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Apr 15 2012

Votive candles and peacock feathers

The Economist paints a grim picture of the outlook for non-alternative aka sane medicine.

By one recent count four in ten American adults use some form of alternative therapy. If Dr Weil’s flourishing business and other programmes are any indication, these will grow even further. For six decades double-blind, randomised, placebo-controlled trials have helped doctors to sort science from opinion and to sift evidence from anecdote. Now those lines are blurring.

Powerful supporters have helped the cause. King George VI helped to ensure that homeopathy would be part of Britain’s newly created National Health Service (his grandson, Prince Charles, is also a fan). Royal Copeland, an American senator and homeopath, saw to it that the Food, Drug and Cosmetic Act of 1938 authorised homeopathic products. Sixty years on another senator, Tom Harkin, helped to set up the National Centre for Complementary and Alternative Medicine (NCCAM) at the world’s leading medical-research outfit, the National Institutes of Health (NIH).

The $1.5 billion that taxpayers have devoted to NCCAM has brought meagre returns. In 2009 Mr Harkin said it had “fallen short” and bemoaned its focus on “disproving things” rather than approving them. But it has spawned a new generation of research outfits. The University of Maryland’s Centre for Integrative Medicine has received $25m from the NIH for research. Separately it offers treatments such as reiki, in which a healer floats his hands over the patient’s body.

In 2003, with NIH funding, Georgetown University created a master’s degree in alternative therapies. The University of Arizona offers training in them for medical students and a two-year distance-learning course for doctors and nurses. The Consortium of Academic Health Centres for Integrative Medicine now has 50 members.

It reminds me of the Templeton Foundation – a matter of creeping legitimation.

The future for the alternative-therapy industry looks particularly bright in America. NCCAM continues to pay for research. Josephine Briggs, its director, says she is neither for nor against alternative treatments; she just wants to test which ones work and which do not (she is also interested in the effect of medical rituals). But Steven Novella, a vocal critic at Yale University, argues that the centre’s very existence fuels the cause. “People say, ‘The government is researching that, so it has got to be legitimate’,” he complains.

See? Templeton, exactly. “People say, ‘Serious academics are researching that, so it has got to be legitimate’.” Creeping legitimation.

 

 

24 comments

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  1. 1
    Pierce R. Butler

    Has the NCCAM so far ever given a stamp of approval to medicines or techniques which fail legitimate testing?

    Harkin may not have gotten what he wanted, but I have yet to hear that NCCAM has failed to do good science.

  2. 2
    'Tis Himself

    I made several attempts to be sarcastic about the promotion of woo but nothing I wrote could rinse the foul taste of “the $1.5 billion that taxpayers have devoted to NCCAM” out of my mouth.

  3. 3
    christopher moyer

    Pierce –

    They are failing to do good science when they research things that have no theoretical basis consistent with known scientific principles.

    -CM

  4. 4
    Ken Pidcock

    NCCAM on homeopathy:

    There are challenges in studying homeopathy and controversies regarding the field. This is largely because a number of its key concepts are not consistent with the current understanding of science, particularly chemistry and physics.

    Thing is, they’re not joking. The implication is that, perhaps, the current understanding of science fails to capture something important. Sound familiar?

  5. 5
    Ken Pidcock

    Hey, you know how FTB advertisements are often about religion? Well, I’m on this page looking at an ad for “Revelar, the first ever breath test for free radical damage. Grow your practice and change lives.”

  6. 6
    San Ban

    Health insurance companies often cover altmed hocus pocus in the USA, and there are docs qualified as “Naturopaths” in the directories of listed in major medical plans. Here is what Cigna says about these “doctors”: [Open in new window]

  7. 7
    Caryn

    Also, see “the state certifies these providers, so they must have evidence to support the efficacy of these practices.” In practice the states may just be leaning libertarian. Caveat emptor, and all that.

  8. 8
    Stewart

    If they made people make a binding choice between alternative medicine and medicine (i.e. you can only have one or the other for the rest of your life), you’d find the problem would largely be solved within a generation.

  9. 9
    Torquil Macneil

    The trouble is Stewart, that alternative medicines do have real therapeutic value in some circs. Doctors can’t prescribe placebos any other way.

  10. 10
    Chris Lawson

    The NCCAM is a legitimate exercise in testing alternative medicines, and it generally undertakes very high quality research that I often refer to when I’m looking up the various alternative medicines my patients present for my opinion. However…

    1. (@Pierce,) the NCCAM has failed to do good research on at least one occasion when they rushed into a stage 3 clinical trial for one of the less plausible alt meds without sufficient background research. That is, they took one or two rather unconvincing trials and jumped straight into a large RCT which is (i) a waste of money, and (ii) arguably unethical in that it exposed a large number of trial subjects to an inadequately tested substance. (I can look up the trial in question if anyone is interested.)

    2. Even though the NCCAM generally does good research, it has yet to show that its $1.5 billion bill has been worth anything because…

    2a. everything they have studied so far has failed to demonstrate a useful benefit…

    2b. and yet the alt med manufacturers continue to market the products which have failed testing for exactly the indications they are marketed at. In other words, regardless of the quality of the NCCAM’s individual trials, it has demonstrably not improved the behaviour of alt med manufacturers.

  11. 11
    Chris Lawson

    Caryn,

    If those states really were hardcore libertarian, caveat emptor states, there would be no such thing as medical registration or drug approvals process.

  12. 12
    Chris Lawson

    @christopher moyer –

    I have no problem with researching agents for which we have no or limited theoretical basis. Most science starts that way, and in medicine we still don’t really understand why paracetamol (acetaminophen) reduces pain and fever or how gold reduces rheumatoid activity.

    I have a big problem with researching agents in large RCTs that are not justified by the available evidence.

    I have an overwhelming problem with researching agents for which there is no evidence of efficacy AND which could only work in direct contradiction to multiple lines of established evidence in several scientific fields (e.g. homeopathy, iridology).

  13. 13
    Caryn

    Chris, I said “leaning libertarian”, not “hardcore libertarian.”

  14. 14
    Aliasalpha

    @’Tis Himself

    nothing I wrote could rinse the foul taste of “the $1.5 billion that taxpayers have devoted to NCCAM” out of my mouth.

    Have you tried a homeopathic mouthwash? Now available in every household tap!

  15. 15
    Ophelia Benson

    Interesting about 2b of your #10, Chris. So it’s heads we win, tails no result, I guess. If the research turns up a useful benefit for alt med, alt med will take it with thanks, and if the research fails to turn up a useful benefit for alt med, alt med will ignore the research.

    Quite a good racket, from their point of view.

  16. 16
    Andrew G.

    Even if all of NCCAM’s science were unquestionably good, its existence would still be promoting crankery and pseudoscience. Here’s where the funding really ends up:

    1. Actual time, materials and effort spent on performing the research studies. This is only a fraction of the total.

    2. Supporting the institution to which the researcher belongs (part of all research funding goes to the institution rather than being spent directly on the research).

    3. NCCAM funds training programs in alt med.

    4. NCCAM funds (independently of specific research grants) institutions specializing in alt med.

    5. NCCAM funds research fellowships and similar positions in alt med at otherwise respectable institutions.

  17. 17
    christopher moyer

    “I have no problem with researching agents for which we have no or limited theoretical basis. Most science starts that way, and in medicine we still don’t really understand why paracetamol (acetaminophen) reduces pain and fever or how gold reduces rheumatoid activity.”

    Sure, there are all kinds of substances that ought to be tested for therapeutic benefit. That’s just ordinary medical research. And, apparently, NCCAM does some of that when they fund research on herbal substances.

    But they fund a lot of other total nonsense with no basis in science, such as studies of reiki, homeopathy, traditional Chinese medicine, and the like – things which have no plausible way of working given what we know about the world today.

    To go back to your example, there is no reason (that I know of) why acetaminophen could not possibly have worked. The therapeutic effect of Tylenol does not depend on recitation of a spell, does it?

    -CM

  18. 18
    eric

    I think the NCAAM folks have done a reasonable job of turning a crappy and biased Congressional order into decent science. Could the money be better spent elsewhere? Yes. But as long as Congress sets aside a pot of money for research into alternative medicine, and orders an executive agency to spend it on such, I am glad this executive agency is spending it to hold alternative medical techniques up to the bright hard light of real science. If we must use tax dollars to build a bridge onto a small Alaskan isle, at least employ real engineers to do it. Build a bridge that will be safe to use, will actually support cars, etc…

    @10, item 2b is the most disturbing to me. It’d be nice if NCAAM had something like the FDA’s legal authority to stop false advertising.

  19. 19
    Pierce R. Butler

    christopher moyer @ # 3: … they research things that have no theoretical basis consistent with known scientific principles.

    The same could be said of other studies which led to major breakthroughs. Should Michelson and Morley have given up trying to measure the speed of light in different directions without having a theory of relativity? Should Hoffman have abandoned lysergic acid diethylamide because no one in the 1940s knew how microgram quantities of any chemical could affect brain function?

    Chris Lawson @ # 10 – Yes, please, do provide a little more info – enough to facilitate online searching, anyhow – as to NCCAM’s specific “rush[ing] into a stage 3 clinical trial for one of the less plausible alt meds without sufficient background research.” That’s a significant breach of relevant standards.

    … everything they have studied so far has failed to demonstrate a useful benefit…

    In other words, they have never given an unjustified seal of approval. We can’t say the same of, e.g., diplomas from just about every major university (HBS, I’m looking at you…).

    … yet the alt med manufacturers continue to market the products which have failed testing …

    So they don’t have recall or enforcement authority. That needs to go to Congress, and possibly the rule-setters at FDA; perhaps alt-med debunkers should also be taken to task for failing to make best possible use of NCCAM reports. In this light, you should be calling for NCCAM to be strengthened, not de-funded.

  20. 20
    christopher moyer

    Pierce (message #19):

    Sure, independent scientists should go ahead and study whatever they like. It doesn’t follow that they should be eligible for gov’t monies to do it with.

    And in any case, your examples do not come close to the absurdity of some of the things NCCAM funds. To use the Hoffman example, there are lots of reasons why ingesting molecules might affect one’s consciousness. There are no reasons to support – and plenty of reasons to rule out – that waving one’s hands over a person in an attempt to influence their subtle energy field will improve health.

    But again, if someone wants to study that independently or with private funds, go nuts. For the gov’t to support that is nonsensical.

    -CM

  21. 21
    Andrew G.

    Pierce @ 19: to consider a specific real example, given that we already know (thanks to many previous trials) that homeopathy doesn’t work in practice, and we further know that there’s no theoretical mechanism by which it could possibly work, what is the point of NCCAM funding a study on whether different homeopathic dilutions have any effect?

  22. 22
    Pierce R. Butler

    christopher moyer @ # 20 & Andrew G @ # 21 – Not knowing the details of particular studies – and lacking the qualifications to analyze them in depth if I did – I still think that there is worthwhile potential in conducting such work in ways that meets the stated standards of both alt-med advocates and mainstream science.

    To take homeopathic medicine for one example: from many reports, this remains popular in Europe (where consumer protection standards are often higher than in the US). I suspect h’pathic boosters there have a list of reasons why their practices fail in lab tests: repeating those tests, with those concerns addressed, by an agency with no axes to grind (whether those of the Prince of Wales Institute or Respectful Insolence Labs, Inc) should provide results useful to all concerned.

    If – as I think most here would expect – no efficacy above placebo is shown, that’s one more nail for the already-oversized hp coffin; if something of interest is found, that’s an opportunity for further research. Either way, work done “independently or with private funds” would, and probably should, be regarded as if it came from Andrew Weill, Suzanne Somers, or Bob Jones University.

    Should NCCAM succumb to the undoubted pressure that Harkin & others are applying to approve shit for shinola purposes, then to hell with ‘em. But so far, with the possible exception noted in # 10, they seem to have carried out their assigned work with integrity.

  23. 23
    christopher moyer

    Pierce –

    I appreciate your perspective and the clear and patient way in which you convey it. But this statement by you:

    “Not knowing the details of particular studies – and lacking the qualifications to analyze them in depth if I did – I still think that there is worthwhile potential in conducting such work in ways that meets the stated standards of both alt-med advocates and mainstream science.”

    …may have a lot to do with our present disagreement.

    I do research on massage therapy and, more recently, on meditation. Each of these are sometimes lumped in with alt med, though in my opinion they don’t deserve to be given they are legitimate practices with some demonstrated effects. (They do, however, attract a community of hangers-on and folks who are fond of many things that really are “alt med,” so maybe that is why they get classified that way.) I have been to several large-scale alt med-focused conferences, and I can assure you that NCCAM has funded some goofy stuff that the government should not be funding. And if you want to see and judge for yourself, I can direct you to the US gov’t databases that will let you see every grant NCCAM has ever awarded. Some are not at all controversial; some are controversial. Some are completely ridiculous.

    I’ll go out on a limb and say that no other branch of NIH is doing anything that would fit easily into the ‘completely ridiculous’ category. (Admittedly, we’d have to operationalize that…)

    Further, you refer above to the ‘standards of alt med advocates.’ I’m here to tell you, there aren’t any. Not scientific ones, anyway. These folks run a study (often badly), and if they don’t get the result they hoped for, they search for any trend in the data that might be suggestive and declare that “more research is needed,” even when it plainly isn’t. In other words, nothing is EVER disproven in that community, and that’s the problem.

    -CM

  24. 24
    Pierce R. Butler

    christopher moyer @ # 23 – thanks (particularly) for describing your situational viewpoint on this.

    They do, however, attract a community of hangers-on and folks who are fond of many things that really are “alt med,” so maybe that is why they get classified that way.

    By which logic a lot of mainstream medicine should be classified as white-collar crime. Only specific examination of actual practices should be used for classification – but that’s more the ideal than the practicality.

    … NCCAM has funded some goofy stuff that the government should not be funding.

    Pls come up with a rough total, so we can compare it with a day’s worth of US operations in Afghanistan.

    … no other branch of NIH is doing anything that would fit easily into the ‘completely ridiculous’ category.

    Check to see if GSA caters their conferences. (Less frivolously – how much of NIH’s budget might be categorized as subsidies for the pharmaceutical/med-tech/insurance/etc industries?)

    Moreover, we need to consider each “ridiculous” project and its context. You & I might agree, say, that reiki is rideikiulous, but if NCCAM’s reiki-”research” programs go to tests with potential debunk value, that’s not the same as giving money to train reiki practitioners. Figuring that would will probably take more than reviewing grant headings and numbers.

    … nothing is EVER disproven in that community, and that’s the problem.

    Does “that community” in this case include NCCAM people?

    I get the impression that NCCAM is producing shelves of detailed disproofs, which skepticist activists are ignoring due to prejudice against the source (see certain comments above). That, more than NCCAM’s funding per se, is the major waste of tax money here.

    Working on the borderlines of mainstream and alt- medicines, you probably experience a bit of such knee-jerk backlash yourself. No?

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