Respectful Insolence

I’ve frequently been critical fo the National Center for Complementary and Alternative Medicine (NCCAM) for funding dubious studies of pseudoscience and, in essence, promoting unscientific quackademic medicine (is there any other kind?) by giving it the patina of seeming respectability. I can’t recall how many times I’ve seen promoters of woo justify their woo by saying, “Well, NCCAM funds it.” As far as apologetics for quackademic medicine, “NCCAM does it” is right up there with “Harvard does it.” Unfortunately, Harvard really does do it, as do too many other bastions of science-based medicine that have betrayed their trust and allowed pseudoscience to infiltrate them in the form of “integrative medicine.” And NCCAM leads the way, your tax dollars funneled into it going towards funding woo.

NCCAM is a bizarre beast. More than anything else, it owes its creation to Senator Tom Harkin (D-IA), who is also a bizarre beast in his own right. A champion of the National Institutes for Health, so much so that he has been honored as such, Harkin is, alas, also very much into quackery and remains, 20 years after NCCAM’s beginning as the Office of Alternative Medicine, its primary patron, protecting it from all legislative slings and arrows and occasionally chastising it for not having validated more quackery. Ostensibly charged with the rigorous investigation of modalities considered “alternative,” NCCAM all too often applies state of the art science to what is at its heart, prescientific mysticism, such as various “energy healing” techniques, acupuncture, and even homeopathy, a practice that Harriet Hall once aptly dubbed “Tooth Fairy science.” Unfortunately, the current director of NCCAM, Dr. Josephine Briggs, seems like a sincere scientist but also seems as though she doesn’t realize that she has been put in charge of the good ship Tooth Fairy. As a result, she gamely tries to get NCCAM to do the very best Tooth Fairy science she can.

She’s also in a difficult spot. Caught between the Scylla of scientists and physicians practicing science-based medicine and the Charybdis of her alt-med constituency, led by her center’s powerful Congressional patron, Dr. Briggs really is in a virtually no-win situation. Worse, she also has to please the National Advisory Council for Complementary and Alternative Medicine (NACCAM), the external body charged with the “responsibility of advising, consulting with, and making recommendations to the Director, NCCAM, on matters relating to the research activities and functions of the Center.” It turns out that just yesterday four new members of NACCAM were announced in a press release. The new members of the advisory council include Brian M. Berman, M.D.; Daniel C. Cherkin, Ph.D.; David G.I. Kingston, Ph.D.; and James Lloyd Michener, M.D. Much like the seemingly schizophrenic nature of NCCAM, these appointments show the classic “split personality.” Dr. Kingston, for example, appears to have a stellar record as a natural products chemist while Dr. Michener appears to be in the science-based camp of physicians. Dr. Cherkin, on the other hand, is seriously into acupuncture and various other woo, to the point of being program chair for the 2009 North American Conference on Complementary and Integrative Medicine.

Then there’s Dr. Berman, who is described in the press release thusly:

Brian M. Berman, M.D., is a professor of family medicine at the University of Maryland, Baltimore, and the founder and director of the University of Maryland Center for Integrative Medicine. He is a practicing family physician and pain management specialist. He chaired both the ad hoc advisory committee to the NIH Office of Alternative Medicine as well as the Consortium of Academic Health Centers for Integrative Medicine. Dr. Berman also co-founded the complementary medicine field within the Cochrane Collaboration, an international organization that evaluates medical practices through systematic reviews of research literature. In addition, Dr. Berman is trained in homeopathy and has a membership in the Faculty of Homeopathy, has a diploma from the London School of Traditional Chinese Medicine, and is a licensed acupuncturist.

A homeopath. NCCAM just named a homeopath to its major advisory committee. Lovely.

We’ve met Dr. Berman before. Just last summer, he somehow managed to get a credulous review article/editorial about acupuncture into the New England Journal of Medicine, thus demonstrating conclusively that there is no bastion of science-based medicine that can’t be breached with pseudoscience. In any event, Dr. Berman is the founder of the University of Maryland Center for Integrative Medicine, which offers the following services:

  • Acupuncture
  • Nutrition
  • Massage
  • Homeopathy
  • Reflexology
  • Life Coaching
  • Reiki
  • Yoga
  • Qi Gong
  • Tai Chi
  • Acupuncture

That’s right, the University of Maryland offers rank quackeries like homeopathy, reflexology, and reiki, along with modalities whose potential benefits are frequently oversold by woo-meisters, such as yoga and tai chi. And, yup, there’s Dr. Berman himself offering homeopathy:

Homeopathic physicians seek to cure their patients on the physical, mental and emotional levels; and, each treatment is tailored to a patient’s individual needs. Remedies are chosen by the law of similars (i.e., let like cure like). Homeopathy is generally a safe treatment, as it uses medicines in extremely diluted quantities. There are usually minimal side effects.

Of course there are minimal side effects from homeopathy. It is, after all, water. Meanwhile, certified life coach, reiki master, and reflexologist Jean Wehner plies her skills on the credulous right in University of Maryland facilities. That’s not all that goes on at the University of Maryland. Even the hallowed halls of the once hard-core science-based trauma program at the University of Maryland’s Shock Trauma Center has succumbed to the pure religion-inspired quackery that is reiki. It’s so bad at the University of Maryland that, even from another campus, faculty member Steve Salzberg expressed extreme dismay, and I likened Maryland to Hogwarts. In retrospect, I realize that was a bit of an insult to Hogwarts. At least at Hogwarts, magic worked. It had observable, quantifiable effects. Not so at Maryland.

Here’s the reason why NCCAM can never rise above the level of Tooth Fairy science. Credulity towards quackery is built into its very DNA through its advisory council. It’s right there in the NACCAM charter:

The Council will consist of 18 members appointed by the Secretary and 5 nonvoting ex officio members: the Secretary; the Director, NIH; the Director, NCCAM; the Chief Medical Director of the Department of Veterans Affairs; the Assistant Secretary of Defense for Health Affairs (or their designees) and any additional officers or employees of the United States as the Secretary determines necessary for the Council to effectively carry out its functions. Of the 18 appointed members, 12 will be selected from among the leading representatives of the health and scientific disciplines (including not less than 2 individuals who are leaders in the fields of public health and the behavioral or social sciences) relevant to the activities of the NCCAM, particularly representatives of the health and scientific disciplines in the areas of complementary and alternative medicine. Nine of the members will be practitioners licensed in one or more of the major systems with which the Center is involved. Six of the members will be appointed by the Secretary from the general public and will include leaders in the fields of public policy, law, health policy, economics, and management. Three of the six will represent the interests of individual consumers of complementary and alternative medicine.

In other words, the council by design is dominated by practitioners of and believers in alternative medicine, with at least half the voting members of the council being made up of practitioners and 2/3 by either true believers or people tending to believe in alternative medicine. In this environment, it makes perfect sense to appoint a Brian Berman or a Daniel Cherkin. The former is both a practitioner and a leader in his field, while the latter is a practitioner. They fit in quite nicely with other members, such as Timothy Birdsall, Vice President, Integrative Medicine, Cancer Treatment Centers of America; Adam Burke, Director, Institute for Holistic Health Studies; and Xiaoming Tian, Director, Academy of Acupuncture and Chinese Medicine.

This is the reason why Dr. Briggs, try as she might to bring rigorous science to NCCAM, can never succeed. She has to answer to the advisory council. If she goes too far in the direction of bringing actual science, rather than Tooth Fairy science, to NCCAM, she’ll have to answer to the likes of Brian Berman.

Comments

  1. #1 Jacob
    June 7, 2011

    “I’ve frequently been critical fo the National Center for Complementary and Alternative Medicine (NCCAM)”

    Fo?

    Is that a Freudian slip or a Jungian Typo?

    Surely Thai Chi, Qi Gong, and Yoga are different from the others and should not stand alongside things like Reiki. It’s not comparing like-for-like!

  2. #2 Jacob
    June 7, 2011

    Yogi Joke

    Three yogis are performing a meditative vigil in a cave high in the Himalayas. One day there is a sound outside of the cave. Six months later one of the yogis says, “that was a tiger.” The cave is silent once again. About a year later, another yogi says, “that wasn’t a tiger it was a lion. Again the cave falls silent. About two years later the third yogi says, “If you two don’t stop arguing I’m leaving.”
    – Courtesy of Brendan Connelly

  3. #3 palindrom
    June 7, 2011

    I think you’re being too hard on the tooth fairy, because When I’d leave a baby tooth under the pillow when I was a kid, I’d get a dime! But homeopathy is _really_ ridiculous.

    Off-topic, Orac, but I’ll be interested in any reaction you have to Marcia Angell’s article on psychiatric drugs in the latest New York Review of Books. As a scientist in another field, I was shocked to hear learn from this that a drug can be approved on the strength of two positive placebo-controlled trials — against a background of _any number_ of negative trials, which is a clear invitation for cherry-picking. Also, she describes a fascinating phenomenon (which you must know about) of patients ‘breaking the blind’ when they experience expected side-effects of the active drug, whereas inert placebos don’t have any. The article is the first of a two-part series.

  4. #4 palindrom
    June 7, 2011

    Jacob @2 — I love the joke. The other Yogi, of course, is Berra, who came up with this sublime masterpiece:

    Other person: “What time is it, Yogi?”

    Yogi Berra : “Do you mean, right now?”

  5. #5 Jacob
    June 7, 2011

    @mordnilap I couldn’t resist telling my psychiatrist* when asked ‘”whats the earliest thing you can remember? ‘I replied, ‘all my memories exist in the present moment as far as I know, and the past is gone!”

    *actually the tumblr bot, same thing.

  6. #6 Dangerous Bacon
    June 7, 2011

    When NCCAM comes to a fork in the road, it should take it.

    NCCAM does have value in that its activities can be thrown back at the woo-prone who claim that no one is researching alt med because of pressure from Big Pharma/alleged lack of patentability of “natural” cures/pure evil etc.

    Speaking of evil, a classic trope just popped up again on a herbalism forum I frequent – from a poster who said “don’t make the mistake of thinking medical doctors want you to be well.”

    Of course they don’t – they want themselves, their friends and loved ones to all sicken and die rather than admit the superiority of alt med cures.

    I admit it – we’re Evil. Bwa-ha-ha-ha-ha!!!!

  7. #7 Anna
    June 7, 2011

    “NCCAM does have value in that its activities can be thrown back at the woo-prone who claim that no one is researching alt med because of pressure from Big Pharma/alleged lack of patentability of “natural” cures/pure evil etc.”

    True, but it’s a bit of a double edged sword. I’ve often heard the argument that alternative medicine must work, because if it didn’t why would the government study it? The mere existence of NCCAM proves to some people that this stuff must be true.

  8. #8 Denice Walter
    June 7, 2011

    Of course, “it ain’t over ’til it’s over**,” but NCCAM hasn’t been able to produce much solid evidence for CAM *in 20 years*- so why not just pull the plug? It is an era of fiscal austerity: Orac’s recent post discusses the “Golden Fleece” and mis-reprentations of “funny-sounding science” but that jaundiced governmental eye hasn’t yet been directed at NCCAM’s follies, truly examples of fleecing the public- in more ways than one. We basically *know* that, like the Tooth Fairy, many of the modalities being studied don’t actually exist,so isn’t further study a gigantic waste of money? And yes, the woo-meisters do crow about the government investigating their arcane medical faves showing how “right” they really are after all ( usually the government is the bad guy curtailing “health freedom”).

    ** about 10 miles west of NYC lies a rather posh, artsy town, Montclair,NJ, home of Yogi. At the state university there, beside a minor league baseball stadium, is the “Yogi Berra Museum and Learning Center”….( fill in your own retort _here_)

  9. #9 lilady
    June 7, 2011

    @ Anna: That’s an interesting point you have raised, that I agree with.

    I suppose it all comes down to semantics “alternative medicine” meaning what? It certainly doesn’t compare to “alternative” fuels which produce the same effect as fossil fuels that power cars and provide heat. It is bothersome that “alternative” is paired with medicine.

    Orac mentioned in another blog that the costs to fund this program out of the NIH is $ 2.2 billion dollars, while other established NIH programs have had their budgets slashed, have been “consolidated”, while NCCAM fritters away the resources. After all, the only research produced by NCCAM that proves any alternative medicine works is the minimally positive result of chiropractic working for some people with chronic back pain. The results are not long lasting and not curative.

    Yes, the NCCAM operating under the auspices of the respected NIH, seems to lend a certain cachet to its “work” and I’m certain that woo practitioners make full use of that fact. What a waste of our health care dollars.

  10. #10 Eric Lund
    June 7, 2011

    NCCAM hasn’t been able to produce much solid evidence for CAM *in 20 years*- so why not just pull the plug?

    Because there is value in debunking woo. Homeopathy should be relatively easy in this regard: you simply show that it has the same efficacy as a placebo. The placebo effect guarantees that the success rate will be nonzero (that’s why you have to include a placebo when testing most drugs: you need to show whether the drug is more effective than the placebo), and a homeopathic remedy is effectively a placebo. Other kinds of woo will be harder to test (how do you do a controlled study of acupuncture?), but if you can test them, you have a shot at debunking them. And it may happen, by pure luck, that one of these alternative treatments turns out to be effective–proving that allows you to move that treatment from “alternative medicine” over to “scientific medicine”.

    Whether NCCAM is actually structured to achieve this purpose is another question. But if you wanted to have an official funding vehicle for debunking woo, you would need something similar to NCCAM.

  11. #11 Denice Walter
    June 7, 2011

    NCCAM studies nutrition!: as an aside, woo-meisters are currently engaged in the battle of “nutritionists” vs. dieticians ( “RD’s”); NaturalNews and Null are amongst the former’s strongest supporters- rememember, most natural health advocates believe that nutrition is the cause, as well as the cure, of virtually all ills: in their eyes, this “profession” is probably the equivalent to that of doctor.

    When we read the infamously tossed-around figures of “iatrogenic death” so beloved by our opponents, we should recall that in the “original document”( pardon me, I’m laughing and coughing simultaneously… OK, better now) there are hints that much of this evil is indeed the work of hospital dieticians who ply their miserable trade spreading death and destruction amongst the infirm elderly. I have heard many passionate rants about how dieticians in hospitals and in nursing homes actually give patients meat, dairy products, and wheat breads. Poisons, all!

    Nutritionists are those folks who hang out in the aisles of health food shops and tell you what to buy to fix yourself. Usually, requirements for becoming a nutritionist are minimal compared to those for an RD, which involves a degree and later testing by the state.

    The Old School saying: “There oughta be a law!” is applicable here.

  12. #12 Denice Walter
    June 7, 2011

    @ Eric Lund: I agree that testing is necessary to debunk woo: we already have the scientific method and journals** for that. I don’t believe that the actual purpose of NCCAM is de-bunking, it’s a pet project for a supplement-loving senator and way to employ woo-meisters masquerading as scientists. Better to fund standard science than facsimile.

    ** sarcasm.

  13. #13 Scott Cunningham
    June 7, 2011

    Much like the seemingly schizophrenic nature of NCCAM, these appointments show the classic “split personality.”

    I’ve seen it all the time. I speculate it takes different skills to learn new ideas versus to test them and toss out failed ones, because I’ve met many a science professor who had plenty of real knowledge (in say chemistry, histology etc.) and a dollop of nonsense to boot.

    @Eric
    The purpose of NCCAM is bunking, not debunking. And in a perfect world, the debunking would be left to something like Skeptical Inquirer, at a cost of zero dollars to the limited grant budget for scientific and medical research. And in a perfect world leaving it to Skeptical Inquirer would also be adequate and no one would fall for this rubbish. Wish I lived there.

  14. #14 cervantes
    June 7, 2011

    Regarding NCCAM and the debunking function —

    This is not a straightforward question. The trials NCCAM has funded are generally reasonably well designed — which is why they have almost universally had negative results. There are two problems however:

    1) It is legitimate to ask whether it is the best use of scarce research dollars to do RCTs on modalities that we already know are highly unlikely to work and

    2) The debunking doesn’t do any good — advocates for quackery just claim that more research is needed, data mine to find a subgroup analysis that looks like something might be going on, or maintain that RCTs cannot legitimately evaluate their methods using various forms of sophistry.

    Lately Harvard (and perhaps others) have been raising NCCAM money to do what they frankly define as studies of the placebo effect, although they spend a lot of money on licensed acupuncturists in order to do this, which seems unnecessary. The research is also largely pointless because we already know that the placebo effect exists. They are giving people functional MRI scans to show that yes, the placebo effect is accompanied by observable changes in brain activity. And? This at a cost of many millions of dollars.

    So it’s not completely indefensible, I suppose, but hard to call it cost effective.

  15. #15 Beamup
    June 7, 2011

    I agree with cervantes. Debunking most types of woo is a complete waste of time and money, since they have already been conclusively debunked. Anyone who doesn’t already reject them is either unaware of the evidence, or ignores it.

    In neither case does adding more evidence to the pile do anything but provide something else to not know and/or ignore. The former case may be reached by education; the latter is a lost cause.

  16. #16 Mike
    June 7, 2011

    “Acupuncture”
    [other stuff]
    “Acupuncture”

    “You said Acupuncture twice.”

    “I like acupuncture.”

    But seriously, Yoga and Tai Chi can at least count as Exercise. Nutrition is part of SBM. And massage has some genuine benefits – much like Yoga and Tai Chi.

    Just disturbing that the woo’s getting so much traction, and the parts that have some legitimate science behind them get blown up into miracle cure alls.

    Well done as usual, Orac.

  17. #17 Candy
    June 7, 2011

    I’m an Iowan, and have at various times worked to help reelect Sen. Harkin – although he is never seriously challenged and doesn’t need much re-electin’ work – and in most respects he has been an excellent senator. I wish he would stop with this embarrassing nonsense. Unfortunately, the woo woo is very much a part of the world view of certain liberals, generally theist liberals. He is, however, a staunchly pro-choice Catholic, despite threats over the years by the arch-diocese to excommunicate him. I’ll take him over the, um, alternatives.

  18. #18 tdoc
    June 7, 2011

    I was reading an interesting book last night and in it was a discussion of the law of similars, sympathetic treatment and homeopathy. Strangely the book, The Golden Bough, by Frazier, referred to these modalities as magic rather than medical options. Quaint.

  19. #19 Denice Walter
    June 7, 2011

    @ tdoc: Frazer envisioned a natural evolutionary progression of human thought from magic through religion, culminating in science… and here we are in 2011, still discussing magic and cultism. Oh, well…

  20. #20 lilady
    June 7, 2011

    @ Candy: I did visit Senator Harkin’s website and it appears that he has some senior positions on health committees.

    Does anyone know if Harken himself believes in CAM…or if he was influenced by family members who are believers? Really why did he propose the legislation for the establishment of the NCCAM? Influence from major manufacturers of supplements in the state or his district, perhaps?

    Of course he might have been the major sponsor of the bill, but who else supported it? Sometimes, when major (non CAM) health care bills are proposed, in order to get some crucial votes for passage they allow some funding for some “pet projects”…hmm? Unbelievably, when votes are shy for the Defense Department…crazy appropriations for crazy pet projects…such as this loser…are tagged on to the Defense Department appropriation bill, as well.

    Such a waste.

  21. #21 Phila
    June 7, 2011

    About two years later the third yogi says, “If you two don’t stop arguing I’m leaving.”

    It’s a lesson that a certain chatterbox commenter would do well to take to heart.

  22. #22 cday881
    June 8, 2011

    @Denice Walter
    #19

    @ tdoc: Frazer envisioned a natural evolutionary progression of human thought from magic through religion, culminating in science…

    But is evolution progressive? And does it culminate in anything?

  23. #23 Jacob
    June 8, 2011

    @Phila

    Aptly yclept scienspi┼í vrachtism? Where’s your evidence?

  24. #24 Jacob
    June 8, 2011

    @Mike

    It’s often said [by whom?] that ashtanga yoga is like a thai massage, where you benefit from the exercise that the masseur would normally get while you lie there being kneaded.

    Like Medicine, Yoga is 99% Practice and 1% theory.

  25. #25 Jacob
    June 8, 2011

    This is nuts! Where is the original paper? Anyone? Lovas!

    http://thautcast.com/drupal5/content/did-abas-founder-help-kill-man

  26. #26 Candy
    June 8, 2011

    lilady – I myself did not even know Sen Harkin had sponsored this until I found out here on Insolence. I may have to do some research, and maybe write a letter to his office to ask for some information on this, when I get some time.

    He’s a highly intelligent man and has always seemed to embrace common sense. It’s my understanding that when he sat for the bar he had the highest scores of his class. His wife, Ruth, is also an extremely competent professional. It’s hard to believe that he could be a sucker for this sort of thing, but then again, we all sadly know how capable the human brain is of compartmentalising.

  27. #27 Candy
    June 8, 2011

    lilady – I myself did not even know Sen Harkin had sponsored this until I found out here on Insolence. I may have to do some research, and maybe write a letter to his office to ask for some information on this, when I get some time.

    He’s a highly intelligent man and has always seemed to embrace common sense. It’s my understanding that when he sat for the bar he had the highest scores of his class. His wife, Ruth, is also an extremely competent professional. It’s hard to believe that he could be a sucker for this sort of thing, but then again, we all sadly know how capable the human brain is of compartmentalising.

  28. #28 Candy
    June 8, 2011

    lilady – I myself did not even know Sen Harkin had sponsored this until I found out here on Insolence. I may have to do some research, and maybe write a letter to his office to ask for some information on this, when I get some time.

    He’s a highly intelligent man and has always seemed to embrace common sense. It’s my understanding that when he sat for the bar he had the highest scores of his class. His wife, Ruth, is also an extremely competent professional. It’s hard to believe that he could be a sucker for this sort of thing, but then again, we all sadly know how capable the human brain is of compartmentalising.

  29. #29 Candy
    June 8, 2011

    lilady – I myself did not even know Sen Harkin had sponsored this until I found out here on Insolence. I may have to do some research, and maybe write a letter to his office to ask for some information on this, when I get some time.

    He’s a highly intelligent man and has always seemed to embrace common sense. It’s my understanding that when he sat for the bar he had the highest scores of his class. His wife, Ruth, is also an extremely competent professional. It’s hard to believe that he could be a sucker for this sort of thing, but then again, we all sadly know how capable the human brain is of compartmentalising.

  30. #30 lilady
    June 9, 2011

    @ Candy: Of course Orac has blogged about Senator Harkin and his support of NCCAM frequently in the past. Orac’s “friend” Dr. Gorski on the Science Based Medicine site has written about NCCAM and the elected officials, including Senator Harkin, who continue to support NCCAM.

    At the NIH NCCAM site is an (in)complete (Very Incomplete) history of the genesis and the funding of the NCCAM and it referred me to three budget appropriation bills (PL 101-170, PL 103-43 and PL 105-277). I spent (wasted) the better part of this morning reading the hundreds of pages of these bills.

    I then did some further research on Senator Harkin/NCCAM and hit the jackpot at:

    Quackwatch: Why the National Center for Complementary and Alternative Medicine (NCCAM) Should be Defunded (Wallace Sampson, M.D. – December 10, 2002)

    Senator Harkin is the grandpappy of NCCAM. In 1992 he assigned $ 2,000,000 of his discretionary funds to establish the “Office of Unconventional Medicine”, later renamed the OAM (Office of Alternative Medicine) and renamed again as the NCCAM at the NIH.

    The first director of the NIH OAM, resigned in protest due to Senator Harkins appointees who included individuals involved in the Laetrile cancer “cure” scam and those operating Tijuana Cancer Clinics.

    Dr. Sampson wrote a rather complete expose of Senator Harkins involvement and use of discretionary funds and influence to establish the forerunners of NCCAM…No wonder the NCCAM site provided a very incomplete history of this division of the NIH.