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Vaccine Wars: the NCCAM Drops the Ball

If you go to the website of the National Center for Complementary and Alternative Medicine (NCCAM), you’ll find that one of its self-identified roles is to “provide information about CAM.” NCCAM Director Josephine Briggs is proud to assert that the website fulfills this expectation. As many readers will recall, three of your bloggers visited the NCCAM last April, after having received an invitation from Dr. Briggs. We differed from her in our opinion of the website: one of our suggestions was that the NCCAM could do a better job providing American citizens with useful and accurate information about “CAM.”

We cited, among several examples, the website offering little response to the dangerous problem of widespread misinformation about childhood immunizations. As Dr. Novella subsequently reported, it seemed that we’d scored a point on that one:

…Dr. Briggs did agree that anti-vaccine sentiments are common in the world of CAM and that the NCCAM can do more to combat this. Information countering anti-vaccine propaganda would be a welcome addition to the NCCAM site.

In anticipation of SBM’s Vaccine Awareness Week, I decided to find out whether such a welcome addition has come to fruition. The short answer: nope.

Go where the Money Is(n’t)

I looked on the NCCAM website in places where common sense would dictate that such content might be found:

In each case I searched for the terms “vaccine,” “vaccination,” “immunization,” “autism,” “MMR,” “thimerosal,” “mercury,” and variations of those words. No dice. I found a couple of mentions of vaccinations by using the general NCCAM website search function; Drs. Novella, Gorski, and I had been aware of these when we visited Dr. Briggs in April, but for completeness’ sake I’ll cite them here. One is in an essay titled Colds and Flu and CAM: At a Glance, dated January, 2010. It states, correctly, that “Vaccination is the best protection against contracting the flu,” but it offers no further comment. There is no rebuttal of vaccine myths, nor even an acknowledgment that such myths exist. Another is in a Message from the Director from October, 2009, which appears to be the precursor of the “Colds and Flu” essay. Here, Dr. Briggs briefly acknowledges vaccine myths:

Vaccination is the best protection against contracting the flu. I know that many people are very concerned about the safety of the flu vaccines, but let me echo the Centers for Disease Control and Prevention, as well as other prominent public health leaders, in assuring you that the vaccines for both the seasonal flu as well as H1N1 have a very good safety track record. Over the years, hundreds of millions of Americans have received the flu vaccine, and the development of the H1N1 vaccine followed the same path of safety and effectiveness testing and approval.

One wonders why that language is absent from the subsequent, larger essay. Not that including it would have addressed the problem of vaccine myths in general, as suggested by the search terms that I chose.

“Whole Medical Systems” lack Whole Discussions

On the NCCAM website there are other notable failures to respond to public misinformation about immunizations. In the Homeopathy treatise there is no mention that homeopaths have famously railed against vaccinations ever since Constantine Hering, the “father of American homeopathy,” called them “always a poisoning.” Nor is there any mention of Hering’s invention, “homeopathic nosodes,” also called “homeopathic vaccinations,” which homeopaths such as Dana Ullman claim to be effective in preventing infectious diseases.

A similar failure exists in the Naturopathy treatise. Many influential naturopaths are anti-vaccine; they advocate “homeopathic nosodes” or other implausible measures. I wonder if Dr. Briggs had any inkling of this when she flattered the American Association of Naturopathic Physicians—whose Position Paper on Childhood Vaccinations is certain to mislead and frighten parents—with her presence at their annual convention in August.

Credentialing Nonsense

Linked from the “Be an Informed Consumer” page on the NCCAM website is an essay titled Credentialing CAM Providers: Understanding CAM Education, Training, Regulation, and Licensing. In it we are told that

A physician’s credentials—the licenses, certificates, and diplomas on the office walls—tell us about that person’s professional qualifications to advise and treat us. We seek similar assurances when we choose a complementary and alternative medicine (CAM) practitioner…

The essay hedges a bit, but is careful to suggest that “CAM” credentials are every bit as trustworthy as those held by real doctors:

Regulations, licenses, or certificates do not guarantee safe, effective treatment from any provider—conventional or CAM.

We are told that “naturopathic physicians” are licensed in 15 states and the District of Columbia, that they have undergone apparently rigorous training in “natural sciences and clinical sciences,” and that they have passed an apparently rigorous, standardized exam offered to “graduates of accredited programs” by their national organization, the American Association of Naturopathic Physicians. The essay makes similar statements about homeopaths and chiropractors—another group with a well-documented distaste for vaccinations.

Such claims of training and credentialing are deceptive, because the fields are bastions of pseudoscience. In the words of Edzard Ernst, “the most meticulous regulation of nonsense must still result in nonsense.” Yet an unsuspecting person looking for responsible information about “CAM” on the NCCAM website would be led to believe, along with all the other nonsense, that the anti-vaccination views of naturopaths, homeopaths, and chiropractors are valid and based on science.

It is no surprise that the NCCAM “Credentialing” essay relies heavily upon the writings of attorney Michael H. Cohen, a champion of quackery about whom we’ve heard before on SBM.

Why?

I used to suppose that the NCCAM website ignoring vaccination hysteria was a matter of naïveté: most NCCAM functionaries know little of the practices and practitioners with which they are expected to be familiar. This probably remains true to a large extent, but we know that Dr. Briggs, at least, is aware of the intimate relation between “CAM” advocacy and the anti-vax movement. Perhaps she hasn’t got around to making the promised changes on the website, but if so, why not? Widespread fear-mongering about vaccines being poisons and causing autism is a far more important public health issue than whether or not glucosamine is useful for osteoarthritis, or whether acupuncture might be useful for fibromyalgia, or any of the rest of the standard, breezy, NCCAM fare. The refutation of dangerous myths about vaccines ought to be a priority.

During our visit, Dr. Briggs, who has been at the NCCAM only since 2008, made a point of denying that she feels pressure from Congressional “CAM” demagogues such as Dan Burton and Tom Harkin. That may seem true in the day-to-day grind of her job, but such pressure has permeated the culture of the NCCAM since before its formal inception, as documented many times here on SBM and elsewhere. Rep. Burton conducted numerous pro-quack hearings during his tenure as chairman of the House Committee on Government Reform. His bullying of NIH directors is largely responsible for two of the most unethical trials ever funded by the NCCAM, the Gonzalez trial for cancer of the pancreas and the Trial to Assess Chelation Therapy. Burton is also a champion of quacks who claim that vaccines cause autism.

Sen. Harkin was the creator of both the NCCAM and its predecessor, the Office of Alternative Medicine (OAM). He famously stacked the OAM advisory panel with four pseudoscientific zealots who would be become known as “Harkinites.” He worries that the NCCAM hasn’t spent its time “seeking out and approving [alternative methods].” He hypes “integrative medicine” as the Next Big Thing, the answer to

the dogmas and biases that have made our current health care system – based overwhelmingly on conventional medicine – in so many ways wasteful and dysfunctional.

In particular, assert Sen. Harkin and other advocates, “integrative medicine” will mean preventative medicine. I’ve discussed this deception previously: it’s worse than a Damned Lie. I can’t help but restate, for the occasion of Vaccine Awareness Week, an unending source of ironic amusement for your SBM bloggers and for rational thinkers everywhere: immunizations, also called vaccinations (for the first of their kind, made from cowpox exudate), are the most effective preventative health measures ever devised; yet “alternative medicine” pushers of every stripe, who claim special, proprietary knowledge about achieving ‘wellness,’ can dependably be counted on to oppose them.

A Web of Misinformation

The NCCAM, whether Dr. Briggs would like to admit it or not, is heavily influenced by such sentiments. We’ve already seen how the Center’s website whitewashes naturopaths, homeopaths, and chiropractors. We’ve seen how Dan Burton has single-handedly forced the NCCAM to fund horrible trials and to employ investigators who are charlatans and even criminals. We know that National Advisory Council for Complementary and Alternative Medicine (NACCAM) has been and continues to be, as a matter of law, a bastion of naturopaths, chiropractors, and other quacks.

“Wait a minute,” someone might be thinking, “you can’t conclude from your cited evidence that Harkin himself is anti-vax.” That’s true, but it doesn’t matter. What’s important, for the purposes of this discussion, is the company that he and the NCCAM keep. Let’s illustrate this by citing an example from the current membership of the Advisory Council.

Janet Kahn is the Executive Director of the Integrated Healthcare Policy Consortium (IHPC). The organization was founded in 2001 at the completion of the “National Policy Dialogue to Advance Integrated Health Care: Finding Common Ground,” whose report was co-authored by two naturopaths. As was true of that report, the IHPC agenda and beliefs are exactly in line with those of Harkin and other “integrative medicine” enthusiasts. The IHPC has a Federal Policy Committee whose goal is to fearlessly and tirelessly “transform the very architecture of the US healthcare system.” This, the IHPC intends, will be accomplished by legislative fiat: practitioners of implausible methods will simply be shoehorned into mainstream health care, bypassing science and rational practice standards.

Now let’s close the anti-vax/NCCAM circle. If you’ve looked at the many documents linked from this post, you might have noticed the name Michael Traub. He is a naturopath and homeopath who is on the IHPC’s Board of Directors, Federal Policy Committee, and Steering Committee. He was co-author of the “National Policy Dialogue” report cited just above. He is a past-President of the American Association of Naturopathic Physicians, and last summer shared the podium with NCCAM Director Briggs.

In 1994, Traub published an article, titled “Homeopathic prophylaxis,” for the Journal of Naturopathic Medicine. As previously explained,

[The] article suggests that homeopathic products are safer and more effective than vaccination for preventing disease. The article’s author (Michael Traub, N.D.) taught public health at the National College of Naturopathic Medicine and helped formulate the AANP’s position papers on immunization and homeopathy. He recommends tetanus vaccine but advises against measles, mumps, rubella, and diphtheria. After paying homage to a homeopathic treatise on “vaccinosis” published more than 100 years ago, Traub’s article details the use of homeopathic nosodes for preventing diphtheria, whooping cough, polio, influenza, tuberculosis, and pneumoccal pneumonia. Nosodes are products made by repeatedly diluting samples of pathological tissues, bacteria, fungi, ova, parasites, virus particles, yeast, disease products (such as pus), or excretions. The protocol Traub describes uses “200C potencies” which means that the nosodes are made by serially diluting the original substance 1-to-100 a total of 200 times. (After the 12th dilution, no molecule of original substance remains.) Traub states that he no longer recommends nosodes but uses other “preventive” homeopathic strategies.

That Traub hasn’t substantially changed his tune since 1994 is suggested by the title of a 2004 article, “Alternatives to Flu Shots”—I won’t pay to read it, but you can find it linked from here—and by Traub’s recent report of his own bout with apparent H1N1 flu, which can most generously be described as ditzy. Circle closed; there are many more.

Conclusion

Is it possible that the ubiquitous influence of “CAM” and its fellow traveler, anti-vaccination hysteria, is the real reason that the NCCAM website lacks responsible, definitive information about immunizations and pseudo-immunizations? If this is not the case, and if Dr. Briggs reads this, I hope she’ll be reminded of our discussion in April and consider this a challenge to show us that she is a player. I also hope that she’ll remember that her constituents are approximately 300 million American citizens, not merely tiny fringe groups of homeopaths, naturopaths, and Jenny McCarthy.

Posted in: Chiropractic, Health Fraud, Homeopathy, Legal, Medical Ethics, Naturopathy, Politics and Regulation, Public Health, Science and the Media

Leave a Comment (7) ↓

7 thoughts on “Vaccine Wars: the NCCAM Drops the Ball

  1. David Gorski says:

    Perhaps she hasn’t got around to making the promised changes on the website, but if so, why not?

    Well, it has been only seven months, and this is the federal government. :-)

    Actually I doubt Dr. Briggs will ever do get around to putting good information about vaccines on the NCCAM website and criticizing the anti-vaccine proclivities of so many CAMsters. It would require going to war with NACCAM, and I didn’t detect in her the steel in the spine necessary to do that.

  2. Khym Chanur says:

    In the Homeopathy treatise there is no mention that homeopaths have famously railed against vaccinations ever since Constantine Hering, the “father of American homeopathy,”

    Interestingly, Hahnemann approved of the smallpox vaccine, probably because he thought that it supported his idea that two different causes of the same set of symptoms can’t exist in the body at the same time (that is, smallpox and cowpox were different diseases with similar symptoms).

  3. Jann Bellamy says:

    With everyone in Washington tripping all over each other trying to reduce government spending, NCCAM is low-hanging fruit ripe for the picking. What other federal agency can claim spending over 2 billion dollars without a single positive result for its “cause” AND being dangerous to the public health to boot? I recently discussed this with a Representative in Congress I know and her staff. She was appalled that researchers at a major public university (with a medical school) in her district regularly went begging for research money while millions were siphoned off for NCCAM. I hope all of you who care about science-based medicine will contact your representatives in Congress and complain.

  4. JMB says:

    NCCAM funding is in many ways an earmark. It is a pet project of a few politicians. Until NCCAM starts reporting negative results, it does not serve the consumer protection. But this is just science practiced by politicians — never admit you were wrong, just stick to a positive spin on negative results, and keep the taxpayer money flowing! I guess the positive spin is that with all that research money wasted, we won’t have to worry about it paying for a new medical intervention that would be expensive (but actually save lives or stamp out disease).

    Too bad there is not a skeptical, empirical legislation rule, in which every law passed must have a mandated metric determining whether the law was successful in it’s intent. Laws that fail the intended effect are automatically repealed, and the politicians who supported it would be discredited.

  5. windriven says:

    Government has become – and maybe democratic government has always been – about making sure that all of the interest groups get a bone. Big interest groups like the NEA get big meaty bones. Smaller interest groups get smaller bones. In the realm of federal spending ~$100 million is a relatively small bone – barely 0.1% of the budget.

    And NCCAM lets the feds have it both ways – a circumstance that politicians of all stripes dearly love. The woo lobby gets its own little chunk of NIH to give it some legitimacy while the (all but nonexistent) skeptic lobby can be assured that NCCAM debunks worthless nostrums.

    The reality is that chiroquacksters (ACA), needle twiddlers (AAAOM) and their ilk take an organized approach to their relationships with Congress. They define themselves to those in Washington as being bone-worthy.

    We on the other hand, blog, comment, punk the occasional troll, congratulate ourselves and go out for a beer. We are not a meaningful interest group. So when it comes to Washington, we just get boned.

  6. cervantes says:

    Until NCCAM starts reporting negative results, it does not serve the consumer protection.

    Actually, it does report negative results. All of the trials it has funded have so far produced negative results. Some of these have been published.

    You could argue that this is all to the good, it tells people to stop wasting their money on quackery, but unfortunately it doesn’t really make any difference. CAM advocates just keep moving the goalposts and saying that more research is needed.

    NCCAM is now attracting investigators who are interested in studying placebo effects. It may not be the best mechanism for doing that, but at least it’s becoming obvious to many that is the only way to reconcile the mission of NCCAM with science.

  7. Ken Pidcock says:

    I recently had occasion to visit NCCAM’s homeopathy page. It’s classic “it’s not necessary to tell the truth so long as you don’t lie” content.

    There are challenges in studying homeopathy and controversies regarding the field. This is largely because a number of its key concepts are not consistent with the current understanding of science, particularly chemistry and physics.

    That agency is an embarrassment to NIH.

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