Jan 21 2009
As part of President Obama’s new approach to politics, with the promise of making it more transparent, his transition team solicited ideas from the public at change.gov. On this site anyone could post an idea and everyone could vote proposals up or down. Apparently the most popular ideas will be given some consideration. It’s an interesting blend of democracy and representative government. Whether is has any utility remains to be seen – but it’s just electrons and therefore it’s easy to experiment.
There are numerous suggestions under the health care category, but one in particular that might be of interest to readers of this blog. The author, Professor S, sent me the link to his suggestion that the new Administration defund the National Center for Complementary and Alternative Medicine (NCCAM).
What a great idea.
The NCCAM has been under considerable criticism by scientists (including here at SBM) since it was created in 1992 (as the Office of Alternative Medicine, converted to NCCAM in 1998) by an act of Congress. The NCCAM is a part of the NIH and it’s mission is to fund studies of so-called complementary and alternative medicine. It’s total budget through 2008 has been 1 billion 85.2 million dollars, and its most recent budget for 2008 was $121.5 million. The real cost is much higher, as the listed budgets do not include studies that are co-sponsored with other centers at the NIH.)
Of course, a billion dollars isn’t what it used to be, but what has the American public and the world received for its billion plus dollars? Exactly nothing. Proponents of unscientific and fraudulent medical claims, however, have received the best PR campaign they could have hoped for.
The measure of success of medical research is the impact it has on medical practice. Studies don’t have to be positive to be useful – showing that a treatment does not work is also highly valuable. Medicine that is science-based changes in response to new research. The more important the question researched, the more relevant the clinical implications, the bigger and better the study, and the more definitive the outcome – the greater the impact of the study.
The problem with CAM is that it is not science-based. It has therefore always been an inherent contradiction to carve out special funding for scientific research into claims that are not based upon science in the first place, and that are used by practitioners who are generally not science-based. That is a guaranteed waste of resources.
Any question or modality worth studying scientifically can be funded through other departments in the NIH. They don’t need special funding. And any claim that cannot justify funding for scientific research through the normal means likely does not deserve to be funded, and the proponents of such claims likely don’t care what the research says anyway.
As a result more than a billion dollars of taxpayer money spent has not changed the practice of CAM one bit. No CAM modality has been abandoned because research showed a lack of efficacy. Neither has any CAM modality been shown to be effective with research of sufficient quality that it has become accepted by mainstream practice. Nothing added or taken away.
Much of the research coming out of the NCCAM isn’t even designed to test safety and efficacy of a specific treatment. Here’s a good example, a look at the effects of “true” vs sham acupuncture on brain activity using fMRI and PET scanning. This is a worthless study for many reasons. First, clinical studies, taken as a whole, have not demonstrated any difference between true and sham acupuncture. Second, this study included only 12 subjects – far too few to pull any signal out of the noise using fMRI or even PET. And further, there is no way to know how to interpret the results – it’s little more than anomaly hunting.
But this kind of research makes acupuncture seem scientific and legitimate. It is worthless scientifically, and doesn’t even address the only important question at this point: does it work – but is great for marketing.
The only worthwhile studies coming out of the NCCAM are those looking at specific herbal remedies for specific conditions. But these kinds of trials do not need the NCCAM. They can be funded through other departments. These studies have largely been negative, but that is useful as there is already a large market for many supplements, and they are almost completely unregulated (which is a separate issue).
Defunding the NCCAM will save money at a time when it is critical to do so. But even more importantly, the NCCAM has not fulfilled its mission. It serves no legitimate function. It only serves to legitimize unscientific medical practices.
President Obama wants more transparent government. I agree, and part of that means we should have one transparent and honest standard. The NCCAM’s true purpose is to create an opaque double-standard based upon distortion of language and misleading claims. I think 17 years of the experiment is enough – end it.
On a side note – I know that the NCCAM is a creation of the Congress, not the Administrative branch of the Federal government. And therefore only Congress can kill the beast it created. However, a popular president can have great power to set policy and agenda, especially when his own party is in the majority in the House and Senate. Further – I am not just calling to Obama, but also to Congress to end the NCCAM.
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