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Dismantling NCCAM: A How-To Primer

Two of the earliest posts I wrote for Science-Based Medicine were entitled The infiltration of complementary and alternative medicine (CAM) and “integrative medicine” into academia and The National Center for Complementary and Alternative Medicine (NCCAM): Your tax dollars hard at work. Both were intended as a lament over how not only is pseudoscientific quackery, much of it based on a prescientific understanding of how the human body works and disease occurs, finding its way into some of the most prestigious academic medical centers in the U.S. (for example, Georgetown and Beth Israel) but it’s even finding its way into the heart of the U.S. military.

Worse, aiding and abetting this infiltration is the federal government itself in the form of NCCAM. As I discussed in my usual excruciating detail in my original post and as Steve Novella, Kimball Atwood, and I have subsequently discussed many times on this very blog, particularly recently (so much so that I’m thinking of giving NCCAM its very own category here on SBM), NCCAM not only funds studies of dubious “alternative” therapies, such as reiki and homeopathy, that estimates of prior probability alone would argue to be so close to impossible as to be not worth spending millions, much less thousands, of dollars upon, but it also promotes quackery by funding “fellowships” at various institutions to teach “complementary and alterantive medicine” (CAM) sometimes also called “integrative medicine” (IM). Given that it spends over $120 million a year on mostly dubious studies and CAM promotion, we all have called for NCCAM to be defunded and disbanded.

Nearly a year has passed since I wrote those two posts. Ironically enough, at the time I wrote my first post about NCCAM for this blog, I pointed out that at first I had disagreed with my co-blogger Wally Sampson and his call to “defund” the NCCAM in an article published on Quackwatch nearly five years ago. My original reason was that I thought that there was value in studying these therapies to find out once and for all whether these therapies do anything greater than placebo or not. I now admit that I was very naive, and this was how I admitted it:

Two developments over the last several years have led me to sour on NCCAM and move towards an opinion more like Dr. Sampson’s. First, after its doubling from FY 1998-2003, the NIH budget stopped growing. In fact, adjusting for inflation, the NIH budget is now contracting. NCCAM’s yearly budget remains in the range of $121 million a year, for well over $1 billion spent since its inception as the Office of Alternative Medicine in 1993. Its yearly budget contains enough money to fund around 75 to 100 new five year R01 grants, give or take. In tight budgetary times my view is that it is a grossly irresponsible use of taxpayer money not to prioritize funding for projects that have hypotheses behind them that have a reasonable chance of being true. Scarce NIH funds should not be for projects that have as their basis hypotheses 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)) but it’s funding training programs. Indeed, that was the core complaint against NCCAM: that it facilitates and promotes the infiltration of nonscience- and nonevidence-based treatments falling under the rubric of so-called “complementary and alternative” or “integrative” medicine into academic medicine.

Nothing has changed since I wrote those words–except for one thing. We now have a new President who stated in his inaugural address:

We will restore science to its rightful place, and wield technology’s wonders to raise health care’s quality and lower its cost. We will harness the sun and the winds and the soil to fuel our cars and run our factories. And we will transform our schools and colleges and universities to meet the demands of a new age. All this we can do. And all this we will do.

As Kimball Atwood put it, Yes We Can! We Can Abolish the NCCAM! The big and as yet unasked (and unanswered) question is: How? Neither defunding nor dismantling NCCAM will be easy, and we have to think about how to preserve the functions of NCCAM that might be worth saving.

Political obstacles

The first thing anyone has to realize about defunding NCCAM is that it will not be easy to develop the necessary consensus among legislators to pass the legislation that would be necessary to disband it. Actually, that’s a huge understatement. In fact, it may well be politically and bureaucratically impossible, and my discussion later in this piece of what we could do with NCCAM’s parts once it is disbanded could very well be sheer fantasy on my part and the parts of my co-bloggers. However, I still think it’s worth discussing how we might go about such a demolition.

The next thing to remember is that NCCAM was not created because of a groundswell of support among physicians and scientists who saw all this quackery out there and said, “Hey, we really ought to study homeopathy (or reiki, or therapeutic touch [or: INSERT FAVORITE WOO HERE]) to see if there’s anything to it.” Rather, NCCAM was created primarily through the effort of a single ideologue, Senator Tom Harkin (D-Iowa), a woo-friendly legislator who believed that bee pollen had somehow cured his allergies. It was Harkin who first assigned $2 million of his discretionary funds to establish the Office of Unconventional Medicine in 1992. The OUM was soon renamed the Office of Alternative Medicine (OAM). Then, as detailed in Wally’s article, the first director of OAM resigned under Senator Harkin’s pressure because he quite properly objected to nominees to the OAM Council who had been involved in Laetrile and Mexican cancer clinic scams. In 1998, then NIH Director Harold Varmus tried to bring the OAM under tighter NIH scientific control to make its studies more rigorous and was stymied when Harkin introduced legislation to elevate OAM to an independent Center. As has been discussed before, NCCAM is constituted so that even its director is hamstrung in what he (or in the case of the current Director, Josephine Briggs, she) can do because the NCCAM charter demands that a majority of its Council members be chosen from practitioners and “leaders” in the CAM field. In other words, true believers control the agenda, and it is difficult for even scientifically inclined NCCAM directors like Dr. Briggs and her predecessor Dr. Stephen Strauss to keep NCCAM from wasting precious grant money investigating the more ludicrous and implausible CAM “therapies” out there–like reiki or homeopathy. The bottom line is that by design there just isn’t that much an NCCAM director can do to change the way NCCAM operates, at least in terms of how it awards its grants and how it disburses its training grant money.

Given this history, does anyone doubt that Tom Harkin, aided by other woo-friendly legislators such as Rep. Dan Burton (R-IN) and Rep. Ron Paul (R-TX), would fight tooth and nail to protect NCCAM if they got even a whiff of news about a serious attempt to defund it? Does anyone doubt that the forces that managed to pass the DSHEA of 1994 would also join in the fight?

It’s a political battle that President Obama may not consider worth the price it would take to win, particularly given all the other problems he’s inherited and the initiatives he wishes to pursue. For defunding NCCAM to be worth his spending political capital to accomplish, there would have to be a groundswell of public support. It would require letter writing campaigns, agitation, and a lot of lobbying. It would require that advocates of science- and evidence-based medicine get down and dirty in the quagmire of politics. I’m not sure it’s even possible, given the low level of science literacy in this country that renders most voters unlikely to understand why NCCAM is such bad science and bad policy. We advocates of science- and evidence-based medicine could try to frame it as a huge waste of taxpayer money, but there are many other government programs that waste as much or even much more money. That would be a hard sell. We could try arguing that NCCAM funds colossal amounts of bad science and that it promotes quackery in medical schools, but, even if we could convince President Obama of this, it’s doubtful that we could convince enough voters to make enough of a stink to overcome the entrenched interests defending NCCAM. I like the recent suggestion to the Obama transition team to defund NCCAM as much as the next guy. But just take a look at the comments near the end, after CAM advocates had been finally warned of the initiative and started to try to vote its score down, egged on by various pro-CAM blogs. The scientific ignorance, the “what’s the problem? attitude, and the “health freedom” posturing (with a huge dollop of big pharma conspiracy mongering, naturally) are depressing to behold.

But let’s imagine for one glorious moment that somehow the political support and will were found to defund NCCAM for real. How might that look? What might be the results?

Defunding NCCAM

It is important to note that NCCAM is not the only source of funding for CAM/IM research in the federal government. The federal government spends close to a quarter of a billion dollars per year funding woo. In actuality, NCCAM’s budget is around $121 million a year. The other money comes from an office in the National Cancer Institute known as the Office of Complementary and Alternative Medicine (OCCAM, an acronym that, given what the Office studies, brings no end of chuckling at the irony), whose budget is also around $121 million a year. Together, that’s nearly a quarter of a billion scarce taxpayer dollars spent on CAM/IM. Both NCCAM and OCCAM would have to be defunded to realize that savings. Also, the entire NIH budget is just under $30 billion. Removing OCCAM and NCCAM would only be less than 1% of the NIH budget. The advantage, however, would be that this would represent more money that could go to studies that might actually tell us something useful or identify new treatments.

The key thing to realize is that not everything NCCAM does is worthless. One of the chief complaints we at SBM have had about CAM in general and NCCAM in particular is how they have appropriated clearly science-based modalities, such as diet, exercise, and relaxation as being somehow “alternative.” As Wally and I have argued before, this appropriation of these modalities represents the “foot in the door” or the “Trojan Horse” to allow all the other woo in, or, as Steve Novella has called it, the “bait and switch.” Diet and exercise are the bait, and the switch is made up of the reiki, homeopathy, acupuncture, and all the other prescientific placebo therapies. The problem is how to separate the woo from the potentially science-based medicine and reclaim the “bait” under the banner of science-based medicine, which is where it belongs, and discarding the pseudoscience that CAM/IM tries to “switch” for the bait. To do this, I think it’s useful to think of four divisions.

For example, let’s consider OCCAM. One huge advantage that OCCAM has is that it doesn’t require the presence of CAM “experts” in the study sections evaluating grants. By and large, study sections looking at projects funded through OCCAM are the same as study sections evaluating any other grants. This is an enormous difference and a huge plus not to be discounted. In fact, it’s the very reason why, despite the fact that the director of OCCAM is led by a legitimate scientist and physician, there is very little being done at OCCAM that couldn’t be done just as well distributed among appropriate study sections elsewhere. This is a good thing. After all, CAM is not a natural, disease- or discipline-specific area; it’s a cobbled-together, made-up wastebasket “discipline” that includes basically anything that isn’t “conventional,” hasn’t been proven, or is wildly implausible from a scientific standpoint. In other words, there is no reason for this hodge-podge of therapies and “studies” to be grouped together under a separate Office in the NCI or under a separate Center in the NIH. Its components are too disparate, too unrelated to each other, and many of its claims are actually mutually contradictory. While that may not bother CAM/IM boosters, it should well bother scientists.

On the other hand, consider this instead. If we want to study nutritional supplements and their potential interactions with chemotherapy, why not just form an Office of Nutrition and Cancer and leave out the “alternative”? If we want to do research looking for natural products that can be used to treat cancer, why not just have an Office of Pharmacognosy, instead of having the long and proud scientific discipline of natural products pharmacology “ghettoized” by its increasing association with all the pseudoscience and woo that has over the last 15 years been increasingly lumped together with the study of herbs and plant products under the CAM/IM label? Remember, pharmacognosy is not herbalism, at least not as herbalists use natural products. Think of pharmacognosy of herbalism brought into the scientific era, because herbalism is simply pharmacognosy as practiced hundreds of years ago.

In fact, CAM could be eliminated entirely if research at each Institute of the NIH were divided into four main areas:

  1. Drugs/pharmacology (pharmacognosy being a subdivision of this large category)
  2. Physical treatments (radiation therapy, medical devices, surgery, etc.)
  3. Nutrition (there’s where your supplements go)
  4. Lifestyle (exercise, relaxation, whatever)

There’s nothing “alternative” there, and close to everything could be encompassed under one or two of those four labels. In fact, to some extent, the NIH already does this, although the exact scheme of division is more complex. Indeed, one could replace “Drugs/pharmacology” with “systemic therapies” and “physical treatments” with “local therapies,” and it would match part of what NIH does fairly closely.

NCCAM, unfortunately, would be far more difficult because its very raison d’être is not just to study pseudoscience but to promote it as well. To this end, every level of the leadership is full of true believers except for the Director, making NCCAM able to resist pretty much any effort to inject any consideration of scientific prior probability or estimates of plausibility into the consideration of any CAM/IM method. Even the utter pseudoscience that is homeopathy is considered as though it were any more scientifically valid that the concepts of sympathetic magic upon which it is based. Don’t believe me? Then remember the example I discussed before, specifically the R21 grant to study homeopathic dilution and succussion and how they affect the dose-response curve of homepathic remedies. This grant was actually awarded to study whether succussion (the vigorous shaking done with each homeopathic dilution) that, claim homeopaths, is necessary to “potentize” homeopathic remedies affects the dose-response characteristics of homeopathic remedies up to a 30C dilution (30 times 100-fold, or a dilution factor of 1 x 10-60). This is a dilution factor many orders of magnitude larger than Avagaddro’s number, which is makes a 30C homeopathic remedy nothing but water. Believe it or not, the investigators are actually going to compare stirring with succussion to see whether succussion, as homepaths claim, improves the dose-response curve. This is no different than studying whether eye of newt or serpent’s tongue is more potent in casting a magic spell.

This is also yet another reason why NCCAM would have to be utterly dismantled and all of its component parts spread among the Institutes of the NIH in such a manner as to make it virtually impossible to reconstitute, at least not easily, if we are to eliminate as much as possible pseudoscience in the NIH.

Conclusion

NCCAM is not a scientific creation, but rather a purely a political one. Scientists did not clamor for NCCAM or even request it; rather, the OAM and then NCCAM were rammed down the throats of the NIH leadership primarily through the efforts of one powerful quackery-loving Senator. As such, NCCAM can only be dismantled through the political process, and, unfortunately, I am not at all optimistic that the necessary political consensus can be developed to the point where it is strong enough to overcome the resistance from NCCAM’s powerful patrons in Congress that any serious initiative to defund it would provoke. That is not to say that I don’t think that it’s totally worth trying to do. Indeed, there has not been a better time in years to undertake this mission, especially since President Obama has expressed a desire to “restore science to its rightful place” and to heed science when developing policy upon which science impacts. I also believe that he is serious about his pledge, and I can’t think of a better way for our new President to demonstrate a newfound respect for what science says than eliminating the worst festering sore of government-funded pseudoscience currently in existence. If President Obama were to eliminate NCCAM, that would be a far more powerful signal than appointing advisors with actual scientific backgrounds doling out a few extra billion dollars to the NIH and NSF, although those, too are powerful signals. Dismantling NCCAM would be a signal that science, not pseudoscience, guides federal government health research policy.

Posted in: Medical Academia, Politics and Regulation, Public Health, Science and Medicine

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27 thoughts on “Dismantling NCCAM: A How-To Primer

  1. Dr Benway says:

    I like the idea of assimilating the good bits back into the medical fold and allowing the irksome “alternative” label to fade.

    Whenever I hear, “Y’know, doctors don’t get much training in nutrition in medical school…” I feel like stabbing someone in the neck with the pen I once used to write TPN orders.

    The health freedom people have my father-in-law terrified that the gubment’s gonna take away his vitamin C. He was let go from his job after 25 years in his late 50s, with no hope of finding comperable employment. My in-laws struggled without health insurance until Medicare kicked in at age 62. In their case, I think worries about access to good medical care fuels their interest in OTC quackery. We may need to address this fear generally before we can fight any political battle against the alties.

  2. Fifi says:

    I’m curious, why haven’t any of the blog authors looked into http://www.healthfreedomusa.org? Or http://www.beatcancer.org? This where the whole “freedom” meme seems to be originating from and there’s a psychiatrist (de-licensed by the look of it) involved and the meme they’re pushing so successfully has even infected Dr Benway’s father! The only people who lose by making this an ideological battle while ignoring that it’s really about money for SCAMmers (who will change their ideology to make more money when useful) – this only confirms to true believers that this is about ideology and not reality or science-based medicine (and ends up making advocates of science-based medicine look like ideologues – which may or may not be true depending on who’s writing here). You’ll never get rid of dandelions by picking the flowers after they’ve gone to seed, you need to dig them up by the roots that spread underground.

    Do any of you understand the differences between linear ways of thinking/structuring and networked/rhizomatic ones?

  3. Dr Benway says:

    Don’t forget General Albert Stubblebine, a font of wackaloon if ever there was.

    Stubblebine and his wife, psychiatrist Rima E. Laibow, M.D., founded the Natural Solutions Foundation (NSF), “a non-profit corporation devoted to protecting and promoting health freedom”. They claim to expose dangerous prescription drugs and vaccines etc. promoted by large pharmaceutical companies, along with food contaminated by drugs. A large part of what NSF does is to lobby against Codex Alimentarius and for DSHEA.

    Download and listen to The Men Who Stare at Goats.

    Seriously. You must do this.

  4. mybhl5762 says:

    What is the strategy to achieve this? Outline the action readers can take, please. To whom do we write? What is it that we will request?

    Thanks.

  5. Fifi,

    Believe me, we’re well aware of them. See:

    http://www.sciencebasedmedicine.org/?p=247

    And: http://www.sciencebasedmedicine.org/?s=health+freedom

    There is also an ideological battle, however. Bravewell doesn’t need “supplement” money; it has its own. Neither does the NCCAM; it has ours. Obviously there is a mix of ideology and mere greed involved in many aspects of the sCAM “movement” (“supplement” lobbyists might push for the NCCAM, and certainly push for keeping DSHEA in force), but we gotta acknowledge both. In the case of the NCCAM and Quackademics, it is ideology disguised as science. Our role is to tear off the disguise.

  6. Dacks says:

    This post, with its focus on the “how-to”, leaves me somewhat more optimistic that the movement to defund NCCAM might be more than tilting at windmills (wait, that’s what the pseudos are doing…)

    Since a frontal attack on NCCAM is almost certain to fail, proposals to “reorganize” the fields of study seem much more promising. And putting forth a plan for reallocation of funds seems more effective than a letter writing campaign, no matter how many letters get written.

  7. Fifi says:

    Dr Benway – Yes, he’s got to be one of the weirdest and most strangely connected players in this whole game! (And that book really is a brilliant read, along with pointing out the rather convoluted relationship the US military and government has with new age beliefs.)

    Dr Atwood – thanks for the links, I’ll check them out. May I suggest that part of the strategy by CAM is to make this into an ideological debate as a means to distract from the fact that it’s really all about money. They’re also aware that it’s about the appearance of it being an ideological debate not having a real debate (or even getting close to debating evidence since ideology doesn’t demand evidence), there really is a lot more to be gained by exposing the profit motives of all concerned since that’s what this is really about for most involved in the high levels of SCAM.

  8. Fifi says:

    It seems that Bravewell gets funded – at least indirectly – by people who are supplement manufacturers and not-for-profit facades of CAM industries – to say there’s no financial incentive and it’s all ideological seems rather naive! This is not to say some wealthy donors aren’t donating out of faith in SCAM, it just means that the profit motive is indeed a driving incentive and the ideological facade has been erected to distract from the money motive.

    http://theintegratorblog.com/site/index.php?option=com_content&task=view&id=361&Itemid=1

  9. tarran says:

    I don’t think you’ll have any problem getting Ron Paul’s support for defunding NCCAM; it, like the National Institute of Health, is clearly unconstitutional.

    Of course, his support won’t be worth much – he has almost no influence on matters relating to the Federal budgetting process – which is why I found his inclusion in the article somewhat amusing.

    With that having been said, there is no political chance of getting NCCAM defunded. The U.S. government’s budgetting process is being driven by a hysteria to increase spending. Politicians are proposing the most ridiculous plans to be included in “emergency stimulus” proposals. The amount of money the treasury department is spending on “shoot from the hip” proposals amounts to tens of billions a month. This spending is massively unpopular with the electorate, yet the representatives keep approving it. A comparatively small entity which has far less opposition in the electorate and is supported by a few well connected special interests faces little risk of being defunded – unless one can catch these people conducting an irresponsible study that kills people, like some of the studies on radiation sickness and syphilis conducted in the mid 20th century by the Federal Government.

    Personally I would be happy if the U. S. government got out of the science business entirely, and returned it to a model of voluntary funding – especially since I am convinced that the current levels of Federal spending are actually wrecking the economy.

  10. David Gorski says:

    I don’t think you’ll have any problem getting Ron Paul’s support for defunding NCCAM; it, like the National Institute of Health, is clearly unconstitutional.

    Really? Do tell…

    Of course, his support won’t be worth much – he has almost no influence on matters relating to the Federal budgetting process – which is why I found his inclusion in the article somewhat amusing.

    He was included because he is one of the most rabid advocates of the faux “health freedom” movement in Congress. He also raised a hell of a lot of cash for the primaries before he flamed out.

  11. tarran says:

    Dr Gorski,

    There are people who support the Health Freedom movement because they find the idea of the government preventing people from deciding what to put in their bodies is as an unconscionable violation of their freedom.

    Now, Ron Paul has some pretty bad positions on issues, like his support for national borders. But, based on the fact that he wants to abolish the NIH entirely, I would be very surprised if he wouldn’t support abolishing one part of it.

    As to the Constutionality of the NIH, which part of the following powers granted the Federal Government by the U.S. Constitution permits it to spend tax-payer money on the NIH?

    To borrow money on the credit of the United States;
    To regulate commerce with foreign nations, and among the several states, and with the Indian tribes;
    To establish a uniform rule of naturalization, and uniform laws on the subject of bankruptcies throughout the United States;
    To coin money, regulate the value thereof, and of foreign coin, and fix the standard of weights and measures;
    To provide for the punishment of counterfeiting the securities and current coin of the United States;
    To establish post offices and post roads;
    To promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries;
    To constitute tribunals inferior to the Supreme Court;
    To define and punish piracies and felonies committed on the high seas, and offenses against the law of nations;
    To declare war, grant letters of marque and reprisal, and make rules concerning captures on land and water;
    To raise and support armies, but no appropriation of money to that use shall be for a longer term than two years;
    To provide and maintain a navy;
    To make rules for the government and regulation of the land and naval forces;
    To provide for calling forth the militia to execute the laws of the union, suppress insurrections and repel invasions;
    To provide for organizing, arming, and disciplining, the militia, and for governing such part of them as may be employed in the service of the United States, reserving to the states respectively, the appointment of the officers, and the authority of training the militia according to the discipline prescribed by Congress;
    To exercise exclusive legislation in all cases whatsoever, over such District (not exceeding ten miles square) as may, by cession of particular states, and the acceptance of Congress, become the seat of the government of the United States, and to exercise like authority over all places purchased by the consent of the legislature of the state in which the same shall be, for the erection of forts, magazines, arsenals, dockyards, and other needful buildings;–And
    To make all laws which shall be necessary and proper for carrying into execution the foregoing powers, and all other powers vested by this Constitution in the government of the United States, or in any department or officer thereof.

    Maybe I’m dense, but I don’t see anything about funding scientific or pseudoscientific research for that matter in that list… ;)

  12. salzberg says:

    tarran wrote that NCCAM stands “little risk of being defunded – unless one can catch these people conducting an irresponsible study that kills people.”

    Hmmm, like maybe a study of chelation therapy? Such as this:
    http://nccam.nih.gov/health/chelation/.

    I believe this study has been halted because someone died, but it appears on the NCCAM site as if it were ongoing.

  13. David Gorski says:

    Maybe I’m dense, but I don’t see anything about funding scientific or pseudoscientific research for that matter in that list…

    Then perhaps you should sue on behalf of taxpayers and take your case to the Supreme Court. I’m sure they’d give your case appropriate consideration. :-)

  14. David Gorski says:

    I believe this study has been halted because someone died, but it appears on the NCCAM site as if it were ongoing.

    Not only that, but NCCAM spent $30 million to study this, as Kimball Atwood has documented extensively on this blog and in a very long article (longer even than the posts I produce for SBM!) on Medscape.

  15. tarran says:

    Then perhaps you should sue on behalf of taxpayers and take your case to the Supreme Court.

    Nah, that would be a waste of time and money…

    The Supreme Court has come up with such risible judgments as:
    1) a black man cannot be a citizen of the United States
    2) a man growing wheat on his own farm for his own consumption constitutes “interstate commerce” (a ruling that was recently reaffirmed as justification for continuing marijuana prohibition)

    Would you complain to a Consiglieri because the mafia don is demanding too much protection money and expect to get a fair hearing? Neither would I. Shrug.

  16. Speaking of powerful NCCAM funding sources, have you read this article in FASEBJ? It’s called “Homeopathy: Holmes, Hogwarts, and the Prince of Wales” by Gerald Weissmann, a beautifully-written piece from 2006.

    The Prince’s activities have not been limited to the UK. In 2003, he authorized his US charity to fund a research fellowship at NIH’s National Center for Complementary and Alternative Medicine (NCCAM). This unusual gift to an agency of the US government came after a private dinner at St. James’s Palace to which the Prince and Camilla Parker Bowles had invited the clinical director of NCCAM, Marc Blackman, his wife, and like-minded guests “to discuss ideas and visions for complementary medicine.”

  17. 24601 says:

    tarran:

    Concerning your claim that the NIH is “clearly unconstitutional,” I would be forced to agree with you were it the case that the federal government’s powers are limited to only those you’ve identified in your post. But, as I suspect you already know, you’ve left out a rather significant federal power from your list, opting instead to cherry pick only those that support your assertion.

    In pertinent part, Article I, Section 8, Clause 1 of the US Constitution gives Congress the power to “provide for the common Defence and general Welfare of the United States.” The Supreme Court has long recognized that the power to spend for the general welfare is not limited by the direct grants of congressional power enumerated in Article I–i.e., the powers you’ve identified in your post. The general welfare clause, as it’s known, independently provides an expansive source of congressional spending authority. See Fullilove v. Klutznick, 448 U.S. 448, 100 S.Ct. 2758, 2772, 65 L.Ed.2d 902 (1980); Buckley v. Valeo, 424 U.S. 1, 90-91, 96 S.Ct. 612, 668-69, 46 L.Ed.2d 659 (1976) (per curiam). Moreover, Congress is given great deference with respect to what is, and what is not, within the penumbra of the “general welfare.” United States v. Butler, 297 U.S. 1, 67, 56 S.Ct. 312, 320, 80 L.Ed. 477 (1936). Those seeking to contest the congressional exercise of its spending power under Article I must demonstrate that “by no reasonable possibility can the challenged legislation fall within the wide range of discretion permitted to the Congress.” Id. at 67, 56 S.Ct. at 320.

    Time and again the courts have viewed public health as a legitimate subset of the nation’s “general welfare.” See, e.g., Helvering v. Davis, 301 U.S. 619, 640-45, 57 S.Ct. 904, 908-10, 81 L.Ed. 1307 (1937); Minnesota ex rel. Hatch v. U.S., 102 F.Supp.2d 1115 (D.Minn. 2000); Harrisburg Hosp. v. Thornburgh, 616 F.Supp. 699 (D.C.Pa. 1985). According to its website, the NIH, an agency within the US Department of Health and Human Services (HHS), is “the primary Federal agency for conducting and supporting medical research,” a public health-related function. HHS receives all of its funding from Congress pursuant to Article I of the US Constitution. As such, the NIH, like HHS, is a constitutionally legitimate federal agency carrying out an important public service in furtherance of the general welfare.

    Not unlike the claims of homeopathy, your assertion that the NIH is “clearly unconstitutional” is, to put it kindly, woo. Because you have made the claim, you have the burden of demonstrating that the law supports your position, and you must do so within the bounds of acceptable legal argument. You may have ideological views (e.g., hyper-strict constitutional constructionism) that differ from the findings of our federal courts; however, simply because you disagree with the law of the land as it has been interpreted by the courts is not enough to demonstrate that you are correct.

    As an aside, referring to the Dred Scott case (Dred Scott v. Sandford, 60 U.S. 393 (1856)), the infamous Supreme Court case that held that Scott, a slave, could never achieve US citizenship and, therefore, did not have standing to sue in the federal courts for his freedom, is another clear case of cherry picking. The Dred Scott case (which, ironically, some have argued is a clear example of strict constructionism gone very wrong) is almost universally deemed an abomination in American jurisprudence. You’ve identified it in your post as the basis for your suggestion that you and your argument couldn’t get a fair shake before the Supreme Court. But you do so without reference to the myriad other landmark cases that the Court got “right,” and you do so for the sole purpose of impugning the integrity of the Court itself. I need not tell you that ad hominem does not an argument make.

    Time is getting short (work beckons), so I won’t comment on your swipe at the Court’s interpretation of the commerce clause. Perhaps another time.

    So worry not, all. The NIH is without any doubt on solid constitutional ground, and there’s no real threat to its continued viability as a constitutionally-approved entity. Of course, this could all change if we begin electing to public office those who would seek to overturn decades of constitutional jurisprudence for no better reason than that they see conspiracies and skulduggery behind even the most benign of governmental assertions of power. Then, it’s anyone’s game. Remember, the laws serves the vigilant.

  18. tarran says:

    24601

    So I guess James Madison, author of that clause was confused when he wrote:
    Some, who have not denied the necessity of the power of taxation, have grounded a very fierce attack against the Constitution, on the language in which it is defined. It has been urged and echoed, that the power “to lay and collect taxes, duties, imposts, and excises, to pay the debts, and provide for the common defense and general welfare of the United States,” amounts to an unlimited commission to exercise every power which may be alleged to be necessary for the common defense or general welfare. No stronger proof could be given of the distress under which these writers labor for objections, than their stooping to such a misconstruction.
    Had no other enumeration or definition of the powers of the Congress been found in the Constitution, than the general expressions just cited, the authors of the objection might have had some color for it; though it would have been difficult to find a reason for so awkward a form of describing an authority to legislate in all possible cases. A power to destroy the freedom of the press, the trial by jury, or even to regulate the course of descents, or the forms of conveyances, must be very singularly expressed by the terms “to raise money for the general welfare.”
    But what color can the objection have, when a specification of the objects alluded to by these general terms immediately follows, and is not even separated by a longer pause than a semicolon? If the different parts of the same instrument ought to be so expounded, as to give meaning to every part which will bear it, shall one part of the same sentence be excluded altogether from a share in the meaning; and shall the more doubtful and indefinite terms be retained in their full extent, and the clear and precise expressions be denied any signification whatsoever? For what purpose could the enumeration of particular powers be inserted, if these and all others were meant to be included in the preceding general power? Nothing is more natural nor common than first to use a general phrase, and then to explain and qualify it by a recital of particulars. But the idea of an enumeration of particulars which neither explain nor qualify the general meaning, and can have no other effect than to confound and mislead, is an absurdity, which, as we are reduced to the dilemma of charging either on the authors of the objection or on the authors of the Constitution, we must take the liberty of supposing, had not its origin with the latter.

    Don’t get me wrong, I honestly think that the anti-federalists such as Brutus were right when they claimed that the U.S. Constitution was a disastrous document that would pave the way for tyranny (You’ll note that Brutus made the same argument you do regarding the lack of any check on government power). I honestly don’t care much about whether something is Constitutional or not, since the U.S. government is essentially a lawless entity that is not constrained by anything other than popular will, and the U.S. Constitution is, at most, a speed bump in the way of government officials.

  19. tarran says:

    Whoops, I messed up the tags. More pleasing version (and please feel free to delete the previous post)

    So I guess James Madison, author of that clause was confused when he wrote:

    Some, who have not denied the necessity of the power of taxation, have grounded a very fierce attack against the Constitution, on the language in which it is defined. It has been urged and echoed, that the power “to lay and collect taxes, duties, imposts, and excises, to pay the debts, and provide for the common defense and general welfare of the United States,” amounts to an unlimited commission to exercise every power which may be alleged to be necessary for the common defense or general welfare. No stronger proof could be given of the distress under which these writers labor for objections, than their stooping to such a misconstruction.
    Had no other enumeration or definition of the powers of the Congress been found in the Constitution, than the general expressions just cited, the authors of the objection might have had some color for it; though it would have been difficult to find a reason for so awkward a form of describing an authority to legislate in all possible cases. A power to destroy the freedom of the press, the trial by jury, or even to regulate the course of descents, or the forms of conveyances, must be very singularly expressed by the terms “to raise money for the general welfare.”
    But what color can the objection have, when a specification of the objects alluded to by these general terms immediately follows, and is not even separated by a longer pause than a semicolon? If the different parts of the same instrument ought to be so expounded, as to give meaning to every part which will bear it, shall one part of the same sentence be excluded altogether from a share in the meaning; and shall the more doubtful and indefinite terms be retained in their full extent, and the clear and precise expressions be denied any signification whatsoever? For what purpose could the enumeration of particular powers be inserted, if these and all others were meant to be included in the preceding general power? Nothing is more natural nor common than first to use a general phrase, and then to explain and qualify it by a recital of particulars. But the idea of an enumeration of particulars which neither explain nor qualify the general meaning, and can have no other effect than to confound and mislead, is an absurdity, which, as we are reduced to the dilemma of charging either on the authors of the objection or on the authors of the Constitution, we must take the liberty of supposing, had not its origin with the latter.

    Don’t get me wrong, I honestly think that the anti-federalists such as Brutus were right when they claimed that the U.S. Constitution was a disastrous document that would pave the way for tyranny (You’ll note that Brutus made the same argument you do regarding the lack of any check on government power). I honestly don’t care much about whether something is Constitutional or not, since the U.S. government is essentially a lawless entity that is not constrained by anything other than popular will, and the U.S. Constitution is, at most, a speed bump in the way of government officials.

  20. Harriet Hall says:

    This is a science-based medicine blog, not a political blog. Please cease and desist.

  21. David Gorski says:

    Harriet,

    I agree to a point.

    The reason I say “to a point” is because Steve, Kimball, and I did open the door for politics when we started advocated defunding NCCAM, as did Peter when writing about what the new Obama administration might mean for science-based medicine. Perhaps we were mistaken to take such stances, perhaps not, but once you open the door to a political discussion on a blog it’s hard to shut it again. That being said, however, I agree wholeheartedly that all this libertarian attacks on the federal government and whether NIH is constitutional (it is) have gotten completely out of hand and are off-topic, both here and on the other three posts. SBM is not a place to argue over whether the “general welfare” clause or the commerce clause of the Constitution covers this or that federal law or program.

    We should stick to a discussion of the merits or lack thereof of defunding NCCAM, which is the topic of this post and two others. Discussions might wander somewhat into what the role of the government should be in supporting science-based medicine and the political considerations involved in the creation or proposed dismantling of NCCAM, but only if the discussion is tightly on topic.

  22. tarran says:

    No worries,

    Incidentally, if I seem like a one issue poster, it is because I follow this blog mainly as a consumer. It is only in the area of economics and political theory that I feel I have anything to contribute, which is why it seems that I foucs only on those topics.

    It is not my intention to try to derail conversation, merely to challenge implicit arguments that lots of people believe are right if I think they are unfounded. Yes, that can be a grey area, for example in this case when that off-hand scurrilous comment was made about Ron Paul supporting NCCAM :), which obviously was tangential to the question of political support for dismantling NCCAM. On the other hand, such offhand comments, if not confronted, tend to shift perceptions until they become the basis for “facts” that everyone knows is true, which is why like comments to the effect that Doctors know nothing about nutrition, need to be confronted whenever they crop up.

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