Jun 11 2009

CAM Research – Much Ado About Nothing

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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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