Respectful Insolence

Be afraid, be very afraid

So there I was, wandering through the exhibit hall at AACR when I came across the National Cancer Institute booth. The NCI has a booth at AACR and ASCO every year, and this year is no different. As I do most years, I wandered through the booth to see if there was anything that caught my interest, such as information that might help me stay funded.

There it was. No, not any information that could help me keep my NIH funding, alas. Worse, it was something that might make it even more difficult if in this tight funding environment the NCI is actually spending money on this stuff. The sign read:

i-903e8f14bef1e4f759f8170c1c66a076-NCICAM.JPG

(Sorry, I used my camera phone.)

Assuming this doesn’t interfere with a meeting I’m supposed to have with a friend and collaborator of mine (which, of course, must take precedence but hasn’t been finalized yet), I think I might find a reason to mosey on over to the NCI booth tomorrow. Anyone attending the AACR Meeting who is interested in finding out how much the NCI is spending on woo should make it over there too. I thought NCCAM was the only source of NIH funding for unscientiific medicine, but apparently I’m wrong.

Comments

  1. #1 Bob O'H
    April 14, 2008

    Perhaps it’s a comedy routine.

  2. #2 DanioPhD
    April 14, 2008

    You must go, Orac. And ask LOTS of questions.

  3. #3 The Integral
    April 14, 2008

    2 stupid questions.

    Stupid question 1: are ALL forms of “alternative medicine” necessarily woo?

    Stupid question 2: what about alternative medicine determines whether it is or isn’t outright woo?

    wait………this question doesn’t count as a stupid question but what the h*** is alternative medicine anyway? Alternative……as opposed to conventional medication, surgery methods, imaging methods, all of the above?

    I’m sure you’ve written several posts already on these topics……I just haven’t seen them yet.

    Links to them or just their titles (and I’ll do the digging) are very much appreciated…..
    thanks

    The Integral

  4. #4 eldereft
    April 14, 2008

    @The Integral – click on the “Alternative medicine” and “Quackery” tags just under the title of the post. Last Friday’s field guide to “Alties” is a bit long and insolent but should clear things up a bit. As I understand it, so-called alternative medicine consists of implausible and insufficiently tested interventions which promote themselves by other than scientific means. They invert the usual process by asserting a method, then demanding that evidence be found supporting it. This is in direct contrast on all three points to reality-based medical claims, which begin with a plausibility and then seek evidence supporting or controverting the effectiveness of the treatment. This should not be confused with the genuine role of professions such as nutritionist or physical therapist.

  5. #5 ellazimm
    April 14, 2008

    To use a Monty Python quote: Run away! Run away!

    I’d avoid eye contact as well.

  6. #6 Dan
    April 14, 2008

    Orac wrote: “I thought NCCAM was the only source of NIH funding for unscientiific medicine, but apparently I’m wrong.”

    You fail to take into account that Bush is still in office.

  7. #7 Abel Pharmboy
    April 14, 2008

    Actually, NCI’s Office of Cancer Complementary & Alternative Medicine (OCCAM) has roughly the same budget as NCCAM (~$120 million). However, I think you’ll find that this agency is far more science-based than NCCAM and is far more dedicated to protecting cancer patients from evidence-null woo. Their literature for patients and practitioners on CAM modalities is highly accurate, evidence-based, and highly-critical of the more egregious forms of alternative medicine in the oncology setting. This is particularly important since, as Orac is well aware, cancer patients are among the most lucrative market for woo.

    NCI is the only IC that has a separate office dealing with CAM modalities in their patient population – it’s actually a far better model than NCCAM in that the latter covers every CAM modality in every medical subdiscipline; it just simply can’t be done. Add to that NCCAM was founded as an advocacy entity while OCCAM was founded to address the veracity wacky approaches used by and promoted to cancer patients. I’ll be interested to hear what Orac thinks of the session but if things haven’t changed since I last had interactions with OCCAM staff, he’ll find the group to be far more critical than anything I’ve seen pumped out by NCCAM.

  8. #8 R N B
    April 14, 2008

    There is an obvious way to differentiate real medicine from CAM – real medicine has been proven to work. Simply, alternative method either has not been tested or has failed the tests.

    The long and insolent list had loads of ways to identify an altie, but it was a bit random and repetitive, I really think it needs to be sorted and classified. Sorry I’m not volunteering here.

  9. #9 Orac
    April 14, 2008

    I’m not 100% sure that I can make it to this session anyway. The reason is that a collaborator of mine wants to do a lunch meeting. If I can’t put him off until after 1:30 or 2 PM, I won’t be able to go. My research has to take precedence over blog material. We’ll see.

  10. #10 Dr Aust
    April 14, 2008

    I wonder what wit in NCI came up with the title to give the Division covering complementary medicine the rather apposite acronym OCCAM…?

    From Wikipedia:

    “Occam’s razor (sometimes spelled Ockham’s razor) is a principle attributed to the 14th-century English logician and Franciscan friar William of Ockham. The principle states that the explanation of any phenomenon should make as few assumptions as possible, eliminating those that make no difference in the observable predictions of the explanatory hypothesis or theory.”

    As an exercise, try applying this useful principle to any paper purporting to show real effects of something like distant healing, asking yourself:

    “To accept this as a real action of healing energy, what underlying assumptions do we have to make? Is there any basis for these assumptions?”

  11. #11 BB
    April 14, 2008

    Orac, can you draft a friend to go later today? Would be interesting to learn more about that session.

  12. #12 PalMD
    April 14, 2008

    My research has to take precedence over blog material.

    Are you FRIGGIN’ INSANE?!?!? How can that be??

  13. #13 Steve
    April 14, 2008

    I would think that people would welcome scientific testing of any alternative methods, to help usher them into the fold of “evidence based medicine” or into the outer darkness, so to speak. At the very it should provide ammunition for discussions of woo, at the very best it might identify useful bits.

    Just an aside – how come there is *so* much attention paid to woo of all types, but very few people belabor doctors and nurses for failing to update their understanding of their fields? Tons of doctors are still handing out advice based on what they learned in the sixties, seventies, eighties, etc.

  14. #14 jre
    April 14, 2008

    re/ Integral, at #3:

    Steven Piantadosi, in Clinical Trials, A Methodologic Perspective, quotes two descriptions of CAM, then gives his own wonderfully succinct definition:

    [CAM is] a treatment whose mechanism of action is poorly defined or incompatible with established biology.

    Not perfect, perhaps, but plenty good enough for everyday use.

  15. #15 S. Rivlin
    April 14, 2008

    Steve,

    As a taxpayer, I object to the idea that my tax money will be spent to test outlandish healing ideas that are generated daily by airheads and charlatans who are driven by motives that have nothing to do with healing or medicine.

  16. #16 moneduloides
    April 14, 2008

    Perhaps in using the term “alternative” they are attempting to highlight the underground medicine that has emerged in the wake of the punk medicine movement of the mid 80s?

  17. #17 richard
    April 14, 2008

    Perhaps in using the term “alternative” they are attempting to highlight the underground medicine that has emerged in the wake of the punk medicine movement of the mid 80s?

    Sadly, there was little evidence for the efficacy of safety pins and varnish used for hair styling to cure all of society’s ills.

    The receptionists in the office were cute, the music was interesting, and the open bar really didn’t hurt the experience, but you tended to walk in with a small pain and walk out drunk, with a black eye, and a hair cut you’d have trouble explaining in full sentences to your peers and your fast food restaurant manager.

  18. #18 Laser Potato
    April 14, 2008

    I swear, I’m probably the only person who still remembers the actual context of that quote.
    “No, I don’t want to!”
    “Don’t be afraid!”
    “No. Be afraid. (long pause) Be very afraid.”

  19. #19 caynazzo
    April 15, 2008

    As a researcher at the NCI studying leukemia, I have two colleagues at the conference, one who has a poster you probably saw. It is rather embarrassing knowing the NCI diddles in CAM, but what’d you expect? With a constrained budget, we need to throw as much money as possible at the Hail Mary cures CAM promises to deliver. Rah, Rah, Woo, Woo.

  20. #20 caynazzo
    April 15, 2008

    sorry about that. I was getting an error.

  21. #21 Alan McCrindle
    April 16, 2008

    How about shining a light on your own kind?

    Or are you very “afraid, very afraid” that you might find some gremlins in there?

    Have you read the recent comments from the editor of the American medical Journal:

    Misleading research is often published in major medical journals and doctors are lending their names to it, the editor of the Journal of the American Medical Association said on Tuesday.

    Maybe he is being paid by the alternative medical community

    Or maybe you are being paid by the pharmas – hey if eating good food, exercising and all those sorts of alternatives to popping pills were to catch on and chronic diseases disappeared where would there profits be and where would your research be.

    No wonder you are afraid – very afraid.

  22. #22 Jon H
    April 16, 2008

    There’s only one almost-reasonable scenario: alleviation of side-effects during cancer treatment.

    I expect the side effects of, say, chemo, are the kind of things that might well be susceptible to the placebo effect.

    If a person finds that accupuncture helps them sleep, or keep their food down, then even if it’s all in their mind I can’t really find fault. It even has one advantage – no chance of adverse drug interactions or dosage errors, and the patient’s body can spend its energy dealing with the chemo drugs and staying alive.

    Other altie remedies probably lack these slim advantages.

    (Cancer patients might also try to get their insurance companies to pay for ‘accupressure’ treatments. Most of the places that advertise *that* are massage parlors.)