The "success" of NCCAM grants on homeopathy

One of the great benefits of having been a blogger for nearly eight years now is that I now have a rich history of thousands of posts. True, there are the occasional posts that I wish I hadn't written and even the occasional post that I consider to be not particularly good, but for the most part I'm proud of my work and would put my blog posts up against nearly anyone else's. Another benefit of having such a long history is that, from time to time, I get the opportunity to revisit really old posts. Having written about these issues for so long, I find it really gratifying when I can revisit a story or an issue with new information and put my inimitable spin and commentary on it.

I've been writing about NCCAM for a long time, which is why I want to take a trip down memory lane in order to follow up on a post from a few years back, which was entitled The The National Center for Complementary and Alternative Medicine (NCCAM): Your Tax Dollars at Work. Specifically, I want to follow up on one specific study I mentioned that was funded by NCCAM. It is a study of homeopathy. Yes, in contrast to the protestations of Dr. Josephine Briggs, the current director of NCCAM, that NCCAM doesn't fund studies of such pure pseudoscience as homeopathy anymore (although she does apparently meet with homeopaths for "balance"), prior to Dr. Briggs' tenure NCCAM actually did fund studies of the magic water with mystical memory known as homeopathy. Two grants in particular I singled out for scorn. The principal investigator for both grants was Iris Bell, who is faculty at Andrew Weil's center of woo at the University of Arizona. The first was an R21 grant for a project entitled Polysomnography in homeopathic remedy effects (NIH grant 1 R21 AT000388).

Here's the abstract:

DESCRIPTION (provided by applicant): Classical homeopathy is a 200-year old system of complementary and alternative medicine (CAM), which claims that a substance that can cause symptoms in a healthy person (provings) can cure similar symptoms in a sick person (Law of Similars). In a design synthesizing homeopathic provings, health psychology, and psychophysiological methodologies, this revised 3-year R21 exploratory study (NCCAM PAR 03-153) will assess the effects of two different homeopathic, plant-derived remedies ([A]: Nux Vomica 30c or [B]: Coffea Cruda 30c) on polysomnographic sleep recordings of adult human subjects of both sexes (N=60). Primary Specific Aims are: I. To evaluate the effects of two different active homeopathic remedies versus placebo on standard sleep stages and spectral EEG in human subjects; and II.To determine the effects of two different active homeopathic remedies versus placebo on nonlinear characteristics of sleep EEG in human subjects; The Secondary Aim is: III. To assess the contribution of baseline individual difference traits and subjective expectation in modifying the physiological outcomes above. The study will examine the interaction of the remedy effects with two different human personality traits associated with insomnia and overlapping those of persons reported in classical homeopathy to respond most strongly to each remedy. Subjects will fall into two subclinical groups of otherwise healthy persons: (i) those who score high on the personality trait of hostility (Type A/coronary-prone; contained within remedy picture of Nux Vomica)(n=30) and (ii) those who score high on the personality trait of anxiety sensitivity (panic-prone; contained within remedy picture of Coffea Cruda)(n=30). All subjects also will report insomnia from drinking coffee (a symptom common in homeopathy to both remedy types) and will replace it with a non-coffee caffeinated beverage for at least 7 days before and for the duration of the study (beverage coffee is reportedly a clinical antidote for many homeopathic remedies). During the 4-week protocol, on the first two nights of each study week, they will undergo at home, all-night polysomnographic sleep recordings, i.e., on days 1 and 2 (baseline 1), 8 and 9 (placebo), 15 and 16 (baseline 2), and 22 and 23 (remedy [A] OR remedy [B]). All will receive placebo at bedtime on day 8, single-blind (placebo given before any remedy to eliminate risk of carry-over effects and/or experimenter intentionality on placebo responses, problems reported in previous homeopathic provings). At bedtime on day 22, half of the subjects from each personality type will receive one dose of Nux Vomica and half will receive one dose of Coffea Cruda on a randomized, double-blind basis. All participants will also record subjective sleep and symptom patterns over the 4 weeks. Statistical analyses will include hierarchical linear models and general linear models. The chosen remedies in 30c doses each showed specific and different effects on sleep electroencephalograms of healthy animals in previous studies. This study will contribute to our long-range goal of understanding the neurophysiological and biopsychosocial mechanisms of classical homeopathic remedy treatment in patients with specific clinical conditions.

Leaving aside the utterly scientifically bankrupt nature of the hypotheses and the methods of testing the, which involve homeopathic provings, health psychology, and psychophysiological methodologies, NIH R21 grants are exploratory grants designed to test preliminary hypotheses. As such, they are much smaller than the usual flagship R01 grants and don't require much preliminary data. Actually, technically they don't require any preliminary data, the idea being that an idea that is based in sound science designed to explore a promising novel hypothesis could potentially be fundable, but in all my years in the lab I've never seen an R21 funded with no preliminary data. Be that as it may, there's no way that anything having to do with homeopathy could be based in sound science, but apparently that didn't stop NCCAM from funding the polysomnography grant (1 R21 AT000388) for three years and scoring total funding of $583,974. If we estimate an indirect cost rate of approximately 50%, that means Dr. Bell scored roughly $389,000 in direct costs to do this study, the rest going to the University of Arizona. (These days, R21s are usually only funded for two years to a maximum of $275,000 in direct costs.) Even so, just the very nature of homeopathy, how it involves diluting compounds to nonexistence (note that Bell is using 30C preparations, which means they've been diluted 10⁶⁰-fold, or approximately 10³⁷-fold more than Avagadro's number), should have been enough to kill this grant in any respectable study section. The same is true of the second grant, which was entitled Dilution and succussion in homeopathic remedy dose-response effects (NIH grant 1 R21 AT003212).

Here's its abstract:

DESCRIPTION (provided by applicant): The purpose of this revised R21 exploratory grant to NCCAM in response to PAR-03-153 is to extend the PI's previous human olfactory psychophysiology research and develop a quantitative electroencephalographic (qEEG) bioassay for registration of individually active (salient) versus inactive homeopathic remedies or placebo. Homeopathy's founder, Samuel Hahnemann MD, originally proposed olfactory sniffing as a valid route for clinical remedy administration. Convergent basic science evidence suggests that succussion (vigorous shaking) in the preparation of homeopathic remedies from animal, mineral, and plant sources, may persistently modify the physical structure of solvent to generate order, i.e., a unique informational signal, even in ultra-diluted solutions beyond Avogadro's number. Torres and Ruiz (1996) proposed that stochastic resonance in sensory systems is a model for optimizing detection of a weak signal (homeopathic remedy information) by addition of noise (succussions). No previous research has directly examined the effects in human populations of a given remedy dilution prepared with different numbers of succussions. Specific aims for the study are: I. To evaluate the feasibility of using acute evoked responses in quantitative electroencephalography (qEEG) alpha power during olfactory administration to detect the presence of a single homeopathic remedy (Sulphur) at different numbers of succussions per dilution step, prepared at a given dilution; II. To determine the feasibility of using the magnitude of acute evoked responses in quantitative electroencephalography (qEEG) alpha power during olfactory administration to detect the presence of a single homeopathic remedy at two different homeopathic serial dilution factors (prepared with a given number of succussions per dilution step); III. To evaluate the generalizability of findings for a separate polycrest remedy (Pulsatilla). Subjects will be N=108 (n=54/remedy) young adult volunteers with moderate (not excellent global health) prescreened for potential remedy salience of either Sulphur or Pulsatilla and tested in a two-phase study (one remedy per phase). Each participant will undergo pre-screening with the Homeopathic Constitutional Type Questionnaire for high criterion scores for symptoms of one of the two test remedies, followed by three laboratory sessions spaced one week apart (dilution sequence subject allocation balanced within each remedy type for 6c, 12c, and 30c potencies). Each session will involve eight presentations within a complete block design of randomized double-blind, placebo- controlled (both succussed remedy-free solvent and succussed plain distilled water) olfactory sniff tests (using time-locked sniff-EEG recordings via an airflow pressure transducer), using a given remedy dilution prepared with stirring only, 10, 20, or 30 succussions. The present study fills a major need in homeopathic clinical research to explore and understand remedy-related and remedy-person interactive factors that could contribute to well-known problems in replicability. Findings from this and follow- up studies via subsequent R01s could improve standardization of homeopathic remedy manufacturing and prescribing used in patient care and thereby advance the quality of clinical treatments and research for this leading form of complementary and alternative medicine worldwide.

Yes, as hard as it is to believe, this is an actual, NIH-funded grant. Yes, it's an R21, and, yes, one could argue that it's fairly impressive (for a believer in homeopathy) that Dr. Bell would like to actually test the effects of succussion on the production of homeopathic remedies. Or it would be, were it not for the science that shows that diluting remedies far beyond Avagadro's number leaves not a single molecule left of the original remedy and that there is no even remotely plausible mechanism by which homeopathic remedies so diluted can work. The way that homeopaths hand wave as above, using terms such as "homeopathy remedy information" should tell you all you need to know.

Putting aside just how nonsensical homeopathy is, I can't help but note that this is now all money that's already been spent. As scientists, how do we judge the value of what came out of a grant like this? Given that, as a general rule, it's often very hard to judge the value of the actual science funded by a grant as it's being done or shortly thereafter, we have to rely on imperfect metrics. These include (1) publications that derive from the work done using the grant funding; (2) new grants that derive from the data generated from work done on the grant; and (3) patents that derive from work. In all fairness, we also have to take into account the fact that these two grants are R21s, which means they're designed to fund preliminary research, which by its very nature is riskier and less likely to pan out than research funded by a nice, "safe" R01 backed by ten papers' worth of preliminary data. Some R21s based in the soundest and most interesting of science will result in not a whole lot of results; it's the nature of the beast. (Preliminary "risky" research is, well, preliminary and risky.) Fortunately, when it comes to finding this out, it's not as difficult as it once was, as the NIH now requires that all papers that result from NIH-funding be reported and made available to the public through PubMed Central, albeit sometimes after a year embargo to satisfy the for-profit publishers. So let's take a look at the publications credited to these grants so far:

Here are the publications deriving from the polysomnography/homeopathy grant (1 R21 AT000388):

1. Menk Otto L, Howerter A, Bell IR, Jackson N (2010). Exploring measures of whole person wellness: integrative well-being and psychological flourishing. Explore (NY) 6(6):364-70.
2. Brooks AJ, Bell IR, Howerter A, Jackson N, Aickin M (2010). Effects of homeopathic medicines on mood of adults with histories of coffee-related insomnia. Forsch Komplementmed 17(5):250-7. PMID: 20980764.
3. Bell IR, Howerter A, Jackson N, Aickin M, Baldwin CM, Bootzin RR (2011). Effects of homeopathic medicines on polysomnographic sleep of young adults with histories of coffee-related insomnia. Sleep Med 12(5):505-11. PMID: 20673648.
4. Bell IR, Koithan M (2006). Models for the study of whole systems. Integr Cancer Ther 5(4):293-307. PMID: 17101758.

Here are the publications deriving from the succussion grant (1 R21 AT003212):

1. Bell IR, Howerter A, Jackson N, Brooks AJ, Schwartz GE (2012). Multiweek resting EEG cordance change patterns from repeated olfactory activation with two constitutionally salient homeopathic remedies in healthy young adults. J Altern Complement Med 18(5):445-53. PMID: 22594648.
2. Bell IR, Brooks AJ, Howerter A, Jackson N, Schwartz GE (2011).Short-term effects of repeated olfactory administration of homeopathic sulphur or pulsatilla on electroencephalographic alpha power in healthy young adults. Homeopathy 100(4):203-11. PMID: 21962194.
3. Menk Otto L, Howerter A, Bell IR, Jackson N (2010). Exploring measures of whole person wellness: integrative well-being and psychological flourishing. Explore (NY) 6(6):364-70. PMID: 21040885.

So far, this is not promising. For all six papers (there's one claimed for both grants), only one appears to be in a "real" journal (i.e., a journal that is not devoted to "alternative" or "integrative" medicine). That journal is Sleep Medicine. All of the other these journals, although ostensibly "peer-reviewed" and, for whatever unknown but almost certainly ridiculous reason, indexed in Medline, are the lowest of the low. Any journal whose title is Homeopathy is clearly devoted to pure pseudoscience. Explore: The Journal of Science and Healing is a journal known for its publication of truly ridiculous studies. Perhaps my favorite of the bunch is from a few years ago and involved looking at whether positive "intent" could be embedded in chocolate, much the way that Masuro Emoto tries to embed "intent" into water. And, of course, the Journal of Alternative and Complementary Medicine, Forschende Komplementärmedizin (Research in Complementary Medicine), and Integrative Cancer Therapies are well-known as go-to journals for all varieties of dubious "integrative" medicine. For instance, the former advertises that it will publish papers in, among other things, homeopathy, naturopathy, subtle energies, energy medicine, or whatever. (My personal favorite, something I haven't quite yet figured out yet, is the topic of "integrative biophysics," which is one of the topics listed as being relevant to this particular journal.)

Of course, it's not enough simply to point out that these three journals are shams masquerading as real scientific journals. You never know. Maybe these three papers are simply awesome. Yes, I know it's highly unlikely when the topic is homeopathy, but, as always, it's necessary to dive into the papers themselves. So let's look at a few of these papers, chosen because they piqued my interest in some way and they represented the number of papers I could get through in the time I had to write this. I'll start with #3 from the succussion/dilution grant, which is also #1 for the polysomnography grant. It's also published in the second woo-iest of the journals, Explore. Or maybe it's the first woo-iest of the journals. After all, it doesn't limit itself to just one quackery, the way Homeopathy does. Looking at the paper, I have a hard time figuring out what the relevance is to either grant, as it is not so much about homeopathy at all. Rather, it's about what the authors abbreviate as WSCAM (which echoes in my mind as "W-SCAM"). WSCAM stands for "whole systems complementary and alternative medicine" and consists mainly of homeopathy, traditional Chinese medicine (TCM), Ayurveda, and naturopathy, defined as systems that "focus on the whole person indicators of health, including patients’ experienced global well-being." To this, Bell wants to apply "nonlinear dynamical systems theory thusly":

Investigators have proposed using scientific concepts drawn from complex nonlinear dynamical systems theory towards improving the external validity of the clinical evidence base on WSCAM studies [8, 11, 12]. Several medical specialties are using methods of complex systems science to evaluate the functioning of body systems in an effort to increase diagnostic capability and assess patterns of disease [13–19]. Study designs such as these are well suited to non-reductive WSCAM studies that evaluate whole-person outcomes, because they attempt to quantify complex variables. In complexity theory the person is an indivisible complex adaptive system of interacting and interdependent parts, nested within and responsive/reactive to a complex environment. Synthesis of WSCAM with complexity theory suggests the need for characterizing WSCAM outcomes in terms of both (a) global and local outcomes and (b) positively and negatively valenced systemic behaviors (i.e., symptoms, signs) [8].

Basically, Bell et al looked at the results of different measures of psychological health, calculating what is known as the "P:N" (positive to negative affect) ratio on a bunch of college students enrolled in an introductory psychology course, tried to figure out if the "ratio of positive to negatively valenced mood has a unique relationship to overall well-being different from its individual components," and dividing the students up into what they called "flourisher" and "languishers." Ultimately, they claim that their goal is to "apply complex systems theory" to additional studies and ask if that can "improve well being." As I said, this study is purely observational and not even particularly interesting. It's also only tangentially related to the grant, perhaps specific aim 3, which is "to assess the contribution of baseline individual difference traits and subjective expectation in modifying the physiological outcomes."

Next up is a paper published in 2011. This trial was, in essence, a homeopathic proving, in which Bell et al had healthy college students sniff various homeopathic remedies while hooked up to an EEG machine. I kid you not. Even more bizarre, the students were screened and tested thusly:

College student volunteers (ages 18–30, both sexes) from an introductory psychology course were screened for good health and relatively elevated Sulphur OR Pulsatilla symptom scores on the Homeopathic Constitutional Type Questionnaire. Subjects underwent a series of 3 once-weekly double-blind sessions during which they repeatedly sniffed the remedy matched to their CTQ type and solvent controls. Each remedy was given in a 6c, 12c, and 30c potency, one potency per week, in randomly assigned order. Solvent controls included both plain distilled water and a water-ethanol (95%) solution. All sniff test solutions were further diluted just prior to laboratory sessions (0.5 ml test solution in 150 ml distilled water). Within a session, remedies and control solvents were administered via 2-second sniffs (8 sniffs of each of 4 different succussion levels for the potency in randomized order). Primary outcome variable was relative EEG power (alpha 1 8–10 hertz; alpha 2 10–12 hertz) averaged over 19 electrode sites, including all succussions for a given potency.

That's right. Your tax dollars funded a study in which students sniffed homeopathic remedies, two of which, the 12C and 30C, were diluted to near-non-existence and non-existence, respectively. In the introduction the investigators went on and on about the "nonlinear" nature of the alleged dose-response of homeopathic remedies in previous studies. One wonders if it ever occurred to them that this would be the result one would expect if what they were seeing were spurious results; i.e., no consistent dose-response curve. It doesn't matter, though. This study was massively unimpressive. If you look at the tables, you'll see that there is no consistent "dose-response" curve. "Effects" fluctuate up and down as dilution increases. In Table 2, only one measure was statistically significantly different, and that appears to be only because the 12C dilution produced a lower power than either the 6C dilution or the 30C dilution. I'll grant the investigators that that's "nonlinear," but it also goes against homeopathic "theory," which claims that diluting the solution makes the remedy more potent.

Table 3 looks at the number of succussion steps. Basically, the investigators looked at whether succussion in addition to dilution matters. Again, I kid you not. Basically, the investigators looked at four different "succussion" levels: no succussion (stirred), 20 succussions, 40 succussions, and 100 succussions). Remember, whenever they are criticized for claiming that their remedies become more potent the more that they are diluted, homeopaths will piously and condescendingly tell us that homeopathy is so much more than just dilution. The succussion steps are supposedly absolutely critical, as they "potentize" the solution of the homeopathic remedy. You might remember that the founder of homeopathy, Samuel Hahnemann himself, recommended slapping the remedy against a Bible to succuss it. Three out of the four measures were not statistically significantly different, and the one that was shows no consistent change in one direction based on the number of succussion steps. In other words, this is about as close to a negative study as can be. Given the number of repeated measures that the investigators looked at, I would have been shocked if they hadn't found one or two seemingly "positive" results; however, there is no consistency to them that would suggest a real effect. In any real world scientific application, this would be a negative study. It looks like nothing more than noise interpreted as signal. It is rather amusing, though, how inconsistent effects that follow no dose-response are touted as a feature, not a bug, of homeopathy.

Speaking of this very feature, I've saved the paper published in the "real" journal for last, specifically the paper in Sleep Medicine. This paper actually took some reading, unfortunately, but I didn't think I could avoid discussing it because, well, it's the only paper from these grants that appeared in a real journal. In brief, this study examines the effect of two homeopathic remedies, Nux Vomica or Coffea Cruda, on insomnia associated with caffeine use. Following the homeopathic principle (for which there is no evidence that it works as a general rule) of like cures like, Bell et al made homeopathic remedies out of unroasted coffee beans (Coffea Cruda), but I can't figure out the rationale for using Nux Vomica, which is basically strychnine, but apparently homeopaths use it for insomnia, colds, flu, bladder infections, and "premature, profuse or erratic menstruation periods wherein the patients tend to faint before the start of their menstruation cycle." Why? Who knows? The one thing I do know is that it's a really good thing that most homeopathic remedies are diluted to nonexistence. One wouldn't want to be taking strychnine at pharmacological doses. In any case, Bell et al describe the use of these two remedies thusly:

Clinically, homeopaths report that Coffea Cruda patients are mild and timid, but also irritable and oversensitive to all types of sensory stimuli, especially noise, as well as to positive emotions [25,26]. Nux Vomica as a homeopathic remedy is used clinically to treat people with competitive, irritable and impatient Type A-like behavioral patterns and tendencies to abuse alcohol, caffeine, and other substances. Both Coffea Cruda and Nux Vomica patients report insomnia in the middle of the night as a symptom [27]. Taken together with the clinical reports, the animal EEG sleep data provide a basis for selecting Coffea Cruda and Nux Vomica as candidate homeopathic remedies to test in the first homeopathic PSG research on human subjects.

I'm sold. How about you? Note that reference 27 is a book quoting Hahnemann. I also can't help but note that every single reference used as a basic science justification for this study, some of which were animal studies claiming that Coffea Cruda or Nux Vomica could decrease caffeine-induced changes in sleep in rats, all came from not just woo journals but homeopathy journals. I took a look at the papers, and, as one might expect, they were...underwhelming. But what about this study?

The experimental design was rather complicated:

Young adults of both sexes (ages 18–31) with above-average scores on standardized personality scales for either cynical hostility or anxiety sensitivity (but not both), and a history of coffee-induced insomnia, participated in the month-long study. At-home polysomnographic recordings were obtained on successive pairs of nights once per week for a total of eight recordings (nights 1, 2, 8, 9, 15, 16, 22, 23). Subjects (N=54) received placebo pellets on night 8 (single-blind) and verum pellets on night 22 (double-blind) in 30c doses of one of two homeopathic remedies, Nux Vomica or Coffea Cruda. Subjects completed daily morning sleep diaries and weekly Pittsburgh Sleep Quality Index scales, as well as Profile of Mood States Scales at bedtime on polysomnography nights.

As the authors readily acknowledge, obtaining polysomnographic (PSG) measurements at home is not a trivial matter. In any case, the factor they were interested in was the PSG sleep time. Well, not exactly. According to the methods section:

Based on the clinical literature and animal studies, primary outcome variables of interest were total sleep time, slow wave sleep, stage changes, and awakenings after sleep onset, as a function of verum remedy versus placebo across all subjects. Given the exploratory and early research phase nature of the current study on human subjects, however, PSG sleep onset and rapid eye movement (REM) latencies, REM and other NREM stages, as well as actigraphic measures of TST, sleep onset latency, sleep efficiency, and fragmentation index, were examined secondarily for possible effects.

One thing I found highly irritating about this paper is the way that they reported their findings. Rather than showing the data in a straightforward bar graph or a table with clear descriptions of what each number means, we're treated to a single table, (Table 2) showing regression findings, which are described as being within-subject Analyses on means for combined remedy nights (22/23) versus means for combined placebo nights 8/9, controlling for gender, personality scores, total time in bed, and means for combined baseline nights (1/2/15/16). Unfortunately, even after reading the paper, I'm not sure exactly how authors controlled for baseline nights. Another thing I noticed right away is that the 95% confidence intervals were large. Really large, as in at least half the value of the actual number, often considerably more.

Also rather curious were the findings themselves, which were that overall PSG for the remedy week showed significantly longer TST, increased NREM sleep including more minutes in stage 2 and increased slow wave sleep (SWS), with a trend toward increased minutes of stage 4 sleep (β=5.8, p<0.10) compared with placebo. The homeopathic remedies also led to more sleep disruptions after sleep onset, with significantly increased awakenings, number of stage changes, and more type 2 arousals compared to placebo. Sound familiar? Once again, it's the same thing we've seen before: Mixed, inconsistent results.

There's also another issue that is mentioned in the discussion, but the authors' explanation is not convincing. The authors note that one possible interpretation of the data could be that the changes in sleep during the remedy week could be due to the passage of time and the adaptation of the subjects to the study protocol and equipment, rather than remedy effects. They are correct but not so convincing in their dismissal of that concern, in which they argue that everything is hunky dory because analyses were controlled for baselines taken on nights 1 and 2 and on nights 15 and 16. Here's the problem. The very experimental design calls for a single-blind placebo during the earlier intervention week. Why single blind? Try not to laugh:

The study design was deliberately structured with single-blind placebo preceding allocation to one or the other of the two remedies double-blind, in order to address a different potential methodological and theoretical concern, i.e., the reported risk of non-local or entanglement confounds of placebo and remedy effects, when treatment arms are administered double-blind in a closed system of a homeopathic study. Keeping the experimental system open with single blind placebo may have provided a strategy to reduce the risk of entanglement between placebo and remedy effects [62–65].

Yes, Bell et al just invoked quantum entanglement. If you don't believe me, check out references 62 through 65. Go ahead. I'll wait. At least I was grateful when I read the paper that Bell actually refrained from citing Lionel Milgrom. Little victories matter. In any case, see how pseudoscience twists a normal protocol. There could very well be bias introduced by always having the placebo first and by having it be only single-blinded. However, because of some fantastical worry about "entanglement," instead of doing the study the way it should be done, totally double blinding it and not restricting whether subjects got the placebo or the "real" homeopathic remedy to one week, they do it in a way that makes it less rigorous and more prone to effects not due to the intervention. Of course, given that homeopathic remedies are basically water packed into sugar pills and then allowed to evaporate, the very concept of a "placebo" in a homeopathy trial is rather risible. After all, the homeopathic remedies are every bit as much placeboes as the placeboes. Be that as it may, this trial is not particularly convincing, either. Even the authors concede that their "present findings do not address the question of whether or not either of the homeopathic remedies tested here would be therapeutic for certain people with insomnia." Now that's an understatement.

Two years ago, NCCAM director Josephine Briggs assured Steve Novella, Kimball Atwood, and myself that NCCAM is a lot more rigorous now and that trials like these two would never be funded under the new regime. That's reassuring, but it doesn't convince me. For one thing, Briggs wouldn't say that no trial of homeopathy would ever be funded by NCCAM, even though she conceded that homeopathy is based on principles that are so unscientific as to be incredibly implausible. While I understand that it's hard for the director of an NIH center to say "never" about anything, what this told me is that Dr. Briggs would be willing to fund homeopathy research if it met some level of scientific rigor. What about homeopathy could have sufficient scientific rigor to be worth throwing hundreds of thousands of dollars at is never said, and another director might be more lax in judgment. Besides, there is a training grant whose principal investigator is—you guessed it!—Iris Bell and whose purpose involves preparing its fellows to be able to study all sorts of dubious alt-med modalities, including homeopathy. Yes, it's the University of Arizona CAM research training program.

So even though NCCAM claims not to fund pure quackery anymore (although that's debatable), it does fund education in quackery in the form of training grants. As for grants like those of Iris Bell, it's depressing to think that NCCAm threw a half million dollars at studies this execrable, in addition to studies just as bad. It's your tax dollars still at work, funding woo. When will it ever end?

Not as long as NCCAM exists.