Gay Men's Health Crisis: Treatment Issues, Volume 7 no. 11/12 - Winter, 1993/94

TREATMENT ISSUES: What is the RCCM? What is its mission?

BUCKLE: The RCCM was set up ten years ago by a group of physicians and alternative practitioners who felt that one of the best ways forward for alternative medicine was through rigorous research that would stand up to scientific nitpicking. Our mission is to encourage, initiate, and oversee rigorous research into all alternative medicine.

We are a privately funded charity and we are not government aided like the Office of Alternative Medicine here. [Editor's note: the OAM is a government funded program which is part of the National Institutes of Health.] And so we've managed to maintain neutrality - total neutrality. We are nonpromotional. And we are nonderogatory. We just want rigorous research into all alternative medicines.

This has enabled us, if you like, to act as brokers between orthodoxy and nonorthodoxy, and to be brokers between government and what they feel the patient wants and what the patient wants. Over the last ten years, we've funded over 1 million pounds' worth of research into alternative medicine. This ranges from a fellowship in homeopathy to very small pilot schemes looking at Alexander Technique and musicians and acupuncture on chronic pain and sickle cell anemia.

TI: Let's talk a little more about funding. You mentioned that the RCCM doesn't receive government money. What is the role of the industry in funding the RCCM? In America, we now are having a debate about the proper role of the dietary supplement and alternative health industry in funding research into their products. What is the situation in Britain?

BUCKLE: The funding of the RCCM, as it's a private charity, comes from private individuals and corporations. We just have to go cup in hand and say, "We've been given a research protocol on whatever, and we feel this merits research funding. Will you fund it?" So we have specific funding for specific things. There are certain organizations or people who will fund us to to look into their pet thing, if you like. Like acupuncture, homeopathy, whole medicine or whatever. Or they may fund us to go into education. They may fund a conference or workshop on methodology or they may fund the existence of our actual organization.

TI: What should the pharmaceutical industry be doing?

BUCKLE: The pharmaceutical industry is obviously looking more and more for more products, because they need more money to generate profits, and it's an ongoing treadmill. Having said that, where would we be without many of the drugs which they have very carefully tried to promote? We need things like penicillin. We need antibiotics. We need a great many of these things. Where would we be without the contraceptive pill? We would survive, yes, but life is greatly enhanced by these "terrible" pharmaceutical people. It would be nice to think that they could fund projects as groups of pharmaceutical companies. So you would have the three or four biggest in America banding together and talking to each other and saying, "Right. Even if it's only philanthropic, we're going to chuck in together in view of our total budget. Let's do this. Let's the four of us actually band together and say we are going to underwrite trials into this to see whether this works."

Because just say, for example, they discovered acupuncture helps something or other. Then that might just trigger off something to them which they could then develop - not acupuncture, but they might realize through their research what endorphins gone off, what neurochemical has gone off.

The pharmaceutical industry could perhaps do a little lateral thinking rather than invest just totally in new chemicals - which are still needed - then, maybe this is the way that everybody can actually work together. If one could actually change the name of the pharmaceutical company or drug company to a health-oriented company - one of the sections of which is pharmaceutical - then maybe you could change the perception of how they are seen and how they see themselves. It's all too easy to get into "them and us." And as I've said, they've saved a great many lives. They will probably save a great many more lives.

TI: Could you define alternative therapy and describe its role in medical care?

BUCKLE: I would suggest that maybe the alternative approach, the complementary approach is looking at another angle. I view orthodox and nonorthodox medicine as yang and yin. On their own, I would suggest that they would be much stronger together. Much stronger together. I would very much feel more comfortable with alternatives as being viewed complementary to the orthodox system.

Different approaches can come together and you have the yang and yin. One could suggest that perhaps a complementary medical approach is a more feminine approach, a more intuitive, a more spiritual, a more emotional nurturing approach than the yang which is the mechanistic, male, we're-going-to-kill-the-bug approach. It's not that either is better than the other. I think together, then there is a very good marriage and a very good possibility of holistic looking at someone's health. And in the end it should be for the patient to feel what is appropriate for them.

If you were to have a heart attack you wouldn't want me to waft lavender over you. On the other hand, there comes a point when people are chronically ill, they don't want anymore drugs tried out on them. They don't want any more things. They perhaps want their wholeness to be nurtured and to allow the terrain of their health to change. And I think very much complementary medicine has been nurtured and been made more acceptable by the AIDS community, who wanted a holistic approach. They realized that there was something missing and they wanted a more holistic, not one or the other.

I would suggest that an alternative therapy is that which is outside the norm of the country in which you are at that particular time. If what we're talking about here is a traditional medicine which is traditional to the country of origin, where it's actually standard, it is orthodox for that system. So for example, traditional Chinese or Japanese medicine is traditional in that country. They've had it for thousands of years, they don't need to validate it. But when you export a system that's traditional to another culture, it becomes an alternative to the medical system of that country. I would like to suggest that we don't view it as alternative, but we view it as complementary to what we have grown up and expect.

So what would be an alternative in China would not be acupuncture because they have a dual system over there. They have MDs and they also have acupuncturists. An alternative medicine is that which has been taken out of its own culture and put somewhere else and then people will look on that instead of their own orthodox training.

I would suggest that possibly one of the big problems of removing a philosophy from the country of origin, is that something is lost in the moving. And this is particularly so of traditional Chinese medicine which is not just acupuncture. It's acupuncture and herbs and a particular form of drawing the blood to the surface. There's a particular form of massage, there's a particular form of meditation - tai ch'i, relaxation and there are five or six parts of it which in China you get together. Then acupuncture has arrived in the West without all those. Now it's a little bit like saying well, we'll have antibiotics but we won't have anything else. Or we'll have antidepressants, and we wouldn't have anything else. How sure can we be that that can work on its own? That it doesn't need the synergy of the other ones?

TI: One of the most difficult issues in treatment education is to instill in lay people the concept of a risk-benefit ratio. Many people seem to believe that alternative equals non-toxic or risk-free. Of course, this is wrong. The toxicities of many alternative products are not known. Other products, particularly some herbs, are known to be toxic. In the absence of research into these products, how would you suggest that somebody evaluate the risk-benefit ratio of a given alternative therapy?

BUCKLE: I think the way is to have a specialist group who knows what each discipline is trying to achieve and the possible side effects, counterproductive effects. For example, if you were to look at - pick one.

TI: Let's say Chinese medicine.

BUCKLE: Chinese medicine. If we were to take Chinese medicine, then you could analyze what Chinese medicine is, roughly, it's one of these six things. You'll most likely come across these. Your therapist can be an MD trained in acupuncture for a few weeks, an MD trained in acupuncture for months, years or somebody who's trained in acupuncture but not an MD. What are the initials after his name mean? So you instantly know how long that person has been trained for.

What is the treatment likely to consist of? How long? How will it make you feel? What is it not going to do? How is it most likely to benefit you? From the pain? From the depression? Sleep? Relaxation? Is there research to substantiate this or is this just anecdotal? If it's anecdotal, how many people have said this and in how many states? And, is this for all acupuncturists or just acupuncturists in San Francisco or New York? What are the possible toxic effects of taking the drugs? Can you take the drugs and mix them with the western drugs that you're taking?

And I think to stress, stress, stress that whatever complimentary therapy your clients are taking, they must tell their MD even if their MD is openly hostile. Because the only way that the two are going to talk to each other is by educating your MD as well as the patient. But if your MD is actually trying something out on you to see whether it's working and you're doing all sorts of other things, he's never going to know what's working and what isn't.

TI: There is another element to the alternative therapy world, because, of course, it is a multi-billion dollar industry which is essentially unregulated. We get a letter every other day about somebody has some new "cure," which costs $10,000 and is only available by going to clinic X. What's your advice to somebody who's looking at the whole panoply of possible therapies? How do you determine the legitimate from the suspicious? How do you smell a fraud?

BUCKLE: Well, if someone was to advertise that I was going to be younger tomorrow if I took this pill, and it would cost me a million dollars, I wouldn't believe it. If they're telling me that I was going to take a pill and I'd lose lot of weight, I wouldn't believe them. So I think if something is being pushed as being very expensive and definitely working, I would be extremely suspicious. As in all things, I tend to go by recommendation. I would go to a specialist doctor because he had been recommended by somebody who'd been who found the doctor helpful. This presumably, because you're in the health business, is exactly the way that you would go.

There will be specific therapies which will be more inviting to particular people. And just go, go where you feel you need to go. HIV people are like everybody else. They have different symptoms - they don't just have one symptom. They will possibly have one or two symptoms which individually to them is really what they can't bear. Okay. Well, go to a therapy which suggests that it might help this and just see. If one therapy doesn't work and you feel like trying another, try another.

One of the problems with complimentary medicine in the UK is not much of it is available on the NHS. Some of it is, but not much. And it becomes very expensive. So you need to budget. How many times can I go and see this acupuncturist? When will I expect a difference? And do this before you go. This is an investment you're making in your health.

Okay, so I have $200 that I'm going to invest to try and improve my symptoms, my quality of life, my life span. I'm going to go to this person, because somebody has recommended them. Take it. Do your own "research" each time. And when you come back - is it helping the diarrhea? Is it helping the sleep? It is helping the sweats? What is it doing? Is it doing anything? And then do your own evaluation. Do your N=1 study. Your own research study. And if everybody did lots N=1, and we put them all together, we might have some very interesting statistics which we then could give to people to get proper funding. So, initially, you can actually begin your own research strategy by doing that.

TI: How is prognosis viewed in alternative medicine and what role does should that play in developing methodologies for research? For instance, one of the issues that I found most interesting was in a book on Chinese medicine that said it was "weak on outcomes" Could you comment on prognosis in alternative medicine - is it a weakness or just a difference?

BUCKLE: I could comment but I think what I would like to do before I comment is to actually explain the difference as I see it. This is a personal view point of someone who is trained in both the orthodox system the alternative system. Western mechanistic medicine goes into fight an infection and kill it, and the person will be better. Alternative medicine suggests that people would not have succumbed to an infection unless there had been a hole in their wholeness. And therefore, if you replace homeostasis, the ability of someone to actually cure themselves of a common cold or heal a cut, or a broken leg to mend, if you enhance that, then the disease won't have a footing, and therefore it will go. So alternative or complementary medicines seem to be more appropriate in chronic conditions rather than acute conditions. If someone has a heart attack, they need Western medicine. But if somebody was to have a chronic condition, perhaps say arthritis, one could perhaps look at the disease from both perspectives. It's something that Western doctors find difficult to accept and it's something that alternative practitioners find very difficult to accept. There is also the ethical situation of viewing disease as one's pathway through life, that we aren't all super-healthy every day. Is there a reason for getting a particular disease at a particular time? And disregarding serious AIDS, cancer, heart attacks and things like that - colds, flus, this sort of thing - if that is your pathway, is it ethical to actually take that away from someone so they don't learn that lesson.

In Western medicine we put great stock on getting somebody back to work. So we will ram them full of this, that and the other hypertensive drug to get their blood pressure down, make them sleep, etc., etc. so they'll carry on exactly the same - same food, same stress, same whatever, which one could argue was precipitating the terrain that caused the problem. And then it will probably happen again and again and again.

TI: Thank you very much for your time.

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