Some of you may know that our beloved National Institutes of Health has a "National Center for Complementary and Alternative Medicine" (NCCAM). This was created quite recently and as far as I can tell, is a collosal waste of precious NIH funds. This is not a victimless crime - funds spent on NCCAM could instead be spent on real NIH research, improving the prospects for curing real diseases.
Instead, NCCAM is basically a booster for "alternative" practices that are mostly complete nonsense, and in some cases are (or should be) downright embarrassing to the NIH. My topic today is Ayurveda, which I blogged about last month when I was preparing to go to a scientific conference where one of the speakers was (to my surprise) planning to speak on Ayurvedic medicine. In preparing for that meeting, I happened upon the NCCAM page on Ayurveda, here. (Yes, that's a link to NIH.)
The NCCAM site on Ayurveda goes on for page after page explaining it, and it is clear that the NIH is trying to present Ayurveda in the best light possible. This is not what NIH should do - it should support scientific investigation of health claims, not provide advertising for "traditional" practices that are little more than superstition. Despite their attempt, they can't really sanitize Ayurveda - in trying to explain it, they delve into the ridiculous beliefs of Ayurveda such as their fundamental notion that everyone has three "doshas", and imbalances in these doshas cause basically all disease. Imbalances in the first dosha - so says the NCCAM website - can make a person susceptible to "skin, neurological, and mental diseases" or with a second dosha, to heart disease and arthritis, and the third causes diabetes, ulcers, and asthma. All the doshas can be upset by eating certain types of food.
You have to scroll way, way down on the page - to point 11 - to finally come to what should be point number 1: "Does Ayurveda work?" The answer is, simply, "No." Actually the entire page should be just that question followed by that answer. But here the NIH really lets the wheels come off, and NCCAM reveals its bias: it says "A summary of the scientific evidence is beyond the scope of this Backgrounder." What??? It then makes things worse by stating that "very few rigorous, controlled scientific studies have been carried out on Ayurvedic practices. In India, the government began systematic research in 1969, and the work continues." So they are trying to suggest that this needs more study - a common ploy of pseudoscience practitioners - and even that "research" is going on today in India.
Ayurveda is harmful. If you read even further down, even the NCCAM site admits this, but only indirectly. What it says is that many Ayurvedic "medications have the potential to be toxic." (No, they are toxic.) What are they - well, even NCCAM admits that they contain lead, mercury, and arsenic. Is this accidental? The NCCAM site would leave this question unanswered, but a web search quickly reveals that Ayurveda intentionally uses these metals and others in their "treatments." So the mercury, lead, and arsenic that are found in Ayurveda potions are in fact the main ingredient.
If you really want to read about Ayurveda, check a site that presents the evidence more objectively - or skeptically, such as quackwatch.com. Unfortunately, the NCCAM site is not objective. They support Ayurveda, and other "alternative" practices, because they seem to think their mission is to be a booster for these sham practices. I think NCCAM should be shut down, and fast.
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This is Steven Salzberg's blog on genomics, pseudoscience, medical breakthroughs, higher education, and other topics, including skepticism about unscientific medical practices. Here's where I can say what I really think about abuses and distortions of science, wherever I see them.
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I agree that there are some "medicinal" practices that do look like witchcraft (like Ayurveda), but they are lots of non-traditional medicines that do work and are well documented. For example, acupuncture, traditional chinese medicine and homeopathy (yes I do use homeopathy in some cases, it does work). The problems with those practices is that we do not have a good scientific understanding of the way they work, and NCCAM is here to fund research to better understand these medicinal practices. In turn, modern medicine could only benefit from this type of research. NCCAM has an important mission and I do not believe it is a waste of money. They fund lots of research on probiotics for examples. Those are very important to complement modern medicine treatments such as chemotherapy for cancer. A better understanding of the human microbiome can results in better probiotic, and NCCAM is very interested in the human microbiome project. May be NCCAM need to be a bit more selective in the projects it funds, but overall its mission is important.
ReplyDeleteJust my two cents...
Well, I can't let that one go.
ReplyDeleteFirst, you assert that homeopathy works, but that sounds like anecdotal evidence. There have indeed been studies of homeopathy, and not a single scientific study that I know of has shown any effect beyond a placebo effect. It's incumbent upon those who claim an effect to prove it, and that hasn't happened with homeopathy. The practitioners protest (some of them do) that their methods require a "relationship" with the patient, but that's just special pleading, and it doesn't wash as a scientific method.
Second, homeopathy was invented long ago, before Avogadro or even the understanding of molecules - which means the original practitioners had no idea that their dilutions had less than 1 molecule per does! So of course there can't be an effect if there is no substance - I don't see how you can argue this. The dilution "units" of homepathic remedies are given as "C10", "C20", and "C30" (the most common strengths) - are you aware what this means? Each "C" value is a 1/100 dilution. So even the strongest homeopathic "medicines" at C10 are diluted by a factor of (1/100) to the 10th power (from the original "pure" substance, which usually isn't pure to begin with). That level allows for perhaps a few molecules in a does - but the next levels, C20 and C30, virtually guarantee that a dose is just water.
Third, NCCAM is a disaster for many reasons, but I'll add one more here in response to your comment: they use significantly lower standards than other NIH entities. Therefore they fund inferior quality research. I don't *care* if NCCAM is interested in the human microbiome project - that doesn't make them OK. Lots of other NIH institutes are interested too, and if the science is good, it will be funded just fine without NCCAM. Arguing that NCCAM is okay because they are supportive of one project that you like is just giving them a blank check for all the nonsense they do if they'll support you on one issue.
I could go on but I'll leave this here for now....
Oh yes, I should add one more comment: acupuncture doesn't work either! There have indeed been some scientific studies of it recently, and they have shown no effect. In fact, what one study found was that Chinese patients were much more submissive with their doctors, so that if the doctors told them that acupuncture would prevent pain (or cure other symptoms) they felt compelled to agree and they *would* agree, even though the acupuncture wasn't working.
ReplyDeleteSo here again I'm not buying any of this until I see a proper study supporting it. But the evidence says none of these "traditional" treatments work, and I'm not funding any more studies of them on my tax dollars if I have a choice. We don't have an obligation to prove that every bogus remedy is indeed bogus - the onus is on the person who claims a benefit to first prove that the benefit is real.
I will avoid commenting on all the details here since I have not read the posts carefully but I just wanted to add one thing. One big big problem with various alternative medicine practices is that they are frequently completely unregulated. And thus they can make claims that have no scientific support without any consequences. For example, I have been told by multiple homepathic medicine and other alternative medicine practitioners that they can cure a disease I have (not posting the disease here, but suffice it to say, it can only be treated with injections). If a "normal" doctor made such claims, they would likely be prosecuted and kicked out of the profession. But not so for most alternative medicine programs. That is not to say that some alternative medicine does not work. But when the complete charlatans are allowed to run rampant within a field, it does not make the field look good. If they really want to become accepted, various alt. med. practices should try and develop a better code of ethics and conduct.
ReplyDelete1) Homeopathy is a very different matter than acupuncture, ayurveda, Chinese herbs, etc. As you say, its efficacy is impossible in our understanding of chemistry; there's no reason why a spoonful of turmeric *couldn't* work.
ReplyDelete2) I don't follow this stuff but a bunch of years ago I saw a very convincing talk about how the effects of acupuncture on mice could be blocked by naloxone, suggesting a pathway. A quick look at PubMed shows plenty of papers on animal models.
3) If funding is limited to well-thought-out projects (I have no idea if it is), the risk-reward ratio seems pretty favorable. The chances of a huge score strike me as a lot better in fresh ground like this than in beating through some Drosophila pathway for the millionth time.
just a comment on your note about mercury being present in ayurvedic medicines. i feel compelled to point out that most vaccines also have mercury (thimerosol, actually) - the difference being that one's body presumably better sequesters mercury that one ingests than the mercury injected straight into the blood stream. at least when it is ingested, there is a better chance that the liver will remove some of it whereas when injected, it probably hits the brain immediately.
ReplyDeletethe fact is that many many modern diseases are probably outward demonstrations of malnourishment. perhaps NIH would do better to rigorously examine nutrition...
My grandfather's friend was the Dean of an Ayurvedic Medical School, with whom I spent quite a bit of time. (I have the "modern medicine" M.D.). If you know a real practitioner your comments on Ayurveda might be a little different.
ReplyDeleteThere are a lot of people who want to pass off quackery as Ayurveda (especially in the US), which doesn't mean that Ayurveda is harmful.
That argument is equally flawed as saying that because some people misrepresent Islam, Islam is harmful.
The solution is to put in processes in place at this new institute so that quackery is identified.
I read the article and commments with great interest. In summary it seems that all of the comments agree that only well designed scientific experiments/ trials will be able to answer some of the unknowns. I believe for this very simple outcome, it was a very good discussion. There is no way around good scientific practice to get to the bottom of such controversial points!
ReplyDeleteMaybe a second suggestions - could someone please post one or two references from the peer reviewed literature that show that some alternative medicines which are mentioned in the discussion are having a statistically significant benificial effect over placebo (I guess the standard procedure to measure the benefit of a drug). Wouldn't that be a good starting point?!!!
I am on the fence on this, and would like to be swayed one way or the other; but again: only hard core scienctific practices will be allowed!
David's request is a good one - for peer-reviewed studies showing that things like homeopathy or Ayurveda work better than placebo. As far as I know, no such studies exist. I suggest you look at the journal Nature of 22 March 2007, which had a couple of articles about homeopathy being taught as science in British universities - and about the outcry by British scientists calling for an end to these courses ("Degrees in homeopathy slated as unscientific", by Jim Giles; and "Science degrees without the science" by David Colquhoun, same issue.) I especially recommend Colquhoun's article, as he is a professor of pharmacology at University College London. Here are some quotes of his:
ReplyDelete"Homeopathy, for example, has barely changed since the beginning of the nineteenth century. It is much more like religion than science. Worse still, many of the doctrines of CAM, and quite a lot of its practitioners, are openly anti-science."
Later he writes: "Proponents of 'nutritional therapy' have been known to claim that changes in diet can cure anything from cancer to AIDS. For example, the British nutritionist Patrick Holford infamously recommends vitamin C as a remedy for HIV and AIDS." This is only one of several examples he gives of how alternative medicines are not only useless, they are often harmful.
Thus I maintain that NCCAM is not only a waste of money, it is downright harmful. It gives the veneer of legitimacy to unscientific practices that people turn to for treatment - believing that these practices may cure them, and tragically missing out (sometimes) on real, scientifically-based medical treatments that could provide a genuine benefit.
David's request is a good one - for peer-reviewed studies showing that things like homeopathy or Ayurveda work better than placebo. As far as I know, no such studies exist....Thus I maintain that NCCAM is not only a waste of money, it is downright harmful.
ReplyDeleteI don't understand. NCCAM has dozens of references listed on their site and PubMed has over 1800 papers from their grantees. You've looked at that stuff before dismissing their work as "a waste of money" as far as you know, right? Or at least thrown "ayurvedic placebo" into a search?
JSinger: you bring up some good questions, but I urge you not to confuse NCCAM's own attempts to publicize themselves (on their own website) with successful use of alternative therapies. Of course there are papers citing support from NCCAM - NIH is funneling millions of dollars to them. There are many things to say here, but I'll just make a couple of points: first, any good clinical study can be funded by the appropriate NIH institute if it has merit - we don't need NCCAM for this. (And in fact NIH has funded many studies in the past of promising treatments that were based on, for example, plant extracts.) A consequence of having NCCAM is that lower-quality research gets funded because NCCAM has lower standards - their mission is to give out the money, so they will give it out regardless of whether the proposals are garbage. By creating NCCAM in the first place, the U.S. government is saying "this type of work is so important that we will set aside a separate budget for it." That makes sense for the National Cancer Institute, not for "alternative" medicine.
ReplyDeleteSecond, many of the results on NCCAM's own site are negative - for example their home page right now lists 5 studies, 2 of which showed no effect. And I can hear you saying already "well isn't it good to find out that there is no effect?" Of course it is - but only if a previous study showed a positive effect! With most alternative treatments, it's just anecdote and tradition - not scientific evidence - that is the source of the "positive" data. We shouldn't spend precious research dollars trying to refute claims (which are endless) that don't have some positive evidence in the first place.
And yes, I looked at the PubMed references supported by NCCAM. This only makes it more obvious to me that we don't need NCCAM. If you look at some of the published studies, you'll find that the good ones are funded by multiple NIH institutes - not just NCCAM - which reinforces my point above: if a study is worthwhile, NIH can fund it without NCCAM. Some investigators are (wisely) asking for money from NCCAM too, if they can make the claim that their work fits there. If all of NCCAM's funds went to investigators who were doing NIH-quality work (and who had other NIH funding), then at least NCCAM wouldn't be entirely wasted. But I did a search of the NIH grants database, and some of the studies are clearly a waste of funds. If NCCAM went away, we could use the money for better science.
I seem to recall a study not too long ago showing the positive effect of prayer. I have no details on it, but I found it interesting. Also, I recall recent studies on yoga and acupuncture that did show positive results (in the US, I believe). I am going to have to try and find them; unfortunately, I receive daily digest emails and I imagine they were located in those.
ReplyDeleteAlso, another interesting topic is - what *is* the placebo effect? We are quick to dismiss it as "default", but there are some papers showing that something is actually going on with it.
I'm not quick to dismiss CAM, but I do agree with some commenters that more rigorous qualifications need to be put in place.
You wrote "I seem to recall a study not too long ago showing the positive effect of prayer."
ReplyDeleteThis kind of vague recollection can't be refuted, but I think you are remembering a recent study (which had a lot of press) that showed exactly the opposite effect. The study design had people pray for critically ill patients, and it looked at 3 groups: patients who were prayed for but didn't know it, patients who were prayed for and who were told about it, and patients who weren't prayed for at all (as a control). The patients who didn't know about being prayed had the same outcomes as those who weren't prayed for at all. Ironically, those who were prayed for did worse. The investigators hypothesized that those who knew about the prayers may have concluded that they were in worse shape than they'd thought, and that this psychological effect might have been harmful.
This isn't a vague recollection, by the way: the study appeared in American Heart Journal in 2006. Here's a link to an article discussing it:
http://www.sciencedaily.com/releases/2006/04/060403133554.htm
I'm not aware of any good studies that showed a positive effect for acupuncture - there are studies that claim a benefit, but they are poorly done (see my later posts on this topic).
I am strong opponent of pseudo science. It is however essential to follow proper process of scientific enquiry both to establish or to reject any theory or stream.
ReplyDeleteYoga was similarly ridiculed by half baked experts, vegetarian diet was considered lacking nutritional value & unsuitable for strength intensive activities and so on ...
Fight pseudo science with epistemic reasoning & empirical evidence, not by pseudo science, ignorance & prejudice.
How does Ayurveda compare with witchcraft? I never saw any similarity. How much have you read, let alone study? While the epistemic background may be weird for present understanding but empirical evidence of 2500 years is overwhelming.
ReplyDeleteI must thank Jacques Ravel to refer Ayurveda as witchcraft. If he thinks Ayurveda is some medicine or medical science then probably he may be favoured on it. Has he studied Ayurveda in its original style and form? Has he studied Sanskrit Language? Then there is now use arguing anything on his comment. If he comments after studying Sanskrit and Ayurveda in its original form then I have to argue him a lot. I have been learning Ayurveda for more than 28 years so also teaching and practicing. Ayurveda never says that it can cure illness rather it is only a science of life and art of living. Now on the question of scientific publications why not they look at Medline, Pubmed etc. search websites. They can find many of them there. What NIH or NICCAM does is not interested to me. We have to experience ourself the knowledge and then judge the things. It is fashion of manyhardcore modern medicine / science scholars to always lookdown on these wisdoms of ancients who had no vested interest of anything.
ReplyDeleteAyurveda provides a balanced healthy lifestyle based on ancient concepts that work today in millions of homes all over the world. It is not quackery unless you that's how you feel that everything that is NOT invented here is quackery. We know that Yoga and Meditation (also parts of Ayurveda treatment) works with ample evidence and scientific proof.
ReplyDeleteWhether you accept Ayurveda or not it is the people who want to feel good and if Ayurveda offers that to improve one's lifestyle than who are we to stop. Life is not just physical but has to be viewed from Mental and Spiritual lvel and that wholistic approach is what Ayurveda provides.
I have been studying Ayurveda for over ten years as an extension of my yoga and meditation practice. If Ayurveda doesn't work, why has it survived for thousans of years? Perhaps it has not been adequately studied in the West because the funding for research has not been avaialble. Where's the profit in teaching pranayama or breathing exercises? Sure, even breathing incorrectly can lead to hyperventilation or even lack of proper oxygen intake. Ayurveda is also a method of observation so that one may be more aware of subtle changes and imbalances in the body and react appropriately.
ReplyDeleteThat's one of my favorite logical fallacies: "it must work because it's an ancient Chinese/Indian/whatever method. Nonsense. Thousands of years ago, life expectancy for humans was about 30 years. If you prefer to use the health care treatments of a pre-scientific era, go ahead. Virtually all of the increases in life expectancy over the past 150 years have been due to modern science-based medical advances.
ReplyDeletePeople are quite capable (as you demonstrate) of clinging to long-held beliefs despite the lack of evidence that they work.
Ayurveda contains principles that have been disprooved years ago. For example the humeral theory. I cannot understand why people still follow it.
ReplyDeleteIf any one disagree with me
Contact me @ kenneth.roy999(at)gmail.com
People follow it because it works. Why is it that people so blinded by the modern scientific method can't open up to actually understanding a different world view? It is so unscientific to dismiss a set of knowledge just because you can't apply your one kind of testing to it. Yoga and Ayurveda are very scientific with logical steps toward health and enlightenment. I dare you to come up with some proof tht they are bullshit. The burden is on the naysayers and not the practitioners, IMO.
ReplyDelete