Now, I can just hear the CAM-fans protesting: "why are you opposed to doing studies of our methods? Are you afraid that studies will prove some of them work?" (This isn't a straw man argument, by the way - I've been asked precisely this question.) Well no, of course I'm not afraid that studies will prove that [acupuncture - homeopathy - naturopathy - Ayurveda - chiropractic - voodoo] will work. There are so many problems (with this CAM announcement) that I don't know where to begin, but one major problem is that studies have already been done, and all the results are negative. As CAM's acting director, Ruth Kirshstein, writes in her request for over $121 million for next year's CAM budget, NCCAM has supported research at more than 260 institutions over the past 7 years. Have any positive results emerged? No. Why throw good money after bad? We shouldn't.
Some of my blogosphere colleagues have already put forward some excellent arguments for why NCCAM's funding should be eliminated - see the recent post by Steven Novella, who argues:
Why can’t studies of CAM modalities be funded through the regular NIH? Because the NIH has standards, and what passes for research in the CAM world is often so laughably pathetic that it could never mean the NIH standard and get funded. NCCAM was created to provide a much lower standard for CAM research. In other words – waste money on studies that are not worth funding when judged by the usual criteria.I couldn't have expressed it better. If this work is any good, it will get funded through the regular NIH mechanisms. Also see the comments of ScienceZoo, who points out that none of the three new CAM Centers are likely to find effective therapies for what they claim to be studying.
While I was celebrating this announcement from NIH, I couldn't help myself (I was so excited!!!) from looking at what their existing "Centers of Excellence" devote themselves to. You can find a list here, and it includes one for acupuncture (see my previous post on that topic), energy medicine (what the heck is that? I'll blog on it another time), and "mindfulness-based stress reduction" in HIV.
That last one is really rather appalling: they will investigate using meditation techniques as a way to "slow disease progression and delay the need for antiretroviral treatment." So they're going to tell HIV-positive patients to delay taking proven therapies and try meditation instead? How many patients need to die before they admit this isn't a good idea.
So you see, we have so much to celebrate this week. Three new NCCAM centers and a request for another $121 million in NCCAM funds next year. I'm so happy.
1) Is "Have any positive results emerged? No." your guess or is that really the result of all their publications?
ReplyDelete2) It seems to me that your response and the others you link to pretty much demonstrate why a solid proposal in an "alternative" field would be unlikely to get a fair shake in the normal NIH routes.
3) There is far more than $121M budgeted to generate another few thousand pointless JBC papers. Given the huge upside here, I'd much rather push for higher standards in NCCAM (or come up with a proposal yourself!) than shout "Skeptic! Skeptic!" until it disappears.
I'm right there with you Steven...but as long as the public read's thing like this on the front page of Yahoo (on 10/16/2007) there will be lots of money for this type of research.
ReplyDeletehttp://news.yahoo.com/s/nm/20071016/hl_nm/acupuncture_pain_dc
"Researchers at Duke University Medical Center in North Carolina analyzed the results of 15 clinical trials on the effectiveness of acupuncture -- a practice that originated in China of inserting thin needles into specific body points.
They concluded that it is valuable for pain control in surgery patients.
The 15 trials showed that patients getting acupuncture before or during various types of operations had significantly less pain afterward than patients who did not get acupuncture."
"These findings augment a growing body of evidence on the value of acupuncture in improving the surgical experience for patients, the researchers said."
Keep up the good work!
Sorry the link before got truncated:
ReplyDeletehttp://news.yahoo.com/s/nm/20071016
/hl_nm/acupuncture_pain_dc
To jsinger: no, I'm not guesssing when I write that all the results are negative. I've not read everything, obviously - but I've read many articles, including large-scale review articles, and I've not seen a single positive result that withstood scrutiny. Some very minor "positive" results have later been shown to disappear with larger or better-designed studies. That's what happens when there is no effect.
ReplyDeleteIf you can point to a good study that shows that any of these "CAM" methods works, I challenge you to do so. Otherwise you sound like you're just taking it on faith that some of these hocus-pocus and sham treatments really might work.
David: thanks for the comment! I agree, it's dismaying that the mainstream press is so gullible, and it perpetuates erroneous beliefs. In the case you cite, the news service simply regurgitated a press release from Duke University. The press release in turn is hyping a presentation by one of their own researches, Tong Joo Gan, who made these claims at a presentation at the Amer. Soc. for Anesthesiology meeting - and the results have not been published in a peer-reviewed journal. So I can't look at them to see if they're any good. However, even the press release says it's a meta-analysis of 15 "small" trials. And as Mark Crislip of QuackCast says, "meta-analysis, schmeta-analysis." (In other words, meta-analysis is very tricky to do well, and it is usually worthless. You have to look at the original studies.)
...I'm not looking for them...but just today another one...the link coming from no other than Biospace!
ReplyDeleteI haven't looked into this...but just going by what I read in this Reuters release...it does sound like hocus pocus!!!
http://www.reuters.com/article/
healthNews/idUSHKG33162320071017
Steven,
ReplyDeleteI do understand your concern about the validity of this "research," but my feeling is that if the NIH doesn't look into this, who will? People are spending millions of dollars on "alternative / complementary / holistic / traditional Chinese / what-have-you" treatments without any objective guidance of any sort, mainly because they're desperate and/or fed up with the inability of Western / modern medicine to meet their needs. People need to know what works and what doesn't based on evidence, and evidence requires research, and research requires money.
Speaking personally, my mother's had ovarian cancer for four years, has had two re-occurrances and is now suffering terribly and it gets progressively worse. I have friends who insist that acupuncture will help her feel better (it helped their parent, spouse, friend etc.), or that a vitamin C infusion will help or some other off-the-wall suggestion. (Although a good friend who is a P.A. has her father on weekly infusions and he feels 100% better and is alive over a year after he was supposed to be dead... in fact Hopkins researchers just published a paper describing how C inhibits tumor growth -
http://www.hopkinsmedicine.org/
Press_releases/2007/09_10_07.html)
The point is that we'd do anything to help my mother survive or just to feel better and everything the standard medical community can do has not helped. In fact more often that not my sisters and I are the ones telling them what they said they were going to do or why she's at a particular appointment or what the standard protocol is for a certain treatment (because we read it! don't they? NO, not half the time).
So who do I turn to for guidance when my sister wants to take my mother to her friend's Reiki massage therapist because somebody told her it helped their sick loved one? I don't even know what the h*ll Reiki is. But my sister took her anyway and that wacko spent the whole time massaging my mother's "aura" and talking to an invisible dead Indian chief who joined them because he claims to be our great-great-great-great-great grandfather... and proceeds to freak my 81-year-old mother right out.
My point is that it's very hard even for people who are well-informed, intelligent and naturally skeptical to dismiss all this stuff out of hand when it gets intensely personal, so we (I'm speaking as a citizen here) need our National Institutes of Health to spend some of our tax dollars to do some of the research necessary to offer some kind of practical advice - even if it's to prove once and for all that none of this stuff works.
I'm most likely to turn to someplace like the Univ. of MD School of Medicine's Center for Integrative Medicine, in part simply because (unlike most medical centers) they really really do emphasize consideration of the "whole person." My wife is a medical social worker in a major hospital so I hear first-hand every day for 30 years how deeply myopic and dis-integrated is most medical treatment - in fact the social worker (and maybe a nurse) is often the only person who knows everything that's going on with a patient medically, much less psycho-socially. (I myself work at Hopkins Medicine, but I'm not an MD nor even a PhD and I don't play one on TV and I don't speak for Hopkins in any way shape or form.) The other, and to me just as important, reason I turn to a place like UMD/CIM is precisely because they have been for over 10 years an NIH "Center of Excellence for Research in Complementary and Alternative Medicine." I have to figure that if anyone anyplace can give me straight advice on what, if anything, we can offer my mother apart from drugs that make her deathly ill, destroy her kidneys and leave her with vertigo and neuropathy so bad that she can hardly lift a fork to feed herself, it's them. And that's thanks in large part to funding from NCCAM.
Now, as to whether NCCAM standards are up to the rest of NIH, that's a different matter and one I can't really speak to. I just wanted to share a personal story from someone stuggling with all this stuff in the real world.
Lee, thanks for your frank and thoughtful comments. First, let me answer your main question: NIH is looking into virtually every possible treatment for cancer, including naturally occurring herbs as well as synthetic drugs, and NIH was doing this long before NCCAM came along. (NCCAM is only 7 years old.) For example, taxol is an effective anti-cancer drug that was isolated from the Pacific yew tree. The original discovery of taxol dates back to NIH-funded work in the late 1960s, and NIH later funded multiple clinical trials.
ReplyDeleteI realize how difficult it is to have a close relative with cancer - without going into details, let me just say that I do also - and I realize you want to do anything possible to help her. Unfortunately, the existence of numerous quack treatments only makes it more difficult - not easier - to find something that has a chance at working. And sadly, many of the people offering these "cures" are just in it for the money, and they take advantage of desperately ill people in a way that I find truly reprehensible. It is difficult to sort through the erroneous claims made by the purveyors of these cures, and it would be great if NIH could help us do so. Unfortunately, although most NIH work is very good, the work at NCCAM is held to a far lower standard, and the NCCAM website - as I've pointed out in an earlier blog entry - is often misleading and sometimes just false.
So there is no need for NCCAM - as Steven Novella wrote in his blog, we don't need a special branch of NIH to fund junk science. Good ideas on how to test new therapies - and properly designed studies - have been funded by NIH for decades and will continue to be.
Finally I'd like to emphasize that the very phrase "alternative medicine" should be eliminated, at least in any serious discussion of medicine. All medicine should be evidence-based medicine, and any treatment that works - and that can be shown to work under controlled conditions - is just medicine, plain and simple.
Thanks again for providing some perspective on how difficult life can be when someone you care about has a disease that medicine cannot effectively cure.
Hi,
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ReplyDelete