SPEAKERS CONTENTS INSERTS
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PLEASE NOTE: The following transcript is a portion of the official hearing record of the Committee on Government Reform. Additional material pertinent to this transcript may be found on the web site of the committee at [http://www.house.gov/reform]. Complete hearing records are available for review at the committee offices and also may be purchased at the U.S. Government Printing Office.
COMPLEMENTARY AND ALTERNATIVE MEDICINE IN GOVERNMENT-FUNDED HEALTH PROGRAMS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTH CONGRESS
Page 2 PREV PAGE TOP OF DOCFEBRUARY 24, 1999
Serial No. 1064
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.house.gov/reform
COMMITTEE ON GOVERNMENT REFORM
DAN BURTON, Indiana, Chairman
BENJAMIN A. GILMAN, New York
CONSTANCE A. MORELLA, Maryland
CHRISTOPHER SHAYS, Connecticut
ILEANA ROS-LEHTINEN, Florida
JOHN M. MCHUGH, New York
STEPHEN HORN, California
JOHN L. MICA, Florida
THOMAS M. DAVIS, Virginia
DAVID M. MCINTOSH, Indiana
MARK E. SOUDER, Indiana
JOE SCARBOROUGH, Florida
STEVEN C. LATOURETTE, Ohio
MARSHALL ''MARK'' SANFORD, South Carolina
BOB BARR, Georgia
DAN MILLER, Florida
Page 3 PREV PAGE TOP OF DOCASA HUTCHINSON, Arkansas
LEE TERRY, Nebraska
JUDY BIGGERT, Illinois
GREG WALDEN, Oregon
DOUG OSE, California
PAUL RYAN, Wisconsin
JOHN T. DOOLITTLE, California
HELEN CHENOWETH, Idaho
HENRY A. WAXMAN, California
TOM LANTOS, California
ROBERT E. WISE, Jr., West Virginia
MAJOR R. OWENS, New York
EDOLPHUS TOWNS, New York
PAUL E. KANJORSKI, Pennsylvania
GARY A. CONDIT, California
PATSY T. MINK, Hawaii
CAROLYN B. MALONEY, New York
ELEANOR HOLMES NORTON, Washington, DC
CHAKA FATTAH, Pennsylvania
ELIJAH E. CUMMINGS, Maryland
DENNIS J. KUCINICH, Ohio
ROD R. BLAGOJEVICH, Illinois
DANNY K. DAVIS, Illinois
JOHN F. TIERNEY, Massachusetts
JIM TURNER, Texas
Page 4 PREV PAGE TOP OF DOCTHOMAS H. ALLEN, Maine
HAROLD E. FORD, Jr., Tennessee
BERNARD SANDERS, Vermont (Independent)
KEVIN BINGER, Staff Director
DANIEL R. MOLL, Deputy Staff Director
DAVID A. KASS, Deputy Counsel and Parliamentarian
CARLA J. MARTIN, Chief Clerk
PHIL SCHILIRO, Minority Staff Director
C O N T E N T S
Hearing held on February 24, 1999
Berman, Brian, M.D., associate professor and director, Program for Complementary Medicine, University of Maryland School of Medicine, Baltimore, MD; and Ollie and Barbara Johnson, Dean Ornish Lifestyle patient and spouse, Columbia, SC
Kamerow, Douglas, M.D., Director, Center for Health Care Technology, Agency for Health Care Policy Research, Department of Health and Human Services; Thomas V. Holohan, M.D., Chief, Patient Care Services Officer, Veterans Health Administration; John F. Mazzuchi, Deputy Assistant Secretary of Defense for Health Affairs, Clinical and Program Policy, Department of Defense; and Jim Zimble, M.D., president of the Uniformed Services University for the Health Sciences
Ornish, Dean, M.D., president and director, Preventive Medicine Research Institute, and clinical professor of medicine, University of California, San Francisco, CA
Seymour, Jane, actress
Page 5 PREV PAGE TOP OF DOCLetters, statements, etc., submitted for the record by:
Berman, Brian, M.D., associate professor and director, Program for Complementary Medicine, University of Maryland School of Medicine, Baltimore, MD, prepared statement of
Burton, Hon. Dan, a Representative in Congress from the State of Illinois:
Information concerning saw palmetto
Letter dated March 1, 1999
Prepared statement of
Holohan, Thomas V., M.D., Chief, Patient Care Services Officer, Veterans Health Administration, prepared statement of
Johnson, Barbara, Dean Ornish Lifestyle spouse, Columbia, SC, prepared statement of
Johnson, Ollie, Dean Ornish Lifestyle patient, Columbia, SC, prepared statement of
Kamerow, Douglas, M.D., Director, Center for Health Care Technology, Agency for Health Care Policy Research, Department of Health and Human Services, prepared statement of
Mazzuchi, John F., Deputy Assistant Secretary of Defense for Health Affairs, Clinical and Program Policy, Department of Defense; and Jim Zimble, M.D., president of the Uniformed Services University for the Health Sciences:
Information concerning FY 98 breast cancer research program
Prepared statement of
Ornish, Dean, M.D., president and director, Preventive Medicine Research Institute, and clinical professor of medicine, University of California, San Francisco, CA, prepared statement of
Sanders, Hon. Bernard, a Representative in Congress from the State of Vermont, prepared statement of
Scarborough, Hon. Joe, a Representative in Congress from the State of Florida, prepared statement of
Seymour, Jane, actress, prepared statement of
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COMPLEMENTARY AND ALTERNATIVE MEDICINE IN GOVERNMENT-FUNDED HEALTH PROGRAMS
WEDNESDAY, FEBRUARY 24, 1999
House of Representatives,
Committee on Government Reform,
The committee met, pursuant to notice, at 10:18 a.m., in room 2154, Rayburn House Office Building, Hon. Dan Burton (chairman of the committee) presiding.
Present: Representatives Burton, Gilman, Morella, Davis, Sanford, Hutchinson, Biggert, Chenoweth, Waxman, Maloney, Norton, Kucinich, and Blagojevich.
Staff present: Kevin Binger, staff director; Daniel R. Moll, deputy staff director; Beth Clay, professional staff member; David Kass, deputy counsel and parliamentarian; John Williams, deputy press secretary; Carla J. Martin, chief clerk; Lisa Smith Arafune, deputy chief clerk; Jackie Moran, legislative aide; Phil Schiliro, minority staff director; Phil Barnett, minority chief counsel; Kristin Amerling, Jon Bouker, and Sarah Despres, minority counsels; Karen Lightfoot, minority professional staff member; Ellen Rayner, minority chief clerk; Courtney Cook and Earley Green, minority staff assistants; and Barbara Wentworth, minority research assistant.
Mr. BURTON. The committee will come to order.
We have a Republican conference going on at this time and we'll probably have Members coming in and out. I was going to wait on them, but because we have a number of witnesses that have time constraints, I thought we would go ahead and get started.
A quorum being present, the committee will be called to order. I ask unanimous consent that all Members and witnesses written opening statements be included in the record and without objection, so ordered.
Page 7 PREV PAGE TOP OF DOC Today, we continue our inquiry into American's access to complementary and alternative medicine. Alternative medicine continues to increase in popularity and use in the United States. A 1997 survey in the Journal of the American Medical Association revealed that over 42 percent of Americans used at least 1 of 16 alternative therapies during the previous year.
Last year, we looked primarily at the research area. We focused on the ability of seriously ill patients to get access to FDA-approved clinical trials in alternative medicine. This may be a relatively small percentage of the overall population, but it is one that is desperately in need of our help.
There are millions of Americans who are suffering from terminal or crippling diseases. For many of them, conventional treatments like chemotherapy do not work, or may be fatal themselves. For these people, alternative drugs and therapies are the only ray of hope that they have. I believe in my heart that we have an obligation to those people to invest the money that's needed into research and clinical trials to find out which treatments work and which ones do not. I believe that if someone is seriously ill and wants to try an experimental drug that safety has been established, the Federal Government has no business in blocking them. After all, it's their life.
I have a special interest in this area because of how my own family has been affected in just the last few years by cancer. Last September and October, I lost both my mother and my father to lung cancer. My wife struggled through breast cancer 5 years ago, and thanks to an experimental alternative cancer treatment, she has been in remission for 5 years. One of the things that has really troubled me over the past 5 years is this experimental program which has been so effective in helping my wife. The Food and Drug Administration, because of technicalities, tried to close the program down. I had about 70 women calling me who were crying on the phone and very upset because the last ray of hope they had was Dr. Springer's alternative therapy which stimulated the immune system. We had to literally have a real hard talk with the Food and Drug Administration because they were not going to relent.
Page 8 PREV PAGE TOP OF DOC Fortunately, they did review the situation, the problem was solved and the program has been ongoing. So those 70-some women who are in this experimental program are still happy and they are doing well, but it is unfortunate that you have to fight for a program like that when so many lives depend on it.
I'd be willing to bet that every member of this committee has lost a family member to cancer, heart disease, or some other serious illness. There is not anyone in this room whose family has not been touched by cancer, heart disease or some other devastating disease.
Last year, we began looking at the level of funding for alternative medicine cancer research through the National Institutes of Health. We learned that less than $20 million of the $2.7 billion that is the budget for the National Cancer Institute, was devoted to research in alternative medicine. This is less than 1 percent of their total budget, and I think that's deplorable.
This year, we are expanding our investigation to include patient access to alternative medicine through Government-funded health programs. Between 25 and 40 percent of Americans receive at least part of their health care through federally funded programs. This includes our active-duty military, veterans, and their families. It also includes Americans who receive medical care through Medicare, Medicaid, public health clinics, and Indian Health Services.
Are research results translating into access to alternative treatments by the average American? Well, the Health Care Financing Administration estimates that national health care expenditures for the United States will double by the year 2007 to exceed $2.13 trillion. Almost $1 trillion of those estimated dollars will be public funds. It is imperative that the Government reduce these healthcare costs while working to improve the health and well being of the American people, and that's where alternative therapy comes in.
With the epidemic-level increases of chronic conditions such as heart disease, obesity, diabetes, arthritis, asthma, and depression, as well as the high percentages of cancers such as lung cancer, breast cancer, prostate cancer, colon cancer, and melanoma, we have to be aggressive and open-minded in looking for additional options in medical care. We have to find effective and efficient ways to treat chronic and debilitating illnesses. We have to find better ways to treat pain. We have to find ways to reduce the use of antibiotics. We just read the last week that many strains of viruses are becoming resistant to antibiotics, and so there has to be alternatives looked at very, very thoroughly. We have to find better ways to treat pain. We also need to better care for the terminally ill. We need to integrate the wisdom of the ages with the knowledge of this century and move forward into the next millennium expediently.
Page 9 PREV PAGE TOP OF DOC I remember when I was a State legislator, I had about 300 or 400 cancer patients who had been adjudged terminally ill come down to the Indiana State Legislature when we were debating an issue called Laetrile, and I know that's a very controversial issue. But many of those people had been helped because they had used alternative therapies and many had used Laetrile with some success. And the thing that frustrated me the most was the whole determination of those who opposed Laetrile as well as any alternative therapy. And the way they just ignored these people who were terminally ill, and it seemed to me at the time and it seems to me today that if somebody is adjudged terminally ill, they ought to be able to do anything they wish to try to save their life. After all, hope is one of the major ingredients in keeping people going. And when you take away that hope and just say go home and die, that's just what they are going to do.
Since a substantial portion of our population receives their healthcare through these agencies, it's important to look at the level of integration of complementary and alternative medicine in these programs. We've heard the cry here in this chamber of ''Show me the science'' in hearings of this committee as the mantra of why alternative medicine should not be used. Caution is important. Good scientific data is important, and thousand of years of safe and effective use of alternatives are also important.
We will hear today from two esteemed physician researchers. Both Dr. Ornish and Dr. Berman have conducted clinical trials in alternative medicine. Each hold teaching positions at highly respected U.S. medical schools. Each has published in peer-reviewed journals. Each has extensive experience and expertise in their fields, and we'll hear that there is good scientific research in alternative medicine and an ever-increasing amount of that reported in peer-reviewed medical journals.
We'll also hear from the Department of Health and Human Services, the Federal Government's principal agency for protecting the health of all Americans. The Department of Health and Human Services is responsible for providing essential human services, especially for those who are least able to help themselves. Among these services is the Medicare program, the Nation's largest health insurer. Many of these services are provided at the local level by State or county agencies or through the private sector grantees.
Page 10 PREV PAGE TOP OF DOC For many Americans, especially those on Medicare and Medicaid, the denial of coverage is a restriction of access and in some cases, ultimately is a death sentence. The Department of Veterans Affairs provides benefits and services to the country's veterans. This is a population of over 25 million. They also provide care for approximately 44 million family members. Given the increased demand by patients to have access to alternative therapies, in April 1998, the Veterans Administration initiated a survey to determine the level of alternative medicine availability and to assess what, if any, alternative therapies should be offered with the Department. That report was due out in December 1998 and it has still not been released and we're going to find out why.
The Department of Defense provides health care to its active-duty service members and active-duty dependants, retirees and their dependants, and survivors of deceased members and former spouses. There's an increasing number of healthcare providers within the Defense Department that have specialized training in complementary and alternative therapies.
Today, we have one of the foremost actresses, Jane Seymour, with us and she will present testimony regarding her experiences in integrating natural healing approaches into her life. Ms. Seymour has had numerous experiences with alternative medicines that have helped her family. She will talk about her father's cancer experience and her experiences of integrating herbs, homeopathy, and other complementary methods with conventional medicines.
Dr. Brian Berman is the Director of the NIH-funded Complementary Medicine Program at the University of Maryland in Baltimore. Dr. Berman has been a long-time advisor to the Federal Government on alternative medicine and he has conducted clinical research in acupuncture, mind-body and relaxation techniques, and coordinates the complementary medicine field group of the Cochrane Collaboration.
We are in a time of change in this country. Healthcare is important to all of us. How can we, as a Government, provide quality and effective care and not increase costs to the point of crippling our system? Complementary and alternative medicine may be a large part of the answer. As I have said before, we've heard the mantra ''Show me the science'' and we are moving to do that today. We will show that there is already scientific data to validate the effectiveness of several complementary and alternative therapies. We have moved to a point of looking at broader availability to our armed-services families and their veterans, and to those who rely on the Federal Government for part or all of their health care. It is time that we assume and assure that scientifically validated healthcare moves out of the ivory towers of research community and into the lives of the American people.
Page 11 PREV PAGE TOP OF DOC We look forward to hearing from today's witnesses. There has been a great desire by many patients, healthcare providers, associations, and researchers to speak to the committee on this topic. And we're not able to bring them all in today, but we will hold the record open until March 10 to allow for written submissions to be included in the record. And I want to thank all of our guests for being here today. I really appreciate it. I know it takes a lot of time out of your busy schedule and we really, really appreciate that.
I'll now turn to Mr. Waxman, our ranking minority member, who just arrived for an opening statement.
[The prepared statement of Hon. Dan Burton follows:]
INSERT OFFSET FOLIOS 1 TO 6 HERE
[The official committee record contains additional material here.]
Mr. WAXMAN. Thank you very much, Mr. Chairman.
There is no denying the growing popularity of alternative medicines. They constitute a rising proportion of our healthcare expenditures. The number and diversity of alternative products and services in the healthcare marketplace are increasing dramatically.
Today's hearing is focused on the right questions about alternative medicines. It is important that we seek information about therapies that can help improve our well being and to encourage access to safe and effective treatments. At the same time, we must promote thorough testing and review of therapies to prevent unnecessary harm and expense to consumers.
I believe that a quote from a recent editorial in the Journal of the American Medical Association provides the appropriate framework for today's discussion. The Journal of the American Medical Association recently wrote ''there is no alternative medicine. There is only scientifically proven evidence-based medicine supported by solid data or unproven medicine for which scientific evidence is lacking.'' This is the test to which we must hold alternative medicine. Medicine of any kind must undergo the crucible of scientific investigation from clinical trials to publications in reputable peer-reviewed journals before it can gain a place in routine practice. We must place our trust in credible evidence and not mere speculation, or tradition, or popularity when we decide how best to care for the sick.
Page 12 PREV PAGE TOP OF DOC The Federal Government and others have invested millions into research on alternative medicines. Some research has had promising results. For example, the Journal of the American Medical Association recently reported on a preliminary study indicating that yoga stretching can relieve some symptoms of carpal tunnel syndrome.
On the other hand, other therapies have proven ineffective or dangerous. For example in 1997, the deaths of three cancer patients were linked to a Manassas physician who had been treating them by injecting them with concentrated aloe vera, a treatment that is not approved by the Food and Drug Administration. Patients reportedly had learned about this physician's treatment through the internet, word of mouth, or an aloe vera supplier.
In highlighting ongoing research, examples of scientifically validated forms of alternative medicine and positive personal experiences with alternative treatments, today's witnesses will help sift through the positive and the negative aspects of this area of medicine.
I join my colleagues in welcoming the witnesses here today and I just want to comment on the fact that we have a change of the list of witnesses and their order which we were never advised of until the very last minute. Not only were we not advised, but the Government witnessesand it would have been helpful for them to know when they were to appearwere suddenly put on a third panel. And, I think for the record, I want to point out that we ought to be courteous to all of the witnesses try to accommodate them and also discuss with our colleagues, if we are going to have collegial hearings, how we're trying to treat the witnesses so we can get the opportunity to hear from them and not have them mistreated by having the schedules changed on them.
Thank you very much, Mr. Chairman. I do appreciate the hearing. I think the hearing is a worthwhile one and I will try to be here as much as possible, but I certainly will review the record for those witnesses where I am not present in the room because of conflict of schedule.
Page 13 PREV PAGE TOP OF DOC Mr. BURTON. Thank you, Mr. Waxman.
Let me just say that wherever possible, we always have our agency and administration officials testify first. We do have some time constraints which are a little unusual today. So, for that reason we've changed our panel structure around a little bit. So if that inconvenienced you, we apologize for that.
Mr. Hutchinson, do you have anything you would like to say?
Mr. HUTCHINSON. Thank you, Mr. Chairman.
I'm just delighted to participate in this hearing. I thank you for conducting this and I look forward to the testimony. And so in the interest of hearing the testimony, I yield back the balance of my time.
Mr. BURTON. Are you saying the chairman talked too long? Is that what you're saying? [Laughter.]
Mr. HUTCHINSON. I would never say that, Mr. Chairman.
Mr. KUCINICH. Thank you very much, Mr. Chairman, Mr. Waxman, fellow committee members, and members of the panel. I appreciate the opportunity to participate in this hearing on complementary and alternative medicine. I applaud the chairman's willingness to address this issue and I thank him for providing us with this forum.
As a witness to the theories and practice of alternative medicine, I support the committee's efforts concerning this issue. With this in mind I look forward to exploring opportunities that will advance medical care and expand the treatment options afforded to today's doctors.
I think that all of us in Congress are fully aware that our healthcare system is on the verge of radical change. The direction that we are going remains to be seen, but with rising costs, with more and more Americans not having access to adequate healthcare, and with more and more Americans questioning whether they have any availability to healthcare, I think there is becoming a greater and greater interest in alternative methods.
Page 14 PREV PAGE TOP OF DOC This, in no way, is an attempt to denigrate allopathic practice because I think that, at a minimum, many allopathic practitioners would agree that alternative healthcare methods and therapies are a proper adjunctive theory. I have great respect for allopathic practice, but at the same time, I think that you will find that allopathic practitioners who are candid will admit that there are limitations to their own practice.
I think that we are fully aware that the United States enjoys some of the most advanced health care in the world, but yet we are unable to provide relief for a number of common ailments. The current standards of practice occasionally fail to recognize that medicine is an ancient art that encompasses all methods of healing. Somewhere along the road to advance medicine we sometimes forget that there are methods of treating those who need help. It's time to help widen the vision of modern medical doctrine and explore alternative medicine. We have to let go of the fear that alternative medical practices will replace and endanger standards and instead embrace the idea that any method that is proven a safe form of treatment ought to be available to the people.
American citizens have a right to health care and as Members of Congress, we have a duty to ensure that they have every available proven treatment option. Complementary and alternative medical care encompasses numerous forms of studies and tested procedures and practices and it is gaining support from mainstream medicine. Unfortunately, there is some unwillingness to support its practice and research. We must ensure nonprejudicial disbursement of research funds to all disciplines of medicine, including alternative medicine. We must utilize this research not only to educate practitioners and the public, but to provide them with access to proven methods of alternative medicine.
I hope these hearings will broaden our understanding of alternative medicine; will expose and end any bias that may exist within our current system of medical doctrine. All citizens deserve access to safe and proven methods of medical care and I thank the chairman and the panel for expanding our understanding of medicine that some would deem, unfortunately, the alternative.
Page 15 PREV PAGE TOP OF DOC Finally, Mr. Chairman, these hearings present a wonderful opportunity. We have to think creatively about healthcare; to think dynamically; to draw new worlds toward us using a higher consciousness of the potential we have within us to make this a better world. I think that we need to urge Government officials to keep an open mind on alternative therapies. Anyone who is watching or listening knows that once an individual has experienced a profound shift in his or her health as the result of a new approach toward health care, it is important that the story of the miracle of an individual's transformation be available to study, certainly, and also to share.
So, I welcome Ms. Seymour and the other witnesses and I thank you for participating in these hearings.
[The prepared statements of Hon. Joe Scarborough and Hon. Bernard Sanders follow:]
INSERT OFFSET FOLIOS 78 TO 85 AND 7 TO 9 TO HERE
[The official committee record contains additional material here.]
Mr. BURTON. Thank you, Mr. Kucinich.
Well, we now finally are at the stage where we hear from our witnesses and the first witness, Ms. Seymour, would you come forward and sit in this chair right here in the middle, and if you would like to have anybody with you, that's fine.
First of all, before you start your statement, let me just say how much we appreciate you being here. I especially appreciate you being here because I am one of your biggest fans. I watched you in East of Eden and I thought you did extremely well in that, and I saw you in ''Somewhere in Time,'' which is a very romantic movie. I saw your picture on the wall in that movie theatre and just swooned. So I just want you to know you have a big fan here in the chairman and
Page 16 PREV PAGE TOP OF DOC Ms. SEYMOUR. Thank you.
Mr. BURTON [continuing]. Although we usually limit testimony to 5 minutes, you can have all the time you want.
STATEMENT OF JANE SEYMOUR, ACTRESS
Ms. SEYMOUR. Thank you very much, Chairman Burton, and thank you all for giving me this opportunity. This is, obviously, very unusual for me and something I am very excited to be a part of.
My first experience with alternative medicine involved my father, Mr. John Frankenberg, a fellow of the Royal College of Obstetricians and Gynecologists in England. He specialized in infertility and prided himself in being a good doctor, with extraordinary results in his field, greatly due to the time he would spend listening to his patients. When he himself was diagnosed with lung and bone cancer and treated with radiation, his oncologist told him that that was it. He had no more options.
Distressed and desperate to find an answer, I found the Virginia Livingston Clinic in San Diego, a complementary medicine program which was heavily criticized by mainstream medicine. I offered this option to my father not believing that he would accept. However, after reading their brochure he did.
On his arrival in California, he was frail, gray, and lifeless. Not the man I had always known, but rather a man who appeared nearly dead, both physically as well as spiritually. After only 1 week there undergoing complementary medicine therapies and antibiotics, he regained his strength and his spirit. He decided to visit Sea World. He walked out of this wheelchair to look more closely at the exhibit. He was healthy looking and happy and we were all, including his oncologist, dumbfounded.
Page 17 PREV PAGE TOP OF DOC Many months later, he died of complications including heart problems, but he had a much longer life than predicted and, without question, a higher quality of life. He visited the opera 2 days before his death. He was happy and comfortable until the end. Before he died, I spoke with him asking if he had any regrets in his life. And he said that his strongest regret was his not knowing more about alternative medicine as he felt he could have been a better doctor with that knowledge to complement his own.
Since then, my sister Anne, who is with me today, has trained as a homeopath in England. I have seen her help many people. One was a woman with fibroid tumors declared unable to conceive and told she needed surgery. Anne treated her homeopathically, and she has just delivered a healthy child and the doctors found no fibroids present in her body. When alternative medicine finally arrives, how many surgeries like this will be prevented?
My nephew with chronic Eczema has found relief at last with homeopathy instead of steroids. My sister, Sally, had a brain aneurysm and after surgery was given Arnica for the swelling with the permission of her brain surgeon who admitted he didn't really understand what Arnica was. He was then astounded, as were all the nurses, who determined her swelling to be one-tenth that of the other patients who had received the identical surgery that day.
In my own life, I've used high-quality herbs, vitamins, and homeopathy. During my 16-hour a day, 5 day-a-week job on Dr. Quinn, I rarely got sick. Indeed, even pregnant with twins at 45, I was able to support my immune system with this regime and not miss a single day of work.
I have recommended remedies to friends for headaches and flu symptoms with amazing success, even to the non-believers. My children, both teens and babies, routinely use alternative medicine first. More often than not, it has solved their problems. My pediatrician suggested homeopathy to avoid the excessive use of antibiotics. One of my twins did so well with this that he was antibiotic-free for over 6 months when all around him were suffering from the flu.
Page 18 PREV PAGE TOP OF DOC Recently, both twins with ear infections received antibiotics due to the severity of the case, but also took a series of other therapies like herbal medicine to support their immune systems. They sailed through this as if they were never sick and needed far less antibiotics rounds. It was amazing.
Another friend with chronic migraines would vomit uncontrollably and lie in a fetal position crying for help. Medicine prescribed for her did little. Only Codeine gave her some pain relief and sleep. The following day, she consulted a naturopathic medicine practitioner who after the session gave her a single remedy. She felt better within a half an hour and has remained pain and headache free ever since.
About 9 years ago, I almost died of anaphalatic shock from an injection of Cephliosporin prescribed for bronchitis. Needless to say since that close call, I've been more inclined to ask questions and seek options in my medical health. Do we all need a severe wake-up call? I have managed to avoid antibiotics on many occasions by catching early warning symptoms of viral infections using proven herbs such as echinacea, vitamins, and homeopathy.
Two years ago, I was very ill with Leptospirosis, a bacterial infection contracted while filming in a swamp. I was eternally grateful to have Tetracycline, which absolutely saved my life. I am also positive that by my abstaining in the past from antibiotics whenever possible and using complementary medicines, the antibiotic worked more effectively in that crisis.
The world of alternative medicine has become a major spark in my life and I am here to suggest the integration of western and alternative medicine within our medical establishments. It would be an injustice to deny America the information about and access to alternative medicine, particularly as it has now been proven through laboratory and clinical research and has shown to be cost effective with 100 to 500 years of reproducible clinical results.
Page 19 PREV PAGE TOP OF DOC I am not standing here as a scientist, but as a concerned member of the public who has had the privilege to try these options which are supported by scientific evidence.
A recent article in JAMA estimated that there were 110,000 deaths annually from the use of medical drugs. It is the fourth cause of death in America. That is not to say that miracles have not been achieved with the use of prescription drugs, and I am not here to vilify western medicine. I am looking for inclusion, not exclusion. I propose every hospital in America include a complementary medicine department consisting of two or three licensed practitioners who direct the complement to unassisted treatments such as chemotherapy side effects and chronic, but not life-threatening, diseases. I propose the NIH stop withholding its billions of dollars in research funds from the implementation of natural medicines and protocols.
When I get sick, my children, or my friends, I want to know that ''all'' has been done to protect their health. Everything! I don't want to feel that I have to choose one medical system over the other. Each of us can benefit from a portfolio of medical choices and I want all the medical options available to me, to my family, and to you. There must be room for all remedies that bring health to the patient. Isn't this hearing about healing? Alternative no longer needs to mean one or the other. There should be no alternative other than the best health care known to man.
[The prepared statement of Ms. Seymour follows:]
INSERT OFFSET FOLIOS 10 TO 12 HERE
[The official committee record contains additional material here.]
Mr. BURTON. Thank you very much, Ms. Seymour. That was a very, very enlightening statement. We are going to ask you some questions now.
Ms. SEYMOUR. OK.
Page 20 PREV PAGE TOP OF DOC Mr. BURTON. You didn't think you were going to get off scott free, did you? [Laughter.]
I'd like to know a little bit more about your father's situation. Do you know what kind of therapy they provided for him when he became deathly ill with cancer and they gave up hope?
Ms. SEYMOUR. I have the data here somewhere that I can show you. He had a number of therapies, but the main ones were intravenous vitamin C, which many people have poo-pooed, which I now believe is done all over the country. And a special vaccine made that was also at that time not allowed. In fact, he was very fortunate to get it. I believe the vaccine is now being used elsewhere in the country routinely for cancer. He also had an enormous amount of emotional counselling, which I think was a very large factor, too.
In his case, of course, the cancer was not caught early enough for him to go into remission. However, I think the point I am trying to make here is that he was given the quality of life, a comfort, and a sense of living until the end which I think that every one who goes through cancer should be entitled to, and especially if that exists.
And I think one of the reasons I am here today is because he was an eminent surgeon who did not necessarily believe or know anything about alternative medicine before. The fact that his only regret in life was that he didn't get to know more about these options until just before he died is really one of the reasons I am here today. I meet an enormous number of medical practitioners who really believe that there are holes in what they are doing and that there really is a great need for alternative medicine as a complement to what they are doing, particularly as you mentioned, in cancer.
I have three friends who just went through breast cancer. All three of whom were told at one point by their oncologist that their white blood cells were at a level that they, basically, were going to die. There was nothing more that could be done for them. And they all said, ''well, what do you mean? What do we do now?'' And their oncologists said, ''well, there is nothing we can do now. We are finished. This is it. We've done our best. That's all we can do.'' And my friends said ''well, are we supposed to walk out of door and die?'' And their oncologists said, ''well, we don't like to put it that way, but there is nothing more that we actually can do.''
Page 21 PREV PAGE TOP OF DOC In all three cases, they found alternative medicine and, in fact in all three cases, it was Chinese herbal medicine that brought back their immune system. All three of them are incredibly healthy. All in remission and all of them would swear by alternative medicine, and that is another reason I am here.
Mr. BURTON. Those are very impressive stories and it is not unlike the situation that my wife went through 5 years ago. They gave her less than a 50-percent chance to live 5 years and she just celebrated her 5th year and she is very healthy.
So, I'd like to make just one more comment along the lines of your father. He was a doctor and he was not enthralled with alternative therapies until he became ill. For those who are from HHS and FDA, I hope you listen to this story.
We had a Governor in Indiana who was deaf on alternative therapies and he supported the AMA's position right down the line. And I fought with him when I was a legislator and he was Governor over some of these alternative therapies. His wife became ill with cancer and he went and used every alternative therapy he could possibly use to save her life and I do not fault him for that. The only thing that bothered me was that that is the way it ought to be for everybody. And he later became the head of HHS, incidentally.
You mentioned in your testimony that you use alternative treatments in your children. How do you decide what is safe for your children?
Ms. SEYMOUR. My pediatrician is actually the person who started me out on this. She is a regular M.D. She does not practice any alternative medicine. Her name is Dr. Lisa Stern, a prominent pediatrician in Los Angeles. She said to me that the use of antibiotics for small children was not safe to do on a regular basis. That they were trying to find other options and she suggested that I consult a homeopath. I consulted Dr. Asa Hershoff in Los Angeles with my twins and we've been using homeopathic and herbal remedies for them really pretty much since they were born. We use, obviously, things like chamomile for teething; Arnica for bumps and bruises; pulsatile for flu. They really are incredibly healthy considering both of them were on heart monitors. Both of them were born early; 6 weeks early and being twins, you know, they are not as resistant usually as other children to infections that are around them because they had low birth weights.
Page 22 PREV PAGE TOP OF DOC I generally will go to the pediatrician first and then I will take them to the homeopath and we'd look at what the options are and, invariably, we'd try homeopathy for at least a couple of days. Usually it works and, therefore, we don't end up having to use the antibiotics.
Mr. BURTON. Let me just ask one more question here. What would you say right now to mothers all across America about the use of antibiotics? You just talked about that. I presume you would just tell them to be very careful; not to use them unless it is absolutely necessary. I mean, how do you judge that and what would you say to them?
Ms. SEYMOUR. I think you go to your regular medical practitioner and I personally believe you also have a homeopath or someone like that, a naturopathic doctor that you can consult. As a motherfor me, I would check their ears and make sure there is no major ear infections or problems that way. And most pediatricians will now agree and say that antibiotics should be used very sparingly in small children and they are very happy to have alternative means to try first.
Mr. BURTON. Thank you. Mr. Waxman.
Mr. WAXMAN. Thank you very much, Mr. Chairman, and Ms. Seymour. We are delighted to have you here and I appreciate your testimony.
I think the important point that I get from what you had to say is that we don't want one medicine here and another medicine there. We want the best healthcare possible for all of our people. And that means that everybody has to be open-minded enough to reevaluate information, and if new information comes out, we ought to accept it. I gather your father had a feeling that as a medical person, he wasn't open to some of these alternatives because he had been trained in a particular way and didn't think about some of these other things that were being suggested.
Is that a correct statement?
Page 23 PREV PAGE TOP OF DOC Ms. SEYMOUR. Yes, I think the temperature has changed in America today. I think people are aware now that they can take health into their own hands and that preventive medicine is probably a very important part of their lives. I think people are very aware of how diet, nutrition, health, exercise, and all kinds of protocols can really help them.
My father discovered rather late in life that this is an area he wished he had known more about.
Mr. WAXMAN. Well, I'm not a scientist, but as a lay person and a consumer, I want to be able to have more of a say over what my family has in terms of healthcare and what decisions they would make and I would make about whatever medicine that I may or may not decide to pursue. But I also want the doctors to be open to otherwe call them alternativesbut other indications of good health care.
To me, one of the shocking things is that how little in medical schools they teach doctors about nutrition. Even though now we are learning so much more about the value of nutrition. Dr. Ornish will be testifying and I know his long record in this area.
It's important that we not look at medicine as one sort or another sciencegood science to me ought to be open to alternatives and then those alternatives ought to be tested and accepted wisdom ought to be retested as well so that we try to get the best that we can for all of our people.
Have you had any obstacles or members of your family encountered any difficulties in trying to get access to these different remedies or different alternative practitioners?
Ms. SEYMOUR. I have had no difficulty whatsoever. There areyou know, we were talking about studies. There are 3,000 blind and double studies, you know, done worldwide on the effects of herbal medicine and these studies comes from countries like Germany, Japan, France, and England. So there are studies that can be evaluated and I think it is rather remarkable that we accept their studies on making fair Mercedes or a German car and that is acceptable to us, but we disregard what the Germans have to say about homeopathy and they are really, probably, the foremost in the world in this area.
Page 24 PREV PAGE TOP OF DOC I, obviously, have had no problem in finding help. No, and none of my friends. I would like to see the general public be able to have this. My sister just brought with me a very interesting report from Englandfrom a part of England which is close to a house that I own where the National Health did a study to see the cost effectiveness and how it would affect the general public in terms of health. And they took half of that area of the National Health. They gave them regular medicine and the other half they used homeopathy and natural medicine and the results were astounding. The patient's response were as that 90 percent of them were very happy with the alternative medicine. Far less of them came back for repeated visits to the doctor afterwards and the cost was so much less to the National Health. So in England, they are taking this very seriously.
Mr. WAXMAN. And we should take it seriously here. There is no question that if we can prevent disease, we are far better off. And I'm encouraged by the amount of attention I see in the press about encouraging people to exercise; watch their diet; to take care of themselves; and to understand the value of nutrition. This is, it seems to me, the direction that we ought to go as we learn more information.
I am going to ask you one other question. Do you have any suggestions on how the Government can help individuals obtain access to alternative treatments that are safe and effective?
Ms. SEYMOUR. I think that it would be very useful to have a panel of maybe 200 to 300 practitioners that is decided within alternative medicineas you know, there is 40 or 50 different forms of itthat they should decide who this panel is. And they should be the people who should monitor amongst themselves as to who is actually doing the right alternative medicine and who isn't. And I would like to see in the hospitals when you go to an oncologist, when you go to a hospital for cancer and you are offered chemotherapy, that someone talks to you about how you can support your immune system while you are going through this.
Page 25 PREV PAGE TOP OF DOC It is very cost effective. In fact, I think you will find less people becoming sick if we educate them in what they can do with alternative therapies as a complement to, of course, the brilliant remedies that we do have in allopathic medicine.
Mr. WAXMAN. I agree with you and
Ms. SEYMOUR. Thank you. I'm glad you do. [Laughter.]
Mr. WAXMAN. I was pleased that you mentioned the point about spirituality because I think that is very important in how people address their ailments because we don't know why, but we do know that those who have an optimistic view of the world often are able to heal themselves.
Ms. SEYMOUR. It is called holistic medicine because wellness is about the whole being. I personally have discovered that homeopathy and Chinese herbs do work for me and for everyone around me with remarkable results. So I do hope that money will be spent to enable this to be shared with the rest of the population.
Mr. BURTON. Thank you, Mr. Waxman.
Mr. GILMAN. Thank you, Mr. Chairman.
I want to commend you for bringing on this important issue before our committee. The hearing should help to stress the need for alternative and complementary treatments into the mainstream of health care and provide patients with a variety of treatment options. And I'm pleased that Dean Ornish is here to tell us about how he's attacked the problems with regard to heart situations.
And I want to thank Ms. Seymour for coming with her examples of how homeopathic treatment has helped her. How did you find the homeopathic physician that you needed? Were they listed properly among physicians or were you just referred by another patient?
Page 26 PREV PAGE TOP OF DOC Ms. SEYMOUR. No, they are listed. They are quite easy to find. In fact, there is a brilliant thing called the Alternative Medicine Digest which is a phenomenal book that will tell you where you can find any practitioner and how all the different methods work. But homeopathy is quite easy to find all over the world.
Mr. GILMAN. One of the things I've found, Mr. Chairman, is that there is so little education on pharmaceutical agendas at the medical schools and I'm just wondering whether alternative medicine has reached the training in the medical schools.
Would you know that Ms. Seymour?
Ms. SEYMOUR. I do know that my homeopath teaches, I thinkis it at UCLA? Yes, he teaches at UCLA and I just recently, 2 nights ago, spoke to one of the top doctors at UCLA, Dr. Becker, who said that they were about to instigate a program there investigating the use of alternative medicine as a complement to what they were doing.
Mr. GILMAN. And maybe Dr. Ornish, in his testimony, can tell us a little bit more about the kind of training that exists in our Nation on alternative medicines.
Studies have found, Mr. Chairman, that more than 40 percent of all of our people try alternative and complementary medical treatments, seeking out the advice of physicians with regard to these treatments. Many who have suffered through the agonizing effects of traditional cancer treatment, such as chemotherapy and radiation. We all know some of those examples are now turning more and more to complementary and alternative treatments like herbal therapy, meditation, and nutritional therapy.
In a bill I introduced several years agoand I'll keep introducing it until we get some placeis a preventive medicine to make certain we do more in prevention that can save us more dollars on the cure if we apply prevention appropriately. And I'm pleased that more and more nutritional advice is finding its way into our medical system.
In our Nation, it is some sort of a stigma when we talk about alternative medicine, and as a result, funding alternative studies has been difficult for physicians and researchers. Significant achievements are being made, though, in the cures for cancer that are occurring overseas and in Europe and Asia. I think it is long overdue that our Nation works together with its foreign counterparts, sharing information, sharing strategies and treatments, and to provide our Nation with easy access to those treatments.
Page 27 PREV PAGE TOP OF DOC Some patients in our Nation have the ability to travel overseas to receive alternative treatments, and we continually hear about how they go to great lengths to try to find some proper remedy. But all Americans should be afforded that opportunity to access all forms of treatments, both traditional and alternative. We should pool our resources to create affordable, beneficial alternatives, to establish treatments in an alternative form, from which all of our patients can benefit.
So, Mr. Chairman, I thank you for focusing attention on the studies that have shown that these alternative complementary treatments create positive results. It is our hope that, with hearings such as this, these treatments will be integrated into our healthcare system.
I thank our panelists, Ms. Seymour and Dr. Ornish, for coming before us.
Thank you, Mr. Chairman.
Mr. BURTON. Thank you, Mr. Gilman. Mr. Kucinich.
Mr. KUCINICH. Thank you again, Mr. Chairman. I want to again state for the record that I think that the Chair is performing a very valuable public service, as is Mrs. Seymour for her participation. This is a subject that we are only beginning to get into on a national level, and Congress has a great ability here to coordinate a lot of knowledge. Again, it needs to be said that Mr. Burton is doing something here that is important for the country. I think that he should be supported in his efforts. That is why I am here.
I also think that there is something about alternative medicine which is uniquely symmetrical with democracy and democratic tradition. We in this country believe in individual responsibility. Alternative medicine certainly does that. Would you agree, Ms. Seymour?
Ms. SEYMOUR. Absolutely.
Mr. KUCINICH. What would be your view as to how those who you love and your family have had more control over their own lives by being able to seek alternative therapies?
Page 28 PREV PAGE TOP OF DOC Ms. SEYMOUR. Well, for example, it was pointed out to me the other day that mammograms, which are routinely done on women, are now shown to be causing cancer unnecessarily. There are other ways of discovering the breast health with thermography and ultrasound used together, and then the mammogram used to bolster that, to make sure that the symptoms are discovered.
There are other options in so many different areas. I think the whole feeling of wellness, the whole concept of holistic medicine is to want to be healthy and to want to be in a well state, rather than constantly patching one's self up with bandaids that will take away symptoms. Somebody once described homeopathy to me as, if you drove a car and the oil light went on to tell you that something was wrong with your oil, you could have that light removed or you could actually go to the garage and find out what part of your car, what part of the oil system is not working. I think this is what we are talking about in alternative medicine, that if we become in tune with our health, then we may not get to such severe cases so often.
Mr. KUCINICH. Would you say that is self-empowering?
Ms. SEYMOUR. Yes, I think there's a lot of things we can do for ourselves, and we can empower people to take care of their own health. Rather than bandaiding it with things that take away symptoms, I think they can listen to their bodies and probably hear the symptoms and be able to notify the doctors as to what is really happening in their bodies.
Mr. KUCINICH. I think, Mr. Chairman, in conclusion, one of the values of this hearing, and hearing from Ms. Seymour and other witnesses, is that we start to shift our view of how health is defined. One could almost ask at the beginning of this hearing, alternative to what? Because as we broaden our knowledge of healthcare, more things that appeared at one time to be on the fringe or alternative suddenly become part of the mainstream.
Ms. SEYMOUR. I think also a huge issue today for all of us is the support of the immune system. We never really thought of the immune system until we had viruses and AIDS and hepatitis C, which I believe is to be the next huge problem we have here. I think we all have a responsibility to ourselves and to our families to keep ourselves in as good health as we can, so that we are able, our bodies are able to withstand these viruses.
Page 29 PREV PAGE TOP OF DOC Mr. KUCINICH. Mr. Chairman
Mr. BURTON. If the gentleman will yield to me just for one commentyears ago, when I was in the Indiana General Assembly and we were working on the laetrile bill, I called Dr. Linus Paulingand I am sure you have all heard of him. He won two Nobel Prizes. I think one was for cancer research or scientific research. I was talking to him about laetrile, and he interrupted me in mid-sentence and said, ''Well, that does have some promising qualities to it,'' he said, ''but the thing that I am convinced is going to save a lot of lives and prevent heart attacks and cancer is megadoses of vitamin C.'' More and more people today are agreeing with what Dr. Linus Pauling said, and this was about 20 years ago.
I might add that he lived to be 92 years old and didn't have cancer or heart trouble.
So thank you very much for yielding, Mr. Kucinich.
Mr. KUCINICH. Just in conclusion, so that we can move on here, what comes from any study of holistic medicine is an understanding that healthcare is a profoundly personal matter. In line with what I indicated previously about a symmetry with democratic tradition and personal responsibility, we learn, as we explore alternative practice, that there is something, a process that begins inside of each of us.
Mr. Waxman referred to the potential for spiritual considerations in that. Belief systems, faith, and hope are all part of that process that, in effect, happens before we meet that outside world, which offers us a variety of choices. So I think that as we look at this, the many options which are available to us begin, first, with our own decision to be open-minded in approaching the possibilities of better healthcare, which begin with ourselves.
Ms. SEYMOUR. Yes, we don't want to be statistics. We want to be considered as human beings, as people. You are very right; if you believe that you are going to be well and that you can be healthy, an enormous amount can be done. The mind can override enormous symptoms.
Page 30 PREV PAGE TOP OF DOC Mr. KUCINICH. Thank you again.
Ms. SEYMOUR. Thank you.
Mr. BURTON. Thank you, Mr. Kucinich. Mrs. Morella.
Mrs. MORELLA. Thank you, Mr. Chairman. Again, this is a very informative hearing. Ms. Seymour, it is a delight to have you here. You are a role model. So, therefore, what you say has a tremendous effect on attitudes.
I just guess I want to try to synopsize your feeling, and that is that attitude is altitude; as we approach something, attitude is critically important; that balance is important and openness. For instance, I think the American public has reached the point where we are skeptical. We just don't know what to believe. One day we hear about St. John's Wort or something that is going to take the place of the antidepressants. We hear about other possible medications or herbs that could be used for arthritis. From one day to the next week, we find that there are differences in approaches. So our confidence is kind of eroded. We just don't know what to believe.
I guess what you are saying is you have got to continue to use mammograms, using that just as an example, since you mentioned it; you have got to continue to have co-rectal examinations, but at the same time you should be open to the totality or the homeopathy. Is this correct?
Ms. SEYMOUR. To some degree. There are other options to mammograms. I think the point I am saying is, rather than the routine mammograms that we blithely all take without considering the cost to ourselves healthwise in terms of the radiation and the fact that it could cause cancer, there are other ways of doing this which are far more cost-effective, which are thermography. I tried it the other day, and it is amazing how they can discover what is wrong with different parts of your body and accurate they were. I had a blind test done on me because I didn't believe in it. Sure enough, we called up my internist and my dentist, and the findings were absolutely agreed up. So there are other ways of detecting disease like that, without necessarily hurting the human being.
Page 31 PREV PAGE TOP OF DOC So I guess it should be investigated anyway.
Mrs. MORELLA. It is an openness, that we look to the various facets, the various aspects. I just don't want people to think that they can't go off and get these examinations regularly, or that they should not be part of their routine.
Ms. SEYMOUR. No, but I do think that it would be nice if we could spend some of those billions of dollars on looking at thermography. There are only 30 people practicing that in this country right now, whereas there are thousands in Europe, where they are doing this very successfully. This would also be a wonderful option for people in Third World countries, where they could really detect what was wrong with patients very inexpensively, very quickly. A lot of people could be helped.
Mrs. MORELLA. I want to thank you. Also, I want to thank you, Mr. Chairman, for the articles that you have given us all, too, that I think are very uplifting in terms of the number of opportunities that are open with regard to alternative medicine. Thank you. Thank you, Mr. Chairman.
Mr. BURTON. Would you yield to me just real quickly?
Mrs. MORELLA. Indeed, yes.
Mr. BURTON. I don't have the exact figure in front of me, but I think $20 million is being used for alternative therapies and alternative therapy research by the departments of health in our country, and $2.3 billion is being used for conventional medicine. I think one of the things that we need to do, and I hope we are stressing today, is giving more funds for the alternative therapy research and complementary research, instead of just going ahead with the conventional approach that we are taking.
We had a doctor named Dr. Barry Marshall. Dr. Barry Marshall came up with a theory that stomach ulcers were not caused by nerves; they were caused by a bacteria. Well, conventional wisdom in the medical profession for years and years and years and years was that it was caused by nerves. They said that bacteria could not live in the acidity of your stomach. Well, he did some research and found that it could. He gave a speechI think it was in Belgiumabout this and he was laughed off the stage, literally. He then went home and drank the bacteria, became deathly ill, and cured himself with a combination of bismuth and some antibiotics.
Page 32 PREV PAGE TOP OF DOC But the point is, there are billions of people in this country that are suffering from stomach ailments that can be cured because of his research. But he was ignored, not unlike what Pasteur was, for a long time. He proved that the bacteria does live in the stomach, and this alternative therapy research that he did alone is going to save thousands, maybe millions, of lives and millions of people from this kind of pain.
That is why I think, and I hope, these hearings that we are going to continue to have will point out the fact to the National Institutes of Health, to FDA, and everybody else, that we need to have more funds used for research into alternative therapies. Because if we do that, we are going to find, like Ms. Seymour has said, that there are alternatives out there that are not as dangerous that are going to help humanity.
I thank the gentlelady for yielding.
Mrs. MORELLA. Thank you. NIH is in my district, and I know that they are moving ahead with alternative medicine.
I just wanted to point out there is no one panacea. So we need to look at the entirety, and not just one little facet of it.
Ms. SEYMOUR. Yes, if I may quickly addI didn't know if I had time in my 5-minute speech, but we see incredible results with acne, which a lot of people suffer from acne and adult acne. Homeopathy can cure this within 4 daysit is amazingwithout the use of injections and steroids and antibiotics and birth control pills and Accutane, which, of course, is very bad for women.
There are options also with migraines and things like these. These are huge issues for the American public that can be helped very inexpensively and very quickly without any adverse effects.
Mr. BURTON. Thank you, Mrs. Morella. Ms. Norton, do you have any questions?
Page 33 PREV PAGE TOP OF DOC Ms. NORTON. Thank you, Mr. Chairman. Mr. Chairman, I think these hearings are very important, and I appreciate that you have called them.
And I appreciate your last statement about research, because in a very real sense oppositional thinking about alternative medicine and traditional medicine is very unhealthy, is not good for your health. Hearings like this I think are important for the way in which theyfor particularly the notion of what is necessary in order to have an informed public.
Ms. Seymour, I think we are very fortunate that you have been willing to come forward. By your own high profile, you raise the profile of this very important subject.
Our country is abysmally behind on coming to grips with alternative medicine. It is hard for me to criticize my country in this regard when I realize what it has done in traditional medicine; that in a real sense it is like being ahead in soccer, and I think you neglect the other sports. We are so ahead on what we have given to the world in everything from AIDS tothat we let this slide. We are only now coming to grips with it.
I have read books thatI must tell you, the only books that convince me about anything are books that have been written by people trained in medicine who have something to compare it with.
I have a question about the way we go about this. I have to confess that, without scientific evidence, I have myself often been very open to alternative suggestions about what to do, and, anecdoctally, have found some of them to be effective. I am more inclined to insist upon the scientific medicine when it comes to traditional medicine than I am to alternative medicine. That is proper, because what the public kind of reads in the newspaper, in the magazines, gets absorbed as what kind of alternative medicine should be done.
That is why what the chairman said about research is no less important for alternative medicine than it is for any other kind of medicineI want to just take issue with your notion, for example, about mammograms. Some of us who are women in this Congress have had a hell of a time getting women to be sufficiently unafraid to get mammograms because of all this stuff about radiation; that the whole notion that anybody without research would say, ''Well, I think I am going to wait until thermo-something''look, all the scientific evidence now tells us that there is not radiation danger, and that if there is, it pales beside the danger of not getting a mammogram.
Page 34 PREV PAGE TOP OF DOC It is very important that there be research into alternative methods. I would support that. But, again, the public really is just left out there now. Whatever comes through the microphones, including what we say here today, becomes what you ought to go out and do. That is not the case with traditional medicine, because there has been some regulation.
I associate alternative medicine as well with preventative medicine. That is one of the reasons why I am a great supporter of it. I applaud what NIH is doing. I don't think it is enough, and I think it came too late, but I think it is important to do.
I don't agree that more training is necessary in order for doctors to do this. I have a young doctor. Young doctors who keep up with good medicine will prescribe alternative medicine. If you go to a doctor who does not know anything about alternative medicine, you ought not go to that doctor, because if she is reading in the literature, she ought to know what is effective and not effective. I don't think people should listen to anybody except a doctor or a scientist about what is effective or not effective, although I applaud the notion of doing what I do. As an intelligent consumer, if you all don't know yet, and nobody tells me that this is harmful to me, well, I am going to do what I think is good for my health. That does not stand in the place of research.
Now I have a question to ask you, because I found your testimony very balanced. For example, you report in your testimony 110 deaths annually from the use of medical drugs. Well, you know, we can get to the point where somebody is going to report, because there are no controls, because there is no good information about deaths from alternative medicine. We are already getting those kinds of reports.
The question for society for alternative medicine is the same question society had when it had to decide whether or not you ought to have x rays for your teeth or whether you ought to listen to these people that say that, if you do, something will happen; you will float into the universe.
Page 35 PREV PAGE TOP OF DOC You have to intelligently decide whether or not there has been sufficient investigation, and there is no way for the public to know now. Thus, the public does what I do. Look, if you say a megadose of A, B, C vitamin will help me feel better in some way, well, fine, let me do this because nobody told me it will kill me. So I am going to use a megadose. It is not very good, Eleanor, but that is what I do.
Now in your testimony you also said something very important here. You said, ''I am not here to vilify western medicine; I am looking for inclusion, not exclusion.'' And that is where our country has failedexclusion of alternative medicine.
I would like to ask you whether or notI noted that in your breast cancer example these three women who used alternative medicine had found that the doctors had said to them, ''There is nothing more we can do for you.'' Now, of course, there are women all over America, and these stories are beginning to come out, for whom something can be done, who believe that this kind of traditional medicine or that kind of traditional medicine for breast cancer isn't what they should do. So they are more likely to go into some alternative which has not been scientifically shown.
I am asking you whether or not you would feel more comfortable if there were far moreif our country engaged in a regime of greatly increased controlled studies, so that the public could make informed decisions, instead of anecdotal decisions, about what is best for their health.
Ms. SEYMOUR. There are studies, conclusive studies in
Ms. NORTON. I am not talking about where there are studies. I am talking about where there are not studies.
Ms. SEYMOUR. We should make studies, yes, and I would like that. I think this is what we are asking for today. Let's appropriate some of those funds and get onto it right away, and have those tests done, maybe even blind testing, the way they did it in England.
Page 36 PREV PAGE TOP OF DOC Ms. NORTON. It must be blind testing.
Ms. SEYMOUR. Do it in the hospitals, and allow the people to have it, rather than waiting another 20 years and then find out that what they were doing for 500 years did work.
I am certainly not saying that mammograms shouldn't be done, and I am certainly not saying that in breast cancer you should not have chemotherapy. What I am saying, and what I testifiedand I am sorry if I was misunderstoodis that we are talking about inclusion here. We are talking about doing chemo alongside Chinese herbal medicine, which will help the patient to survive not only the cancer, but the chemotherapy. We have seen countless stories of people where this has worked.
I guess while we are eventually, however this happens in government, appropriating those funds, so we can investigate these and find out who the true practitioners are, what the real scientific data, and everyone gets happy about it. Meanwhile, Americans are trying these things. You, indeed, yourself are trying these things. You, indeed, are sort of admitting that they do work for you.
Ms. NORTON. Absolutely do.
Ms. SEYMOUR. Absolutely.
Ms. NORTON. I want to make sure that I am not having an effect in my mind rather than in my mind.
Ms. SEYMOUR. Well, the other people are the doctors, and they will tell you, but, from what I have been told in my data, maybe one or two people, if that, died last year from homeopathy, from side effects of homeopathy. It is almost impossible to die from a side effect from those forms of alternative medicine, whereas it is very easy and has been scientifically proven that over 110,000 people died last year from adverse drug reactions. These are not people who took drugs without being told by the doctors. These were people who were specifically designated to take those drugs for those specific things, and at the time it seemed to be appropriate for them to take those things.
Page 37 PREV PAGE TOP OF DOC Ms. NORTON. Thank you, Mr. Chairman.
Mr. BURTON. Ms. Chenoweth.
Mrs. CHENOWETH. Thank you, Mr. Chairman.
Mrs. Seymour, I can't tell you how very pleased I am that you are here today.
John Kennedy, back in the 1960's, who was not the President of my party, but I am deeply grateful to him for raising the awareness of how important exercise is in our life. And perhaps you will help supplement how important it is that we control our own health and stay ahead of the power curve in terms of boosting our immune systems and staying healthy. You may very well be one who will take us on into the next century in boosting the public awareness that we need alternative forms of medicine.
You, like I, we are both very busy women. We shake a lot of hands, and we see a lot of people. We fly on a lot of airplanes. We are exposed to a lot of things. I find it interesting, Mrs. Seymour, that I am 61, and my 30-something-year-old staff have to follow me out to Idaho and back for a weekend and take 2 days to recover. [Laughter.]
Now the only difference is that I believe in homeopathy and I take massive doses of vitamin C. The reason I did, after having worked for physicians for 18 years and really appreciating all that they do for their patients and the love they have for their patients, and how much they givenevertheless, there was such an entire freeze-out of other alternative forms of medicine from the status quo institutional form of medicine, that when someone suggested to me, when I had a very severe case of Manieres disease, that I see a naturopath, I thought they were crazy. Finally, when the physician suggested surgery in the head for a shunt to relieve the symptoms of the Manieres disease, I finally went to a naturopath, who took a hair analysis and put me on zinc. The symptoms disappeared.
I went out of obligation to the naturopath because of the deep respect I had for the person who just begged me to do it. Now not everybody can have a miracle cure like that, but it certainly made me realize alternative forms of medicine are so important to us being able to stay healthy and not ever have to, hopefully, expend a lot of money as we reach the final years of our life, which I don't expect will be for quite a while for me, but I intend to stay healthy.
Page 38 PREV PAGE TOP OF DOC Thank you very, very much for your contribution. It is deeply appreciated.
I want to share with you the fact that there was a recent decision in the 10th circuit court of appeals involving two litigants, Dirk Pearson and Sandy Shaw, who challenged the FDA on the first amendment rights for people involved in homeopathy to be able to talk about the results of their alternative medicine. The court agreed with them that it is a first amendment right. In fact, the court bifurcated the decision and said, we will deal first with the constitutional issue of first amendment rights, and then we will come down after with a decision on the Administrative Procedures Act. That was significant in the way the court did that. The court, obviously, felt very compelled about first amendment rights in this issue. I was thrilled to see the way the court dealt with it. If you haven't seen that case, I recommend it to you.
I think that it is important, Mrs. Seymour, that the government, the Congress recognize the importance of alternative form of medicine. I think that we need to support it in research. But, looking down the pike, if we give government money for supporting research, I want to make sure that those first amendment rights are guarded, and that government does not exert undue control, to the point that, again, we lose control of our own ability to stay healthy.
Thank you so much for what you are doing, and thank you very much for being here.
Ms. SEYMOUR. Thank you.
Mr. BURTON. Thank you, Ms. Chenoweth. Ms. Norton has an introduction, I think, real briefly here.
Ms. NORTON. I thank you, Mr. Chairman, for allowing me to introduce some youngsters who I am very glad have gotten to hear this.
I do want to say to Ms. Chenoweth that the reason that the young people who travel back are so much more tired than you may be the same reason that you don't look 61. [Laughter.]
Page 39 PREV PAGE TOP OF DOC Good genes.
Mrs. CHENOWETH. Very good genes.
Ms. NORTON. Mr. Chairman, I am pleased that the youngsters from the Knolle Elementary School had an opportunity to sit in. They are part of a program that I run for D.C. youngsters, who, after all, live in the District, called D.C. Students in the Capital. I want to welcome them. I will take them out in the hall now to say a few words to them.
Thank you, Mr. Chairman.
Mr. BURTON. Thank you, Ms. Norton, and welcome to you, students. It is nice that you are here learning more about your government.
Mr. DAVIS. Thank you very much.
I know it has been a long morning for you, Ms. Seymour, but thank you very much, because I think what you have to say is very important. Sometimes somebody of your stature coming up here and saying it just wakes everybody up to something we have been hearing anecdotally for some time.
My wife is an OB/GYN. She was a tenured professor of obstetrics and gynecology, but I think she would agree with everything that you have said today.
I don't think there is any reason we can't, up here in Congress, direct some money for the complementary medicine departments or courses in the medical schools, so at least doctors will have some exposure to this. Right now they don't seem to get it. In fact, conventional medicine, there is almost a push on against some of this.
Your coming up here and speaking about it, and opening up that a lot of us have anecdotal information, I think helps that a lot.
The key here is that Washington and Congress, and even the medical establishment, doesn't always know best. We are dealing in some very changing areas where we are learning new things every day. We want to enable consumers to make their best choice. We best do that by the kind of things that you have outlined heregiving them the full gamut of information, so they can make intelligent choices, and letting our doctors and medical community, NIH, and others do some exploration to see why some of these things seem to work; that it is not necessarily in somebody's head if it is working medi-physically as well.
Page 40 PREV PAGE TOP OF DOC So you have done a great job. I appreciate your being here, and I hope that we can followup legislatively to some of that. I know it has been a long morning. I won't use all my time. But thank you very much.
Ms. SEYMOUR. Thank you.
Mr. BURTON. Thank you, Mr. Davis. Ms. Biggert.
Ms. BIGGERT. Thank you, Mr. Chairman.
Mrs. Seymour, I was in Bolivia over our break on another issue, but we had the opportunity to stop by a museum, which was a museum of preventative medicine by the natives, Indians, of Bolivia. It was quite interesting to see the bottles of herbs and the way that they addressedby looking at animals and the organs, how they would determine whether somebody had that illness.
I wondered if that really is a part of homeopathic medicine. Has there been any movement to categorize what is used in, well, Native American or other countries, the types of medicines that they use that has been of help to us?
Ms. SEYMOUR. Well, I think, obviously, the people to ask about homeopathy are here today. You should address them on that issue.
I always found it amusing, when I was playing Dr. Quinn, that digitalis is what the Native Americans suggested as one of the herbs that she used. Then, of course, the Native Americans had herbs which, of course, are now used in synthesized form in our regular medicines today.
So, yes, very much, I think these are things that we should look into. I mean, we all now take echinacea, a large number of the population. Not very long ago, everyone said ''echinacea what?'' What is this stuff? As he said, Linus Pauling and vitamin C, and I am sure Bolivia has a lot of things to offer us and I am sure there are experts here who can answer you exactly on that.
Page 41 PREV PAGE TOP OF DOC Ms. BIGGERT. Thank you, Mr. Chairman.
Mr. BURTON. Thank you.
We now have a vote on. So what I think we will do is we will have the committee break, go down and vote, and come back. As soon as we returnand I apologize to the second panelwe will have the second panel come forward.
Dr. Ornish, I understand you have limited time. You have time constraints. So we will have you testify first and see how we are going on time. Then, at around noon, we have food and refreshments back there for the panelists. So we will break around noon, and then we will come back and finish right after we have lunch.
Ms. Seymour, you have been a lovely witness. We really appreciate your being here. If you can stay around later, fine. If not, we will see you later on today.
Ms. SEYMOUR. Thank you.
Mr. BURTON. Thank you very much.
We stand in recess to the fall of the gavel.
Mr. BURTON. Because of Dean Ornish's time constraints, I would like to go ahead and get started with his testimony. Then we will break shortly after that for about 2025 minutes, so everybody can get a bite to eat. Then we will come back and finish with the second panel.
Would the second panel come forward.
So, Dean Ornish, welcome. We really appreciate your being here. I have read a great deal about you. Since we want to save some time and get you on your way in a timely fashion, we will go ahead and let you testify now.
STATEMENT OF DEAN ORNISH, M.D., PRESIDENT AND DIRECTOR, PREVENTIVE MEDICINE RESEARCH INSTITUTE, AND CLINICAL PROFESSOR OF MEDICINE, UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, CA
Page 42 PREV PAGE TOP OF DOC Dr. ORNISH. Well, thank you, Mr. Chairman. I don't know how much time you want, but I am available until 10 after 1, just so you know.
Mr. Chairman, members of the committee, Ms. Clay, thank you very much for the opportunity to be here today. My name is Dean Ornish. I am a physician. I am founder, president, and director of the nonprofit Preventive Medicine Research Institute and a clinical professor of medicine at the University of California, San Francisco, School of Medicine, where I am also one of the founders of the new Osher Center for Integrative Medicine there.
The theme of all of my work is simple, and that is, if we don't treat the underlying cause of a problem, any problemin this case, heart diseasethat more often than not, the same problem comes back again. We get a new set of problems or side effects that we hadn't counted, or on a social and health policy level we are often faced with painful choices.
Whenever I lecture, I often start by showing a cartoon of doctors mopping up the floor around a sink that is overflowing, and nobody is turning off the fauceta little like ignoring the oil indicator light on the car that Ms. Seymour was talking about.
During the past 22 years, my colleagues and I have conducted a series of clinical trials demonstrating for the first time that the progression of even severe coronary heart disease often is actually reversible by making comprehensive changes in diet and lifestyle. These include a low-fat vegetarian diet, moderate exercise, stopping smoking, a variety of stress management techniques, including stretching and breathing and meditation exercises, and a lot of emphasis on psyho-social and emotional support.
This was a radical idea when I began my first study 22 years ago. It has now become mainstreamthe idea that heart disease is often reversible. It has become generally accepted by most cardiologists.
In my testimony and in my research I am going to focus on heart disease, but I think it is also a much bigger issue. It is an example of how powerful changes in diet and lifestyle can be. We often think it has to be a new drug or a new laser or a new surgical technique, or something really high-tech and expensive to be powerful. We often have a hard time believing that these simple choices that we make in our lives every day can make such a powerful difference, but they do.
Page 43 PREV PAGE TOP OF DOC In the research that my colleagues and I have done, we have used these very high-tech, state-of-the-art measures to prove the power of these very ancient and low-tech, and low-cost interventions.
Within a few weeks after making these changes, the patients in these studies showed a 91 percent reduction in the frequency of chest pain. Most of them became essentially pain-free, including those who had been unable to work or even walk across the street without getting severe chest pain. Within a month, we found that those patients not only felt better, but in most cases they were better in ways we could actually measure. We found that the blood flow to the heart improved. We found that the ability of the heart to pump blood was better. After a year, we found that even severely blocked arteries began to become measurably less blocked, became improved, in 82 percent of the patients.
These research findings were published in the most respected peer review medical journals, including the Journal of the AMA, the Lancet circulation, the American Journal of Cardiology, and others.
This research was funded in part by the National Heart, Lung, and Blood Institute of NIH. Although it is very difficult to get funding to do this kind of work, and early on, when I began doing it, it was a bit of a catch22, because it was thought impossible to reverse heart disease. So it was hard to get funding from the government and from the conventional major foundations. Without the funding, we couldn't show it was feasible. And since they didn't think it was feasible, they didn't want to fund it. And then they said, well, where's the evidence to show that we should fund it? It becomes a self-fulfilling prophecy.
I might add, by the way, that in order to get the studies underway, we said, let's just raise the money as we go along and hope that we can do it. As we began to get more data showing it was working, initially financed by just individuals who thought this was an interesting idea, over time we later got major foundation and much later NIH support.
Page 44 PREV PAGE TOP OF DOC In our latest report, which was published in the December 16, 1998 issue of the Journal of the AMA, we found that these patients were able to stay with it for 5 years, not just for 1, and, on average, they showed even more reversal of heart disease after 5 years than they did after 1 year.
In contrast, the patients who were in the comparison or control group, who were making more moderate changes, got worse after 1 year, and even worse after 5 years. So moderate changes don't go far enough even to stop heart disease from getting worse. But the good news is that, if people are willing to make bigger changes, they can stop and in most cases even reverse it.
We also found that the incidence of cardiac events, like heart attacks and strokes and operations, was 2 1/2 times lower in the patients who made these lifestyle changes than in the control group.
There has been strong interest in the general public as well, as Ms. Seymour has alluded to. A 1-hour documentary of our work was broadcast on NOVA, the PBS science series, and was featured in Bill Moyers' series, ''Healing in the Mind.''
I think these research findings have particular significance for older Americans and the Medicare population. One of the most meaningful findings was that the older patients who made lifestyle changes in our research improved as much as the younger ones. When I began doing this work, I thought that the younger patients with milder disease would be more likely to show reversal, but I was wrong. The major determinant of improvement wasn't how old or how sick they were; it was how much they changed. In fact, the oldest patient, who is now 83, showed more reversal than anyone.
This is, I think, a very hopeful message for people in the Medicare population, because it says, since the risk of bypass surgery and angioplasty increase with age, that the benefits of changing lifestyle occur at any age, I think that this has particular benefit for older Americans and offers many of them new hope and new choices that they didn't have before.
Page 45 PREV PAGE TOP OF DOC I think these findings have particular significance also for women. This is by far the leading cause of death in women, especially in the Medicare population. They have less access to conventional treatments like bypass surgery and angioplasty. I spoke for the Surgeon General's Conference a couple of years ago on this very issue. When women do get operated on, they don't do as well as men. They have higher rates of mortality and morbidity following a bypass or an angioplasty. So that is the bad news.
But the good news: Women seem to be able to reverse heart disease easier than men can, whether through diet and lifestyle or even through lipid-loren drug therapy. If you give a woman estrogen to lower the risk of heart disease, you raise their risk of breast cancer. But if you change lifestyle to lower the risk of heart disease, you lower the risk of breast cancer and osteoporosis. Here again, when you treat the cause, you don't have to make these painful choices that often occur when we literally or figuratively just bypass the problem without also treating the cause.
The next research question, once we demonstrated that heart disease was reversible, and that became generally accepted, was: How practical is this? People said, well, sure, you can reverse heart disease, but you live in California; they will do anything there; no one else can do this. So we began training hospitals around the country.
As you know, there has been bipartisan interest in finding ways of controlling healthcare costs without compromising the quality of care. Many people are concerned that the managed care approach is simply shortening hospital stays and shifting to outpatient surgery and forcing doctors to see more and more patients in less and less time, while compromising the quality of care, because, here again, they are not treating the cause. It is frustrating for physicians, and it is frustrating for patients as well.
Beginning 5 years ago, my colleagues and I established the Multi-Center Lifestyle Demonstration Project, a nonprofit institute. We wanted to find out: How practical is this? Can we train other health professionals in other parts of the country to do this? Can they motivate their patients to the same degree that we did? Can this be not only a medically effective, but also a cost-effective alternative to things like bypass surgery and angioplasty?
Page 46 PREV PAGE TOP OF DOC In the past, lifestyle changes have been viewed as prevention, but we are showing they can also be an alternative treatment. I went to insurance companies and I said, ''Would you pay for these kinds of interventions?''
They said, ''No, we don't pay for diet and lifestyle.''
''We don't pay for that because that is prevention. We don't pay for prevention.''
''What is wrong with prevention?''
''Twenty to thirty percent of people change companies every year. It may take years to see the benefits. So why should we spend our money today for some future benefit that may occur years later, when chances are some other company will get it?''
And I said, ''It is the right thing to do.'' That wasn't persuasive enough. So I said, ''It is not just prevention. It can be an alternative treatment. For every patient, every man or woman, who chooses to change lifestyle rather than, say, undergoing bypass surgery, you save $50,000 immediatelyreal dollars today, not just theoretical dollars years later.''
They replied, ''That sounds great in theory. We don't think people can do it. So it is too hard to change lifestyles. So if we pay for your program, most patients who can't follow it, we will end up paying for their bypasses anyway. Now our costs have gone up rather than down.''
So the missing links really were the data on adherence. Then not only the immediate savings, but also the long-term savings can occur because so many bypasses and angioplasties clog up after just a few months or a few years; 40 to 50 percent of angioplastied arteries clog up again within just 4 to 6 months.
There is potentially a lot of money to be saved. In 1994, over $15 billion in the United States was spent just on those two operations. So that even if only 20 or 30 percent of the people were willing to make these changes, it is a savings of billions of dollars per yearreal dollars today, because it is a direct alternative to these treatments.
Page 47 PREV PAGE TOP OF DOC So we have trained a diverse selection of hospitalsAlegeon Emmanuel Center in Omaha, and Mercy Medical Center in Omaha, Beth Israel Medical Center in New York, Mercy Hospital in Iowa, Broward General Hospital in Ft. Lauderdalea whole list of them that are in my written testimony. Also, High Mark, which is western Pennsylvania Blue Cross/Blue Shield is both providing the program as well as covering it. Over 40 other insurance companies are covering this program as a defined program at the sites that we have trained.
We have been approved by the Technology Assessment Committees of Blue Cross and of Blue Shield of California separately two separate times, and found to be reimbursable and noninvestigational.
What we found, which we published in the American Journal of Cardiology 3 months ago, was that 77 percent of men and women who were eligible for bypass surgery were able to avoid it by changing lifestyle, by going on our program.
Mutual of Omaha, which was the first insurance company to cover this program, calculated savings almost $30,000 per patient immediately. These patients reported reductions in chest pain or angina comparable to what you can get with bypass surgery or angioplasty, but without the costs and the risks of going through that.
Now what about Medicare? Over half a million Americans die annual from coronary heart disease, making it by far the leading cause of death in both men and women. As I mentioned, $15.6 billion was spent in 1994, more than for any other surgical procedure. Not everybody is interested in changing lifestyle, but a lot of people are, and billions could be saved if people changed.
But, as you said in your opening remarks, Mr. Chairman, for many Americans the denial of coverage is the denial of access. Surgery is covered; angioplasty is covered, but lifestyle changes are not.
Because of the success of our research and demonstration projects, we asked HCFA, the Health Care Financing Administration, to consider providing coverage for this program, or ones like it, if they had the evidence to prove that they were. I really believe that this can help provide a new model for lowering Medicare costs without compromising the quality of care or access to care. It is a new model that is more caring and more compassionate and more cost-effective and competent, because we are treating the cause; we don't have to have these painful choices.
Page 48 PREV PAGE TOP OF DOC This approach empowers the individual. It can immediately and substantially reduce healthcare costs by billions of dollars, while improving the quality of care, rather than limiting access to it. It offers the information and tools that allow individuals to be individually responsible, personally responsible, for their own healthcare choices and decisions, and it provides access to quality, compassionate, and competent, affordable healthcare to those who most need it.
Now, without going into the detailsand I am happy to elaborate in the question-and-answer periodI first began meeting with officials from HCFA in June 1994, almost 5 years ago, and I have had many, many meetings and conversations with them since then. Then, as now, the concern was that, if we start to pay for anything other than surgical procedures, and so on, if we start to pay for anything that is, ''alternative'' medicine, then a Pandora's box would be opened. In other words, anyone who had any kind of alternative medicine program would say, well, you are covering this program; why don't you cover ours? Or, even in a more limited way, people who had one for treating heart disease would say that. I understand this concern. It is a valid one.
In the first meeting almost 5 years ago with people from HCFA, I was accompanied by the medical director at that time with Mutual of Omaha. He said,
We have the same concerns and here is how we dealt with it: We only pay for programs that have scientific data to support them, whether they are traditional or nontraditional approaches. And this right now is the only lifestyle intervention that has scientific data from randomized control trials showing that it can reverse heart disease. So we paid for it. And when other people develop those data or they have programs that are similar enough, we will pay for those, too.
Page 49 PREV PAGE TOP OF DOC I appreciate very much the leadership of Honorable Nancy-Ann Min DeParle and her colleagues, Dr. Jeff Kans, Dr. Bob Berenson, Dr. John Whyte, and others at HCFA. After going back and forth with them for years now, during which a variety of different options have been considered, including a demonstration project, I am respectfully requesting that HCFA now make a decision to cover this program for selective patients.
Another demonstration project would, in effect, duplicate largely what we have already done and what we have already published in peer review journals. It would cost millions of dollars. It would take years before a coverage decision could be made, and I think the time is right to do it now because Americans can benefit from this.
Coverage can be limited to those people who are choosing this program as a direct alternative to a bypass or angioplasty, because these are the patients for whom the cost savings are the most dramatic and the most immediate. It, also, can reduce the likelihood of fraud and abuse because you have to get a letter from your doctor saying that this person is sick enough to need a bypass. You have present test data from angiography and other tests showing that this person really is qualified to have a bypass or angioplasty. Because the program is difficult, people who aren't interested in changing lifestyle to this degree aren't going to do it, and they self-select, which is good. Because the real question is not, how many Americans are willing to change; the real question, if I were at HCFA, would be, how likely is it, if we pay for someone, that they are likely to succeed? If they self-select for people who are likely to succeed, that is OK. That is part of the reason why we found that almost 80 percent of people were able to avoid these operations.
Then my colleagues and I would be happy to work with an outside group. I am meeting in 10 days with the heads of the American College of Cardiology at their annual scientific meeting in New Orleans to say, you could be a credentialing group to certify who has the scientific evidencenot just as anyone who has the evidence to support that their program works. That can meet HCFA's understandable need for credentialing of programs, to make the program available to the people who most need it.
Page 50 PREV PAGE TOP OF DOC In response to an earlier request from Bruce Vladeck, Honorable DeParle's predecessor, Dr. Claude Lenfant, the Director of the Heart, Lung, and Blood Institute at NIH, evaluated this program, found it to be safeactually, had to go through a process saying it was safe for older Americans to walk and meditate and quit smoking and eat vegetables, but we have been through that process.
We also have strong bipartisan letters of support from some of the most conservative Republicans, some of the most liberal Democrats, and everyone in between. I think this committee is an example of how this is a basic need that affects all Americans. This is an area we can all come together, I think at a time when our country really needs that kind of bipartisan support.
We have support from some of the country's most eminent medical authorities: Dr. Alexander Leaf, who was the chief of medicine at Harvard; Dr. Christine Cassel, who is the immediate past president of the American Board of Internal Medicine in the American College of Physicians; Dr. Marion Nestle, the chairman of nutrition at NYU, and so on.
We also appreciate very much a recent appropriation from Congress to the Department of Defense to make this program available at the Walter Reed Army Medical Center. I am very grateful to Dr. James Simbol, who is the president of the Uniformed Services University, and Dr. John Mazzuchi, in the Office of the Secretary of Defense, who are here this morning.
Because if heart disease can be reversed, not only can it save money in the military, but the implications for prevention are even greater. As we have talked about, we focused on heart disease as a model, but I think the same kind of lifestyle interventions can reduce the likelihood of diabetes, hypertension, obesity, breast cancer, prostate cancer, and colon cancer.
I am directing a study now, in collaboration with Dr. William Fair from Memorial Sloan-Kettering Cancer Center, who has been the chief of urology there, and Dr. Peter Carroll, the chairman of urology at UCSF, to see whether the progression of prostate cancer might be stopped or reversed. It is the first randomized control trial to look at that. Our preliminary data are very encouraging, and if it is true for prostate cancer, chances are it may be true for breast cancer as well.
Page 51 PREV PAGE TOP OF DOC A recent editorial by the editors of the New England Journal of Medicine last year said, ''There can't be two kinds of medicine, conventional and alternative.'' This is very similar to what was said earlier about the JAMA editorial.
There is only medicine that has been adequately tested and medicine that has not; medicine that works and medicine that may or not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.
Now this program, our lifestyle program, has been tested rigorously. It has been found to be safe and effective. It works. So, therefore, I respectfully submit that it should be covered by Medicare for selective heart patients as an alternative to a bypass or angioplasty.
Everyone benefits. Patients have access to new choices that empower the individual. Health professionals have new options to serve their patients. Medicare does something innovative to lower healthcare costs without compromising the quality of care, and Congress can demonstrate bipartisan leadership in an area that is important to so many Americans.
I appreciate very much the opportunity to be here today. I would be delighted to answer any questions you may have.
[The prepared statement of Dr. Ornish follows:]
INSERT OFFSET FOLIOS 13 TO 21 HERE
[The official committee record contains additional material here.]
Mr. BURTON. Thank you, Dr. Ornish.
Now HCFA has been unresponsive to your request, is that correct?
Page 52 PREV PAGE TOP OF DOC Dr. ORNISH. No, sir, I wouldn't put it quite like that. I think Honorable DeParle has been very responsive, and I have great admiration and appreciation for what she and her colleagues are doing.
But I think that to make this a covered benefit will require congressional statutory authority because it currently isn't. They don't cover, just like many insurance companies didn't cover, lifestyle interventions.
Mr. BURTON. I wasn't aware of that. So, without congressional authority, they can't expand the funding for this kind of a program?
Dr. ORNISH. Well, these are things we don't learn much about in medical school, so I am not sure.
Mr. BURTON. I will have to check into that. I will tell my staff to check into that, but we will try to contact the people at HCFA and HHS to see if we can have a dialog about that. We may have some people from those agencies here today; I think we do back there. I will be happy to talk to them about that as well.
Dr. ORNISH. Thank you.
Mr. BURTON. I have a number of my colleagues and friends who have had bypass surgery and have had angioplasty, and it is depressing and surprising for me to hear you say that, within 4 to 6 months after angioplasty, the arteries can once again close up.
Dr. ORNISH. Yes, in 30 to 50 percent of the cases.
Mr. BURTON. In 30 to 50 percent of the cases?
Dr. ORNISH. Yes, sir.
Mr. BURTON. Is that widely known? I was not aware of that.
Dr. ORNISH. Well, there is a lot that isn't widely known. This is widely known within the medical profession. But, you know, it goes even further than that, sir.
Mr. BURTON. If it is fairly wide known in the medical profession, why is that not communicated to patients and the public, because I don't think it has been? Angioplasty, at least the people that I have talked to that have had it, is seen as a panacea. Obviously, they ask them to have dietary changes, and so forth, to try to keep it from coming back, and they take an aspirin and all that sort of thing.
Page 53 PREV PAGE TOP OF DOC But the fact is, I don't think anybody I have ever talked to that has had angioplasty knows that there is a good chance it will reoccur within a short period of time.
Dr. ORNISH. Well, that is the problem, getting the information out, and that is part of why I write books and give lectures and things, and why I appreciate the chance to be here today.
But if you actually look at all the scientific data, if we talk about we want evidence-based, randomized, double-blindor not double-blind, but placebo-controlled studies. There have been three major randomized trials of bypass surgery, and in every one of them they found that bypass surgery prolongs life or prevents heart attacks in only about 2 percent of people. Those are the most severe diseases.
Mr. BURTON. Only in 2 percent of the people.
Dr. ORNISH. Two point one percent, to be exact. These are people with left main coronary artery disease and poor left articular function.
No study has ever even been conducted that compares angioplasty with just drug therapy to see whether it prolongs life or prevents heart attacks. So for the vast majority of Americans who get operated on for these two operations, for which billions of dollars are spent every year, there is no evidence that it prolongs their life or prevents heart attacks. What it does do is relieve their chest pain or their angina. So it has value. But we found in all of our studies a greater than 90 percent reduction in angina or chest pain within weeks when people make bigger changes in diet and lifestyle than most doctors recommend.
Mr. BURTON. Within weeks, you say?
Dr. ORNISH. Within weeks.
Mr. BURTON. Usually, when people go in and they are diagnosed with arteries that are closed or almost completely closed, the doctors prescribe surgery or angioplasty within a very, very short period of time.
Page 54 PREV PAGE TOP OF DOC Dr. ORNISH. Yes, sir.
Mr. BURTON. The danger is, somebody says, I have been diagnosed with 90 percent closure in one artery and 100 percent in another, and the doctor says, if we don't act pretty quickly, you are going to have a heart attack. The fear factor is very great.
Dr. ORNISH. That is correct.
Mr. BURTON. For them to talk to somebody like you, who says, if you change your diet and change your lifestyle, in 4 to 6 weeks things will get betterthey worry about being around in 4 to 6 weeks.
Dr. ORNISH. That is right.
Mr. BURTON. So how does a person who goes in, they say you have got closed arteries; you run the risk of a heart attackhow does he get that information, when his doctor says you have to have surgery; you have to have angioplasty?
Dr. ORNISH. Well, it is a very important question. Let me respond on two levels. The first is, how do you get the information out? And the other is, what does the medical science show us? In terms of how to get the information out, I think you change reimbursement, you change medical practice, and you change medical education. I used to think that good science was sufficient, and I was naive. I think good science is important, but generally sufficient to motivate lasting changes in physician behavior. I think we have to change reimbursement. And I want to make it clear, most doctors are motivated by service, but if you are trained to do these things and you get reimbursed to do these things, then that is what people do.
So if Medicare were to cover this, it would have implications that go far beyond this. It would change medical education as well as medical practice.
Now it turns out that the 90 percent lesions are not as dangerous as the 30 percent ones. That is the conventional thinking now among some of the leaders in the field, like Dr. Valentine Fuster at Harvard, and so on. It seems a little counterintuitive because you think that, the more blocked it is, the greater the danger. The more blocked it is, the more likely it is to cause chest pain. But it is actually the more mild lesions, the 30 to 40 percent, that are more likely to cause heart attacks because they are more unstable.
Page 55 PREV PAGE TOP OF DOC Now no one is going to bypass the 30 percent blockage, and yet, those are the ones that may be the most dangerous. But when a person changes diet and lifestyle to the degree that we do, or even when they go on cholesterol-lowering drug therapy, the endothelium, the lining of the artery, stabilizes, and the risk of a heart attack goes down dramatically.
Most patients don't know that the surgery is unlikely to prolong their life, unless they are unstable, which is a separate category, which most patients are not, or they are the 2.1 percent of patients. For most patients, the surgery is not going to prolong their life or prevent a heart attack. They don't know that, if they were willing to change their lifestyle, they could accomplish the same reduction in angina.
Mr. BURTON. Let me ask you two quick questions.
Dr. ORNISH. Yes, sir.
Mr. BURTON. If a person who normally would have a very small chance of survival, like you said, it is not going to change their life-and-death situation if they have the heart surgery or the angioplasty. If they have the heart surgery or if they took the alternative therapy, do you have any studies or any figures that show how long their lives would be extended, or do you have any kind of an average?
Dr. ORNISH. Yes, sir. We found, in the study that came out in the Journal of the American Medical Association 2 months ago in December 1998, there were 2 1/2 times fewer cardiac events in people who changed their lifestyle compared to the control group that made more moderate changes. So people not only feel better, but in most cases they are better.
We used quantitative arteriography to measure the blockages. We used cardiac PET scans, positron emission tomography, to measure blood flow to the heart. The state-of-the-art showed these patients got better and better over time.
Now not everybody wants to change lifestyle. I don't even tell my own patients to change. But I do believe in freedom of choice. I think it is a very American idea. For those people who don't want to change, I find a good surgeon or a good interventional cardiologist or I put them on drugs. But for that subset of patients who are willing and who are motivated to changeand that subset is a lot bigger when people really know what the facts areI think it would be nice to give them the freedom of choice, too, by covering programs like this.
Page 56 PREV PAGE TOP OF DOC Mr. BURTON. Thank you.
Ms. Norton, do you have any questions?
Ms. NORTON. Yes, Mr. Chairman. This hearing is very well-structured, Mr. Chairman, I think, because we are going to get to questions of representatives of the Federal Government to establish responsibility here. I am glad we heard of your own testimony beforehand, Dr. Ornish. I think it is very valuable testimony, precisely because you are a credentialed and experienced physician.
Dr. ORNISH. Thank you.
Ms. NORTON. The balance that you bring to the table is very important, particularly as we try to play catch-up, it seems to me, on making available these approaches. What you have spoken about is hard to call an alternative approach because it is also a preventive approach.
Dr. ORNISH. Yes.
Ms. NORTON. It is what most fascinates me about homeopathic medicine. I appreciate the full information you have given us. For example, the chairman asked an important question: Well, how in the world, if 30 to 50 percent close back up again, as it were, but you indicate that they do bring some relief. Obviously, a physician wants to bring some relief to the chest pains. So he wants to do whatever he can; he wants to do it quickly. So he has something that works and he hopes that the next thing will work. I want to ask a question about that.
I do believe what you say about, well, let those who will; most people won't. Well, let's do it for those who will. I do think there is a very strong case to be made, since I do believeand here you are talking about what we do have evidence aboutthat these changes, if you are willing to make themcan both prevent heart disease and help retard it once you have had a heart attack.
Page 57 PREV PAGE TOP OF DOC This morning there was a reportI heard it on the National Public Radio; it was a very informative reportabout autopsies that were done on young men. I think it was young men from the Korean War. Now they have done all of the studies.
Dr. ORNISH. Yes, ma'am.
Ms. NORTON. It was quite amazing. Essentially, it is not about old fogies like me. It is about how young people like my legislative assistants are getting their arteries all clogged up, as I speak
Dr. ORNISH. Yes.
Ms. NORTON [continuing]. And won't pay any attention to it until they get to be middle age, and then they have found that these people in their twenties are showing signs, significant signs, of heart disease. By the time they got as old as 35, they just had it. Nobody even thinks about heart disease at those ages.
Two questions: One is, if this information is available, so that physicians, who also don't concentrate on young people, in part, because they don't go to the doctor, if physicians look to young people as a way of dealing with heart disease, a runaway problem in this society, won't this, in turn, get us to the point that you want to get, which is the change in the lifestyle will become more automatic?
I ask this question because young people became environmentalists when it took old people, who had been so used to being wasteful, to understand it. So they became teachers, as it were, for older people.
Is there a way, now that we know that heart disease it not simply a disease of middle and old age, to get to where you want to get simply by changing our focus from the pool that has been the target to a younger pool, in which case some of the problems get prevented and the others, it seems to me, we are able to deal with in a lifestyle you indicate. I would like to hear you discuss how this might be done, if it could be done, if it would be effective. Second, how it might be done, given the fact that young people not only believe they are immortal, but have no reason to seek the help of physicians, for the most part?
Page 58 PREV PAGE TOP OF DOC Dr. ORNISH. Well, Ms. Norton, I appreciate so much the question. You are absolutely right; studies have shown that American soldiers killed in Korea, Vietnam, the Persian Gulf, even at the age of 19, had significant plague in their coronary arteries. A study done by Dr. Gerald Berenson in Louisiana found that children who died in accidents, that half of them had severe plaque, and all of them had blockages in their aortas. So this is a problem that begins in childhood and progresses over a period of decades. So you are quite right; that is where we have to begin.
Now the old joke is, if I change my lifestyle, if I eat this way, am I going to live longer or is it just going to seem longer? You know, that is what a lot of young people think, that lifestyle changes
Ms. NORTON. Either will do.
Dr. ORNISH. Pardon me?
Ms. NORTON. Either will do at this point. [Laughter.]
Dr. ORNISH. Well, there is this myth that the good life is eating a high-fat diet and getting drunk and using cocaine and smoking and getting under a lot of stress, and that it is boring to have a healthy lifestyle. Part of what I have learned is that telling a young person they are going to live to be 86 instead of 85 does not motivate them. In fact, it hardly motivates people who are 85[laughter]because people want to feel better.
The paradox I have found is that it is actually easier to make big changes than to make small ones. That is why I began changing when I was 19, growing up in Texas, eating meat a lot, because I found I felt better. I had more energy. I could think more clearly.
Now you know Viagra came out last year at the same time the Nobel Prize was awarded to the doctors who discovered a compound called nitric oxide, which dilates blood vessels. One of the things that happens when people change their diet is that their sexual function often improves, particularly in older men, because it is not just your heart that gets more blood flow. People find that they think more clearly. They have more energy. Now, as a scientist, those are harder things to measure than arteries in coronary blood vessels getting better, but from the motivational standpoint, one of the most effective anti-smoking ads was not ''smoking causes cancer,'' but ''do you want to taste like you have been licking an ashtray when someone kisses you?'' It puts it into the here and now.
Page 59 PREV PAGE TOP OF DOC That is what younger people really respond to, changes that affect their quality of life in the short run. We doctors like to talk about risk factor reduction and prevention, but most young people find that boring. I have found that we need to talk about changes in lifestyle that improve the quality of your life very quickly. That is what happens when you make changes. I think it is never too early to begin making these changes, and it is never too late to begin making them.
Ms. NORTON. Thank you. Thank you, Mr. Chairman.
Mr. BURTON. Thank you. Thank you, Doctor.
Mrs. CHENOWETH. Thank you, Mr. Chairman.
Dr. Ornish, I was fascinated as you gave your testimony because you almost gave it word for word with rarely looking at your notes. [Laughter.]
I wanted to ask you, it seems that the dog in the manger seems to be the insurance companies. You said it better than I did. You were more politically correct. You said, once reimbursements get in line, then the rest of the policy will follow. I couldn't agree with you more.
On page 4 of your testimony, you mention that 77 percent of the patients who were candidates for bypass surgery or angioplasty responded very positively to your recommendations or those types of recommendations, and that Mutual of Omaha said that it saved $30,000 per patient.
Dr. ORNISH. Immediately.
Mrs. CHENOWETH. Immediately. These guys look at the bottom linewhy aren't they responding to this? What is wrong? That startled me.
Dr. ORNISH. Well, they are responding. That is why 40 insurance companies are now covering this program in the hospitals that we have trained. But if HCFA, if Medicare were to cover this, then most of the other insurance companies would follow suit. That is really the Rosetta Stone. That is where the leverage point is. That is where the opportunity for change is the greatest.
Page 60 PREV PAGE TOP OF DOC If we can focus on the area where the cost savings were the most immediate and the most dramatic, then I am hoping it will be a much smaller step for them to see that there is value in paying for preventive services as well. But let's start in an area that I think is where the cost savings can really be shown the most quickly and the most dramatically. That is why we focused on that area, but it is by no means limited to that in terms of the benefits.
Mrs. CHENOWETH. I have been frustrated because other alternative forms of medicine, such as the practice of chiropracty and naturopathy, and so forth, there seems to be so much manipulation in terms of what will be paid for and what won't be paid for, and what takes certain approvals, and so forth. So I hoping that shortly we will see people working togetherMD's working in consultation with other people who have an expertise in an area that they could offer great advice. That is my hope.
In following up with the chairman's comments, this 77 percent figure fascinated me. Doctor, does that mean that 23 percent of the people would be eligible and would need bypass or angioplastic surgery because they were the unstable candidate, those that may not live for the next week or so?
Dr. ORNISH. The patients, for whatever reason, 23 percent ended up getting operated on during that 3-year period. It was a 1-year program. We followed them for 3 years.
Now an interesting fact is that, because the cost differential between a bypass and paying for lifestyle intervention is so greatit is, say, maybe $50,000 for a bypass and, say, $7,000 for a year of lifestyle trainingif we just delayed surgery for a year and a half, and then 100 percent of people failed, the interest saved on that $50,000 would more than cover the cost of a lifestyle program. We have certainly done a lot better than that.
So from an economic, hard-dollars standpoint, this makes sense. I would love to see coming out of these hearings two things. One has already been discussed, which is increased funding for research. I am a scientist. That is what I do. I have great appreciation for the value of science to help sort out what works and what doesn't work, and for whom and under what circumstances, so we can cut through a lot of the hype and say, what really is the science here?
Page 61 PREV PAGE TOP OF DOC The other thing that I would like to come out of this is that there are a few so-called alternative approaches, like what we have done, that have been proven to work, that are both medically effective and cost-effective. Let's now take them to the level of reimbursement, which is where change really can happen. Then I think you will find it will affect medical education, as well as medical practice, as well as medical research.
Mrs. CHENOWETH. Thank you, Doctor.
Mr. BURTON. We are going to break for lunch for about 2025 minutes because I can hear people's stomachs growling, and we have some food for the panelists along with some refreshments.
But I would like to end up by asking you just one really hard question.
Dr. ORNISH. Yes, sir.
Mr. BURTON. Do you believe, as a scientist and a doctor, that there is resistance from some areas of government and medicine because of the profit that is to be made by pharmaceutical companies and the medical profession in performing these types of operations and prescribing these types of medicines?
Dr. ORNISH. Well, time for lunch. [Laughter.]
Mr. BURTON. I don't want to take too much time, but this is very serious, because there has been some suspicion among some of us in Congress that people who work at the Food and Drug Administration and at Health and Human Services have been influenced unduly by pharmaceutical companies, for instance. Many of them have been paid fees for some forms of research. They have put on boards by some of the pharmaceutical companies, and that tie kind of concerns us, because what we want, as Members of the Congress, is the best quality of healthcare, whatever it is, for the American people. That emanates, in part, from the pharmaceutical companies and the research they do, but it also emanates from holistic approaches. So I am concerned that maybe our health agencies in the Federal Government might be unduly influenced, and that is why I would like to have your opinion about that.
Page 62 PREV PAGE TOP OF DOC Dr. ORNISH. Well, let me put it in a slightly different context. I think most doctors are genuinely interested in doing what is best for their patients. I believe the vast majority of doctors are generally interested in service. But, at the same time, having been trained very conventionalyou know, I went to medical school at Baylor and did my course surgery medical surgical rotation with Michael DeBakey, the eminent heart surgeon. I did my post-graduate training at Harvard and Mass. General, and I am at UCSF now.
I understand that training process, and I also understand how hard it is to be a doctor these days, when you are getting squeezed from all sides. If managed care says you have to see a new patient every 7 minutes, even if you are interested in nutrition or dealing with the psychosocial and the emotional and spiritual dimensions of health and well-being, you don't have time to do it. In 7 minutes, you don't have time to talk to about the problems with the marriage or the problems at work or the problems with the kids on drugs, whatever it happens to be. You, basically, have time to listen to the heart and lungs. You write a prescription for a cholesterol-lowering drug. You are on to the next patient.
It is profoundly unsatisfying for most physicians and for most patients. Most physicians, according to the latest surveys, which I am sure you have seen, wouldn't recommend medicine as a career for their sons or daughters because it is not fun.
Now we are trying to say, look, if you treat the cause of the problem, if we change reimbursement, we offer different approaches. Of course, there is an economic incentive the way things are set up now, but why can't there be an economic incentive to do things differently. We always have the money to pay the $50,000 for a bypass. Why not the $7,000 for a year of lifestyle training, which is a whole team of people, not just a physician, but a dietician, an exercise physiologist, a stress management instructor, a psychologist, and so on, to deal with the cause of the problem?
If we can make it economically reimbursable, then we change those other incentives. Some patients do need surgery. Some patients do benefit from drugs. But I think we also need to include these other approaches which are of permanent benefit, which can really empower the individual and make such a huge difference in both their quality of lives and in their survival.
Page 63 PREV PAGE TOP OF DOC Mr. BURTON. Thank you, Dr. Ornish. That was a great statement, and it had some real political overtones. Have you thought about entering politics? [Laughter.]
Dr. ORNISH. Well, I am trying to build bridges here.
Mr. BURTON. Yes, I know you are, and I appreciate that.
We have some people from HCFA here, don't we? Do we not? Don't we have somebody from the Department here? Can you come back and have lunch with us? I would like for Dr. Ornish and you and I to talk a little bit.
OK, I think we will break now for about a half an hour and have a little bite to eat. You have to leave at 10 after 1?
Dr. ORNISH. Yes, sir, but I just want to say, in closing, how grateful I am to you for organizing these hearings and for the opportunity to be here today.
Mr. BURTON. Thank you, Doctor.
We will reconvene in about 30 minutes.
Mr. BURTON. We will reconvene.
We will have other Members, I believe, coming back here shortly. They are running all over the place because there's a number of hearings going on today. So I apologize for the people coming in and out.
But I would like to have Dr. Brian Berman of the University of Maryland and Mr. Ollie Johnson and his lovely wife, Barbara, come forward. We will have your testimony now.
I appreciate very much your patience and hope you did get something to eat. We normally don't provide that service, but today we did.
Why don't we start with Dr. Berman? Dr. Berman, do you want to start and give us an opening statement? If you want to, you can submit your statement for the record, and then summarize.
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STATEMENTS OF BRIAN BERMAN, M.D., ASSOCIATE PROFESSOR AND DIRECTOR, PROGRAM FOR COMPLEMENTARY MEDICINE, UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE, BALTIMORE, MD; AND OLLIE AND BARBARA JOHNSON, DEAN ORNISH LIFESTYLE PATIENT AND SPOUSE, COLUMBIA, SC
Dr. BERMAN. Thank you very much. Mr. Chairman, members of the committee, I am extremely honored to be here today and given the opportunity to provide testimony to the Committee on Government Reform.
I am a board-certified family physician and pain management specialist, and I am also trained in acupuncture and homeopathy at the Royal London Homeopathic Hospital. I went on to look at some of these therapies and incorporate those into my practice because I was frustrated that I didn't have all the answers for my patientsexcellent training for acute care, trauma, but not for a lot of the chronic diseases that we see every day.
I have been practicing integrated medicine for the past 17 years. I am also associate professor at the University of Maryland School of Medicine and director of the complementary medicine program there, and principal investigator on the National Institute of Health-funded Center for Alternative Medicine Pain Research and Evaluation, as well as CAM research grants from the NIH and the Department of Defense. So I have been asked to present today from the three perspectives as a clinician, as a researcher, and as an advisor to the government for the past 6 or so years.
Our center was started in 1991, and we really started it because of some of the remarks that were made today. Back then, I really felt that these types of therapies weren't going to be brought into the mainstream of medicine unless there was a proven scientific base to these therapies. So we started back then, in a time when there was a great deal of public interest, but the medical community's interest was low, if not hostile. As we all know, and it has been said today by you, there has been a great sea of change over the past 7 or 8 years. It has gone from 3 in 10 to 4 in 10 Americans using these therapies, and worldwide 75 percent of the world uses these forms of therapy as their primary form of healthcare. In this country, we see that there has been an increase in expenditures to $21 billion just for the providers' side, and another $13 billion for the other out-of-pocket expenses of herbs, vitamins, books, and so forth.
Page 65 PREV PAGE TOP OF DOC What has also changed over this period of time has been the government's support, and that started really with the opening of the Office of Alternative Medicine at the NIH in 1992, through the support of Senator Harkins and others. Thanks to the efforts of this Congress, now it has become a center with increased autonomy, increased budget, which has brought the much-needed funding or the start of the much-needed funding to an area that does not have access to the deep pockets of an industry, the sort of research and development industry, of a pharmaceutical industry that we have with modern medicine.
So I became involved with the Office of Alternative Medicine at its start through chairing the Ad Hoc Advisory Committee, the consensus meetings in Chantilly and then the report for the NIH ''Alternative Medicine: Expanding Medical Horizons Report,'' and as an advisory council member. Over these years, I have seen tremendous progress in the field. One has been the Office of Alternative Medicine's funding 11 centers of research, and that has started the infrastructure. Over the past 2 days, I was at meetings of the principal investigators, and the excitement to see people representing the field of cancer, heart disease, pediatrics, pain, many areas, women's health, and having from 7 to 10 projects, really getting out information that the Congress and the public really wanted to see.
Pilot projects have been funded, and now definitive studies in several promising areas are underway, such as osteoarthritis or acupuncture in the use of osteoarthritis in the elderly, St. John's Wort clinical trial, and some of these definitive studies that we have all been wanting to see happen.
At the University of Maryland we focus on the area of pain, and particularly the modalities of acupuncture and mind/body therapies. I would like to use these right now as an example of the progress that has been made in some areas of complementary medicine, and then give a picture of where they stand as regards the government policy.
We at our place are building a mosaic of information, of evidence, basic science information, looking at how does acupuncture actually work, studies ongoing there; randomized controlled trials. Is acupuncture and mind/body therapy safe, effective for acute pain conditions such as post-operative dental pain, as well as chronic pain problems like osteoarthritis in the elderly, lower back pain, fibromyalgia? Also, what is going on in the actual clinical setting, tracking the outcomes and the real-life experience of patients?
Page 66 PREV PAGE TOP OF DOC We are also collecting and evaluating the existing literature. One of the criticisms of complementary medicine, as we heard alluded to today, is the general lack of scientific evidence. We have found and collected over 11,000 citations in complementary medicine and pain alone. The difficulty, in part, has been finding this literature, that it is in either foreign journals or nonmainstream journals.
So our investigations to date, they paint the picture that acupuncture and mind/body therapies, part of which we heard earlier by Dean Ornish, mind/body therapies and acupuncture have great potential, whether alone or as adjunct to therapies, for many of the pain problems. More research is needed to complete this picture and fill in the gaps.
While this research is important and the building block for practicing evidence-based healthcare, how is it being brought into the public arena, where it can be useful in setting clinical guidelines and affecting healthcare policy? Some of the things that have occurredback in 1994, the NIH and the FDA held a joint conference looking at acupuncture. The outcome of that meeting was that they determined there was enough evidence to say that acupuncture was no longer going to be listed as an experimental device.
The NIH Acupuncture Consensus Conference was held in 1997. The outcome there was they found there was sufficient evidence to expand its use into conventional medicine and to conduct future studies. They listed a whole range of conditions, from addiction, to asthma, to pain conditions, where there was fairly good evidence.
There was also a Technology Assessment Conference in Mind/Body Therapies for Pain and Insomnia, held through the National Institutes of Health, for which I was a panel member. There the findings were that there was strong evidence for treating a wide range of chronic pain conditions.
Both conferences recommended these therapies be covered by healthcare payers. This is far from the reality today. So the recurring theme of coverage comes up. Insurers and healthcare companies, they put them on today sometimes as additional riders or reduced rates. Over the 7-year increase in patients usage that we saw from those surveys, there wasn't any change in the coverage.
Page 67 PREV PAGE TOP OF DOC What about the government-funded healthcare programs? I would like to just give you a quick story about one of my patients. Before I came here, last week when I was preparing for this testimony, one of my patients, an elderly gentleman with chronic back pain, whose insurance is Medicare, called me, and he said, ''I won't be able to come for treatment any longer.'' Now he had tried all the conventional treatments for his chronic back pain without success. He came to me. We treated him with acupuncture. Maryland has acupuncture licensing laws. I am licensed in the State of Maryland to practice acupuncture. He benefited greatly over the course of about 4 months' time. Now he has to come back and say, it is not going to be covered, so he has to go back to the treatment which he had before, physical therapy, which really didn't benefit him. And as a side, there isn't much in the way of strong evidence to show the efficacy of physical therapy for chronic back pain.
At the end of the day, who is being served by this? Certainly, not the patient, who now has to give up an effective treatment for him, and certainly not Medicare. I think it is time to start considering complementary and alternative medicine as viable healthcare options in our healthcare system.
So how do we do this? With over 200 modalities under this broad umbrella ''complementary medicine,'' it could seem an overwhelming task to know what information there is, which treatments merit consideration based on solid evidence. At our university, part of our program, one of our main efforts has been in gathering the best information and trying to disseminate that.
Part of that effort is through the Cochrane Collaboration, which is an international organization dedicated to evaluating all medical therapies. So we are coordinating this international field for complementary medicine as part of the Cochrane Collaboration, and through these efforts, there now exists a specialized registry of randomized controlled trials that is available worldwide of about 4,000 clinical studies and another 4,000 we are considering.
Page 68 PREV PAGE TOP OF DOC We and others worldwide are involved with reviewing this evidence with a systemic review and then drawing conclusions that can help guide clinical decisions and future research. There have been 164 of these reviews completed, and it is this type of information that can help guide the integration of complementary medicine into the mainstream.
So, in conclusion Mr. Chairman, I offer the following: We need continued proactive funding by the government. Most complementary alternative medicine therapies are not patentable, and therefore, of little interest to industry. We need to continue to investigate the safety, efficacy, cost-effectiveness, and use the full range of methodologies from randomized controlled trials to basic sciences to health services research.
No. 2, we need quality information that is succinct and evidence-based made available to the public, to researchers, payers, and policymakers.
No. 3, based on this research and quality information, we need to make complementary therapy more accessible, especially to those with little disposable income. I think this can be accomplished, one, through coverage, through Medicaid/Medicare, and, two, through setting up demonstration programs at places like the VA system, military medicine, the Bureau of Primary Health Care.
Then, last is setting up the President's commission. There was language to set up the President's commission. I think we should go forward with that. I think that will help us facilitate other government agencies become involved in this field.
I think the continued interest and support of your committee and other government programs will help ensure that ours and future generations benefit from the availability of effective healthcare approaches, regardless of whether they are labeled alternative, complementary, or conventional.
Thank you very much.
[The prepared statement of Dr. Berman follows:]
Page 69 PREV PAGE TOP OF DOC INSERT OFFSET FOLIOS 22 TO 26 HERE
[The official committee record contains additional material here.]
Mr. BURTON. I have some questions, but we will go ahead and hear the other panelists, and I will ask you about those in just a moment.
Mrs. Johnson, ladies before gentlemen.
Ms. BARBARA JOHNSON. Thank you.
Mr. BURTON. Would you pull the microphone pretty close? Thank you very much.
Ms. BARBARA JOHNSON. Mr. Chairman, members of the committee, thank you for the kind invitation to allow me to testify at this hearing today. My name is Barbara Johnson, and I have been my family's caregiver for 42 years. I appreciate the opportunity to share with you mine and Ollie's journey to the Dr. Dean Ornish's Program for Heart Disease Reversal.
In 1987, my husband, Ollie Johnson, was diagnosed with heart disease. He had a heart catheterization at Richland Memorial Hospital in Columbia, SC, which showed that he had a 70 percent blockage in one artery and a 90 percent blockage in another. His doctor did not think that he was a candidate for any kind of surgery, so he prescribed medication for him. All of the medication was provided by the pharmacy at Moncrief Army Hospital at Ft. Jackson, SC, since Ollie is retired from the Air Force.
At my insistence, the doctor also provided a way for Ollie to go to the cardiac rehab program at the University of South Carolina. On my own, I bought cookbooks which were recommended by the American Heart Association, because we didn't really get any nutritional information from the doctor, and started cooking, ''heart healthy.'' We stopped eating beef and ate chicken, pork, and fish. We stuck to this regimen for several years. He exercised periodically by walking 3 to 5 miles a week.
Page 70 PREV PAGE TOP OF DOC In 1991, I began to see Dr. Dean Ornish on various talk shows and became intrigued with his program. I bought his book, ''Dr. Dean Ornish's Program for Reversing Heart Disease,'' and knew that the program would work for us.
When Ollie had his next regularly scheduled appointment with his cardiologist, we mentioned the book and program to him, and expressed a keen interest in trying it. The doctor quickly dismissed us and said, ''You can't do that program. It's too harsh.'' I did not believe this, but was powerless against his suggestion. So for the next 4 years, we followed the American Heart Association diet with a 30 percent fat intake.
By June 1995, when Ollie had his yearly checkup, it was discovered that his heart disease had gotten worse, and now a third artery had significant blockage. Knowing that the Dean Ornish program would stop the progression of the disease, I asked the doctor what did we need to do to stop the disease from getting any worse. By this time, the Richland Memorial Hospital offered the program. The doctor said that the only way that he knew of to get the disease to stop was to enroll in the Ornish program. So I asked him to please get us in the next class, and he did.
We started the program in July 1995. For the first 3 months, we were required to go to the hospital 3 nights a week for lectures, exercise, stress management, and supper. This is how we learned to live the program.
At one point, our family members were invited to the hospital and they were given information on the program. Their questions were answered, and we all had a meal together. This event was invaluable to us because it emphasized the value of staying with the program and how family support was so important.
I do not have heart disease, but I entered the program to support my husband and to ensure his success. In our home we eat and live the Ornish lifestyle. When we started the program in July, we were told that Ollie's insurance, Blue Cross/Blue Shield, would not pay for our participation. We had to pay $5,000 for Ollie and $1,000 for me. We paid $3,000 down and were given 2 years to pay off the remaining $3,000. We paid a monthly payment to the hospital.
Page 71 PREV PAGE TOP OF DOC During the first year in the program, we faithfully stayed in compliance with all of the dietary, exercise, and stress management requirements. We filled out program compliance sheets daily and mailed them to the hospital monthly. We actually filled out these forms for 3 years. The first year was a year of learninglearning how to cook so that meals were tasty and satisfying.
We also had to give ourselves time to adjust to the new lifestyle. Travel and eating out were challenges that we were up to and slowly but surely mastered. During the first 2 1/2 years, whenever we traveled, we took an electric cooler and a two-burner stove and all of our food with us. If we couldn't find a restaurant to serve us, we would cook in our hotel room. We made this fun and never saw it as a hardship.
After 3 years, I am very good at preparing our meals and we are both energetic and healthy. Ollie walks 15 to 20 miles a week and lifts weights three times a week. I walk 30 to 35 miles a week, work out at the gym on weight machines three times a week, and take an aerobics class twice a week. And by the way, I am in training for the Cooper River Bridge Race.
Another plus of this program is that our food bill has gone down dramatically. When you do not have to buy meat, you realize a substantial savings at the grocery store.
When Ollie had the thallium stress test and blood work after 1 year, his test results were so favorable that his doctor took him off the Procardia and reduced the Tenormin from 50 milligrams to 25 milligrams daily, and the doctor tells us on the side that he doesn't really think Ollie needs the Tenormin, but he is scared to take him off of it.
Eliminating the Procardia amounted to a savings of $40 a month to the U.S. Army. The current cost of Tenormin is less than 1 cent per day. Every thallium stress test that he has had since then has been more favorable each year.
The hospital had been sending Ollie's medical test results and our compliance sheets to the insurance provider. After we had paid on the remaining $3,000 for 13 months, the insurance company paid off the balance. The insurance provider currently pays for some patients to participate in the program. However, when we entered the program, the insurance provider would only pay if the participant had previously had a heart attack, bypass surgery, angioplasty, or stints.
Page 72 PREV PAGE TOP OF DOC We are fortunate and grateful that the Dr. Dean Ornish program is available in Columbia. In July 1995, Columbia was one of only seven locations in the United States. However, there is a need for this program to be available throughout the United States. I believe that participation in this program has eliminated the potential of my husband having a heart attack or bypass or some other kind of invasive measure. I wholeheartedly recommend that this, the Dean Ornish program, be authorized under Medicare.
I thank you for your attention, and I will be glad to answer any questions.
[The prepared statement of Mrs. Johnson follows:]
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[The official committee record contains additional material here.]
Mr. BURTON. Mr. Johnson, would you care to comment?
Mr. OLLIE JOHNSON. Thank you, Mr. Chairman. I'm Ollie Johnson, and I am the patient here. I appreciate the opportunity to share with you my experiences overcoming my heart disease and also my thoughts as a taxpayer.
It is very sobering when one is told, ''You are going to have a heart attack.'' I was told that by my cardiologist, and later by a nurse while I was in the cardiac rehab. unit at the University of South Carolina. Fortunately, at this time in my life I feel very certain that it is not going to happen.
My initial attempt to seek treatment in 1987 was at the Moncrief Army Hospital at Ft. Jackson. I was seen by a clinical nurse who administered an at-rest EKG. There were no visible symptoms since I was not put under stress. Consequently, I was told that I had no problem.
We were not satisfied with this diagnosis, and subsequently, saw my current cardiologist, who at that time diagnosed blockage after a more thorough examination and verification by cardiac catheterization. After completing the cardiac rehabilitation in 1987 and changing my lifestyle, the possibility of a heart episode still remained. When I started the Dean Ornish program to reverse heart disease in 1995, initial tests showed that my heart disease had progressed, but simply at a slower pace.
Page 73 PREV PAGE TOP OF DOC After the first 6 months in the Ornish program, tests showed a significant lowering of my cholesterol levels, favorable levels of my HDL, LDL, and triglycerides. This was viewed by the Heart Center staff as the environment in which reversal takes place.
After 1 year, the progression of my disease completely stopped. After the second year, there was evidence that the area served by the blockage was getting more blood. After the third year, even more blood flow was noted. In addition, my ischemia had disappeared.
My cardiologist commented that, if you didn't know that I had heart disease, he could not tell from my electrocardiogram stress test. I feel confident that my disease is being cured, and that I will not require a catastrophic heart procedure. I am healthy and energetic. I walk 15 to 20 miles a week. I meditate for 1 hour 4 to 6 days each week, and I adhere to the Ornish diet.
My wife and I are involved in our community. I do part-time consulting work. We travel, occasionally visit and enjoy our grandchildren, and enjoy our lifestyles.
I would be remiss if I did not thank the many people who have helped save my life. Dr. Dean Ornish, who invented and developed this program, and weathered the rocky road to get this program widely accepted; the Heart Center at Palmetto Richland Memorial Hospital for making this program available in South Carolina; the medical directors, Drs. Don Sanders and Joe Collins; my cardiologist, Dr. Stephen Humphrey; the wonderful staff at the Heart Center: Susan Bevron, who coordinated the Ornish program when we entered it; Colleen Wracker, a nutrition specialist who patiently taught us how to eat Ornish and answered all of our many questions; Brent Schell, our stress management specialist, and Jean Humphrey, our group support volunteerand last, but by no means least, my wife, Barbara Johnson, who determined long before I knew that this was the program that would save my life. She is my advocate, my cook, my motivator, my caregiver, and she is the mother of my children. I am truly blessed, and I am grateful for this program.
I just want to share with you as a taxpayer that I feel very strongly that when the government invests in the health and well-being of its citizens, there should be specific outcomes. The program should have a favorable impact on the society that it serves. It should be cost-effective, and it should be measurable.
Page 74 PREV PAGE TOP OF DOC I believe that the Dr. Dean Ornish Lifestyle Program meets these outcomes. I am healthier. There is evidence that my blockage is regressing, and I am avoiding a catastrophic bypass procedure cost of about $45,000 to me and my insurance carrier.
I have some data from the South Carolina Budget and Control Board, Office of Research and Statistics. These figures show cardiac procedures, angioplasty and bypass, and their average costs for the period October 1997 through September 1998. There were 6,587 procedures at a cost of more than $228 million. If one-fourth of that population had early access to, and embraced, the Dean Ornish Heart Disease Reversal Program, there was a potential savings of more than $57 million in medical costs within South Carolina; and, 1,646 people might have avoided catastrophic invasive procedures.
I would certainly urge this distinguished panel to support Medicare coverage of this program. I thank you for allowing me to participate. I will answer any of your questions.
[The prepared statement of Mr. Johnson follows:]
INSERT OFFSET FOLIOS 31 TO 34 HERE
[The official committee record contains additional material here.]
Mr. BURTON. Thank you, Mr. Johnson. Your wife must be an extraordinary woman, as well as a good cook.
Mr. OLLIE JOHNSON. Yes, she is.
Mr. BURTON. Mr. Sanford ought to be very proud of you as constituents, because you make a very strong case, and you are examples of what people ought to do to make sure their lifestyles are enhanced. So congratulations.
Let me just ask you a couple of questions, and then I will yield to Mr. Sanford.
Page 75 PREV PAGE TOP OF DOC What is your cholesterol level now?
Mr. OLLIE JOHNSON. 196 or 195.
Mr. BURTON. Is that right, below 200?
Mr. OLLIE JOHNSON. Oh, yes, it has been down to 170, but I had some tests last week and it was about 195 or 190, somewhere in there.
Mr. BURTON. Your LDL and HDL are at acceptable levels as well?
Mr. OLLIE JOHNSON. They are all in acceptable levels, yes.
Mr. BURTON. What were they before? Do you recall?
Mr. OLLIE JOHNSON. I don't know because I didn't pay too much attention to it until I got them, and when I first was checked, it was 3 or 4 months into the program; they had all just kind of gotten into compliance.
Mr. BURTON. What about your blood pressure? Is it pretty good?
Mr. OLLIE JOHNSON. Yes, my blood pressurethey have to sort of wake me up.
Mr. BURTON. 120 over 80 or
Mr. OLLIE JOHNSON. Yes, it is usually somewhere at 120 over 80, 78.
Mr. BURTON. But it was higher than that when you first started taking Tenormin, I guess?
Mr. OLLIE JOHNSON. Yes. Yes, it was higher than that. But I haven't had a problem in 3 1/2 years.
Mr. BURTON. Did you take Zocor or any of the cholesterol-controlling drugs at any time?
Mr. OLLIE JOHNSON. No. I took Procardia that dilutes your blood vessels. They took me off that medication and they reduced my Tenormin from 50 milligrams to 25 milligrams. Right now I am taking 25 milligrams of Tenormin and a baby aspirin, and I take a multiple vitamin.
Page 76 PREV PAGE TOP OF DOC Mr. BURTON. But the doctor really doesn't even think you need those; it is just a precaution?
Mr. OLLIE JOHNSON. That is correct. He doesn't really think I need that, but he won't take me off of it.
Mr. BURTON. OK, very good. Well, I can tell you right now that we are going to be having meetings with Dean Ornish and people at HCFA. I have already talked to some of the people over there about that. It sounds like to me that there is not a lot of opposition over at Health and Human Services and HCFA to the Ornish program. The problem, I guess, it looks like to me, is that we need some legislation to enable them to approve this program being paid for by the Medicare system. If we can get HCFA and Health and Human Services, FDA, and everybody onboard, then it seems to me we ought to be able to get the Congress to go along with that. We should be able to get that done. So maybe your wish and Dr. Ornish's wishes, will be realized before too long. Anyhow, we are going to be meeting with them in the not-too-distant future.
I would like to ask Dr. Berman a couple of questions about the acupuncture. You said in your testimony thatI may be paraphrasing what you saidbut, because it is not profitable, a lot of the companies are not interested in this, or a lot of the providers are not interested in this. Maybe you could clarify that. I might have
Dr. BERMAN. I think what I was saying was that a lot of these therapies or complementary alternative medicines are not patentable. So because there is no patent, there is no great incentive for a drug company to put the amount of money that it takes to go through the steps to have it. So, therefore, they don't really get evaluated and taken to that sort of stage from people's observationsyes, it seems to work anecdotallyall the way through to the clinical trials that we need.
I was more talking about that research dollars are really needed, and it is not going to come froma lot of our research is from the drug industry, and that is where a lot of the dollars come from.
Page 77 PREV PAGE TOP OF DOC Mr. BURTON. Do you think that some of the opposition to the procedures that you provide comes from pharmaceutical companies because there is no real profit incentive?
Dr. BERMAN. We are back to that question again.
Mr. BURTON. Well, you know, I ask that question, and I asked it of Dean Ornish, and the reason I ask it is because it is very important that we get that out in the open. That is not something you can hide behind, because if agencies of the Federal Government are being controlled, in part even, by pharmaceutical companies, because they invest large amounts of moneys in research, and they are afraid their research dollars are going to go down the tube because somebody finds bark off a tree that is going to cure cancer, instead of their product, then if they have that kind of influence, it is unseemingly.
I think in the processand I am going to go off on a little tirade hereI think in the process of getting alternative therapies accepted, we may have to, as a government, figure out some way to protect pharmaceutical companies against making great investments in scientific research, and then have something come along that didn't cost anything that knocks their research out of the box, and there is maybe $2 or $3 billion that has gone down the tubes.
I am sympathetic to the problem that they face. If they patent something, they go through all the research; they come up with a compound that works, and then somebody comes up with something that is homeopathic that works just as well, but doesn't cost anything. So they are out all that money. So I am sympathetic to that.
But, at the same time, I think we need to know in the Congress if pharmaceutical companies, if medical facilities in this country are using their influence to keep a lid on alternative therapies, so that they can still make the almighty dollar.
Dr. BERMAN. I think that does exist. I think we would have to say straight that there is a great profit motive, and it is not there for many of these therapies. So while some of them are nowquite a few of the big pharmaceutical companies are starting to look at this field, they are coming along with a big net to see where is the market, and beginning to start their own lines of vitamins and minerals, and have not yet gone the other way to say, let's put in the research dollars, because of these concerns: Where is that patent going to be, and their payout at the end of the line.
Page 78 PREV PAGE TOP OF DOC Mr. BURTON. Well, perhaps we can wade through that and figure out some way to be able to encourage them, so that they can make money and still get to the final conclusion we all want.
Let me ask you a little bit about acupuncture, because I am not that familiar with it. How does it work on joints and pain? If you use acupuncture, for instance, if you have knee problems or tennis elbow or shoulder problems or back problems, does it give long-lasting relief or is it just a temporary thing, like aspirin or acetaminophen or something?
Dr. BERMAN. What we have found is that it generally, in the beginning, the treatments are maybeif somebody has a chronic problemif it is an acute problem, often it lasts. But if it is a chronic disease, let's say, like somebody with osteoarthritis of the knees, and they have had this for many, many years. Initially, you may find that the treatments last for just a couple of days, and then as you go along, if this treatment is working for this particular patient, they tend to last longer and longer, and there is more of a carryover effect. From some of our studies, it has lasted sort of for 12 weeks before we saw any decrease in the effects from the treatment.
Mr. BURTON. Does it ever provide a complete cure or is it just like some kind of pharmaceutical that would provide a cure for a short period of time, and you have to take it again?
Dr. BERMAN. Well, in the traditional way of looking at it, they would say the cure might be that you come in once a season eventually, and it has to do with not just your local knee pain, but your general health. Whether or not it canit really depends on which problem. I mean, I have seen it cure tennis elbow quite effectively and some problems of chronic headaches.
But something where it is reallylooking at osteoarthritis, part of the joint is gone, and they are waiting to have joint replacement, it is not going to regenerate that joint. There is some evidence that glucosamine and some of the other compounds might have some effect there, but for acupuncture you are not going to regenerate it, but you will decrease the inflammation around that joint. You will decrease the pain, and you will increase the quality of life, so that the person is really perhaps able to not have the surgery or avoid having the surgery.
Page 79 PREV PAGE TOP OF DOC Mr. BURTON. Very good.
Mr. SANFORD. I guess I would ask this of my fellow South Carolinians. We grew up not only in the Sunbelt, but in the stroke belt as well. Growing up where we did, I have a particular love of fried chicken, country fried steak, fried okra. My hope that is, as you look at the Ornish program, a part of it is what you eat; a part of it what you do in terms of exercise, and a part of it, I suppose, is what you think with meditation, and maybe there are other elements in terms of herbs.
How much of it is the nutrition part? Can I skip out on the nutrition part and still be OK, or, no, it is all three?
Mr. OLLIE JOHNSON. It is all of them. We asked that question. It is like we can only have one drink a day. I asked, could I save them up until Saturday? They said, no, you can't. [Laughter.]
But the food part, we don't eat meat; we don't eat seafood. We go to a restaurant and we talk to the cook or we say, ''Look, can you fix up the meal?'' They will say, ''We can fix you a vegetarian meal.'' But if they are going to put ''fat-back'' into it, we have a problem there. So we actually just leave.
Mr. SANFORD. So is it equal, a third, a third, a third, or is it really more relying on what you eat than anything else?
Mr. OLLIE JOHNSON. No, sir. I don't know that they have an answer for that, because we never got one that is one-fourth exercise, one-fourth meditation, one-fourth diet, and one-fourth group support. I don't believe they have any evidence to say which is the most influential. We have not at this point. So we do all of it. We do all of it, and it is working.
Mr. SANFORD. What would you say to folks that saydetractors, in essence, of alternative medicine who say, wait a minute, the Federal Government can only fund so many things. This is not magic. I know that fried okra probably isn't the best thing in the world for me, but I grew up eating it; I love eating it.
Page 80 PREV PAGE TOP OF DOC In other words, since it is not magic, since I know it is not good for me, therefore, you could have figured this out earlier. What shouldn't government involvement be reserved for the very end of things? In other words, what would you say to a detractor that said, only so many dollars; save it for the end because people, if they are really disciplined, could be doing this stuff without having government involved in a program of Dean Ornish or others?
Mr. OLLIE JOHNSON. Well, I think the evidence of it, good or bad, is the cost in South Carolina right now, $228 million, just last year alone. All of those peopleI didn't have any figures on what their ages were, but I would suspect that they are maybe older people. I sort of crossed that bridge. I have a lot of friends who still eat Kentucky Fried Chicken, or ''KFC'' nowwe don't say, ''fried'' anymore. [Laughter.]
And we don't perceive it as being a hard thing. It is really very difficult to convince another person that this is a good way that is not so bad. Most of my friends do not eat Ornish, and they know I eat Ornish. We go to a restaurant, and I may end up eating a salad, but that is it. Every now and then, when they say, ''Your weight, you look pretty good,'' I say, ''Well, it is part of the program that I am in.'' They will ask me a few more questions. I know that they are eating better. They probably gave up the double hamburgers and stuff like that, and they are eating more turkey, because they see me every day and they believe that something is happening with that guy; he is a better person because I know he is meditating. He is a little bit better to get along with.
So I don't criticize their lifestyle. I am willing to tell them about mine.
Mr. SANFORD. Right.
Mr. OLLIE JOHNSON. I have had that question, ''Well, I can't do that because I am enjoying this lifestyle,'' but we are both at the concert or the theater, you see.
Page 81 PREV PAGE TOP OF DOC Mr. SANFORD. I would ask the question, I suppose, to Mr. Berman, unless you want to throw in your thoughts. That is, how would you guard against quackery, though? In other words, if you open up government to doing a lot of other things, surely, there would be a lot of folks that maybeAMA has pretty strict guidelines. How you have an AMA-like control over who does or doesn't do acupuncture or herbal remedy?
Dr. BERMAN. There is a lot of efforts in that way. There is certification. You look at certification, regulation, licensing, education, experience, and there are the acupuncturists, the chiropractors, massage therapists, they do have nationaland many of the States have their own regulations. So you would go look at that. I think that is very important.
You could set up many things. You could set up looking at the adverse reactions of many of these therapies, so you could look at what goes on with them adversely. And you would also continue to do the research, so you could separate out what doesn't work and discard those, and then keep in the ones that do work.
So I think there are many ways that we could really improve, both from a conventional as well as a complementary medicine side, to separate out the quackery.
Mr. SANFORD. Mr. Chairman, thank you.
Mr. BURTON. Thank you. I would just like to say, Mr. Sanford, that we had Dean Ornish in earlier, and, of course, I think you were in other committee meetings or something. I hope that you and some of the other members will take advantage of an invitation Dean Ornish made, and that was that he said he would be willing to come back from San Francisco to meet with a number of Congressmen to tell them about his specific program, and if you are interested, get you on it, because it has had substantial results.
In addition to that, they have scientific research in his program that backs up, in Dean Ornish's case, what these people have said here today, that it does eliminate in many cases, but certainly reduces the necessity for heart surgery and bypass surgery and also angioplasty. They estimated that it would save $30,000 to $35,000 for each case. When you put a pencil to that, if we could get Health and Human Service, HCFA, and all the health agencies to incorporate this into Medicare, it would probably save billions of dollars for the Medicare program that could be well used elsewhere. It is one of the things that I know that you will want to work with us, and I will talk to you about that.
Page 82 PREV PAGE TOP OF DOC Let me just thank you very much. I am going to have to find out, Mrs. Johnson, what you cook that tastes so good that doesn't have cholesterol in it. [Laughter.]
Maybe I can get you to come to Indiana and teach me and my family. But, anyhow, I am just teasing you.
Thank you very much for being here, and I am sorry you had to wait so long. We will take to heart what you said. We are going to meet with Dean Ornish. What you are requesting is going to be looked into very thoroughly and, hopefully, we will get some results on it. So thank you very much.
Thank you, Dr. Berman. We are going to check into the acupuncture. I may be talking to you about acupuncture myself.
Dr. BERMAN. OK.
Mr. BURTON. Why don't we have the next panel come forward? We will get started with the next panel.
We are going to have a vote coming up here right now.
The next panel is Dr. Kamerow, Dr. Holohan, and Dr. Mazzuchi.
Dr. Kamerow, we talked earlier today. You know, Dr. Kamerow, I only wish the Army had as nice of uniforms as you guys. I was in the Army and our uniforms never could measure up to you or the Marines.
Why don't we start with Dr. Kamerow, since we will just go from left to right? Did I mention everybody or did I leave someone out?
Mr. MAZZUCHI. Dr. Zimble is here with me, sir. He is the president of the Uniformed Services University of the Health Sciences.
Mr. BURTON. Oh, Doctor, well, I apologize for that. OK.
Page 83 PREV PAGE TOP OF DOCSTATEMENTS OF DOUGLAS KAMEROW, M.D., DIRECTOR, CENTER FOR HEALTH CARE TECHNOLOGY, AGENCY FOR HEALTH CARE POLICY RESEARCH, DEPARTMENT OF HEALTH AND HUMAN SERVICES; THOMAS V. HOLOHAN, M.D., CHIEF, PATIENT CARE SERVICES OFFICER, VETERANS HEALTH ADMINISTRATION; JOHN F. MAZZUCHI, DEPUTY ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS, CLINICAL AND PROGRAM POLICY, DEPARTMENT OF DEFENSE; AND JIM ZIMBLE, M.D., PRESIDENT OF THE UNIFORMED SERVICES UNIVERSITY FOR THE HEALTH SCIENCES
Dr. KAMEROW. Thank you, Mr. Chairman, members of the committee. I am Dr. Douglas Kamerow, testifying on behalf of the Department of Health and Human Services. Our Department, HHS, has a number of roles related to complementary and alternative medicine. NIH, the National Institutes of Health, facilitates research into new health therapies that may someday be options for the treatment of illnesses. FDA, the Food and Drug Administration, is responsible for approving new medical devices or drugs that are safe and effective in the treatment and prevention of disease.
I work in another public health service agency, the Agency for Health Care Policy and Research, AHCPR. Unlike my colleagues on the panel here today, we at AHCPR neither deliver care nor regulate care. Our mission is to access the evidence for what works and what does not work in healthcare.
We support and conduct research that improves the quality, the outcomes, and the appropriate use of healthcare services. We provide the scientific foundation that is necessary for informed healthcare decisions. We want those decisions, which are being made every day by patients, by clinicians, by purchasers, healthcare system leaders, and policymakers, to be based on solid evidence about what works, when it works, and for whom it works.
The study of complementary and alternative medicine is squarely within AHCPR's mission. While we have done some work in this area, we have really just begun to look at it. Let me tell you a little, about 3 minutes' worth, of what it is that we have done and what we are doing.
Page 84 PREV PAGE TOP OF DOC First, we are working to provide accurate statistics about the use of complementary and alternative medicine in the United States. One of our surveys, the Medical Expenditure Panel Survey, has collected information on persons who consult with complementary and alternative medicine providers. This is the largest available survey of persons who have used alternative care, and when we release results, they will provide the most accurate estimates yet about the use of complementary and alternative care providers.
Second, we supported a number of early studies on the effectiveness and cost-effectiveness of alternative therapies for treatment of low back pain, including chiropractic, acupuncture, and spinal manipulation. We have also evaluated patient satisfaction with their care compared to patients treated with conventional therapies.
Third, we are working closely with our colleagues at NIH, at the National Center for Complementary and Alternative Medicine, to co-sponsor two studies on acupuncture: one looking at the effectiveness of acupuncture on back pain and, second, in treating depression during pregnancy.
Fourth and finally, we are helping to document and synthesize the scientific and clinical evidence that supports complementary and alternative medicine. In 1997, we established 12 evidence-based practice centers around North America to systematically analyze important clinical topics. Let me give you one example.
I am a family physician. A patient recently asked me about using garlic preparations to help reduce his blood pressure and his cholesterol. I was frustrated because there really was nowhere I could turn for reliable information about this substance, which is commonly used in this country and abroad. I am pleased to say that now we at AHCPR have commissioned what we call an evidence report on garlic. One of our EPCs will scour the world's literature about it, systematically review that research, and authoritatively tell us what is known about what works and what doesn't work about garlic.
Page 85 PREV PAGE TOP OF DOC In addition to this report, we are also reviewing other complementary and alternative medicine topics for future reports, and we are discussing further collaboration with our colleagues at NIH.
Now AHCPR is a small agency, and therefore our investment in this area only scratches the surface. What is needed to create the scientific foundation for CAM, for complementary and alternative medicine? We need to develop better, more reliable methods for studying and evaluating these therapies, and much more research is needed on their effectiveness and outcomes. We need to increase the available data on their use, and we need to know how patients feel about the care they receive and why.
We at AHCPR believe that the best evaluation of medical care is one that measures the impact on the outcomes that patients care about and what they care about most. The bottom line is that all of usdoctors, other health professionals, patients, health systems, and payersneed evidence. We need to know what works and for
whom. It is our job at AHCPR to provide this evidence. These efforts will allow us to identify complementary and alternative therapies that improve health, improve health care, and enhance the quality of life of our patients.
[The prepared statement of Dr. Kamerow follows:]
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[The official committee record contains additional material here.]
Mr. BURTON. Thank you, Doctor.
We have 5 minutes before this vote expires. So I apologize to the panelists. I mean, how would you like to live this life where you run back and forth? The only good thing about it
Page 86 PREV PAGE TOP OF DOC Dr. KAMEROW. Exercise.
Mr. BURTON [continuing]. Is exercise, yes. We will be back in 5 or 10 minutes.
Mr. BURTON. We will reconvene.
Thank you, Dr. Kamerow, for your testimony.
We will hear from Dr. Mazzuchi now.
Mr. MAZZUCHI. Yes, thank you, Mr. Chairman. I will just highlight some pieces of my testimony for you, in the interest of time.
Mr. BURTON. Thank you, Doctor.
Mr. MAZZUCHI. One of the questions that you had asked that I cover in my testimony, and I have covered it in some detail in the written testimony, deals with a chiropractic demonstration program that the Department of Defense is operating in response to the Defense Authorization Act of 1995. We now have 13 sites. We use two different models: a patient choice model and a managed care model. In addition to those 13 sites, we have 3 comparison-sites where we also ask similar questions to patients who are undergoing care, but from traditional providers, and not the chiropractic providers. The data-gathering phase of that will continue through September 30, 1999, and then we will report to Congress, which we are required to do by the act, which requires us to report on both the feasibility and the advisability of adopting the chiropractic care into the military health system.
We don't have enough data for me to give you the answer to that yet, but I can say, from the information that we have gathered, that the patients who are receiving chiropractic care are quite pleased with that care.
In my opinion, one of the most beneficial aspects of complementary and alternative medicine is that these therapies tend to focus on self-care and stress a balance in living. We in the DOD continue to initiate and implement programs that recognize that personal health behaviors are extremely important in reducing the incidence and severity of disease, injury, and disability.
Page 87 PREV PAGE TOP OF DOC The first step in any comprehensive healthcare plan to promote a healthy lifestyle is to evaluate current health status. The Health Enrollment Evaluation Assessment Review [HEAR], is an age-appropriate tool that surveys the general health status of each of our beneficiaries. The HEAR gathers information on current health status, family medical history, currency of immunizations, prevention screenings, mental health, use of alcohol and drugs, et cetera, and has become a very important instrument to us as we look at lifestyle, so that we can initiate prevention programs that meet the needs of our population both individually and our population as a whole.
Let me address the fact that you asked about training of our DOD providers. Overall, there are many elements of CAM offered in DOD facilities throughout our Department. Our physicians have been trained in acupuncture techniques. They have been appropriately credentialed and now treat patients with acupuncture in DOD facilities.
For example, selected providers at both Walter Reed Army Medical Center and Andrews Air Force Base, both here in Washington, at the Family Practice Clinic, treat patients who have chronic pain with acupuncture.
Another example: a radiation oncologist assigned to Edwards Air Force Base conducts an acupuncture practice every morning in his practice and has accommodated about 1,200 visits for the treatment of pain, smoking cessation, and obesity.
Many of our hospitals and clinics offer stress management programs that include relaxation training, visualization, breathing techniques, exercise information, and cognitive therapies. Our psychology clinics within the Department offer biofeedback and other behavioral modification services. Some mental health professionals and other staff use meditation techniques with our patients. T'ai Chi, for instance, is used by some of our facilities as a routine for relaxation therapy.
Many therapies considered to be complementary or alternative have not been adopted as mainstream medicine because of the current lack of evidence for their scientific support for their efficacy and safety. We are held accountable to a particular standard for the services we cover outside of our medical treatment facilities.
Page 88 PREV PAGE TOP OF DOC And just so that you understand, we have a military health system that involves not only the MTFs, or the medical treatment facilities, that we ourselves run and operate, but we also have a managed care program as well as the standard CHAMPUS program, which is a piece of that program, that offers care outside of our facilities.
So what we can cover on the outside is governed by a standard that requires us to show the cost-effectiveness and scientific efficacy and safety of those products. Inside the house, we do have our physician community who are trained in many CAM techniques. They do actually provide those techniques within our healthcare system, but we do not pay for them outside of our system.
To uphold our accountability, we have regulations and program policies that restrict covered benefits. However, the DOD will follow very carefully the research done through institutions such as the Office of Alternative Medicine within the National Institutes of Health, the Uniformed Services University of the Health Sciences, and programs of other medical schools, such as the one we heard about at the University of Maryland's Complementary Medicine Center, for answers to the questions that CAM therapies pose to us.
Many of our beneficiaries are interested in complementary and alternative medicine, and our providers realize that within each person there is the natural recuperative power that is the key to all healing, and that taking charge of one's own health and well-being, both physically, mentally, emotionally, and spiritually, is within the grasp of each of us.
Moreover, the Department does not restrict the practice of providers who are knowledgeable, willing, and able to provide alternative medicine therapies to their patients. The spectrum of CAM, however, is broad, involving many things, and the truth is that there is no one single definition that can clearly define what is alternative medicine. Moreover, the line between what is alternative medicine and mainstream therapy is not consistently clear in the minds of patients and providers alike.
Page 89 PREV PAGE TOP OF DOC We remain a society that is built upon science and depended upon science to solve many of the problems that we, as well as our future generations, will be facing. As therapies which are currently considered complementary or alternative are tested and shown to be safe, efficacious, and cost-effective, they will be integrated into the DOD health system.
Dr. Zimble is with me here today. He is the president of the Uniformed Services University and is here to talk about two particular aspects that you asked in your program, mainly, medical school training, since he operates our military medical school, as well as the Dean Ornish Demonstration Project, which funds were just transferred this week, so we can move on with thatif Dr. Zimble would like to do that.
Dr. ZIMBLE. Mr. Chairman, I want to thank you very much for allowing me to be a strap-hanger with Dr. Mazzuchi. I have learned a great deal here today about the sense of this committee and, also, some of the great contributions that are being toward the integration more and more into mainstream medicine.
We have started at the Armed Services University interest in CAM in 1994, when we began seminars for the complementary and alternative medicine. We have had about 64 seminars since that time in 1994.
Also, in 1996, we had what I consider to be a really good beginning in getting involvement of other medical schools and schools of nursing into an interest in CAM. We held a 3-day Consensus Conference with representation from about 33 different institutions, looking at various aspects of all types of alternative/complementary medicine, including workshops by many of the practitioners.
Now we are beginning an elective 4th-year curriculum to teach complementary medicine and then alternative medicine. We have about 13 research projects, protocols, currently underway within our school of basic sciences and clinical sciences that deal with various aspects of complementary medicine. Now we want to do more of this, and, as I listen to the Ornish that is described, I have a great deal of difficulty in accepting this as an alternative medicine. I think this is mainstream medicine that is currently underfunded and under-recognized.
Page 90 PREV PAGE TOP OF DOC As the evidence accrues, we need to learn how to integrate that into the practice of medicine. We try to teach that to our students. By the way, one out of every five physicians in on active duty today is a graduate of your Uniformed Services University. So we are a growing enterprise, and we are part of the academic health center of the military health system.
I am very pleased that the first Director of the Office of Alternative Medicine, Dr. Wayne Jonus, is now a member of our facility. He is a lieutenant colonel, family medicine physician in our Department of Family Medicine. I was very pleased when Mr. Waxman
quoted him from his editorial in the November 11th Journal of the American Medical Association.
I have a full statement that is included in the written report to you, and I stand by to answer any questions you might have.
[The prepared statement of Drs. Mazzuchi and Zimble follows:]
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Mr. BURTON. Thank you. We will get back to questions in just a moment.
Dr. HOLOHAN. Thank you, Mr. Chairman. I am glad to be sitting next to the president of USUHS, which has a superb faculty, I am told, as well.
First, permit me to note that Dr. Kizer, the Under Secretary for Health, yesterday sent letters to the committee Chair and ranking member in which he emphasized some points that we made in our written testimony, and complimented the committee for addressing this topic. A conflict in his schedule prevents him from being present to testify today.
Public interest in alternative medical practices is increasing, and there are likely many reasons for this, including dissatisfaction with limitations of conventional medicine, desire for treatment directed toward the whole person, distrust of drugs and side effects, and some understandable frustration in search for a cure on the part of patients afflicted with chronic or serious disorders.
Page 91 PREV PAGE TOP OF DOC Conventional medicine's interest is evidenced by the fact that an entire recent issue of the Journal of the American Medical Association was devoted to this topic. Of note, VA participated in one of the trials that was reported in that issue.
Alternative medicine is a very nonspecific term that has been used to describe a heterogeneous group of practices. While their underlying philosophies and the manner in which their agents and techniques are employed diverge from mainstream medical principles and practices, that separation is not distinct and absolute, as we shall later discuss and as has been mentioned several times by previous witnesses.
VA recently awarded a contract to evaluate alternative practices as they might apply to our system of healthcare in VA. At present, that report hasn't been completed, but we do, however, have some preliminary survey data regarding the state of alternative practices in VA facilities.
While knowledge and even awareness of alternative practices varied widely among providers and facilities, most of the 131 facilities surveyed provide some such treatments. These practices usually reflected the presence of a practitioner or practitioner advocates and managerial willingness to accept the implementation of those programs. Most of the facility management teams were reported as pragmatically oriented and described as having no biases for or against alternative treatments.
The main concerns VA personnel expressed related to the highly variable training and credentialing of practitioners, the lack of sound scientific evidence supporting the use of many alternative therapies, and uneasiness about the budgetary impact of alternative practice in an environment of constrained resources.
We note that many practices often considered as alternative have been or are also used by conventional medicine. For example, physical and manual treatment significantly overlap with modalities that are widely used in the current practice of physical medicine and rehabilitation. Many nutritional therapy models have counterparts in allopathic medicine, such as the use of hyperalimentation as an adjunct to conventional cancer treatment.
Page 92 PREV PAGE TOP OF DOC The mainstream medical literature contains numerous studies of vitamin supplementation, the use of zinc and antioxidants, among many others. Many drugs that are used by conventional practitioners are, in fact, botanical preparations which have been evaluated in clinical trials and approved for marketing by FDA. These include vincristine from the periwinkle plant, digitalis from foxglove, and taxol, which was originally extracted from the Pacific yew tree bark.
Moreover, mind/body interaction is not a phenomenon that is only recognized by alternative practitioners, as there is, in fact, a long history in medicine of appreciation of those mutual effects. A significant body of mainstream research has provided data that indicate the prognosis for coronary disease patients with depression is worse than for those without; that breast cancer patients who attended a support group had measurably better outcomes than those who did not, and that single male cancer patients had poorer prognoses than married patients.
Many similar findings are published, and currently, in VA we are developing a formal systemwide strategy to fully integrate mental health and medical services throughout our system of care, based upon our belief that all diseases or disorders exist within an individual who is the unit of the care.
At the same time, one cannot ignore alternative or unconventional care that may be extreme. There are a number of therapies whose advocates have proposed unreasonably optimistic claims and whose treatments have been ineffective and often harmful. Our written testimony provided specific examples of a number of such regimens.
Indeed, in the early 1980's, a committee chaired by the late Congressman Claude Pepper published a comprehensive, sobering, yet remarkable, report on the wide variety of ineffective treatments being sold to the public. We do not mean by imply that all unconventional treatments are ipso facto suspect. The critical point to be made is that the advocate of any treatment, conventional or unconventional, allopathic or homeopathic, surgical or psychological, has an ethical and moral obligation to provide high-quality evidence that satisfactorily demonstrates the treatment is effective, and that the benefit is clearly proportionate to the risk. This is true for conventional treatment, and it is true for alternative practices.
Page 93 PREV PAGE TOP OF DOC Claims that assert that scientific research standards are inappropriate or irrelevant to alternative practices are wrong. Science is not a belief system, but merely a disciplined method of investigation that enables one to test the hypothesis, and its applicability is virtually universal, we feel.
The scientific method is the only instrument that permits a mathematically sound statement of the probability that a particular cause will result in a specific effect. A casual and an unsystemic linkage of cause and effect is too often erroneous, and for those reasons, prudent clinicians are loathe to accept anecdotal evidence, a few cases, or subjective judgments as proof of efficacy.
VA believes we have a serious responsibility to demand evidence of benefit and safety for treatments we provide to veteran patients, and we have invested considerable resources to that end. We also believe that opinion or beliefs do not constitute scientific evidence and that anecdotes or small series studies represent the weakest forms of evidence and only serve to provide a hypothesis that can be tested in a well-designed trial.
While such positions are not in accord with the opinions of some in both the conventional and alternative medical fields, they are ratified by how most of us, tacitly or overtly, rely on the scientific method in our daily lives. When we step into an airplane, we are aware of our dependence upon the research and experimentation underlying the engineer's theories and upon the repeated testing of materials and design of the airframe, engines, and controls. We expect the Federal Aviation Administration to provide serious oversight of aircraft manufacture, and that design and construction will rely in the application of scientific investigation. We also expect that production will be accomplished by technical experts qualified by training and experience, and certified as competent by reliable and responsible authorities.
It is dangerous to assume that so-called natural or nonpharmaceutical products are by nature safe. In our written testimony, we noted the recent recall of a dietary supplement, gamma butyrolactone, or GBL, which has caused comas, seizures, cardiac and respiratory arrest, and death. Undoubtedly, most consumers made ill or killed by GBL assumed its production and sale implied at least some research demonstrating safety, if not effectiveness. Sadly, they were mistaken.
Page 94 PREV PAGE TOP OF DOC At present, there is a paucity of rigorous, reliable, and valid clinical trial data supporting many alternative interventions. Indeed, that was identified as a major concern of VA personnel in our contractors' survey. We believe that evidence is critical in our determination as to the role alternative medicine may play in the care of our patients. To that end, our research and development program will continue to fund scientifically meritorious investigator-initiated research related to alternative practice at all levels.
Inconsistent alternative provider credentialing, licensing, and regulation pose serious problems in the utilization of those practitioners and techniques. And, Mr. Chairman, you asked a question about this a minute ago of Dr. Berman. Acupuncturists are licensed in 35 States; massage therapists in 27; naturopaths in 4, and homeopaths in 14 States.
I did some surfing of the internet on naturopathy and found an internet site that provided naturopathy informationactually, two sitesthat made a statement that, ''Certified naturopaths may complete a 4-year program of study or they may be someone with nothing more than a diploma from a diploma mill or a correspondence school.''
VA has set high standards for practitioner education, credentialing, and certification. All newly hired VA physicians must be licensed and board-certified. Advanced practice nurses must possess licensure, national certification, and a graduate degree; and registered nurses, licensure and a bachelor's degree. We believe that all providers in VA should meet appropriate comparable standards, irrespective of their practice focus.
In closing, VA is investigating alternative medicine practices and is presently gathering data to address the interest of our clinicians and the extent of alternative medicine use in our system. We expect to be reviewing information developed from the literature base for alternative practices, the appropriateness of employment for our population, and information on cost and cost-effectiveness.
VA expects that any treatment offered to veteran patients, whether conventional or alternative, and provided outside the context of a clinical trial, will be chosen on the basis of objective evidence sufficient to permit the conclusion that it is both safe and effective.
Page 95 PREV PAGE TOP OF DOC Thank you.
[The prepared statement of Dr. Holohan follows:]
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Mr. BURTON. Thank you, Dr. Holohan.
Dr. Kamerow, why is it that, if there is a program like Dr. Ornish's that has substantial evidence that shows that it is effective in reducing conventional therapies, such as open heart surgery andwhat is the balloon thing againangioplasty, why is it that there is not some mechanism for the Department of Health and Human Services to contact Congress and suggest to us that we take legislative action that will enable you to put that under the Medicare program?
I guess the point I am trying to make is this: We are finding out today that most of the people here agree that that program has merit, is effective, and is going to save a lot of money in the area of reduced heart surgeries and angioplasties. If that is the case, we are finding out about it, and we are going to be getting together with you and others at the Department of HHS, along with the doctor, to figure out some way to provide the passage of legislation, so that you can put that into the Medicare program.
My question is, why is it, when something like this happens, do you have to wait for Congress to come to you and take the initiative? Wouldn't it be better, if you know that there is something that works, for you to tell people in Congress about it, so that we could start the wheels rolling that will enable you to incorporate it into your procedures?
Dr. KAMEROW. I think that is a good idea, Mr. Chairman. I will certainly check with the Health Care Financing Administration and suggest that to them.
I think that in this particular case it is only really recentlyand I mean quite recently, such as the last several monthsthat there have been good randomized control studies in fairly large populations of the kinds of interventions that Dr. Ornish is talking about. It is a very intensive regimen
Page 96 PREV PAGE TOP OF DOC Mr. BURTON. I understand.
Dr. KAMEROW [continuing]. And it has been done successfully in small numbers of people. My understanding is that the people at HCFA are looking at it closely and would be glad to talk to you about it.
Mr. BURTON. I understand it takes a lot of discipline.
I wish you would suggest to themI know that the agencies are not supposed to lobby Members of Congress. However, I can tell you, as one Member of Congress and chairman of one committee, that I would not consider it lobbying if, for instance, the Department of HHS came to us and said, ''Here is a procedure that will help people, reduce medical costs, and one that we could use in the Medicare program with great efficiency and effectiveness, if Congress would allow us to do it, but right now we are prohibited from doing it because there is a legislative prohibition against it.''
Dr. KAMEROW. I will be glad to take that message
Mr. BURTON. And, really, I don't think anybody would consider that lobbyingit is that you gave us some ideas or suggestionsand I certainly wouldn't. I wish you would tell them that over there, because there may be other things that we don't know about besides this program that might be very advantageous to the Medicare program, to HHS, and to the populace in general.
Dr. KAMEROW. I would he happy to do that.
Mr. BURTON. Let me ask you just a couple more questions. I know that you are pinch-hitting for the Secretary, since there is no one on her staff that covers alternative medicine. Do you think that it would be helpful for HHS to have an Associate Secretary for Complementary or Alternative Medicine?
Dr. KAMEROW. I think that the Department is working to coordinate these issues at multiple levels, and that they would be glad to consider those kinds of suggestions from you. As I said in the testimony, there certainly are a number of activities going on throughout the Department and a number of agencies. I think they are working together to try to coordinate them. The Director of NIH, Dr. Varmus, does have a committee that he convenes across the Public Health Service, with representatives from the different agencies, to talk about research in complementary and alternative medicine. So I think there are some mechanisms that are in place now to coordinate the different activities.
Page 97 PREV PAGE TOP OF DOC Mr. BURTON. I guess the question I am posing isI am not talking about a person who is an advocate for alternative therapy, but someone who would constantly peruse the medical journals and check to see if there are new alternative ways that are coming online that have been proven effective that they could point out to the people who are in charge of HHS, who will be making decisions on whether or not to move into different areas or new areas that might help the population.
So you might throw that out to them, as well as some idea on how to keep Congress informed, as well as the upper echelons of HHS, on new therapies that may be coming along of an alternative nature.
Dr. KAMEROW. I would be happy to do that.
Mr. BURTON. In 1997, the NIH consensus panel, their consensus was that acupuncture was effective in the treatment of post-operative and chemotherapy nausea. Why is it that they are still not allowing acupuncture to be utilized through the Medicare program?
Dr. KAMEROW. My understanding about acupuncture and Medicare is that there is a national noncoverage statement and policy, and that, in light of the recent Consensus Conference and other evidence, that they are looking at this, and when they feel that the evidence is strong enough, that they will change that.
It is important to point out that evidence from one source, such as an NIH Consensus Conference, may not be all that is necessary. It may be the opinion of some experts, and HCFA often requires that there be the kinds of randomized control trials that Dr. Ornish talked about before they will cover interventions. But that is one kind of evidence, and they certainly are taking that under consideration.
Mr. BURTON. Well, I have some personal experience. My wife had chemotherapy. My mother and father, who both died last September and October, had chemotherapy. And I know the kinds of problems that you have when you take that after a period of time. You regurgitate. You have all kinds of complications. It just seems to me if acupuncture has been helpfuleven though they took medication, they still had these kinds of problems. If acupuncture relieves those kinds of symptoms, and it has been proven to do so, as we believe it has, it seems to me that that ought to be something that is seriously considered. You might want to put some limitations on acupuncture until other things are proven, but if it is helping in those areas, I wish that you would at least talk to them about that and look into that.
Page 98 PREV PAGE TOP OF DOC Dr. KAMEROW. I certainly will.
Mr. BURTON. How much money has VA invested in alternative medicine research?
Dr. HOLOHAN. I will pass that question over to our representative from the Office of Research, Dr. Burris.
Mr. BURTON. Doctor, why don't you come over to the microphone, so that I can hear you?
Do you know how much they have spent?
Dr. BURRIS. In fiscal year 1998, there were over 100 individual research products in the area of complementary and alternative medicine being conducted in VA facilities. They were funded at approximately $5.5 million by VA, and an additional over $9 million from all other sources of funding combined, other Federal agencies as well as nonprofit organizations.
Mr. BURTON. So the total for VA as well as other Federal agencies was about $14, $15 million?
Dr. BURRIS. In fiscal year 1998, that is correct.
Mr. BURTON. What percentage of that would be the total expenditure for conventional healthcare therapies?
Dr. BURRIS. It would be a little less than 2 percent of the VA research budget for that fiscal year.
Mr. BURTON. As well as the other agencies you were talking about?
Dr. BURRIS. No, I don't know what the figure would be of the other agencies.
Mr. BURTON. OK. But it is about 2 percent?
Page 99 PREV PAGE TOP OF DOC Dr. BURRIS. Of the VA budget.
Mr. BURTON. In the area of cancer research, didn't you say that it was about 1 percent, that we are putting $2.3 billion into conventional cancer research and about $20 million into alternative therapies? So we are looking at somewhere between 1 and 2 percent for alternative therapies.
Is there any suggestion that VA or the Department of Defense or at HHS that we increase that percentage? Because some of these alternatives have been very, very effective. Dr. Mazzuchi?
Mr. MAZZUCHI. Well, there is a way of doing that, I think, without necessarily increasing the percentage. I wish I had better data for you, and I can get it for you. As part of the DOD's breast cancer research program, where the Congress has appropriated considerable amount of money to the Department for breast cancer research, some of those moneys are set aside for IDEA grants. I have forgotten what the IDEA acronym stands for, but, basically, it is research moneys given to researchers who do not have a proven track record in the business; they have not been in the business of cancer research, or who are looking at alternative therapies or new techniques. It is basically meant to stimulate research in areas from people who have not been in this area before and with ideas that are different from some of the more mainstream research ideas. I think that is a good way to go with alternative medical research, is that you open the door, not necessarily setting out a certain percentage, but you certainly encourage, as part of your overall grant, that some areas would be in places that were not
Mr. BURTON. See, the concern I have is that to encourage is kind of a nebulous thing. If there are specific funds that are allocated for a project or an area, that money is going to be used for that specific area. If you do it any other way, then the money, in all probability, won't get to that.
Mr. MAZZUCHI. Our IDEA grants actually are a certain amount of money that is set aside. It is not really percentage, but I guess you could make it a percentage of the money.
Page 100 PREV PAGE TOP OF DOC Mr. BURTON. OK, what amount of money is set aside for that?
Mr. MAZZUCHI. I have to get the number for you. It is quite large. It is about a quarter of the research grants are done with IDEA grants. Now all the IDEA grants aren't alternative medicine. They are simply with people who have not done this kind of research in the main or are trying to attract both new scientists and new methodologies, which some of that would go into.
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Mr. BURTON. Well, we know that in the area of HHS and cancer it was about 1 percent, and we know now that at VA it is about 2 percent. So that is a very, very small percentage of the overall spending. There is a growing sense in the country among people who are veterans, at the VA, people in the Defense Department, and the general population that alternative therapies are something that they really want to take a hard look at before they go with conventional therapies. So it seems to me that there ought to be more money spent in that area instead of just a mere pittance; 1 or 2 percent is not going to cut it.
Dr. ZIMBLE. Mr. Burton, I just wanted to mention, I overlooked one fairly important fact, and that is that, in the 1999 appropriation to the Department of Defense, $2.5 million was appropriated to our university to support the Ornish program. We will be bringing that to Walter Reed Army Medical Center, which will be doing some work specifically for that.
Mr. BURTON. So you are very supportive of that program?
Dr. ZIMBLE. Oh, yes, sir.
Page 101 PREV PAGE TOP OF DOC Mr. BURTON. What I would like for you to do, if you would, for mebecause we are going to be meeting with the people at the HHS about that program, and we are going to have Dr. Ornish come back from San Francisco to meet with us, to try to figure out some way to legislatively get that program online, so we can incorporate it into the Medicare program. If you are sympathetic toward that end with the VA and the Department of Defense, if you could send me a letter to that effect, I would sure like to have that, just saying that you think it has worked; it has been effective.
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Mr. BURTON. Let me ask you one more question regarding the veterans. Is saw palmetto available to veterans? We understand that that has had a positive impact on prostate problems.
Dr. HOLOHAN. Frankly, Mr. Chairman, I don't know.
Mr. BURTON. Well, could somebody maybe check into that and let me know? Because that is one thing that there is some evidence that has been helpful in a number of prostate problems in men.
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Mr. BURTON. You mentioned that the Defense Department will begin integrating alternative therapies when they have been tested and shown to be safe and cost-effective. Since acupuncture has been shown by an NIH consensus panel to be effective for post-operative and chemotherapy nausea, as well as dental pain, when will the Defense Department begin making acupuncture in certain cases available systemwide?
Page 102 PREV PAGE TOP OF DOC Mr. MAZZUCHI. We have begun the process to do that. Based on the Consensus Conference at NIH, we communicated that information to the office in Aurora, which is the benefits office, which tends to look at new technologies and does technology assessment with us. That office is looking at the literature right now, and is looking at perhaps doing some clinical trials to determine whether this should be a covered benefit. It is a process that takes between 1 and 2 years. We are about 8 or 9 months into that process now. My expectation is that, based on the literature we have seen so far, it looks fairly favorable that at least in some circumstances it would be covered. Now, as I have said, we do cover it inside the MTFs, our medical treatment facilities, like Walter Reed, and so forth. But in terms of being paid for, if you receive your care external to our military hospitals, that we still do not do, but that is where we are heading.
Mr. BURTON. Let me just make one more comment, and then we will let you folks go. I am sorry you had to wait all day. I really appreciate your patience.
One of the things that I believe Dr. Ornish mentioned was that they had a very difficult timeI think it was Dr. Ornishthey had a very difficult time getting the funds to get the body of evidence that was necessary to show that the program was effective. He said he had to go to private foundations to get the money, which was very difficult. He could not get any from the Federal Government, even though we now know, in retrospect, that the program does work and it does have real benefits.
Are any of the funds that you are allocated being used to look into these alternative therapies, so that people like Dr. Ornish can get the results that you require, so that they can be incorporated into your programs? Do you see what I am saying? I mean, if a very small percentage is dedicated for alternative therapy research, and somebody like Dr. Ornish comes up with a new procedure that is going to be very effective and save money and help save lives, and everything else, how can we allocate more of our resources so that they can get that kind of testing result finalized, so that you can have it for your review, and, ultimately, for getting the procedure into your practices and your policies? Did I make myself clear? Maybe I didn't.
Page 103 PREV PAGE TOP OF DOC Dr. ZIMBLE. At the Uniformed Services University, we work with a statutorily created 501(3)(c) foundation, the Henry M. Jackson Foundation for the Advancement of Military Medicine.
Mr. BURTON. Who puts the money into that? Is that a government funded
Dr. ZIMBLE. That can come through government. It comes from both the private sector and can come from the government. The $2.5 million I mentioned to you previously will go from me to the foundation. The foundation will give some of that to the Walter Reed Army Medical Center. Some of that will go to Dr. Ornish for his preventive medicine research.
Mr. BURTON. I am not just talking about Dr. Ornish. I am talking about the other
Dr. ZIMBLE. Right, but we can use thatthat paradigm can be used for other methodologies.
Mr. BURTON. OK. So the Department of Defense, even though the funds are not high
Dr. ZIMBLE. Right.
Mr. BURTON [continuing]. It is a very small amountyou do have a way of doing that. How about NIH and HHS?
Dr. KAMEROW. HHS has a number of mechanisms for either new investigators or small grants for novel ideas, sometimes more off-the-wall ideas, that they can use. I know that AHCPR, we have a small grants program for just those kinds of pilot programs or early research, where people can apply if they don't have the credentials that Dr. Ornish was talking about before to get funding for these kinds of projects.
Mr. BURTON. How do they make the judgment on who gets those grants?
Page 104 PREV PAGE TOP OF DOC Dr. KAMEROW. They are reviewed in study sections, which is typical.
Mr. BURTON. By whom?
Dr. KAMEROW. By peers. Peer review.
Mr. BURTON. Peer review, doctors. Are any of those doctors on any boards of any pharmaceutical companies, or have they ever been employees of any pharmaceutical companies?
Dr. KAMEROW. I believe that is a pretty
Mr. BURTON. Broad question?
Dr. KAMEROW [continuing]. Pretty broad question. I am sure somewhere there is, but they are generally university and other researchers.
Mr. BURTON. Well, I think you know why I asked that question. There is a concern that, if an alternative therapy or alternative vitamin or drug, or whatever it might be, comes on the market, that there might be some impediments to them getting that approved or even getting a grant to have it tested thoroughly because of influence being exerted by people who have a vested interest.
Dr. KAMEROW. I think that this is an important point that you have made a couple of times during the hearing, and my response would be that I think it is through the government research where this kind of nonprofitable, if you will, research gets a chance, because the R&D that gets paid for by the drug companies won't pay for this kind of work. So really it is very important for us in the public sector to fund this research in the most impartial way possible.
Mr. BURTON. Toward that end, if we can be of any help at all, and if you think that there is any way, any of your agencies, that we could be of help, I wish you would let me know.
Page 105 PREV PAGE TOP OF DOC Dr. Kamerow, I look forward to talking with you further about HHS and Dr. Ornish's program and some legislation that we might be able to put together, together, that might get that thing into the overall Medicare program.
Dr. KAMEROW. Yes, sir.
Mr. BURTON. Well, thank you very much for being here. I really appreciate it.
Thank you very much.
We stand adjourned.
[Whereupon, at 3:16 p.m., the committee was adjourned.]
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