Is it time to shut down the National Center for Complementary and Alternative Medicine (NCCAM)?

By: 

The NCCAM was set up under the NIH in 1992 through the effort of Senator Tom Harkin (D-Iowa), with an initial outlay of $2 million of federal funding. Since then it has grown to a budget of $122 million.

Its mission is to investigate alternative medical practices such as acupuncture, homeopathy, and natureopathy.  Another part of the NIH also studies these types of treatments, for a total annual outlay of $300 million. Thanks to the efforts of the Science Based Medicine blog, Steven Salzberg’s blog on pseudoscience, and an article and blog posting in the Washington Post, this expenditure is now receiving some scrutiny.

Unfortunately, the scientific record for the alternative approaches that NCCAM has investigated have not been encouraging. A great book on the subject, “Snake Oil Science: The Truth about Complementary and Alternative Medicine” by R. Barker Bausell goes through the current evidence in some detail, and it is largely the case that none of these treatments have been found to be more effective than placebo.

In the case of homeopathy, which has thousands of practitioners, the evidence is especially clear, by a quirk of this particular practice. Since homeopathy argues that the more diluted the dosage, the more potent the drug, it is quite easy to do studies where the placebo and the test groups are given pills that are nearly identical. This avoids a frequent problem with placebo control studies, which is that the placebo groups can usually tell (through lack of any drug related side effects) that they are in the placebo group.

Despite the dearth of evidence in support of many of the alternative treatments investigated by the NCCAM, Senator Harkin continues his support for the center. As recently as a few weeks ago he stated:

"One of the purposes when we drafted that legislation in 1992 . . . was to investigate and validate alternative approaches. Quite frankly, I must say it's fallen short. I think quite frankly that in this center, and previously in the office before it, most of its focus has been on disproving things, rather than seeking out and proving things."

(Quoted by Kimball Atwood: http://www.sciencebasedmedicine.org/?p=399)

This illuminating passage stands as a testimonial to, at best, a poor understanding of the scientific method, and at worst a disingenuous gloss of a record of failure. To state that the purpose is to validate alternative approaches, if that’s what Senator Harkin truly believes, seems to get the cart before the horse. NCCAM's purpose was to subject these approaches to rigorous scientific evaluation. That has happened, and the results have been negative in many cases.

There is a need for a branch of the NIH that will investigate treatments which are unlikely to be picked up by researchers or private companies. However, it should also come clean and make recommendations as to what approaches have withstood scientific scrutiny, and those that have not, and stop funding investigations of the latter. Thus, we should reform the NCCAM, or close it down and re-establish an office to concern itself with the needed studies.

Tags: 

Comments

Ignorance is not bliss, especially in the defense of science. Therefore, before assuming (incorrectly) that homeopathic medicine is bunk, it seems that you're showing your ignorance on the subject and have thus proven the NEED for NCCAM.

Below are just some studies that are worthy of your attention. Please consider doing some homework before embarrassing yourself by showing your ignorance on the subject:

K. Linde, N. Clausius, G. Ramirez, et al., "Are the Clinical Effects of Homoeopathy Placebo Effects? A Meta-analysis of Placebo-Controlled Trials," Lancet, September 20, 1997, 350:834-843. Even critics have called this meta-analysis "completely state of the art." It reviews 186 studies, 89 of which fit pre-defined criteria for its meta-analysis. Homeopathic medicines had a 2.45 times greater effect than placebo.

J. Kleijnen, P. Knipschild, G. ter Riet, "Clinical Trials of Homoeopathy," British Medical Journal, February 9, 1991, 302:316-323. This is the best objective meta-analysis of clinical research prior to 1991. This meta-analysis reviewed 107 studies, 81 of which showed efficacy of homeopathic medicines. Of the best 22 studies, 15 showed efficacy.

Responses to the “junk science” review of research published in the Lancet (2005) by Shang, Eggers, et al.:

-- Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analysed trials. Journal of Clinical Epidemiology. 61, 12:1197-1204. doi: 10.1016/j.jclinepi.2008.06/015.

-- Rutten ALB, Stolper CF, The 2005 meta-analysis of homeopathy: the importance of post-publication data. Homeopathy. 2008, 97:169-177. doi:10.1016/j.homp.2008.09/008 (These two reviews and re-analyses of the Shang data threw into doubt the narrow analysis of Shang and team.)

WB Jonas, TJ Kaptchuk, K Linde, A Critical Overview of Homeopathy, Annals in Internal Medicine, March 4, 2003:138:393-399. Although this is not a meta-analysis, it is still a very good review of the clinical literature in homeopathy.

Clinical Trials Published in Leading Conventional Journals
Vickers AJ. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. Cochrane Reviews. 2007. http://www.medscape.com/viewarticle/485935. Four treatment trials (N=1,194) found “promising” results from Oscillococcinum in the treatment of influenza or influenza-like syndrome. Three prevention trials (N=2,265) did not find efficacy of Oscillococcinum in the prevention of these conditions. Because Oscillococcinum is made from the liver & heart of a duck and because ducks are reservoirs of flu viruses, this drug make sense, biologically. It has been used in homeopathy since the 1920s and thus verifies that homeopaths have been knowledgeable of avian sources of flu virus for a long time.

J. Jacobs, WB Jonas, M Jimenez-Perez, D Crothers, Homeopathy for Childhood Diarrhea: Combined Results and Meta-analysis from Three Randomized, Controlled Clinical Trials, Pediatr Infect Dis J, 2003;22:229-34. This meta-analysis of 242 children showed a highly significant result in the duration of childhood diarrhea (P=0.008).

Frass, M, Dielacher, C, Linkesch, M, Endler, C, Muchitsch, I, Schuster, E, Kaye, A. Influence of potassium dichromate on tracheal secretions in critically ill patients, Chest, March, 2005;127:936-941. This is an impressive study was conducted at the University of Vienna and published in the leading respiratory medicine journal...with substantially significant results in the homeopathic treatment of people with chronic obstructive pulmonary disease (COPD is the #4 reason that people in the USA die). The medicine used in this trial was Kali bichromicum 30C. At present, two different universities are conducted trials to replicate this important study.

Bell IR, Lewis II DA, Brooks AJ, et al. Improved clinical status in fibromyalgia patients treated with individualized homeopathic remedies versus placebo, Rheumatology. 2004:1111-5. Participants in active treatment showed significantly greater improvements in tender poit count and tender point pain, quality of life, global health and a trend toward less depression compared with those on placebo. “Helpfulness from treatment” in homeopathic patients was very significant (P=.004). People on homeopathic treatment also experienced changes in EEG readings. The evidence of clinical benefits coupled with the objective evidence of EEG readings combine to verify a therapeutic effect from a physiologically active medicine.

Belon P, Banerjee P, Choudhury SC, Banerjee A., Can administration of potentized homeopathic remedy, Arsenicum album, alter antinuclear antibody (ANA) titer in people living in high-risk arsenic contaminated areas? I. A correlation with certain hematological parameters. Evid Based Complement Alternat Med. 2006 Mar;3(1):99-107. A couple of dozen trials testing homeopathic doses of arsenic to treat mice who were exposed to toxic doses of arsenic provide additional evidence of the benefits from homeopathic treatment.

Basic Science Trials
Witt CM, Bluth M, Albrecht H, Weisshuhn TE, Baumgartner S, Willich SN. The in vitro evidence for an effect of high homeopathic potencies--a systematic review of the literature. Complement Ther Med. 2007 Jun;15(2):128-38. Epub 2007 Mar 28. From 75 publications, 67 experiments (1/3 of them replications) were evaluated. Nearly 3/4 of them found a high potency effect, and 2/3 of those 18 that scored 6 points or more and controlled contamination. Nearly 3/4 of all replications were positive.

Banerjee, P.; Biswas, S. J.; Belon, P.; Khuda-Bukhsh, A. R. A Potentized Homeopathic Drug, Arsenicum Album 200, Can Ameliorate Genotoxicity Induced by Repeated Injections of Arsenic Trioxide in Mice. Journal of Veterinary Medicine, Series A, Volume 54, Number 7, September 2007 , pp. 370-376(7). DOI: 10.1111/j.1439-0442.2007.00945.x

References to water and homeopathic medicines: --Site of Professor Martin Chaplin, a world renowned expert on water: http://www.lsbu.ac.uk/water/homeop.html and http://www.lsbu.ac.uk/water/memory.html -- This site has almost 2,000 references to articles and research about water. Simple-minded people who assert that it is “impossible” for homeopathic medicines to have any effect or who assert that homeopathic medicines break present laws of physics simply are not adequately informed.

Elia, V, and Niccoli, M. Thermodynamics of Extremely Diluted Aqueous Solutions, Annals of the New York Academy of Sciences, 879, 1999:241-248.

Rey, L. Thermoluminescence of Ultra-High Dilutions of Lithium Chloride and Sodium Chloride. Physica A, 323(2003)67-74.

Homeopathy is built on the principle that "like cures like" and that if a potion is deemed to be curative, then a more diluted version of the potion is progressively more potent. Can Ullman tell us what scientific principle can explain this? By the time a potion is diluted down 10 times or so it becomes indistinguishable from water, even using the most sensitive detection equipment, and yet we spend millions of dollars researching its efficacy. I would say that any medical treatment offering patients this kind of false hope is bunk.

Dana Ullman thank you for your comment. I don't assume in my posting that homeopathy is bunk. I state that the evidence suggests that the practice is not better than placebo (which, keep in mind, is known to have a substantial effect). I stand by that claim. Your long list of supposed rebuttals of this claim is wanting. Lets consider two items: mechanism, and current evidence.

As the other commentator points out, the mechanism for homeopathic efficacy seems to be outside of any known principle of science. One idea offered by your community is that highly diluted homeopathic treatments (where there is unlikely to be a single molecule of the active substance left) work by modifying the shape of the molecules of water – the so-called water memory effect. Your comment has two links to homeopathic articles offering this discredited idea up as “experimentally corroborated.” In fact, Cowan et al. in the paper “Ultrafast memory loss and energy redistribution in the hydrogen bond network of liquid H2O,” Nature 434: 199-02, showed that water loses any structural correlations within 50 femtoseconds (less than a millionth of a millionth of a second). For further discussion of this point please look at this insightful article in the Skeptical Inquirer, 2008: http://www.csicop.org/si/2008-01/kutschera.html

As far as current evidence, the Lancet meta-analysis by
Shang et al., 2005, which you denigrate as “junk science,” remains the single most carefully performed meta-analysis of homeopathy trials yet conducted. As you know, it found no efficacy to homeopathy beyond placebo.

One of the papers you indicate to examine for questioning the results of this meta-analysis, Ludtke and Rutten 2008 (incidentally, one of these authors is a homeopath and the other works for an association dedicated to funding of research into homeopathy) makes a point that there is sensitivity to which of the 110 placebo controlled studies were selected for further analysis. This is carefully discussed in the Shang et al. paper (and there response to letters vol 366, Dec 17/24/31, 2005), and it is not clear to me that Ludtke and Rutten have a significant argument. I found it telling, at the end of their paper, that Ludtke and Rutten mention that no mechanism for homeopathy has been found, and state “Until such a mechanism of action is not established, the a priori credibility for homeopathy is low.”

Dana Ullman wrote: "K. Linde, N. Clausius, G. Ramirez, et al., "Are the Clinical Effects of Homoeopathy Placebo Effects? A Meta-analysis of Placebo-Controlled Trials," Lancet, September 20, 1997, 350:834-843. Even critics have called this meta-analysis "completely state of the art.""

You seem to have forgotten about Linde K, Scholz M, Ramirez G, Clausius N, Melchart D, Jonas WB. "Impact of study quality on outcome in placebo-controlled trials of homeopathy." J Clin Epidemiol. 1999 Jul;52(7):631-6, in which they re-analysed the same data, with particular attention to study quality, and concluded that the 1997 paper "at least overestimated the effects of homeopathic treatment".

Hello, my name is AlexAndria M. Kung, PhD, MPH. Dana, perhaps I know you, did you go to Tulane University? Anyway, Dana you are so refreshing. Malcolm, I have come across many many arguments such as the one you have brought up here and I am astonished how many people like yourself can have such medical ethnocentrism. I have traveled to over 117 countries over all continents. I am also EurAsian and grew up with both eastern and western medical philosophy. I am telling you this because I have grown up to be open-minded to all cultures--and with culture comes medicine. I urge you to become educated in other cultures, submerge yourself in their ways of practicing medicine, perhaps live among them for a while, and then tell me NCCAM should be shut down. It is this ignorance and medical ethnocentrism that is keeping people from exploring other possibilities that may otherwise bring health and well-being. I am no way against westernized medicine, I just don't feel that it is the ONLY way to heal people. Being schooled in western and eastern medicine, I understand that everyone is always looking for 'proof'-and whatever is not deemed as 'FDA Stage 4 clinical trials-proof' is then deemed as placebo. This is as cop-out, as placebo is another way of saying, 'I don't understand this medicine, and am afraid of it. THEY don't use MY way of thinking. Therefore, it MUST be placebo.' Malcolm, I recommend that if you do not understand someone's culture--and medicine is part of their culture, be respectful of it. It is their way of life. Right or wrong in your eyes, that particular medical treatment is part of their culture and may or may not be effective for them--as sometimes our westernized drugs don't work for us, or cause SAEs or even placebo. But they are using their own way of medical treatments. You have to understand, their way of medicine may have been the only thing they have known for centuries. Instead of saying 'this is right and this is wrong' just accept it as not what you are used to, and be respectful. Not everyone in the world can do things the westernized way with 4 stages of clinical trials and submittal to the FDA keeping in mind the ICH. One time I was in India, in the jungles. I was sick and the medicine man from the village conjured up some herbs for me. It was either this, or I am sure I would have fainted or perhaps died. I figured why not. I drank it. Felt better and here I am. You may say placebo. I say something else. Sometimes these things cannot be explained the '4 Stage FDA way'--but these remote places in the bush don't have facilities like that. I hope I have shed light on your problem of medical ethnocentrism. AlexAndria M. Kung, PhD, MPH

How great to see a voice of reason emanating from my home-town educational giant (I am an Evanstonian)! I am thrilled to hear a skeptical opinion about CAM. More exciting, however, is the entire enterprise of your blog/website—connecting society and science. I will do my part to let folks in the northwest Chicago suburbs know about your mission. Lots of luck!

have come across many many arguments such as the one you have brought up here and I am astonished how many people like yourself can have such medical ethnocentrism.

Add new comment

Filtered HTML

  • Web page addresses and e-mail addresses turn into links automatically.
  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd> <p> <div> <br> <sup> <sub>
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.