Complementary and alternative medicine Medicine Politics Quackery

NCCAM: Your tax dollars hard at work funding woo

I used to be somewhat of a supporter of the National Center for Complementary and Alternative Medicine (NCCAM). I really did. This was back when I was more naïve and idealistic. Indeed, when I first read Wally Sampson’s article Why NCCAM should be defunded, I thought it a bit too strident and even rather close-minded. At the time, I thought that the best way to separate the wheat from the chaff was to apply the scientific method to the various “CAM” modalities and let the chips fall where they may.

Unfortunately, two developments have made me sour on NCCAM and develop an opinion more like Dr. Sampson’s. First, the NIH budget stopped growing and, adjusted for inflation, is now contracting. NCCAM’s yearly budget is in the range of $121 million a year. That’s enough money to fund around 75 to 100 five year R01 grants, give or take, and in tight budgetary times my view is that prioritization of funding should be for projects that do not have hypotheses behind them that are outlandishly implausible from a scientific standpoint. Second, I’ve seen over the last few years how NCCAM is not only funding research (most of which is of the sort that wouldn’t stand a chance in a study section from other Institutes or Centers, making NCCAM the affirmative action of scientific funding) but it’s funding training programs. These training programs are, quite frankly, designed to indoctrinate the next generation of physicians into being woo-friendly, and they are working. Indeed, one of the big reasons for the expansion of the Academic Woo Aggregator is fellowships and programs funded by NCCAM.

Yesterday, I learned how NCCAM is putting my tax dollars to work (and, of course, yours) when I saw its announcement of the research projects that it funded in FY 2007. I could scarcely believe some of what I read, and I could all too readily believe the rest.

Perusing the list of projects is truly depressing. True, a lot of the projects seem to be yet another study of Ginkgo Biloba, cranberry juice, or soy in various diseases. That’s all well and good, but why is the study of natural products considered “alternative” or “complementary”? It’s the same sort of stuff that pharmacologists have been doing for decades, and, indeed, I suspect some pharmacologists and medicinal chemists are probably looking at NCCAM as easy money if they just slap together a project to study the herb du jour. If they’re trying to isolate the active constitutent of these herbal remedies, it’s OK science, but really what they are studying is mostly impure mixtures of hundreds of compounds that make up herbal remedies.

More disturbing is the woo. For instance, there is an R21 grant funding a study called Polysomnography in Homeopathic Remedy Effects. Yes, you have it right. Your tax dollars are going to fund at least a study this year on homeopathic remedies (a.k.a. water). But it’s even worse than that. There was actually awarded an R21 grant to study homeopathic dilution and succussion and how they affect the dose-response curve of homepathic remedies. I kid you not. I just about spit out my tea onto my laptop keyboard when I read it. Naturally, it’s at the Integrative Medicine Program at the University of Arizona. Get a load of the public abstract:

The purpose of this revised R21 exploratory grant to NCCAM in response to PAR-03-153 is to extend the PI’s previous human olfactory psychophysiology research and develop a quantitative electroencephalographic (qEEG) bioassay for registration of individually active (salient) versus inactive homeopathic remedies or placebo. Homeopathy’s founder, Samuel Hahnemann MD, originally proposed olfactory sniffing as a valid route for clinical remedy administration. Convergent basic science evidence suggests that succussion (vigorous shaking) in the preparation of homeopathic remedies from animal, mineral, and plant sources, may persistently modify the physical structure of solvent to generate order, i.e., a unique informational signal, even in ultra-diluted solutions beyond Avogadro’s number. Torres and Ruiz (1996) proposed that stochastic resonance in sensory systems is a model for optimizing detection of a weak signal (homeopathic remedy information) by addition of noise (succussions). No previous research has directly examined the effects in human populations of a given remedy dilution prepared with different numbers of succussions. Specific aims for the study are: I. To evaluate the feasibility of using acute evoked responses in quantitative electroencephalography (qEEG) alpha power during olfactory administration to detect the presence of a single homeopathic remedy (Sulphur) at different numbers of succussions per dilution step, prepared at a given dilution; II. To determine the feasibility of using the magnitude of acute evoked responses in quantitative electroencephalography (qEEG) alpha power during olfactory administration to detect the presence of a single homeopathic remedy at two different homeopathic serial dilution factors (prepared with a given number of succussions per dilution step); III. To evaluate the generalizability of findings for a separate polycrest remedy (Pulsatilla). Subjects will be N=108 (n=54/remedy) young adult volunteers with moderate (not excellent global health) prescreened for potential remedy salience of either Sulphur or Pulsatilla and tested in a two-phase study (one remedy per phase). Each participant will undergo pre-screening with the Homeopathic Constitutional Type Questionnaire for high criterion scores for symptoms of one of the two test remedies, followed by three laboratory sessions spaced one week apart (dilution sequence subject allocation balanced within each remedy type for 6c, 12c, and 30c potencies). Each session will involve eight presentations within a complete block design of randomized double-blind, placebo- controlled (both succussed remedy-free solvent and succussed plain distilled water) olfactory sniff tests (using time-locked sniff-EEG recordings via an airflow pressure transducer), using a given remedy dilution prepared with stirring only, 10, 20, or 30 succussions. The present study fills a major need in homeopathic clinical research to explore and understand remedy-related and remedy-person interactive factors that could contribute to well-known problems in replicability. Findings from this and follow- up studies via subsequent R01s could improve standardization of homeopathic remedy manufacturing and prescribing used in patient care and thereby advance the quality of clinical treatments and research for this leading form of complementary and alternative medicine worldwide.

People, this is an NIH-funded grant to study woo. There’s no other way to put it. A 30C homeopathic remedy is nothing but water. Period. So is a 20C homeopathic remedy. They’re actually going to compare stirring with succussion to see whether succussion, as homepaths claim, makes a difference! Truly, you can’t make stuff like this up. Have the study sections lost their minds? Here’s another thing to consider: An NIH-funded grant (which, by the way, I worked my ass off to obtain and will have to work my ass off to have even a 50-50 chance of keeping it) is the pinnacle of external funding mechanisms. In the eyes of universities (and probably the public) it doesn’t matter whether that grant came from NCCAM, the NCI, NHLBI, NIAA, NIDDK, or whatever. Universities will be just as happy if investigators get grants from NCCAM as from any other agency within the NIH.

But more insidious are the grants listed at the end. It’s easy enough to laugh at grants being offered to study whether homeopathic succussion does anything other than aerate the solution, but when I see how much NCCAM is laying out for the promotion of woo through “education” grants, I want to cry. There are grants to fund fellowships in CAM at the University of North Carolina Chapel Hill, the Weill Medical College of Cornell University, the University of Virginia (a new one for the Woo Aggregator!), Harvard University, the University of Arizona, Oregon Health and Science University, UCSF, and a naturopathic college (Bastyr University). Of course some of these are not new awards, but continuations of awards granted a couple of years ago, but it shows that NCCAM is seriously into funding CAM centers.

Studying CAM is not the only thing NCCAM does. If that were the case, I would have less problem with it, the waste of taxpayer dollars on studies of homeopathy notwithstanding. The real problem with NCCAM is that a big part of its mission is to train CAM researchers and disseminate “authoritative information” to the public and professionals. It’s also to support the creation of research centers, the majority of which, as I have shown before, tend to take a very credulous view of CAM therapies, studying in effect not if various CAM therapies work but assuming they “work” and studying how to “integrate” them with conventional science- and evidence-based medicine. Moreover, the longer NCCAM exists, the more a culture of credulity develops within it and within the centers it funds, a culture that will spread and vie with science for the hearts and minds of future doctors.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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