Respectful Insolence

Senator Tom Harkin (D-Iowa) owes me a new irony meter.

I’ll explain in a minute, but first you have to know why I even give a rodent’s posterior about Harkin. As you may recall, no single legislator in the U.S. has done more to damage the cause of science- and evidence-based medicine than Tom Harkin. It was through his efforts that the National Institutes of Health, despite the fact that its scientists were not agitating for it, had the National Center for Complementary and Alternative Medicine (NCCAM) rammed down its throat, first as the Office of Alternative Medicine (OAM) and then, when NIH Director Harold Varmus tried to place OAM under more scientific NIH control in 1998, by elevating OAM to a full and independent Center within the NIH.

I’ve complained many times about how NCCAM funds studies of pseudoscience and quackery and even more about how it promotes unscientific medical practices. I’ve said time and time again that there is nothing that is funded by NCCAM that wouldn’t better be dealt with by other Centers or Institutes within the NIH. I’ve also pointed out Harkin and other CAM-friendly legislators created and promoted NCCAM not for the purpose of rigorous scientific evaluation of CAM practices, but rather to promote CAM and ultimately “integrate” it with scientific medicine. At this they have been enormously successful.

At “proving” that CAM works, not so much, so much so that Senator Tom Harkin is very, very unhappy with NCCAM and said so recently, as pointed out by Majikthise. On Thursday, Harkin told a Senate panel that he was disappointed that NCCAM had disproven too many alternative therapies. The video can be viewed here. In addition, Harkin’s statements have also been posted to his Senate blog:

I am pleased to co-chair this morning’s hearing with Senator Mikulski. And I am eager to hear our distinguished witnesses’ ideas on using integrative care to keep people healthy, improve healthcare outcomes, and reduce healthcare costs.

It is fashionable, these days, to quote Abraham Lincoln. So I would like to quote from his 1862 address to Congress – words that should inspire us as we craft health care reform legislation. Lincoln said, “The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty . . . . As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country.

Clearly, the time has come to “think anew” and to “disenthrall ourselves” from the dogmas and biases that have made our current health care system – based overwhelmingly on conventional medicine – in so many ways wasteful and dysfunctional.

I note that on the video, Harkin does not say “conventional medicine.” Rather, he says “conventional allopathic medicine.” And, as any regular reader of this blog knows, anyone who uses the term “allopathic” in such a contemptuous manner to describe conventional scientific medicine has clearly drunk the Kool Aid. But, consistent with how I’ve warned that CAM advocates would do their best to hijack any effort on the part of the Obama administration to reform the health care system by trying to link all manner of unscientific woo to “prevention,” Harkin goes on to do just that:

It is time to end the discrimination against alternative health care practices.

“It is time for America’s health care system to emphasize coordination and continuity of care, patient-centeredness, and prevention.

“And it is time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative.

“This is about giving people the pragmatic alternatives they want, while ending discrimination against practitioners of scientifically based alternative health care. It is about improving health care outcomes. And, yes, it is about reducing health care costs. Generally speaking, alternative therapies are less expensive and less intrusive – and we need to take advantage of that.

Note the false dichotomy. It is not necessary to embrace pseudoscience in order to reform the health care system to emphasize coordination, continuity of care, and prevention. Nor, I would argue, is it necessary to use placebo medicine to reduce costs, and, let’s face it, that’s what the vast majority of the hodge-podge of unscientific and pseudoscientific practices that fall under the rubric of CAM are: Placebo medicine.

Most tellingly, Harkins makes the following remarks about NCCAM. Harkins first prefaces his remarks by explaining how he decided he wanted to write the legislation that brought into existence the OAM and, later, NCCAM. Not surprisingly, it was based on an anecdote about a friend of his from the House of Representatives who had a serious illness, tried “alternative” approaches, and supposedly got better. Then, Harkins makes a startling admission:

One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.

Note what Harkin first says here. He doesn’t say that the purpose of NCCAM was to investigate alternative approaches and determine if they work or not. Rather, he says that the purpose of NCCAM was to investigate and validate alternative approaches. That’s why he’s so disappointed that the vast majority of the studies coming out of NCCAM are actually negative. Moreover, he doesn’t understand science. Hypothesis testing involves designing experiments or clinical trials that can be falsified; i.e., “disproved.” That’s how the scientific method works. But Tom Harkin does not want NCCAM to work by the scientific method. Not really. Or, at least, he said he did in the beginning until the studies performed by believers even under conditions most optimized to produce “positive results” have failed to do so. Now he’s unhappy, and his new strategy is to “integrate” these therapies that have failed thus far to stand up to scientific scrutiny with scientific medicine. In fact, he makes it very clear that he plans on yoking any health care reform that President Obama tries to pass through the Congress to the addition of integrative medicine:

Since 1992 the field has evolved and matured. Today, we are not just talking about alternative practices but also the integration between conventional and alternative therapies in order to achieve truly integrative health. We need to have practitioners talking with each other, collaborating to treat the whole person. And this is the model we intend to build into our health care reform bill.

On several occasions, I have laid down a public marker, saying that if we pass a bill that greatly extends health insurance coverage but does nothing to create a dramatically stronger prevention and public health infrastructure and agenda, then we will have failed the American people.

Well, this morning, I want to lay down a second marker: If we fail to seize this unique opportunity to adopt a pragmatic, integrative approach to health care, then that, too, would constitute a serious failure.

That, my dear readers, is what we are dealing with. A balder statement of what purveyors of pseudoscientific medicine plan I cannot imagine.

Comments

  1. #1 King of Ferrets
    March 2, 2009

    So, you’re sure that woos are actually human, and not aliens from another planet where the words “logic” and “science” have no meaning?

    I’m not sure I believe you.

  2. #2 Matthew Platte
    March 2, 2009

    Excuse me for being way off topic, but that frikkin’ Flash widget from getbetterhealth.com is borked and it’s really annonying. As an occasional ActionScript developer, I have just about zero tolerance for mis-behaving Flash apps and, well, you know the feeling: you express it in the article above.

    You should remove it from your sidebar until they get it fixed. It’s even broken on *their* site.

  3. #3 Danio
    March 2, 2009

    Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.

    Wow. I’m just gobsmacked that he presents this as a problem with the *center*, and not with the treatments under investigation. Do you think he imagines a battalion of bow-tied, bespectacled pencil pushers sitting at their desks and liberally applying the ‘Denied!’ rubber stamp to all the completely validated CAM results? This man scares the bejeezus out of me.

  4. #4 IBY
    March 2, 2009

    It feels strange when I hear someone saying that he is unhappy because certain things are disproven. Really, it is good to disprove things that really don’t work. Hold on, I must have to much science in my mind. I… Must… be… stupid…

  5. #5 Elf Eye
    March 2, 2009

    So here we are, facing an massive budget deficit. Seems like a perfect time to Stop. Paying. For. ‘Treatments’. That. Have. Not. Been. Proven. To. Work. Researchers test a ‘treatment’. They can’t find evidence that it works. And Harkin wants to keep sinking money into it? How are we coming along on brain transplants, because Harkin sure needs one.

  6. #6 Tracy W
    March 2, 2009

    I think that a lot of people are just missing out on being taught critical thinking or the scientific method at school. I once was in a debate about education policy with a person who kept saying that I should be able to assume that English teachers were good at their jobs. I had the devil’s own job convincing him that there was a difference between assuming something and knowing something.

  7. #7 Mike Haubrich, FCD
    March 2, 2009

    Elf Eye, you are missing the point. The stimulus plan will put people back to work, and snarkiness aside I am in favor of it. Back to snark: We need to pay alter-practors so that they can employ people.

  8. #8 qetzal
    March 2, 2009

    Like any true believer, Harkin already knows woo works. NCCAM’s job was just to prove it.

    The fact that NCCAM keeps finding evidence against woo is de facto proof that NCCAM is doing something wrong.

  9. #9 techskeptic
    March 2, 2009

    Question for Orac,

    Am I wrong here, or haven’t we been hating NCCAM because of their promotion of nonsense? I even recall a discussion of it at change.gov proposing to remove it altogether saving 200+ million a year. Further, I do recall a post here by you, sort of congratulating them on a well done study, exploring the power of placebo.

    Maybe I am wrong, but if they are out there disproving woo as Harkin’s delusion describes, aren’t they a force for good in the world?

    Or is it that they are simply not consistent with their goodness?

  10. #10 SLC
    March 2, 2009

    It should be noted that liberal senator Harkin supporting pseudoscience proves that the war on science is not the exclusive province of the Rethuglican right.

  11. #11 Mu
    March 2, 2009

    The solution is simple, make NCCAM the approval center for sole the safety of alternative treatments, without need for efficacy. I’m sure all homeopathic remedies get immediate approval, so do all those biofield realignment devices, pending FCC testing.
    At the same time (sneaky reintroduction of science) make them disallow any alternative treatments with potential for harm (chelation and lupron for autism, chiropractors, herbal remedies of unknown origin, the Indian mercury treatment etc)unless a fully qualified study shows high efficacy outweighing the risk.

  12. #12 Natalie
    March 2, 2009

    SLC, sadly true. The acceptance of alternative medicine and various medical conspiracy theories among the left has always annoyed me as a liberal. My college in particular was full of this nonsense – I was probably one of the only students who got a regular physical, pap, and STD screen.

  13. #13 Joey
    March 2, 2009

    SLC and Natalie nailed it. Being a free thinker means being able to critically analyze arguments from the left and the right. Progressive politics too often gets a pass from the otherwise razor-sharp minds on ScienceBlogs.

    And a huge thank you to Orac from the pediatric side of the house for your tireless efforts defending the science of immunizations.

  14. #14 Chas
    March 2, 2009

    I suggest all readers go to Sen Harkin’s post and leave some comments re: CAM vs. evidence-based medicine. I advised him to stop funding NICCAM (not that he will) – let’s start a ground swell!

  15. #15 gopi
    March 2, 2009

    Perhaps NCCAM’s problem is that they’re simply being too slow.

    NIH hears about some sort of interesting and genuinely promising alternative medicine technique. Before NCCAM has a chance to do anything, some other branch of NIH gets a hold of it, tests it, and, well, now it’s too late. Now it’s just medicine, and there’s nothing left for NCCAM to do…

  16. #16 Joshua Zelinsky
    March 2, 2009

    Harkin is already on my list of people I mention when people claim that the Democrats are pro-science. The party is in many ways just less anti-science than the Republicans. It is a convenient coincidence that more science agrees with the common Democratic ideologies. Here we see an example where the ideologies don’t agree and it just goes out the window.

    Really though, I’d seriously appreciate if I didn’t keep getting more and more examples to back up this thesis. It really isn’t one that makes me happy.

  17. #17 SLC
    March 2, 2009

    Re Joshua Zelinsky

    It should also be pointed out that many of the anti-vaxers like Jenny McCarthy lean to the left.

  18. #18 PalMD
    March 2, 2009
  19. #19 Orac
    March 2, 2009

    You mean like Representative Dan Burton (R-Indiana)?

    There are lots of right wing antivaccinationists, too. Antivaccinationism and alternative medicine are truly bipartisan forms of woo. In fact, I could point out that the Nazi regime was very much into naturopathy and homeopathy–to the point of encouraging “volkish” medicine as a matter of public policy–if I wanted to risk Godwinization. However, I bring this up because it’s just not true that support for alt-med is not really a matter of left wing/right wing.

  20. #20 Robster, FCD
    March 2, 2009

    Natalie, it should make you happy to hear that the right has its own “health freedom” nuts, too. Orrin Hatch is the right’s equivalent to Harkin on this.

    ——–

    Poor Harkin, his rubber stamp doesn’t work.

  21. #21 Orac
    March 2, 2009

    Let’s not forget Ron Paul, either.

  22. #22 Scott
    March 2, 2009

    I found these quotes particularly telling:

    And it is time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative.

    Dramatically failing to recognize that anything scientifically validated then becomes conventional. So by definition, there’s no such thing as scientifically based alternative therapies.

    This is about giving people the pragmatic alternatives they want, while ending discrimination against practitioners of scientifically based alternative health care.

    And again, by definition any practitioner of alternative health care is not scientifically based. So this is effectively equivalent to complaining about discrimination against three-headed people. The supposedly discriminated-against group does not contain any members.

  23. #23 Pineyman
    March 2, 2009

    Maybe teh Harkin can promote the integrative approach of: exercise, nutritional awareness, appropriate caloric proportions, preventative/well care….

    Nah.

  24. #24 Tracy W
    March 2, 2009

    Elf Eye, you are missing the point. The stimulus plan will put people back to work, and snarkiness aside I am in favor of it.

    Sorry, the economics is a bit more complicated than that. Firstly, there’s a fair bit of debate amongst macroeconomists as to whether the stimulus plan will work. You can’t do randomised double-blind experiments in macroeconomics like in medicine, and real-world economies keep changing all the time. Basically macroeconomics at its *best* consists of people running around trying to make sense of case studies and some theoretical basis.

    Secondly, if you’re going to have a stimulus plan, it should ideally get people working in sectors that will be useful in the long-run, which NCCAM isn’t. Otherwise you just have the dislocation effects when the stimulus ends and the people employed there have to find other work.

    Thirdly, stimulus should be more beneficial if focused on areas with significant positive externalities (this was the argument for bailing out banks – the argument is that the financial sector’s lending function is necessary to keep the rest of the economy functioning). For example, vaccines may well produce positive externalities by in the long-run increasing the health and numbers of the working age population. It’s hard to think of an argument that NCCAM produces significant positive externalities.

  25. #25 Comrade PhysioProf
    March 2, 2009

    Just out of curiosity, why does Harking give a fuck about this shit? I.E., who is pumping him with campaign contributions who gives a fuck about this shit?

  26. #26 Joshua Zelinsky
    March 2, 2009

    Orac, you are correct that alternative medicine pseudoscience is not unique to the left end of the spectrum, but it is in many ways more prominent on that end than on the other end. My impression is that anti-vaccination woo which was generally on the left and always had a small right-wing following gained a much larger right-wing following post Gardasil which gave the right an additional ideological reason to support the anti-vaccination nonsense.

  27. #27 Dianne
    March 2, 2009

    McCarthy, Harkin, Ron Paul, Burton…foolishness about alternative medicine is a bipartisan failing.

  28. #28 Pareidolius
    March 2, 2009

    Ask your doctor if Placebo™ is right for you.

  29. #29 D. C. Sessions
    March 2, 2009

    On related news, United States courts’ continuing failure to convict all of the defendants brought before it should not interfere with executing them anyway.

  30. #30 GreedyAlgorithm
    March 2, 2009

    His statements on his blog don’t include the most damning parts, namely “One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.”

    And I can’t seem to get the video to play. Is there a full transcript anywhere?

  31. #31 DLC
    March 2, 2009

    With all due respect to the Right Honourable Gentleman from Illinois, when you ask science to test the improbable, and most of the things tested fail, do not blame the scientists.

    For Techskeptic: In essence, NCCAM have been compelled by their mandate to prove who killed cock-robin, over and over again. This is why Orac and others have been writing that NCCAM is a waste of taxpayer dollars — because they’re testing “alternative modalities” that are so improbable that proof of their efficacy would set the laws of physics on their ear.

  32. #32 wfjag
    March 2, 2009

    Welcome to Universal Health Care. When demand exceeds supply, merely create another “supply” of “providers.” If the UK can establish and subsidize Homeopathetic Hospitals and providers, it’s not much of a leap in logic to foresee a politically powerful US Senator, who is a member of the majority party in both Houses of Congress, slipping CAM friendly legislation into a program favored by the President (who is a member of the same party). There are obviously not going to be enough MDs, DOs, and Nurse Practioners to meet the demand under Universal Health Care, so why not let DCs, Homeopaths, Naturalopaths and other “paths” fill the demand? Not based in science? Since when is politics limited by science? With luck, at least there’ll be a requirement for adequate liability insurance for malpractice — that won’t help the patient, but it will help the trial lawyers and (maybe) the heirs.

  33. #33 TechSkeptic
    March 2, 2009

    Thanks DLC,

    this insane. If woo is not tested then it is a conspiracy by big pharma. If it is tested, then they aren’t doing enough to prove preferred predetermined outcomes.

    Which would you rather? Conspiracy theories about bigpharma, or tax payer money spent on nonsense.

    Why can’t NCCAM do what the FDA does. REquire that practitioneers of woo, prove in double blind studies that what they say works actually does. Then to get an NCCAM certification these woomongering organizations would simply have to put hteir money where their mouths are.

  34. #34 Robster, FCD
    March 2, 2009

    wfjag, Ugh. That is really scary, and since the AMA got nailed by chiropractors for antitrust violations of saying that MDs were doctors but dCs weren’t (yes it was more complex than that) we won’t see them standing up for evidence based medicine.

    It certainly happened in China, where the wealthy and connected got real healthcare, but everybody else gets acupuncture and herbs.

    We definitely need universal health care, but we don’t need to empower quackery or fraud.

  35. #35 Prometheus
    March 2, 2009

    I think that a lot of Sen. Harkin’s enthusiasm for “alternative” medicine is the result of his peculiar brand of “Prairie Populism”. He sees “alternative” medicine as being more egalitarian than real medicine, which relies on people and therapies that have had to undergo rigorous testing. You don’t need any “book learnin’” to practice woo.

    Sen. Harkin is simply taking the American democratic ideal to its logical conclusion – he wants to make science and medicine reflect public opinion. If the majority of people think that “alternative” medicine works, then – in Sen. Harkin’s world – it must work. End of story.

    Seen in that light, Sen. Harkin’s outrage at the NCCAM is perfectly understandable. The fact that the NCCAM hasn’t found a single “alternative” treatment to be better than placebo (imagine my surprise at that!) means they must be “resisting” the popular will.

    Think about this when you contemplate Universal Health Care. The people making the policies for any sort of national health care will be – on average – people like Sen. Harkin; long on ideology and short on actual information.

    Do you really think that “alternative” medicine won’t be given prominence in Universal Health Care? If so, then explain why homeopathic remedies have a specific exemption in the FDA regulations – going back to the Pure Food and Drug Act. What about all of those licensed chiropractors, naturopaths and homeopaths? It was political power – pure and simple – that did that.

    The “alternative” medicine industry is going to put tremendous amounts of money behind getting their brand of woo included in any national health plan. This is their chance to get in on the ground floor and eliminate any restrictive language about efficacy or safety before it gets into the plan.

    I don’t care which political party they belong to – politicians are only interested in getting re-elected; any benefit to the citizens is purely coincidental. If Sen. Harkin or Pres. Obama think they will get more votes by including “alternative” medicine in the national health care plan than by excluding it, Universal Care will cover it.

    Prometheus

  36. #36 T. Bruce McNeely
    March 2, 2009

    It is fashionable, these days, to quote Abraham Lincoln. So I would like to quote from his 1862 address to Congress – words that should inspire us as we craft health care reform legislation. Lincoln said, “The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty . . . . As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country.

    …which of course explains why alties justify treatments like acupuncture and homeopathy by claiming that they have been used for thousands of years.

  37. #37 Militant Agnostic
    March 2, 2009

    While wre quoting Lincoln, didn’t Lincoln also once describe an opponents argument as being “as thin as the homeopathic soup made from the shadow of pigeon that starved to death”?

    It sounds like Lincoln knew homeopathy was absurd.

    Up here in Canuckistan we have kept woo out of our universal health care so far, probably because our politicians tend to respect experts a little more than yours do.

  38. #38 Ace of Sevens
    March 2, 2009

    I must confess I’ve voted for Harking several times. If you saw the Republican nominees, you’d understand. Maybe we can get Evil Monkey or Tara Smith to run for his seat? They live in Iowa and I’m pretty sure they’re old enough. For that matter, I’ll be old enough by the time the next election comes around, but I am sure I’m unelectable.

  39. #39 Cuttlefish
    March 2, 2009

    You can lead a man to Senate, but you cannot make him think.

    http://digitalcuttlefish.blogspot.com/2009/03/to-senators-health.html

  40. #40 SLC
    March 3, 2009

    Re Orac

    The sad part of this is that Congressperson Paul is a medical doctor, who, unlike no-nothings like Harkin and Burton, should know better. But of course, given the nuttiness of Dr. Oracs’ favorite neurosurgeon, Dr. Egnor, and Dr. Jay Gordon, perhaps we shouldn’t be surprised that even medical doctors can be whackjobs.

  41. #41 Prometheus
    March 3, 2009

    SLC,

    Abandon all hope that an advanced degree in science or medicine offers any protection from being seduced to “The Dark Side” of mysticism and “woo”.

    Linus Pauling
    William Shockley
    Peter Duesberg
    Boyd Haley
    Sidney Baker

    and the list goes on….

    The top two were awarded the Nobel Prize (chemistry and physics, respectively); the rest either have a PhD or MD degree. There are too many others to even attempt a comprehensive list.

    A scientific education can only help you recognize “woo” if you use it. Otherwise, it’s just protective cover – a framed diploma you can point to when you tell people, “See, I have proof that I know what I’m talking about.”

    This is just one of the many reasons I remain anonymous – it keeps me from using my name as an argument from authority. All of my arguments have to stand on their own – they can’t use my reputation as a crutch.

    Prometheus

  42. #42 Karl Withakay
    March 3, 2009

    RE: “One of the purposes of this center was to investigate and validate alternative approaches”

    My analogy: “One of the purposes of the courts system is to try and find guilty people charged with crimes.”

    See anything wrong in common with both those statements?

  43. #43 Scientizzle
    March 4, 2009

    I wrote a lengthy letter, now posted for all the intarwebs, to Senator Harkin. I was, in particular, struck by this statement:

    This is about giving people the pragmatic alternatives they want, while ending discrimination against practitioners of scientifically based alternative health care.

    …this argument sound familiar…
    WAIT! Replace “alternative health care” with, oh, I don’t know, intelligent design. Yep. That’s it. I knew it smelled familiar.
    Was NCCAM altmed’s Wedge Document?

  44. #44 ltg
    July 16, 2009

    If you had seen Harkin’s remarks regarding marijuana (‘families have sold children to pay fro their addiction”), then you would know he derives all his knowledge from inaccurate anecdotal information.

    Unfortunately, the right wing has been as antiscience as new agers. Remember colloidal silver?