NCCAM and homeopathy

Some of those who read this blog might wonder if there are other examples of pseudoscience and quackery supported by NIH's National Center for Complementary and Alternative Medicine (NCCAM) beyond the study on magnetic field therapy I pointed out back in June.

Unfortunately, there are lots of examples. I'm going to highlight a few more in the coming weeks, starting today. As I've written before, NCCAM is an embarrassment to NIH - it funds research that never would have made it through the rigorous review at other NIH institutes, and it is a waste of money. NIH should shut it down.

Today's example is a triple play: three grants all funded by NCCAM to the same investigator, Professor Iris Bell at the University of Arizona, who is a big fan of the homeopathy, a pseudoscience that I and many others have written critically about (see the Homeowatch site, for example).

The first one (grant R21AT003212) is called "Dilution and Succussion in Homepathic Remedy Dose-Response Patterns." This study, which should have been laughed out of the review panel, proposes to measure the effect of "succussion" on homeopathic remedies. Succussion is just shaking - you mix the stuff in, shake it up, and then dilute it. As I've explained before, homeopathic dilutions reduce the amount of "active ingredient" (usually an ingredient that doesn't provide any benefit anyway) to zero - literally so, because the dilution is so great that there is almost no chance that even a single molecule of the original substance remains, so all you have is water. Bell argues (as other homeopaths have recently) that the water retains a "memory" of the substance, and that this water still has a beneficial effect. There is no physical theory - and no evidence whatsoever - to support this claim, but there it is, right in the abstract of this grant. Dr. Bell hijacks the language of real science - clinical trials - to propose a randomized trial of various dilutions with "stirring only" versus 10, 20, or 30 succussions - that is, shakings. So NCCAM will fund a study that will compare several variants of a completely ineffective "potion." Dr. Bell isn't even going to test its effectiveness on a specific ailment - instead, she proposes to test how well subjects can "sniff" the different preparations. This is, frankly, ridiculous.

Grant number 2 to Dr. Bell is R21AT000388, "Polysomnography in Homeopathic Remedy Effects." This one will test the effects of two plant extracts on people's EEGs while sleeping (and compare them to a placebo). Both extracts will be given in 30c doses. "30c" means a dilution of 100 raised to the 30th power, or 1 followed by 60 zeros - in other words, the subjects will be given water that has a near 100% chance of containing not a single molecule of the plant extract (one of which comes from a coffee plant). The argument for using coffee is homeopathy's "Law of Similars" - that (quoting from the grant itself) "a substance that can cause symptoms in a healthy person can cure similar symptoms in a sick person." Luckily for the subjects, they won't actually get any coffee before bedtime, because the homeopathic potion won't contain any. Again, this should have been laughed out of the review panel.

Grant number 3 to Dr. Bell is 5K24AT000057 (and she has a 4th grant from NCCAM too), "Individual Differences in CAM Patient-Centered Outcomes", is already in its 8th year of funding. This doesn't have very specific aims, but instead supports "a program of research to understand the nature of global and multidimensional whole person healing patterns within homeopathy as a whole system of CAM."

None of this work should be funded with precious NIH research dollars. NCCAM undermines the credibility of all the terrific work going on in other institutes, and it drains precious funds from other studies where those funds would contribute to real science. Congress and NIH should shut it down.

Religion in the journal Nature

Kudos to Sam Harris - author of The End of Faith - for writing a letter to Nature (Nature 448, 864, 23 August 2007) criticizing the editors of Nature for their support of supernatural beliefs; i.e., religion. Harris first points out the hypocrisy in Nature's publication of an earlier opinion piece (in the July 12 issue) that argues that Islam has "an intrinsically rational world view." Ironically, the author of the earlier piece (Z. Sardar) acknowledges that "science in Muslim society has suffered a drastic decline," and he seems to genuinely believe that the Islamic religion is consistent with scientific thought, and that science can "reunit[e] reason with revelation." Harris points out that Islam - just like Christianity - regards its holy book as something that "cannot be challenged or contradicted, being the perfect word of the creator of the Universe" - which is a supremely un-scientific attitude. Harris also criticizes Nature for their favorable editorial about Francis Collins' recent book on his own personal religious (Christian) beliefs, and he includes some choice quotes pointing out how un-scientific that book is.

Harris' criticism of Nature is right on the mark. We are inundated with writing about religion, and religious people have a huge number of highly visible outlets to express their views. Religion is discussed daily in the mainstream media as well as countless specialized publications and television shows. We have a President here in the U.S. who constantly talks about religion, and he is supported by a fundamentalist movement that wants nothing more than to impose their religion on the rest of the country. Science, on the other hand, has a far smaller number of venues, and has much less of the public's attention. Scientific publications - especially those with a large readership, such as Nature - should focus on science and science policy. Harris is right when he says: "There are bridges and there are gangplanks, and it is the business of journals such as Nature to know the difference."

Or, to put it another way, the title of the journal is Nature, not Supernature. If the editors of Nature want to publish articles about supernatural phenomena, they should change the title of the journal.

Universities should support open access to literature and medicine alike

Gavin Yamey has a thought-provoking commentary over at the PLoS blog site, in which he argues that open access to the scientific literature is related to access to essential medicines. One of the points that I agree with is that our system - indeed, even the very notion - of intellectual property rights is preventing both the dissemination of knowledge and of valuable medical treatments.

We scientists publish our work primarily so that it will be disseminated as widely as possible. (Yes, I know that we also publish so that we can get promoted in our jobs, increase our funding, and other less noble goals.) To that end, open access publishing, which puts no barriers in the way of the interested reader, is the best system from the consumer's (reader's) point of view. Even more important, in many cases, is that open access publishing allows the author to retain control of the intellectual property in the article, which is logical enough since the author created it in the first place. It never made sense to me to sign over copyright to a publisher, but publisher's were able to extort these rights from authors when they controlled the means of distribution.

As Yamey points out, access to drugs is restricted in a different - but closely related - way, through patents. I've made arguments against patents before - particularly against patents on software, which I've argued should be abolished (see my editorial here). Drug patents, despite the arguments made by the pharmaceutical industry which has a huge vested interest in the current system, are "impeding the world's poor from accessing live-saving medications," says Yamey. He's right - and more than that, they encourage drugmakers to invest only in blockbuster drugs - not necessarily drugs that cure mankind's greatest ills, but those that make the most profit - and then to invest even more in legal strategies to extend their patents and prevent competition.

Where do our universities sit in this argument? Sadly, in the U.S. at least, universities have been filing 1000's of patents a year. Starting in 1980, when Congress passed a law (the Bayh-Dole Act) encouraging universities to commercialize their discoveries, the growth in university-driven efforts to protect intellectual property has been enormous. On the whole, I believe these efforts have been harmful, because they directly contradict the mission of universities - and scientists - to disseminate knowledge.

Fortunately, there is now a group, Universities Allied for Essential Medicine, that is at least making an effort to pressure some universities to recognize the harm they're doing, and to stop it. They've called on the Univ. of Wisconsin, which has an unusually aggressive licensing arm (called WARF), to demand that Abbott reintroduce a drug that they have withdrawn from Thailand over patent disputes. (WARF owns rights to the drug.) The University of British Columbia has actually drafted a new IP policy that will guarantee access to UBC inventions in the developing world (read it here).

For now, US universities are followers, not leaders. I encourage anyone in academia to pressure your administration at every opportunity to encourage free dissemination of knowledge, through open access and through rapid, unrestricted publication of discoveries - without patents. I'm trying this already at my own institute, the University of Maryland. Not surprisingly I'm meeting resistance, but I will persist, and I hope others will join me.

One thing we professors can do on our own is to halt the practice - common in some disciplines - of counting patents as publications. I've seen many resumes with patents listed, and I don't consider these to be equivalent to publications at all. For one thing, patents aren't peer-reviewed, but are reviewed by an overburdened patent office that lacks expertise in most disciplines. For another, patents are often written to conceal the true invention, so as to discourage others from trying to re-create it. Let your colleagues know that patents don't count in promotion cases, and they'll have less incentive to file them. This is just a small step, but I think it's be a step in right direction.