Criticism for CAM
I usually read The Rheumatologist with pleasure, but September’s issue had an unpleasant surprise on the front page: the article “CAM & RA” featuring an overview of complementary therapies that may benefit patients with RA by Professor Wang of the Center for Integrative Medicine at Tufts University, and supported by the National Center for Complementary and Alternative Medicine of the National Institutes of Health.
I think this article is misleading and does both physicians and patients a disservice. Its publication suggests that the ACR and ARHP promote services and therapies that are at best of uncertain benefit, at worst quackery, harmful, and usually costly.
The leader on p. 31 claims that the literature in the past two decades “has consistently recognized the potential therapeutic benefits of Tai Chi mind–body exercise for chronic conditions.” Apart from Tai Chi, the overview features acupuncture, Trypterygium Wilfordii Hook F, and Tibetan Five Nectar formula. For acupuncture, Dr. Wang reports her personal updated but unpublished review, concluding benefits are uncertain. For Tai Chi, she contrasts her positive pilot trial of 20 patients with a Cochrane review that only suggests it may confer some benefit for a decidedly noncore outcome, i.e., lower extremity range of motion, particularly the ankle joint. For Hook F, she reports a published trial in 35 patients that concluded the treatment was safe (no mention of efficacy) and again an unpublished trial that reports efficacy. For Tibetan nectar, the studies were of such poor quality that even Dr. Wang chose not to provide details. The reference list includes some familiar titles, but also periodicals of import such as BMC Complement Altern Med, Chin Acupunct Moxibustion, and Hunan Guiding J TCM.
The article concludes that, while evidence on complementary therapies on RA remains limited, some of these treatments warrant future exploration.
Even on the basis of this highly selective and unsystematic review, I beg to differ. Let’s spend our money on developments that have more potential than those that have had 3,000 years or more to prove their worth (and still haven’t). Although I realize that The Rheumatologist is not a scientific journal, I think its message should be in keeping with evidence-based medicine. An article on complementary medicine should appropriately weigh the overwhelming amount of evidence against meaningful efficacy of such therapies, and protect us from biased reports of promising, uncontrolled, and unpublished results.
Maarten Boers, MSc, MD, PhD
Professor of Clinical Epidemiology
Department of Epidemiology and Biostatistics
VU University Medical Center
Amsterdam, Netherlands
Criticism for CAM: Dr. Wang Responds
I appreciate the comments and welcome the opportunity to clarify the substance of my overview, titled: “CAM & RA: Acupuncture, mind–body therapy, and Chinese herb and Tibetan medicine may benefit patients with RA” (September 2013, p. 1).
