This week's Science includes an interesting "forum" on the value of the National Center for Complementary and Alternative Medicine (NCCAM), that wing of the U.S. National Institutes of Health charged with checking out whether or not herbal remedies and other medical techniques not sanctioned by MDs are worth taking.
The center's been around for about eight years now, and apparently not everyone thinks it's a wise use of $123 million of taxpayers' money every year. My first thought was: isn't it a good idea to apply the scientific method to testing the efficacy of echinacea, St. John's wort and other such stuff? The answer appears to be "yes, but..."
On the defence is the head of the NCCAM, Stephen E. Straus:
Before the establishment of NCCAM, there was no central source of CAM information. NCCAM brings evidence-based information on CAM to the public, practitioners, and researchers. NCCAM disseminates research findings and provides reliable information about commonly used CAM practices through numerous channels, including its information clearinghouse and its award-winning Web site (11).
and
We have raised the bar on the study design and methods used in CAM research, including the quality of products under investigation. Our portfolio of basic research will inform subsequent clinical studies to ensure that we are testing a high-quality product, at the optimal dose, and in the appropriate population.
On the attack are Donald M. Marcus and Arthur P. Grollman of the Baylor College of Medicine in Houston and the State University of New York at Stony Brook, respectively:
We believe that NCCAM funds proposals of dubious merit; its research agenda is shaped more by politics than by science; and it is structured by its charter in a manner that precludes an independent review of its performance. The central issue is not whether research into alternative therapies should be supported by NIH. In view of the popularity of alternative therapies, it is appropriate to evaluate the efficacy and safety of selected treatments. The issue is that the administration of research by NCCAM falls below the standards of other NIH institutes and that the evaluation of alternative therapies could be performed by mechanisms that are already in place at NIH.
The way Marcus and Grollman see it, the NCCAM was set up for political, not scientific reasons. It is forced by its mandate to include practitioners of complementary and alternative therapies in its review panels, and therefore its output isn't up to snuff. And I admit to finding their argument persuasive.
But more troubling was some old news included in the two papers that I hadn't come across before. If the results of a survey of American users of C and A medicines are genuinely representative, then there's little point in the very purpose of the center. According to a 2001 paper in the Archives of Internal Medicine (161:805-810), people simply don't care what science has to say about their favorite therapies.
When asked what they would do if a government agency said that the supplement they use most often was ineffective, 71% of regular users reported that they would continue to use it. In the follow-up survey, respondents were asked what they would do if the FDA specifically said that the supplement they use most often was ineffective to see if using the FDA's name vs an unknown government agency would alter the result. The addition of the FDA did not lead to different responses. Once again, two thirds (67%) of regular and sometimes users said that they would continue to take the supplement.
And 62% of Americans use some form of CAM, according to a report from the Centers for Disease Control. This is the sort of thing that drives skeptics to drink. I'm mean, what's the point of it all? Indeed, the NCCAM has released reports on St. John's wort, echinacea, and saw palmetto, finding all of them no better than placebos. But that hasn't stopped lots of people from continuing to use each of them.
To be fair, there are some intriguing data that suggest the same is largely true for Prozac and other anti-depressants, (American Journal of Psychiatry 159:5) so "conventional" doctors shouldn't feel too smug. But at least that controversy is being thrashed out among scientists with a common epistemological background.
At the end of day, what Marcus and Grollman are arguing for is not the dismantling of the NCCAM or the end of scientific review of CAM. They just say someone should conduct a thorough review of the center and see if we're getting our money's worth. Given the context of a seemingly disinterested and/or ignorant public, that's probably a darn good idea.
At the very least, the center should be working harder to ensure its reports find their way into the popular media with more frequency and punch.
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This is not a new a new argument. For example, Wally Sampson argued nearly four years ago that NCCAM is a boondoggle that should be defunded.
The problem is exactly as you point out. NCCAM does fund studies of very dubious merit, including studies on Reiki and various "energy healing methods." The very mandate of NCCAM states that all sorts of alternative medical practitioners who are looking for an air of scientific respectability for their practices, not appropriate scientific skepticism.
Personally, I used to be a supporter of NCCAM, but, seeing what it has become, I'm now coming to the opinion that NCCAM isn't doing anything that couldn't be done just as well or better distributed among the various Institutes and Centers of the NIH.
There are a lot of politics behind this that are being missed, and yes, it's quite obvious the point of NCCAM has always been political. NCCAM will not go away as long as Dan Burton is in congress. He's a major agitator for CAM and other crazy non-scientific stuff like the vaccination/autism link.
Strauss therefore has an impossible job, I don't know who he pissed off to get it, but there it is. He has to study, and scientifically verify the efficacy of a religion. I'm not being snarky, that's what CAM is to many many people. They believe in these treatments without any evidence other than their own subjective experience. When NCCAM comes out with a study failing to prove the efficacy, the advocates for these treatments go nuts. The drug isn't abandoned, instead they get Dan Burton to go apeshit at the center, they send nasty letters and criticize the study endlessly. Usually they say the wrong amount of drug was used or the wrong brand or a slightly different variety blah blah blah.
I see it as a necessary evil. A waste of money, yes, but why spread the misery around the entire NIH? This way all the energy of the crazies is sent in one direction, towards a center that's actually become quite adept at handling them. Initially it was clearly a shock how vehement the critics were. They though that once CAM was being studied scientifically they'd get a break. It just wasn't the case. When they come out with negative results it's like proving Jesus didn't exist. People go apeshit. NCCAM has my utmost sympathy.
I thought the article was well presented in terms of representing its facts. I understand that CAM is not a cure all thing, however I believe people should have access to alternative care when conventional care failed. I came from a long line of family in alternative care. Without it, I don't think I would be here today. I was very sick during my early childhood years. I had really bad coughs at night and was vomiting almost every night. By taking herbal medication it helped heal me physically and internally. In fact a lot of these CAM cares are well documented and proven it works. All we need is to take the time to look into it to understand how each of the techniques work.