I used to be somewhat of a supporter of the National Center for Complementary and Alternative Medicine (NCCAM). I really did. This was back when I was more naïve and idealistic. Indeed, when I first read Wally Sampson's article Why NCCAM should be defunded, I thought it a bit too strident and even rather close-minded. At the time, I thought that the best way to separate the wheat from the chaff was to apply the scientific method to the various "CAM" modalities and let the chips fall where they may.
Unfortunately, two developments have made me sour on NCCAM and develop an opinion more like Dr. Sampson's. First, the NIH budget stopped growing and, adjusted for inflation, is now contracting. NCCAM's yearly budget is in the range of $121 million a year. That's enough money to fund around 75 to 100 five year R01 grants, give or take, and in tight budgetary times my view is that prioritization of funding should be for projects that do not have hypotheses behind them that are outlandishly implausible from a scientific standpoint. Second, I've seen over the last few years how NCCAM is not only funding research (most of which is of the sort that wouldn't stand a chance in a study section from other Institutes or Centers, making NCCAM the affirmative action of scientific funding) but it's funding training programs. These training programs are, quite frankly, designed to indoctrinate the next generation of physicians into being woo-friendly, and they are working. Indeed, one of the big reasons for the expansion of the Academic Woo Aggregator is fellowships and programs funded by NCCAM.
Yesterday, I learned how NCCAM is putting my tax dollars to work (and, of course, yours) when I saw its announcement of the research projects that it funded in FY 2007. I could scarcely believe some of what I read, and I could all too readily believe the rest.
Perusing the list of projects is truly depressing. True, a lot of the projects seem to be yet another study of Ginkgo Biloba, cranberry juice, or soy in various diseases. That's all well and good, but why is the study of natural products considered "alternative" or "complementary"? It's the same sort of stuff that pharmacologists have been doing for decades, and, indeed, I suspect some pharmacologists and medicinal chemists are probably looking at NCCAM as easy money if they just slap together a project to study the herb du jour. If they're trying to isolate the active constitutent of these herbal remedies, it's OK science, but really what they are studying is mostly impure mixtures of hundreds of compounds that make up herbal remedies.
More disturbing is the woo. For instance, there is an R21 grant funding a study called Polysomnography in Homeopathic Remedy Effects. Yes, you have it right. Your tax dollars are going to fund at least a study this year on homeopathic remedies (a.k.a. water). But it's even worse than that. There was actually awarded an R21 grant to study homeopathic dilution and succussion and how they affect the dose-response curve of homepathic remedies. I kid you not. I just about spit out my tea onto my laptop keyboard when I read it. Naturally, it's at the Integrative Medicine Program at the University of Arizona. Get a load of the public abstract:
The purpose of this revised R21 exploratory grant to NCCAM in response to PAR-03-153 is to extend the PI's previous human olfactory psychophysiology research and develop a quantitative electroencephalographic (qEEG) bioassay for registration of individually active (salient) versus inactive homeopathic remedies or placebo. Homeopathy's founder, Samuel Hahnemann MD, originally proposed olfactory sniffing as a valid route for clinical remedy administration. Convergent basic science evidence suggests that succussion (vigorous shaking) in the preparation of homeopathic remedies from animal, mineral, and plant sources, may persistently modify the physical structure of solvent to generate order, i.e., a unique informational signal, even in ultra-diluted solutions beyond Avogadro's number. Torres and Ruiz (1996) proposed that stochastic resonance in sensory systems is a model for optimizing detection of a weak signal (homeopathic remedy information) by addition of noise (succussions). No previous research has directly examined the effects in human populations of a given remedy dilution prepared with different numbers of succussions. Specific aims for the study are: I. To evaluate the feasibility of using acute evoked responses in quantitative electroencephalography (qEEG) alpha power during olfactory administration to detect the presence of a single homeopathic remedy (Sulphur) at different numbers of succussions per dilution step, prepared at a given dilution; II. To determine the feasibility of using the magnitude of acute evoked responses in quantitative electroencephalography (qEEG) alpha power during olfactory administration to detect the presence of a single homeopathic remedy at two different homeopathic serial dilution factors (prepared with a given number of succussions per dilution step); III. To evaluate the generalizability of findings for a separate polycrest remedy (Pulsatilla). Subjects will be N=108 (n=54/remedy) young adult volunteers with moderate (not excellent global health) prescreened for potential remedy salience of either Sulphur or Pulsatilla and tested in a two-phase study (one remedy per phase). Each participant will undergo pre-screening with the Homeopathic Constitutional Type Questionnaire for high criterion scores for symptoms of one of the two test remedies, followed by three laboratory sessions spaced one week apart (dilution sequence subject allocation balanced within each remedy type for 6c, 12c, and 30c potencies). Each session will involve eight presentations within a complete block design of randomized double-blind, placebo- controlled (both succussed remedy-free solvent and succussed plain distilled water) olfactory sniff tests (using time-locked sniff-EEG recordings via an airflow pressure transducer), using a given remedy dilution prepared with stirring only, 10, 20, or 30 succussions. The present study fills a major need in homeopathic clinical research to explore and understand remedy-related and remedy-person interactive factors that could contribute to well-known problems in replicability. Findings from this and follow- up studies via subsequent R01s could improve standardization of homeopathic remedy manufacturing and prescribing used in patient care and thereby advance the quality of clinical treatments and research for this leading form of complementary and alternative medicine worldwide.
People, this is an NIH-funded grant to study woo. There's no other way to put it. A 30C homeopathic remedy is nothing but water. Period. So is a 20C homeopathic remedy. They're actually going to compare stirring with succussion to see whether succussion, as homepaths claim, makes a difference! Truly, you can't make stuff like this up. Have the study sections lost their minds? Here's another thing to consider: An NIH-funded grant (which, by the way, I worked my ass off to obtain and will have to work my ass off to have even a 50-50 chance of keeping it) is the pinnacle of external funding mechanisms. In the eyes of universities (and probably the public) it doesn't matter whether that grant came from NCCAM, the NCI, NHLBI, NIAA, NIDDK, or whatever. Universities will be just as happy if investigators get grants from NCCAM as from any other agency within the NIH.
But more insidious are the grants listed at the end. It's easy enough to laugh at grants being offered to study whether homeopathic succussion does anything other than aerate the solution, but when I see how much NCCAM is laying out for the promotion of woo through "education" grants, I want to cry. There are grants to fund fellowships in CAM at the University of North Carolina Chapel Hill, the Weill Medical College of Cornell University, the University of Virginia (a new one for the Woo Aggregator!), Harvard University, the University of Arizona, Oregon Health and Science University, UCSF, and a naturopathic college (Bastyr University). Of course some of these are not new awards, but continuations of awards granted a couple of years ago, but it shows that NCCAM is seriously into funding CAM centers.
Studying CAM is not the only thing NCCAM does. If that were the case, I would have less problem with it, the waste of taxpayer dollars on studies of homeopathy notwithstanding. The real problem with NCCAM is that a big part of its mission is to train CAM researchers and disseminate "authoritative information" to the public and professionals. It's also to support the creation of research centers, the majority of which, as I have shown before, tend to take a very credulous view of CAM therapies, studying in effect not if various CAM therapies work but assuming they "work" and studying how to "integrate" them with conventional science- and evidence-based medicine. Moreover, the longer NCCAM exists, the more a culture of credulity develops within it and within the centers it funds, a culture that will spread and vie with science for the hearts and minds of future doctors.
As much as you bemoan the advent of quackademic medicine, I just wanted to let you know that not all of us medical students buy it. As a relatively new reader of your blog, I just wanted to say thank you.
They are looking for test volunteers. Poor controls and some skeptical volunteers to seriously skew the supposed effects (either way would be fun) should provide for some amusing articles.
It is unlikely that they will be properly blinded if they want to see good results, so reversing their bias shouldn't be too difficult...The magic water....it burns...
The goggles! They do nothing!
I'm off to write my congressman... Not that they ever respond...
There's a Bond joke in here somewhere....but now I have to go write my congressman about this NCCAM b.s. so I don't have time to properly word it. $121 M for these "studies" is truly very sad.
Calling this crap the "affirmative action" of science is a real low blow, considering that with affirmative action, you're supposed to hire the equally-qualified minority candidate, and there's nothing equally qualified about any of this. It's more like the rank nepotism of science, where the boss hires his do-nothing frat buddy from college. (The oxymorons, they burn!)
Who do they get to sit on these study sections? Seriously, has anyone looked at the sitting members and their qualifications?
I used to look at NCCAM study section rosters on the NIH web site but I had to give it up for health reasons.
NCCAM special emphasis panels are a trip, or at least this one was: http://www.circare.org/tact/nccamsepZAT1K02_20020104.pdf
This SEP reviewed the (single) application to conduct an RCT on so-called EDTA chelation therapy for CAD. Apparently the review was favorable enough to award a $30 million congressional earmark to the (single) applicant.
The roster consisted of an epidemiologist, a professor of public health, a cardiologist, and one of the most notorious "CAM" providers of so-called EDTA chelation therapy. Oddly this last member was named in the grant application, having been designated as a member of one of the trial management committees.
Maybe the NCCAM scientific review administrator sent him an empty envelope and a plane ticket to DC so he could abstain from the review. Right.
If they were to actually do the study of homeopathic dilutions properly (double blind, with controls, as the promise they will) it would actually be a very effective way of showing that the "effectiveness" of homeopathy has nothing to do with the "remedy" they are dispensing. Of course, I would never trust anyone who wrote "Samuel Hahnemann MD". I never trust people who add credentials in places where they would not normally be used. (I was reading a blog post by Orac, MD PhD, where he said...)
Hmm. Spending on alternative medicine is an issue because, let's see, all treatment for medical conditions must be scientifc, I guess. (Is this a natural law, or a commandment of the almighty?) Okay, but wow! talk about missing the forest for a tree, no, a little bitty bush. Gee, $121 million for 'alternative' medicine that yes, isn't science, but hey, I can chalk that up to life in a democracy. Let's see, what's hurting funding of scientific research -- wasting $121 million of a trillion dollar budget on alternative medicine or, spending a billion dollars a day or something on wars. So, let's write our congressional reps to protest spending on non-scientific attempts to treat disease. That's the big problem, these days, huh?
I would bet money you are right about the mainstream people seeing NCCAM as an easy touch. I recognise a couple of people in the RO1 list as noted orthodox scientists and/or clinician scientists in my own field, and I can't believe anything other than "We can score grant money from this to fund our work" is at bottom of their signing up.
It has always been the case (from what my US Univ bioscience buddies used to tell me, both when I worked at NIH a decade back and since) that people will "gravitate" to the NIH Institute with the best funding percentage. The market at work.
PS Orac - there seem to be a ton of "Mindfulness" studies for all kind of things. What exactly is "mindfulness" when it's at home? Is it a new code for meditation, or is it something like Woo cognitive therapy?
Mindfulness, at least how I've been taught is a way of observing what's going on at the same time as experiencing it. It's awareness. Among other things, some of which may be woo, practicing mindfulness is supposed to let you concentrate on doing what needs to be done, or talk about things, even while you're having very strong emotions.
Mindfulness is NOT a relaxation technique. It is an awareness and attention focusing technique. It may result in relaxation, but that is not the purpose. Some people do mindful meditation, but that is a subset of mindfulness. You can walk mindfully, or brush your teeth mindfully as well.
Part of mindfulness is accepting what you notice, but not necessarily acting on it. This is supposed to help with impulse control.
I believe it comes from an eastern philosophy. I ran across it in Dialectical Behavior Training, which is a form of cognitive therapy that particularly stresses that you don't have to pick one extreme or another, but can mix them. (e.g. you don't have to be angry or happy, but can be a mix of both, or neither, or another emotion.)
Holy false dichotomy, Batman! Albion, people can miraculously care about more than one issue at the same time. Protest isn't a zero sum game; complaining about federally funded woo doesn't take anything away from efforts against the Iraq war. Take your concern trolling someplace else.
A quick look at some of those proposals does seem to indicate that a least some of these researchers equate mindfulness with meditation. When I first came across the concept, in of all places, a cookbook (which I no longer own, alas), it seemed entirely non-wooish and perfectly reasonable. The idea was to focus on what you were doing, one task at a time, and maybe treat the task itself as a form of meditation. IOW, be mindful of what you're doing, and don't try to multitask. Since then, most of the uses of the term I've come across have seemed wooish.
There has apparently been something in Science not so long ago discussing NCCAM:
Debating the Worth of NCCAM Research
Folkman et al.
Science 17 November 2006: 1083-1084
DOI: 10.1126/science.314.5802.1083
- behind a paywall but imagine some people here have access.
I would think that there would be a good smattering of ex-scientists turned Woo-boosters ("Turned to the Darkside") on the NCCAM Study Section(s)s - here is an example - and rather few people with a known scepticism about Woo in general. But that's just me being cynical.
BTW, speaking as a mainstream biomedical scientist, Orac is echoing my feelings about the "Quackademic" end of Alt-ery exactly. Like him, I started from a position of some sympathy - "let's test it properly and we'll find out". And also like him, I used to think folk like Wallace Sampson and David Colquhoun were laying on the denunciations kind of thick. But after a few years of see-ing the antics of the Anti-evidence Brigade, and engaging on the blogs, I have to conclude that they are only interested in seeing the answer they already believe in and boosting Woo (all of it) pretty much uncritically. I mean, experiments on probiotic effects on gut cells are one thing - but "Biofields" and "Energies" of a kind unknown to physics - puh-lease.
Just for a taster, try reading this NCCAM background factsheet on "Energy Medicine" without your jaw hitting the floor - a tough ask.
I'm vigorously shaking my fists. This is a true wtf? moment.
Um, Orac, you lost the footnote reference there. There was a footnote number, wasn't there? Convergent basic science? I donno, I don't speak whatever language that is, but the next word is "evidence". So surely they had a citation to said evidence, right? If it's convergent, it ought to be at least 4 or 5 citations. Three, maybe. Two at least. Okay, one? Maybe just an asterisk? Like this:
>*<
Oh, that's where they got the evidence from!
It's an abstract; abstracts don't require references.
Presumably he cited references in the full grant application, no doubt with lots of citations of the work of Rustum Roy and and articles published in Homeopathy.
Why not let them find out if there is any truth in homeopathy or not? If they try and fail, then the controversy will be resolved. If you don't give them a chance to try, they will continue insisting that homeopathy works.
So what the heck is wrong with funding homeopathic research? And why are you so sure that water can't preserve information? I don't see anything ridiculous about the idea. It just hasn't been confirmed by mainstream science, because mainstream science has decided ahead of time that it can't be true.
Calling something woo doesn't make it false. It has to be decided by research. And why are so strongly against deciding these questions with research? Are you opposed to science?
Why not let them find out if there is any truth in homeopathy or not? If they try and fail, then the controversy will be resolved. If you don't give them a chance to try, they will continue insisting that homeopathy works.
So what the heck is wrong with funding homeopathic research? And why are you so sure that water can't preserve information? I don't see anything ridiculous about the idea. It just hasn't been confirmed by mainstream science, because mainstream science has decided ahead of time that it can't be true.
Calling something woo doesn't make it false. It has to be decided by research. And why are so strongly against deciding these questions with research? Are you opposed to science?
You are falsely assuming that practioners of homeopathy will admit that there is no basis to their "modality" if a NCCAM study shows no effect of homeopathic solutions.
History shows that this is not the case.
If the NCCAM actually performed this role then it would be valuable.
Can you provide any example of a NCCAM study with negative results actually effecting the practioners of that modality? It simply doesn't happen.
Homeopathic practioners will keep on doing homeopathy anyway.
Well, one of many reasons -- allocation of funds. It could be better distributed. It's disheartening to see that NCCAM is getting a good chunk while I read about researchers plea for more funding b/c they are on a verge of breakthrough but are afraid that next year they won't have the funding to continue.
Homeopathy has been tested. It failed. Repeatedly. When bias and placebo effects were removed...but woo's had their personal testimonials and anecdotes and these apparently trump double blind tests from others.
Also the more research done on a topic...the more seriously it will be taken because it looks from the outside like there is something to investigate.
Pec's email, and Chris Noble's and Richard Eis' responses, sum up, in a nutshell, why something like NCCAM drives us science types crazy. The Woos are in a win-win situation here since:
(i) If NCCAM were to get disbanded, they could and would scream loudly "Suppression! Oppression! Dissenting voices silenced! THEY don't want you to know THE TRUTH"
But....
(ii) If NCCAM goes on funding research that never squarely addresses the Big Question ("Do these things work better than a placebo - yes or no?") then you get an ever-expanding body of equivocal Pseudo-research, allowing people to say (as Richard Eis notes)- "Hmm looks like something there to investigate - must be something to it".
The only solution would be to have NCCAM fund research truly directed at the central question of efficacy. But their record shows they have not done this, although they have spent a Billion of your tax dollars. This really has to be down to the composition of their funding panels, which in turn is skewed by the "political" nature of NCCAM's original remit.
NCCAM's website tells you their first five-yr strategic plan "Expanding Horizons of Healthcare" (2001-2005") "...outlined a set of broad goals and objectives in four strategic areas: investing in research, training CAM investigators, expanding outreach, and facilitating integration."
To me that sounds suspiciously like promoting Woo, especially the final two.
NCCAM was, according to their website, founded in 1998. Were the Clintons into this woo then? Or was it the Republican Congress? In any case, this can't be blamed on Bush.
I note that they have several "completed" clinical trials. But, I could not find the results anywhere. Just trial descriptions. Does anyone have any idea where the results would be?
Over here in the UK Woo is pretty much bipartisan, Oldfart, and I suspect the same is true in the US. Our former Prime Minister, the saintly Tony Blair, while generally very supportive of science, made it pretty clear he viewed changing the law to allow the sale of homeopathic remedies (aka water) with labels saying "Homeopathic medicine for colds" as strictly a business issue - there was a market out there for the stuff, so the homeopathic medicine crew should be allowed to serve it.
For NCCAM, according to Wallace Sampson's broadside about it the originator was Sen Tom Harkin (D-Iowa). But then President and Mrs Reagan had their astrologer, so mystic and evidence-free beliefs turn up right across the political spectrum.
Oldfart,
Yea, Tom Harkin got the ball rolling, with Bill Clinton's assistance. Here's my favorite re-telling of NCCAM's history - it's a doozy:
http://www.quackwatch.org/01QuackeryRelatedTopics/Hearing/gorski2.html
Don't forget Orrin Hatch -- as a bigwig in the Mormons, he's been the strongest voice in the Senate on behalf of alternative medicine.
Thing is, look at how little a typical alt-med treatment costs, compared to even a day's hospital stay. Then put yourselves in the shoes of someone facing cancer, and who wants to leave an actual estate and not put her or his loved ones a quarter-million bucks in the hole. The patient's probably thinking "Well, I go the regular-med route and bankrupt my family and it might not work, or I could give this weird silver shit a try..."
You really want to strike a blow against woo? Back single-payer health care. That will have more effect than all the pictures of blue men ever posted.
TCE - thanks for the link. That is absolutely scary. Is there no one left? We need that science debate more than ever but, suppose EVERY CANDIDATE FAILS IT!
Dr. Aust - is the "saintly" Tony Blair related in any way to the Sainted Reagan? lol.
Second Oldfart's comment - anyone who hasn't read it should check out the quackwatch link The Crack Emcee gave - truly a jaw-dropper.
Oldfart - the description of that nice Mr Blair (probably speaking soon at a US Univ near you, tickets only $ 10) as "saintly" was because that was how he always seemed to see himself. Although he is clearly a great admirer of the Sainted Reagan's British friend Mrs Thatcher, herself known to parts of the Tory party as "The Blessed Margaret"
Better they study it than let unproven claims proliferate.
Ah, but there's the rub: Unproven claims still proliferate, and no NCCAM-funded research has definitely demonstrated or disproven the efficacy of any so-called CAM modalities. Even when negative studies are published, CAM advocates dismiss them and demand more studies--and more money, of course.
Orac,
I aspirated my muffin when I read that the NCsCAM was funding a "study" to see if there was a difference between stirring and "succussing" a homeopathic "remedy".
This is a joke, right? Please tell me this was a joke, because I'd hate to think that my tax money was spent on such a stupid study.
The funny part (the part where I aspirated my muffin) came when it dawned on me what the likely (almost certain) outcome of this "study" would be. When they finish up and "discover" that neither stirring nor "succussing" produces an effective remedy, do you know what the title will be?
"Stirring and succussing equally effective for making homepathic remedies".
It's a scream, isn't it?
At least, I think that we should be screaming about it.
Prometheus
I should have mentioned that, since there is no credible data showing that homeopathic remedies work at all, it is - to say the least - premature to investigate different ways to make them.
It's sort of like funding a study to find the optimal way to make an aluminium foil hat to ward off mind control rays.
Prometheus
Prometheus wrote "It's sort of like funding a study to find the optimal way to make an aluminium foil hat to ward off mind control rays."
I think that was done at MIT a couple years ago. I don't have the citation handy; but I believe you can find it among the IgNobel prizes.
You see! That's the problem with trying to parody woo and quackery - the stuff's already so far over the top that parody sounds reasoned and even rational by comparison.
As a literature professor once told me - you can't parody a farce.
Prometheus
There would have to be a follow-up study to look at the importance of type of bible used in the "succussing".
Hard-cover, leather, paperback: which has the greater efficacy?
Choke on these ...
Massage to Increase Well-Being and Immune Function in Dominican Children Infected With HIV: http://www.clinicaltrials.gov/ct2/show/NCT00070980
(drug tx. withheld)
Garlic in Hyperlipidemia Caused by HAART:
http://www.clinicaltrials.gov/ct2/show/NCT00029250
(phase II study (above) terminated after a non-nccam phase I study showed garlic lowered blood levels of saquinavir)
Oddly NCCAM forgot to mention their terminated trial in the press release: http://nccam.nih.gov/news/2001/120501.htm
It would be nice if it were that simple. Unfortunately, it's not. If you examine the prevalence of SCAM in countries that have free medical care, it seems to make no difference.