Articles

Consortium of Academic Health Centers for Integrative Medicine research conference disappoints even NCCAM

From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link)

From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link)

In May, the International Research Congress on Integrative Medicine and Health (IRCIMH) conference was held in Miami. In the words of its website, the conference was “convened by” the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM), “in association with” the International Society for Complementary Medicine Research. As CAHCIM chirped in this tweet: “Three days, 22 countries, 100 academic medical institutions, [and] 900 researchers, physicians, educators, and trainees…” Interestingly, despite the fact that “use of all appropriate … healthcare professionals and disciplines to achieve optimal health and healing” is part of CAHCIM’s definition of integrative medicine, actual CAM providers were barely visible among the conference committee bigwigs.

Emmeline Edwards, Ph.D., Director, Division of Extramural Research at the National Center for Complementary and Alternative Medicine (NCCAM), herself on the conference’s Program Committee, was decidedly underwhelmed. (NCCAM helped fund the conference. Additional funding information here.) After offering rather tepid congratulations to the organizers and participants, Dr. Edwards launched into a pointed, but very politely delivered, criticism of the research presented (emphasis mine):

The poster sessions offered a great opportunity to meet many new investigators engaged in exciting research in the field of integrative health. Reflecting on some highlights of these sessions, I was brought to the realization that we could strive for better balance in the science featured in the IRCIMH poster presentations. The clinical research posters outnumbered the basic research presentations 3:1, and research on mind and body strategies dominated the research landscape. One concern is that many clinical research projects were not developed from adequate mechanistic studies and, hence, the outcomes from these projects may not be very informative, provide a well-defined path for the next study, or give direction for future research programs.

How right you are, Dr. Edwards! We’ve been saying some of the same things here at SBM for years. We’ve noticed these very same problems in the organization you work for. Recently, as a matter of fact.

Perhaps I can help Dr. Edwards understand the deficiencies she noted. Integrative medicine proponents prefer clinical research over basic research and don’t particularly care for “adequate mechanistic studies” because having to demonstrate a plausible mechanism of action would eliminate their use of too many of the tools of IM, such as acupuncture, homeopathy, therapeutic touch and reiki. They much prefer tooth fairy science, where prior plausibility is considered unnecessary and plunging right into clinical research allows them to skip the hard stuff.

It doesn’t matter that the outcomes may not be “informative” or provide a “well defined path” or guide future research. Outcomes aren’t that important. You will find an array of “alternative” therapies employed by IM practitioners (also here and here, among many others) where there is no good evidence of effectiveness. Nor is a “well defined path” to the next study necessary when research continues willy-nilly on all sorts of implausible and unpromising treatments. (Just look at the list of abstracts at the very conference you discuss.) How many times have you seen the statement “more research is needed” at the end of a study of some wholly implausible treatment that shows no evidence of effectiveness? As long as “more research is needed” and researchers can find the money to fund it from, say, NCCAM, or other taxpayer funded or private source, research will continue, whether we need it or not.

And why is there so much emphasis on “mind and body interventions?” That’s where the money is. Your agency, NCCAM, has lumped just about all of CAM into one massive category called “mind and body medicine.”

As used in this plan, mind and body encompasses interventions from the three domains of mind/body medicine, manipulative and body-based practices, and energy medicine.

In the ever-shifting definition of CAM, a category called “mind and body medicine” includes “mind/body” as one subset and “body” as another subset. Clear on that? Me neither. Thus, now practically all of CAM is “mind and body medicine,” including such diverse practices as acupuncture, yoga, spinal manipulation, Pilates, reiki, craniosacral therapy and reflexology.

An independent review

The Journal of Alternative and Complementary Medicine has granted open access to the abstracts of poster presentations from the conference. Let’s take a look and see why Dr. Edwards might be concerned that the poster presentations weren’t up to snuff. And let’s see if these presentations measure up to the CAHCIM’s mission of “disseminating information on rigorous scientific research.”

The existence of a Scientific Review Committee for the conference indicates there were some sort of criteria these poster presentations had to meet, but there is no information I could find as to what those criteria might be. Evidently, the bar was extremely low, as we shall see. The Committee was headed by Chairs David Eisenberg, MD, of Harvard, who has a position at the Samueli Institute as well, and Peter Wayne, PhD, also of Harvard. Dr. Eisenberg’s colleague at the Samueli Institute, Wayne Jonas, M.D., was on the Committee too, in charge of Research Methods.

Tooth fairy science

We’ll start with a few examples of tooth fairy science, or as Dr. Edwards put it, clinical research “not developed from adequate mechanistic studies,” and begin with a real jaw-dropper. Six pediatric patients who presented with appendicitis at the Children’s Hospital in Los Angeles emergency room were recruited for a trial of Japanese acupuncture for pain and inflammation. The rationale?

Acupuncture has been shown to treat various medical conditions including acute and chronic pain, and there is speculation that it has anti-inflammatory effects.

Since when is “speculation” a sufficient basis for pediatric human subjects research?

Many iterations of acupuncture were the subject of poster presentations: Japanese acupuncture, “regular” acupuncture, electro-acupuncture, group acupuncture, bee venom acupuncture, and music electro-acupuncture. Had to look that last one up.

[Researchers] suggested that sound waves converted to electric currents may be used to stimulate acupuncture needles to get better results. An apparatus has been devised . . . to convert music into electric waves suitable for use in electro-acupuncture by which the frequency is changed in accordance with the music.

Researchers at the School of Acupuncture-Moxibustion and Tuina in Beijing tested this on rats to see if it might improve mild depression and concluded that it “could have a positive effect.” I wonder if the type of music matters? Is punk rock better or worse than classical? How about jazz versus country music? Obviously, more research is needed.

In addition to many studies of acupuncture, there were studies of wet cupping on depression and anxiety as well as on markers of inflammation and Hsp proteins in patients with metabolic syndrome. You’ll not be surprised to learn that wet cupping didn’t work.

It seems TCM practitioners are dissatisfied with their “theories,” so much so that they feel the need to correlate them with “Western” tests and diagnoses. One study of TCM diagnoses opined that “liver housing blood” could be concluded from lab tests showing, for example, reduced potassium levels. Another found that “the changes of tongue picture can reflect the severity of hepatic cirrhosis in a certain extent.”

Apparently, in kinesiology “theory,” one muscle will weaken after the practitioner speaks a lie and stay strong if he speaks the truth. According to this series of studies, kinesiology practitioners correctly distinguished lies from the truth more often than by chance alone or by guessing. Sense About Science take note: the researchers are from the University of Oxford and City University London.

Researchers concluded that therapeutic touch had significant effects on immune responses by down-regulating serum cytokines, macrophages, and modulated lymphocyte subsets in mice. It also significantly reduced metastasis but not primary tumor size in a mouse breast cancer model. Per another study, Bach Flower Remedies, whose intent is to “harmonize the ethereal, emotional and metal body”, decreased anxiety.

One study employed The Reiki Client Quality Monitoring Tool (who knew?) and found that a decrease in pain and stress and an increase in “happiness” for both in- and out-patient oncology patients. (No control, no blinding.) Brennan Healing Science is another energy healing modality. (This was the first I’d heard of “BHS.”) A “survey development and pilot testing” for a BHS study to see “which conditions may be amenable to energy healing” was presented. If you ask the healers, a lot of conditions are amenable, according to the abstract. The healers reported that 25.4% of physical symptoms and 27.8% of psychosocial symptoms improved completely. (I‘m not sure what “improved completely” means.) “Spiritual factors” (whatever they are) improved the most. This small survey of healers will now be “administered to hundreds of others worldwide.”

Integrative medicine research can make for strange bedfellows. The Upper Cervical Research Foundation, which posits that “when a small but measurable spinal misalignment known as the Atlas Subluxation Complex (ASC) is detected and corrected, a return toward good health and normal activity can be realized,” partnered with the University of Calgary and Alberta Health Services to conduct research on the effect of upper cervical manipulation on migraine headaches. They determined that this intervention was indeed beneficial.

And here are some stunning statistics regarding “unconventional” lab tests. Researchers from Yale, Georgetown and Ohio State conducted a survey of 638 licensed healthcare professionals who were “associated with” CAM/integrative medicine organizations. The most frequently used lab tests included, among others, stool analyses, salivary hormone assays and urine heavy metal tests, all biggies in the alt med field. The results showed that about a third of adults and up to a whopping 46% of pediatric patients were subjected to these unconventional tests.  61% of practitioners used unconventional tests for children and adolescents.  40-53% of adult tests were reimbursed by third parties, such as Medicare and private insurance.

So what were the researchers’ recommendations? Investigate why taxpayers are footing the bill for nonsensical tests? Outrage that children were being subjected to these tests? A call for tighter regulations on lab testing? Nope. None of these. They want “further study” of their validity, apparently based on the nonsensical rationale that “unconventional tests are often utilized in chronic conditions without reliable mainstream treatments.” So, since there isn’t a science-based treatment, we need to study how CAM providers determine the need for bogus treatments with bogus tests.

Rebranding

Apparently, the quest to rebrand is never ending in integrative medicine. Here we have an example from the University of Kansas. The victim is the discipline of Dietetics and Nutrition. As the abstract points out,

Integrative Medicine is an expanding field of healthcare that emphasizes nutrition as a key component.

Yes, expanding by rebranding. Dietetic interns were placed in the IM program and a new subspecialty was created, Dietetics in Integrative Medicine (“DIM”), which includes a new Master of Science degree for a Graduate Certificate in DIM. As budding dieticians, perhaps the DIM students could perform an actual demonstration of Crislip’s Theorem:

If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.

Rebranding in integrative medicine includes not only poaching from science-based medicine, but also recasting negative results as positive. Two examples:

In a Norwegian study, two medical doctors reviewed complaints of adverse reactions to homeopathy. These reactions were then evaluated independently by two homeopaths. The homeopaths rebranded about two-thirds of the adverse effects as “homeopathic aggravations,” which actually “indicates an improved health status after an initial aggravation.”

Good evidence has been rebranded as bad attitude. In a survey of 750 CAM providers, 47.6% reported feeling pressure to demonstrate practice effectiveness. Cranial sacral therapists reported the least pressure, which is good for them, considering there is no evidence whatsoever that cranial sacral therapy is effective. Chiropractors, naturopaths and reiki practitioners (of all people) reported more pressure. I would think this increased perception of the importance of evidence-based practice would be viewed as a positive development, but research begs to differ. Why? Because, according to Self-Determination Theory, healthcare providers who feel pressure to demonstrate effectiveness “will adopt a controlling rather than an autonomy-supportive motivational orientation.” So now evidence-based practice is bad? (Which would sure be a good thing for CAM.) And is the hegemony of reductionist conventional medicine applying the screws? Nope. They are the least mentioned source. Most common source? The general public. Good for them.

Physics

No discussion of CAM research would be complete without a look into what we’ll call “alternative physics.”

One presentation from two researchers at the University of Maryland and its medical school purported to test the hypothesis that “human bioenergy fields consist of a form of energy that can push against physical objects, as in psychokinesis.” (James Randi, are you listening?) They claim to have discovered, by using a torsion pendulum balance, not only that “effects were dramatic” but also that “the pendulum oscillated with many new frequencies.” They found “intriguing” the fact that “effects exerted by the subject on the pendulum persist for 30-60 minutes after the subjects departs from the pendulum” suggesting to them that “the effects are somehow retained within the molecular/atomic structure of the steel mesh or coco fiber hemisphere” which were the aforesaid physical objects in this research project.

William Tiller and Nisha Manek of the Tiller Institute had a poster presentation on “Information Medicine: Emergence of a New Medical Paradigm.” Tiller is the founder of the Institute for Psychoenergetic Science, an outfit showcasing, well, basically, him. Here’s the abstract’s word salad, I mean, conclusion:

Information (intention) is a source of free energy and can change whole living systems in a specific and beneficial direction and robustly expands the normal molecular theories of bio-information. Crucially, human consciousness as the source of free energy is capable of driving chemical processes and opens the door to INFOMED. Modern physics concepts of information theory suggest a higher level of therapeutic intervention that go beyond the traditional mental, emotional and physical approaches to treating diseases.

In another strange bedfellows combination, the Tiller Institute teamed up with the Biostatistics Department at the University of Iowa to conduct a study of an “Intention Host Device [IHD] imprinted with intention to assist autistic individuals [n=39], located around the globe, to integrate into the physical bodies and experience.”

The researchers concluded that “intention broadcast by an IHD resulted in significant gains” for the test subjects in sociability, communication and other improvements.

There were four poster presentations on two related products, the BioPower Bioceramics Pad and the BioPower Bioceramics shirt. What are they? BioPower products are a combination of two “technologies.” From the company’s (Multiple Energy Technologies, LLC) website:

BIO Power technology is based in part on bioceramics, ultrafine mineral particles with photothermal properties that are extracted from the Amazon rainforest. When heated by the human body or another source, the minerals embedded in the product emit long infrared radiation that increases cellular metabolism, induces analgesia, promotes muscle relaxation, and decreases inflammation and oxidative stress.

The other half of BIO Power’s dual technology is vibrational therapy, the practice of

manipulating energy fields to affect health. The human biofield is a network of complex electromagnetic fields engendered by the movement of sub-atomic particles. BIO Power products are imprinted with signature frequencies that transmit to the user upon contact, rebalancing the energy fields that help to regulate cellular physiology.

Apparently these studies did not test the claim that the “energy fields” of mice or men (or women) could be manipulated to “rebalance” them. It is not clear from the website whether the shirts include the vibrational therapy feature. In any event, according to these researchers, the bioceramics pad was beneficial to mice pain, paw strength and stamina. The shirts were beneficial to judo practitioners’ and basketball players’ performance.

Why bother?

All in all, I think you’d have to agree that CAHCIM certainly met its goal of “disseminating information on rigorous scientific research” with these outstanding presentations. Excellent job, Scientific Review Committee!

Dr. Edwards ended her comments by reminding integrative medicine researchers of NCCAM’s goals for its research portfolio (emphasis mine):

research that is conducted at the appropriate stage based on current evidence; research that is statistically powered to assess clinically meaningful outcomes (when the evidence base is sufficient to support an efficacy trial); and research that proposes realistic timeframes and budgets and test hypotheses that will guide future research. We want to encourage our investigators to give strong consideration to the strength and quality of their preliminary data, the appropriateness of the proposed methods to answer their stated hypotheses, the feasibility of a clinical trial as designed, and the potential impact of trial outcome to shape future studies.

The most likely result of following these rules, of course, is that even more studies will demonstrate a lack of benefit for CAM practices. And since evidence doesn’t seem to matter to integrative medicine practitioners, why bother?

Posted in: Acupuncture, Basic Science, Clinical Trials, Energy Medicine, Homeopathy, Medical Academia, Medical Ethics, Science and Medicine

Leave a Comment (23) ↓

23 thoughts on “Consortium of Academic Health Centers for Integrative Medicine research conference disappoints even NCCAM

  1. john mcsorley says:

    The most likely result of following these rules, of course, is that even more studies will demonstrate a lack of benefit for CAM practices. And since evidence doesn’t seem to matter to integrative medicine practitioners, why bother?

    The answer to that question surely is the same as to all sceptical activities.

    Because it needs to be done. It seems to me that you have missed the central positive of your own post.

    Dr. Edwards launched into a pointed, but very politely delivered, criticism of the research presented

    Very few people are converted in a damascene manner, this lady is creeping towards us one frustrating argument at a time. I think its either Edward Ernzt or Chris French who is a famous sceptical activist who when he tried to prove woo by doing good research changed his mind. Do you not think that whilst this worthy was undergoing his change of tack he could have made similar statements?

    Unsinkable rubber duckies is I believe the phrase. You wont get rid of CAM today or tomorrow. You might get this lady to go further down the road of recognising the problems of her own field.

    1. Tyler Kokjohn says:

      I agree, ‘why bother?’ and a firm declaration of all future experimental outcomes before the fact do not reflect the spirit of scientific investigation or skepticism.

      Researchers will be well served by reflecting on the suggestions offered by Dr. Edwards and adopting several that will improve their efforts. Some may be far more useful than others.

      When Newton first published his ideas he did not have a well-defined physical mechanism to justify them.

    2. Thor says:

      Why bother? I think you and john may have missed something. Because of many things—the prior probability and plausibility factors of so many of these studied ‘entities’, to name two. How much more money should be spent on studying the various CAM offerings? “More studies needed. More studies needed”. Ad infinitum. Why bother? Because no matter the amount of evidence that keeps piling up against the absurdity that is CAM, it’s purveyors will never, ever accept it. Practitioners and consumers don’t understand science and its method, or want to.
      CAM is mainly about belief. A way of thinking. A world-view.

      Not that there aren’t, or won’t be, some interesting things to study. Someday they could even become medicine (if they work they can’t by definition be CAM). Marijuana has some promise, for example.

      1. Windriven says:

        Thor,
        I don’t think John missed the point but I do think Kokjohn both missed the point and has a fractured view of science.

        1. Thor says:

          Windriven, I thought Jann was asking why bother to even do more studies, and that John answered because it needs to be done. I understand his point, which he further supported, I just think enough already.

          1. Windriven says:

            Crap. After rereading John’s comment I see that you are correct.

            (Rosanna Roasanna Danna voice:) Never mind.

            1. Thor says:

              wink (don’t have the emoticons down, only with emails).

      2. Jann Bellamy says:

        Exactly. Researchers of institutions of this caliber know good and well what the rules are and they have chosen to honor them mainly in the breach. If they want to undertake good quality mechanistic studies and well-designed clinical trials they know exactly what to do. No one needs to explain it to them.

  2. Windriven says:

    Emmeline Edwards, PhD
    University of Iowa Biostatistics Department
    University of Maryland Medical School
    University of Calgary
    University of Kansas
    Oxford City University London
    David Eisenberg, MD – Harvard
    Wayne Jonas, MD – Harvard
    Yale
    Georgetown
    Ohio State

    Schools with fine reputations. Men and women with distinguished academic credentials. So really, what the f*ck? Someone spends 20 or more years earning a doctorate and then decides that analyzing the odor of unicorn farts is her grand calling in life? Universities that produced luminaries like Sidney Farber and Richard Starr Ross now build temples to necromancy? Have we become so witless, so gutless, that there is no adult at Georgetown or Harvard who will stand up and say, “No. That is a ridiculous idea and we certainly aren’t doing that.”?

    I was at Oberlin in the 70s when the inmates were running the asylum. Bobby Fuller was the president. Jack Scott (of SLA and Patty Hearst fame) was Athletic Director, An architect teaching in the the Media program arranged and oversaw the production of a pornographic film including the daughter of a Congressman as one of the ‘leads’ for a class project. That film, and a follow on that intercut the original with snippets of interviews with various campus luminaries about the content and production values, finally galvanized the adults on the Board to stage a coup and a clean sweep.

    Perhaps it is this history that leads me to wonder what – if anything – will prove so egregious, so monumentally stupid, that the adults will say: enough. Until they do, this website can look forward to a vibrant future.

    1. drongo says:

      FYI, the “Oxford City University” in your list doesn’t really qualify as a university with “fine reputation”. It’s a case of misleading branding. See http://www.oxfordmail.co.uk/news/11066535.City_FC_owner_rethinks_Oxford_university_plan/

      1. Windriven says:

        There should have been a return/line feed after Oxford. City University London, to the best of my knowledge, is unrelated to Oxford City University. I apologize for the confusion.

  3. Cervantes says:

    Very glad not to see the name of my own institution anywhere in the post, as far as I know we remain largely free of this taint. But Harvard? Come on guys! (Our medical school did once invite Kaptchuk to speak, I wrote the organizers a nasty letter but they did not respond.)

  4. Angora Rabbit says:

    I certainly applaud Dr. Edwards’ speech and would be curious about its reception. However, little will happen unless this message is enforced at the level of study section – which she has the power to do. It will be interesting to see if and how this message is transmitted to actually change policy and direction at NCCAM.

    Does anyone know if pressure has been separately applied to Francis Collins to make change at NCCAM? Or do Dr. Edwards’ comments perhaps reflect that this may have happened? (I know, I lead a rich fantasy life.)

    1. Draal says:

      about 2 months ago, I asked Dr Collins in person about the future of NCCAM; he was very supportive of the center. … He left me disappointed.

  5. Angora Rabbit says:

    “Dietetic interns were placed in the IM program and a new subspecialty was created, Dietetics in Integrative Medicine (“DIM”), which includes a new Master of Science degree for a Graduate Certificate in DIM. ”

    I’m calling out Univ Kansas and shaming them. Good dieticians, like other good health practitioners, already practice “integrative medicine”, that is, strong science-based medicine that correctly addresses client needs in toto.

    The Academy of Nutrition and Dietetics is mandating a M.S. for all entry-level dietitians as of 2024. We are all scrambling to develop these programs. The practice guidelines (which are still being developed) place a higher standard of skill and knowledge. What UK has done is not how we are supposed to do this – the emphasis is still on science-based practice. Shame on UK. I will not be recommending their program to our students – in fact, I’ll be warning them away from it.

    1. WilliamLawrenceUtridge says:

      Well since you’re not going to step up, allow me to be the first to mock their terrible and terribly accurate choice of acronym.

      Any hopes that the program will be anything but the routine pushing of expensive superfoods? I see none.

      1. Angora Rabbit says:

        Well, AND is supposed to have specific knowledge bases and endpoints. We’re developing one ourselves and it is definitely science heavy (as well as popular, which is reassuring). But until AND finally agrees what the learning objectives will be, the MS will be vulnerable to the BS like this.

        Any other nutritionists out there who’d like to weigh in on this?

    2. David says:

      Nutrition is always trying to be co-opted by alternative “medicine”. It’s hard not to find an article written by an RD that emphasizes some type of quackery or bad science (think supplements, detox, or GMOs). In addition to alt med based nutrition programs, such as the Dietetics in Integrative Medicine program, the Academy of Nutrition and Dietetics allows a Dietitians in Integrative and Functional Medicine Dietetic Practice Group (http://integrativerd.org/). To me it violates their rules of integrity where all RDs have to use evidence and science based practices and research in their practice.

  6. Ausduck says:

    I’d be terribly interested to know what ethics approval was given at LA Children’s Hospital for the acupuncture trial. On children.
    And if it was given, how the trial was sold to the Medical Ethics Committee.
    Here in Aus it’s terribly terribly hard to get ethics approval for research on adult hospital patients even if there are mechanistic/ prior plausability studies. Wanting to perform such research on children ups the ante considerably. And such a small sample!

  7. Peter S says:

    I went through a phase as a patient where I went to a few alternative practitioners and I happened to have the same “unconventional” test done by the same lab — at great expense — twice within a short period of time. Although I had made no intervening changes in medication, diet, exercise, or anything of significance, the results were dramatically different. Certain results went from very high to very low, and others the opposite. For all I know the lab could have been using a random number generator — which by the way is what I suspect IS used on some of these hand-held devices that measure “biofields” etc. Naturally, when I contacted the lab to try to get an explanation, I was rebuffed.

  8. Anthony Hawes says:

    Bach Flower Remedies, whose intent is to “harmonize the ethereal, emotional and metal body”, decreased anxiety.

    Works on robots then.

    1. Jann Bellamy says:

      LOL! and thanks for catching the error. Should be “mental” not “metal.” Although I am not sure the claim that Bach Flower Remedies “harmonize” the “mental” body is any more plausible than claiming they “harmonize” the “metal” body. Perhaps proponents just haven’t thought up the claim that Bach Flower Remedies benefit robots yet. Give them time.

      1. WilliamLawrenceUtridge says:

        I read that comment three times going “what’s he trying to say?” Completely added the missing “n” each time in the process.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>