An acupuncturist taps needles into a patient's skin. It is rarely painful.
Until the mid-1990s, most academic centers treated CAM like a pack of scruffy mutts, noisy and unworthy of notice. A large pot of federal and foundation research funds—now close to $250 million per year just from NCCAM and the National Cancer Institute, plus tens of millions more from private donors such as the Bravewell Collaborative—helped turn that sniffy attitude into solicitous attention, says longtime CAM commentator Donald Marcus. "The funding gave them respect from the medical school community," says Marcus, a professor of medicine and immunology at Baylor College of Medicine in Houston, where he has long taught a CAM course. A survey of hospitals found that 27 percent offered CAM in 2005, up from 8 percent in 1998. At the Cleveland Clinic, for example, NIH money is behind a clinical trial to see whether reiki, another energy therapy, can reduce stress and anxiety in prostate cancer patients.
The integrative medicine program at Children's Memorial got off the ground in 2003 with $1.7 million in foundation seed money and is now chasing NIH grants. David Steinhorn, a pediatric intensivist and medical director of the hospital's CAM program, says several privately funded trials, including Mikey's, are underway or in the works. Steinhorn is a passionate champion of investigating CAM therapies, no matter how unlikely, if he believes they may help patients and are safe. "I'm a very serious, hard-core ICU doctor, but I have seen these therapies benefit my patients, even if I don't know how," he says.
Patient access. CAM's ascendance isn't entirely driven by money—researchers make frequent references to obligation. "We want patients to have access to these therapies in a responsible fashion," says Lisa Corbin, medical director of the Center for Integrative Medicine at the University of Colorado Hospital. That implies a public clamor for such services, and patients may indeed talk about and ask for CAM more than they used to (although that isn't clear). But surveys showing widespread use—like one issued by the Centers for Disease Control and Prevention in 2004 reporting that 62 percent of adult Americans had used some form of CAM in the previous year—are highly misleading. The big numbers reflect activities such as prayer, which few would consider CAM, and meditation, now routinely prescribed to help lower high blood pressure. The Atkins and Zone diets ("diet-based therapies") were counted in the CDC survey, too. A more selective reading indicates that about 5 percent used yoga, 1.1 percent acupuncture, and 0.5 percent energy therapy, to pick three more-representative offerings.
The purpose of Mikey's trial is to put his touch therapy to the kind of test demanded by CAM critics: Prove that it can produce medical results beyond simply reducing stress or anxiety. Children having a bone marrow transplant are being divided into two groups. One will receive the therapy before and in the weeks after the marrow transplant. The other group will be visited on the same schedule by staff or volunteers who talk, read, or color with them. (The investigators won't know which children are in which group.) The working presumption, says Steinhorn, is that the energy-therapy group will take up the transplanted bone marrow stem cells more readily and with fewer complications, allowing those children to leave the hospital sooner. Early findings should be available by the end of this year.
Most academic hospitals are fairly conservative when it comes to CAM; the usual menu offers acupuncture, yoga, meditation, and variations on massage such as reiki. This tracks the philosophy of Andrew Weil, founder of the University of Arizona Program in Integrative Medicine and CAM's public face, if there is one. "I teach and urge people to use a sliding scale of evidence," says Weil. "The greater the potential to cause harm, the greater the standard of evidence should be."
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