CLINICAL DIABETES These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. COMMENTARY New Therapies: Proof or Consequences Irl B. Hirsch, MD Few days go by in my clinic without at least one patient informing me that he or she is using some type of "alternative therapy." This therapy may be for the treatment of high blood glucose, the treatment of dyslipidemia, or the treatment of neuropathic foot pain, to name a few. Often, patients are reluctant to inform me of these therapies. Others are anxious to tell me how much more efficacious their therapy is than our "traditional medicine." Although I try to keep an open mind, I have many reservations based on some very bad experiences. For example, one patient was "prescribed" an over-the-counter extract from a naturopathic physician due to the fact that he was chronically cold. His other physicians (including me) could find no etiology for this, despite an extensive workup. The patient had type 2 diabetes and had had a heart transplant several years earlier. He had a regular clinic visit with me several days after starting the new extract and told me he was "cured" and that he was not cold anymore. For the first time in years, he and his wife did not disagree on how high to set the thermostat at night. I was concerned when I noted that his heart rate was 110 beats per minute. I subsequently discovered that he was thyrotoxic, and that the extract contained significant amounts of triiodothyronine (T3). Yes, he was now comfortable, but his cyclosporin level was subtherapeutic, and he was fortunate that he did not reject his transplanted organ. For the most part, however, I suspect most alternative therapies are harmless, and indeed many may be beneficial. My training, however, is traditional, in that I need to see well-controlled (double-blinded with a placebo group) research studies before embracing any new therapy, whether it is a homeopathic remedy, a new agent to treat hypertension or insulin resistance, or a new technology that can potentially assist our patients. Furthermore, the reporting of any positive new therapy needs to be published in a peer-reviewed journal. Even anecdotal case reports, which may suggest an important new therapy to be formally tested later, need peer review, because all too often there are conflicts of interest that may compromise results and conclusions. Ideally, all new therapies would be held to the same scientific and academic standards. As we all know, this is not the case, and each of us sees examples of this daily. To emphasize the importance of having sound research to back up the claims of proponents of various alternative therapies, we are publishing in this issue of Clinical Diabetes the American Diabetes Association's position statement on unproven therapies. In this new era of "evidence-based medicine," we need to do a better job of educating our patients about the scientific method. Irl B. Hirsch, MD, is an associate professor of medicine and medical director of the Diabetes Care Center at the University of Washington School of Medicine in Seattle. He is editor-in-chief of Clinical Diabetes. Copyright © 1999 American Diabetes
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