Respectful Insolence

P.Z. Myers turned me on to a phenomenal proposal at Change.gov, the website of President-Elect Barack Obama’s transition team:

Defund the National Center for Complementary and Alternative Medicine:

Here’s a way to increase the available funding to NIH without increasing the NIH budget: halt funding to NCCAM, the National Center for Complementary and Alternative Medicine. This Center was created not by scientists, who never thought it was a good idea, but by Congress, and specifically by just two Congressmen in the 1990’s who believed in particular “alternative” (but scientifically dubious) treatments. Defunding NCCAM would save at least $225 million, possibly more.

Defunding NCCAM would also provide a direct societal benefit. Practitioners of so-called “alternative” medicines constantly refer to NIH’s support as a way of validating their practices and beliefs, most of which are not supported by evidence. The fact is that after >10 years, NCCAM has not yet found a single piece of positive evidence for any of these methods, which include acupuncture, “qi”, homoepathy, magnet therapy, and other treatments.

Any legitimate, promising medical treatment can be funded by one of the existing NIH Institutes. There’s no need for a separate center for “alternative” therapies – but what has happened is that NCCAM has become a last refuge for poorly designed, unscientific studies that couldn’t get funded through the normal peer-reviewed process.

The person who proposes this is correct that the federal government spends around $225 million per year on unscientific and dubious studies of therapies mostly based on prescientific understanding. What he’s wrong about is where the total comes from. In actuality, NCCAM’s budget is around $121 million a year. The other money comes from an office in the National Cancer Institute known as the Office of Complementary and Alternative Medicine, whose budget is also around $121 million a year. Together, that’s nearly a quarter of a billion scarce taxpayer dollars spent on woo. Both NCCAM and OCCAM would have to be defunded to realize that savings. Also, the entire NIH budget is just under $30 billion. Removing OCCAM and NCCAM would only be less than 1% of the NIH budget.

But it would at least be a start in shoring up the NIH, which has suffered grievously during the last four years. As our new Prez would say, “Yes we can!” Spread the word! Mobilize fellow supporters of science- and evidence-based medicine! It may not do any good, but at least it’s worth trying to emphasize to the new administration that there is support for eliminating a useless entity whose functions could be better done folded back into the NIH.

My power may be small compared to that of P.Z., but, please, my readers, fly, fly over to Change.gov, register, and vote up this proposal. The more votes, the higher it goes on the priority list. You know the woo-philes, when they find out about it, will be trying to vote it down.

After all, they’ve voted up a proposal for “health freedom” and “freedom from chemtrails” to a much, much higher level than the proposal to defund NCCAM. While you’re at it, you might want to vote that one down. Just don’t read the comments. The level of neuron-apoptosing stupidity there is enough to fry the brains of every scientist in the world a dozen times over.

Comments

  1. #1 Steven Salzberg
    January 15, 2009

    Orac, thanks for setting me straight about the funding totals. I should have been more careful in my proposal to specify that the NIH funds supporting CAM are in two separate pots. We need to target both of them and get this money back where it can support science instead of woo.

  2. #2 Pierce R. Butler
    January 15, 2009

    The fact is that after >10 years, NCCAM has not yet found a single piece of positive evidence for any of these methods…

    All of which indicates that (a) NCCAM researchers have honestly reported their results, rather than trying to boost their constituency by Republican methods (i.e., rank distortion); and (b) they’ve provided impeccable ammunition for debunkers of multiple quackeries.

    If you want to work on reducing the federal deficit, focus on the Pentagon and the financial-sector bailouts: the rest is chicken feed.

  3. #3 orac
    January 15, 2009

    If you want to work on reducing the federal deficit, focus on the Pentagon and the financial-sector bailouts: the rest is chicken feed.

    Where did I say this proposal was designed to lower the deficit? It’s designed to increase the NIH budget devoted to good biomedical research without spending one penny. It’s about eliminating funding for pseudoscience from the budget.

  4. #4 Scott
    January 15, 2009

    If you want to work on reducing the federal deficit, focus onSocial Security and Medicare: the rest is chicken feed.

    Corrected.

  5. #5 Niki
    January 15, 2009

    Wish I could help vote on this (I’m Canadian) but I’m really glad that your govenment is at least making a show of trying to get rid of woo. Good on you.

  6. #6 Kerry Maxwell
    January 15, 2009

    Oh brother! I made the mistake of reading the comments in *UFO Full Disclosure* thread…

    really sad

  7. #7 ERV
    January 15, 2009

    To quote a ‘debate’ on this topic in Science a few years ago:

    Because of its charter, NCCAM advisory and review groups include many individuals whose scientific credentials would not qualify them for appointment to other NIH institutes. Of greater importance, the continued funding of poor-quality proposals refutes Straus and Chesney’s claim that NCCAM applies the same review standards as other NIH institutes.

    I spoke with a PI recently who submits grants to NCCAM (his research is actually good, so I was like, ‘WTF?’– money is money to a PI)– Swear to gawd he said he said there were goddamned shamans on NCCAM study sections.

    *facepalm*

  8. #8 jim
    January 15, 2009

    Wnen presbyopia leads to mental whiplash…

    Did anyone else read the title as “defend”?

  9. #9 storkdok
    January 15, 2009

    @jim…yes. ;0)

    @Orac, thanks for the heads up with the correct information. Voted.

  10. #10 Abel Pharmboy
    January 15, 2009

    If I may. I completely support the campaign against NCCAM for about 90% of the work they fund – yes, ERV, there are alternative practitioners on NCCAM study sections as a rule.

    However. I beg that we be careful about throwing NCI’s OCCAM into the discussion. This is a legitimate arm of NCI led by an outstanding medical oncologist with an interest in nutrition. My last review of their annual report revealed at least 85-90% of the projects that I found based in solid science and, as you might expect, about 55% are to investigate natural sources for novel antitumor or chemopreventative agents. Yes, there are some studies on acupuncture that snuck through and both Orac and I have remarked on a couple of these misadventures. However, the biggest difference between NCCAM and OCCAM is that OCCAM’s grant are largely reviewed by chartered study sections comprised of cancer biologist, pharmacologists, and clinician scientists.

    Moreover, OCCAM supports a good amount of work on supplement interactions with chemotherapy, radiation, and coagulation issues that could create big problems for surgeon and patient. As long as supplements are available in the US as they are, docs need to know which supplements are absolute no-nos in order to counsel patients.

    Disclaimer: my laboratory does not currently have funding from either NCCAM or OCCAM. However, I was on a project several years ago that was funded partly by OCCAM.

  11. #11 Evinfuilt
    January 15, 2009

    Any real science being done by NCCAM would be able to get funding under NIH, so I don’t think we need worry about losing science. At most, delaying a project so that more can be started.

  12. #12 ERV
    January 15, 2009

    My labs ‘other arm’ studies dietary control of ERVs and cancer. Bossman could have submitted his grants to OCCAM/NCCAM, but he didnt. I mean we already have NCI and NIDDK for ‘cancer+nutrition’ or ‘nutrition+cancer’.

    NCCAM/OCCAM seems like unnecessary overlap that opens a door for bullshit.

    O/T– Anyone else loling at ‘OCCAM’?

  13. #13 Samantha
    January 15, 2009

    I quickly lost count of the number of UFO statements. Have you seen what comes up when you search for autism? Ugh.

  14. #14 Abel Pharmboy
    January 15, 2009

    I’ve been loling at OCCAM for many years – I wish they picked something else.

    ERV, I have to look for a post I may have on the subject but the distinction between NCCAM and OCCAM is much greater. NCCAM is not disease-specific – so you’ll review a grant for herbal medicine in cardiovascular disease first and then the next app would be for massage in cancer patients. I think NCI’s OCCAM is a great model for all NIH ICs because it puts the test of the most likely science-based “alt” approaches and reviews them with much greater and specific expertise. I submit that if each IC had a very small “alt” arm to judge the very small percentage of alt things based in science, only the best projects would be funded with very little impact on the overall NIH budget.

  15. #15 Orac
    January 15, 2009

    Abel,

    You know we’re BFF (blog friends forever), and I respect your opinion. I really do. But I really soured on OCCAM after my encounter with OCCAM people at the AACR Meeting last year:

    http://scienceblogs.com/insolence/2008/04/be_afraid_be_very_afraid.php
    http://scienceblogs.com/insolence/2008/05/why_arent_there_more_trials_studying_the.php

    I don’t think I ever wrote it up as a blog post, but I was very disturbed by the stuff the OCCAM rep said to me, going on and on about “emperor” and “prime minister” herbs, kind of like this:

    http://acupuncture.com/education/tcmbasics/herbprescrip.htm

    Basically, I think OCCAM is in the process of becoming woo-ified. You yourself have noted the creeping influx of woo into its research portfolio.

    In any case, I don’t see anything in OCCAM that couldn’t just be done through the NCI without a special “alternative” medicine office. In fact, your pointing out that the grants are reviewed under normal study sections, without any “alternative” practitioners, tells me that this could fairly easily be done. CAM doesn’t need to be under a separate office; it’s not a natural division or discipline. Its components are too disparate, too unrelated.

    On the other hand, consider this instead: To study, nutritional supplements and interaction with chemotherapy? Why not just form an Office of Nutrition and Cancer and leave out the “alternative”? Research looking for natural products that can be used to treat cancer? Why not just have an Office of Pharmacognosy, instead of having the long and proud scientific discipline of natural products pharmacology “ghettoized” by being associated with all the woo that gets lumped into the CAM label?

    In fact, CAM could be eliminated entirely if research at each Institute of the NIH were divided into four main areas:

    1. Drugs/pharmacology (pharmacognosy being a subdivision of this large category)
    2. Physical treatments (radiation therapy, medical devices, surgery, etc.)
    3. Nutrition (there’s where your supplements go)
    4. Lifestyle (exercise, relaxation, whatever)

    Nothing “alternative” there, and close to everything could be encompassed under one or two of those four labels.

    Hmmm. There’s an idea for a post. I may have to think more about this and perhaps expand on the idea next week.

  16. #16 DLC
    January 15, 2009

    I voted it up. Defund NCCAM now.
    oh, and repealing the DSHEA would be a good idea too.

  17. #17 Prometheus
    January 15, 2009

    You know, the funny thing is that the quacks (and their witless accomplices) like to argue two contradictory points, when it comes to the NCCAM:

    [1] “There isn’t any money available to study ‘CAM’ treatments.” (obviously false, but when has THAT ever stopped them?)

    [2] “The existence of the NCCAM indicates that ‘CAM’ really works!” (presumably because “the government” never spends money on things that don’t work?)

    Since the sCAMmers haven’t stopped bleating about how nobody will give them any money to do a proper study of their “treatments”, I see absolutely no purpose in handing over hundreds of millions of our tax dollars to find out that homeopathy is just water and naturopathy is mare dangerous and less effective than “artificial” drugs.

    Pull the plug! Send the woomongers home!

    Prometheus

  18. #18 arvind
    January 15, 2009

    Basically, I think OCCAM is in the process of becoming woo-ified.

    Time for it to get the razor then!

  19. #19 sanjiva
    January 15, 2009

    The NCCAM simply shouldn’t exist because it creates a false dichotomy. Orac is correct in saying that many “altie” therapies could just as easily – and should – fall under mainstream evidence-based inquiry. For instance, senna extract for the treatment of constipation should not be considered “alternative”; it has a plausible mechanism of action and is supported by clinical data.

    The downside of course is that defunding the NCCAM would give ammunition to proponents of woo who claim there is a mainstream conspiracy by pharmaceutical giants and healthcare professionals to suppress the “truth”, or that no one is willing to study skin brushing as a cure for pancreatic cancer because they are afraid of finding a cure and losing their livelihood. On the other hand, at least this means patients don’t have to go through this with meaningless clinical trials.

  20. #20 gregi
    January 16, 2009

    For all you people saying 1% is only a drop in the bucket, you’re thinking about it all wrong. It is more rational to think at the margin, and in absolute $ terms.

    In a competitive environment, that 1% can be half of your total advantage. As these things go, 1% is a real whopper!

  21. #21 Abel Pharmboy
    January 16, 2009

    Yes, BFF, I had forgotten your experience with someone from OCCAM at the AACR meeting – I wish I knew who that was. That was indeed very disturbing and raised great concern for me. If that’s how they are representing themselves to basic and clinical researchers at a major conference, they deserve the criticism.

    Where we seem to agree is that the best, science-based projects in the OCCAM portfolio would still likely exist with NCI support even if there were no OCCAM. Even the RFAs and RFPs for things like supplement/chemo interactions would still be possible without OCCAM (although I don’t know administratively if helps to be an “Office” in an IC).

    OCCAM does provide other information resources that come up on Google hits to counter the sales and marketing pages of pitchers of woo. I think that they’ve also done a good job on psychological approaches in cancer survivorship – again, though, this probably could still be supported without a dedicated office.

    But if you want to establish an Office of Pharmacognosy, you have my vote for new NIH director.

    I also like the 4 subdivisions you have – go to this NCI search page and look at the menu under “Research Type, Common Scientific Outline” to see how NCI divides and codifies their research portfolio.

  22. #22 Mishal
    January 16, 2009

    Thanks for bringing this to wider attention, I am more than happy to have a reputable idea to throw my support to.

  23. #23 Marc Abian
    January 16, 2009

    Niki, it seems anyone can sign up and vote.

    Make sure to bury those UFO and Health Freedom ideas while you’re at it too.

  24. #24 Robert
    January 16, 2009

    I’m in the middle of a ‘lanche. Perfect time for me to put up a post about this!

  25. #25 Jennyj0
    January 17, 2009

    I know I shouldn’t have read the comments, but ofcourse I had to (not all pages of them, mind you!). It’s the same depressing old BS you can read everywhere, but it never ceases to boggle the mind – raw milk, chemtrails??
    I’m afraid they will encounter a number of unsurmountable problems though: legislation to put a stop to things that don’t exist in the first place (chemtrails for example), I can’t imagine how that’s going to work.

    Sadly, I can’t vote, I’m from Europe, but a loud NO! is the only answer against the amount of stupidity and intolerance.

    What I can’t get my head around though is what motivates people of usually normal intelligence to believe this kind of nonsense. And where does all the hate come from? It scares me sometimes.

  26. #26 juniorprof
    January 17, 2009

    Juniorprof has voted. Thanks for pointing out this wonderful idea!

  27. #27 Sohbet Odası
    January 17, 2009

    Thanks.

  28. #28 Donna B.
    January 18, 2009

    I voted that one up and didn’t read any comments on any of ideas or suggestions. I’m afraid to as most of the suggestions are nuts.

  29. #29 Hawkeye
    January 18, 2009

    Complementary and Alternative Medicine should be treated like Creationism. NCCAM=Discovery Institute

  30. #30 Henry Teng
    April 17, 2009

    Finally somebody spoke out. Not only we should defund NCCAM, IMO I think congressional funding on NCCAM may violate the 1st Amendment, because there are way too many religious concepts involved in alternative medicine. For example:

    –Acpuncture. While to study its effect may be a legimtive research, its core theories are built upon Qi flow and Ying Yang, two concepts evolved from Taosim.

    –Mind-body relationship, which is obviously religious.

    –Faith healing/prayer, obvious Christian/Islam/ concepts

    –Chaleton Therapy: Using heavy metal to cure certain illness, while it is effective in rare case, it is not only dangerous, but a branch of alchemy.

    Just a few examples.

  31. #31 Henry Teng
    April 17, 2009

    _Legitimate_….what was I thinking?

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