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Funding CAM Research

Paul Offit has published a thoughtful essay in the most recent Journal of the American Medical Association (JAMA) in which he argues against funding research into complementary and alternative therapies (CAM). Offit is a leading critic of the anti-vaccine movement and has written popular books discrediting many of their claims, such as disproved claim for a connection between some vaccines or ingredients and risk of developing autism. In his article he mirrors points we have made here at SBM many times in the past.

Offit makes several salient points – the first being that the track record of research into CAM, mostly funded by the NCCAM, is pretty dismal.

“NCCAM officials have spent $375,000 to find that inhaling lemon and lavender scents does not promote wound healing; $750,000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390,000 to find that ancient Indian remedies do not control type 2 diabetes; $700,000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406,000 to find that coffee enemas do not cure pancreatic cancer.”

The reason for the poor track record is fairly simple to identify – by definition CAM includes treatments that are scientifically implausible, which means there is a low prior probability that they will work. If the treatments were scientifically plausible then they wouldn’t be alternative.

CAM proponents argue that the treatments they advocate, like acupuncture, certain herbal remedies, and homeopathy, are not implausible, they are just neglected by mainstream medicine because they don’t fit into the narrow (and profitable) paradigm of “Western” medicine.  This argument, however, is demonstrably wrong. Homeopathy is rejected by the mainstream because our current understanding of physics, chemistry, and biology tell us that it is impossible for homeopathic potions with extreme dilutions to have any physiological effect.

I admit that one benefit of all the research that the NCCAM has funded is to test these two versions of reality. Are CAM modalities scientifically implausible or are they just not being given a fair shake by modern medicine? If the former then research into CAM modalities should be largely negative, if the latter than we should regularly be finding CAM diamonds in the rough. Well, after 1.6 billion dollars of research any score of studies the NCCAM has left behind it a trail of negative studies, such as those listed above. This strongly supports the SBM view that “alternatives” to science-based treatments are not science-based.

CAM research, therefore, is like playing the lottery – the chance of winning is so small it is not significantly different from zero, but if you get really lucky perhaps you may hit upon something. As a society we have to decide if this is a worthy investment of our limited research dollars. To continue this analogy, financial advisers often recommend a range of investments from conservative to risky, but I don’t think they would consider buying lottery tickets part of a sound financial plan.

The first major criticism against doing research into CAM, therefore, is that it is simply a waste of resources – not just research money but all the components of the infrastructure of research. This includes access to sick patients.  Patients who enter into a clinical study of a low-probability CAM modality may therefore not be available to enter into a study of a more plausible treatment.

That most of the studies funded by NCCAM are negative raises another point discussed by Offit – the value of negative studies. Offit acknowledges that negative studies in medicine can be very valuable. It is important to know what doesn’t work, especially if it is a treatment that is already being used. In fact I and others at SBM have argued that journal editors need to make more room in their journals (or at least in the online versions) for negative studies (and also for replications, but that is a separate issue), in order to limit the “publication bias” toward positive studies.

This, I feel, is the one legitimate argument for doing CAM research – the value of solid scientific evidence for lack of efficacy of a treatment that is being promoted, even on the fringe. But Offit raises a very important point – does this negative evidence have any effect on the practice of those who are promoting or using CAM modalities? The answer is largely, no. He gives as examples many supplements, like gingko biloba or echinacea, that continue to have robust sales even after large rigorous studies found they do not work.

There is some wiggle room in the data to spin it in more than one way. NCCAM director Josephine Briggs has argued that negative studies from the NCCAM have decreased the sales of specific herbal remedies, like echinacea. This is true, but the decrease was modest and temporary. Sales figures indicate that echinacea remains a popular herb and overall herbal product sales continue to increase (over $5 billion dollars in the US in 2009).  The relative popularity of specific herbs is affected by large published studies that gain some media attention – but not dramatically.

The real problem is that regulation of herbs and supplements are not adequately tied to scientific evidence. Aggressive marketing can therefore have a greater long term effect on the popularity of a CAM treatment than a published study that the public soon forgets. Also, the media often does a poor job of putting published scientific studies into a proper context. For every large rigorous negative study, there are many small, preliminary, and positive studies. In the media, therefore, the positive will tend to get more headlines and more overall attention, even though their relative scientific value is much lower. The media just reports – “a study showed.”

There are also other issues of concern with CAM research. One is ethics – the ethics of biomedical human research is such that we owe it to people we experiment on to maximize the probability that the experimental treatment will be safe and effective. That is why there is the need for a great deal of pre-clinical and preliminary clinical studies before going to a large human trial. Researchers also have to justify their treatment with sound science that indicates it is plausible, that it is likely to be of benefit to the study subjects.

The entire notion of plausibility, however, was thrown out by the very concept of CAM. Offit argues that many CAM modalities “border on mysticism.” I would argue that many of them are mysticism or thinly veiled versions of faith healing. Not only is there no known mechanism, but there is no known way they can possibly work. It is one thing to not know what receptor is the target of interest for a specific effect of a drug, it is another to violate basic concepts of physics and chemistry.

In other words, some CAM modalities are the equivalent of magic. Is it ethical, therefore, to study magic therapies on human subjects? Does this violate the ethical requirement of informed consent? Even worse, in some cases there is already adequate evidence for lack of efficacy (such as the chelation trial that Kimball Atwood has been criticizing).

Conclusion

There is much to criticize in the funding of medical research into highly implausible treatments – they are a waste of resources with little probability of resulting in effective treatments, while negative evidence is useful, users of unscientific treatments don’t listen very much to the evidence, and there are significant ethical concerns.

I propose that as a society we strike a bargain with the proponents of so-called CAM. We will fund and conduct research into CAM modalities where it is reasonably ethical to do so, but in exchange treatments for which there is evidence of lack of efficacy will be abandoned. Further, regulations for health products (like herbal remedies) will better reflect the scientific evidence. I would prefer that evidence of safety and efficacy would be required before marketing, but failing that the FDA should have the power to remove a product from the market after research shows that it is ineffective (right now the FDA must meet a difficult burden of proof of harm to do so).

So, if the evidence shows that homeopathy does not work, the homeopathic industry will vanish. If a rigorous study shows that chiropractic manipulation does not work for asthma then chiropractors will condemn the practice and stop doing it.

However, if scientific evidence does not significantly affect practice or product sales, then why should we pay for it? Further, if CAM continues to be disconnected from scientific evidence, why should it enjoy any legitimacy?

Posted in: Clinical Trials, Herbs & Supplements, Medical Ethics, Politics and Regulation, Science and Medicine

Leave a Comment (64) ↓

64 thoughts on “Funding CAM Research

  1. windriven says:

    “I admit that one benefit of all the research that the NCCAM has funded is to test these two versions of reality.”

    And when that test – conducted at taxpayer expense – exposes a fraud to be, well, a fraud, why is there no requirement for labeling that says:

    NCCAM has investigated claims made for (tincture of horsesh!t root or whatever) and found them to have no scientific merit.

    This would at least put this stuff on a similar footing with tobacco, another “natural” product. And how about a dope-slap tax as well to defray the cost of testing products with no scientific plausibility?

  2. jt says:

    “However, if scientific evidence does not significantly affect practice or product sales, then why should we pay for it?”

    The same might be said about the doctors ignoring the new scientific evidence regarding useless PSA testing.

    http://newoldage.blogs.nytimes.com/2012/04/25/p-s-a-testing-continues-in-older-men/

    And what about the new scientific evidence showing frequent Mammograms are unnecessary and dangerous?

    http://technorati.com/women/article/are-annual-mammograms-necessary-study-suggests/

    It is absolute hypocrisy to criticize CAM research on a “science based medicine” blog. You should be applauding the efforts of these researchers who are separating the effective treatments from the ineffective. This article is a glaring testament to the bias evident on this site.

  3. David Gorski says:

    Spare me.

    You’re obviously new here if you think we concentrate only on CAM. I’ve written extensively about mammography and its shortcomings, the USPSTF guidelines, the problem of overdiagnosis on mammography, lead time bias, and the rest. I’ve also written at least once about PSA testing that I can recall, and Harriet and I have both written about overdiagnosis and overtreatment in various contexts. We’ve also written numerous posts critical “conventional” treatments and research. Indeed, my posts from the last three weeks in a row before my post on supplements and cancer this week were about just such issues, with nary a mention of CAM.

    Our only “bias” is that we are biased in favor of using science and evidence to direct medical care. Unfortunately, for the vast majority of CAM, science and evidence do not support its modalities.

  4. Harriet Hall says:

    @jt,

    You pick a couple of examples where old habits are dying more slowly than they should. You ignore the entire history of scientific medicine in which doctors have changed their practice in response to scientific evidence. We gave up bloodletting to balance the humors, we gave up routine annual chest x-rays and urinalyses, we gave up internal mammary ligation surgery for coronary disease, the list goes on…

    You say we should be applauding the efforts of CAM researchers. You ignore Dr. Novella’s explanation of why we are not. Maybe you didn’t understand what he wrote.

    Maybe you believe in magic. Should we allocate scare research funds strictly on a first-come first-serve basis rather than using any judgment to prioritize? Should we fund studies of Tong Ren?

  5. zippyfx says:

    Playing devils advocate (I am not a CAM subscriber)…

    Their is a lengthy list of CAM that did not pan out. Are there any that have?

    Stepping back in history how do we rationalize things like chewing on bark as a folk remedy evolving to our understanding of aspirin. Originally it was CAM/folk wisdom that when studied became fact. And, yes, for every success such as aspirin I am sure there were hundreds of failures.

    Just through it out there for discussion.

  6. sciencebehind says:

    This kind of close minded thinking from a scientist boggles my mind. The amount of money you highlight is a fraction of what is regularly spent by the NIH and pharmaceutical companies to promote treatments that are costly to the patient for marginal benefit. IV vitamin C therapy for cancer, vitamin D and sunlight benefits to mood and immunity, folic acid for neural tube defects, zinc for reducing cold symptoms. Perhaps these therapies are not for people who have severe health issues but prevention and a healthy lifestyle should be a key component to medicine not just treatment of the severely ill. I think it’s shameful to promote suppression of research, there may be limited funding but if there is preliminary data suggesting that a CAM treatment is effective then that’s a lot more worthwhile research than 3 labs competing over who gets to publish on the same signaling pathway first.

  7. Ed Whitney says:

    It is important to be careful about cherry-picking results of NCCAM-sponsored studies which had such low biological plausibility that they should not have been conducted. The reader of the JAMA Viewpoint Editorial might be left unaware, for example, of a negative RCT of cranberry juice on the rate of recurrence of UTI sponsored by NCCAM :

    Cranberry Juice Fails to Prevent Recurrent Urinary Tract Infection: Results From a Randomized Placebo-Controlled Trial. Barbosa-Cesnik et al, Clin Infect Dis. 2011 January 1; 52(1): 23–30.

    This study had a well-reasoned rationale (the role of frequent antibiotic use in driving the emergence of resistant organisms) and at least a reasonable measure of biological plausibility (in vitro experiments demonstrating that cranberry juice reduces the adherence of E. coli to uroepithelial cells). The RCT was done; the incidence of UTI in women at risk did not differ between cranberry juice and placebo, and a non-obvious but scientifically valuable result was generated. The NCCAM, in bringing this result to light, has done taxpayers a service.

  8. Harriet Hall says:

    @sciencebehind,

    “if there is preliminary data suggesting that a CAM treatment is effective.”

    The problem is that you can find preliminary data to “suggest” anything.
    If there is good reason to think a CAM treatment might be effective, based on evaluation of all the published data and considering the quality of the studies, then of course it should be studied.
    Nothing in Dr. Novella’s post suggests otherwise.

  9. chaos4zap says:

    Apparently, Sciencebehind…has truly left…science behind. It didn’t take long for the bait and switch defense. The idea that doctors only pay attention and consider illness after the fact and pay no mind to prevention and healthy life styles is a super straw-man. Doctors do focus on these factors and almost everyone will promote healthier diets, more exercise, not smoking. The fact that you try and say that doctors don’t care about prevention and overall health, then try and say that is some kind of primary function of the alternative medicine crowd and then go even further (the bait and switch) to say that because healthy lifestyles and prevention are effective and alt med practitioners promote this, therefore….somehow all of the non-sense that is under the banner of alt med is vindicated! There is nothing “alternative” about prevention, diet and healthy lifestyles and most doctors spend a good deal of time on these factors. I suggest you come up with a new way to promote your confirmation bias, that old jem just doesn’t hold water.

    IV Vitamin C therapy for cancer, and then you follow that with saying that maybe these treatments are not for those who have “severe health issues”? When, exactly, is Cancer not a severe health issue?

  10. cervantes says:

    Talk about changing the subject. It is true that pharmaceutical companies (not NIH) spend a lot of money on “me too” drugs and evergreening (making marginal tweaks to existing drugs so they can hold on to patents). I believe that is a problem which has been addressed here. The profit motive does distort research priorities in relation to the public interest. (E.g., insufficient investment in new antibiotics.)

    NIH, however, places a strong value on innovation — maybe too strong, sometimes, since replication and extending findings to different populations and circumstances get short shrift. But why that somehow justifies NCCAM I cannot understand.

    As for the cranberry juice thing — if that study did have a strong rationale and biological plausibility, which I will stipulate, it could have been done by NIAID.

  11. sciencebehind says:

    @Harriet Hall – The definition of CAM used by Novella is conveniently demonizing “by definition CAM includes treatments that are scientifically implausible, which means there is a low prior probability that they will work. If the treatments were scientifically plausible then they wouldn’t be alternative.” Really that’s not the definition of CAM – it’s alternative medicine because it’s widely used though not thoroughly tested. Of course some traditional or alternative medicine will not hold up against rigorous testing but that’s why you test it, to help patients understand what common practices are beneficial and which are not. Novella kind of argues this but his only presentation is that there will be negative findings, which is just blatantly untrue and that kind of misinformation has no place in science.

    @chaos4zap – I meant more zinc decreasing duration and severity of cold symptoms, should have been more specific.

  12. Harriet Hall says:

    @sciencebehind,

    You are mis-reading. He said CAM “includes” treatments that are scientifically implausible. He is not saying that everything under the CAM umbrella is scientifically implausible.

  13. cervantes says:

    And again, if a treatment is scientifically plausible, you don’t need NCCAM to test it. If something appears promising, then any of the other institutes which are appropriate to the question can evaluate proposals to study it. The only unique role of NCCAM seems to be to study interventions that are not scientifically plausible.

    And, as Paul Offit says in the commentary, there might be value in that if people were thereby persuaded not to waste their money on useless quackery. But since that appears not to be happening, the money is better spent elsewhere.

  14. windriven says:

    @sciencebehind

    “it’s alternative medicine because it’s widely used though not thoroughly tested.”

    Bullcrap. It is speculative self-experimentation and best and speculative stupidity at worst (and arguably most often). It is not medicine until it has been proven effective for some therapeutic object. Calling it alternative anything is weasel-speak.

    Tell us, do you indulge in “alternative” physics? “Alternative” chemistry? Would you fly in an airplane designed using the principles of “alternative” aeronautical engineering? Sweet zombie Jesus sciencebehind, give your head a shake and join the 21st century.

  15. sciencebehind – you are laboring under a misconception about what is CAM. Your definition does not work – many things that are not adequately tested are not considered part of CAM, and many that are tested and have been found to work are part of CAM.

    Your confusion is evident when you list folic acid to prevent neural tube defects as alternative. How is this alternative? Not everything nutritional is alternative. That is a fiction. You are the victim of slick propaganda.

    If you look at all the modalities that are generally considered to fall under the loose and poorly defined CAM umbrella you find only one feature that they really have in common – they are generally not science-based. That’s really it.

    In practice CAM is a double standard and that is all. NCCAM is a funding double standard, largely funding studies that would not be funded on their own merits. They include herbs for political reasons – they are alternative only to the extent that they are used without proper evidence or with mystical justifications. Otherwise they are just unpurified drugs, and have been studied as such for centuries.

    Also – saying we should not fund worthless or unethical research is not suppressing research.

  16. DugganSC says:

    While I applaud the idea of making the best use of one’s money, I am always a bit leery when it comes to deciding whole segments of research aren’t worthwhile based on the results of prior negative tests. How many drugs do we have that failed in their initial trials before someone recognized that the test was bad, or that the wrong things were being tested for? And how many inventions were thought to be impossible prior to someone proving that they worked? As it is, the current system puts most of the money into variations of tried-and-true methods and a small fraction into researching these other methods. While it sounds nice to be able to write some of them off after a negative trial, I feel like we run the risk of dismissing too soon and losing something worthwhile, that gem among the dross. True, they’re rare, but they do occasionally come up.

    The quote above of “by definition CAM includes treatments that are scientifically implausible, which means there is a low prior probability that they will work. If the treatments were scientifically plausible then they wouldn’t be alternative” does feel like it’s a bit of a self-fulfilling prophecy. When something in CAM is found to be useful, once we figure out why it works, it’s brought into regular medicine because we understand it. To some degree, it feels like the One True Scotsman fallacy where whenever an example is provided that contradicts the statement, the identity of those involved is changed to keep the statement true. Both sides are guilty of it at times. The proponents of chiropractry will look at a failure of their method and claim that it failed because “it was an irregular subluxation.” A drug company will rule out people who didn’t respond to the drug, claiming that their particular disorder wasn’t the one being treated or that outside factors caused the drug to fail. Osteopaths were considered to be Alternative Medicine and therefore worthy of scorn until their methods were shown to work, whereupon they were embraced as standard medicine.

    Ultimately, I think most of what’s in CAM is bunkus, but we need to be careful to not be too proud and throw the baby out with the bathwater by rejecting all of it just because it doesn’t fit our model. That said, if a given form of therapy keeps failing over and over again, well, they say the definition of insanity is doing the same thing over and over again and expecting different results.

  17. qetzal says:

    @jt

    We have good evidence that psa tests and mammograms really do work and really do have value in at least some situations. That alone makes them categorically unlike 99% of the CAM products out there.

    Your claims of hypocrisy are ludicrous. It is perfectly appropriate and scientific to argue that some things are too improbable to be worthy of research. That’s the whole point of “science-based medicine.” Just because I might claim that St. Augustine grass clippings cure ebola doesn’t mean NIH should run a trial to prove me wrong. Surely you can see that.

  18. sciencebehind says:

    @Harriet Hall – perhaps I’m misreading but from the second half of his statement ‘If the treatments were scientifically plausible then they wouldn’t be alternative’ he seems to include everything under CAM. I made the statement that perhaps the treatments don’t yield results for severe health issues because this article seems to be ignoring the benefits that CAM has positively demonstrated. And the only explanation that I can come up with, besides just ignoring it, is that the results aren’t dramatic enough. And I don’t think drama is the only thing that needs to be researched. Everyday living is a good thing to research as well.

    @cervantes – I don’t dismiss placebo effects but I tend to think that there can be wisdom in community behaviors. If this article discussed how to more effectively target CAM treatments that show promise I’d be all for that. But just to throw it all out as junk without investigation seems quite unscientific.

  19. sciencebehind says:

    @Novella – folic acid is listed on the CAM website as being studied for cancer treatment and having no effect. So folic acid is still studied under CAM. I do agree that the definition is a bit up and the air but I disagree that it’s only the study of hocus pocus.

    Why should we not study unpurified drugs. Because it’s a cheaper alternative? I know, because it’s hard to have consistent, reliable doses – but that’s an approachable problem since they’re not highly concentrated doses, the consistency most likely doesn’t have to be as precise to have similar effects…..another things to study ;)

    There is basic science to support the use of herbs and there’s psychological evidence to support the use of things like yoga and meditation. Perhaps not all herbs but it’s really quite extensive to throw out every herb because the basic science isn’t there for all yet.

  20. Harriet Hall says:

    @sciencebehind,

    “I disagree that it’s only the study of hocus pocus”

    You are trying to disagree with something he didn’t say. Please try to read what is actually written rather than what you want to believe was written.

    “it’s really quite extensive to throw out every herb because the basic science isn’t there for all yet.”

    Yes, it would be if anyone advocated that. No one does. You are creating a straw man.

    “a cheaper alternative….since they’re not highly concentrated doses, the consistency most likely doesn’t have to be as precise to have similar effects”

    Would you advocate using foxglove instead of Digoxin just because it’s cheaper? I don’t think concentration is the issue, but dosage is, and in the case of digitalis, the toxic dose is only slightly greater than the effective dose.

  21. cervantes says:

    Indeed. As Paul Offit says, most of our drugs are found in nature, or are variations on chemicals found in nature, and many of the most famous were indeed first used in the form of plant materials, e.g. aspirin and digitalis. Scientists at this very moment are scouring the earth for potentially useful plant compounds. They undertake expeditions to remote areas and ask the local shamans to teach them about the plants they use. (There’s in fact a lot of controversy over royalties — but the very fact that drug developers are being accused of ripping off poor people in distant lands is proof that they are indeed interested in herbal products.) Then these plants are studied to find out what’s in them, the compounds are screened for biological effect, and promising compounds are tested in vitro and in animals and if they continue to seem promising they ultimately get tested in humans. This is going on right now, it’s a substantial scientific enterprise. But that is not what NCCAM is funding.

    Think tamoxifen, oseltamivir, statins (found in a fungus traditionally used in China to treat heart disease, no less), on and on. None of these discoveries had anything to do with NCCAM, but they did have to do with people studying plants.

  22. sciencebehind says:

    @Harriet Hall – what you quoted was in reply to Novellas statement in the comments

    “they include herbs for political reasons – they are alternative only to the extent that they are used without proper evidence or with mystical justifications. Otherwise they are just unpurified drugs, and have been studied as such for centuries.”

    Perhaps I should have used his wording of ‘mythical justification’ but I thought hocus pocus was similar enough.

  23. sciencebehind says:

    @Harriet Hall – as for your last comment I think you’re exaggerating my point a bit. I don’t think treating potentially fatal heart disease is necessarily the place for unpurified compounds but if there is a roll for foxglove before it gets to the point of severity I think it’s a worthwhile investigation.

  24. fledarmus1 says:

    @sciencbehind – “But just to throw it all out as junk without investigation seems quite unscientific.”

    The problem is, as the original article states, that it DOESN’T get thrown out as junk, even WITH investigation that proves it doesn’t work! So why bother to study it, and especially, why SPEND MY MONEY to study it? There is no rational basis for expecting it to work, and no advantage to be gained by proving yet again that it doesn’t.

    Science-based medicine is at least self-correcting. I doubt that yearly mammography for the general population will continue much longer, as the scientific evidence mounts about which populations it may be useful for and which it shows no effect on. At that point, like full body MRI’s, it will probably be advertised directly to the general population in spite of the science, and form simply another version of CAM, with insurance companies paying for it only if consumers can convince lawmakers to require it despite the scientific evidence.

  25. chaos4zap says:

    @sciencebehind

    Zinc reduces the duration of a cold? At what cost? Is people losing their sense of smell and acceptable risk for a condition that is, by and large, self-limiting anyway? And that is when Zinc is used in the nose. Who knows what possible adverse effects could result from taking it internally? How much is in each dose? How much is too much? Is the amount of product on the label actually in the product? What about contaminants? no one knows the answers to these questions, and that is the point. A major point of this article is that, if there is a negative uncovered in any of these areas, the CAM practitioners just ignore it and push forward anyway. You are not seeing the larger picture here. Even if it is effective, how effective? What are the side effects? These are not known for many CAM interventions (supplements, in this case) because there is no requirement for them to demonstrate safety and efficacy, this is the double standard Dr. Novella is talking about. When products do not have sufficient evidence for safety and efficacy…then it is a rip-off, at best and immediately dangerous to life at worse. If it does have sufficient evidence for safety and efficacy, then there is nothing alternative about it….then it’s just medicine.

  26. pmoran says:

    sciencebehind: – IV vitamin C therapy for cancer –

    This has been used for decades by Riordan and others with the merest handful of “successes”, most of which have other possible explanations. Yet you are suggesting that it now has established worth. Is there something I have missed?

  27. sciencebehind says:

    @chaos – that’s for zinc up the nose that you get loss of smell but zinc taken orally has been shown to reduce cold severity and not have loss of smell.

    @fled – I think that’s where the disagreement is – I’d be all for an article that says how to make CAM better but by presenting only negative data (while there have been positive findings) he says just throw the whole thing out. In my opinion that’s a bit of an overextending conclusion.

  28. Harriet Hall says:

    @sciencebehind,

    He didn’t say all of CAM involves mystical justifications. He said herbs “are alternative only to the extent that they are used without proper evidence or with mystical justifications. Otherwise they are just unpurified drugs.” You don’t seem to appreciate the nuances of what he wrote. Something that is used without proper evidence is not hocus pocus.

    “if there is a roll for foxglove before it gets to the point of severity I think it’s a worthwhile investigation.”

    Your ignorance is showing. There is a role for digitalis both before and after heart disease gets to the point of severity. Foxglove was used as a source of digitalis but the amount of active ingredient couldn’t be controlled and it frequently caused fatal toxicity. The active ingredient was isolated and is now available as a pharmaceutical with precise dosage and purity, and we even have a way to reverse its action if the patient inadvertently gets too much. There is no role for foxglove today. That’s what pharmacology is all about.

    Foxglove was herbal medicine and CAM, but it was highly effective and scientists had good reason to study it, and they did.

  29. Harriet Hall says:

    @sciencebehind,

    “he says just throw the whole thing out”

    No he doesn’t.

  30. pmoran says:

    NCCAM research has confirmed the predictive power of current medical science concerning which treatments are likely to possess intrinsic efficacy. The public should find that reassuring, even if for various reasons they will surely continue to try discredited methods out when sick. Very little human behaviour is completely rational and we should stop expecting that.

    It should be becoming obvious to all that it is time to change tack and confine CAM research to promising and potentially important methods that might otherwise not attract funding.

    I personally would favor studies that would reassure me that the striking, apparent, placebo responsiveness of some of the more complex CAM methods is of minimal real clinical value, as standard skeptical doctrine implies. The difficulty here is finding a study design that can satisfactorily tease out the various contributing elements, so perhaps the time for that has not yet come. .

    The remaining question is whether under some circumstances we should be prepared to perform studies that might answer questions that are looming large in the public mind and creating political pressure. We actually do this sometimes with cancer treatments, when they have aroused intense public interest (Laetrile, oral vitamin C, Di Bella, Holt in Australia).

    I approve of this. There are limits to which we can get away with telling the public — “Look, we just KNOW these methods don’t work!”. Yes, some people will keep on using them no matter what, but most cancer patients probably know deep down that methods that we do not endorse are a gamble. Nothing stops the “true believers”.

  31. jt says:

    Harriett Hall: “Maybe you believe in magic. Should we allocate scare research funds strictly on a first-come first-serve basis rather than using any judgment to prioritize? Should we fund studies of Tong Ren?”

    “Biomedical research funding increased from 37.1 billion dollars in 1994 to 94.3 billion dollars in 2003 and doubled when adjusted for inflation. Principal research sponsors in 2003 were industry (57%) and the National Institutes of Health (28%)” ( https://www.ncbi.nlm.nih.gov/pubmed/16174691 )

    94.3 billion dollars doesn’t seem like “scarce research funds” to me–the 1.6 billion dollars that NCCAM is spending is 1.7% of that.

    Given that the majority of medical research is now funded by industry, it seems that the primary judgment in prioritizing research has become “will this make me filthy rich?”

    This idea is supported by the fact that pharmaceutical companies spend more than 1.6 billion hawking their products with direct-to-consumer advertising; they spent 4.2 billion in 2005 ( http://bit.ly/nvZ6od ) and are projected to spend 11.4 billion per year by 2017 ( http://yhoo.it/ImQlrS ).

    I hadn’t read about Tong Ren until just now, and it does seem ridiculous. The more plausible CAM therapies should definitely be tested first. However, I see no harm in putting any therapy that shows some promise to the test and either validating it or discrediting it.

    Again, it is completely hypocritical for the members of a science-based medicine blog to criticize scientific research of CAM.

  32. “Stepping back in history how do we rationalize things like chewing on bark as a folk remedy evolving to our understanding of aspirin.”

    Even better – chewing on a coca leaf. A habit still practiced in certain corners of the world.

  33. sciencebehind says:

    @Harriet Hall – He says “CAM research, therefore, is like playing the lottery – the chance of winning is so small it is not significantly different from zero” and his suggestions for improvement are also out there. Ban traditional teas if they’re not shown effective in one study? Come on, those aren’t credible solutions or suggestions of anything other than dismantling CAM.

    My reading of nuance is just fine and I think he made it quite clear that he thinks CAM modalities are based on magic because of his own biased definition of it. Sure he qualifies it with the word ‘some’ but none of his other writing suggests he means ‘some’ and not ‘all’

    As for foxglove – everything’s a poison at the right dose. And good thing foxglove was investigated. And heart disease isn’t the only thing it’s used for, external applications of it are also used, perhaps there is a role there still for foxglove in medicine.

  34. David Gorski says:

    This has been used for decades by Riordan and others with the merest handful of “successes”, most of which have other possible explanations. Yet you are suggesting that it now has established worth. Is there something I have missed?

    No, there isn’t.

    http://www.sciencebasedmedicine.org/index.php/high-dose-vitamin-c-and-cancer-has-linus-pauling-been-vindicated/
    http://www.sciencebasedmedicine.org/index.php/vitamin-c-strikes-out-again/

  35. Harriet Hall says:

    @sciencebehind,

    “none of his other writing suggests he means ‘some’ and not ‘all’”

    All of his writing shows his consummate ability to reason and his understanding of science and evidence. He does not generalize inappropriately. We recognize that some things commonly called “alternative” may have value and have simply not been studied adequately. But those are not really anything “alternative” and they can be studied within the realm of science. The term “alternative medicine” is an ideological, philosophical concept, not a scientifically meaningful category; it was coined as a means of lending prestige to things outside the realm of science. Its definitions are flawed because the concept is flawed.

  36. Angora Rabbit says:

    Sciencebehind is distracting from the real point of Steve’s post: in a time where NIH funding rates are (optimistically) at the 10-12 percentile, is NCCAM the wisest way to expend limited funds? I agree that the answer is an emphatic “No!” NCCAM was a way to weasel-around the reality that badly supported studies were not being funded during peer-review. Having one’s own institute doth not guarantee high-quality science. In fact, I rather wonder if it is worse given what I hear about how insular the NCCAM study sections are. That is to say, how cross-disciplinary/cross-institute are the NCCAM study sections vs. those on other research topics such as cardiovascular disease or cancers?

    In an environment where only the top 10% of proposals are funded – reality being that 25-30% are meritorious – is this truly a good investment of hard-earned taxpayer $$? (And exactly what are the NCCAM funding rates? Maybe I should get me some of this???)

  37. David Gorski says:

    Sciencebehind is distracting from the real point of Steve’s post: in a time where NIH funding rates are (optimistically) at the 10-12 percentile

    Try the seventh percentile. That’s the pay line for the NCI right now. That 10-12 number comes from counting all resubmissions and takes a bit of numerical prestidigitation to make the number seem anything better than disastrous. Per round of submission, the number is considerably lower.

    The only reassuring thing is that NCCAM funding rates are no better and might even be worse.

  38. Davdoodles says:

    “I propose that as a society we strike a bargain with the proponents of so-called CAM. We will fund and conduct research into CAM modalities where it is reasonably ethical to do so, but in exchange treatments for which there is evidence of lack of efficacy will be abandoned.”

    I think the problem is this: Science deniers will never stick to their part of the bargain. That is the point of being a science denier – science cannot disprove their hypothesis. If it does, shift the goalposts, shiek Bag Pharma, etc ad nauseum. To them, that is not a bug, it’s a feature.

    Bu I’m forced to wonder: What sort of a brain decides that being wrong about everything is better than ever having to admit being wrong about anything?

  39. Eugenie Mielczarek says:

    It was gratifying to see our study “Measuring Mythology” Skeptical Inquirer Jan/Feb 2012 referenced by Dr. Offit in a medical journal. We had offered our study to medical journals, magazines, newspapers, science journalists, letters to the editor all rejected our attempts to publish. In quoting and summarizing some of our main findings and referencing our study Offit achieved a breakthrough.
    Jean Mielczarek

  40. DugganSC says:

    @Davdoodles:
    “What sort of a brain decides that being wrong about everything is better than ever having to admit being wrong about anything?”
    Actually, I’m pretty sure that’s a fundamental trait of most human brains… the self-correcting nature of our thought processes makes it hard to move away from a lodged position.

    “The term “alternative medicine” is an ideological, philosophical concept”
    Ah. Well, that’s where we get to things cutting both ways. On one hand, you have people trying to legitimize junk science by using the term “alternative medicine” and on the other, you have people here lumping it in such that anything alternative is automatically junk. I don’t think it’s a majority opinion, one of the reasons we are still funding studies, but I point it out because, as I said before, I fear the prospect of us throwing out the good with the bad because of the company it keeps, or the company we’ve forced it to keep by labeling it as “alternative”.

  41. gretemike says:

    Your proposal strikes out CAM modalities that are not “reasonably ethical.”

    NCCAM’s chelation study was approved (http://nccam.nih.gov/health/chelation) despite ethical concerns.

  42. Jan Willem Nienhuys says:

    Homeopathy is rejected by the mainstream because our current understanding of physics, chemistry, and biology tell us that it is impossible for homeopathic potions with extreme dilutions to have any physiological effect.

    There arte more reasons to reject homeopathy. Various RCTs have been performed and by and large they tell us that none of the many variants of homeopathy have any effect.

    If we compare to physics, there are several discoveries in physics that were completely in conflict with the then ‘current understanding’ of physics. One example is the quantum hypothesis of Planck. Planck constructed his formula for black body radiation after accurate measurements threw out older formulas. Then Planck tried to come up with a reason. For many years afterwards he himself didn’t believe his reasons were correct, even after Einstein had explained the photoeelctric effect with it.

    So when Planck came up with his crazy formula, or rather his strange deduction for that experimental formula, the then current understanding of physics told him and many others that it couldn’t be right. But the experiments were on the side of the quantum hypothesis.

    Other examples can be given. But the point is that homeopaths don’t have good experiments to back them up. If they had, then all over the world peoiple would jump in to repeat them. Physics has shown various examples. Recenly we have seen cold fusion and hot superconduction and even more recently the the superluminal neutrino’s. No matter whether the new theory or the experiment is right or wrong, scientists are eager to repeat it and study it. The discovery of X-rays went like a flash over the world (even generating spurious results like N-rays of Blondlot and the black rays of Le Bon, but also giving rise to the discovery of radioactivity).

    Homeopaths have a wide field where they can demonstrate their viewpoints. Their Materia Medica are full of symptoms that supposedly reliably appear when a person takes a highly diluted version of whatever. They only need to demonstrate a few to make the world go mad with trrying to obtain further experimental evidence. Don’t think there is a paucity of possibilities. There are in the order of 1000 items in their Materia Medica, each with in the order of 1000 ‘symptoms’.

    But rather than doing this, homeopaths shun almost every effort to establish the validity of their Materia Medica. How do they defend their thesis? They collect many RCTs and then they lie about them. The common technique is that they misrepresent the results. Often these RCTs have been done by believers. If these believers don’t cheat, they still try to see some glimmers of hope. Then the homeopaths merely quote such a glimmer.

    Another technique of twisting viewpoints of others is how they use a publication by Vandenbroucke. V. had said: RCTs don’t have the last word. When authors are strongly prejudiced, this can skew the results. Take for instance the totally mad system of homeopathy. If it wasn’t homeopathy, the results of homeopathy would be accepted by mainstream medicine. Homeopaths twist this into: Vandenbroucke says also that homeopathy is proven by RCTs.

    So, summarizing, it’s not only the crazy high dilutions, it’s only the fact that in 200 years homeopaths haven’t been able to come upwith a convincing experiment that could be duplicated and serve as a startingpoint for epoch making research. And this is not for want of trying or want of possibilities. There have been many efforts, and there a millions of homeopathic claims waiting for a simple and cheap experiment to justify such claims.

  43. mousethatroared says:

    ““The term “alternative medicine” is an ideological, philosophical concept” (Dr Harriet Hall)
    DugganSC”Ah. Well, that’s where we get to things cutting both ways. On one hand, you have people trying to legitimize junk science by using the term “alternative medicine” and on the other, you have people here lumping it in such that anything alternative is automatically junk. I don’t think it’s a majority opinion, one of the reasons we are still funding studies, but I point it out because, as I said before, I fear the prospect of us throwing out the good with the bad because of the company it keeps, or the company we’ve forced it to keep by labeling it as “alternative”.

    How does having separate funding sources with separate selection criteria help this problem?

    In my mind I see three research projects, one project wants to investigate the use of a particular speech therapy technique in the treatment of childhood stuttering. Another wants to investigate accupunture for the treatment of childhood stuttering, a third wants to investigate the use of omega 3 supplementation in the treatment of childhood stuttering.

    Who should they look to for funding? What should be the criteria for receiving funding? Should there be different criteria based on whether the treatment carries a social/political label of “alternative” or “conventional”?

    I think, if the funding is coming from the goverment, that the criteria should be the same regardless of the label. If one needs to have two distinct agencies handling funding for medicine, the distinctions should be based on some reasonably objective, measurable criteria (like prevention vs treatment) rather than the subjective, fluid label or CAM vs Traditional ( Conventional, whatever).

  44. sciencebehind and I are talking past each other because, I think, he does not understand where I am coming from.

    CAM is not my label or category. I did not invent it, define it, or ever endorse it. It was invented by proponents.

    The problem here is the very existence of CAM as a category. The category itself is fuzzy and does not have a meaningful operational definition. This makes it difficult to say anything categorical about CAM, except, perhaps, how the category is used.

    It is used to create a double standard – a double standard of logic, evidence, regulation, ethics, scholarship, and research. I address in this post just the research double standard, because that’s what Offit wrote about and I was discussing his article.

    We should be deciding what to research and what has value based upon its inherent merits – not on a fuzzy and poorly defined label. I am not so much saying we should not research treatments that are considered CAM as there should be no label of CAM.

    Herbal remedies should be studies, as they always have been, and there is even a category of research for them already – pharmacognasy.

    Nutrition is nutrition. It’s science based. It is only considered CAM by some because the loose definition of CAM allows them to “steal” legitimate sciences in order to give the false impression of legitimacy to the entire false category.

    Otherwise, individual questions, theories, treatments, etc. should be evaluated on their own merits. Are they plausible? What does the basic science tell us about them? What does existing clinical evidence say? Is it worth public funding?

    If you disagree – then please give me an operational definition of CAM.

  45. elmer says:

    I’ve just noticed that a lot of the bloggers here seem to enjoy making these wacky overgeneralizations periodically, always inspiring the same incredibly obvious objections, which presumably have been made above by someone or other. At this point I’ve just come to view this sort of thing as kind of like a fart. Now if you’ll excuse me, I’m going to go powder my nose.

  46. Angora Rabbit says:

    David, I knew you’d say something. :) The number is from my own institute and I know that NCI, for example, is much tighter. The situation is just as horrific for other disciplines. Didn’t mean to trivialize your experiences. No matter how we slice it, good science is being turned down due to lack of funds.

  47. David Gorski says:

    Yup. Depressingly, it’s quite possible—likely even—that next year my lab will shut down for lack of funds. I was good enough to stay funded when the pay line was around the 15th percentile, but it’s quite possible that I might not be good enough when the pay line’s only at the 7th percentile. At least I can always go back to operating for a living if I have to. I feel very bad for the young scientists at our university who are facing the end of their startup funds and time before they either have to achieve tenure or lose their jobs.

    However, if your institute’s pay line is the 12th percentile, maybe I should find me a way to frame my research as being part of that institute’s mission and apply there. :-)

  48. gretemike says:

    What got posted was:

    Your proposal strikes out CAM modalities that are not “reasonably ethical.”

    NCCAM’s chelation study was approved (http://nccam.nih.gov/health/chelation) despite ethical concerns.

    What got chopped off probably due to user error:

    What does “reasonably ethical” mean? Aren’t human studies supposed to be ethical without a preceeding modifier? Is that a new proposed standard just for CAM, or is that in fact the requirement generally for human trials (I’m not an expert in this area, maybe it is)? The chelation study cost $30 million, is spending that much money to study the effect of a drug that has no plausible mechanism of action to work as it’s proponents claim (but which is known to cause hypocalcemia) EVER ethical? Or does it just meet the “reasonably ethical” standard? I’m trying to understand what would have happened to that study if your proposal had been widely accepted prior to it being proposed.

  49. pmoran says:

    Steve: The problem here is the very existence of CAM as a category. The category itself is fuzzy and does not have a meaningful operational definition. This makes it difficult to say anything categorical about CAM, except, perhaps, how the category is used.

    It is used to create a double standard – a double standard of logic, evidence, regulation, ethics, scholarship, and research. I address in this post just the research double standard, because that’s what Offit wrote about and I was discussing his article.

    ———————————-
    If you disagree – then please give me an operational definition of CAM.

    The first step towards clarity might be to regard CAM as a set of medical claims, not as a set of methods having any particular properties. Chelation, for example is a valid scientific concept and a valid medical procedure, but CAM when claimed to cure autism.

    Then, should you believe that homeopathy works with certain conditions, it is not unethical to use it. If you say that acupuncture probably helps some patients through a combination of non-specific influences, you are not making an unscientific statement.

    All you are then locked into is having to describe the quality of those claims that sets them apart, which should not be too difficult.

  50. pmoran – right, so what you are saying is, if it’s unscientific, then it’s CAM. That, I believe, was my original point. It is the only meaningful definition, claims for which there is insufficient evidence or rationale. But since CAM proponents don’t admit this they confuse the issue by pretending CAM includes proven nutritional therapies.

    In practice CAM has a shifting, fuzzy, and confusing definition. But the real purpose of the category is to create a scientific double standard – which is another way of saying what you did.

  51. Harriet Hall says:

    @pmoran,

    “should you believe that homeopathy works with certain conditions, it is not unethical to use it.”

    If you are treating patients under the guise of a trustworthy science-based physician and you influence patients with your superstitious beliefs about nonsense that is not only implausible but has been tested and failed, isn’t that unethical? Isn’t it unethical not to tell them about the evidence against homeopathy?

  52. marcus welby says:

    Physicians for a National Health Plan takes on the CAM issue with encouraging results:

    http://www.pnhp.org/news/2012/may/should-a-single-payer-system-include-complementary-and-alternative-therapies

  53. pmoran says:

    @pmoran,

    “should you believe that homeopathy works with certain conditions, it is not unethical to use it.”

    If you are treating patients under the guise of a trustworthy science-based physician and you influence patients with your superstitious beliefs about nonsense that is not only implausible but has been tested and failed, isn’t that unethical? Isn’t it unethical not to tell them about the evidence against homeopathy?

    The beauty of the approach I recommend is that it does focus on the specific claim and the specific setting, which can bring all such considerations into play. There will still be differences of opinion as to what is ethical and what is not, but less blurriness as to which claims can be classed as CAM.

    However doesn’t the ethics depend upon knowing the mind of the claimant?

    If he is selling homeopathic remedies to his patients knowing that ” they don’t work”, that is fraud — obviously unethical.

    OTOH Peter Fisher (the Queen’s homeopath) sincerely believes that it works with his patients, despite participating in a number of negative clinical studies. I don’t know exactly what he thinks — he might be thinking “placebo-related influences”; but no one can admit to anything like that without being pounced on by the medical version of the Spanish Inquisition – which no one ever expects, let alone ever engaged as experts on ethical questions (–just joshing, folks!).

    Or he may still imagine, against my understanding and yours, that there are other ways in which therapeutic effects can be suppressed in placebo-controlled RCTs. Are we entitled to accuse people of ethical misdemeanour when the true villain is poor logic, deeply entrenched and constantly reinforced belief, or even an inability to think things through?

  54. sciencebehind says:

    @Novella – I think of CAM as either traditional or common health practices (you can put health in quotes if you like) that have not yet been tested using the scientific method. I think these practices certainly needs a place to be studied – often people aren’t just lemmings following a shaman but they do perceive and gain benefit from their ‘health’ actions. Some research you say can fall under different funding mechanisms but CAM helps keep the door open to some common public practices that are otherwise ignored. And not all research funded by CAM comes up will nill. I’m also all for basic science and funding research that has some backbone but it’s very hard to make mice do yoga.

  55. Jan Willem Nienhuys says:

    pmoran writes:

    Peter Fisher (the Queen’s homeopath) sincerely believes that it works with his patients, despite participating in a number of negative clinical studies. I don’t know exactly what he thinks — he might be thinking “placebo-related influences”;

    I don’t know about Peter Fisher, but I do know about Elly de Lange. (E.S.M. de Lange-de Klerk). She did a research which consisted of following about 170 children with recurrent upper respiratory tract infection (URTI) for a year, treating them with classical homeopathy in an RCT. In fact, it was her Ph.D. research (heavily subsidized by the Dutch government). I have read her 1993 dissertation, which is much more extensive than the short article in BMJ.

    http://www.bmj.com/content/309/6965/1329.full

    She (or her thesis advisor) took the precaution to break the code only after the last patient had completed its full year of surveillance.
    Even then the code was only broken half: the groups were denoted x and y, and only after all the comparisons between the groups were made, it was revealed which of x and y was the placebo group.

    The choice for recurrent URTI was made because at the time it was generally believed that this was a domain where homeopathy really made a clear difference. Of course, recurrent URTI gradually improves until the immune system of the children has fully matured and ‘knows’ most of the virusses involved. This gradual improvement contributes to the illusion that homeopathy is the cause.

    The two groups differed a bit, but not significantly so. So it would seem entirely reasonable that the small difference was nothing but the luck of the draw. Even though the two groups x and y were comparable at the outset, the luck of the draw may have assigned children whose immune system improved somewhat faster to one group, as it happend to the verum group. The difference was consistent: the total length of the sickness episodes, the number of sickness episodes and the cumulative symptom index score all pointed to the same direction. One may even conjecture that the difference was in the way parents reacted to having to report sickness symptoms every two weeks.

    De Lange went on practising homeopathy (I believe she still does), because she believed herself that the small difference was caused by the homeopathic treatment. See http://www.lokaalloket.nl/amstelveen/aanbieder.php?id=11099 where you can find that she practices in Amstelveen, and that the information on that web page was checked as recent as March 2012

    The BMJ article ends with

    In conclusion, the observed differences between the groups were small but consistent. The clinical relevance, however, is questionable.

    Not only Elly de Lange thought that the small difference was a real consequence of using homeopathy, but proponents of homeopathy mark this study as ‘positive’ for homeopathy.

    I think that in any study yielding more than a single results one can see some positive glimmers, or one can cheat oneself with various fibs. For example Brigo did an RCT for homeopathy with migraine. The result was highly significant (in the statistical sense) but with a suspiciously low placebo effect. When Walach et al. duplicated it, they did a very thorough blinding. They had a notary do the randomizing (no blocks, just a coin or a die) and the distribution of medicines. It came out non-significant (but homeopathy on the verge of being significantly worse). Afterwards the therapists complained that the patients had been not at all typical of their usual patients. And Walach went on believing in homeopathy, he even developed a theory that homeopathy works because of some quantum mechanical three way entanglement between healer, patient and medicine. I guess knowledgeable people have told him that his quantum mechanics is a travesty of the real stuff, but he doesn’t listen.

  56. gretemike says:

    Perhaps Peter Fisher is simply thinking about his job.

  57. pmoran says:

    Perhaps Peter Fisher is simply thinking about his job.

    Yes, or finding it hard to admit that he has been terribly wrong, and has devoted his life to self-delusion?

    I would not be surprised if such matters enter his mind. But I suspect that he then thinks of this patient and that body of experience and reassures himself that he might yet be right and the naysayers wrong.

    Remember that his patients will be constantly telling him how well his treatments work and he can always hark back to a few seemingly dramatic successes. If we are honest with ourselves, we all come across some cases that make us think twice, before (rightly enough) falling back upon “it’s still only anecdotal” or “‘only’ placebo”.

    It must also be much easier not to start using homeopathy than to stop it once having experienced the illusions that inevitably arise with the use of inactive remedies. Those who sincerely believe in their methods, to the degree that they have been prepared to test them out in proper studies, should be given credit for that and not accused of unethical behaviour without further knowledge of their true motives.

  58. gretemike says:

    A good point Dr. Moran.

  59. James S says:

    The closest definition for CAM that I could think of is any non-medical treatment option for health-related concerns. Since medicine is the SCIENCE of healing and most CAM has not been demonstrated using scientifically-valid techniques, it seemed like a good definition.

    The biggest problem with defining CAM that way is that it would also seem to throw legitimate scientific research under the CAM label, since every legitimate medical treatment has to go through a process of scientific corroboration. However, I still think that definition holds because, to use an example, new drugs like AZT were only given out in experimental trials and were not made available for general prescription until properly vetted.

    CAM, by contrast, is always made available to the general public in some form before it has been properly vetted by the medical community. This definition may allow CAM research to fall under the aegis of legitimate medicine, but certainly not the “experimental” treatments being made available outside of a research setting.

    As for the research question, which you address quite well here and in other places, I think the solution is just to eliminate special funding for CAM research altogether. Much of the research into CAM might be legitimate, but there is no reason that research into CAM treatments should not have to compete for funding on a level playing field with all medical research.

  60. herbalgram11 says:

    “Science Based Medicine is Potentially Tantamount to Scurrilous Pompous Quackery.”

    Says this doctor of medicine: Joseph Chikelue Obi

    http://www.trcbnews.com/science-based-medicine-is-potentially-tantamount-to-scurrilous-pompous-quackery/118492/

    A good example might be the prevalence over the past 50 odd years of prescribing antibiotics for cold / flu viruses – see:
    http://www.healthinsite.gov.au/content/internal/page.cfm?ObjID=D2A4507F-09D0-38A1-472A26FA1DA297AC&PID=76582
    which the WHO says is now one of our greatest health threats. Thanks, orthodox medicine!

    Here are some examples of sham orthodox medicine:

    Flu vaccines, found by the Cochrane database to be ineffective in a recent review, and chemotherapy, also debunked as being less than efficaceous (Australian Prescriber Editorial: The emperor’s new clothes – can chemotherapy survive?http://www.australianprescriber.com/magazine/29/1/2/3/ ; original study: Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol 2004;16:549-60http://www.ncbi.nlm.nih.gov/pubmed/15630849 )

    Why are these sham medicines and research into these areas still publically funded?

    “…only 15% of medical interventions are supported by solid scientific evidence…(and)…only 1% of the articles in medical journals are scientifically sound…many treatments have never been assessed at all…”
    (Smith R. Where is the wisdom…? The poverty of medical evidence. Editorial. British Medical J 1991;303(Oct 5):798-799 )

    This suggests that 99% of published trials, or at least the reporting of them – cannot be relied on!

  61. Chris says:

    So what is the scientifically verified herbal cure for influenza? Please post the title, journal and dates of the PubMed indexed papers outlining the appropriate prevention measures and cures for influenza. Thank you.

  62. Scottynuke says:

    Not that herbalgram will be inclined to listen, but one might want to try using SBM’s search engine to examine Obi’s track record before invoking his name.

    Hint: he has as much credibility here as whale.to (OK, maybe a little more, but that’s not saying much, now is it?)

    Oh, and editorials (otherwise known as opinions) are not evidence, particularly when they’re elided to the extent herbalgram has gone to. And they’re certainly not a basis for such a sweeping assumption as herbalgram tries to make.

  63. WilliamLawrenceUtridge says:

    “…only 15% of medical interventions are supported by solid scientific evidence…(and)…only 1% of the articles in medical journals are scientifically sound…many treatments have never been assessed at all…”
    (Smith R. Where is the wisdom…? The poverty of medical evidence. Editorial. British Medical J 1991;303(Oct 5):798-799 )

    Wow, I wasn’t aware that the medical evidence base ceased to be updated since 1991! We should tell someone.

    and chemotherapy, also debunked as being less than efficaceous…original study: Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol 2004;16:549-60 http://www.ncbi.nlm.nih.gov/pubmed/15630849 )

    Actually, that “debunking” has been debunked.

    And of course, even if it were true it doesn’t mean herbs work. But please keep posting CAM talking points, it helps refresh our grasp of basic facts and provides a convenient way for new readers to become familiar with the myriad fallacies of CAM promoters and the quick responses to those fallacies.

    It’d be nice if you read the links we include as rebuttals, but if you’re like most CAM promoters you won’t because you aren’t interested in an honest assessment of the evidence, you just want to sound off.

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