Pharyngula

Damn the NCCAM

Since I was just griping about the false claim that the political left is as anti-scientific as the right, I will mention one exception where I think the argument has some merit: alternative medicine. I am not a fan of the National Center for Complementary and Alternative Medicine (NCCAM), which had a 2005 budget of 123 million dollars—123 million dollars that was sucked away from legitimate science and placed in the hands of quacks. The latest issue of Science has two articles, pro and con, on NCCAM, and you might be able to guess where my sympathies lay.

A major goal of NCCAM has been to carry out clinical trials of various herbal medicines…which is a good thing. Some might work, and this is how we’d find out, and some might fail, and then we can dismiss them and move on. Unfortunately, what seems to be happening is that these herbs flop in the trials, and nothing happens. They’re still kept on as active candidates for research, there certainly is no regulatory action taken against the peddlers of these nostrums, and apparently, no one is going to believe any recommendation anyway.

A major emphasis of NCCAM’s first 5-year strategic plan was to perform phase III clinical trials of popular herbal medicines and other supplements to inform the public about their efficacy. Accordingly, the fraction of funds allocated to clinical research by NCCAM has been high, ranging from 80% in fiscal 2000 to 68% in 2004, compared with ~33% by the rest of NIH. The results of clinical trials of St. John’s wort, echinacea, and saw palmetto have been published, and none of these herbal medicines was more effective than the placebo controls. Although Straus has commented that "he for one is satisfied that echinacea is not an effective cold remedy", spokesmen for the herbal and nutraceutical industries predictably responded that the studies were flawed and that more research is needed. It appears doubtful that these negative trials will change the practices of many people who use herbal remedies, given their belief in the healing power of natural products and their distrust of physicians, scientists, and the pharmaceutical industry. When regular users of dietary supplements were asked, "If a government agency said that the dietary supplement is ineffective, what would you do?," 71% responded that they would keep using the supplement.

You can read what NCCAM has to say about St John’s Wort, Echinacea, and Saw Palmetto—while admitting that they’ve shown no significant effect in the trials, they also surround the descriptions with weasel words: “it has traditionally been used for…”, “it is believed to…”, and most cunningly of all, they undermine their work with that sneaky “some studies show otherwise…”. I’d be more impressed with NCCAM if they showed the slightest sign of skepticism and actually had the spine to come right out and say “This treatment confers no health benefit at all and we advocate slapping herbal medicine suppliers who say otherwise with lawsuits and criminal penalties.” I don’t think you will ever see anything close to that from that group.

They also need to show some sign that they recognize irony. I was amused at their bland mollycoddling of homeopathy:

Homeopathic medicines in high dilutions, taken under the supervision of trained professionals, are considered safe and unlikely to cause severe adverse reactions.

As anyone who has looked into homeopathy at all knows, these are very high dilutions—dilutions that mean there is no active agent present at all, so they are telling readers that they need the supervision of trained professionals in order to have a drink of water. This may be true of the people who fall for the homeopathy scam, but the rest of us really don’t need to consult a homeopath when we’re thirsty.

I should at least mention the pro-NCCAM article from the director of the institute; I found it unconvincing, but it does highlight the fact that they do carry out real clinical trials and that they acknowledge that scientific standards of evidence must be upheld.

We fully support the Institute of Medicine’s recommendation that the same principles and standards of evidence apply to all treatments, whether labeled as conventional medicine or CAM. We believe that we have succeeded in establishing a research enterprise that will achieve this standard. While challenges remain, we are confident that knowledge gained from NCCAM-supported studies will continue to inform the public, health-care providers, and policy-makers about how and when evidence-based CAM therapies should be used and effectively integrated into conventional medical care.

All well and good, but I don’t see the point of NCCAM at all, then. If an alternative treatment can meet the rigorous demands of science, why not just go through NIH directly? NCCAM adds nothing other than a way to fast-track dubious claims, bypassing the constraints of regular NIH funding, and perhaps a way for snake-oil salesmen to borrow on the respectability of a federal research institution.

I favor the conclusion of the anti-NCCAM paper.

Conclusions
We believe that NCCAM funds proposals of dubious merit; its research agenda is shaped more by politics than by science; and it is structured by its charter in a manner that precludes an independent review of its performance. The central issue is not whether research into alternative therapies should be supported by NIH. In view of the popularity of alternative therapies, it is appropriate to evaluate the efficacy and safety of selected treatments. The issue is that the administration of research by NCCAM falls below the standards of other NIH institutes and that the evaluation of alternative therapies could be performed by mechanisms that are already in place at NIH. We do not question the qualifications or integrity of Stephen Straus and his staff. However, because of the constraints under which it operates, NCCAM is unable to implement a research agenda that addresses legitimate scientific opportunities or health-care needs. Applicants for NCCAM grants must follow the center’s guidelines that stipulate which therapies are eligible for study. In contrast, applicants to NIH institutes can propose any project that may provide new insights into human biology or the pathogenesis or treatment of disease.

Recommendations
We propose that the IOM appoint an independent panel of scientists to review NCCAM. The panel should evaluate the center’s unique charter as well as its research portfolio, and its members should not include NIH or NCCAM staff, NCCAM grantees, and other stakeholders. An independent review is likely to be strongly opposed by members of Congress whose beliefs led to the creation of NCCAM and the passage of the DSHEA. Therefore, scientists and professional organizations should communicate to Congress and to Elias Zerhouni, the director of NIH, their strong support for an external assessment of NCCAM.

The “alternative” to science-based medicine is hardly medicine at all, but a hodge-podge of magical thinking, witchcraft, and pseudoscience—it isn’t made more palatable by setting up a special funding agency with standards lowered to allow junk to be privileged with their own private pot of grant money.


Marcus DM, Grollman AP (2006) Review for NCCAM Is Overdue. Science 313(5785):301-302.

Straus SE, Chesney MA (2006) In Defense of NCCAM. Science 313(5785):303-304.

Comments

  1. #1 Simon Middlemiss
    July 24, 2006

    So I am justified in telling my wife to stop spending fortunes on malic acid then?

  2. #2 wamba
    July 24, 2006

    Unlike you, I didn’t agree entirely with the latter conclusion. I would quibble with one particular sentence:
    We do not question the qualifications or integrity of Stephen Straus and his staff.

    Here’s an idea: let’s carry out a review of NCCAM using astrology and tarot cards.

  3. #3 Steve LaBonne
    July 24, 2006

    It’s all about politics. The 123 big ones is the price of mollifying certain members of Congress who would otherwise take their petty stupidity out on the rest of NIH.

  4. #4 highD
    July 24, 2006

    I think the truth in advertising and journalism people should put some numbers to the infinitesimal high-dilution dilution claims. 20C = 10^-40

  5. #5 Sid Schwab
    July 24, 2006

    I agree, and find it mysterious, that many liberals seem to have credulity lacunae when it comes to alternative medicine. As a liberal and a doc, it puzzles and annoys me. In my state (wherein PZ got his PhD) the liberal insurance commissioner and legislature passed, a few years ago, rules requiring health insurance companies to cover such things as chiropractic, massage therapy, aroma therapy, etc. I think it’s highly worthwhile to study these modalities, for the reasons PZ stated. But to do so in a non-politicized environment.

  6. #6 Bronze Dog
    July 24, 2006

    Glad to see that you’re willing to take on organizations other than the Discovery Institute and your other regulars, PZ. :)

  7. #7 Tim Murtaugh
    July 24, 2006

    This is a test post.

  8. #8 natural cynic
    July 24, 2006

    Has anyone checked the political affiliations of the legislators pushing the NCCAM? I have seen elsewhere that they are strongly supported by several prominant Republicans, including Rep. Burton who is the chair of the Finance Committee. The support of woo seems to be a political equal opportunity endeavor.

  9. #9 compass
    July 24, 2006

    the false claim that the political left is as anti-scientific as the right,

    Right. And the global warming Chicken Little screeching isn’t politically driven either. This is Gore’s opening salvo in the 2008 race, nothing more.

  10. #10 Steve LaBonne
    July 24, 2006

    Thanks, compass, for reminding us just how anti-scientific the right is. Climate deniers, as PZ has said in the past, are no more respectable than creationists.

  11. #11 gordonsowner
    July 24, 2006

    Yeah, from personal experience, I don’t think the alternative medicine is distinctly left/right… my mother-in-law is far right wing, and she runs a christian alternative-medicine business. Also, look at Katherine Harris and her involvement with miracle water (I can’t remember the link, but I’m sure someone does). Fundamentalism and anti-science there seems to be spawning a right-wing embrace of alternative medicine as well.

    Oh, and to compass… Gore has been working on Global Warming for over a decade, and your own Reagan hagiographer Peggy Noonan recently lamented that scientists haven’t been able to come to a consensus on global warming when it’s obvious that it has been a fact (see a recent PZ post). On a more childish note, it’s probably been suggested, but I think ‘dumbass’ is a more appropriate handle for compass…

  12. #12 G. TIngey
    July 24, 2006

    Global Warming…

    Has anyone here (apart possibly from PZ) looked at ec=vidence collected entirely outside the USa, and what is more, by tens of thousands of unpaid volunteers.
    The statistical evidence than stacks up to the “you can’t ignore it” point – except some people do.

    Try this link:
    http://www.naturescalendar.org.uk/

    and then try “climate change”
    BUT
    The other links and pages are very interesting.
    Enjoy!

  13. #13 DocAmazing
    July 24, 2006

    Why not rely on the NIH? Well, we’ve seen the FDA approve all kinds of problematic (and, frequently, potentially toxic) crap under pressure from the pharmaceutical industry, and we’ve seen the well-connected tuck into that NIH research-dollar pie while others with equally promising research (but skimpier Rolodexes) were left to salivate.

    The short answer to the question “Why is there an NCCAM?” is that there needs to be a counterweight to Big Pharma’s demands on medical schience to keep producing profitable but useless crap like seventeen variations on an H2 blocker or yet another erectile-dysfunction medication. The nice thing about herbals and neutraceuticals is that they’re cheap and (usually) have favorable side-effect profiles.

    Frankly, NCCAM could produce poppycock by the bushel and still be a better use of the taxpayers’ money than helping fund research that turns The Purple Pill into The New Purple Pill.

  14. #14 wamba
    July 24, 2006

    Has anyone checked the political affiliations of the legislators pushing the NCCAM?

    Science Fiction

    by Chris Mooney

    Over the past decade, several events prompted the beginnings of a reconciliation between scientific medicine and CAM. In 1992, Sens. Tom Harkin (D-Iowa) and Orrin Hatch (R-Utah) convinced Congress that the NIH should establish an Office of Alternative Medicine and awarded it a $2 million budget (Harkin believed that bee pollen, a popular alternative treatment, cured his allergies and wanted further scientific study).

  15. #15 Corkscrew
    July 24, 2006

    As anyone who has looked into homeopathy at all knows, these are very high dilutions–dilutions that mean there is no active agent present at all, so they are telling readers that they need the supervision of trained professionals in order to have a drink of water.

    I think the risk is that, if they’re not produced by trained professionals, they might contain something other than water. I can well imagine some moron trying to create a hemlock-based homeopathic remedy and accidentally poisoning themselves.

    Which is a fair point, albeit one they could have phrased better.

  16. #16 Minnesotachuck
    July 24, 2006

    I’d make a two item list of science blind spots of the left, with nuclear power being the other item on it. That’s not to say there aren’t serious risks to the technology; there most definitely are. But there are also risks in continuing to spew billions of tons of CO2 into the air annually, and it seems that every week more science comes out indicating that the effects are worse than we thought before, and that we’re closer to a point of no return, if not past it already. The world, and especially the USA, is going to have to drastically cut down on CO2 emmissions from fossil-fired electric generating plants, especially coal-burning ones, and probably on a time scale faster than other green sources can come on line, or than carbon sequestration technology can be fully commercialized and deployed. Nuclear is the only CO2 emission-free technology available to replace it in the interim. The alternative would be massive electricity shortages that will make the social and economic chaos caused by California’s 2000-2001 deregulation debacle look like child’s play.

  17. #17 Calladus
    July 24, 2006

    PZ,

    Possible error here. Yes, Homeopathy doesn’t work, but it’s not always true that only water is used to dilute the original substance. Alcohol is also used, depending on the manufacturer.

    So, it’s possible that some types of homeopathic solutions, when drunk in sufficient quantities, could actually have some affect on the subject.

    But personally, I’d rather enjoy a nice Rum Punch. It tastes better, it’s cheaper, and it comes with a cheerful umbrella and slice of fruit.

  18. #18 Calladus
    July 24, 2006

    Darn it, I meant “effect”, not “affect”.

  19. #19 Dan
    July 24, 2006

    When regular users of dietary supplements were asked, “If a government agency said that the dietary supplement is ineffective, what would you do?,” 71% responded that they would keep using the supplement.

    That pretty much sums it up right there.

    The major problem we have in the battle between ignorance and wisdom is that stupid people don’t fight fair. Being ignorant is easy. It doesn’t require any effort or self-awareness at all. Our culture encourages a high level of ingrained and pervasive intellectual laziness. People don’t give that up willingly.

  20. #20 oldhippie
    July 24, 2006

    “If an alternative treatment can meet the rigorous demands of science, why not just go through NIH directly?”
    Because herbals cannot by patented and so no one would bother to pay for their testing.
    I do think however, all bottles of products that have been tested and found ineffective should be so labelled.

  21. #21 Nymphalidae
    July 24, 2006

    I’ve never found the hippies with their earth mother stuff and crystals and alternative medicines to be any more credible than creationists and global warming deniers. One is so open minded all their brains have fallen out, the other hasn’t had a new idea since about 1890.

  22. #22 speedwell
    July 24, 2006

    There’s no such thing as alternative medicine. There’s only medicine. Either a given mode of therapy is useful for a given person, or it is not. There’s no more virtue in “alternative” medicine than there is in “alternative” physics. The NCCAM are a bunch of dangerous maniacs with their hands in the pockets of the vulnerable and suffering.

    I have an interesting background to be saying this sort of thing, though. Before I got hit on the head with a gold brick wrapped in a slice of lime and found atheism and skepticism, I actually took quite a few formal classes in various sorts of alternative therapies on my way to a degree in “naturopathy.” My insistence that therapies had to WORK and be PROVEN to work made me very, very unpopular at that school. Finally I gave up, threw away all the iridology and crystals and touch therapy and homeopathy nonsense, and concentrated on trying to find out what really worked and was really effective. There’s not that much.

    I’m now scaled back to a few effective herbs (there are some), vitamins in deficiency cases, a little aromatherapy (which is nothing but the use of essential oils, themselves powerful medicines in many cases), music/dance/storytelling for cases of depression and shyness, non-directed meditation (it’s good to be quiet sometimes), sensible nutritious food, and simple principles of modesty and cleanliness in body and mind.

    OK, you can start giving me flack about the choices I’ve made. But I don’t prescribe, I’m not selling anything, I admit when I don’t know something, and I don’t make claims that I can’t personally back up. I’m well aware of the placebo effect and the misleading appeal of anecdotes. I don’t mind changing my mind when the evidence warrants. I really don’t think I can be accused of woo-woo-ism. :)

  23. #23 speedwell
    July 24, 2006

    Oh… and yes, I do go to the doctor, and she’s a very competent and tough old geriatric oncologist. (Luck of the draw choosing a primary care physician on my HMO.) She and I agree that modern scientific medicine is the product of very smart and dedicated humans, with all the pros and cons that entails. We believe in the proper tool for the job, and don’t accept anything on faith, that’s all.

  24. #24 mjfgates
    July 24, 2006

    There are good reasons for people to believe in alternative medicine. It’s not that it WORKS, but to understand why it doesn’t, you have to have some understanding of statistics. If Aunt Tillie tries going to a chiropractor for her back pain, and the back pain goes away, that’s going to convince a lot of people that maybe chiropractication does something useful. (“Chiropractcy?” “Chiroprism?” “Chiropractorization?” Noun, please, somebody give me a NOUN!) Likewise, there are a *lot* of problems that don’t go away even given the best medical care possible.

    There’s also the fact that many doctors didn’t really trust or use scientific methods up until fifty years ago or so EITHER. It took HOW long to get those guys to start washing their hands between patients?…

  25. #25 j
    July 24, 2006

    I used to have an indifferent opinion with regards to alternative medicine. My mother is a big fan of feng shui, acupuncture, and all sorts of eastern alternative medicine. It seemed pretty harmless to me, a little bit like religion–why not let each person retain his or her own delusions?

    Then I realized that alternative medicine, like organized religion, was leeching government funding away from infinitely more important and pressing initiatives. I have now begun the fruitless task of convincing my mother of the uselessness of alternative medicine.

  26. #26 Russell
    July 24, 2006

    There are several ways in which the non-liberal left is just as loopy as the religious right. At this point, one has to pretty much ignore two centuries of history to still believe that socialism is a viable economic system. (By socialism, I mean the notion that all business should be owned by the government, not the democratic socialism of a nation like Sweden, which provides generous social services that are funded by taxing a thoroughly capitalist underlying economy.) There is also on the fringe left a relativism that paints science as a cultural enterprise whose findings are mere cultural artifacts with no more claim to veracity than those produced by any other cultural enterprise.

    Extreme political ideology is a scary thing. The foreboding of the current time isn’t because the conservative party is in power, but because it is in power at the same time that it has been taken over by religious right radicals.

  27. #27 furtim
    July 24, 2006

    “we’ve seen the FDA approve all kinds of problematic (and, frequently, potentially toxic) crap under pressure from the pharmaceutical industry”

    Like? Oh, and don’t say amalgam fillings, or the terrorists have already won.

    speedwell: Most people, even skeptics, have no problem with proven herbal remedies. Much of modern medicine, after all, originally derived from natural compounds that were later isolated and synthesised into stronger forms. Penicillin and aspirin are good examples of this. The problem is that, like your classmates, most believers in “alternative” medicine skip the proven part, which is pretty significant. And then you have the homeopaths who are completely blind to basic chemistry, on top of that. But if you’re spreading responsible use of proven remedies, then good for you.

    You mention “luck of the draw” with your HMO, though. I have to wonder how much a factor that is with driving people to seek “alternative” medicine in the first place. You’re bound to have a stable of firm true believers no matter what, but I wonder how many people would opt for traditional (read: real) medicine instead if HMOs and the like simply provided better service.

  28. #28 Jim Wynne
    July 24, 2006

    mjfgates:

    The noun you’re looking for is “chiropractic.” (It’s also an adjective.)

    Now, what was your point? I don’t think it’s a lack of understanding statitistics that’s the problem, it’s use of faulty logic. I dated a girl many years ago who believed that taking tetracycline (to the exclusion of all other antibiotics, mind you) helped to abate cold symptoms. At some point, her taking the drug was coincidental with the cessation of symptoms, so she erroneously ascribed the “cure” to the tetracycline, and no amount of reason could convince her otherwise.

  29. #29 dAVE
    July 24, 2006

    In the mid-90s you saw a lot of anti-science on the left. One branch of it was from radical cultural relativism that contended that science was just another social construct, a “way of knowing” that had nothing more to do with reality than any other cultural system of myths or metaphysics. This viewed the ideas that things burned because of fire spirits equally valid as the idea that combustion involves things like oxidation, etc.

    Another popular view at the time was the radical feminist notion that science was inheriently sexist in its conception, since it was invented largely by men. (Of course the history of science is filled with examples of using so-called “scientific evidence” to justify racism and sexism. That is indisputable.) I’m talking about the contention that calculating the physics of solid objects was farther along than fluid dynamics because “rigid” therefore masculine items were privileged over “fluid” and therefore feminine items. Not becuase fluid dynamics is just plain waaay harder to solve mathematically. Of course, the contention would be that math is sexist if so-called “feminine” problems were harder to solve.

    Re: alternative medicine. I understand the distrust of Big Pharma and their profit motive, but is that supposed to mean that the herbal companies are somehow NOT profit-driven? ‘Cause they are.

  30. #30 Ian H Spedding
    July 24, 2006
  31. #31 HPLC_Sean
    July 24, 2006

    If you ask me, it’s money well spent! It’s about time the public had some data on the efficacy of these preparations. Private industry would NEVER have footed the bill for these trials and would NEVER have published any data that contradicts the anecdotal claims the industry relies upon for $$$.
    Minds, especially the chronically ignorant ones, are not changed overnight. I mean, how many people can actually tell you what a double-blind placebo-controlled clinical trial is anyway?

  32. #32 flame821
    July 24, 2006

    I think it depends on the situation. It was my OB/GYN who sent me to a chiropractor when I was 7+ months pregnant and suffering from sciatica. It did make a huge difference, and as an odd aside it also helped with my migraines.

    Now, what might the long term effects be with ongoing chiropractic treatment? I have no idea, I don’t know if anyone has bothered doing any studies either. However I do know that getting my spine ‘cracked’ once a month sure beats self injecting and enduring rebound headaches 2-3 times a month. And its more cost effective to boot.

    Now would I recommend chiropractic to someone as a cure for heart disease or cancer. Hell no! That would be irresponsible and possibly criminal.

    Common sense would be a good guide to use.

  33. #33 Kagehi
    July 24, 2006

    “If an alternative treatment can meet the rigorous demands of science, why not just go through NIH directly?”

    Because, this statement: “We believe that NCCAM funds proposals of dubious merit”, doesn’t **always** refer to quackery and gibberish. All too often it refers to stuff that either isn’t covered by the FDA, because its grown, not patented, or which is simply rejected, on the not always correct grounds that it, “simply can’t work.” Sadly, even now, this is not an uncommon stance. Its fundimentally the same flaw that leads physicists to reject biology or come up with some nutty BS, like cells talking to each other and other people with “light”, it just generates the opposite conclusion, by rejecting a possibility that might be real, instead of embracing one that is totally unbelievable.

    But your right about one thing. These people are far less rigorous in pointing out when things are completely stupid, than in testing to see if they are.

  34. #34 Carlie
    July 24, 2006

    Why is it “chiropractic” and not “chiropractice”?
    That always really bugged me.

  35. #35 DocAmazing
    July 24, 2006

    What has the FDA approved that has proven dangerous? A few things spring to mind: Phen-Fen, cox-2 inhibitors, Thalidomide…even NutraSweet is starting to look scary, now that time has passed. Please note that each of these things can be used safely and responsibly, but that trials and approval rushed by so that the downsides were not elucidated until the stuff hit the market.

    The answer, as always, is more research, not less.

  36. #36 Orac
    July 24, 2006

    Ack. I saw those articles too and was tempted to blog on them, but the Abraham Cherrix case preempted my attention. Come to think of it, the Cherrix case is exactly the sort of thing that happens when quackery is given the veneer of science.

    In any case, I used to be a supporter of NCCAM, but when I started to see trials of piffle like Qi Gong and Reiki therapy being funded by NCCAM, I started to come around to Wally Sampson‘s point of view.

    I’ll also point out that love of altie pseudoscience isn’t just limited to the left. Dan Burton, for instance, is a big supporter of the mercury-thimerosal link, and a lot of the bloggers falsely claiming that the Hoxsey treatment is a valid alternative to chemotherapy in Hodgkins’ disease (they’re coming out of the woodwork on my blog right now) are very conservative, evangelical Christian, home-schooling types.

    Actually, I have a copy of the strategic plan for NCCAM for the next five years that I happened to pick up at the NCCAM booth at the American Association for Cancer Research Meeting in April, and I’ve been meaning to blog on some of the more ridiculous things I’ve found there. This might just be the prod to get me to do it.

  37. #37 Kristjan Wager
    July 24, 2006

    Actually, I have a copy of the strategic plan for NCCAM for the next five years that I happened to pick up at the NCCAM booth at the American Association for Cancer Research Meeting in April, and I’ve been meaning to blog on some of the more ridiculous things I’ve found there. This might just be the prod to get me to do it.

    But will they give B├ęchamp a fair hearing? Or will they continue to ignore him because of their faith in Pasteur? (for those not aware of my reference, look over at Tara’s blog, where things will become more clear – or as clear as they can become when alties are involved).

  38. #38 Chakolate
    July 24, 2006

    Unfortunately, ‘science-based medicine’ is actually ‘Big Pharma-funded-science-based medicine’. And what is paid for is generally worth the money – for Big Pharma. Science-based medicine backs prescription of drugs that kill 100,000 people every year. And I mean legally and correctly prescribed drugs, taken as prescribed.

    If ‘alternative medicine’ includes nutrition, it’s worth more than all the ‘science-based medicine’ there is.

  39. #39 Kristjan Wager
    July 24, 2006

    What is it with all these alties coming out of the woodworks?

  40. #40 Orac
    July 24, 2006

    What is it with all these alties coming out of the woodworks?

    Welcome to my world.

  41. #41 Colin
    July 24, 2006

    I agree that there may be way too much money being thrown at therapies that should have been abandoned a while ago. However if it wasn’t for NCCAM many of these products would never have been researched at all. There is no incentive for the alt medicine market to research these claims.

    What really needs to be done is allocate some of the NCCAM money in a educational campaign showing what may have benefit and what doesn’t. We need to give people options — people will rather do something rather than nothing.

    There are a few (ok very few) alt meds that show some effectiveness and we need to support those at the same time as bash the useless treatments. If people are just told that such and such doesn’t work they’ll just ignore you. However if they are told this doesn’t work but this may work, they will probably switch.

    Also, we really can’t completely ignore the placebo effect here. Some people are more reassured by the hyped promise of the alt med providers. Compare the human connection that a person gets from a professional acupuncturist to the typical HMO “Hi take this leave” style treatment. This connection may actually make a difference with the person’s recovery.

  42. #42 craig
    July 24, 2006

    Kind of going off on a tangent here, but it is true that treatments that are effective but not patentable get ignored.

    I happen to have a “rare” incurable illness for which there is no consistently effective treatment, at least in the US. For over 30 years this disease has been treated in most European countries and Canada with varying but generally positive success with the prescription of a cheap and relatively safe chemical compound.

    In the states, this compound has not been FDA approved. Here, the treatment in milder cases pretty much consists of “get used to it…” and in severe cases there’s surgery. The surgery is expensive, dangerous, the recuperation is reportedly horrible, the surgery works only about half the time, and for those for whom it does work the effect is usually temporary.

    The compound has not been approved in the US NOT due to safety concernes – decades of use have shown it to be safe and effective – but because it is too CHEAP. A month’s prescription would likely cost under $5.

    A support group for sufferers of this illness did lobby pharmaceutical companies to apply for FDA approval, and there was one company that seriously considered it, leaving sufferers hopeful for a couple of years – but finally they opted not to because they felt there wouldn’t be enough profits to justify forking over the application fees.

    So currently, people with this illness who want to try it have to either travel to Canada regularly and get a Canadian doctor to prescribe it (of course not covered by their health insurance), or if they find a US doctor aware of it and willing to prescribe it, they can track down a compounding pharmacy (and endangered species) and have this stuff put together…

    It’s real experiences like this that unfortunately lend support to the quacks, because it gives people the impression that the government and industry are working against them.

    About that survey quoted above where people said they would still take an herbal remedy if the government study showed it as ineffective? You can bet that for at least some of them, they would take that study as proof that it WORKS.

  43. #43 craig
    July 24, 2006

    Please note there was a typo in my message… should read “they can track down a compounding pharmacy (an endangered species) and have this stuff put together…”

    the typo might have made it seem like I was talking about powdered rhino horn or something.

  44. #44 Sastra
    July 24, 2006

    If ‘alternative medicine’ includes nutrition, it’s worth more than all the ‘science-based medicine’ there is.

    I think most doctors would agree that good nutrition IS science-based medicine, and it’s something they’ve been harping on for years. The word “alternative” is usually reserved for medicines or therapies which are either untested, or were tested and failed.

    If alties *alone* are pushing a particular kind of nutrition, watch out. It likely won’t be something reasonable, it will be extreme and fringe.

  45. #45 Bronze Dog
    July 24, 2006

    Alties like to talk about nutrition, but they usually tell you that you should buy more of their suppliments, rather than eat more fruit, vegetables, and cereal, like my doctor tells me.

  46. #46 hank
    July 24, 2006

    Craig’s comment illustrates what bothers me most about the organization.

    They should be giving us a complete list of all the medicines — like the one he says works for him (wish I knew exactly what it is!).

    There are a lot of things that aren’t patented and aren’t for sale in the US but are used in other countries, as prescription medicines.

    We should get information about (ha!) the ones that won’t make the nutraceutical campaign donors any money, as alternatives.

  47. #47 speedwell
    July 24, 2006

    Bronze Dog, you speak truth :)

    I am so sick and tired of those quaks and their nostrums. They and their cultists killed my mom, who believed in the power of noni juice, essiac, and the laying on of hands to cure her breast cancer, put off her treatment too long, and succumbed. This all happened a few years after I gave up on the nonsense myself, but Mom would not listen to me, oh no, and she wouldn’t listen to her doctors, no way… she only listened to her herb-and-noni-peddling “friends” and her sanctimonious hypocrite pastor.

  48. #48 dAVE
    July 24, 2006

    The problem of having effective treatments not profitable enough to be worth manufacturing is a problem, and really demonstrates why we need an alternative to the corporate model for pharmaceuticals. The universities for research, and government factories are what I advocate.

    But, man, supplements. What a racket, huh? I mean, wouldn’t you love to be able to just grind up a bunch of weeds, slap a label on it, with some appealing copy, and sell it for beaucoup dollars? There’s no testing for purity or accuracy, so you don’t even have to put in the bottle what it says!

    Or just take an ordinary product and get creative with the labeling. Like this friend of mine would buy something called someoneorother’s amino fuel. It had this impressive label showing all these amino acids. But if you looked closely, you would see that they were in tiny, tiny amounts, especially when you looked at the serving size. It was basically a low sodium soy sauce. Basically, they took soy sauce, ran it through chemical analysis, and marketed it as a potion with all the amino acids that you need. Unfortunately the amino acids were in less than 10mg per serving, so you’d be getting more of ‘em all in the food you were putting the damn stuff on.

    But hey, you could charge a helluva lot more than you could for soy sauce.

  49. #49 oldhippie
    July 24, 2006

    So, we have a number of problems with the way we test medicines in the USA these days. Anyone who has read “overdosed America” or one of the similar volumes published recently will see that many of our medicines are based on really disgraceful science. In some cases negative results have been hidden and only positive ones published. Added to which, as several other people have pointed out there is no motivation for drug companies to test stuff they will not profit from. This certainly will not lead to the best medical care.
    For example, as I remember it, a test was done in Europe comparing some drug for high blood pressure with advising people on having a healthier life style. The latter proved far more effective – and this was just ADVISE with no way of making the patients do any of the stuff.
    So what we probably need is more government funding of drug testing, and not just to rely just on the drug companies and the profit motive. The investment would result in much less expensive drugs. This has little to do with testing alternative medicines, but these have been around for such a long time it is probably good to test them, to at least lay them to rest. But as with prayer there is no point in testing time and time again if they clearly do nothing.

  50. #50 John Emerson
    July 24, 2006

    In my experience left alternative medicine is most common among sectarian and spiritual far-leftists, more than among liberal Democrats.

    One group which is surprisingly involved with alternative medicine, in my work experience in a hospital, is registered nurses. There are various ways of explaining this — the most plausible to me is that it’s the result of mistrust of doctors.

  51. #51 speedwell
    July 24, 2006

    There are various ways of explaining this — the most plausible to me is that it’s the result of mistrust of doctors.

    It’s the feminist mistrust of men. When I was taking my course in Therapeutic Touch, a discredited energy “therapy” much beloved of nurses, it was presented as a gentle, non-invasive, caring, healing “wise woman” thing to do to balance the rough, invasive, authoritarian, tyrannical “warrior male” medicine of the doctors. But believe me, this “good witch battling the evil king” mentality is by no means confined to nurses.

  52. #52 antid_oto
    July 25, 2006

    Minnesotachuck: I felt as you did about nuclear power for a while. And it may well be an important part of easing the transition to greener power generation. But more recently I’ve been convinced that it’s not the panacea I might have wished, largely because of this article. Short version: it’s not that it’s too dangerous, but that there simply isn’t enough rich uranium ore in the world for it to replace a much larger portion of our power generation than it currently represents.

  53. #53 Kristjan Wager
    July 25, 2006

    It’s the feminist mistrust of men.

    The return of the strawfeminist.

    Quite a few of us who comment here are feminists, or pro-feminists, and are quite pro-science. The mindset you mention, have nothing to do with feminism as such.

  54. #54 bones@mac.com
    July 25, 2006

    The problem is straightforward. Medicine developed from shaminism. Magic thru intercession from the gods. Too often we hark back to the dark days with a “medical miracle” and a “miracle cure”. People subconsciously want magic, not medicine. Medicine fails relatively often: people die in surgery, a drug that proves effective for 80% actually hurts 5%, people don’t “get better” with numerous medications. They want MAGIC. There is a pill that cures everything, even things you don’t know you have and will keep you 20 years old for 300 years. MAGIC. That’s why I can give someone a product off label and 20% will get better, placebo or shaminism. Americans are also too self centered and require immediate gratification to appreciate scientific truths, for goodness sake look at the Creationist problem, large numbers of people turning their backs on actual science and whipping up a dark “conspiracy” of scientists out to steal their and their children’s souls. We need to educate our children in the scientific method and when we do that well, then they can use that as a yardstick to evaluate everything in life-medicine, energy policy, political candidates, and shamen.

  55. #55 nccammole
    July 25, 2006

    Hmmm…I’ve heard that Straus has brain cancer and much of the day-to-day leadership is left to Dr. Margaret Chesney. She’d most likely take over if Straus either leaves NCCAM or this realm. Therefore, it is quite surprising that she was not a co-author on the support paper – perhaps a strategic move by the Center to distance the next leader from Straus???

  56. #56 speedwell
    July 25, 2006

    The mindset you mention, have nothing to do with feminism as such.

    Fair enough. I’d rather use a word that’s strictly correct, and I’m aware that benevolent, rational feminists exist. What would you suggest?

  57. #57 CrazyChemist
    July 25, 2006

    http://www.chirowatch.com/Chiro-news/mg-000326schwarcz.html

    Read down to the final portion, the follow-up to the original article. At best, alternative medicine is sending your money to a bunch of quacks who really don’t care about your health. At worst, alternative medicine is deadly (and chances are, if they perform something that ends up being potentially fatal, they won’t beable to recognise it and the potentially qualifier will disapear within a few minutes).

  58. #58 Kristjan Wager
    July 25, 2006

    Fair enough. I’d rather use a word that’s strictly correct, and I’m aware that benevolent, rational feminists exist. What would you suggest?

    What you are refering to is some kind of mythological ur-gender devide, very much against the whole concept behind feminism. It smacks of some primitive shamanism of some kind.

  59. #59 speedwell
    July 26, 2006

    Primitive shamanism, OK. But it’s a weird sort of postmodernist shamanism from the looks of it. Oh–I just found it by Googling “mythopoetic.” It’s probably what’s referred to as “New Age Shamanism.” Thanks for the help.

    I’m certainly for equal rights for everyone, but since equality isn’t very equal unless you assume both sides of the equation resolve to the same quantity, I prefer to consider myself simply a humanist (as opposed to a feminist, or whatever the corresponding thing is with respect to men… Chauvinist?).

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