration of all different fields of medicine, which ultimately is, in my mind, the best for the patient," said Dr. Anna MacIntosh, the dean of research at the National College of Naturopathic Medicine, another collaborator for both grants.
Three studies are currently being planned at the Kaiser Center, which received a grant of $7.96 million. Dr. Alex White, a dentist and public health researcher, will be the lead researcher for the Kaiser group.
One study of particular interest to doctors of chiropractic concerns the treatment of temporomandibular joint disorder (TMD), a condition that causes chronic face and jaw pain and afflicts approximately 10 million people, the majority of whom are women. In the study, patients will be randomly assigned to one of four groups and will receive either chiropractic manipulation, traditional dental care, acupuncture or massage therapy to determine which form of care works best.
"This study gives us the opportunity to look at the benefits of chiropractic care for TMD, including manipulation of the temporomandibular joint," explained Dr. Mitchell Haas, Western States' interim director of research and the college's investigator on the project. "It brings us a step closer to discovering which therapies are most effective in treating this widespread disorder."
Dr. White has expressed optimism about the project, noting that these types of treatment could provide answers that allopathic medicine has yet to find. "I'm interested in trying to see if there are different ways of thinking about the condition," said White. "The way we've thought about it in the past hasn't given us treatments that always make our patients better."
Researchers at Kaiser will also conduct a study using traditional Chinese medicine or naturopathic medicine for treating women who have TMD in addition to four or more other chronic ailments. A third study will look at the use of naturopathic nutrients and herbal supplements to treat periodontal disease.
Dr. Barry Oken, a neurologist, will lead the research team at Oregon Health Sciences University, which received a $7.8 million grant. A portion of that money has been used to form the Oregon Center for Complementary and Alternative Medicine in Neurological Disorders (ORCCAMIND), which will be based at OHSU.
The center's current projects do not directly include chiropractic, instead focusing more on the prevention and treatment of neurological disorders such as Alzheimer's disease and multiple sclerosis. Nevertheless, they may still provide useful information that doctors of chiropractic could incorporate into their practice.
"For years, the alternative and conventional specialists have been working for the same goals independently," said Dr. Oken. "This center and others like it will attempt to close that gap."
One of the first planned studies at OHSU will try to determine the effect of yoga on the health of older adults or people with MS. Another project will look at the use of ginkgo tree extract and the possible prevention of age-related cognitive decline. Other projects will examine the role of antioxidants such as vitamin C, selenium and plant extracts in the treatment of MS and Alzheimer's. Future studies will involve the use of chiropractic manipulation, diet therapy and acupuncture.
"It is important to sort it through," added Dr. Oken in regards to the different treatments and therapies that will be studied. "If there are things that are useful, they are definitely underutilized. The things that aren't valuable, you don't want people to spend their money on."
One thing that Americans do appear to be spending their money on is alternative health care. In 1997, according to a survey by Dr. David Eisenberg of the Beth Israel Deaconess Medical Center in Boston, Americans made more visits to alternative care practitioners than primary care physicians and spent more than $21.2 billion on "alternative therapies" such as chiropractic, acupuncture and massage therapy.1
The federal government seems to have taken notice of the trend toward alternative care as well. At a combined total of $15.76 million, the grants are among the largest ever awarded to alternative care researchers in the Northwest, and in fact amount to more money than the government's Office of Alternative Medicine spent on all of its grant programs from 1992-96 combined.
The grants also signal a response to a growing demand among lawmakers and health care practitioners to study the efficacy of alternative therapies. Earlier this year, Congress more than doubled the amount of money to be spent on alternative care research, from $20 million in 1998 to $50 million in 1999. The Office of Alternative Medicine was also upgraded and renamed the National Center for Complementary and Alternative Medicine, with increased funding, grant-making capabilities, and more independence from competing NIH centers.
The $16 million given to Kaiser and OHSU may seem insignificant compared to the $11.2 billion spent by NIH on "conventional" biomedical research grants in 1998. Nevertheless, considering the sheer numbers of people who are using (or are considering using) alternative care, and the potential these treatments hold for increasing one's quality of life, it appears to be money well spent.
Reference
1. Eisenberg DM, et al. Trends in alternative medicine use in the United States, 1990-1997. Results of a followup national survey. JAMA November 11, 1998;280(18):1569-1575.
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