NCCAM: the not-even-wrong agency

The National Center for Complementary and Alternative Medicine (NCCAM) is a government agency tasked with (among other things), “[exploring] complementary and alternative healing practices in the context of rigorous science.” In this space we have talked about NCCAM quite a bit, but I have to admit that I don’t think about them very much. The other day, though, I was reading though JAMA and I came across a study funded by the agency. The study, which showed that Ginkgo does not prevent Alzheimer’s-type dementia, was pretty good, so I cruised on over to NCCAM’s website to see what else they’ve been up to.

A quick glance at NCCAM’s front page:

    “Ginkgo Evaluation of Memory (GEM) Study Fails To Show Benefit in Preventing Dementia in the Elderly”
    “CAM and Hepatitis C: A Focus on Herbal Supplements ‘No CAM treatment has yet been proven effective for treating hepatitis C or its complications.'”
    “Selenium and Vitamin E in Prostate Cancer Prevention Study, ‘selenium and vitamin E supplements, taken either alone or together, did not prevent prostate cancer.'”

It seems that NCCAM is finding out something we already strongly suspected:  improbable medical claims are usually wrong.  Since that’s not how they see things,  and since I don’t believe that there is such a thing as alternative medicine, I was curious how they defined CAM.

CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. Some health care providers practice both CAM and conventional medicine. While some scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies–questions such as whether these therapies are safe and whether they work for the diseases or medical conditions for which they are used.

The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge. emphasis mine, ed.

The list of NCCAM studies appears to fall into three broad categories.

The first is the “positive study”, or the type mentioned in the last paragraph above.  How often does NCCAM shepherd newly validated CAM into the “regular” medical world?  I couldn’t find much, but feel free to fill me in.

Next is the “negative study”.  What about the negative studies, such as the current one about Ginkgo, or the negative evaluation of Echinacea for the common cold;  how often is CAM rejected when there is overwhelming evidence against it? Orac and I had a lively discussion about this a while back, but the gist is that alternative med beliefs are just that—beliefs.  They are taken on faith, and no amount of evidence will cause their adherents to walk away from them.  This is in stark contrast to reality-based scientists who, when presented with overwhelming evidence that their hypothesis is incorrect, move on to the next idea, or risk a life of professional exile and intellectual stagnation.

Negative studies are terrific, but not quite as useful when they ask a question no rational person was asking, which brings us to our final category of  studies, which often overlaps with the first two: that of completely improbable ideas.  As we’ve written many, many times, claims that have no scientific basis and that violate the basic tenets of science are unlikely yield to scientific investigation, and when positive results are found, they are likely to be false positives.  Take this list from the NCCAM website:

    Therapeutic Touch for Wrist Fractures in Postmenopausal Women
    The Use of Reiki for Patients With Advanced AIDS
    Distance Healing in Wound Healing

All of these hypotheses are ridiculous. Why are we funding them at all?

You see, sloppy hypotheses are a mark of sloppy (and often ideological) thinking.  Take one of the recent announcements from NCCAM: “New Research Gives Insight Into How Acupuncture May Relieve Pain.”

The title pretty much exemplifies the problems with the agency.  It begs the question, assuming that acupuncture actually relieves pain, when the research is actually rather against it.  The study looked at a small number of patients given “sham” and “real” acupuncture (which studies have shown behave, in the aggregate, interchangeably, with one sometimes being better than the other, or both acting equally).  After making this questionable assumption, it then measured changes in the brain which may or may not have anything to do with the intervention. “The researchers conclude that acupuncture changes resting-state brain activity in ways that may account for its analgesic and other therapeutic effects.”  At least one informed reader didn’t conclude any such thing.  The number of possibly-unrelated dots that they’ve shoved together are a pipe-dream.  A real hypothesis rests on real science with reasonable assumptions, tests the hypothesis with the best available science, controls for confounding, and accepts or rejects the hypothesis as warranted.

The National Center for Alternative and Complementary has failed. It funds some good studies that other agencies could just as easily fund.  It doesn’t help “good” CAM become mainstream. Its negative studies are ignored by CAM-adherents.  And most important, the great preponderance of its studies “aren’t even wrong“.  NCCAM has failed its mission and needs to go away.

Posted in: Clinical Trials, Politics and Regulation, Science and Medicine

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10 thoughts on “NCCAM: the not-even-wrong agency

  1. Harriet Hall says:

    I can’t decide what to ask Santa for this Christmas. I’m torn between eliminating the NCCAM and repealing DSHEA.

  2. David Gorski says:

    I appreciate the tactical air support, my brother in arms.

  3. Peter Lipson says:

    Any time, and I found that darned post on scienceblogs and WCU about failure to abandon CAM despite evidence. I never really thought too hard about NCCAM until recently, especially after looking at the list of completed studies.

  4. Joe says:

    Dr. Sampson has written on this. One can hope he will add his links/references.

  5. MedsVsTherapy says:

    “All of these hypotheses are ridiculous. Why are we funding them at all?”

    All of these are idealogically silly to you, based on your opinions and beliefs.

    Nonetheelss, the scientific method does not care whether these theories fit your beliefs.

    Your theories and beliefs may generally be sopt-on, but there is no systematic testing of validity built into your system of belifs, opinions, and experiences. Close, but not quite. Medical and scientific education on top of a decent natural sciences/math/physics background is a great start.

    But science does not care.

    Bring a hypothesis to science, and let science evaluate the validity of the claim.

    Rikkki may or may not work. Sure, I agree that it is foolish. But just set up the test, with a disprovable hypothesis. Once you actually manage to corral the millions of random, loosely connected thoughts that come out of th eminds of the CAM folks. Pin these folks down to at least one testable hyptohesis. Their claim. Their methods. Agreed-upon criteria for measuring success or failure.

    Then do the test.


    When their kooky hypothesis fails, allow them to wander off with silly tag-lines about working outside of the scientific paradigm, etc. But when they want to come back and start arguiing, repeat the process noted above.

    Allow them to refine hypothesis, refine the operationalization of their constructs, allow them to redefine the outcomes, etc.

    Then repeat.

    The simple power of evidence.

    If Rikki heals a fractured wrist, then if we get a verified, true-blue CAM Rikki person to conduct Rikkki under the most optimal conditions (new age music, incense, mood lighting, etc.), for one hundred broken-wrist cases (per the Rikki advocates’ case definition, so they can’t later claim that you fixed the contest), and measure outcomes. Cetainly, if a Rikkki master declares: Rikkki fixes a broken wrist,” then ask them how many out of 100 patients should be healed.

    Then let science steamroll on over the whole issue.

    Let them head off agai nwith the various loosely constructed complaints about the dominant paradigm, alternate paradigms of knowledge, etc.

    When the Rikkki masters turn to come back at ya, bring up that “science” idea again, and agree to test any claim, using ALL of their claims, measures, and outcomes, then test again.

    This is the value I see in the Govt testing ACM.

    There could actually be an herbal supplement out there, or some spice, that actually could be superior to some recognized treatment. The next aspirin.

    Well, let’s discover it.

    so, the value is to 1. shut up the various claims, at least for those who are intersted in truth versus opinion 2: discover what actually might work.

  6. Karl Withakay says:

    The ideas are not ideologically silly, they are scientifically implausible; they are so implausible as to be ridiculous.

    1 No amount of scientific proof seems sufficient to enlighten woo believers. Plenty of well designed studies have already been done showing numerous CAM treatments are no better than sham treatment, and CAM hasn’t gone away yet.

    Science has already steamrollered over the whole issue, but the CAMers are not listening.

    2 I don’t care for my tax dollars being spent on (more) studies of highly implausible treatments . Should we spend tax dollars researching whether praying to space aliens and using astrology can prevent prostate cancer just because I or a certain number of people believe such?

    If studies were free or money grew on trees, I might agree with the concept of “then do the test”.

    We already have a science for finding the next aspirin, it’s called pharmaceuticals. Well done studies of herbal remedies and supplements are not CAM, they are science. Lumping them in with CAM is a way of adding validity to CAM. It’s either Scientific medicine or it’s not; there’s really no such thing as complementary medicine. For me, CAM stands for Complete Alternative to Medicine.

  7. wertys says:

    I would like to suggest that an obscure but beautiful word be revived and used in the context of SCAM treatments which defy scientific plausibility….incompossibility.

    This is a polite way of saying that, as Ambrose Bierce puts it, “the world of being has scope enough for one of them, but not enough for both”

    SCAM modalities are not only incompossible with the known laws of the universe, they are incompossible with each other. When will NCCAM ever get around to doing comparative studies of SCAM modalities head-to-head to determine whether either, both or neither can co-exist in the one person. Is it their subtle energy, innate intelligence or qi which is the problem? If they have problems with their gallbladder meridien how does this relate to their orgone level or could it possibly be able to predict response to therapeutic touch instead of reiki ?

    These are not trivial questions. Within medicine, there are different approaches to health and disease, such as medical vs surgical, interventional vs conservative etc, but they are not incompossible, they truly are complementary of each other. They show different sides of the same elephant. Without even venturing onto the wilder shores of SCAM modalities, we can find evidence of incompossibility between (say) chiropractic and TCM. Innate intelligence or qi..which is the vital force ? Does treating subluxations alter the flow of qi? Is it even an elephant they are looking at ?

  8. NCCAM is representative of the kind of magical thinking that has become socially acceptable among (otherwise) reasonable people. This is the America that mostly disbelieves evolution, and reacts favorably when the President’s favorite philosopher is Jesus Christ.

    This used to be a country that believed in science. The Apollo mission, nuclear bomb design, solid-fuel rocket boosters. Did the Vietnam War discredit the eggheads?

    People want their iPod and their Acai Juice. Can you have it both ways?

    Say what you like, at least the NCCAM is systematically debunking farfetched memes. These things have a lifecycle of their own, and I’m not sure NCCAM’s yearly $100 million makes a big difference in the long run.

    By the way, this is a marvelous site, keep up the good work.

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