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.
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.
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.