Terra Sigillata

Chris Mooney just asked the question as to why sci/med bloggers are up in arms about Sen Tom Harkin’s recent complaints about the National Center for Complementary and Alternative Medicine (NCCAM), the arm of NIH charged with funding studies to investigate the mechanisms and efficacy of modalities not currently considered mainstream medicine. I left a comment for Chris that ended up being a blog post so I’ll share it with Terra Sig readers here and expound a bit for good measure.

The problem is that Harkin has stated that the establishment is discriminating against alternative medicine and that it seems to him that NCCAM has been doing too much to disprove the efficacy of alternative therapies. [see excellent post by Dr David Gorski at Science-Based Medicine].

The story of Harkin’s amazing statements were first popularized last week by Majikthise journalist, Lindsay Beyerstein, daughter of the famous Simon Fraser Univ Prof Barry L Beyerstein whose article, Why Bogus Therapies Often Seem to Work, I keep in my sidebar to the lower left. Lindsay notes:

Harkin used his clout on the Appropriations Committee in 1992 to create the National Office of Alternative Medicine. In 1998 he co-sponsored legislation with Republican Bill Frist to upgrade the national office to a national center.

Over a decade later, Harkin’s disappointed that the NCCAM’s research is failing to confirm his biases.

Harkin doesn’t seem to realize that by publicly pressuring an ostensibly independent research center to produce positive results, he’s undermining the credibility of the center he worked so hard to create. If even if NCCAM does come up with positive results, Harkin’s giving the scientific community an excuse to discount that research as tainted.


In reality, many things have been tested, especially herbal remedies in my field, but the majority of the results have been negative. To the contrary of Harkin’s view of NCCAM and the researchers they supported, I would submit that the PIs of these grants were primarily advocates of alternative therapies who were sorely disappointed their ideas didn’t flesh out.

Harkin seems to be espousing an advocacy role rather than a scientific role. Moreover, the foursome that he brought to testify to the Senate primarily spoke of preventive medicine approaches that are not considered “alternative” but are rather being co-opted by so-called “integrative medicine” as their own since the more unscientific modalities have not proven effective. Saying that nutrition and cardiovascular preventive approaches are CAM or integrative medicine is utterly ridiculous.

Hence, I submit that integrative medicine is not “transformational.” Instead, it is the thinly veiled adoption of real medicine that works to provide an air of legitimacy around the highly-questionable approaches often offered, packaging it into a new-agey vibe where “patients” can go to spa-like clinics on academic medical center campuses, and have the luxury of paying out-of-pocket for “services.”

Yes, the key to the integrative business model is avoiding that nasty insurance business and capturing those willing and able to pay. I am waiting for a medical economics study to confirm my informal observations but integrative medicine, IMHO, is medicine for the rich and famous.

Believe me, as a natural products pharmacologist I would love to see some of these remedies have therapeutic efficacy. They may ultimately do so if proper basic science is done first that informs the dosing schedules used for clinical trials. However, NCCAM was under political pressure to show some benefit of anything and therefore supported expensive clinical trials in premature, Hail Mary attempts to get quick and early payoffs.

Instead, NCCAM is left with a trash heap of negative data (ginkgo, glucosamine/chondroitin, echinacea, St. John’s wort, shark cartilage) – not because the approaches are being discriminated again but rather because the science did not support their efficacy.

Hence, I argue that NCCAM is a victim of itself and its own establishment as an advocacy arm, not a scientific arm, of NIH.

Comments

  1. #1 leigh
    March 5, 2009

    abel, being in natural products, i’m almost surprised you’re not in neuropharmacology! we’ve got lots of exciting natural products going on over here.

    nccam was set up to be a failure by its very own contradictory nature- apparently this was not foreseen. it’s a failure for not proving some dude’s hunches, and it’s a waste of research money because we’re getting loads of negative data.

  2. #2 kelebek
    March 6, 2009

    güzel güzel

  3. #3 Abel Pharmboy
    March 7, 2009

    leigh, it’s actually amazing that i didn’t end up in neuropharm because my grad dept was extremely heavy in neuroscience and, as you say, most of the early natural products used by indigenous peoples were cns-active agents.

    maybe i could do my next sabbatical in your lab.

  4. #4 Dr Benway
    March 8, 2009

    Harkin can’t stand up to the chiropracters, who view him as their champion. It seems a very dysfunctional relationship.

    Google “Harkin” and “chiropractic.”

    The fight is being spun as an MD vs. DC turf war. We’ll need all the non-MDs we can get helping to hold up the standards of good science.

  5. #5 isles
    March 9, 2009

    Politicians are always thinking they’re smarter and more competent than they really are, and it causes bigger problems in science than anywhere else, I think, because they can be flat-out incontrovertibly wrong, and still get their way.

    Is there anything to be done about Harkin?

  6. #6 Dr Benway
    March 9, 2009

    Sometimes raising a stink helps. It worked to castrate Trent Lott, anyway.

    But I’ve no idea how to raise a stink.

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