It's that time of year again! Time for the one Center of the NIH dedicated to studying "remedies," regardless of how scientifically implausible or lacking in evidence to support them, the National Center for Complimentary and Alternative Medicine (NCCAM) to put forth its budget request for FY 2008. What's the bill for government-funded studies of woo?
Depressing. Let's see what the possible justification is for sending $121 million on studying things such as homeopathy:
Large numbers of American health care consumers are using CAM modalities in an effort to preempt disease and disability or promote health and a sense of well-being. Despite the relative paucity of information about the effectiveness and safety of these uses, Americans are de facto personalizing medicine through approaches that often require their active ongoing participation in a diverse variety of health practices and behavior change approaches.Driven largely by consumer demand for CAM, integrative medicine -- which can be defined as a health care approach that makes use of all appropriate evidence-based disciplines, therapies, and health care professionals to achieve optimal health and healing -- is rapidly becoming a major force shaping health care systems in the United States and around the world. At the same time, studies continue to show that open communication between conventional medical practitioners and their patients about CAM use is uncommon. Such communication is vital to ensure well-coordinated, comprehensive, and safe care.
In other words, scientific evidence and plausibility doesn't matter; because a lot of people believe this woo, we have to spend your taxpayer dollars to try to come up with "scientific" evidence that it works. More annoyingly, NCCAM claims:
Whether a study's result is positive or negative, we expand our knowledge not only about the tested therapy, but also learn more about the condition it is supposed to treat.
Here's the problem. Negative studies don't matter. If a study shows that a particular CAM "remedy" does no better than placebo, CAM practitioners don't believe it. Can anyone point me in the direction of a single "alternative" remedy that, after multiple negative studies, has been abandoned? For example, multiple studies show that chelation therapy for cardiovascular disease is no better than placebo. Yet, people still use it, and NCCAM is still studying it to determine whether it is efficacious. Indeed, there appears to be no woo so implausible, so without basis in science, that NCCAM won't take it seriously. Homeopathy? Check. Qi gong? Check. Craniosacral manipulations? Check. In children, yet! Shamanic healing? Check! Distant healing? Check!
Your tax dollars hard at work.
I used to think that NCCAM had value, but over the last couple of years I've come to realize that it's the only branch of the NIH dedicated to promoting pseudoscience. It's the political construct of woo-loving Senators and Representative to put the imprimatur of the federal government on quackery. It does fund some decent studies on herbal remedies, but if you wander beyond plausible treament modalities with pharmacological activity, you find that almost no woo is too beyond the pale to be supported by NCCAM.
Given the current tight budget of the NIH, this $120 million could be better spent distributed among the various Institutes, rather than locked up to study so much dubious "science." There is nothing that NCCAM does that couldn't be done better with its functions dispersed throughout the rest of the NIH. Good studies of herbal remedies and other "alternative" treatments would be funded, regardless of whether its NCCAM or another Institute, while other Institutes wouldn't waste money funding studies of quackery like distant healing.
I often wonder if this is a wedge strategy to increase religious right power...if other woo is ok, so is faith healing, and we can keep the dollars away from evilllll stem cell research, etc.
I often wonder if this is a wedge strategy to increase religious right power...if other woo is ok, so is faith healing, and we can keep the dollars away from evilllll stem cell research, etc.
Orac,
Not sure how government funding works, but couldn't you get a piece of the pie by getting a big grant, then spending $5 of it to produce a report with "Doesn't Work!" in large, friendly letters on the front cover? Spend the rest on actual research.
I'm lobbying for "herbal remedies" to be renamed "random dosages of several different unknown substances of unknown effects."
I think obscurifer has the brilliant idea here though. Skeptical scientists should be applying for grants from this center. Even if they get turned down for hostility, that's still a pretty darn good lobbying point that these modalities and this center are basically scared of critical examination.
One thing stood out for me - a reference to open communication between doctor and patient. Woomeisters know to portray themselves as being in favor of same, while conventional practitioners are portrayed as being unwilling to communicate openly.
Research sponsored by the NCCAM cannot be different from research sponsored by the NSF, which looks for the origin of man in the Creation Museum in kentucky.
I don't mind money being spent researching CAM, although $120m seems like a lot. After all, the only way we're going to debunk it is with hard evidence, although obviously it will never go away completely. It's better than spending government money to promote CAM and call it science, as the British government does.
PalMD, this nonsense is bipartisan. Plenty of new-age pseudo-science originates on the left.
I do think it's a wedge, though. Not for the religious right, but for quackery. Those promoting quackery use tactics virtually indistinguishable from those employed by the Discovery Institute, after all -- in particular, hypocritical arguments about "equal time", freedom of choice, and fairness that ultimately result in none of those things.
In this case I disagree. 121 million is a pittance in the total NIH budget which is something around 20 billion dollars?
Yet millions of Americans are enthralled with Alternative Cures, and probably waste at least that much money purchasing them.
Rather than leave those people in the dark about whether these treatments are worth anything I like to think that by studying them some small light of reality will be shed. The government is a major supplier of information across the economy and I can not begrudge $120 million spent to provide a little bit regarding these so called "cures."
AnnR,
In more than a decade, NCCAM has never debunked any quack remedy, although studies of them always yield negative results. They do leave people "in the dark" by discounting those negative results.
If the $120M (much more, over the years) were well spent, it would result in confirmation of some methods and/or rejection of others. It has done neither. Continuing the expense is like getting married after nine divorces- a triumph of hope over experience. Einstein noted that "insanity" is doing the same thing repeatedly, hoping for a different result.
What you suggest is an ideal that has not been realized, and is unlikely to be realized.
"One thing stood out for me - a reference to open communication between doctor and patient. Woomeisters know to portray themselves as being in favor of same, while conventional practitioners are portrayed as being unwilling to communicate openly. "
Many doctors are not willing to communicate openly on this matter, i.e. tell patients they are dumb to even think of using a homepathic remedy, as they may end up having to look for the next patient.
But here is way they can do it. "Well there is a lot of controversy about this stuff - you can read some of this on these sites": Orac, Improbable science etc etc.
I stand corrected...perhaps there is some from the right, but anyone who wants to make a buck on woo will prolong the agony with studies as long s possible.
Great post. I'll probably pile on tonight if I'm not too tired.
rw
obscurifier: "Not sure how government funding works, but couldn't you get a piece of the pie by getting a big grant, then spending $5 of it..."
That is an excellent idea. In fact, I am a participant on two such grant applications right now. I had to hold my nose, shut up for a while and listen to woo put forth by various collaborators on the applications; but if it succeeds I can get funds to do some good science.
How on earth did they get ethical approval for the chelation study? There's good evidence that this doesn't work, and the 'therapy' does have risks attached.
What about informed consent, too? Wouldn't they need to tell patients something like - 'there's good evidence that the treatment we want to test on you won't work, and here's a list of possible side effects'.
Sailor wrote:
Ha! Exactly! "Teach the controversy!"
~David D.G.
Can anyone point me in the direction of a single "alternative" remedy that, after multiple negative studies, has been abandoned?
Completely abandoned? No, I don't think so. But it's too soon to say that there's been no effect to negative studies, mostly because nobody's studied the spread of these practices and how people make the decision to use them or not.
My gut (ample, if not evidence) suggest that there's a "maybe" group out there -- possibly very large -- for whom negative results can be persuasive and can increase their resistance to "unconfirmed" alternative methods.
Jon asked:
How on earth did they get ethical approval for the chelation study? There's good evidence that this doesn't work, and the 'therapy' does have risks attached.
What about informed consent, too? Wouldn't they need to tell patients something like - 'there's good evidence that the treatment we want to test on you won't work, and here's a list of possible side effects'.
Yep:
http://www.circare.org/tact/tactconsentform_20030113.pdf
bloody hell - who'd agree to participate after seeing that consent form? Then again, given how many people pay to have this done...
Maybe the 46 million Americans without health insurance have to have something to cling to for hope.
The only way to get rid of woo is a few large felony manslaughter or negligent homicide cases. The woo-believers, however, like the poor, will always be with us.
bloody hell - who'd agree to participate after seeing that consent form?
Not many, apparently: http://www.clinicaltrials.gov/ct/show/NCT00044213?order=1
The original N was 2372 with completion in 2007; now N=1950 with closure projected for 2009. Power calculation anyone?
Budget cuts forced them to drop academic medical institutions (high F&A fees) in favor of "community chelation clinics."
In the real world studies are terminated when they fail to accrue. Not so in NCCAM wonderland it seems.
Sigh.
PalMD, this nonsense is bipartisan. Plenty of new-age pseudo-science originates on the left.
Not true. I'm an ardent conservative, and practice CAM.