Field of Science

Washington Post shines light on waste at NCCAM

Science reporter David Brown at The Washington Post wrote an excellent article today entitled "Critics Object to 'Pseudoscience' Center," which focused on my efforts - and the efforts of others, notably bloggers at Science-Based Medicine - to eliminate the funding for NIH's National Center for Complementary and Alternative Medicine (NCCAM). You can read the article here (requires login, but it's free).

I'm quoted in the beginning of the article, which also makes reference to my proposal to de-fund NCCAM, posted on Change.gov in January. Brown also reports that NCCAM is getting a boost of $31 million in its budget this year, thanks to the recently-passed stimulus bill in Congress. That's on top of an overall NIH portfolio of $300 million dedicated to "alternative medicine", which includes $122M for NCCAM and $122M for OCCAM.

NCCAM was created initially by Senator Tom Harkin, who continues to push it. In a hearing just a couple of weeks ago, he stated
"One of the purposes when we drafted that legislation in 1992 . . . was to investigate and validate alternative approaches. Quite frankly, I must say it's fallen short. I think quite frankly that in this center, and previously in the office before it, most of its focus has been on disproving things, rather than seeking out and proving things."
Brown quoted this in his article and also paraphrased my response that this shows how badly Harkin understands science. Science doesn't set out to "investigate and validate" - it just investigates, and sometimes the results are negative. That's precisely what has happened with every well-done study of many of the pseudoscientific claims that NCCAM supports, including energy healing (see my previous blog post), acupuncture, homeopathy, magnet therapy, Ayurveda, qi, and others.

In an effort to achieve balance, Brown also interviewed a leading naturopath, Carlo Calabrese, who was formerly on NCCAM's advisory board. Calabrese seems to concede - oddly - that his practices might be no better than placebo treatment, but he argues "What can be done to generate a better placebo? Why isn't that an interesting and valid area of investigation?" How telling: he thinks that even if the methods are just placebos, they still deserve funding. He doesn't seem to see the problems inherent in lying to patients - which is exactly what you're doing if you give them a treatment that you know is a fake.

Kudos to David Brown, and to the Washington Post, for shining some light on the use of NIH funds to support pseudoscience.

11 comments:

  1. With all the taxpayer monies going into research, some of it should be earmarked for alternative medicine research.

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  2. I think it is a dis-service to science by ruling out alternative medicine.

    Ayurveda is an ancient Indian science developed by scholars after experimentation. Negating it would be like negating the benefits of yoga that is developed by the same scholoars.

    Homeopathy has excellent remedies. For sore throat just taking one dose of Belladona, saved me a week of antibiotics. My first thoughts when offered this medicine was it is just non-sense. But it worked time and again for over 8 years now. It makes complete sense to me now.

    There are some excellent remedies that does even cost a penny to maintain good health.

    There are thousands are fake herbal cures that are being marketed today without any scientific basis. It is important to have an agency at least to fight these false claims.

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  3. Anonymous1: it's just not valid to earmark any research funding for a class of therapies that has no scientific justification. The same argument could be used to justify set-asides for all sorts of nonsensical work.

    Anonymous2: Ayurveda is in no way a science. It might be ancient and Indian, but that doesn't give it scientific validity. But you obviously are a true believer: you think taking Belladona - a very toxic plant - cured your sore throat? Not a chance. Luckily for you, homeopathic preparations don't actually contain anything but water. So you paid a high price for some water, drank it, and eventually your sore throat got better.

    And finally on your last point: NCCAM does NOT "fight these false claims". Herbal cures are largely unregulated, but when they do make medical claims, this is regulated (in the U.S.) by the FDA, which is completely separate from NIH and NCCAM.

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  4. I think the most interesting thing in the article is the mention of the "Office of Cancer Complementary and Alternative Medicine", which I had never heard of -- apparently there's *two* pseudoscience groups at the NIH, not just the (in)famous NCCAM.

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  5. I was quoted to at the end of Brown's article. I did not concede that most of CAM is placebo as Steven says (on the contrary there is an enormous amount of data supporting many CAM practices), rather pointed out that placebo is operative in all forms of medicine and that, rather than trying to isolate and eliminate it, we, as a society, should be trying to maximize it.

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  6. Re: "on the contrary there is an enormous amount of data supporting many CAM practices" - I can't let that go unchallenged. What CAM practices? Sure, there is data supporting some natural extracts that later turned out to have medicinal properties. But there is no scientific data at all - and no reason to believe there ever will be - to support homeopathy, Reiki, Healing Touch, Ayurveda, acupuncture, qi gong, magnet therapy, and half a dozen more belief systems (that's what I'd call them) supported by NCCAM.

    And it's misleading to state that "rather than trying to isolate and eliminate it [placebo], we, as a society, should be trying to maximize it." Excuse me? In a clinical trial, we try to isolate the effect of placebo, in order to determine whether a treatment has any separate effect otherwise. If a placebo effect helps a patient, that's fine. You are mistakenly conflating the design of clinical trials with the practice of medicine.

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  7. wow you've attracted all the nuts right here to your blog comments. great! keep up the good work shutting them down and shutting them up.

    can i add that as a soon-to-be-postdoc looking for fellowship funding that the NCCAM has its own separate postdoc fellowships. no idea how many they give out, but every one of them should be given to real scientists. or at best, the alternative medicine postdocs can compete against the masses, and stand on their own feet (fall over).

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  8. If you can see it, touch it, taste it, smell it or measure it then it doesn't exist. Your ignorance and arrogance shines brightly. If you don't know much about a subject (such as homeopathy) please don't pretend you are an expert.
    Too bad for you. Too bad for health care that you have such a loud voice.
    But it is a good thing you didn't become a medical doctor.
    You should come up to Harvard Medical School on a Thursday night to learn why medical doctors all over the world are learning about alternative therapies.

    But I do agree that the research on CAM therapies is a waste of time because the evidence based methodologies - RCT do not fit the model of care that alternative practitioners give. The treatments vary on a patient's condition it isn't one pill for one sickness. The model doesn't work. There is no way to have sham acupuncture. Also treatments are very practitioner/patient dependent as is any medical care.

    ...actually not sure why I waste my time here, you are so stuck in your limited thinking. I hope you eventually wake up to what is beyond your 5 senses.
    If you believe acupuncture points are bogus then you should meet up with the man in this url. I think you'll change your mind quickly. Please educate yourself before spewing false information.

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  9. Dr Salzberg, I'd like to commend you on your determination. I sincerely hope you aren't discouraged in the slightest by some of the nonsense on your comments board.

    Homeopathy? What a joke.

    The point is that once alternative medicine is proven as scientifically sound, it is no longer 'alternative'.
    There is no point in wasting time pursuing the research of subjects like homeopathy and reiki when time and time again, unbiased investigation shows them to be no better than a placebo.
    Imagine if someone found an ancient Egyptian text in the pyramids that advised putting sand in your ears to cure Athlete's Foot. Should we investigate that? Sure, by all means. But what if absolutely nothing is proven after rigorous trials? To continue research for the sole reason that others believe in it is completely irrational and unfair to those laboratories that are doing justified research.

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  10. Re. the National Cancer Institute (NCI) funding CAM, the blogger Orac (cancer surgeon and researcher) has written about this here
    .

    If you want to see at a glance how far nonsense is embedded into NCCAM, try this truly mind-boggling NCCAM "backgrounder" on "Energy medicine". I quote:

    -------------------------

    "Energy medicine is a domain in CAM that deals with energy fields of two types:

    * Veritable, which can be measured
    * Putative, which have yet to be measured...

    ...In contrast [to real measurable energy fields], putative energy fields (also called biofields) have defied measurement to date by reproducible methods."

    -------------------------------------

    Or: NCCAM divides energy into real and imaginary. And then behaves as if the imaginary is real. And no-one is allowed to point out that this is bull***t because this would be non-PC.

    Anyone remember Hans Christian Andersen's famous kids' story about the Emperor's New Clothes?

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  11. Good point, here is the text, but I can only post 4000 characters in the comment so it's only the first 1/2 or so.

    Critics Object to 'Pseudoscience' Center

    By David Brown
    Washington Post Staff Writer
    Tuesday, March 17, 2009

    The impending national discussion about broadening access to health care, improving medical practice and saving money is giving a group of scientists an opening to make a once-unthinkable proposal: Shut down the National Center for Complementary and Alternative Medicine at the National Institutes of Health.

    The notion that the world's best-known medical research agency sponsors studies of homeopathy, acupuncture, therapeutic touch and herbal medicine has always rankled many scientists. That the idea for its creation 17 years ago came from a U.S. senator newly converted to alternative medicine's promise didn't help.

    Although NCCAM has a comparatively minuscule budget and although it is a "center" rather than an "institute," making it officially second-class in the NIH pantheon, the principle is what mattered. But as NIH's budget has flattened in recent years, better use for NCCAM's money has also become an issue.

    "With a new administration and President Obama's stated goal of moving science to the forefront, now is the time for scientists to start speaking up about issues that concern us," Steven Salzberg, a genome researcher and computational biologist at the University of Maryland, said last week. "One of our concerns is that NIH is funding pseudoscience."

    Salzberg suggested that NCCAM be defunded on an electronic bulletin board that the Obama transition team set up to solicit ideas after November's election. The proposal generated 218 comments, most of them in favor, before the bulletin board closed on Jan. 19.

    NCCAM has grown steadily since its founding in 1992, largely at the insistence of Sen. Tom Harkin (D-Iowa), as the Office of Alternative Medicine (OAM) with a budget of $2 million. In 1998, NIH director and Nobel laureate Harold Varmus pushed to have all alternative medicine research done through NIH's roughly two dozen institutes, with OAM coordinating, and in some cases paying for, the studies. Harkin parried with legislation that turned OAM into a higher-status "center" (although not a full-fledged "institute"), and boosted its budget from $20 million to $50 million. NCCAM's budget this year is about $122 million.

    Research in alternative medicine is done elsewhere at NIH, notably in the National Cancer Institute, whose Office of Cancer Complementary and Alternative Medicine also has a budget of $122 million.

    The entire NIH alternative medicine portfolio is about $300 million a year, out of a total budget of about $29 billion. (NIH will get an additional $10.4 billion in economic stimulus money over the next two years, of which $31 million is expected to go to NCCAM.)

    Critics of alternative medicine say the vast majority of studies of homeopathy, acupuncture, therapeutic touch and other treatments based on unconventional understandings of physiology and disease have shown little or no effect. Further, they argue that the field's more-plausible interventions -- such as diet, relaxation, yoga and botanical remedies -- can be studied just as well in other parts of NIH, where they would need to compete head-to-head with conventional research projects.

    The critics say that alternative medicine (also known as "complementary" and "integrative" medicine, and disparagingly labeled "woo" by opponents) doesn't need or deserve its own home at NIH.

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