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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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