The Federal Funding Accountability and Transparency Act (FFATA) was signed on September 26, 2006. The intent is to empower every American with the ability to hold the government accountable for each spending decision. The end result is to reduce wasteful spending in the government. The FFATA legislation requires information on federal awards (federal financial assistance and expenditures) be made available to the public via a single, searchable website, which is www.USASpending.gov.
And what subject is more deserving of being held accountable by the American people than complementary/alternative/integrative medicine? After all, in what other area of government spending does scientific implausibility – indeed, even scientific impossibility – offer no impediment to spending millions of taxpayer dollars in research funds? We’ve complained about the NCCAM’s wasteful spending on pseudomedicine here on SBM several times: here, here, here and here, among others. As you shall see, the problem doesn’t stop at that particular $2.5 billion.
I ask you: does NASA fund astrology research? No. Does it give money to schools teaching astrology? No. Does the Department of Transportation fund studies of perpetual motion machines as an “alternative” engine for vehicles? Not to my knowledge. How about the Department of the Interior? Do they give people money to look for woodland nymphs? Don’t think so.
The beauty of www.USASpending.gov is that it allows us to hone in on exactly who the beneficiaries of this wasteful government largesse are and what are they are being compensated for, over a period of 2001 to 2014. (Imperfectly, however. The website is somewhat creaky and it’s not always clear how they are getting their totals. Also, I’m using amounts from a search of the “prime awards” only. Your results may differ.) That’s how I know the federal government has not spent a single penny on perpetual motion machines or locating woodland nymphs. I did find one study of “Art and Astrology in Renaissance Italy” that got $40,000 from the National Endowment of the Humanities. Of course, the 1300s – 1500s is exactly where astrology should be, along with acupuncture and other pre-scientific concepts.
Acupuncture, on the other hand, has received more government funding than astrology. Much, much more. A whopping $76,848,958 since 2001, in the form of contracts, grants and direct payments. Small Business Association loans accounted for an additional $250,000, including $80,000 to the Eternal Health Wellness Acupuncture Center in San Jose, California, which claims to treat a wide variety of diseases and conditions, such as MS, macro [sic] degeneration, bipolar disorder and herpes, among many others.
The biggest beneficiary of acupuncture research funds has been Massachusetts General Hospital, which received $23,229,593 from NIH between 2009 and 2014 (we are just shy of finishing the 2014 fiscal year). Many of those research dollars went into brain imaging studies of patients being treated with acupuncture, or who were thinking about being treated with acupuncture (“An fMRI study of expectancy on acupuncture treatment outcomes in knee OA”). As Steve Novella and David Coloquhoun pointed out, looking at surrogate outcomes is inappropriate until it is shown that patients get a useful degree of relief, and that hasn’t happened yet. (You can see some of the fruits of your tax dollars being used to stick people with needles and look at their brains here.)
The Department of Defense and Veterans Administration are also big fans of acupuncture research. Although they can’t match NCCAM, they’ve spent close to $8 million on such unpromising research projects as that conducted by the New England School of Acupuncture for “Effectiveness of Acupuncture in the Treatment of Gulf War Illness.” The school, recipient of a little over $5.5 million, promotes such appalling quackery as this:
Pediatrics in general and neurodevelopmental pediatrics in particular are perfect opportunities to apply the principles and practices of Chinese Medicine to help children manifest their destiny. In this two-day workshop, Stephen Cowan MD, developmental pediatrician and author of Fire Child Water Child will offer an in-depth discussion of the physiological unfoldings in child development and the treatment approaches to common developmental dysfunctions that include: attention deficit disorder, emotional dysregulation, learning disabilities and autism.
To add insult to injury, the school has a white coat ceremony for students. Yet another honored medical tradition corrupted by “alternative medicine.”
The Department of Defense paid $750,000 to the Samueli Institute for “Acupuncture for the Treatment of Trauma-Induced Spectrum Disorder: A Three-Arm Randomized Pilot Study.” (The results of a Samueli-sponsored study of acupuncture for PTSD touted before a Congressional Committee last year still have not been reported, as far as I can tell.)
The Samueli Institute is led by Wayne Jonas. M.D., and promotes “integrative medicine” and various “alternative” therapies, such as acupuncture and healing touch, an issue I addressed before on SBM. All in all, the Institute has received over $31 million in taxpayer funds from the Department of Defense and over $43 million in taxpayer dollars altogether since 2003, although none in 2014.
Dr. Jonas recently wrote an opinion piece in JAMA Internal Medicine in which he expressed concern over opioid use for pain in the military and called for a “better way.” And how might we discover this “better way?” More research on integrative medicine. I think we can see where this is headed.
Perhaps just as disturbing as the actual studies are the monies spent in spreading acupuncture throughout the military. Last year, the Henry M. Jackson Foundation for the Advancement of Military Medicine Research got over $3 million for acupuncture training “across clinical settings.” Joseph M. Helms, MD, PC, (a proponent of medical acupuncture) has received $1.3 million, much of it for education and curriculum development
The government has spent almost $120 million on chiropractic, including $4.4 million on Small Business Administration loans to chiropractic practices. There are also direct student loans, but those show up as $0, a curious outcome considering the default rate on chiropractic student loans runs into the millions of dollars. (Again, it’s not clear how the government is reaching the totals given on the website.) The balance is in grants, contracts and direct payments.
One of the primary benefactors of government monies is Palmer Chiropractic College, which received $14 million from the NIH and the Department of HHS Health Resources and Services Administration, as well as the military. These monies have gone toward the establishment of, and research conducted by, the Palmer Research Center. We’ve mentioned the Center before, in its conduct of a study which didn’t seem to produce much of anything in the way of useful results. (See Orac’s dissection here.) That didn’t stop another $7 million plus from going to the RAND Corporation, which will, with the help of the Research Center and the Samueli Institute, conduct an even larger study of standard medical care alone plus standard medical care and “chiropractic care.” One wonders why not just spinal manipulative therapy, not “chiropractic care?” At least that would help isolate the variable that may produce an effect. Or why not medical care and physical therapy?
The study’s title reveals a curious mixture of subjects: “Assessment of Chiropractic Treatment for Low Back Pain, Military Readiness, and Smoking Cessation in Military Active Duty Personnel.” Smoking cessation, by the way, will not be a part of standard medical care – only the chiropractors will get to do that. Let’s just imagine what the results will be: patients who get the extra time and attention beyond standard medical care will do better and this study won’t tell us why, including whether it was simply the extra attention.
But the problems with giving Palmer College all this money go beyond the questionable utility of spending millions of dollars on this study. Palmer is firmly rooted in the non-existent subluxation and its students are required to be proficient in its “detection” and “correction.” As befitting a school loyal to the subluxation, it teaches quack diagnostic and treatment methods like the NUCCA technique and the Atlas Orthogonal Technique. And although the Palmer College website is suspiciously silent on immunizations, chiropractic opposition to vaccination is well-known and one doubts that students are taught objective, evidence-based guidelines for immunizations.
The Center has also participated in other sketchy government-funded research, including the TACT trial. This year, a study was conducted on “Effect of Lumbar Hypo & Hypermobility on Sensory Responses to Spinal Manipulation.” Let’s decode this title. Hypo/hypermobility of the vertebrae is of legitimate concern to manual therapists, but to some chiropractors this hypo/hypermobility is an indication of the presence of a “subluxation.” In other words, it appears Palmer researchers are continuing to look for evidence that the elusive subluxation actually exists.
Why do I think this is a reasonable suspicion? One, as discussed, Palmer College is loyal to the subluxation as a viable “theory” and teaches the concept and its clinical application to students. Two, although the page was removed after I mentioned it in a post last year, as of July, 2013, the Center was telling the public that one of its three areas of research was “mechanisms of care, which encompass normative data, spine lesions (e.g. vertebral subluxation complex) and spinal manipulation/adjustment.”
Contrast the school’s credulous acceptance of a pseudo-scientific concept with the Palmer Research Center director’s taking the American Heart Association/American Stroke Association “to task” over their warning that stroke may be associated with cervical manipulation. Here’s what Christine Goertz, DC, PhD, had to say about that:
“The facts are that VADs are very, very rare events, and there’s absolutely no research that shows a cause-and-effect relationship between chiropractic care and stroke,” said Dr. Goertz. “Doctors need to be careful about how they counsel patients based on misleading statements, like this one from the American Heart Association.”
(Note the euphemistic “chiropractic care” used as a substitute for neck manipulation.)
In sum, looking for evidence of the non-existent chiropractic subluxation is perfectly reasonable, but we need research “that shows a cause-and-effect relationship between chiropractic care and stroke” to conclude that stroke may be associated with cervical manipulation.
Compared to acupuncture and chiropractic, naturopathy has received a paltry $6 million since 2003, and the amount has dwindled to a less than $400,000 this year. The majority of that was spent at naturopathic schools to teach naturopaths how to do research and most of it went to the National College of Natural Medicine, with a small portion going to Bastyr. Educating naturopaths in research seems like a fool’s errand, since the evidence indicates they care little about evidence-based practice. (See also: here, here and here, among others.)
A small amount of naturopathic funding went to actual research, including “Carpal Tunnel Syndrome and Static Magnetic Field Therapy.” There was also a small (n=40) prospective study of adjunctive naturopathic care for Type 2 diabetes, in which patients got up to 8 visits to a naturopath in addition to medical care, but any positive results could not be attributed to anything the naturopaths did. (This seems to be a recurring theme in CAM practitioner research: giving CAM an advantage in comparing it to standard medical care by providing extras to the CAM care group.)
Homeopathy got about $230,000 in government funding (including a study titled “Polysomnography in Homeopathic Remedy Effects” at the University of Arizona) although no money’s been spent since 2008. Reiki, on the other hand, has gotten almost a million dollars, including over $400,000 paid by the Department of Defense to a “Reiki Master” in El Paso, Texas.
Why are we doing this?
As has been pointed out before, the government should not be funding research of pseudomedicine and quackery because it doesn’t appear to affect CAM practices. Why bother? It is also a terrible waste of resources. How many other worthy projects went wanting due to lack of available funding?
But the spending has another deleterious effect. It perpetuates institutions that have little respect for science. It helps businesses get started that promote quackery. Even where their operations are not directly affected by government largesse, this money allows those institutions to burnish their images with the presumed respectability of, for example, NIH research funding. It also builds infrastructure and allows the hiring of staff. I doubt there would be a Palmer Research Center without government funding. According to its 2011 tax return, over half of the Samueli Institute’s annual expenses of about $12.5 million came from the government. Dr. Jonas’s salary from this and a related organization were reported at just over $500,000.
Gosh, what we wouldn’t give for a measly half a million dollars to promote science-based medicine?
Addendum: I had no idea when I wrote this post that a pointed and well-deserved critique of complementary/alternative/integrative medicine research would appear practically simultaneously in the journal Trends in Molecular Medicine, written by SBM’s own David Gorski and Steve Novella. Be sure to read the post (found here) for more information and a link to this excellent article.