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It is
time for Congress to defund the National
Center for
Complementary and Alternative Medicine (NCCAM.) After ten years
of existence and over $200 million in expenditures, it has not proved
effectiveness for any "alternative" method. It has added to proof
of ineffectiveness of some methods, but we had that disproof before NCCAM
was formed. NCCAM proposals for 2002 and 2003 promise no more. Its major
accomplishment has been to ensure the positions of school faculty who might
become otherwise employed - in more productive pursuits.
Such situations are not often tolerated in scientific fields - at least
attempts are made to minimize them. NCCAM seems to be tolerated for three
reasons. First, economically strapped medical schools welcome the funds.
Second, although most medical scientists recognize the scientific absurdity
of most "alternative" claims, most grant recipients and a few
deans harbor the same absurd beliefs as do the advocates about the methods'
efficacy. Third, and most important, major congressional powers are "CAM" advocates. They have a tight hold on the
NIH budgets that fund investigations of real medical science as well. The
deal seems to be that if the schools will play ball with and not oppose the
senators, the senators will be generous in kind.
Classical Quackery
While the public is distracted by terror attacks, wars, and personal and
business scandals, modern medicine's integrity is being eroded by New Age
mysticism, cult-like schemes, ideologies, and classical quackery, all known
as "alternative medicine." Using obscure language and misleading
claims, they promote changes that would propel medicine back five centuries
or more. They would supplant objectivity and reason with myths, feelings,
hunches and sophistry. NCCAM is being presented as a scientific vehicle to
study alternative medicine's anomalous methods. But NCCAM actually promotes
the movement by assuming that false and implausible claims are legitimate
things to study.
In 1992, Senator Tom Harkin (D - Iowa), convinced that his allergies were
cured by bee pollen, assigned $2 million of his discretionary funds to
establish the Office of Alternative Medicine (OAM) - NCCAM's first
incarnation. OAM was assigned to investigate the "alternative"
methods that medical science considered false or implausible. But since
their inception, OAM and NCCAM have had serious problems.
The first OAM director resigned under Sen. Harkin's pressure, having
objected to Harkin's OAM Council nominees who represented cancer scams such
as the Laetrile and Tijuana
cancer clinics. One influential Harkin collaborator and constituent was a
travel agent for a Bahamas
cancer clinic. And The Federal Trade Commission fined Harkin's bee pollen
distributor, $200,000 for false claims.
In 1998, Dr. Edward Halperin, President of the North Carolina Medical
Association called for disbanding the Office. Responding to objections from
the science and medicine communities, NIH Director Harold Varmus placed OAM
under more scientific NIH control. But Sen. Harkin countered, elevating OAM
to an independent Center. By 2001, the annual budget rocketed to nearly $90
million per year and by 2002, over $100 million per year. Congress,
believing erroneously that public demand for unscientific services had
increased, passed appropriations without a dissenting vote.
Scientists look at the facts. They see that no sectarian or aberrant method
has cured a single person, or extended a life for as much as a day. They
see the "CAM" movement to be
responding to people's irrational reactions to illness and narcissistic,
self-centered wishes. They see no chance for "alternative" or
"complementary" methods to replace modern methods. Recent surveys
show that the methods merely add on to scientific medicine - adding to cost
of care.
We already know that these aberrant methods do not work, or are so unlikely
to work that more clinical trials are not reasonable. Why is that? Because
we have found the best quality studies are uniformly negative. Most positive
studies are poorly designed and poorly controlled.
Testing, Testing
Looking at the most popularly promoted methods we find that acupuncture,
after thirty years, over 400 clinical trials, and 33 comprehensive
literature reviews of those trials, only two specific conditions were found
affected by acupuncture more than sham procedures. But even those effects
are minimal, they are not superior to standard medical methods, they remain
implausible and unpredictable. They will probably not be confirmed because
of their results are best explained by biased experimental errors.
After 100 years and hundreds of trials, chiropractic manipulation shows no
advantage over shams for any condition. As for homeopathy, after 200 years
and hundreds of studies, researchers cannot prove an effect for any
homeopathic remedy for any condition. After a dozen studies, prolonged
survival from psychological support for cancer patients has been
essentially disproved. Herb product contents cannot be controlled, and
their contents have been proved harmful. Some products have been
adulterated with common pharmaceutical drugs that account for their
apparent effects. If supplement marketers were held responsible for product
effects, what more would there be to research?
Millions, Billions, Trillions?
NCCAM Director, Dr. Steven Straus, a career NIH physician without "CAM" experience, now oversees the $113 million
annual budget. He wants more funding for more NCCAM trials. But what is the
NCCAM record? After eight years of projects and over $200 million, NCCAM
and advocates have not proved any method to be effective. Perhaps more
important, NCCAM has not declared any method to be ineffective, thus
keeping open continuing congressional appropriations.
NCCAM is ridden with potential and actual conflicts of interest. Ten
individuals account for 20% of NCCAM awards. None of them has produced a
definitively positive or negative report. Most recipients have produced no
report at all. Two individuals originally on the Advisory Council that
approves NCCAM policy were awarded over $4 million and $5 million in
repeated awards.
NCCAM recently announced research on "chelation therapy" for
heart disease - a method already disproved and potentially dangerous. And
$10 million is planned for research into herbs with their uncontrollable
contents and unreliable results. Similarly troubling is NCCAM's awards of
over $1 million into psychic healing, and $1.5 million for homeopathy. Both
are highly implausible, being not only repeated failures, but promoted
falsely as well.
NCCAM recently awarded $15 million to nine medical schools to develop
teaching of these subjects - all by advocates of "CAM."
It gave no funds to the five medical school courses with curricula already
developed that teach about the subject rationally. In other words, NCCAM's
research agenda fits its congressional supporters' ideological vision and
finds unproductive ways to use up its ballooning appropriations.
NCCAM will never be able to fulfill Dr. Straus's goal to determine
effectiveness. Rigorous trials cost $1-5 million each. Five to twenty
trials are needed to prove or disprove effectiveness of each product or
method. After staff expenses, $100 million per year can support only 10-20
reliable trials per year. Given hundreds of products and methods for
hundreds of conditions, costs would be hundreds of billions to trillions of
dollars over decades - all to prove what we already know. Then, as occurred
after the negative Laetrile and vitamin C trials for cancer, advocates just
think up new claims, or claim that the trials were rigged. Sales continue
regardless of the disproof. By finding them worthy of study, NCCAM lends
legitimacy to implausible methods, resulting in the public spending tens of
billions of dollars annually on them.
Ideological Health
We also know that ill-conceived research produces misleading results. The
results then lead to repetitive cycles of unproductive work to explain what
was found, usually just to disprove the erroneous results. As a result of all
this, claims continue.
Tens of millions of U.S.
citizens lack medical insurance. Millions of illegal residents produce
economic burdens on local medical systems. While real medicine and
technology solve these problems and prolong productive life, "alternatives"
appeal mostly to disaffected health dilettantes, and add nothing to public
health. Worse, CAM's fuzzy thinking style
and radical social ideology lead to wrong-headed policies such as the
denial of HIV as the cause of AIDS, and the recent fears of vaccinations
and electromagnetic fields.
Special commercial interests and irrational, wishful thinking created
NCCAM. NCCAM is the only entity in the NIH devoted to an ideological
approach to health. To correct the situation, Congress must consider at
least interrupting funding of NCCAM while results of work in progress
mature. NCCAM could be dissolved, its functions returned to other NIH
centers, with no loss of knowledge, and an economic gain. Funds could be
invested into studies of how such misadventures into
"alternative" medicine can be avoided, and on studying the
warping of human perceptions and beliefs that led to the present situation.
More public money for investigating methods with negligible promise is
foolish economics and even more, is unwise public policy.
Wallace Sampson, MD is Editor of the Scientific Review of Alternative
Medicine and Emeritus Clinical Professor of Medicine at Stanford University
where he teaches analysis of unfounded medical claims.
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