BETHESDAFor many oncologists, the term complementary
and alternative medicine, or CAM, brings to mind laetrile and
other worthless cancer cures. Last October, the National
Cancer Institute (NCI) established the Office of Cancer Complementary
and Alternative Medicine and named Jeffrey D. White, MD, as its
In this interview with Patrick Young, Oncology News
Internationals Washington Bureau Chief, Dr. White discusses his
offices role within NCI and its interactions with the National
Institutes of Healths National Center for Complementary and
Alternative Medicine and its Cancer Advisory Panel for Complementary
and Alternative Medicine.
ONI: Why is NCI getting involved in such a controversial area of medicine?
DR. WHITE: Although stories like laetrile and others show the
negative side of alternative medicine, the field itself is so large
that it encompasses a tremendous number of things that probably do
need to be investigated.
That is part of the answer. Another part is the tremendous public
interest in complementary and alternative medicine approaches. More
good-quality research needs to be done to give people valuable
information on which to make decisions. I think the clinical trials
that NCI has been involved withvitamin C, laetrile, hydrazine
sulfatehave yielded useful information for the public.
ONI: Useful in what way?
DR. WHITE: Useful in a negative way. They supplied the public and the
general practitioners with information that educated them about the
risks of using these approaches. It is useful sometimes to look at
things in a hard scientific way to show that they dont work or
that they are dangerous.
ONI: How does NCI define complementary and alternative medicine,
and how does it distinguish between the two?
DR. WHITE: It is hard in such a diverse area to put down a definition
in one or two paragraphs. In the past, it wasnt a major
priority for NCI to have a definition because we dealt with
individual projects and not with whether they were alternatives.
Now that there is a national center to deal with complementary and
alternative medicine at NIH, an NIH definition will be developed.
The distinction between complementary and
alternative medicine really comes about from a practice
point of view of how it is utilized. Alternative approaches are used
more as a sole approach or as a substitute for conventional
approaches. The alternative component is rather small. There
arent that many people who use these approaches to the
exclusion of conventional medicine.
This whole area has moved. More and more MDs are getting credentials
in various things such as acupuncture. I was at a conference today
where it was mentioned that there are 4,000 MDs in the United States
who are licensed acupuncturists. So acupuncture in their hands is a
ONI: Is the NCI effort driven by science or by congressional and
DR. WHITE: This is a science-driven approach. NCI has been involved
in this area for a number of years, largely in a reactive way. We saw
a need for an office that would serve as a focal point to direct CAM
investigations. We want to deal with complementary and alternative
medicine in as rigorous a way as we do conventional medicine.
ONI: What is the role of your office?
DR. WHITE: Basically, I am the liaison from the NCI to the National
Center for Complementary and Alternative Medicine [NCCAM]. In that
role, we try to identify common projects.
I also work with the Cancer Advisory Panel for CAM. This is a panel
put together jointly by NCI and NCCAM to advise the NCCAM about
cancer projects that it should support and to recommend further
research in certain areas.
Another role is to be the coordinator of complementary and
alternative medicine activities for the NCI, which involves
contributing to various projects that are going on in different
divisions within the Institute.
ONI: How would you contribute?
DR. WHITE: If a project is done with the NCCAM, my contribution may
be in the communication element between the two institutes. Or it
could be helping certain NCI divisions develop their own CAM agendas
or CAM projects.
Another contribution is to develop an institutional agenda in
alternative and complementary medicine to try to grow research that
might support future clinical research in these areas.
Also, we will interface with NCCAM on public issues that relate to
complementary and alternative medicine. That includes individual
citizens who may have either ideas or interest in the area. But
mostly it involves dealing with practi-tioners who treat cancer
patients and ways in which we interact with themmostly through
something we call the best-case series.
We also deal with oncologists and cancer researchers who have an
interest in initiating alternative medicine projects and who would
like to know the NCIs interests in that area or which program
directors to contact.
ONI: What is the best-case series?
DR. WHITE: This is a system that the NCI has had in place since 1991.
A practitioner can come to us with a CAM approach to treating cancer
and ask us to look at the results. We require 10 cases that include
patient histories; copies of x-ray and pathology reports; and
clinical, laboratory, and radiographic follow-ups. When we have all
the information necessary, we present it to the Cancer Advisory Panel
ONI: So the decision whether to pursue further research on such
treatments rests with the advisory panel.
DR. WHITE: Yes. They would make a recommendation to the national
center to either do more research or not, and maybe what specific
research should be done. Then the national center would work with NCI
to establish the appropriate project.
ONI: How do you determine which therapy areas, as opposed to
specific treatments, are worth studying?
DR. WHITE: One approach would be to do a systematic literature review
of projects we are trying to develop. Again, a lot of it will be
passed to the Cancer Advisory Panel to get their opinion. There is a
lot of European literature on CAM therapies about their
effectiveness, some of it not even translated into English. We
certainly could take a look at some of those products and assess
whether they warrant more clinical investigation.
A Diverse Portfolio?
ONI: What criteria will be used in deciding which projects get priority?
DR. WHITE: Ideally, we would like to have a diverse portfolio of
different types of projects, not only direct treatment of the cancer
but also palliation of side effects of conventional therapy and of
the cancer itself. However, priority really comes down to the quality
of the project and the opportunity for getting meaningful research
ONI: Are you seeking grant applications?
DR. WHITE: We are in certain forms. We have signed onto three RFAs
[requests for applications] for certain projects, such as an NIH
institute-wide RFA for CAM research centers. Another is the botanical
RFA put out by the Nutrition Committee, an NIH-wide coordinating
committee. The NCI has put in language about our interest in
supporting botanical research in cancer. The third is a breast cancer
RFA supported by money that came to NCI from sales of the breast
cancer stamp. In it, we expressed specific interest in complementary
and alternative approaches.
ONI: Have you encountered opposition to CAM research?
DR. WHITE: None at all within NCI, and I have not received any
comments from the oncology community that I would characterize that
way. There are groups, some call themselves quack busters,
who are very concerned about our doing alternative medicine
research, and they have contacted NCI expressing those concerns.
ONI: How do you respond to people who say you are promoting quackery?
DR. WHITE: You respond to it as honestly as you can about the
rationale for doing any particular project. If it is a philosophical
question about why would the NCI even consider doing research in this
area, we say it is because this is an area fraught with the hazard of
misleading people in directions that can harm them. The best way to
prevent this is to develop quality research and disseminate it, so
people can become better informed.
However, there is also the potential for new therapies, and we need
to do research in these areas. This is a huge field, a field in flux,
and certainly botanical research needs to be investigated in very
deep ways for drug development.