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Senator Tom Harkin: “Disappointed” that NCCAM hasn’t “validated” more CAM

Senator Tom Harkin (D-Iowa) owes me a new irony meter.

I’ll explain in a minute, but first you have to know why I even care about what Harkin says or does, given that he’s not my Senator. As you may recall, arguably no single legislator in the U.S. has done more to harm to the cause of promoting science- and evidence-based medicine than Tom Harkin. That’s because it was primarily through Harkin’s efforts that the National Institutes of Health, despite the fact that its scientists were not agitating for it, had the National Center for Complementary and Alternative Medicine (NCCAM) rammed down its throat in 1992, first as the Office of Alternative Medicine (OAM), then in 1998, when NIH Director Harold Varmus tried to place OAM under more scientific NIH control, by elevating OAM to a full and independent Center within the NIH. Thus was NCCAM born.

I’ve complained many times about how NCCAM funds studies that, let’s face it, are of pseudoscience and quackery (homeopathy, anyone?) and even more about how it promotes unscientific medical practices. I’ve argued time and time again that there is no research that is funded by NCCAM that couldn’t be dealt with as well or better by other Centers or Institutes within the NIH. I’ve even argued that NCCAM should be defunded and dismantled, allowing CAM grant applications to be evaluated by the most appropriate center, as has our fearless leader Steve Novella. Most vociferous of all has been my fellow SBM blogger Kimball Atwood, who has made similar arguments at even greater length. I’ve also pointed out Harkin and other CAM-friendly legislators created and managed to increase the funding of NCCAM to the tune of $120+ million a year not for the purpose of rigorous scientific evaluation of CAM practices, but rather to promote CAM and ultimately “integrate” it with scientific medicine. At this they have been enormously successful.

Let me clarify. What I meant is that NCCAM, along with the Bravewell Collaborative, has been very successful in popularizing CAM in medical academia; at “proving” that CAM works, not so much. Evidence that this is so comes from a recent observation that Senator Tom Harkin is very, very unhappy with NCCAM these days and has publicly said so recently, as pointed out by Lindsay Beyerstein, daughter of the late, great skeptical psychologist Barry Beyerstein. On Thursday, Harkin told a Senate panel, Integrative Care: A Pathway to a Healthier Nation, that he was disappointed that NCCAM had disproven too many alternative therapies. (His remarks begin about 17 minutes into the video on the webpage to which I linked.) In addition, Harkin’s statements have also been posted to his Senate blog:

“I am pleased to co-chair this morning’s hearing with Senator Mikulski. And I am eager to hear our distinguished witnesses’ ideas on using integrative care to keep people healthy, improve healthcare outcomes, and reduce healthcare costs.

“It is fashionable, these days, to quote Abraham Lincoln. So I would like to quote from his 1862 address to Congress – words that should inspire us as we craft health care reform legislation. Lincoln said, “The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty . . . . As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country.”

“Clearly, the time has come to “think anew” and to “disenthrall ourselves” from the dogmas and biases that have made our current health care system – based overwhelmingly on conventional medicine – in so many ways wasteful and dysfunctional.

I note that on the video, Harkin does not say “conventional medicine.” In fact, he says “conventional allopathic medicine.” And, as any regular reader of this blog knows, anyone who uses the term “allopathic” in such a contemptuous manner to describe conventional scientific medicine has clearly drunk the Kool Aid. But, consistent with how I’ve warned that CAM advocates would do their best to hijack any effort on the part of the Obama administration to reform the health care system by trying to link all manner of unscientific woo to “prevention,” Harkin goes on to do just that:

It is time to end the discrimination against alternative health care practices.

“It is time for America’s health care system to emphasize coordination and continuity of care, patient-centeredness, and prevention.

“And it is time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative.

“This is about giving people the pragmatic alternatives they want, while ending discrimination against practitioners of scientifically based alternative health care. It is about improving health care outcomes. And, yes, it is about reducing health care costs. Generally speaking, alternative therapies are less expensive and less intrusive – and we need to take advantage of that.

Note the false dichotomy. It is not necessary to embrace pseudoscience in order to reform the health care system to emphasize “coordination, continuity of care, and prevention.” Nor, I would argue, is it necessary to use placebo medicine as a coequal to scientific medicine in order to reduce costs (unless, of course, your goal is to reduce costs by not treating patients adequately), and, let’s face it, placebo medicine is what the vast majority of the hodge-podge of unscientific and pseudoscientific practices that fall under the rubric of CAM are.

Most tellingly, Harkins makes the agenda of CAM advocates to hijack health care reform in order to get their foot in the door as “preventative” medicine as plain as can be, exactly as I described recently. Harkins first prefaces his remarks by explaining how he decided he wanted to write the legislation that brought into existence the OAM and, later, NCCAM. Not surprisingly, it was based on an anecdote about a friend of his from the House of Representatives who had a serious illness, tried “alternative” approaches, and supposedly got better. Then, Harkins makes a startling admission:

One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.

Note what Harkin first says here. He doesn’t say that the purpose of NCCAM was to investigate alternative approaches and determine if they work or not, regardless of what the results turned out to be. Rather, he states plainly that the purpose of NCCAM was to investigate and validate alternative approaches. His concept for NCCAM is that it would prove that his favored woo works. That’s why he’s so disappointed that the vast majority of the studies coming out of NCCAM are actually negative. Moreover, he clearly doesn’t understand how science works. Hypothesis testing involves designing experiments or clinical trials that can be falsified; i.e., “disproved.” If an experiment or clinical trial can’t falsify the hypothesis that is being tested, then it is not really science. Falsification (attempting to disprove the hypothesis) is at the heart of how the scientific method works. But Tom Harkin does not want NCCAM to work by the scientific method. Not really. He has claimed that he does, but his statements above make it very clear that he only likes the scientific method when its results are what he wants them to be. Under NCCAM, many studies have been performed by believers under conditions quite favorable to producing apparently “positive results”; yet few and far between are any results resembling anything postive when it comes to NCCAM-funded studies, and they’re firtually nonexistent for studies funded by NCCAM for the major favored CAM modalities, such as “energy healing,” acupuncture, therapeutic touch. Only studies of herbs produce positive results, and such studies are nothing more than pharmacognosy, which could be done in virtually any Institute, depending upon what natural product is being studied. A special center for herbalism is not needed, and all the other CAM practices have, by and large, failed to stand up to even the favorable scrutiny of NCCAM-funded studies.

In any case, now Senator Harkin is unhappy because NCCAM isn’t proving what he wants it to prove. So what’s his new strategy? Why, to “integrate” these therapies that have failed thus far to stand up to scientific scrutiny with scientific medicine! In fact, he makes it very clear that he plans on yoking any health care reform that President Obama tries to pass through the Congress to the addition of integrative medicine:

Since 1992 the field has evolved and matured. Today, we are not just talking about alternative practices but also the integration between conventional and alternative therapies in order to achieve truly integrative health. We need to have practitioners talking with each other, collaborating to treat the whole person. And this is the model we intend to build into our health care reform bill.

On several occasions, I have laid down a public marker, saying that if we pass a bill that greatly extends health insurance coverage but does nothing to create a dramatically stronger prevention and public health infrastructure and agenda, then we will have failed the American people.

Well, this morning, I want to lay down a second marker: If we fail to seize this unique opportunity to adopt a pragmatic, integrative approach to health care, then that, too, would constitute a serious failure.

That, my dear readers, is what we are dealing with. A very powerful, senior Senator invites “luminaries” of the CAM movement to testify in front of his Senate committee and states openly that he will consider any health care reform that doesn’t include “integrative medicine” to be a failure. Funny, but as an advocate of science- and evidence-based medicine, I would consider a health care reform package that does include the integration of unproven health care modalities, many of which are based on a pre-scientific understanding of illness, with science- and evidence-based medicine to be a catastrophic failure of health care reform.

I encourage our readers, particularly the ones who are registered voters in Iowa, to comment on Senator Harkin’s statement using the link at the bottom of his blog entry.

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

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24 thoughts on “Senator Tom Harkin: “Disappointed” that NCCAM hasn’t “validated” more CAM

  1. wertys says:

    He seems a very long way down the rabbit-hole ! Do we know how his campaigns have been funded ?

  2. A very powerful, senior Senator… will consider any health care reform that doesn’t include “integrative medicine” to be a failure.

    Sheesh. This position is somewhat like saying that any teaching of life development would not be complete without references to intelligent design, creationism, and etc.

  3. David Gorski says:

    Actually, it’s worse than that. It’s like saying that any teaching of life development that doesn’t put the integration of creationism with evolution at its very core would be a failure.

  4. mmarsh says:

    I’d suggest to Sen. Harkin that the reason the NCCAM hasn’t proven any “alternative” treatments is that, however much they may look the same to you, you’ll never prove that a jackass is a thoroughbred.

  5. daijiyobu says:

    Dr. G. wrote: “Harkin says ‘conventional allopathic medicine’.”

    My term for this is ‘CAM’s false reverse-sectarian-accusation’: it reminds me of the creation scientists’ failed strategy that claimed evolution [science] is as much a religion as Genesis, and therefore their sectarian ideology deserved an equal footing in the curriculum of a publicly funded high school science classroom.

    And: “‘most of its focus has been on disproving things rather than seeking out and approving’ [...] if an experiment or clinical trial can’t falsify the hypothesis that is being tested, then it is not really science [...Harkin] makes it very clear that he plans on yoking any health care reform that President Obama tries to pass through the Congress to the addition of integrative medicine.”

    I guess there’s no such thing as statistical analysis in Harkinland, and science is, therein, merely the ‘sword of sectarianism’ [used to support predeterminations!] — as opposed to objective, rigorous & delusion-busting; while Karl Popper rocks on!

    Per: “a very powerful, senior Senator invites ‘luminaries’ of the CAM movement to testify in front of his Senate committee and states openly that he will consider any health care reform that doesn’t include ‘integrative medicine’ to be a failure”,

    Jade, K.A. (ND Bastyr 2004) (see http://www.examiner.com/x-4737-Seattle-Alternative-Medicine-Examiner~y2009m3d1-Alternative-medicine-gurus-testify-before-Senate ) reports [!!!]:

    “on Thursday, February 26th, some of the top alternative medicine gurus in the US testified before the senate on how alternative medicine can help solve our health care crisis.”

    Speaking of IRONY METERS exploding…GURU is the most perfect label for these sCAM luminaries.

    G.U.R.U. = Go Under the Radar and Usurp!!!

    And Jade also reports [promotes!!!]:

    “functional medicine [FM, a sCAM sub-brand] is patient-centered form of alternative health care that addresses the unique interactions among genetic, environmental and lifestyle factors influencing both health and complex, chronic disease [...it's] the science-based treatment of chronic disease [...partly led by] Bastyr University’s President Emeritus Dr. Joseph E. Pizzorno, ND, [an ND G.U.R.U. who is] one of the world’s leading authorities on science-based natural medicine [naturopathy!!!].”

    I’ll see your irony, and I raise:

    per the above, sCAM’s FM is unique [unrepeatable! / untestable!] but scientific [verifiable! / rigorously tested!] — while Pizzorno, the science-based medicine expert specifically states that naturopathy is a [sectarian...religulous!] “spirit”-based system per

    http://web.archive.org/web/20050217052048/http:/www.healthy.net/scr/Article.asp?Id=1235

    -r.c.

  6. LindaRosaRN says:

    Harkin reminds me of a state senator I testified before regarding a health freedom bill a few years ago. I was, of course, stumping for science as the standard for medicine. (The bill would have reduced the standard to whatever sounds reasonable to the man in the street.) After I spoke, the senator commented, “What’s so great about science? Look at Scientology!”

  7. Mojo says:

    I note that on the video, Harkin does not say “conventional medicine.” In fact, he says “conventional allopathic medicine.”

    The irony is that the only forms of medicine that apply “allopathic” principles (i.e. attempting to heal using opposing effects/balancing of “humours”) these days are systems that Harkin most likely approves of such as TCM or Ayurveda.

    An ongoing problem with many proponents of CAM is that they seem unable to understand that medicine has moved on over the last couple of centuries. I suppose it’s an easy mistake to make if you support fossilized mistakes such as homoeopathy.

  8. Dr Benway says:

    This is about giving people the pragmatic alternatives they want, while ending discrimination against practitioners of scientifically based alternative health care.

    Has no one told the senator that “alternative” means “unproven”? Does he understand why scientists “discriminate” against those who assert claims without evidence?

    Does the senator believe that ignorance is strength, war is peace, and slavery is freedom?

  9. Joe says:

    wertys on 01 Mar 2009 at 8:10 pm asked “… Do we know how his campaigns have been funded ?”

    The short answer is that I do not. However, I have never heard any allegations; he seems to be a true believer. He thinks his allergies were cured by bee-pollen. Then he came under the thrall of a sCAM merchant.

  10. tarran says:

    Does the senator believe that ignorance is strength, war is peace, and slavery is freedom?

    He is a legislator, so the answer is yes. Ask yourself why, if we already have a department of defense, he was pushing for the creation of a department of homeland security?

    Snark aside, the root cause here is not that Tom Harkin is an idiot, but that has has a huge pot of someone else’s money to play with. He does not bear the costs of any dumb spending decisions he may make. Ditto, incidentally, for the proponents of government-funded scientific research.

    If one contrasts endeavors which are voluntarily funded with ones that are not, one will notice that the controversies and spending decisions are made quite differently. Imagine a NIH that was funded by voluntary donations. If a board member had proposed the creation of a NCCAM and the divertion of funds to that purpose, there would probably be a share-holder battle. If the implacable opposition, the guys who would stop funding the NIH if NCCAM was created, were sufficiently numerous, then the shruggies on the board would decide that the lost revenue from the opposition would more than outweigh any extra funding, if any, they would get from adding an NCCAM. The pro-NCCAM guys, would also be free to set up their own competing independent institute, which would be judged based on how well it satisfied its donors.

    In science, reputation matters. In voluntarily-funded science, reputation is absolutely critical, because once the idea that you are wasting donor funds gets about, the funds will quickly dry up, never to come again.

    The existence of government funded science gives the pro-woo guys the following opportunity: they spend perhaps 1 million dollars on lobbying. They get several million dollars’ worth of “research” grants and oodles of free publicity, all paid for by the disinterested and long-suffering taxpayer. By concentrating the money available for scientific research into one basket, it inevitably forces people to fight each other tooth and nail in a winner take all type contest. And the fact that the political leaders are elected means that some real vile and/or stupid people will be picking the winners.

  11. Fifi says:

    tarran – “He is a legislator, so the answer is yes. Ask yourself why, if we already have a department of defense, he was pushing for the creation of a department of homeland security?”

    Thanks for saying that with less snark than I could! ;-) Though, I think really it’s’ “he is a politician, so the answer is yes.”

    tarran – “In voluntarily-funded science, reputation is absolutely critical, because once the idea that you are wasting donor funds gets about, the funds will quickly dry up, never to come again.”

    Well, yes. That’s why research paid for by various private/corporate interests is considered suspect (the researchers are highly motived to please their masters). Show that smoking is bad for health, no funding from the tobacco lobby. Show that a wealthy philanthropist’s religious beliefs about yoga are fantasy, no more funding for that researcher. Wealthy philanthropists are happy to fund CAM wings of hospitals and research as advised by their gurus as a form of “right action” (to make up for how they made their money – about the only thing religion is good for is making rich people feel guilty and like they need to keep up appearances of themselves as generous, caring, “good” people).

    Lobbyists and propagandists aren’t really that interested in scientific integrity or their reputation vis a vis having scientific integrity (after all, they’re “mavericks” – just like Sarah Palin), they’re interested in their public/commercial reputation since their primary goal is selling things (the appearance of scientific legitimacy is just one more way to step up the con/marketing, it’s not actually about the science but about looking “sciency”).

  12. LindaRosaRN says:

    Tarran, well said.

    Is anyone speaking for science-based medicine before Congress to counter the recent testimony by Weil, Oz, Ornish, etc. — those greedy bastards who are characterizing CAM as “preventative medicine” for the future? All those 5,000-year-old rituals weren’t all that preventative in the past, were they…

  13. Fifi says:

    Senator Harkin’s second biggest donator is Herbalife International.

    Organization Contributions
    ATTORNEY $103,510
    PHYSICIAN $56,450
    *HERBALIFE INTERNATIONAL $42,286*
    CONSULTANT $35,300
    FARMER $29,060
    RETIRED $27,650
    GOLDMAN SACHS $24,580
    CONNELL CO $24,000
    TPG CAPITAL $23,100
    SELF-EMPLOYED $19,580

    http://www.maplight.org/map/us/legislator/573/individuals

    ….America, the best “democracy” money can buy….

  14. Joe says:

    Fifi,

    Thanks for linking to that.

  15. Dr Benway says:

    The tufted titmouse makes parody of Senator Tom Harken:

    Integrative Reporting to Keep News Interesting.”

  16. weing says:

    Dr Benway,
    It sure would leave Americans better informed if Weekly World News was integrated with The New York Times and Wall Street Journal.

  17. Jurjen S. says:

    Latching on to Dr Benway’s earlier observation regarding Sen. Harkin’s use of the term “discrimination” to describe the differing attitudes towards science-based medicine and alternative health care (and I should note Harkin has not been the only to do so of late), it deserves to be pointed out that, in both legal terms and common parlance, “discrimination” means treating people in different ways based on irrelevant distinctions. It’s not discrimination when a fire department refuses to hire a paraplegic as a firefighter, because the paraplegic is physically incapable of performing the tasks firefighters need to be able to do (though it would be discrimination if a fire department refused to hire a paraplegic as a dispatcher). It’s also not discrimination if a butcher refuses to hire a vegan who refuses to handle meat products.

    As Dr. Gorski has pointed out ad nauseam on this blog, and his own, the only thing that makes “alternative” health care “alternative” is that it has not (yet) been proven to work, or indeed, as even Sen. Harkin is forced to acknowledge applies to a number of such practices, has been proven not to work (at best, no better than placebo). If any “alternative” health care practice could be demonstrated to work better than placebo, it would be ipso facto be adopted by the “conventional” (i.e. science-based) medical establishment.

    Thus, while “conventional” medicine may receive preferential treatment over “alternative” health care, the difference in treatment is not, in and of itself, evidence of discrimination, because the distinction is based on a crucial difference, namely that science-based medicine can be demonstrated to work, whereas “alternative” health care cannot. Yes, I acknowledge I said “not (yet) proven,” but let’s be honest, when it comes to the more common forms of “alternative” health care, OAM/NCCAM has had more than enough time and funding to produce some evidence–enough to actually justify additional research–but has come up empty-handed every time.

    So, in a nutshell, what I’m saying is: “challenge illegitimate uses of the word ‘discrimination’.”

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