Jun 11 2009

CAM Research – Much Ado About Nothing

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Comments: 24

After a decade of research, and 2.5 billion dollars of taxpayer money, government funded research into so-called “alternative” medicine has little to show for it. The AP has put out a fairly insightful review of this research, which echos many of the points I have been making over the years.

They report:

Echinacea for colds. Ginkgo biloba for memory. Glucosamine and chondroitin for arthritis. Black cohosh for menopausal hot flashes. Saw palmetto for prostate problems. Shark cartilage for cancer. All proved no better than dummy pills in big studies funded by the National Center for Complementary and Alternative Medicine. The lone exception: ginger capsules may help chemotherapy nausea.

As for therapies, acupuncture has been shown to help certain conditions, and yoga, massage, meditation and other relaxation methods may relieve symptoms like pain, anxiety and fatigue.

And to reinforce that point:

(Dr. Josephine Briggs) conceded there were no big wins from its first decade, other than a study that found acupuncture helped knee arthritis. That finding was called into question when a later, larger study found that sham treatment worked just as well.

Dr. Briggs is the current director of the National Center for Complementary and Alternative Medicine (NCCAM) – the NIH center that funds this research.

To summarize – the government spent 2.5 billion dollars to determine that unpurified, poorly controlled drugs with generally low doses of active ingredients don’t work very well, that treatments based upon unscientific notions don’t work, and exercise and relaxation make people feel better. Oh – and they found that acupuncture does not work, proponents just haven’t noticed yet.

Actually, the government spent 2.5 billion dollars to advertise and promote unscientific medicine to the public.

And yet Briggs says that they are just getting started. “More research is needed,” is the mantra of CAM scientists, no matter how much negative evidence is piled on top of implausibility.

The report included some juicy quotes from names I recognize.

“There’s been a deliberate policy of never saying something doesn’t work. It’s as though you can only speak in one direction,” and say a different version or dose might give different results, said Dr. Stephen Barrett, a retired physician who runs Quackwatch, a web site on medical scams.

That’s right. The NCCAM never met an alternative modality that did not work. I have pointed out that the point of medical research is more often to weed away what does not work. Further, science-based medicine means stopping the use of modalities that are shown to be unsafe or ineffective. CAM proponents never (to my knowledge) do that. NCCAM researchers have not crossed a single CAM modality off the list.

“It’s the fox guarding the chicken coop,” said Dr. Joseph Jacobs, who headed the Office of Alternative Medicine, a smaller federal agency that preceded the center’s creation. “This is not science, it’s ideology on the part of the advocates.”

Jacobs was the first director of the OAM – and resigned for the very reason he states above. He saw what was happening – the office was created to promote an ideology, not conduct scientific research. So he was replaced by Wayne Jonas, a homeopath, who apparently was a much better fit.

“You expect scientific thinking” at a federal science agency, said R. Barker Bausell, author of “Snake Oil Science” and a research methods expert at the University of Maryland, one of the agency’s top-funded research sites. “It’s become politically correct to investigate nonsense.”

Go, Barker.  It is also politically-incorrect to criticize nonsense, even within academia.

“There’s very little basic science behind these things. Most of it begins with a tradition, or personal testimony and people’s beliefs, even as a fad. And then pressure comes: ‘It’s being popular, it’s being used, it should be studied.’ It turns things upside down,” said Dr. Edward Campion, a senior editor who reviews alternative medicine research submitted to the New England Journal of Medicine.

Again – a point I have hammered for years. The CAM philosophy seems to be to promote first and ask questions later.  And then keep promoting, no matter what the answers are. It is a bizzaro world of scientific medicine.

The response to negative data is also very telling. After a massive echinacea study showed no effect for the common cold – it’s most common use – proponents said that the wrong species was used. Like those who submit for the Million Dollar Psychic Challenge, this criticism came only after the study was negative. I wonder if they would have thought that if the study were positive.

But also this shows the bias in this community – treatments are thought to be effective until proven otherwise, as if they are “innocent until proven guilty.” But that is not the world of scientific medicine, where treatments are assumed not to be safe and effective until they are adequately demonstrated to be. Echinace sellers place the burden of proof on others to demonstrate that their products do not work – and of course they can set the standard as high as they wish. Until you test every part of the plant of every echinacea species in a high enough dose with every cold-causing virus – you have not proven it doesn’t work.

Unfortunately, US laws currently validate this bizzaro world view. The supplement industry can assume safety and efficacy and make all sorts of quasi-health claims for their products, and the burden of proof is on the FDA to show that they are unsafe, or on the FTC to show that they are making fraudulent claims.

What this means, in my opinion, is that the NCCAM is broken, and it cannot be fixed because it’s very reason for existing and founding philosophy are broken. It seeks to set a double standard for medical research. In so doing it serves only to promote unscientific modalities. Negative studies do not make ineffective modalities go away. There is no legitimate role for scientific evidence in an unscientific profession.

Having said that, I do think that certain individual studies within the NCCAM may be useful – especially those with herbs. As I have said before, herbs are drugs, they are just not purified. But herbal research can be funded without the NCCAM, through botanical research. Any other modality can fend for itself within the normal rules of funding research – show that you have some basic research to back up your claims and that there is a reasonable prior probability for safety and efficacy.

The NCCAM double standard has not served the public well. It has wasted a great deal of money, and worse it has given a significant boost to health claims and modalities that don’t work and the practitioners who use them. The NCCAM should go away.

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24 responses so far

24 Responses to “CAM Research – Much Ado About Nothing”

  1. Jim Shaveron 11 Jun 2009 at 10:17 am

    Thanks for another great article, Dr. Novella.

    One thing, regarding this:

    The CAM philosophy seems to be to promote first and ask questions later. And then keep promoting, no matter what the answers are. It is a bizzaro world of scientific medicine.

    Don’t you mean it is a bizzaro world of unscientific medicine?

  2. Steven Novellaon 11 Jun 2009 at 10:39 am

    No – scientific medicine is the real world, and NCCAM is the bizzaro world counterpart to scientific medicine.

    Or, you can look at it as – NCCAM is scientific medicine in bizarro world.

    I guess I wasn’t clear.

  3. HHCon 11 Jun 2009 at 11:39 am

    Some techniques that are reported to work may not. Take yoga, for instance. If you have herniated discs or degenerating discs, you certainly can irritate the discs depending on the position of the exercise and whether you are moving your body forward or backward. Massage may not be therapeutic if the masseuse or masseur creates bruises by being heavy-handed or rants about his/her personal problems during the session. Meditation and relaxation techniques can do the opposite depending on what anxiety-producing thoughts the consumer is focused on. As for glucososamine chondroitin sulfate, I have used it continuously at the recommendation of an internist to repair disc herniations. I use the brand on which clinical trials have been conducted. I also use the brand utilized in Europe. In fact, the European brand is considered a prescribable medication. At least I have been successful at disc repair.

  4. DevoutCatalyston 11 Jun 2009 at 12:13 pm

    CAM doesn’t “own” the categories which they purport to be “theirs”. A good speed bag session is meditative and you don’t need a guru or scented candles. The inessential trappings, the exclusivity, can be safely discarded, if desired.

    There are alternatives to alternative medicine. You can learn massage with a partner in less than an hour, and thereafter spend a lifetime honing your skills with someone you love, alternating roles, giving then receiving. Experience the thrill of drawing closer to another human being, without the contamination of judgmental attitudes which organized massage too often hacks up towards conventional medicine.

    And so on. Get a life.

    I don’t worship at the house of CAM. Anything they’ve hijacked that’s actually good can be liberated and explored some other way. Joyously.

  5. Steven Novellaon 11 Jun 2009 at 12:28 pm

    Devout – I agree. The real problem is the false dichotomy created by this artificial category. Each modality should be looked upon for it own merits. And they did hijack much that was already part of common sense and mainstream medicine – like massage, relaxation, nutrition, etc. Or, they make woo claims for these things that go beyond evidence.

    And that is my biggest problem with the NCCAM – it perpetuates this fake category and double standard.

  6. Karl Withakayon 11 Jun 2009 at 2:15 pm

    The article gets one thing wrong,

    “…acupuncture has been shown to help certain conditions…”

    Even though it doesn’t matter where you use the needles, or if the needles even penetrate.

    I guess if you consider placebo effective, you can consider acupuncture effective as well.

  7. Watcheron 11 Jun 2009 at 2:16 pm

    Another thing i find amazing is that this arm of the NIH, no matter how it got there, has not funded something that is medically viable since it’s inception 10 years ago. Talk about failure …

  8. Watcheron 11 Jun 2009 at 2:17 pm

    @Karl

    Yeah that bugged me when they said that even though they qualified it later on in the article. :(

  9. HHCon 11 Jun 2009 at 3:20 pm

    Its true physical movement can be meditative.

  10. superdaveon 11 Jun 2009 at 7:16 pm

    The NCCAM was invented to prove altmed correct, and yet i have read many comments on this story claiming that it is just part of the anti alt med conspiracy. That just makes so much sense..(eye roll)

  11. spliceron 11 Jun 2009 at 8:05 pm

    Steve I’m glad you saw this too. The AP link did not show the author but it was written by Marilynn Marchione and she is shown as a medical writer. She had this article and several others this week on CAM and supplements.

  12. Michael Kingsford Grayon 11 Jun 2009 at 8:28 pm

    @Karl:
    Acupuncture has most decisively been found to relieve at least one condition: a congested wallet.

  13. sonicon 12 Jun 2009 at 4:59 am

    This news report needs to be put into context.

    The article says-
    “…The lone exception: ginger capsules may help chemotherapy nausea.
    As for therapies, acupuncture has been shown to help certain conditions, and yoga, massage, meditation and other relaxation methods may relieve symptoms like pain, anxiety and fatigue.”

    So we spent 2.5 billion to find a treatment for chemo nausea and a number of therapies that are effective for various symptoms. These therapies may be more appropriate than the usual addictive, narcotic, mind-altering, drugs that are often prescribed for some people. (I for one would prefer a relaxation method to an addictive narcotic)
    2.5 billion might be seem high, but read this-

    http://csdd.tufts.edu/NewsEvents/RecentNews.asp?newsid=29
    “BOSTON – May 13, 2003 – The fully capitalized cost to develop a new drug, including studies conducted after receiving regulatory approval, averages $897 million, according to an analysis released today by the Tufts Center for the Study of Drug Development. “

    So we may have actually done well for the money spent. The drug companies would not give us this many valuable remedies for the 2.5 billion. And they certainly would not inform us of the failures of many popular elixirs while they were at it.

    Next- I agree that there is a problem with the people running the studies putting a spin on the results and the various conflicts of interest. But to say that is a problem for CAM and not all medicine would be wholly inaccurate–

    (An example of a drug company spin)

    http://www.miamiherald.com/living/health/costs/story/1073030.html
    “The company said in a press release that the trial of the drug, called CPP-109, did not show that ”a significantly larger proportion of CPP-109-treated subjects than placebo-treated subjects were cocaine-free during the last two weeks of the treatment period,” which was weeks 11 and 12 of the trial. Chief Executive Patrick J. McEnany told The Miami Herald, “We’ve only begun our analysis of the data. The data is immense. We’re trying to get our arms around it.’ He noted the drug had performed well in three prior human studies, and he wasn’t sure why this study was different. “Cocaine addicts are a very unpredictable group.” A study in Mexico had much more positive results, he said, and Catalyst scientists will be examining whether differences in demographics could have led to different results.”

    (This accusation goes beyond spin)

    http://www.theage.com.au/news/national/drug-firms-manipulating-trials/2006/08/06/1154802756201.html ONE of Australia’s most senior cancer specialists has accused pharmaceutical companies of manipulating some clinical trials of medicines for commercial reasons, including deliberately delaying the release of negative findings and being reluctant to fund research into the toxicity of their drugs.

    (Did someone say ‘conflict of interest’?)

    http://www.theage.com.au/news/national/conflict-of-interest-problem-endemic-specialist/2006/08/06/1154802756204.html Professor Tattersall, a cancer specialist, also has a big problem. He says that finding experts to sit on the committee is now all but impossible because so many doctors have “huge conflicts of interest” with drug companies.

    So at first glance these results might seem expensive and worthless, but actually they are not expensive, they did find valid therapies and they did show that a number of popular remedies are not useful. One should not be put off by the fact that the MSNBC choose a headline that is misleading. The purpose of the headline is often to excite emotion. If a headline excites emotion, then it might run even though it is a misrepresentation of the material in the article. Something about selling papers- Go figure.

    Further- while it may be true that the people in charge of the studies do some spinning of data and exhibit conflict of interest, to conclude that this is a problem specific to these studies would be incorrect.
    I think that given this track record it is probably a valid and valuable function of government to continue to do scientific studies on popular medical type remedies.

  14. Steven Novellaon 12 Jun 2009 at 7:46 am

    Sonic – the comparison to pharmaceutical research is not meaningful for many reasons. First, drug development is extremely expensive because of FDA regulations. This is good and necessary – but they can’t be blamed for following the rules.

    Drug development also include a great deal of basic science – chemistry, finding targets, animal research – and this expands our medical knowledge beyond the development of a single drug.

    Also – if you want to know which drugs fail, just check out the FDA website. Companies have to register every drug they carry to human trials.

    Also – I agree that drug companies are corporations out for their own profit, and they spend serious money on spin and distortion. That is why they need to be highly regulated, which they are. This is not “medicine” – this is the pharmaceutical industry.

    The medical community does not spin negative results – they change their practice.

    And you cannot compare NIH funded research to the pharmaceutical industry. You should compare NCCAM research to other NIH research. That is the point. NCCAM has special rules and exceptions for studies that would not get funded through the regular NIH rule – because they shouldn’t be. The string of negative studies is evidence of that.

    The claims used to support the NCCAM were that it would find a lot of useful therapies that were being ignored, or at least help weed out the chaff. It has done neither.

    The positive studies on yoga, etc. were just confirming some basic things that were already known. We did not need the NCCAM to tell us that exercise, relaxation, and stretching are good for you.

    Same for ginger (which is still preliminary, I might add) – let the botanical researchers who actually know what they are doing research herbs. Many of them are actually angry that their field has been “ghettoized” – their term – by its association with CAM.

  15. HHCon 12 Jun 2009 at 11:27 am

    Yep, yoga is good for you especially when you have tendonitis in your shoulders from too much exercise and you hold the plank position for a prolonged time:-D

  16. HHCon 13 Jun 2009 at 2:08 pm

    Yoga does involve hyperextension. If you succeed in positioning yourself into yoga postures, you will move vertabrae segments out of the normal alignment. The question then becomes what do you do after you have misaligned the spine with exercise?

  17. artfulDon 13 Jun 2009 at 2:13 pm

    Malign it further with chiropractic?

  18. HHCon 13 Jun 2009 at 6:18 pm

    Malign means to speak ill of, your word choice is improper. I could suggest a sports physician.

  19. artfulDon 13 Jun 2009 at 7:24 pm

    The use of the word malign was deliberate. It’s known by the more astute as a play on words.
    Any reason why you, being a chiropractor, asked the question and then decided NOT to recommend chiropractic. Or is “sports physician” a euphemistic term for same?

  20. HHCon 14 Jun 2009 at 8:08 pm

    artfulD, I am not a chiropractor. A sports physician has a M.D.

  21. artfulDon 14 Jun 2009 at 8:29 pm

    Sports physicians don’t ordinarily support chiropractic voodoo, so if you’re implying you’re an M.D., you’re not fooling anyone.

  22. [...] there didn’t appear to be anything happening this weekend that so inspired me to post, and Steve Novella already discussed recent articles in the AP about CAM and how, after an investment of over $2.5 [...]

  23. HHCon 15 Jun 2009 at 3:56 pm

    artfulD, I am not a D.C. or an M.D. I’m just Jane Q. Citizen.

  24. Zelockaon 16 Jun 2009 at 3:55 pm

    Sorry but I would need to see the details on the studies. The AP story is way too broad and while I agree that most claims are total crap (vitamin C being a big example of a completely useless supplement outside of scurvy),

    I dislike blanket statements being dropped when specific studies are more useful. Also without the details there is no way to tell how accurate these studies are. Just because they are government funded doesn’t mean they have enough of a group to be statistically accurate or have all the secondary factors controlled or even that there methods of testing success are correct. Then again I have the same issue with drugs that are FDA approved. :p

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