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Devising a plan to study unconventional medicine, says one observer on Capitol Hill, is like "orchestrating a roomful of cats...or setting the agenda for a convention of anarchists." The field is a smorgasbord of therapies--ranging from meditation and prayer to acupuncture, homeopathy, shark-cartilage enemas for cancer, biofeedback, massage, dosing with bee pollen to stop allergies, and many, many more. Each school is confident that its methods are the best. All distrust "the medical establishment." And most aren't skilled in collecting data. Yet for the past 3 years, the National Institutes of Health (NIH) has been struggling--under orders from the U.S. Senate-to rope these diverse schools into a coherent research program.
In the past month, that effort has been thrown into chaos, and even NIH Deputy Director Ruth Kirschstein admits that it "needs better management." The physician who has directed NIH's Office of Alternative Medicine (OAM) for the past 24 months, Joseph Jacobs, has quit-effective today. And Jacobs is leaving with a bang: In an interview with Science he blasted politicians--especially Senator Tom Harkin, the powerful Democrat from Iowa--and some advocates of alternative medicine for pressuring his office, promoting certain therapies, and, he says, attempting an end run around objective science.
He's not the only one speaking his mind. On 1 September, members of OAM's independent advisory council--most of them alternative medicine advocates--held their first official meeting, during which they attacked NIH for setting an agenda for OAM without their consent. The panel got OAM to make drastic, last-minute changes in a plan, drawn up 6 months ago, which called for spending $1.8 million on up to four centers to examine alternative therapies, a plan that some activists deplored as pro-establishment. The number of centers will be halved, but because the money must be spent by 30 September--the end of the fiscal year--OAM is working slapdash to find a way of spending the full $1.8 million.
And if this were not pressure enough, Congress has just turned up the heat. Led by Harkin, Congress has nearly doubled OAM's budget for 1995, which begins next week, increasing it from $3.5 million to $6 million. The amount may seem small-just 0.050 of NIH's total appropriation-but running OAM has suddenly become a major concern in the NIH director's office....