Aug 16 2007

Is NCCAM A Waste of Money?

I have long been a critic of the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health (NIH), the main organ of the federal government that funds medical research. The NCCAM, originally the Office of Alternative Medicine (OAM), was created by political fiat – forced through congress by advocates of CAM. It has since had a very uneasy relationship with the research community.

The acting director, Ruth L. Kirschstein, M.D., has recently submitted her request for the NCCAM 2008 budget – $121,699,000. The briefing is yet another fine piece of pro-CAM propaganda This one http://nccam.nih.gov/about/offices/od/directortestimony/0607.htm, but this is to be expected from someone who is asking Congress for more money. Government entities do have to constantly justify their own existence. So while we cannot expect Dr. Kirschstein to give an objective assessment, we can at least snipe at her from the science blogosphere.

She writes:

In the 7 years since it was established, NCCAM has built a global enterprise of scientific excellence and leadership in research on complementary and alternative medicine (CAM). NCCAM-supported studies, carried out at more than 260 institutions, encompass the wide range of CAM practices and have resulted in more than 1,500 scientific papers published in peer-reviewed journals. The progress that has been made by the research community in understanding the scientific basis of CAM is, in large part, attributable to the leadership of Stephen E. Straus, M.D., NCCAM’s director from 1999 to 2006. Under his leadership, CAM research has been established as a legitimate field of scientific inquiry that is laying the scientific foundation for the emerging discipline of integrative medicine.

Yes, all the appearance of legitimate scientific research without the real substance. The main problem with the NCCAM is that it fails at the core raison d’être of medical research – to change the practice of medicine, to make it better. The only true measure of the success of a clinical (I stress clinical, because this does not apply to basic research) research program is the net effect it has on the practice of medicine. As I and others have pointed out, in the decade of its existence the NCCAM/OAM has failed to definitively establish any previously CAM modality as scientifically legitimate. Further – and more significantly – it has failed to provide definitive evidence of the lack of efficacy of a CAM modality in such a way that the modality has been abandoned by practitioners.

One might argue that this is a failure of the practitioners and not the research, but the two cannot be cleanly separated. The research is conducted largely by proponents and practitioners, and it is the practitioners – those ideologically in support of CAM – who are calling for the research, then ignoring any inconvenient results.

Skeptics, who are often conflicted on this issue, sometime point out that it is better to have the data than not to have it. It is certainly useful to have a solid negative study to point to when evaluated a dubious treatment. I am not sure I am willing to spend limited healthcare research dollars to get it, however. It seems that the people who listen to such research don’t need it, because they don’t accept the nonsense in the first place; and those who do need the results don’t listen to them. So what’s the point.

At the very least the scientists who are participating in this research and the politicians who are funding it have a responsibility to make sure that the results influence the practice of medicine. Of course, this would mean subjecting CAM to scientific standards, and that is not what proponents want – they want a double standard, an easier, anything goes, standard for CAM.

The NCCAM itself is a reflection of this very double standard. Why can’t studies of CAM modalities be funded through the regular NIH? Because the NIH has standards, and what passes for research in the CAM world is often so laughably pathetic that it could never mean the NIH standard and get funded. NCCAM was created to provide a much lower standard for CAM research. In other words – waste money on studies that are not worth funding when judged by the usual criteria.

As an alternative to the NCCAM we could just require those wishing to do research on CAM modalities to meet the strict scientific standards of the NIH. Well, let’s not get crazy.

What bothers me most about Dr. Kirschstein’s testimony to Congress is that it assumes there is value in CAM. Rather than asking – does any of this work, it takes as its premise that it has a “scientific basis,” that it is “legitimate” and that integrative medicine is an “emerging discipline.” This is all very typical of the pro-CAM crowd.

Rather, the NCCAM should be trying to find out IF there is any scientific basis or legitimacy to anything in the CAM world. I challenge Dr. Kirschstein to name a single CAM modality that has gained real scientific legitimacy – and I don’t mean fake CAM modalities that have just been stolen from mainstream scientific medicine, like nutrition.

Even at the plausible end of the spectrum – herbal therapy – these should be treated like any other pharmacological agent. Rather, they are treated by a magically different standard simply by labeling them as “supplements.” This is fiction. Basing a research program on fiction is inherently flawed.

In he final analysis the NCCAM serves only as a means of propaganda to support CAM. I am hoping that as an unintended consequence we might squeeze out some legitimate research, and we (meaning real scientists and professionals) can use this to support a rational backlash against CAM. It certainly is having no influence in the CAM world itself.

I will happily revise my opinion on the day that a major CAM modality, like homeopathy, is truly abandoned by mainstream CAM (if there is such a thing) as worthless. Until that day, there is no reason to believe that every dime spent by the NCCAM is not a complete waste.

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