Feb 09 2012
“Obama Promises $156 Million to Alzheimer’s…But where will the money come from?” That’s easy: the NCCAM!
The quoted language above is part of the headline of this story in today’s The Scientist:
Citing the rising tide of Americans with Alzheimer’s—projections suggest 10 million people will be afflicted by 2050—the Obama administration and top National Institutes of Health officials are taking action. On February 7, they announced that they will add an additional $80 million to the 2013 NIH budget for the Alzheimer’s research program.
The problem is that there ain’t no such thing as a free lunch:
However, Richard Hodes, director of the NIH’s National Institute on Aging, told Nature that the 2013 dollars still have to be approved by Congress in the next budget and, if not, existing programs may need to be cut. And this year’s $50 million is likely to bump other projects, perhaps at NIH’s National Human Genome Research Institute. “If there’s a finite budget anywhere, once there’s more of something, there is less of something else,” he said.
Often such budget compromises are difficult, because there is no ready way to choose between two or more competing recipients of taxpayers’ money, each of which might be comparably worthy. Thus it is with a great sense of relief that in this case, we in the biomedical community can assure President Obama that no such dilemma exists. This is one of those occasional decisions that requires no hair-pulling whatsoever. The obvious solution is to defund the National Center for Complementary and Alternative Medicine (NCCAM), which, at about $130 million/yr, would solve the problem of funding Alzheimer’s research and take the heat off other worthy programs such as those mentioned by Richard Hodes.
Defunding the NCCAM would serve yet another worthy purpose: to end the period of nearly two decades during which the National Institutes of Health (NIH) has been bullied into acting as though pseudoscientific health claims ought to be taken seriously, thus embarrassing itself and medicine, endangering human subjects for no justifiable purpose, contributing to erroneous content in medical school courses, bankrolling ‘integrative medicine’ centers when there is no evidence that these are useful, and adding to the widespread scientific illiteracy of the American public. Here is a smattering of more articles making those points over the years, only some of which have been written by the authors here at Science-Based Medicine:
- The politics of alternative medicine —Science 1994
- Lobbying Blitz Attacks Alternative Medicine —Science 11 July 1997: 277 (5323), 169. [DOI:10.1126/science.277.5323.169e]
- Let’s Abolish the Office of Alternative Medicine at the National Institutes of Health —North Carolina Journal of Medicine 1998.
- Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded —Quackwatch 2002
- The Ongoing Problem with the National Center for Complementary and Alternative Medicine —Skeptical Inquirer 2003.
- Science and government. Review for NCCAM is overdue. —Science 2006
- The National Center for Complementary and Alternative Medicine (NCCAM): Your tax dollars hard at work —Science-Based Medicine 2008
- Let President-Elect Obama know that NCCAM should be defunded! —Science-Based Medicine 2009
- President Obama – Defund the NCCAM —Science-Based Medicine 2009
- Yes We Can! We Can Abolish the NCCAM! —Science-Based Medicine 2009
- Save NIH $$$: eliminate “alternative” medicine —Genomics, Evolution, and Pseudoscience 2010
- Update on Josephine Briggs and the NCCAM —Science-Based Medicine 2011
- Measuring Mythology: Startling Concepts in NCCAM Grants —Skeptical Inquirer 2012 Preview available here.
It is clear that things have not improved much, in spite of the two most recent NCCAM Directors, Stephen Straus and Josephine Briggs, having previously been, at least on paper, legitimate scientists. The explanation for that paradox is two-fold: the very language that spawned the NCCAM makes it impossible for more than a smattering of useful, legitimate science to be done; the two Directors have been company (wo)men first, scientists second.
Regarding the NCCAM mandate, consider these passages in the law that established the Center (emphasis added):
(a) In General.–The general purposes of the National Center for Complementary and Alternative Medicine…are the conduct and support of basic and applied research…and other programs with respect to identifying, investigating, and validating complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems…
(b) Advisory Council.–The Secretary shall establish an advisory council for the Center in accordance with section 406, except that at least half of the members of the advisory council who are not ex officio members shall include practitioners licensed in one or more of the major systems with which the Center is concerned, and at least 3 individuals representing the interests of individual consumers of complementary and alternative medicine.
(c) Complement to Conventional Medicine.–In carrying out subsection (a), the Director of the Center shall, as appropriate, study the integration of alternative treatment, diagnostic and prevention systems, modalities, and disciplines with the practice of conventional medicine as a complement to such medicine and into health care delivery systems in the United States.
(d) Appropriate Scientific Expertise and Coordination With Institutes and Federal Agencies.–The Director of the Center, after consultation with the advisory council for the Center and the division of research grants, shall ensure that scientists with appropriate expertise in research on complementary and alternative medicine are incorporated into the review, oversight, and management processes of all research projects and other activities funded by the Center...
(e) Evaluation of Various Disciplines and Systems.–In carrying out subsection (a), the Director of the Center shall identify and evaluate alternative and complementary medical treatment, diagnostic and prevention modalities in each of the disciplines and systems with which the Center is concerned, including each discipline and system in which accreditation, national certification, or a State license is available.
(f) Ensuring High Quality, Rigorous Scientific Review.–In order to ensure high quality, rigorous scientific review of complementary and alternative, diagnostic and prevention modalities, disciplines and systems, the Director of the Center shall conduct or support the following activities:
(1) Outcomes research and investigations.
(2) Epidemiological studies.
(3) Health services research.
(4) Basic science research.
(5) Clinical trials.
(6) Other appropriate research and investigational
That language is anti-scientific for many reasons. I’ll explain a few; feel free to look here for more discussion. Paragraph (a) guarantees a cherry-picking approach to the topic: start with a treatment claim that has no scientific basis, assume that it works for something, then try to find a ‘something’ that seems to ‘validate’ it. This is the opposite of the way clinical research, including that done by most NIH-sponsored trials, proceeds. Paragraph (b) is self-explanatory: if the ‘major systems’ have no scientific validity—and no system other than modern, science-based medicine does—the NCCAM Advisory Council will certainly not be expected to acknowledge that fact, and it hasn’t. Paragraph (c) begs the question and betrays the real agenda of the NCCAM’s creators.
Paragraph (d) presumes that there are scientists “with appropriate expertise in research on complementary and alternative medicine.” There actually are a few such people, such as Edzard Ernst, but the NCCAM has not “incorporated” them. Rather, it has incorporated pretenders to science such as those quoted in this recent post. Paragraph (e) guarantees that the NCCAM will cotton to quacks who, regrettably, have been licensed to practice in one or more states. Paragraph (f) predicts that various implausible ministrations will inevitably be found to “work,” relying as it does on “outcome studies”—a form of Cinderella Medicine—as the first choice in testing.
Regarding my second assertion, that Directors Straus and Briggs forsook their scientific (and ethical) roots in favor of a perceived mandate to go along with the company gag, I can offer numerous pieces of evidence in addition to those already linked above: here, here, here (my response to that is here), here (Dr. Briggs’s contribution to this), and here (circling the wagons in response to this), for example.
Which makes me wonder: if Dr. Briggs were really honest with herself, would she think that taxpayers’ money is better spent on the NCCAM than it would be on Alzheimer’s research? A cheap shot, you say? I don’t think so: once there’s more of something, there is less of something else.
A final note to the president: as easy as this decision is, there’s yet another easy one. You can double your (our) money by defunding the rest of NIH ‘CAM’ research! You’ll find most of that at the National Cancer Institute (NCI).
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