Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Friday, March 11, 2005

The Alternative Universe, by Wallace Sampson, MD

The Alternative Universe
By Wallace Sampson, MD

It is time for Congress to defund the National Center for Complementary and Alternative Medicine (NCCAM.) After ten years of existence and over $200 million in expenditures, it has not proved effectiveness for any "alternative" method. It has added to proof of ineffectiveness of some methods, but we had that disproof before NCCAM was formed. NCCAM proposals for 2002 and 2003 promise no more. Its major accomplishment has been to ensure the positions of school faculty who might become otherwise employed - in more productive pursuits.

Such situations are not often tolerated in scientific fields - at least attempts are made to minimize them. NCCAM seems to be tolerated for three reasons. First, economically strapped medical schools welcome the funds. Second, although most medical scientists recognize the scientific absurdity of most "alternative" claims, most grant recipients and a few deans harbor the same absurd beliefs as do the advocates about the methods' efficacy. Third, and most important, major congressional powers are "CAM" advocates. They have a tight hold on the NIH budgets that fund investigations of real medical science as well. The deal seems to be that if the schools will play ball with and not oppose the senators, the senators will be generous in kind.

Classical Quackery

While the public is distracted by terror attacks, wars, and personal and business scandals, modern medicine's integrity is being eroded by New Age mysticism, cult-like schemes, ideologies, and classical quackery, all known as "alternative medicine." Using obscure language and misleading claims, they promote changes that would propel medicine back five centuries or more. They would supplant objectivity and reason with myths, feelings, hunches and sophistry. NCCAM is being presented as a scientific vehicle to study alternative medicine's anomalous methods. But NCCAM actually promotes the movement by assuming that false and implausible claims are legitimate things to study.

In 1992, Senator Tom Harkin (D - Iowa), convinced that his allergies were cured by bee pollen, assigned $2 million of his discretionary funds to establish the Office of Alternative Medicine (OAM) - NCCAM's first incarnation. OAM was assigned to investigate the "alternative" methods that medical science considered false or implausible. But since their inception, OAM and NCCAM have had serious problems.

The first OAM director resigned under Sen. Harkin's pressure, having objected to Harkin's OAM Council nominees who represented cancer scams such as the Laetrile and Tijuana cancer clinics. One influential Harkin collaborator and constituent was a travel agent for a Bahamas cancer clinic. And The Federal Trade Commission fined Harkin's bee pollen distributor, $200,000 for false claims.

In 1998, Dr. Edward Halperin, President of the North Carolina Medical Association called for disbanding the Office. Responding to objections from the science and medicine communities, NIH Director Harold Varmus placed OAM under more scientific NIH control. But Sen. Harkin countered, elevating OAM to an independent Center. By 2001, the annual budget rocketed to nearly $90 million per year and by 2002, over $100 million per year. Congress, believing erroneously that public demand for unscientific services had increased, passed appropriations without a dissenting vote.

Scientists look at the facts. They see that no sectarian or aberrant method has cured a single person, or extended a life for as much as a day. They see the "CAM" movement to be responding to people's irrational reactions to illness and narcissistic, self-centered wishes. They see no chance for "alternative" or "complementary" methods to replace modern methods. Recent surveys show that the methods merely add on to scientific medicine - adding to cost of care.

We already know that these aberrant methods do not work, or are so unlikely to work that more clinical trials are not reasonable. Why is that? Because we have found the best quality studies are uniformly negative. Most positive studies are poorly designed and poorly controlled.

Testing, Testing

Looking at the most popularly promoted methods we find that acupuncture, after thirty years, over 400 clinical trials, and 33 comprehensive literature reviews of those trials, only two specific conditions were found affected by acupuncture more than sham procedures. But even those effects are minimal, they are not superior to standard medical methods, they remain implausible and unpredictable. They will probably not be confirmed because of their results are best explained by biased experimental errors.

After 100 years and hundreds of trials, chiropractic manipulation shows no advantage over shams for any condition. As for homeopathy, after 200 years and hundreds of studies, researchers cannot prove an effect for any homeopathic remedy for any condition. After a dozen studies, prolonged survival from psychological support for cancer patients has been essentially disproved. Herb product contents cannot be controlled, and their contents have been proved harmful. Some products have been adulterated with common pharmaceutical drugs that account for their apparent effects. If supplement marketers were held responsible for product effects, what more would there be to research?

Millions, Billions, Trillions?

NCCAM Director, Dr. Steven Straus, a career NIH physician without "CAM" experience, now oversees the $113 million annual budget. He wants more funding for more NCCAM trials. But what is the NCCAM record? After eight years of projects and over $200 million, NCCAM and advocates have not proved any method to be effective. Perhaps more important, NCCAM has not declared any method to be ineffective, thus keeping open continuing congressional appropriations.

NCCAM is ridden with potential and actual conflicts of interest. Ten individuals account for 20% of NCCAM awards. None of them has produced a definitively positive or negative report. Most recipients have produced no report at all. Two individuals originally on the Advisory Council that approves NCCAM policy were awarded over $4 million and $5 million in repeated awards.

NCCAM recently announced research on "chelation therapy" for heart disease - a method already disproved and potentially dangerous. And $10 million is planned for research into herbs with their uncontrollable contents and unreliable results. Similarly troubling is NCCAM's awards of over $1 million into psychic healing, and $1.5 million for homeopathy. Both are highly implausible, being not only repeated failures, but promoted falsely as well.

NCCAM recently awarded $15 million to nine medical schools to develop teaching of these subjects - all by advocates of "CAM." It gave no funds to the five medical school courses with curricula already developed that teach about the subject rationally. In other words, NCCAM's research agenda fits its congressional supporters' ideological vision and finds unproductive ways to use up its ballooning appropriations.

NCCAM will never be able to fulfill Dr. Straus's goal to determine effectiveness. Rigorous trials cost $1-5 million each. Five to twenty trials are needed to prove or disprove effectiveness of each product or method. After staff expenses, $100 million per year can support only 10-20 reliable trials per year. Given hundreds of products and methods for hundreds of conditions, costs would be hundreds of billions to trillions of dollars over decades - all to prove what we already know. Then, as occurred after the negative Laetrile and vitamin C trials for cancer, advocates just think up new claims, or claim that the trials were rigged. Sales continue regardless of the disproof. By finding them worthy of study, NCCAM lends legitimacy to implausible methods, resulting in the public spending tens of billions of dollars annually on them.

Ideological Health

We also know that ill-conceived research produces misleading results. The results then lead to repetitive cycles of unproductive work to explain what was found, usually just to disprove the erroneous results. As a result of all this, claims continue.

Tens of millions of U.S. citizens lack medical insurance. Millions of illegal residents produce economic burdens on local medical systems. While real medicine and technology solve these problems and prolong productive life, "alternatives" appeal mostly to disaffected health dilettantes, and add nothing to public health. Worse, CAM's fuzzy thinking style and radical social ideology lead to wrong-headed policies such as the denial of HIV as the cause of AIDS, and the recent fears of vaccinations and electromagnetic fields.

Special commercial interests and irrational, wishful thinking created NCCAM. NCCAM is the only entity in the NIH devoted to an ideological approach to health. To correct the situation, Congress must consider at least interrupting funding of NCCAM while results of work in progress mature. NCCAM could be dissolved, its functions returned to other NIH centers, with no loss of knowledge, and an economic gain. Funds could be invested into studies of how such misadventures into "alternative" medicine can be avoided, and on studying the warping of human perceptions and beliefs that led to the present situation. More public money for investigating methods with negligible promise is foolish economics and even more, is unwise public policy.

Wallace Sampson, MD is Editor of the Scientific Review of Alternative Medicine and Emeritus Clinical Professor of Medicine at Stanford University where he teaches analysis of unfounded medical claims.