Lack of medical interest in research exploring complementary and alternative therapies can seem like a conspiracy of silence. The truth is far more complex.
“Don’t those doctors ever read the scientific research?” Peter* angrily asked as he slapped a sheaf of medical journal articles on my desk. He’d just come from his HIV specialist outpatient appointment. Peter’s use of natural therapies had been met with a decidedly cool response from his doctor which became virtually frigid by the time the consultation was over.
“Look”, said Peter, a former biochemist, showing me his most recent find. “Here’s a report by Dr Kaiser from the University of California showing people raising their CD4s by taking some nutritional supplements.”
The report he showed me was of a double-blindA clinical trial design in which neither the participating individuals nor the study staff knows which participants are receiving the experimental drug and which are receiving a placebo (or another therapy). Double-blind trials are thought to produce objective results, since the expectations of the doctor and the participant about the experimental drug do not affect the outcome; also called double-masked study., placebo controlledA method of investigation of drugs in which an inactive substance (the placebo) is given to one group of participants, while the drug being tested is given to another group. The results obtained in the two groups are then compared to see if the investigational treatment is more effective in treating the condition. trial of a high dose vitamin and mineral supplement, plus acetyl-l-carnitine, n-acetyl-cysteine and lipoic acid1. People on this trial who took the supplements for 12 weeks in addition to their anti-HIV drugs increased their CD4 count on average from 356 to 421 (p <.03). A control groupA group of patients in a clinical trial who do not receive the drug or treatment being investigated, for the purpose of comparison with those who do. Participants in the control group of a clinical trial are either given standard treatment (excluding the drug being studied) or a placebo. taking only the antiviralsA medication or substance which is active against one or more viruses. May include anti-HIV drugs, but these are more accurately termed antiretrovirals. had no CD4 increase.
“And look at this one,” Peter said, turning up the next report in his collection. “This research showed that taking ginseng along with AZT reduced development of viral resistanceHIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant. to the AZT. That’s obviously really important!”
This trial of ginseng also showed important effects on CD4s2. People taking the ginseng and AZT combination had very stable CD4 counts: from a starting average of 239, six years later they were virtually unchanged at 234. People on AZT alone had started on a higher average (272) but just over four years later their counts had fallen to 146 (p < 0.01).
Two years into the trial, just over four percent of the ginseng-plus-AZT group showed signs of AZT resistance. In the group not taking ginseng, resistance appeared much more quickly, with 47 percent of the AZT group showing AZT resistance (P < 0.01).
“And look at this amazing result,” said Peter, still less than half way through his stack of articles. “Did you know that your viral loadA measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma. drops faster if you take vitamin E when you’re starting a triple drug combination?”
I hadn’t seen this one — although vitamin E is probably my most recommended supplement. This small study compared the rate at which viral load fell for two groups: one taking 800mg/day of vitamin E for 60 days along with anti-HIV drugs; the other taking only antivirals3. The group taking the antivirals plus vitamin E had more rapid viral load reductions than the group taking only the antivirals (p<0.05).
“Not one doctor in my 11 years of having HIV has ever mentioned any of this research,” Peter fumed. “None of the national AIDS conferences I’ve been to have reported any of it, and even the conferences for people with HIV don’t seem to allow any natural therapy research to be discussed,” he said.
“Why do we have to find all this information on our own? Its almost like there’s a conspiracy of silence!”
It’s easy to see, talking with someone like Peter, how HIV “conspiracy theories” begin. It’s easy to believe them when that is exactly what the evidence looks like.
Anyone, like Peter, who can understand research reports and who can access medical journals or knows the arcane art of searching large biomedical databases such as Medline and puts in a few months reading will see a distinct pattern emerging. They’ll start noticing that the range of treatments and complementary therapiesA broad range of healing philosophies, approaches, and therapies that Western (conventional) medicine does not commonly use to promote well-being or treat health conditions. Examples include acupuncture, herbs, Traditional Chinese Medicine, etc. reported in the medical literature is much wider that that typically discussed by most HIV specialist doctors.
In a medical consultation, treatments other than antiretroviralA medication or other substance which is active against retroviruses such as HIV. and other drugs are rarely mentioned. Clearly there are some more open-minded doctors, but generally a patient’s inquiries about non-drug treatments are brushed off or, as Peter described, trivialised.
It’s as though the hundreds of trials, research reports and journal articles on non-drug treatments don’t exist. Or, as the conspiracy theorists put it, “someone” is deliberately suppressing knowledge of them.
Sometimes I wish conspiracy theories were true. Unfortunately, the reality is much more complex.
*not his real name but his remarks are included with his permission
Jim Arachne is the Complementary Therapy Treatment Officer for the Victorian AIDS Council.
References:
1 Broad-Spectrum Micronutrient Supplementation in HIV-infected Patients With Dideoxynucleoside-related Peripheral Neuropathy: A Prospective, Double-Blind, PlaceboA dummy medical treatment, designed to have no pharmacological effect, administered to the control group of a clinical trial. Controlled Trial. J Kaiser, J Ondercin, G Santos, et al., Poster 494, 11th CROI, February 8-12, 2004 San Francisco, California.
2 Long-term intake of Korean red ginseng in HIV-1One of two distinct HIV species, HIV-1 is the predominant type in Australia and around the world.-infected patients: development of resistance mutation to zidovudine is delayed. Cho YK, Sung H, Lee HJ, Joo CH, Cho GJ., Int Immunopharmacol 2001 Jul;1(7):1295-1305.
3 An evaluation of antiretroviral therapy associated with alpha-tocopherol supplementation in HIV-infected patients. Spada C, Treitinger A, Reis M, et al., Clin Chem Lab Med 2002 May;40(5):456-9
4 Dehydroepiandrosterone as predictor for progression to AIDS in asymptomatic human immunodeficiency virusA small infective organism which is incapable of reproducing outside a host cell.-infected men. Mulder JW; Frissen PH; Krijnen P; et al., J Infect Dis. 1992 Mar;165(3):413-8.
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