Skeptics love to hate CAM. And often, with good reason. Alternative medicines or medical treatments, as is often pointed out, become "mainstream" when the available science suggests that they work, so it is almost axiomatic that "alternative" means "unproven" and it is probably almost always true that the kinds of things that end up as "alternatives" come from sources with poor track records. For instance, one of the most common forms of alternative medicine used over the last several decades is Extra X where X is some substance we know the body uses, and that we know a deficiency of is bad. The idea is that if something is good at a certain level, loading it on by a factor of anywhere from two or three to several hundred over the usually consumed amount must be REALLY good. If a substance is used in the body for something we like ... an immune system function, tissue repair, muscle energetics, etc. ... then consuming vast quantities of it MUST be good. And, in some cases, this turns out to be true. There are times when consuming huge quantities of potassium is medically indicated, for instance. But this does not mean that a daily intake of seven or eight hundred bananas is a good idea. It turns out that loading huge quantities of vitamins and minerals has very little or no positive effect and it can be rather harmful in some cases. (Though there may be some exceptions.)
Another source of alternative medicine is plants or other "natural" products. Over human prehistory and history, around the world, people have adopted the practice of eating one kind of plant or another (or extracts or products from those plants) for a ritual purpose, or sometimes, health related reasons. If we believe that culture is highly adaptive and that human cultures would, over the long term and on average, mainly adopt and maintain practices that work, then we would expect a lot of "natural" cures or supplements to be effective. And, it turns out that some are. However, it is also true that some of the most effective natural substances have already been incorporated into our mainstream medicine, and in some cases, subsequently replaced by improved synthetic versions of the original "natural" product. Mostly, though, human culture turns out to be a lot like chimp culture; Both humans and chimps do things that seem at first to have a certain purpose but are by and large arbitrary and non-functional in any direct sense. (There is some interesting discussion of this here.)
So, we can probably think of "Alternative Medicine" as a proving ground or sandbox for new ideas, but one that kinda sucks as a place to actually get new ideas that lead to anything. In fact, University research departments and Big Pharm have expended a fair amount of effort in examining plants and animals as sources of medicines. I don't think it is ever going to be productive to search around among, say, New Age Americans to see what they are doing to find new cures for diseases. Monitoring plant and animal use by cultures world wide is probably still worthwhile because it is interesting, but likely to also be low-yield in terms of real medicines. The systematic examination of life forms for interesting and useful molecules is probably the best way to go, until science has caught up somewhat with nature and can produce and test newly imagined molecules more effectively. And that day is coming; It will not be long before there is a new anti-biotic or psychotherapeutic drug invented by someone's screen saver.
Alternative medicines might have "Placebo effects." But I'm pretty sure I understand placebo effects and I'm pretty sure that the phrase is misused and misunderstood. Nonetheless, some people may feel better or improve more quickly from certain conditions if they carry out certain medically useless rituals. And, even if this is of only limited use, people are still going to do it. Therefore, it seems reasonable to allow for a certain amount of "Alternative Medical" research on wooish substances simply to demonstrate their safety or lack thereof. I want the NIH and the FDA to discover that this or that herbal remedy is dangerous, so people can be warned or the product regulated. But the search for effective cures among substances that we know are ineffective is a bad idea.
Having said all that, I would now like to point out that the term "CAM" has three words in it, not one. CAM does not mean what most people think it means.
Most Skeptics, when they hear the term "CAM" focus on "Alliterative" and get all skeptically thinking about that and claim that CAM is BS because acupuncture does not work, your chiropractor is a quack, and creatin does not build muscles. At the same time, people who are favorable towards CAM hear the term "CAM" and hear "Medicine" ... i.e., a thing that cures you makes you feel better, etc. Neither group is hearing the first word in the phrase: Complementary!
If you like the alternative stuff, and you take your Echinacea every morning, then you may need to be reminded that CAM is not Medicine. It is Complementary. So, for instance, the process of dialysis is not CAM, it's medicine. The practice of making a dialysis room, where someone will sit hooked up to a bunch of tubes for several hours a week, a more relaxing and less stressful place to be, is CAM. A practice that is complementary to the medicine, and maybe a good thing.
I had the opportunity a few years ago to advise a number of students in one of the country's largest CAM programs. The CAM program was designed for medical students, but undergraduates in my program pursuing individualized degrees could sometimes hook up with CAM faculty and do projects, or even an entire undergraduate degree, related to faculty interests. I want to say that all of my CAM students but one were students that I inherited when I started working in this particular degree program (which had nothing to do with the CAM department) and it was unlikely that had the program not been cut and had I continued there, that I would personally have attracted or developed very many additional CAM students. Having said that, the students I worked with were smart, industrious, and not annoying from a skeptical perspective (mostly). I was quite impressed, in fact. And, to help my fellow skeptics understand what CAM is a bit better than they may now, I want to relate a few experiences.
At one point I was asked to sit on the oral exam committee of a student graduating from the program. My main question for the student was this: "You've been in the program for several years. What sorts of things that you thought were true, or likely true, in the beginning of your time in the program that you now think differently of, and why?"
The answer was essentially this: In early days, she said, she and others thought that "Alternatives Medicine" would provide specific cures for specific things. Acupuncture would be good for pain, some herbal extract would be good for a certain infection or other disease. Now, she said, we understand that most of these things either don't work at all, or if they have a benefit, it is a more general one related to a person's sense of well being or level of stress.
In other words, what she learned after being involved in this program for a few years was pretty much what you, as a skeptic, were probably thinking as well.
Another students worked out something I mentioned above: How to make a dialysis facility less stressful. That same student, in a different project, worked on the mind-body-art problem. When someone engages in certain kinds of activity, often involved with art, one tends to go into a trance-likes state. Is this related to some of the things shamans in various cultures do? Is it in any way beneficial? What does the brain look like when this is happenings? This was an undergraduate research project linked to a couple of classes, not a PhD, so she did not answer these questions fully. But, her approach was scientific, and she learned quite a bit, and nothing homeopathic happened.
I'm not suggesting that we build more CAM centers. Rather, I'd prefer to see those useful elements of CAM that have developed over the last couple of decades become incorporated in medical practice. Having said that, I also understand that the world of standard medicine may not be a good place for such things to exist. Perhaps CAM needs to be separate, institutionally, simply so that it won't be eaten alive, gutted, re-purposed, or crushed.
And, having said that, I do think CAM funding should not be spent on testing things we know don't work. Yet, having said THAT, I do not trust the medical profession to make sound judgments in that area. There are a handful of cases of medical experts writing off things prematurely that eventually became part of standard medicine, and those cases generally demonstrate that medical researchers and physicians are often not good skeptics. They receive their knowledge from their local culture the same way Vitamin-C popping New Agers do. I mentioned Creatin above. Some years back, I looked into Creatin and found that mainstream medical experts claimed it would not do what body builders thought it would do for a particular physiological reason that made sense to me at the time. But I also found out that some medical practitioners were using large quantities of Creatin effectively in certain special cases (of heart disease) in a way that violated our assumptions of why it should not work at all. And lately, I see that the Mayo Clinic web page on Creatin suggests that maybe it does work for body building after all, though with much equivocation. I no longer uncritically accept the assurances I was given ten years ago by M.D.'s that Creatin was a useless dilatory supplement. Perhaps it is, perhaps it is not (obviously I've got to read up on this again!). What I do remember from my first look at it is this: It was stated that a "peer reviewed study" had disproved the effectiveness of Creatin in body building. I found the study and read it, and discovered that the study's results were ambiguous and the methodology sucked. Apparently, a study that confirms expectations is good enough to uncritically cite even if it is a bad study. This does not engender a high level of trust, does it?
Anyway, Elyse Anders asks about funding of CAM in a recent blog post which actually inspired the post you are reading now. She points out that some 120 million dollars or so are spent each year by NIH on CAM related research. That is around one half percent of the NIH budget, if my figures are correct. So, not much. Still, is it being well spent?
That funding is done through the National Center for Complimentary and Alternative Medicine (NCCAM). So, our question would be, what does NCCAM fund, and how much of it is crazy stuff vs. possibly not crazy stuff?
Well, this is what they funded in 2011. There are 15 pages of grants, so I'm not sure how to examine or summarize this for a mere blog post. How about if I tell you about the first item on every other page as a sample?
- ACUPUNCTURE PRACTITIONER RESEARCH EDUCATION ENHANCEMENT 90K
- BOTANICALS AND METABOLIC SYNDROME 540K (plus 924K from NIH)
- N-ACETYLCYSTEINE AND MILK THISTLE FOR TREATMENT OF DIABETIC NEPHROPATHY 155K
- MIDCAREER INVESTIGATOR AWARD IN PATIENT-ORIENTED RESEARCH (K24) 202K
- ELUCIDATING THE PLACEBO EFFECTS OF ACUPUNCTURE: HOT FLASHES AS A CLINICAL MODEL 132K
- AUTOMATED TECHNOLOGY FOR PURIFICATION OF ACTIVE INGREDIENTS IN NATURAL PRODUCTS 381K
- MEDICAL STUDENT BEHAVIORAL SCIENCE LEARNING/TEACHING 135K
- VITAMIN C IN POLYMICROBIAL SEPSIS 345
Before you even think about commenting on this list, please remember that a list of titles and amounts is very very hard to put a meaning to. Don't criticize a research project until you've read the grant proposal or at least the summary of it (and you can find them via the link above) or you are no better than Bobby Jindal with his Earthquake Prediction Research remarks.
Having said that, I do feel a bit icky about the above randomesque sample. I was under the impression that acupuncture was total woo (am I wrong about that?). If it is, then is funding research on it merely throwing expensive bones to poorly behaved dogs? Med student behavioral science learning and teaching might be interesting. Let's look at the description of that one:
Most medical schools recognize the growing need for future practitioners to know basic aspects of behavioral health and social science, yet pervasive challenges in teaching these topics impact the effective learning of the essential skills, knowledge, and attitudes.
1) Often behavioral and social science content is not integrated with what is traditionally viewed as the "core" curriculum, causing students, and faculty to view these topics as less important than others in the curriculum.
2) The effective teaching of behavioral health skills requires small-group instruction and practice, necessitating a large number of well-trained faculty tutors. Preparing these tutors to convey the necessary knowledge and attitudes as well as the skills presents a major challenge for medical schools.
3) Preparation for the rapidly changing world of medicine necessitates that students learn more than how to perform specific skills. Students need to learn to assess the evidence for doing something in a particular way, and the underlying theory as to why it works. At UCLA there is an established, integrated curriculum in behavioral science and extensive training available for faculty teachers. Thus the primary challenge, and the one to which this proposal is directed, is to bring in competencies in the "why" as well as the "how." The overall goals of this proposal are to develop
1) curricular modules demonstrating the evidence base for behavioral sciences,
2) effective faculty development materials, and
3) valid and reliable assessment tools that illuminate the evidence base and attitudes behind the skills and knowledge we are teaching, and to
4) disseminate these materials to other medical schools.
This will be done by a Curricular Planning Committee, under the direction of Margaret Stuber, M.D. An Expert Consensus Panel of content experts from a variety of medical specialties, public health, health psychology, and medical anthropology, as well as students, consultants from RAND, the community, and other schools of medicine, will contribute a public health and research perspective to the content.
Basically, a good idea. The success and importance of such a program will all be in the execution. But I would say this is not woo.
Let's look at one of the more technical and physiological oriented ones that has to do with a "plant that can cure you": The use of Milk Thistle extract for treating Diabetic Nephropathy:
Oxidative stress and glutathione (GSH) imbalance are major contributors to the pathogenesis of diabetic nephropathy. Circulating monocytes participate to this process since these cells carry a high oxidative burden and are found in diabetic renal tissue. Current options for the treatment of oxidative stress in diabetic nephropathy are limited and only partially effective, thus interest in the development of new strategies is high. N-acetylcysteine (NAC) and the milk thistle (MTh) plant flavonolignans are nutritional supplements with complementary antioxidant properties. Both supplements are capable of neutralizing directly toxic free radicals but, more importantly, NAC is substrate for the intracellular generation of GSH and the MTh flavonolignans are inducers of many cellular enzymes participating in GSH metabolism, including GSH-reductase (GSH-R), GSH-peroxidase (GSH-Px), GSH-S-transferases (GST) and superoxide dismutase (SOD). We propose that combined oral supplementation of NAC and MTh flavonolignans will reduce proteinuria and urinary and systemic manifestations of oxidative stress and inflammation, which are characteristically observed in patients with type 2 diabetes mellitus (T2DM) and related nephropathy. We expect these effects to be achieved with minimal or no side effects, and with good patient tolerance.
To test this hypothesis, we propose a double-blind randomized, placebo-controlled, five-arm pilot study which includes a dose ranging component in patients with T2DM and established nephropathy. Intervention will consist of the individual and combined oral administration of one level of NAC and two levels of MTh flavonolignans or placebo for three months. The intervention groups are: (A) placebo; (B) NAC 600 mg BID; (C) Siliphosï 480 mg BID; (D) NAC 600 mg BID + Siliphosï 480 mg BID; and (E) NAC 600 mg BID + Siliphosï 960 mg BID. The primary outcome measure will be urinary excretion of albumin, a marker of glomerular injury. Secondary outcome measures will be alpha-1 microglobulin, a marker of tubular injury, and urinary excretion of inflammatory cytokines and C-C chemokines, i.e. markers of renal inflammation. In plasma and in peripheral blood monocytes from the same patients, we will analyze GSH content and activity of GSH metabolizing enzymes. In addition, we will analyze the plasma and urine glycoproteome, with focus on those glycoproteins serving as inflammatory cell messengers and hormones. These variables will be monitored in relation to both treatment allocation and prevalent blood and urine levels of the active treatment. Throughout the trial, we will monitor the safety and tolerability of this combination treatment.
Cool. I wonder how it came out. This is quite possibly a good example of a CAM grant, assuming that there has not already been piles of research ruling out this thistle milk stuff. Or, it could be a case of throwing bones. I would have to do a literature review to come close to making a decision on that. In theory (and as we all know, theories are just stuff we make up but don't believe) the whole point of having an NIH is to have trusted experts making these decisions.
The thing is, there are also politics at work when it comes to federal funding. Is the NIH funding useful research, training, and development or not? And, is it the role of the Skeptical Community to get involved in this sort of question?
The answer to the last question is a resounding yet provisional YES! I gave you the link. Pick a project, read the related literature, and figure out if funding that project is a valid use of funds, a bit of congressional pork, a wooish pet product of some bureaucrat, or a bone being thrown to someone. Write a blog post about it. Don't extrapolate from your one careful look to the entire program, but rather, put it in proper context. If you don't have a blog post, you can put it here as a guest post (if it is legit).
Otherwise, though, please don't be a "relieved skeptic." Elyse asked a valid question and raised important issues, and more are raised here. NCCAM is worth looking at ... critically. We should do that.
- Log in to post comments
Dude, you're way behind the times here. The preferred term is not CAM anymore. Didn't you hear? It's "integrative medicine." As if it's a good thing to integrate quackery with real medicine. Of course, it's all just a brand rather than an actual specialty that contributes anything to medicine:
http://www.sciencebasedmedicine.org/index.php/integrative-medicine-a-br…
Of course, it's largely survey-driven, rather than science-driven:
http://scienceblogs.com/insolence/2011/09/surveying_integrative_medicin…
Interesting you focused on the Milk Thistle one Greg - http://www.sciencedaily.com/releases/2011/11/111115145236.htm is interesting as they have found that milk thistle extract seems to stop lung cancer from spreading in mice.
If, and it seems so from what you've noted above, that NIH is giving grants to those whose research is scientifically rigorous, then I retract my comment earlier on G+ that it's a waste of research $.
Missed your comment on G+. Anyway, as I say, look through the grant list. I picked this one out of a quai-random sample. I don't want to suggest a particular conclusion regarding the NCCAM funding source without knowing more about it. It does look like this particular project is far from quackery.
Greg,
NCCAM funding comes under examination every now and then, and this is one of those times.
My concern, as a taxpayer, is that after a billion dollars in funding, not one CAM modality or treatment has been determined "no better than placebo." Meanwhile, my local CVS is charging $26 for a package of homeopathic Oscillococcinum 30C. Basic physics tells us that whatever the starting ingredient for this product, at 30C dilution there's nothing left but water. In this case, water dribbled over a sugar pill.
So as far as I can tell, NCCAM is spending my money in attempts to legitimize CAM by searching for nuggets of possible benefit, but is doing absolutely nothing to protect the public from obvious scams and nonsense. Many of the studies performed by NCCAM have found no effect. That's why Senator Harkin is so "disappointed". But why aren't the negative studies getting any press at all? Why isn't the public benefiting from the research they're paying for?
If Senator Harkin, while discussing the discoveries of NCCAM, would stand up and say NCCAM has also determined that there is no evidence homeopathy is better than placebo, or that Reiki Energy Healing is no different than basic massage, then I'd be more comfortable that my tax dollars are being well-spent at NCCAM.
But, the truth is, it is the skeptical community (medical and otherwise) that is exposing frauds like Power Balance bracelets and chiropractic cures for colic. And they're doing it for free.
As a skeptic, I don't uncritically accept your statement, which I see repeated often, that 'not one CAM modality or treatment has been determined "no better than placebo."' for two reasons. First, it looks like some of the NCCAM funding is for potentially valuable research (NCCAM funding is the subject of discussion here) and some isn't, indeed, even about efficacy or safety of drugs (not all medical research is about this or that pill). Second, as stated by Elyse and generally known, once a thing (a drug, treatment, whatever) shows effectiveness it is absorbed into the growing body of medical practice and is no longer an "alternation modality"
So, of the studies funded in 2011, are you saying that every single one of them was of no value, or just many? Have you looked through the list, and can you point to a few examples of grants given that are clearly re-addressing old ground about some woo or another or in some way supporting foundationless science? As I said in the post, I see indicators of some of this but without looking more closely at the specific studies I'd rather not make a strong statement. As much as I recoil at the term "acupuncture," we can't yell at Bobby Jindal for dissing geology without knowing what he is talking about while at the same time write off 120 million dollars in funding because the word "alternative" appears in the agency's title or a particular project because of specific dog whistle words that appear in the grant's title.
Perhaps the world of skeptics is being less effective than it could be because it is not as systematic and thoughtful in it's approaches. Perhaps we should figure out a way to blogospherically address every single funded grant at NCCAM every year ... fairly and professionally ... ad a matter of routine. There is a lot of skeptical writing and blogging, but I don't think it is that systematic.
Anyway, I agree that NCCAM funding should, ideally, result in science policy that addresses the $26 homeopathis/snake oil product problem. The question here is how does that work? Citizens are very good at unskeptically demanding that the government does things that the government does not actually do, or that a particular agency does not actually do. Does the NIH usuall fund research that determines safety and efficacy without FDA involvement? If not, perhaps we should lobby to have NCCAM funded project results feed more directly into the FDA and/or USDA regulatory system, and do work exposing lobbying activity working in the opposite direction. (If you can really sell a bottle of sugar pills for 26 bucks, and you can, there must be some money changing hands here!)
Has NCCAM funded studies of Energy Healing or balance bracelets?
It does seem that even though 0.5% of the total budget is not a lot, if it is mainly paying off complainers or congressional pork, it should be cut. As I say in the post, I'm not entirely sure from the list of projects and a quick look into some of them what the value, or lack thereof, is of this subagency.
@RickK and Greg: One problem with studies aiming to discredit firmly entrenched treatments like homeopathy is that each time negative results come in proponents will always second guess the trial design and just say "you didn't do it the way I do it". It's Whack-a-Mole.
Benefits might come instead from the effect of the research on HMOs and PPOs that currently offer alt/integrative medicine, either as a way to market themselves or as a way to provide (relatively) inexpensive placebos for chronic conditions.
Consider an HMO that offers a list of NCCAM discredited therapies while simultaneously disallowing several expensive but evidence based chemotherapy regimens - because those are considered (by the insurance company) to be experimental. When the cases head to court, will they will be facing a bigger battle proving their decisions were based on medical reasons as opposed to financial ones?
Looking at NCCAM's mission statement "... NCCAM achieves its mission through basic, translational ("bench-to-bedside"), and clinical research; research capacity building and training; and education and outreach programs.", it's the "education and outreach programs" that concern me the most. Why provide education and outreach for unproven modalities?
Interesting strategy, hibob.
Regarding education, look at the example I provide above. It would probably account for education and looks like a good project.
I think we do have to keep our critique of NCCAM evidence based, referring where possible to specific grants that are awarded and critique those awards where appropriate, favor them where appropriate. I do like the idea of studying approaches at the HMO level. I wonder if that has been done by NCCAM at all. (One of my students in the CAM program did something along those lines.)
Why can't these "promising" interventions just be funded through conventional channels? Particularly if they're so "promising"? Why can't milk thistle follow the regular path from bench to mice to men to clinical trials like a novel compound synthesized in a GSK lab? Filtering "good" interventions from bad through the NCCAM is like making mouse cheese - it takes a lot of work to produce something that probably isn't worth the effort. And this is in addition to the fact that practitioners use NCCAM clinical trials to promote the idea that their woo works. As in "Acupuncture works, just look at this trial being funded by the NCCAM!" The NCCAM's budget might be tiny in terms of percentage of overall research funding, but in gross dollars that's quite a bit of cash being diverted to research that lacks considerable amounts of prior probability. And on top of that, the people conducting the studies don't necessarily understand good experimental procedures, control groups, the importance of strict randomization and the like. This kind of testing is better done by skeptical scientists, not True Believers guaranteed to get some funding because of political pressure. Throwing a billion dollars at a whole bunch of really suspect topics just in case something good comes out of it because a thousand years ago someone thought it looked like a lung and should be good for breathing seems like a waste of lots of money.
Mouse cheese might actually be delicious.
WLU, I think everything you say makes a good point up to this:
And on top of that, the people conducting the studies don't necessarily understand good experimental procedures, control groups, the importance of strict randomization and the like.
Are you sure? Which studies funded by NCCAM were done poorly? I'm not saying you are wrong. what I am saying is that the critique of NCCAM must be evidence based. So which studies? Tell me which ones they are and I'll personally hunt them down and blog them!
Seems so.
Bugger, forgot to paste the line I was responding to. This:
âAnd on top of that, the people conducting the studies don't necessarily understand good experimental procedures, control groups, the importance of strict randomization and the like.â
Including, of course, medical research ethics:
http://www.sciencebasedmedicine.org/index.php/my-nccam-wish-list/
That aside... WLU has identified perhaps the major issue with the very existence of such a thing as the NCCAM. Quoting from another of SBM's NCCAM-related posts:
âWe are collectively concerned that the NCCAM primarily serves as a means for promoting unscientific medicine, and any useful research it funds can be handled by other centers at the NIH.â
and another:
âAlso notice another thing. Iâve referred to certain aspects of CAM, sometimes called âintegrative medicineâ (IM) and, in this case called âintegrative oncologyâ (IO), as a âTrojan horseâ to bring woo into medical schools and academic medical centers. Most â but not all â academic medical centers do not use hard core quackery like homeopathy, although many appear to be using a modality just as bad, reiki, which happens to be Dr. Mehmet Ozâs favorite modality. In any case, whenever you see discussions of âintegrative medicineâ and in particular âintegrative oncology,â chances are, the modalities discussed generally include yoga, various dietary modalities, exercise, and, quite frequently, acupuncture. Sometimes, they include various herbal remedies. In other words, âintegrative oncologyâ rebrands modalities that have no reason not to be counted as part of science-based medicine as âalternativeâ or âintegrativeâ and points to them as having some promise. They then lump together pseudoscience like reiki and acupuncture with the rebranded modalities, such as herbal therapies.â
http://www.sciencebasedmedicine.org/index.php/integrative-oncology-troj…
That Milk Thistle study looks like it might be a very good example of a piece of this CAM Trojan horse - neither complementary nor alternative:
http://en.wikipedia.org/wiki/Pharmacognosy
Greg,
You challenged me with: " So, of the studies funded in 2011, are you saying that every single one of them was of no value, or just many?"
I neither said that nor suggested it. I clearly acknowledged that NCCAM is doing studies and producing results. My questions were: " Why aren't the negative studies getting any press at all? Why isn't the public benefiting from the research they're paying for?"
You asked what the NIH should do. Well, isn't the NIH is in the business of giving official guidance to the medical community and to the public? That's part of what we pay for. Now we have a branch of NIH dedicated to CAM. So let's see some actual NIH-style recommendations.
It is well within the NIH's responsibility and operating parameters to take those tax dollars and do for CAM what it does for diet, exercise and many other areas of health - take a stand and go on record. Is it unreasonable to request some official NIH recommendations in return for our billion dollars?
Does a 30C homeopathic dilution do anything other than placebo? The answer is scientifically clear, and the weight of evidence is conclusive. Why can't NCCAM say so? If a 9-year old girl (Emily Rosa) can design a study that proves therapeutic touch is nothing but placebo, why can't the NIH?
There are plenty of people out there who will jump on studies that show a CAM modality has benefit. But if the National Center for Complimentary and Alternative Medicine won't say something definitive about ineffective/failed CAM modalities, who will?
@Greg:
well, there's the first, albeit the smallest item on your list:
ACUPUNCTURE PRACTITIONER RESEARCH EDUCATION ENHANCEMENT
Sounds good.
Googling for grant recipients for APREE, I found the Oregon College of Oriental Medicine:
http://societyacuresearch.org/index.php?option=com_content&view=article…
Still sounds good.
Yet NCCAM's webpage "What the Science Says About Acupuncture for Pain" says, for each condition mentioned, that either that there is no evidence for acupuncture being effective or the evidence of efficacy is of poor/preliminary quality. So then of course OCOM decided to quit the practice of using/teaching acupuncture for pain since there's little evidence it's better than placebo.
Right?
Actually, I cut out part of what the NPREE grant funded program taught OCOM students:
"... frames research as a âway of knowingâ... "
NOW I have a problem with NCCAM APREE grants!
Well, isn't the NIH is in the business of giving official guidance to the medical community and to the public?
No, they fund and promote research. You may be thinking of the FDA and the USDA.
They have a mission statement:
http://www.nih.gov/about/mission.htm
Does a 30C homeopathic dilution do anything other than placebo?
H2O is the most powerful solvent in the universe!!!
Anyway, all I'm asking for is something other than arm waving. Which studies on the list I provided support homeopathy, or even address it, and how has that information been used or not used? Are there examples of NCCAM studies that address homeopathy and conclude that it may have a beneficial (placebo-esque?) effect?
The only example of a medicine being looked at in my (very small) sample appears to be a valid case of something that may have use. One might ask why the NIH and not the NCCAM funds that, but then we must also ask, what is the deal with demanding that anything not woo be moved out of the NCCAM purview, and then demanding that the NCCAM explain why it has only woo????
I'm surprised no one has responded to my questions about acupuncture, by the way.
@Greg:
Well ...
(emphasis mine)
Official Guidance really is the purview of the FDA, but a mandate to promote and communicate good science is still close. When I looked at an ACUPUNCTURE PRACTITIONER RESEARCH EDUCATION ENHANCEMENT grant recipient's webpage (comment with link in moderation), it looks like the money was used to train acupuncture students how to interpret medical research and how to perform medical research.
Okeydoke.
But when it comes to determining research's influence on acupuncture practice, the " application of that knowledge to enhance health" part, the training NCCAM paid for states "research is a way of knowing". One that doesn't hold any weight when the results are inconvenient, apparently.
A reasonable argument, though I tend to agree with a number of the critiques already raised. My key arguments against NCCAM generally would be these:
1. The overwhelming majority of studies have found negative results, yet NCCAM has not taken any strong stands against any therapies, and there is no evidence from survey data that the money spent disproving these has had any impact at all on public perception or CAM use. The politicians such as Harkin behind the agency clearly see it as a vehicle not for finding out the truth but for validating their beliefs, and that has affected how research projects are selected, conducted, and publicized.
2. The very idea that CAM requires a separate agency within NIH is a form of special pleading. Plausible ideas with reasonable pre-clinical data will find clinical trial funding regardless of whether they bear the political/ideological label of CAM.
3. The TACT trial (http://www.sciencebasedmedicine.org/index.php/gonzalez-regimen-for-canc…) and the Gonzalez Cancer trial (http://www.sciencebasedmedicine.org/index.php/gonzalez-regimen-for-canc…)both illustate how political pressure drives poor quality and ethically questionable research aimed at validating implausible therapies which politicians have faith in. This makes it difficult to trust the impartiality of NCCAM, to say the least.
4. Government resources for medical research are scarce. It is very difficult to justify spending them on very implausible therapies, and NCCAM is more likely to do so than ordinary NIH centers by the very nature of how it is designed and governed.
5. COmplementary still implies something of value is being offered. Often, there is no evidence that is true. And int he cases where placebo or psychological effects can be had, there is no reason these cannot also be had with validated conventional therapies and without the ideological baggage of nonsense that so often accompanies CAM interventions.
I would not say that ideas labeled as CAM never merit research. However, I see the creation of a special government agency for the express purpose of validating therapies which conventional medical science sees as unlikely, and which never seems to make effective use of the large number of negative results generated, as a poor investment and more likely to create the false impression of validity for useless therapies than to separate the few grains of wheat from the mounds of chaff.
hibob, yes, I read that. Guidance to the public etc. etc. really isn't in there, that really is the FDA.
What should probably be happening is that the FDA should be funding research in safety of existing treatments. The NIH certainly funds the widest range of research, but they fund research. The NIH does not, for instance, require labeling, recall drugs, approve drugs for use, etc. etc. They are not a regulatory body. They are a research institution.
SkeptVet, regarding your point number 5, I think you are making the same mistake I cautioned against in my post. "Complementary" is not "Alternative." A very simple example would be bedside manner. Good bedside manner is not an alternative cure. But it should complement the good medicine. You are holding research on whether or not painting clouds on the ceiling or making a dialysis room not smell bad is helpful to patient comfort to the standard of double blind peer reviewed studies, etc.
My experience with a CAM program was that this sort of thing... the complementary part of it, not alternative medicine or "modalities" as they are called ... actually seems to be of some value.
I do disagree that plausable but fringe potential treatments and such would get even close to a fair deal if there was not a special funding pool for it. The idea that science, and especially medical science, is a great finder of truth and will typically progress in the right direction on its on is easily disproved. Having said that, I am not making the argument that the NCCAM program is funding a lot of research that should be funded.
Still, though, the number of projects that have been identified that look good in this comment thread and post is one, and the number that have been clearly shown to be not good is zero. This is because we are not talking about the research that is being funded. We are talking about what we think the funding is doing.
It may be that this agency should not exist. It may be that it should. Let's look at the 15 pages of grants linked to above. Are they all useless garbage? Half? 10%? and how does that compare to the main NIH funding?
Name names!
"Consider an HMO that offers a list of NCCAM discredited therapies while simultaneously disallowing several expensive but evidence based chemotherapy regimens - because those are considered (by the insurance company) to be experimental."
They often are experimental and not always good for you. A good example is bone marrow transplant for breast cancer. This experimental treatment was, through political pressure, swept into the mainstream before it was properly evaluated. The overall result years later - it was no more effective than conventional treatment and probably made the last years of a vast number of patients much more miserable than it would have been, at an incredible cost to the health care system.
It's not just NCCAM that's putting money into this. The great state of Minnesota, in the 2011 Special Session, found money for a complementary and alternative medicine demonstration project for the state's Medicaid program. (Minnesota Statutes 256B.771). In the same bill, they cut payments to virtually all medical providers because of a budget shortfall.
What did the project do?
The legislation instructs the Minnesota Department of Human Services to issue an RFP which seeks to contract with a Minnesota-based academic or clinical research institution specializing in providing complementary and alternative medicine education and clinical services to implement a five year study to improve the quality and cost-effectiveness of care to patients with neck and back problems. Chiropractic is specifically mentioned (the chair of the House Human Services Committee is a chiropractor). The language can be found here: https://www.revisor.mn.gov/statutes/?id=256B.771
The RFP has not been issued yet.
THERE. That is a good case to examine further. You should blog about it. Do you have a blog? That is potentially a very good example of CAM related activities being carried out due to a specific legislator's interest and to his benefit.
"SkeptVet, regarding your point number 5, I think you are making the same mistake I cautioned against in my post. "Complementary" is not "Alternative." A very simple example would be bedside manner. Good bedside manner is not an alternative cure."
Right, and it does not need a special label or a special NIH center to study it. The psychological benefits and placebo value of the therapeutic relationship and rituals are all available witin the context of legitimate scientific medicine. Doctors may need better training to make use of these supportive tools, but they don't need to be associated with pseudoscientific rationales like "energy medicine" or with untested or disproven therapies. The value of such comfort interventions seems diluted by their inherent affiliation with nonsense and anti-scientific attitudes when we study them as a special category outside regular healthcare. The best way to get these measures to patients is to make treating the emotional and psychological needs of patients a higher priority within mainstream medicine, not to create an ideological intellectual ghetto called "CAM" within which comforting human relationships and environments are inextricably tied to bogus theories about health and disease.
SkeptVet, I agree with what you say, but I don't assume that NCCAM is a ghetto without some evidence, and an examination of the evidence (the specific studies that are funded) is well worthwhile not only to test that supposition but to point out why a program like this should not be funded, or at least not funded as it is.
And, this may be painful to hear, but the fact that not a single person has produced (in the present discussion) a shred of evidence that NCCAM is funding woo is, I think/fear, because of the inherent institutional arrogance of the medical profession. Which in turn is the best argument that can be made for having a separate funding stream.
By the way, I was thinking about this earlier and a rather shocking thought occurred to me: I've heard again and again the statement that "if an alternative medicine works it becomes medicine" but I hear very few examples of that. What treatments were classifiable as "alternative", tested out by scientific research, and then absorbed into modern medicine, in recent times? I suppose Milk Thistle is an example. It would seem to me that identifying several such examples would be useful. First, it would demonstrate that the statement itself is not just something that sounds good and makes sense, but is actually something that has happened (more than once or twice). Second, it would suggest what kinds of altenratives are worth looking at, and third (and most related to this discussion) I would like to know if this is something that used to happen but no longer does, or perhaps, it is something that has increased in frequency with the development of NCCAM (and enhanced through that funding) or not. If NCCAM funding is channeling (as it were) "altnernative" treatements into mainstream by identifying, testing, and in some way proving the viable treatments or ideas, then that's good. If it is trying to do this but not doing so, or not even trying because there are no such things, then that is another argument for abandoning or severely reducing funding to the program.
Greg, I think your "n" is a little small. If you are going to blog on his subject, perhaps you ought to look further into the research done by NCCAM. Half the articles you list are not researching treatments, which is the part of NCCAM that most skeptics take issue with. I am not sure that "here are 6 things funded by NCCAM. What's wrong with these?" is the best approach to evaluate the the effectiveness of this agency's use of over a billion dollars. I have to believe that there are some more worthy uses for this money ... areas of more legitimate research or otherwise promoting public health. Here is a better challenge for you. Find one positive study with a clinically relavent result in the entire history of the NCCAM. If I remember correctly, there were two studies of actual treatments done by NCCAM that showed clinically relavent positive results: ginger for mild nausea and neti pots for nasal congestion. However the ginger was less effective than existing medications and the neti pot only worked for the very short term. Hardly worth a billion dollars.
Moderation, please be careful in using quotes around words that I did not say.
I presented a link to 15 pages of grant proposals and I've asked people to look at them and comment. The six I listed were to provide a flavor for what is there. They were selected quasi-randomly as described in the post. I have not drawn conclusions about them. I am asking people to back up their statements with reference to data. So far there has not been much of that.
" I have to believe that there are some more worthy uses for this money ... areas of more legitimate research or otherwise promoting public health."
Yes, I know. You have beliefs. If I needed to whip out a belief on which to act, I'd have the same one. I am, however, asking that we move beyond belief here.
"Here is a better challenge for you."
Better than what?
"Find one positive study with a clinically relavent result in the entire history of the NCCAM."
I have no idea why that is a good approach. There have been hundreds of studies. Let's say one of them results in a cure for some horrid painful disease hardly anyone gets but it affects cute little children with puppies. How do you evaluate that?
Instead of looking for particularistic results, why not compare across all of the studies from NCCAM, and then compare those results with the other NIH funding?
"If I remember correctly, there were two studies of actual treatments done by NCCAM that showed clinically relavent positive results: ginger for mild nausea and neti pots for nasal congestion. However the ginger was less effective than existing medications and the neti pot only worked for the very short term. Hardly worth a billion dollars."
I am not impressed with those results, but I'm less impressed with your approach. You've just stated, it seems, that two rather weak results have come from a billion dollars of study, but above others who know more about it than me have described results that seem to be much more intresting that came from one particular alternative medicine study. So right there you are signorine data.
What is more interesting, though, is that you continue the trend to focus on alternative medicines. If the model that so many people insist is true is accurate .. that the moment an "alternative" treatment "works" it is incorporated into mainstream medicine, then I would imagine that there woudl only be one or two studies per such treatment or drug under a program like NCCAM, then the NIH would fund further research. But again, for all the woo and crazy shit we see in CAM and related areas only some what is addressed by the grab sample I provide above is about treatment.
Again, you are giving me your relieved knowledge. I already knew that. Tell me something I didn't know.
@Greg
If guidance to the public isn't in the purview of the NIH, then why is NCCAM (part of the NIH) providing it?
Pages on their website:
"Selecting A CAM Practitioner"
"Using Dietary Supplements Wisely"
"Herbs At A Glance"
And their news digests include fact sheets for patients.
I think we differ on what we consider guidance: my view is looser, and includes providing information like the above pages to the public.
A lot of what you find in those pages is actually good information, for example:
Greg,
I think this was an excellent post. It gets to the heart of a larger issue... often in heated debates there is a middle ground of truth that neither side wants to see for fear of losing the strength of their position. I think you've done an exemplary job of pointing out where that middle ground lies.
>And, this may be painful to hear, but the fact that not a single person has produced (in the >present discussion) a shred of evidence that NCCAM is funding woo
OK.
Clinical trials to date show that acupuncture and sham acupuncture are equally effective for treating chronic pain.
So I had a look at NCCAM's 2011 grants:
5R01AT005896-02 Contact PI / Project Leader:DEBAR, LYNN LARSON
Title: USE OF ACUPUNCTURE FOR CHRONIC PAIN WITHIN AN INTEGRATED HEALTH PLAN
$754,891
So why is NCCAM still funding studies of acupuncture for chronic pain?
hibob, that's what I thought.
Now, I did once read in a comment on a blog that "repeated double blind studies showed that cranberry juice consumed daily has absolutely no effect on frequency of bladder infection in women" and when I searched for the "repeated double blind studies" that showed that, there were none. Nada. Zip. Zilcho. The received knowledge that fruit juice is always woo was sufficient to make someone say something utterly inaccurate.
I have a memory of studies showing sham and real acupuncture, those memories mainly being of me thinking "how do you pretend to poke someone with a needle" but I don't remember anything about the studies.
So we need the citations.
Which I can come up with, I'm sure, but really, I still have yet to see an evidence based claim made on this thread!!!!
A 2009 study: A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
A total of 638 adults with chronic mechanical low back pain were randomized to individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland-Morris Disability Questionnaire score; range, 0-23) and symptom bothersomeness (0-10 scale). Outcomes were assessed at baseline and after 8, 26, and 52 weeks.
Results: At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P < .001). Participants receiving real or simulated acupuncture were more likely than those receiving usual care to experience clinically meaningful improvements on the dysfunction scale (60% vs 39%; P < .001). Symptoms improved by 1.6 to 1.9 points in the treatment groups compared with 0.7 points in the usual care group (P < .001). After 1 year, participants in the treatment groups were more likely than those receiving usual care to experience clinically meaningful improvements in dysfunction (59% to 65% vs 50%, respectively; P = .02) but not in symptoms (P > .05).
Conclusions: Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.
Title of blog post about this study: Acupuncture Does Not Work for Back Pain (by Steven Novella)
Here's the link to Novella's blog post: http://www.sciencebasedmedicine.org/index.php/acupuncture-does-not-work…
And their news digests include fact sheets for patients.
I think we differ on what we consider guidance: my view is looser, and includes providing information like the above pages to the public.
I'm talking about regulation, you are talking about an agency putting stuff on the web. The word guidance may well fit your description better, but I still think regulation is the issue, and NIH doesn't seem to be a regulatory agency.
The acupuncture thing now looks more ambiguous to me, where before the relieved knowledge module in my brain was saying that acupuncture was proven to be total woo. I'm now seeing a study that poking people with sharp things reduces pain, and that acupuncture experts have a similar approach to what they do as medical professoinals: They believe things to be deterministic of effectiveness that when examined more closely are not.
We are not doing well, people. I'm rather disappointed in us.
Greg,
I think you'll agree that it's prudent to be as cautious about a claim that something is disproven as with a claim that something is proven. The absence of a main effect in a given study is not the same as 'proof the main effect does not exist'.
There's no shortage of clinical studies for acupuncture, although you can judge for yourself the quality. Below is a sampling from a decidedly pro-acupuncture site--
(from : http://www.medicalacupuncture.org/acu_info/articles/acupuncture_bibliog… ARTICLES)
Fan, Y. and Yang, Z.; Acupuncture treatment of side-effects of chemotherapy. Inter J Clin Acup 2000. Vol.11[1], p.23.
Grass, G. W.; Reversal of chemotherapy-induced myelosupression with electroacupuncture. Med Acup 2003. Vol.15[1], p.35-39.
Guerra, M. del C.; Acupuncture for refractory cases of chemotherapy-induced nausea and vomiting. Med Acup 2004. Vol.16[1], p.40-42.
Li, H. and et al; Clinical study on acupuncture treatment of side reactions of radiotherapy and chemotherapy for malignant tumor. World J Acup-Moxi 1998. Vol.8[2], p.8-12.
*************
Health claims generally require a healthy dose of skepticism, not just those arising from the realm of alternative and complimentary treatments-- plenty of prescription pharmaceuticals are on the market with scant evidence of benefit, and research showing harmful effects are routinely suppressed by drug manufacturers, e.g., Cox-2 inhibitors:
(from: http://fsi.stanford.edu/news/cox2_inhibitors_were_prescribed_for_millio…)
" ...problems associated with COX-2 inhibitors should serve as a cautionary tale about the growing trend of turning custom-fit medications into one-size-fits-all remedies. The researchers attribute the overuse of the drugs to several non-clinical factors that have spurred sales of other drugs as well - including heavy marketing and the tendency of patients and physicians to assume newer medicines are better.
"This phenomenon is not limited to COX-2 inhibitors," Stafford said, noting that it also happened with drugs for hypertension, diabetes and some infections. 'There are a number of instances where use has expanded beyond the narrow clinical situations in which the drugs are most effective and cost-effective.'
The medical profession has a term for expanding the use of a drug beyond its intended target population: "therapeutic creep." In the case of COX-2s, not only does this expansion mean that millions of people paid more for a drug without reaping a substantial medical benefit, but it now appears they unnecessarily exposed themselves to the risk of heart problems, Stafford said.
COX-2 inhibitors have been at the center of a controversy since last September when Vioxx was pulled from the market after clinical trials showed that it posed significant risks of heart attacks. Similar findings were also recently reported for Celebrex, although it is still available.
What makes the widespread use of COX-2s so troubling, Stafford said, is that they aren't any more effective at controlling pain than NSAIDs."
***********
The upshot for me is to try and be an informed tax payer and consumer, and not discount a remedy out of hand because it is 'traditional' or 'alternative'.
Pharmaceutical companies and 'mainstream (allopathic) medicine' have a long history of dubious treatments, and a strong profit incentive to discredit alternatives.
So I want my tax dollars funding basic research into treatments that for profit insitutions won't study.
Well, I guess we will have to agree to disagree. I see 1.4 billion dollars spent without return on that investment at NCCAM. You obviously see that differently. The one thing you have said to justify your point of view that is flat out illogical is that because CAM is so unaccented in the medical community, this justifies having a special and independent section under the NIH to study it. Using that logic and applying it to global warming ... because there is a very tiny segment of the scientific community that does not believe humans are contributing to global warming, we should therefore have a special government agency devoting money to exploring what ever theory this minority of scientist hold. Perhaps 1 to 1.4 billion dollars would be enough.
Moderation, where did I say that this was 1.4 billion dollars well spent?
I didn't say that and I don't happen to think that.
"I'm now seeing a study that poking people with sharp things reduces pain, and that acupuncture experts have a similar approach to what they do as medical professoinals: They believe things to be deterministic of effectiveness that when examined more closely are not."
So your argument is that sham acupuncture (such as used in the GERAC trial) counts as acupuncture instead of as placebo?
"but I still think regulation is the issue, and NIH doesn't seem to be a regulatory agency."
The question you were responding to:
"It is well within the NIH's responsibility and operating parameters to take those tax dollars and do for CAM what it does for diet, exercise and many other areas of health - take a stand and go on record. Is it unreasonable to request some official NIH recommendations in return for our billion dollars?"
RickK wasn't asking the NIH to ban or regulate anything, he was asking for recommendations like this:
http://www.nia.nih.gov/HealthInformation/Publications/ExerciseGuide/
NIH took a stand and went on record for exercise. NCCAM can do the same for debunked alt meds. And as a matter of fact, under NCCAM's strategic objectives for 2011-2015:
NCCAM is tasked with doing just that.
So your argument is that sham acupuncture (such as used in the GERAC trial) counts as acupuncture instead of as placebo?
I'm not making an argument about acupuncture. I'm asking questions about how studies are interpreted.
Yes, yes, yes, NIH/NCCAM is more involved in "guiding" the public than i was thinking it was. But I really am talking about regulation, as others are as well in this discussion. Taking homeopathic "medicines" of the market does not happen because a web site says they are useless. It happens because the FDA takes them off the market.
You should look into "ayurveda." It's the oldest body of health knowledge on Earth. You should also know that the body is nothing but consciousness, which is also what the universe itself is. Read The Yoga Sutras of Patanjali.
The answers to the above questions you will find in the book tittled: THE HUMAN MOLD, prevention from origin. This book is coming out by the end of December. If you wish to know more about it, write to the following address: thehumanmold@hotmail.com
I'm afraid that we should not be that accepting of synthetic versions of natural substances that have been proven to work.
There are far too many chemicals introduced into daily life, and remediation for the negative environmental effects caused by many of these chemicals cannot keep up with their generation.
Incidently, I developed chronic hives after receiving a Kenalog shot (with dyes/additives removed) for a foot injury. I tried everything medicinal and alternative. Milk Thistle was the only thing that helped me control the hives.
Greg said: "Yes, yes, yes, NIH/NCCAM is more involved in "guiding" the public than i was thinking it was."
Thank you for finally sort of grudgingly admitting that the NIH really should DO something with the $1.4 trillion in research it has done, and that the same organization whose website is filled with health recommendations to protect consumers should also perhaps have something to say about CAM modalities that are nothing more than placebo and theater.
Greg said: "But I really am talking about regulation, as others are as well in this discussion. Taking homeopathic "medicines" of the market does not happen because a web site says they are useless. It happens because the FDA takes them off the market."
Doesn't regulation start with research? Hasn't the research been done? A 9-year-old girl proved that energy healers don't work. Yet here we are, years into NCCAM funding, and companies like California Reiki are quoting NCCAM in their promotional ads for "distance Reiki". They're using the fact that NCCAM "recognizes" Reiki as a complimentary therapy.
So my tax dollars are going to research that nobody actually uses to shut down this nonsense, and the mere fact that NCCAM exists and "officially" explains what these therapies are is used as promotional material for the charlatans.
What is so hard, after $1.4 billion dollars, for the National Institutes of Health to simply state "it is our conclusion based on the science and the research to date that Reiki energy healing offers no benefit beyond placebo, that the treatment should not make medical claims without proof of efficacy, and that public funds will no longer be allocated to Reiki."
And the same with homeopathic dilutions... And acupuncture benefits that you pay hundreds of dollars for from a "trained" Chinese practitioner can just as easily be derived from some random person with a box of toothpicks.
Why are we funding this research if accomplishes nothing but lending legitimacy to shams and placebos?
http://www.chicagotribune.com/health/ct-met-nccam-overview-20111211,0,3…
Thank you for finally sort of grudgingly admitting that the NIH really should DO something with the $1.4 trillion in research it has done,
Excuse me?
Doesn't regulation start with research?
No. Precede, perhaps, not start with. And produces as well, but that's a nuance I'm not sure this conversation can handle!
So my tax dollars are going to research that nobody actually uses to shut down this nonsense, and the mere fact that NCCAM exists and "officially" explains what these therapies are is used as promotional material for the charlatans.
That would be bad. I'm not sure where anyone has documented that this happens.
What is so hard, after $1.4 billion dollars, for the National Institutes of Health to simply state "it is our conclusion based on the science and the research to date that Reiki energy healing offers no benefit beyond placebo, that the treatment should not make medical claims without proof of efficacy, and that public funds will no longer be allocated to Reiki."
I see what you did there. You linked a number that has been thrown around, 1.4 billion, with a specific treatment (or whatever it is) called "Reiki" and made it seem like the NIH has spent 1.4 billion on that one thing, and then you made them look silly for that.
Did you check the funding criteria for the upcoming years? Is Reiki still fundable? Can you cite the expenditures on Reiki to date instead of making this up, and can you cite the research that shows that it is stupid and useless?
Do you understand what I'm asking for and why?
And the same with homeopathic dilutions... And acupuncture benefits that you pay hundreds of dollars for from a "trained" Chinese practitioner can just as easily be derived from some random person with a box of toothpicks.
The original database won't load for me now. How much did you find that they spent on homeopathic dilutions last year? I didn't notice that. The string "homeopath" does not appear in the article you cite. I was thinking none, but I could be wrong. It would be crazy.
Thanks for the link. While the spirit of your argument is admirable, it is old, been done, we've been there for a very long time. Your argument is full of stuff you can't prove or did not back up and some of it is just plain wrong. What separates your argument about the woo from the woo itself in terms of skeptical thinking? A little, but not much. You are spewing (respewing?) received knowledge.