assumes that because it's "alternative," it's safe and
effective . . . but that's just not the case.
William McDonald, Assistant Professor
1994, microbiology professor Linda Gooding became the first U.S.
researcher to win Food and Drug Administration approval to test
Chinese herbs in humans. Preliminary results of the study, funded
by the newly established Office of Alternative Medicine at the National
Institutes of Health, were promising. But funding ran out before
the study could offer definitive findings. The research program
in alternative therapies Gooding had hoped to seed never received
university support, and like-minded researchers tended not to stay
long in Emorys medical school.
Several Emory researchers observe that while programs in complementary
and alternative medicine were sprouting at schools like Harvard
and Hopkins in the 1990s, Emory lagged in this area. One reason,
Gooding suggests, is our self-image is that were a specialty
center, and complementary medicine tends to address primary care
issues. At Emory and across the nation, though, more researchers
are beginning to take seriously a long-held belief of millions of
Americansthat the intimate kinship of body and mind calls
for a more sophisticated dialogue between traditional and alternative
Its true that the $70 million the NIH pours into research
and alternative therapies is a mere drop in its $90 billion total
budget. But growth in this funding has been logarithmic,
says Mahlon DeLong, chair of the department of neurology and director
of Emorys new Center for Research on Complementary and Alternative
Medicine (CAM), which just won $5.7 million to study alternative
therapies for neurodegenerative diseases. Just after DeLong and
CAM co-director, Professor of Rehabilitation Medicine Steven Wolf,
launched their center, another group of doctors, led by Associate
Professor of Psychiatry Andrew Miller, established the Mind-Body
Program in the Department of Psychiatry. While CAM researchers assess
the value of alternative therapies, investigators in the Mind-Body
Program focus more on the biological mechanisms that govern the
marriage of mind and body.
The advent of these two programs
at Emory comes amid a surge of national interest in alternative
medicine. Discoveries in this emerging field may shake up medical
schools in some of the same ways that alternative literatures
and methodologies shook up the humanities and social sciences in
recent decadesa phenomenon commonly called the culture
Like that movement to reshape the traditional canons of literature
and history, the push for better understanding of alternative medicine
reflects a growing interest in non-Western cultural traditions.
For instance, to illuminate the relationship between mood disorders
and the systems that regulate body temperature, Assistant Professor
of Psychiatry Charles Raison and postdoctoral collaborator Guiseppe
Pagnoni plan to study a Tibetan Buddhist meditation technique that
raises body temperature. And Wolf has already proven that Tai Chi
can reduce injuries and falls in elderly people.
What really came into focus for me, says Michael McQuaide,
an Oxford professor of sociology who has walked with shamans in
the forests of Ecuador and witnessed sacred, fiery rituals, is
the role that expectation plays in healing. From a Western point
of view, it shouldnt work. But for the supplicant, the shamans
authority is real.
To scientists, the authority of some practitioners of alternative
therapies is becoming more real as treatments such as acupuncture
are validated in rigorous, controlled studies. Basically,
once we prove a treatment effective, its no longer labeled
alternative, says DeLong, indicating that the
boundary between orthodox and alternative medicine is permeable
Another shift reminiscent of the culture wars is a heightened interest
in topics previously seen as marginal to the field. Neuroscientists,
for example, traditionally describe areas like the immune system
as peripheral. The implication of that language,
in the periphery, is that its not central, and
that we brain scientists of course study things central to the brain,
says Assistant Professor of Psychiatry and Behavioral Sciences Brad
Pearce. With Miller and others, Pearce is reassessing those assumptions.
A lot of neuroscientists look at the body as a support system
for the brain, but I realize now that the interface is actually
For instance, infections and other stressors that strike far from
the brain seem to set off complex reactions that ultimately shape
mood and behavioral disorders. Key
travelers between brain and body appear to be immune system molecules
called cytokines. The similarity between the lethargy we feel when
we battle a virus and the lethargy of depression led Millers
team to focus on cytokines. Their research suggests that some depression
may, in fact, be triggered by an overactive immune system. In
some ways, says Miller, our work is a reversal of that
old story about the minds powerful influence on the body.
Instead, were finding the brain hostage to bodily influences.
The street is two-way.
A striking difference between
the culture wars that raged on campuses in past decades
and this shift in medicine lies in its high stakesmoney and
health. Ameri-cans spent $27 billion on alternative therapies in
1997 alone, according to conservative estimates published in the
Journal of the American Medical Association. In the same year, visits
to practitioners of alternative therapies reached 629 million, exceeding
total visits to primary care doctors. An estimated one in five people
takes prescription medicines along with herbal remedies, high-dose
vitamins, or other alternative therapies. But about 60 percent of
users of alternative therapies do not tell their medical doctors
about the other therapies, thereby risking potentially harmful drug
I think there is a good chance that many of these therapies
have value, but its not enough to believe they work,
says DeLong. We need to scrutinize them scientifically to
ascertain safety and efficacy. Many herbal remedies, for example,
are impure. What people are taking over the counter may contain
toxinsheavy metals, lead, mercury.
The simultaneous emergence of these two programs may well indicate
a significant change in the culture of medical research. But whether
this trend will reshape assumptions and methodologies in the school
of medicineas the culture wars have done across
campusremains an open question. A.B.B.