NCCAM, weight loss scams, and acupressure

Looking for questionable projects funded by NIH’s NCCAM (the National Center for Complementary and Alternative Medicine) is like shooting fish in a barrel. It’s also painful, because I know these funds could have been invested in real science and medicine instead of quackery. Nonetheless, we shouldn’t give NCCAM a free pass to waste our money. Perhaps after enough critical scrutiny, Congress (which created NCCAM in the first place) will realize that precious federal research dollars need to go into real research, not scams.

My latest search hit on a study called “Randomized Trial of Tapas Acupressure for Weight Loss Maintenance”, an R01 grant (R01-AT003928) from NCCAM to Charles Elder at the Oregon Center for CAM (OCCAM) run by Kaiser Permanente Northwest. This is one of NCCAM’s big national centers of research, and I quickly learned that the acupressure grant was just the tip of the iceberg.

Let’s start with Elder’s study. The Kaiser site says that Elder trained with them in “meditation and Ayurvedic medicine”. That’s reassuring. (See my earlier blog entry on Ayurveda.) This new project was funded based on a pilot study in which Elder “assess[ed] the feasibility and impact of two mind-body interventions from the Chinese Medicine tradition for weight loss maintenance in overweight and obese adults.” He explains that the method he wants to pursue further, the Tapas Acupressure Technique (TAT):

warrants further research as a potential tool for weight loss maintenance. The TAT procedure combines self-acupressure administration with specific mental focus. Patients are taught how to first identify counterproductive beliefs and actions, focus on those images while applying pressure to acupoints GB21, BL1, and Yin Tang, and then transition to a focus on positive images.

In other words, they press their hands on certain points on their own bodies (“self-acupressure) while thinking certain thoughts, and this will help them with “weight loss maintenance.” Notice that he’s not claiming it will help them lose weight in the first place, just that it will help keep the weight off. Hmm.

Okay, there’s too much meaningless mumbo jumbo in those few sentences for me to refute it, but let’s ask a simpler question: what did that pilot study really show? It must have been pretty exciting to justify an R01 grant – these are NIH’s most prestigious and most competitive awards, and NIH rejects almost 90% of R01 applications right now because funding is so tight.

Elder published his results, in a 2007 paper called “Randomized trial of two mind-body interventions for weight-loss maintenance,” in the Journal of Alternative and Complementary Medicine. First I have to point out that this is a terrible journal, created by CAM practitioners as a vehicle for publishing their results. Their editorial board (no suprise) consists mostly of CAM practitioners from highly questionable institutions, such as The Academy for Future Science (no, I’m not making that up) and the Oregon College of Oriental Medicine.

But hey, maybe this article is better than most in that journal. So what did they do? They recruited a small number (92) of overweight adults, and put them all through a 12-week weight-loss program. Then they used three methods to help them keep the weight off: qigong, or “qi”; Tapas Acupressure, or TAT, and a “self-directed support” group as a control. The results of this small, poorly-controlled study: the TAT group regained 0.1 kg, the controls regained 1.3 kg, and the qi group regained 2.9 kg. They claim that this very slight advantage for the TAT group over the controls means that “TAT warrants further research.” How about qi? Do they admit it doesn’t work? No, they say “further research on qigong should use a modification of our protocol.”

My conclusion is different: none of this stuff works, so they resort to to publishing a crappy study in an even crappier journal. A small random variation is reported as a significant win for acupressure (they claim a p-value of 0.13 in their original abstract, later revised to 0.09, which most scientists would never report as significant, and why should I believe these guys’ statistics anyway?), and they then go to NIH and ask for funding to continue the work. All this would be easy to ignore if the lead author weren’t getting a prestigious NIH R01 grant to continue the work. It’s so outrageous that it is hard to know which is worse: the sad waste of NIH funds, the shameless misleading of the public, or the act of taking patients’ money and giving them therapies that don’t work.

By the way, what the heck is acupressure? Well, it’s just what you might guess: acupuncture without needles. You just use your hands to put pressure on various points on the body. Reviews of clinical trials conducted by the Cochrane reviews, one of the best review groups in the biomedical literature, have shown that acupressure doesn’t work – for anything. For weight loss? Not a chance.

But wait, there's more! The Oregon CAM Center also funds “researchers” (I have to put that in quotes) at the National College of Natural Medicine in Portland, Oregon. I guess I shouldn’t be surprised to read that these places exist, but their own description of what they do, and what they train their students to do, is so filled with nonsense that it is scary. Here’s a quote from their site:

NCNM offers two graduate professional degrees... Doctor of Naturopathic Medicine, a four-year program of clinical sciences and holistic methods of healing and disease prevention, instilled with the ancient principle of the healing power of nature. Master of Science in Oriental Medicine (MSOM), a four-year program that delves deeply into thousands of years of classical Chinese methods of diagnostics and healing, using herbs, acupuncture, bodywork and therapeutic exercise.

But don’t worry, their degrees are accredited by the Council on Naturopathic Medical Education and the Accreditation Commission for Acupuncture and Oriental Medicine. I’ll have to devote more space to naturopathy later: this is one of the worst of the scam practices supported by NCCAM. It’s appalling to see NIH supporting it – and equally appalling that at least three naturopaths (they call themselves “naturopathic doctors” although they do not have a medical degree) have served on the NCCAM Advisory Council. In fact, one of them – a “professor” at NCNM – is on the NCCAM Council now.

I wish this were harmless mumbo-jumbo, but it isn’t. People spend money to get treated by these methods that have no basis in physiology, anatomy, medicine, or any other branch of science, and that don’t work, and sometimes they miss out on real treatments that do work. It is sad that such pathetically poor proposals are getting NIH funding when so many worthwhile, legitimate NIH proposals are being turned down because of lack of funds. (NCCAM runs its own review panels because the projects they fund would have no chance if they had to compete against real science.) I can’t help thinking that if the public knew that good proposals to treat cancer, heart disease, infectious diseases, and countless other real problems were being turned down in favor of acupressure and naturopathy, they would join me in calling on Congress to shut down NCCAM and return its funds to other NIH institutes.

Public (mis)understanding of science

The National Science Board has published the results of its latest report on the state of the art in science and engineering. The report includes, as it always does, a set of survey questions about common scientific facts, and a detailed breakdown of how well the public did. It's an interesting snapshot, especially when you compare it to previous years, which go back to 1988. The report is produced every two years by the U.S. National Science Foundation.

You may read various summaries of the report in the news, which will likely say that the public is still relatively uniformed about science, but that we're doing about as well as European countries on most questions except evolution, where we are abysmally bad. I thought it would be interesting to dig into the reports Appendices and look at some specific survey questions.

1. Evolution. The precise question asked was this: "Human beings, as we know them today, developed from earlier species of animals (true or false)." This is the one that gets the most attention, so I have to include it. 43% of the U.S. public got this one right, a number that has hardly budged in 20 years - the number was 45% in 1985. Note that because this is a true/false question, the fact that only 43% gave the correct answer ("true") means that we did worse than random guessing. Evidently the average person misses this one not because he/she is guessing, but because he/she is confident in the wrong answer. Rather sad but not surprising on this one. We have a lot of work yet to do to counteract the creationists.

2. "Does the Earth go around the Sun, or the does the Sun go around the Earth?" For this question, 76% of people answered correctly, a number that is very slightly better than the average of 72-73% in most years. But this is still a terrible result, because again we have a true/false question. A simple bit of statistics tells us that fewer than 76% of the public actually knows the answer: if 50% of people know the answer for certain, and the remaining 50% just guess, then the latter group will still get the right answer half the time. This means we'll observe 75% correct answers, which is basically what the survey found. So only 50% of the public knows that the earth goes around the sun. And the survey included a followup question: "How long does it take for the Earth to go around the Sun?" Only 55% correctly answered "one year." (How long do the other 45% think it takes?) As a scientist, I can't accept that our public is scientifically literate until they get 100% on this one, so we have a really long way to go.

3. There is some good news in the survey: we seem to be slowly educating the public about the overuse of antibiotics. Here's the survey question: "Antibiotics kill viruses as well as bacteria (true or false)." In 1988, only 26% correctly said false to this one, which shows that the public was seriously misinformed. (Again, mere guessing would get 50% correct, so we can infer that the true "correct" rate of those who really knew the answer was even lower.) In the current survey, this number has risen to 56%, and it's one of the few questions where we see steady improvements over the years. 56% is still just a bit better than guessing, but it is far better than it was 20 years ago. We need to keep spreading the message that viruses are not affected by antibiotics (stop taking antibiotics when you have a cold!), because this one seems to be working. I'll hazard a guess that one reason we're seeing improvement here is that doctors are helping to spread the word among their patients.

4. "Electrons are smaller than atoms." Only 53% got this true/false question right (it’s true! of course) and that’s an improvement over 45% in the previous survey in 2004. I'm not sure what people think electrons are, but I guess most of them don't exactly know.

The rest of the results can be found in the National Science Board report’s appendices – I’ll put the actual 12 questions at the bottom of this entry. In another very interesting survey, they tested people’s understanding of scientific experiments with the following scenario and question:

(1) Two scientists want to know if a certain drug is effective against high blood pressure. The first scientist wants to give the drug to 1,000 people with high blood pressure and see how many of them experience lower blood pressure levels. The second scientist wants to give the drug to 500 people with high blood pressure and not give the drug to another 500 people with high blood pressure, and see how many in both groups experience lower blood pressure levels. Which is the better way to test this drug? and (2) Why is it better to test the drug this way?

The correct answer, of course, is that the second scientist has a better design, for multiple reasons, including the placebo effect and natural variation in blood pressure. Only 42% of respondents got this correct, but that is quite a bit higher than 1995 (the first year they asked this question), when only 26% got it. So perhaps we are slowly making progress in educating the public about the scientific method. But 42% is still an F in my classes!

Overall, it appears public understanding is improving very slightly in a few areas, and not budging in others. (And it decreased on one question, about the Big Bang.) This does not bode well for the progress of our society, but we have to keep trying: as scientists, we need to educate the public at every opportunity. Most scientific concepts are not controversial, and an appreciation for science by the public might put pressure on politicians to use good science (rather than distorting or ignoring it) in decisions affecting all of us. One strategy that might help is to explain that it's in everyone's self-interest to understand basic scientific methods, so you won't be fooled by politicians, special interest groups, or quacks offering bogus medical treatments who are only too happy to distort science to support their own agenda.

The Questions (and answers)

The center of the Earth is very hot. (True)
All radioactivity is man-made. (False)
Lasers work by focusing sound waves. (False)
Electrons are smaller than atoms. (True)
The universe began with a huge explosion. (True)
The continents on which we live have been moving their location for millions of years
and will continue to move in the future. (True)
Does the Earth go around the Sun, or does the Sun go around the Earth?
(Earth around Sun)
How long does it take for the Earth to go around the Sun? (One year)
It is the father’s gene that decides whether the baby is a boy or a girl. (True)
Antibiotics kill viruses as well as bacteria. (False)
Human beings, as we know them today, developed from earlier species
of animals. (True)

Where do the presidential candidates stand on science and research?

To answer this question, a large group of eminent scientists (including my colleague, former NSF director Rita Colwell) is calling for a “Science Debate” among the candidates, and they have created a website at http://www.sciencedebate2008.com. Although I support the idea, I decided to do my own homework to find out where the candidates stand on science. I quickly realized that most of them are not likely to agree to a debate, not only because some of them just haven’t thought much about scientific research, but also because they just don’t think it's that important. So I put together this blog entry to summarize their positions and provide some useful links.

I took a look at the six top candidates – three from each party – plus one independent, looking for any information on each of their own websites about their positions on supporting scientific research. Every candidate has an “Issues” link, but in most cases scientific research wasn’t listed and I had to do some digging to find out what they think. I also looked at a variety of independent sites when I couldn’t find information on the candidates’ own sites. Here are my findings, with Republicans first, then Democrats, and then one independent plus a closing comment.

Republican presidential candidates

ADDED on January 23: entry for John McCain (below Giuliani)

Rudy Giuliani’s website focuses on his “12 commitments,” but the site makes no mention of supporting scientific research. In fact, Giuliani goes out of his way to say he is opposed to increasing science funding, by including an attack on Hillary Clinton’s proposal to increase funding for NSF and NIH [here's a link to this (added Jan 10)]. I can only conclude he is opposed to increasing funding for either one. On the positive side, he accepts that evolution is “an accepted part of science” – see this link.

John McCain's website does not include much detail on his support for science funding and scientific research. On global warming, his site says "he has been a leader on the issue of global warming with the courage to call the nation to action on an issue we can no longer afford to ignore" - so apparently he differs with the Bush administration on this issue. Under health care, he includes a long list of positions, including this one: "Dedicate federal research on the basis of sound science resulting in greater focus on care and cure of chronic disease." Without any details, this statement could easily translate into either increases or decreases for NIH research. Also, "sound science" is a buzzword that has been adopted by corporate interests trying to support their own positions, often in contradiction to legitimate scientific findings. (See the blog "Code Words 101" for more.)

New: AAAS has a new website that lists positions of all the candidates on science. The listing for McCain doesn't say any more than I've described here, though.

Mitt Romney makes no mention of science or biomedical research on his website, except for energy research (which all the candidates support in one form or another). His only known position is opposition to human embryonic stem-cell research, although he supported it in 2002 (see this link).

Mike Huckabee is probably the worst of all the leading candidates when it comes to support for scientific research and his own personal understanding of science. His website says nothing about scientific research, and he has explicitly stated that he supports creationism and rejects evolutionary theory. He also believes students in public schools should be taught creationism. One can only guess what he would recommend for the NIH and NSF budgets, but I fear the worst.

Democratic presidential candidates

Hillary Clinton has by far the most explicit and detailed set of positions on science and scientific research, with 9 major points, all very strongly supportive of science. Note that I am not currently planning to vote for Sen. Clinton, but I was very impressed by her science policy and it may yet change my mind. The entire plan is at http://www.hillaryclinton.com/feature/innovation. Here are some highlights (verbatim):

1. Increase the basic research budgets 50% over 10 years at the National Science Foundation (NSF), the Department of Energy’s Office of Science, and the Defense Department.
2. Increase research focus on the physical sciences and engineering.
3. Require that federal research agencies set aside at least 8% of their research budgets for discretionary funding of high-risk research.
4. Boost support for multidisciplinary research in areas such as the intersection of bio, info, and nanotechnologies.
5. Increase the NIH budget by 50% over 5 years and aim to double it over 10 years.
6. Increase investment in the non-health applications of biotechnology in order to fuel 21st century industry.
7. Triple the number of NSF fellowships and increase the size of each award by 33 percent.
8. Restore integrity to science policy. It is important to reinvigorate the Office of Science and Technology Policy to ensure that the President receives objective, fact-based advice.

Barack Obama has two statements on science and scientific research on his website, both supportive. First, he has a detailed plan to reduce carbon emissions by 80% by 2050, described here. Second, he strongly supports increased funding for basic scientific research, as in this quote:

Invest in the Sciences: Barack Obama supports doubling federal funding for basic research, changing the posture of our federal government from being one of the most anti-science administrations in American history to one that embraces science and technology.

For more details on Obama's position, see his website here.

John Edwards has a broad agenda (like Clinton, he calls it his "innovation" agenda) with 6 points, two of which are about scientific research and science policy, as follows:

* Supporting American Ingenuity: The most important factor for America's future prosperity is investment in education, science, technology and innovation. ... Ideological debates at NIH about things like stem cell technology have drained resources from promising research. Edwards will increase spending on basic research at the National Science Foundation and National Institutes of Health and lift stifling research restrictions. He will also modernize our patent laws — which haven't been updated in 50 years — to provide incentives for research.
* Respecting Science: John Edwards ... will make sure that government professionals charged with the collection and analysis of scientific data — from medical research to mercury emissions — are insulated from political influence. As president, he will:
- Eliminate political litmus tests for government scientists.
- Protect the integrity of government science by prohibiting political appointees from overriding agencies' scientific findings unless the chief White House science advisor concludes they are erroneous.
- Reverse the demotion of the head of the White House Office of Science and Technology Policy, and restore the office to a central role as an assistant to the president, a rank held in previous administrations.

See Edwards’ full policy at http://www.johnedwards.com/issues/innovation.

Finally, one independent who is still a non-candidate, but who may yet run (see http://draftmichael.com), is Mike Bloomberg, the mayor of New York and also the chairman of the Board of Trustees at Johns Hopkins University. He is not only a very strong supporter of scientific research, he is also scientifically literate. Here is a quote from him on evolution:

“It boggles the mind that nearly two centuries after Darwin, and 80 years after John Scopes was put on trial, the country is still debating the validity of evolution.... This not only devalues science, it cheapens theology. As well as condemning these students to an inferior education, it ultimately hurts their professional opportunities.”

Unlikely as an independent candidacy is to win, I hope Bloomberg runs – but regardless of whether he does or doesn’t, I'd be encouraged if any of the leading candidates would be brave enough, and intelligent enough, to make similar strong statements. Scientific and biomedical research are critically important to improving the human condition – for everyone, not just for narrow special interests - and the U.S. government has been the largest supporter of research in the world for many years. I hope that the next president will strengthen our commitment to science.