Terra Sigillata

Sorry to get to this so late but I wanted to weigh on an excellent post from my cancer blogging colleague, Orac, the other day on the investigation of CAM therapies in cancer. The post covers a lot of ground, as expected from any of Orac’s exhaustive missives, but I wanted to focus on the comparison and contracts between NIH’s National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Cancer Complementary and Alternative Medicine within the National Cancer Institute (NCI-OCCAM).

I am on record as a strong critic of NCCAM but a supporter of NCI’s OCCAM in that the latter is much more committed to real science and issues of cancer patients being preyed upon by unscrupulous marketers. I would argue that each NIH Institute would best have a division like OCCAM to focus on the most widely used alternative therapies within each disease area and dismantle NCCAM.

One of Orac’s commenters, factician, commented that she might swallow her ethics and apply for some of this NCCAM funding:

It makes me more than a little bit angry to know that if I were dishonest or incompetent, that I would have an easier time getting money applying to the NCCAM.

But contrary to what you might think, NCCAM funding is not easy money at all. Looking at the NIH IC rankings for FY2007, overall funding success % (not percentiles, which are much lower) is barely 11% for NCCAM while it is about twice that for NCI, NIDDK, etc. In fact, many superb investigators are quite surprised when their NCCAM-directed grants get shitcanned.

Back to OCCAM and the title of this post, I just received their annual report which notes that 80.3% of their funding goes toward the study of CAM therapies considered “nutritional therapeutic” or “pharmacological and biological treatments.” But as Orac and others point out, these are essentially experimental therapeutic medical modalities and NOT CAM under my pharmacological or biochemical definitions. Nevertheless, people who define themselves as CAM practitioners have co-opted what we consider experimental medicine (natural products, herbal supplements) or legitimate areas of health and medicine like nutrition, perhaps because these are the only CAM areas with a possibility of proving effective. This Oracian gem is well-worth repeating in this context:

There’s no scientific rationale why such studies should be segregated away as “alternative”; they could and should be evaluated just like any other scientific study, and, worse segregating them into the CAM ghetto devalues them and, by association with the woo also being funded under the rubric of “CAM,” makes them look like woo too. [emphasis mine]

However, I’ll still be critical of OCCAM where it is warranted, such as Orac’s experience with a OCCAM representative at the recent AACR annual meeting carrying on with non-scientific terminology of what sounds like the simple study of pharmacological additivity/synergy. Not so sure of the source of funding of the “homeopathy” study Orac points out in his post – it is listed on the NCI website but a CRISP database search fails to pull out the PI or product – by the way, Traumeel is not homeopathic; instead it is a dilute herbal extract mixture from plants with in vitro data supporting anti-inflammatory activity – so CAM investigators in this case do not even use the proper terminology to define their study agents. As far a scientific rationale for this study, at least one study published in 2002 in Cancer indicates that this product has some activity in relieving the mucositis/stomatitis associated with chemotherapy. However, as Orac points out correctly, these cancer CAM studies on healing touch and reiki are just plainly based on magical thinking and not scientific mechanisms. These trials, no matter how well-designed, are simply testing placebo against placebo.

I am certainly suffering like everyone else with NIH funding percentiles of 10-15 but I can justify that the more conceptually comprehensible of what is characterized as CAM is worthy of study, if for nothing else that to provide docs and allied health professionals with fuel to inform patients what works and what doesn’t. But as we’ve seen, and Orac points out, negative trials and preclinical studies do not dissuade CAM advocates from continuing to espouse their own Lost Cause. We can at least use facts to combat that stance.

Comments

  1. #1 Abel Pharmboy
    May 8, 2008

    In point of fact, an integrative medicine website/database blog implies in this post that the prescription drugs, paclitaxel and docetaxel, are essentially herbal medicines because they were isolated originally (or semi-synthesized from) compounds in the Pacific and European yew trees.

  2. #2 bill
    May 8, 2008

    …Oracian gem…

    Orac-ular, surely?

  3. #3 isles
    May 8, 2008

    It seems like the bad thing about nutritional trials being classified as CAM is not so much that the label makes the trials look like woo, as that being in the same category as these trials gives the nonsensical stuff a sheen of respectability.

  4. #4 Joe
    May 8, 2008

    APB wrote “In point of fact, an integrative medicine website/database blog implies in this post that the prescription drugs, paclitaxel and docetaxel, are essentially herbal medicines because they were isolated originally (or semi-synthesized from) compounds in the Pacific and European yew trees.”

    That is a stretch of the imagination. Taxol is not orally bioavailable. I doubt if a practical, herbal dose was ever administered by injection. I also doubt if Taxus extracts were ever recommended for cervical cancer.

    Nature abounds with pharmaceutically active products. Calling one, in hindsight, an herbal medicine is inane; especially when the herb is clinically inactive and the indication is unknown to traditional use.

  5. #5 Joe
    May 8, 2008

    Furthermore, the “Natural Standard” site is operated by quacks. look at the NDs and other bogus credentials. If I recall, scroll down among contributors- uber-quack Andy Weil is there.

    “Natural Standard, a Harvard-based group that bases reports on published scientific papers but does not take plausibility into account in its evaluations. Thus it almost never says that something doesn’t work. In addition, it does not take into account that some positive reports are falsified, and it uses weasel words to tone down negative evaluations. Applied kinesiology is a pseudoscience based on the anatomically and physiologically impossible notion that muscle-testing enables the practitioner to determine “weaknesses” of organs throughout the body that “correspond” to nutrients placed under the tongue. Instead of acknowledging that this is nonsense, Natural Standard concludes: “High-quality scientific research of applied kinesiology is limited. Some studies suggest that muscle responses are not related to underlying diseases, and others report that diagnoses made by applied kinesiology practitioners are not consistent and may not accurately reflect nutritional status. Because of weaknesses in available research, the effectiveness of applied kinesiology remains unclear.” An honest assessment would state that properly designed studies have found no relationship between muscle responses and underlying disease and that the diagnoses made by practitioners have nothing whatsoever to do with nutritional status.”
    http://www.quackwatch.org/12Web/uracviolators.html

    They don’t know that applied kinesiology is quackery, and we are supposed to believe whatever they tell us?! This is a reason that Harvard is on Orac’s quackademic medicine list.

    Years ago I reviewed their site, and they had a free, sample, monograph on “hydrotherapy” which suggested that (the usually unspecified) “toxins” can be drawn through the skin into water!!

    I have to stop. “Natural Standards” is not a source for health information.

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