ACSM, NEJM weigh in on alternative therapies

Within weeks of each other, the American College of Sports Medicine (ACSM) and the New England Journal of Medicine (NEJM) have issued warnings about dietary supplements and other unregulated, "alternative" therapies.

On the heels of publicity about such dietary supplements as androstenedione (taken by slugger Mark McGwire), the ACSM has called for the federal Food and Drug Administration (FDA) to revisit the Dietary Supplements Health and Education Act of 1994 (DSHEA).

"ACSM understands that Congress’ intent in enacting the DSHEA was to meet the concerns of consumers and manufacturers to help ensure that safe and appropriately labeled products can remain on the shelf. However, many physicians feel that some supplements have little or no physiologic effects," said ACSM president Paul D. Thompson, MD, FACSM, in a prepared statement. "Unfortunately, most supplements have not been evaluated for either their potential risks or benefits promoted via advertising."

"Certainly, there are positive effects to the supplements being questioned," notes Gary I. Wadler, MD, FACSM, associate professor of clinical medicine at New York University, in New York City. "Our concern is that many of the newer substances have not yet been tested for their long-term physiological and potentially adverse effects. Even more of a concern is the use of these products by adolescents."

The lack of test data was also the main concern expressed in an editorial in the Sept. 17 NEJM.

"What most sets alternative medicine apart, in our view, is that it has not been scientifically tested and its advocates largely deny the need for such testing. By testing, we mean the marshaling of rigorous evidence of safety and efficacy, as required by the FDA for the approval of drugs and by the best peer-reviewed medical journals for the publication of research reports," wrote authors Marcia Angell, MD, and Jerome P. Kassirer, MD.1

" . . . Alternative medicine also distinguishes itself by an ideology that largely ignores biologic mechanisms, often disparages modern science, and relies on what are purported to be ancient practices and natural remedies (which are seen as somehow being simultaneously more potent and less toxic than conventional medicine)," they continued. "Accordingly, herbs or mixtures of herbs are considered superior to the active compounds isolated in the laboratory. And healing methods such as homeopathy and therapeutic touch are fervently promoted despite not only the lack of good clinical evidence of effectiveness, but the presence of a rationale that violates fundamental scientific laws — surely a circumstance that requires more, rather than less, evidence."1


1. Angell M., Kassirer JP. Alternative Medicine – The Risks of Untested and Unregulated Remedies. N Engl J Med 1998;339: 839-841 – S.