Clinical trials Complementary and alternative medicine Medicine

NCCAM in the news: Why does it still exist?

I’ve made no secret of my admiration for Trine Tsouderos. Whether it be her investigations into the rank quackery of prominent members of the mercury militia wing of the anti-vaccine lunatic fringe, Mark and David Geier, who seem to think that chemical castration is a perfectly fine and dandy treatment for autism because testosterone binds mercury (it doesn’t under physiological conditions) and prevents it from being removed by chelation therapy, the equally rank quackery that is the “autism biomed” movement, or the chronic Lyme disease underground, Tsouderos is one of the rare journalists who “get it” when it comes to science-based medicine. In fact, she “gets” it to the point where she’s even willing to take on “America’s doctor,” Dr. Mehmet Oz, one of my least-favorite media personalities due to his promotion of homeopathy, faith healing, Joe Mercola, reiki, and even psychic scammer (is that redundant?) John Edward. The result, not surprisingly, is that she’s found herself kicked out of autism quackfests or portrayed as a baby-eating cannibal by everybody’s favorite anti-vaccine propaganda blog Age of Autism.

We need more journalists like her.

And Trine just proved it once again by doing something that I don’t recall seeing any mainstream journalist do–ever. She just did a trilogy plus one in terms of stories. Terror if you think that medicine should have a sound basis in science. Terror if you don’t think that our taxpayer dollars should be funding research into fairy dust. Terror if you’re affiliated with the National Center for Complementary and Alternative Medicine (NCCAM). OK, maybe I exaggerate, but who cares? It’s so rare to see stories like this make it to a major media outlet. It warms the cockles of a skeptic’s heart.

Sunday and Monday, the Chicago Tribune published a series of stories on NCCAM, all penned by Tsouderos:

What’s so surprising was to read in a major newspaper something like this:

Thanks to a $374,000 taxpayer-funded grant, we now know that inhaling lemon and lavender scents doesn’t do a lot for our ability to heal a wound. With $666,000 in federal research money, scientists examined whether distant prayer could heal AIDS. It could not.

The National Center for Complementary and Alternative Medicine also helped pay scientists to study whether squirting brewed coffee into someone’s intestines can help treat pancreatic cancer (a $406,000 grant) and whether massage makes people with advanced cancer feel better ($1.25 million). The coffee enemas did not help. The massage did.

NCCAM also has invested in studies of various forms of energy healing, including one based on the ideas of a self-described “healer, clairvoyant and medicine woman” who says her children inspired her to learn to read auras. The cost for that was $104,000.

A small, little-known branch of the National Institutes of Health, NCCAM was launched a dozen years ago to study alternative treatments used by the public but not accepted by mainstream medicine. Since its birth, the center has spent $1.4 billion, most of it on research.

Every since I discovered NCCAM way back after I first started blogging, I wanted to believe that it was actually a worthwhile endeavor to study the things NCCAM studied. I came to change my mind about NCCAM over the years. The reasons are many, but much of the reason why is that I came to understand that prior probability matters. If a therapy is incredibly implausible from a scientific basis, as in so implausible that multiple laws of physics would have to be radically rewritten in order for it to work (yes, I’m talking about homeopathy or reiki), then what you’re likely to see if you do clinical trials on such a therapy is nothing more than random noise amplified by normal flaws that are present in any clinical trial. The result, as I pointed out nearly four years ago, are ridiculous studies like studies to try to determine the most effective technique of dilution and succussion of homeopathic remedies–or, as Tsouderos points out, studies of distant prayer as a cure for AIDS or studies of regimens including coffee enemas (i.e., the Gonzalez protocol), can cure pancreatic cancer. (Hint: It can’t, no matter how much Nicholas Gonzalez tries to explain away his failure.) Even worse, such studies all too often can be profoundly unethical, as the Gonzalez trial was and TACT, which Tsouderos describes well, is, given that there is no good evidence that chelation therapy does anything for coronary artery disease, certainly not enough to justify a $30 million multicenter phase III trial.

I’m not going to go over all the articles in detail, given that I’ve covered the ground in them many times before. I encourage you to read all three articles for yourself. Instead, I’ll “cherry pick” the parts that most interested me. One part that caught my interest was what NCCAM director Dr. Josephine Briggs has to say. As some readers might recall, back in the spring of 2010, Steve Novella, Kimball Atwood (featured in Tsouderos’ article on TACT), and I actually met Dr. Briggs, and that meeting is the prism through which I see Dr. Briggs’ responses in this article. For example:

Briggs, a respected NIH researcher and physician who has headed NCCAM for nearly four years, said in an interview that she is dedicated to evidence-based medicine and that the center, under her leadership, is committed to rigorous scientific studies.

The center’s recently adopted strategic plan focuses on studies of supplements and other natural products along with the effect of “mind and body” therapies like yoga, massage and acupuncture on pain and other symptoms. In fiscal years 2008-2011, NCCAM funded more than $140 million in grants involving mind and body therapies, including $33 million for pain research in fiscal 2011.

The new strategic plan “reflects real change or an evolution in our mission,” Briggs said. “We are not your grandmother’s NCCAM.”

Studies of energy healing or distant prayer likely would not get funded by NCCAM today, she said.

I’ve read NCCAM’s strategic plan. I’m not particularly impressed. It all basically boils down to a promise to do some real science for a change. And in this article, we find Briggs trying to hide from the woo:

Dr. Josephine Briggs, director of NCCAM since 2008, wrote in an email that the center has not awarded any new grants to study practices like distant prayer or other energy healing for several years.

One notes that Dr. Briggs is referring to a study on “energy chelation” that I wrote about in my very own inimitable fashion back in August that really was brain-meltingly bad, as a certain expert in the article referred to it.

Be that as it may, what Dr. Briggs says here is very much of a piece with what she said to us when we met with her. Basically, her responses to criticisms like this always seem to boil down to trying to convince people that NCCAM doesn’t look at nonsense like homeopathy or energy healing anymore. If that’s true, that’s all well and good, but it’s not enough. NCCAM still does fund a lot of studies in modalities that are almost as implausible, the most prominent example of which is acupuncture, which is based on exactly the same sort of mystical, magical ideas that underlie reiki and distance healing. The only difference is that, because acupuncture involves actually sticking a little bit of cold steel into the body, it somehow seems more plausible. Heck, it did to me several years ago. Then I started paying attention to the scientific literature and clinical trials being published about acupuncture and realized that there’s no there there. Just type acupuncture into the search box of this blog and you’ll find a number of posts by me explaining exactly why in more detail. The CliffsNotes version is that acupuncture is placebo. It doesn’t matter where you stick the needles. It doesn’t even matter if you stick the needles in. Twirling toothpicks on the skin “works” just as well as any acupuncture.

More importantly, there is nothing done at NCCAM that requires a separate institute or center within the NIH. Nothing. Supplements and herbal medicines are arguably the most plausible of all the modalities studies of which are funded by NCCAM. They are–or can be–drugs, after all. Funded through other institutes, studies of herbal remedies are nothing more than pharmacognosy, a branch of pharmacology concerned with the study of natural products in which scientists try to isolate the active ingredient or ingredients in plants and natural products. Funded through NCCAM, studies of these modalities are infused with woo, in which the herbs, supplements, and various other natural compounds are claimed, without evidence, to be synergistic when combined. In reality, far more often they are impure, adulterated drugs in which the content of natural ingredient is inconsistent. As for other modalities, there’s no reason why “mind-body” interventions can’t be studied at NIMH or NINDS. Placebo studies, which could be very useful in medicine if done rigorously and scientifically, could easily be carried out in these institutes or several others. There, they would be freed from the concept at NCCAM that placebo effects are some sort of seemingly magical effect. In this paradigm, studies of completely implausible modalities that require rewriting the laws of physics to work (again, homeopathy, reiki, and “energy healing”), wouldn’t be funded at all without evidence to demonstrate that there is an actual phenomenon to study. To do otherwise is what Harriet Hall likes to call tooth fairy science.

Moreover, as Kimball Atwood emphasizes (and I have emphasized as well), performing clinical trials on highly implausible remedies can be potentially highly unethical. The Gonzalez trial showed that patients receiving Gonzalez’s treatments survived pancreatic cancer only 1/3 as long as patients receiving state-of-the-art chemotherapy. Briggs, being understandably embarrassed by this atrocity against medical science and ethics, might try to dismiss this study as “ancient history,” but there is nothing preventing such a study from happening again. At least, if there is, Dr. Briggs doesn’t say what it is. All we seem to have is her assurance, and maybe as long as she’s director of NCCAM there won’t be another Gonzalez trial or TACT trial, from which she also tries to distance himself there won’t be another Gonzalez trial or TACT. But she won’t be NCCAM director forever. Whoever succeeds her might not be as dedicated to scientific rigor, particularly if NCCAM’s most powerful congressional patron, Senator Tom Harkin (D-IA) has anything to say about it. Also remember, that the director answers to the National Advisory Council for Complementary and Alternative Medicine, and there’s a lot of credulity on that council, whose eighteen members must include at least twelve members who are in “relevant” disciplines; i.e., “leaders” in CAM.

In other words, I don’t think NCCAM can be reformed. Under Dr. Briggs’ tenure, NCCAM is probably less noxious in its offenses against science than it was before. In fact, I honestly believe that Dr. Briggs’ heart is in the right place in terms of trying to bring more rigorous science to the study of CAM areas where rigorous science is possible. But she’s working under the delusion that she can turn tooth fairy science into real science. Meanwhile, the aspects of CAM that have some plausibility (i.e., natural products and supplement, diet, exercise) are the Trojan horse that hides woo and quackery as it is brought into academia. It’s the foot in the door, after which the quackery follows. It’s not for nothing I refer to much of academic CAM as “quackademic medicine.”

Even worse, it works. Even self-identified skeptics are taken in by it, as Greg Laden was when he was overly impressed by a study of milk thistle for treating diabetic nephropathy as evidence that NCCAM is needed and worthwhile. Here’s a hint: This study is nothing more than pharmacognosy. There’s nothing “alternative” or “complementary” about it. There is no need for a special center within the NIH to fund studies like this. NIDDK could handle such a study perfectly well. He’s also way behind the times when he emphasizes that skeptics concentrate too much on the word “alternative.” Such a statement reveals a profound ignorance of the use of language by CAM advocates as a tool to achieve the appearance of scientific legitimacy. Hasn’t he heard? CAM is dead. CAM advocates themselves killed it because “complementary” implies inferiority or subsidiary status to real medicine. The preferred term these days is “integrative” medicine, which implies more equality with medicine. Indeed, I’m surprised that Tom Harkin hasn’t stuck a line in an NIH appropriations bill to change NCCAM’s name to the National Center for Integrative Medicine.

It’s coming someday, though. Just you watch.

What contributes to this misunderstanding is that Greg seems to have a massive strawman view of the SBM position that completely misunderstands our criticism of NCCAM when he says:

So, of the studies funded in 2011, are you saying that every single one of them was of no value, or just many? Have you looked through the list, and can you point to a few examples of grants given that are clearly re-addressing old ground about some woo or another or in some way supporting foundationless science?

These are the words of someone who thoroughly misunderstands NCCAM and misunderstands what our complaint as proponents of science-based medicine about NCCAM. Our complaint isn’t that there isn’t any good science going on there. There is, although it’s nearly all in the area of natural products pharmacology (studies that are routinely criticized, by the way, as too “reductionistic” by CAM advocates, by the way). Our point is that there is no need for a separate center for these modalities. CAM is a political and ideological entity, not a scientific entity. It is a cliche, but it is true. There is no such thing as “complementary” or “alternative” medicine. When a treatment modality is demonstrated to work through science and clinical trials, it ceases to be “alternative” or “complementary” and becomes just medicine. Having a center like NCCAM in essence legitimizes modalities that are quackery (such as acupuncture) while ghettoizing modalities that are not (such as milk thistle and other examples of natural products that might have medicinal value). Such a system serves neither science nor medicine, which is why NCCAM should be abolished and its grant portfolio absorbed into the appropriate Institutes and Centers of the NIH.

Another reason that nonphysicians, or even physicians who aren’t involved in clinical trials, often fail to understand that testing highly implausible treatment modalities in human beings is inherently unethical, as they violate principles of informed consent (patients aren’t told that the remedy being tested is incredibly unlikely to have anything other than placebo effects based on basic science alone, something I like to call “misinformed consent”) and clinical equipoise (the modality tested is incredibly unlikely based on basic science alone to to benefit the subject). Sadly, Greg even uses a tired old “science has been wrong before”-style argument about Creatin (as if that says anything about CAM or anything at all other than that Greg apparently mistrusts doctors) and then claims that we should appropriate what has been found to be “useful” in CAM into medicine. The problem is, he can’t identify anything useful in CAM that is really “alternative” or “complementary.” Milk thistle or herbal remedies don’t count. Neither do placebo effects. Both are–or should be–firmly within the realm of scientific medicine. Nor is it necessary to cede to quacks the realm of building caring relationships with patients in order to enhance placebo effects. One can enhance placebo effects through care and attention to patients without resorting to woo.

In the end, NCCAM exists to promote CAM far more than anything else. That is what Harkin intended, and he was disappointed when it failed to do a good enough job at it, haranguing NCCAM for not having validated enough CAM modalities. In such an environment, science will always be secondary. Dr. Briggs might be able to swim upstream for a while, perhaps even for a few years, in her effort to bring scientific rigor to NCCAM, but sooner or later time will win out. She will retire or move on to another position. When that happens, institutional inertia and pressure from woo-friendly legislators like Sen. Harkin and Representative Dan Burton (R-IN) will build again. What has happened before will happen again. Remember, back in the late 1990s when NIH director Harold Varmus tried to rein in NCCAM’s predecessor agency and bring scientific rigor to it, Harkin responded by elevating it to a full independent center and thereby reducing the level of control any NIH director has over it. Thus was born NCCAM in its current incarnation.

Whatever good science it might be doing now, NCCAM is beyond permanent reform.

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]

76 replies on “NCCAM in the news: Why does it still exist?”

A reminder-SBM doctors prescribed Vioxx so called researched etc. It killed
people and made a profit of $2.5 billion in sales in 2003 alone. Maybe people
just want to try non-drug modalities. Can anyone blame them?

Try all the woo you like but recognize that science moves forward, not without missteps, but forward in an understandable, repeatable way. Woo sits and spins.

Homeopathy is just water, faith healing is bollocks, distance healing is ridiculous, energy fields provide no discernible assistance in healing, etc. What you support (apparently) is useless. Worse if it delays or redirects treatments that could help.

Also lurker,
Edison tried many, many filaments for his light bulb before he hit on one that worked. If his belief in physical science matched your belief in medical science, I’m guessing history would have a different look.

Wait, lurker, I’m confused.

1) Vioxx was researched but ended up killing people. Bad, bad, BAD scientists and government!!!!

2) Complementary medicine needs research, so it should be done by NCCAM, which is, er, a government organisation where the research is done by scientists.

Um. I think there might be a problem here.

The Free Online Dictionary has a nice summary definition of science: “The observation, identification, description, experimental investigation, and theoretical explanation of phenomena.” I would add that in general all these elements need to be present, because any one alone is insufficient.
So, if you have such disdain for medicine codified and practiced using these elements, what would you replace it with? What are the alternate ways of acquiring and systematizing medical knowledge that you would endorse?
How about emotion-based medicine? Intuition-based medicine? I will leave out superstition-based medicine because you already believe in that, but how about chance-based medicine? Any of this really sound good to you? Would you really risk your life and health by adopting any system that doesn’t use systematic testing of its claims?

Interesting articles..

I do wonder why ‘massage’ is studied bij nccam… Isn’t that something that’s practiced by physical therapists? Wouldn’t that fall under regular medicine?

You’re beginning to get it. “CAM” appropriates science-based modalities (such as diet, exercise, natural products medicines, and massage) and labels them as “complementary” or “alternative” in order to provide plausibility to the rest of real woo. It’s the “bait and switch.” Or, as I like to say, the plausible stuff is the Trojan horse hiding the quackery.

I’ve been thinking lately that the NCCAM is actually an opportunity for folks like me (and Orac). Funding is tough these days, but it seems like one could hit up the NCCAM with some fundamental studies to test some of the claims made by alties. For example, the whole Geier nonsense originated by the finding that mercury binds to testosterone. So why not apply to the NCCAM for funding to examine binding of transition metals to biologicial substrates? People have done things like that all the time using mass spectrometry (albeit not with these specific metals and substrates) but there’s not much money for those types of studies these days (because they are generally too routine).

We could do it, and I have absolutely no expectation that we would find anything that would validate any of the Geier’s claims, but hey, the NCCAM is all about negative findings anyway, and we could learn some really nice physics along the way.

Similarly, Orac could get some money that tests some (implied) mechanism of alternative medicine. If they are REALLY interested in funding the science of alternative medicine, they should be supporting this type of stuff, as well as hopeless clinical trials.

At some point, my scruples get in the way, though. But yeah, why shouldn’t legitimate scientists cash in on that money to fund studies of alternative medicine claims?

Vioxx? Isn’t that made by the same honest, non-woo medical company that currently sells 90% of the 71 injections our children are required to recieve so they can attend public school? Just asking.

Vioxx? Isn’t that made by the same honest, non-woo medical company that currently sells 90% of the 71 injections our children are required to recieve so they can attend public school? Just asking.

What “71 injections” are you talking about, Sherry? My 3 yo is mostly done with his shots, with only an MMR booster left, I think, and so far he has had maybe 20 shots (conservatively – he never has had more than 4 at an appt, and he had shots at 2, 4, 6, 12, and maybe 18 mos). So where are you getting this “71 injections” nonsense?

Just asking.


Please provide a cite for your ’71 injections’ claim. Since you are also asserting that the majority of these are manufactured by Merck, please also substantiate this with CDC references to approved vaccines in the United States.

Otherwise, the best conclusion is that you are making these things up.

Otherwise, the best conclusion is that you are making these things up.

More likely she got it from some anti-vax propaganda page.

Three Hepatitis B, 2 Hep. A, 4 polio, 3 rotavirus, 4 HIB, 2 MMR, 5 DTaP, 4 pneumococal, TD booster, 2 chickenpox, 19 flu (6 months to age 18), 3 HPV, 2 Menningitis. Ooops. It’s 71 vaccines but only 54 injections. Thank God for the combos.

Here’s the approved vaccine list;

lurker said:

“Maybe people just want to try non-drug modalities. Can anyone blame them?”

Did you read the entry? Do you mean “non-drug” modalities like the Gonzales protocol and the TACT study?

And I suppose you won’t buy a car from any company that had made a car with a bad reputation in the past.

I had not realized that the flu shot was required to attend public schools in any jurisdiction. Or HPV, for that matter.

Huge props to Trine Tsouderos – she definitely deserves some official recognition from our various skeptical organizations.


You certainly have an interesting way of doing math. I count 13 vaccines (16 if you count individual diseases), less if you go with some of the newer combo vaccines. You correctly note 54 administrations (not all are injections, e.g., rotavirus and LAIV flu vaccines are not injected). And that is only if you get every single one of the recommended immunizations. Not all are required for school/day care attendance in each state.

But, what’s your point? Do have any evidence that protecting children from diseases is a bad thing?

Also, you still need to back up your claim that Merck sells 90% of the vaccines given to kids.

Do try to stick to facts and reality, rather than made-up nonsense.

I’m also dying to know what public school system requires an annual flu vaccine as a condition of enrollment, as that constitutes a significant number of the “injections” on Sherry’s list.

Sherry, next you’ll be telling us there are 57 card-carrying Communists in the State Department. I’ll also point out that including “just asking” in a post is a huge, screaming label that you aren’t.

And Sherry, linking to the thimerosol content table also tips your hand: you should’ve linked to the actual vaccine schedule…
… but I guess that wasn’t supportive enough of your argument, given how many of the shots there are listed as optional or recommended only as “catch up” for children who’d missed the immunisation earlier. That lops off 10 from your count right there.

But thank you at least for linking to a Johns Hopkins site and not one of the usual (and less constrained by reality) suspects.

— Steve


(Actually, Sherry, my kid’s Rotavirus vaxs were oral, not “injections”. And a lot of flu vax are given through nasal spray.)

I really think it’s the jab that bothers a lot of anti-vax nuts and nothing else. If vaccines were administered by having a doctor come in and wave a magic wand over the patient, a LOT fewer people would have a problem with it.

I’m not saying it’s a picnic to hold and comfort my screaming infant while someone puts a needle in her, but neither would it be a picnic to sit by her bedside as she dies of a vaccine preventable illness. I’ll take her thirty seconds of crying.

Sherry (#9):

“…the 71 injections our children are required to recieve so they can attend public school?”

Sherry (#14):

“Three Hepatitis B, 2 Hep. A, 4 polio, 3 rotavirus, 4 HIB, 2 MMR, 5 DTaP, 4 pneumococal, TD booster, 2 chickenpox, 19 flu (6 months to age 18), 3 HPV, 2 Menningitis.”

The hepatitis A, rotavirus, pneumococcal, HPV and influenza vaccines are not required to attend public school – at least, they aren’t in Illinois and many surrounding states.

I should also point out that Merck, the manufacturer of Vioxx, is not the only company making childhood vaccines (although there are few that still do) and that the problems with Vioxx are not restricted to the Merck product but are common to all Cox2-selective NSAID’s.

Of course, I doubt that any of this scientific subtlety will matter to “Sherry”, as she already has all the “facts” she wants.


Since, as Harkin complains, NCCAM has so far failed to validate any of the mishegos it has tested, one might argue that there is value in producing evidence that this stuff doesn’t work, since a lot of people spend money on it. I used to think so myself. Alas, the negative findings make no difference, the quacks carry on unaffected and their victims pay no mind. (As one can readily see from some of the comments on this blog.)

None so blind as those who will not see.

Knowing how tight the federal budgets for individual agencies are becoming (and only becoming much tighter in the future), it really pisses me off that scare grant money & agency money (for administrative functions – including salaries, etc) is being wasted on this crap!

A reminder-SBM doctors prescribed Vioxx so called researched etc. It killed people and made a profit of $2.5 billion in sales in 2003 alone.

And thank god we had the NCAAM and brave alternative medicine researchers who found the problems with Vioxx and got it pulled from the market. Oh, wait, that’s wrong. It was mainstream researchers funded by the company that made Vioxx that found the problem. And terminated the study because of the problems found. And published the results. Some conspiracy-they couldn’t even suppress their own results adequately.

@ cervantes:
” a lot of people spend money on it”

I wouldn’t be surprised if woo *aficionados* used an economic argument that since people spend money on woo ( supplements, spurious treatments, books, media) it is a true stimulus to the sluggish economy which- god-knows- which certainly could use it in these harsh times.

My late father used to remark derisively, when he truly disliked something or thought it ridiculous or wasteful, that,” At least it creates jobs.” One of the rare instances where we didn’t agree.

one might argue that there is value in producing evidence that this stuff doesn’t work,

cervantes – see my comment above about more basic studies. Unlike with clinical trials, basic studies that turn out to not support alt medicine can at least provide us with some new insight regarding mechanism or structure.

I know that Edison claimed that they also learned 10000 ways to not make a lightbulb, but if you pay attention to what is happening in those failures, you can learn a lot about the fate of metals upon electron emission in various atmospheres. This is real positive content, far more than “supplement X doesn’t do anything more than placebo.”

IOW, while there is value in learning stuff that doesn’t work, there is a lot more value in examining the proposed mechanisms for things that are claimed to work and showing that they are baseless, because here is what is really happening.

It’s actually (as my doctor said to me) kind of a shame that Vioxx got taken off the market. As I understand it, the subgroup that was vulnerable to cardiac issues because of Vioxx doesn’t comprise the entire possible patient group (normally with a lot of drugs that’s simply a contraindication, not a reason for banning a drug), and it would be of great benefit to another specific subgroup, which is people like me. I am only in my mid-30s and already taking the max dose of Celebrex for arthritis, and not without side effects, either…

Big Pharma may have overreacted based on the availability heuristic, but it wouldn’t be the first time.


That was my understanding, as well. Vioxx was a very effective drug, providing very real relief to a lot of people who had no alternatives that were anywhere near as effective. Part of its demise was due to Merck’s own idiotic PR machine.

It’s been a while since I studied that particular case, but from what I can recall, it should have gotten a black box warning slapped on it, like some of its later competitors, rather than banned outright.

I’ve no idea whether I would be in the group that’s vulnerable to the side-effects of Vioxx or not. What I do know is that I once got a two-week sample prescription of the stuff for plantar fascitis, and the results were astounding. The pain just went away — within a day — when I really hadn’t expected any results at all. I can well believe that there are plenty of people out there who got excellent results and are now worse off (at least pain-wise).

Dave: If I understand correctly, the increased risk of arterial vascular disease with vioxx was when it was taken for long periods of time so the 2 week prescription probably did nothing in particular to your risk.

I strongly suspect that vioxx got pulled because the FDA and consumers were annoyed at having gotten taken in by Merck’s aggressive advertising and slick presentation of the drug. It really could have gotten away with a black box warning under other circumstances. And might yet come back with a black box warning: the trial that established the risk in vascular disease also established that it did decrease the risk of colon adenomas. Maybe there’s a role for vioxx in patients with high risk of colorectal cancer and not much risk of thrombosis.


A reminder-SBM doctors prescribed Vioxx so called researched etc. It killed
people and made a profit of $2.5 billion in sales in 2003 alone. Maybe people
just want to try non-drug modalities. Can anyone blame them?

C’mon. There are problems with one drug, therefore it’s sensible to avoid regulated, tested medications in favor of unproven modalities? Science is what tells us that Vioxx caused problems. So you think it’s reasonable to abandon science and go with things where the sellers make no effort to find out if they cause similar problems? That seems a bit ridiculous.

@ Interrobang: Indeed, Vioxx is not the only case of a drug taken off the US market completely even though there’s a subset of patients who a) greatly benefit from it, and b) are at little risk from its side-effects. The case of pemoline (Cylert), a medication for narcolepsy and ADHD where some liver toxicity was documented in children but not in adults, comes to mind:


Vioxx? Isn’t that made by the same honest, non-woo medical company that currently sells 90% of the 71 injections our children are required to recieve so they can attend public school? Just asking.

Okay, the CDC schedule actually has a bit of flexibility in it, and includes more than schools may actually require. The influenza vaccine, for instance, is not required for entry at any school I’ve ever heard of (except perhaps med school when you start your residency). And, of course, there are several products available in various different combinations from various different manufacturers, so it’s not possible to say just by looking at the schedule what percentage of the market any given manufacturer has. So I decided that for fun, I’d just look at what my kids actually got, since I’ve got records for that. I know my first daughter did get a rotavirus vaccine, but did not complete the schedule; I think it was the one that got withdrawn. That’s probably why it’s not listed in her immunization record. So, going from what’s on the record, one of my daughters has had 30% of her vaccines made by Merck, and the other has 24-28% (I was unable to find the brand of one of them, and Merck is one of the two manufacturers who make that particular vaccine). Note also that neither daughter has had more than 30 doses of any vaccine, including the eight-year-old, and they are both adequately vaccinated to attend public school, so the 71 injection claim is ludicrous.

I do not believe it is possible to complete the school entry requirements in any state with even 50% Merck products, much less 90%…..

I have a comment for Sherry in moderation. I was curious, so I decided to see what percent of my children’s vaccines was actually made by Merck. Spoiler warning: it’s less than 90%.

“Three Hepatitis B, 2 Hep. A, 4 polio, 3 rotavirus, 4 HIB, 2 MMR, 5 DTaP, 4 pneumococal, TD booster, 2 chickenpox, 19 flu (6 months to age 18), 3 HPV, 2 Menningitis.”

Actually, you’re required in most school districts in the US to have these: DTaP, TDap, Polio, MMR, Hep B and Chicken Pox. Some add Hep A.

Not that the truth of the matter is important to you. Because clearly, as your online resume shows, lying is what you’re about.

My HMO will pay for acupuncture and Chiropractic, which I don’t use,but not massage which I would use.

The woo friendly alties on love complain that that no studies are being done to see if alternative medicine really works. I have pointed out many times the budget for NCCAM is approximately 127 million a year. One altie proclaimed it to be a good start and weeks later posted that “no studies are being done in alternative medicine and this needs to change”

It’s been my experience that hard core alties really don’t want to know the truth. They want to live in a make believe world and will deeply resent anyone questioning the validy of their alternative beliefs. Trying to get them to switch to science or evidence based medicine is like trying to get them to switch their religious beliefs.

“The National Center for Complementary and Alternative Medicine also helped pay scientists to study whether squirting brewed coffee into someone’s intestines can help treat pancreatic cancer (a $406,000 grant)…”

But people doing real work on say STAT3 inhibitors for pancreatic cancer, asking for R21 funding of $275,000 get zip, zero, nada, not a cent.

The sad thing is there’s no reason to encourage anyone to think about a career in serious lab science.

A reminder-SBM doctors prescribed Vioxx so called researched etc. It killed people and made a profit of $2.5 billion in sales in 2003 alone.

IIRC, Science-Based Medicine is such a recent label (coined in response to EBM, itself an early-1990s phenomenon) that back in 2003 only a handful of doctors were calling themselves SBM. I was hoping that lurker would become more specific, and explain exactly which of this small group were prescribing Vioxx the so called researched etc. — otherwise the comment looked like meaningless bullshit.
Still waiting.

For someone whose nom-du-net is a claim to lurk, ‘lurker’ does an awful lot of inflammatory trolling.

“Although some adverse drug reactions (ADR) are not very serious, others cause the death, hospitalization, or serious injury of more than 2 million people in the United States each year, including more than 100,000 fatalities. In fact, adverse drug reactions are one of the leading causes of death in the United States.1 Most of the time, these dangerous events could and should have been avoided. Even the less drastic reactions, such as change in mood, loss of appetite, and nausea, may seriously diminish the quality of life.”…….
“A recent review of all studies concerning the reasons for pediatric hospitalization (children under the age of 19) found that 2.09% of all pediatric hospitalizations were caused by adverse drug reactions and that 39% of these were life-threatening.7 Using the most recent published data on pediatric hospitalizations,8 there were 3.8 million children under the age of 19 hospitalized in the United States in 1997. This means that in one year, there are 79,000 children (2.09% x 3.8 million children) admitted to the hospital because of adverse drug reactions, 31,000 of these children having life-threatening adverse reactions.”
I didn’t include the link because it would probably go into moderation.


You could put the link in the URL box. Barring that, you could at the very least provide the title of the article, author and some indication of how we might go about finding it.

(How ever did we do citations before hyperlinks? Clearly, no one in the history of writing papers ever did in the pre-internet age.)

You must forgive Sherry for her false statements.

When I first read her comments I thought she was arguing that despite Merck’s problem with Vioxx, they should be credited with still producing vaccines (that have saved and do save more lives than Vioxx took).

Trotting out “71 injections” should have been my first clue that she doesn’t think for herself and didn’t really consider how her comments would be read/interpreted.

If nothing else, Sherry’s statements provide a strong argument for not delaying education of children – starting public school at 18 years of age obviously makes it near impossible for a person to learn how to think for themselves.

#37 Black-cat:
I tear my hair out over that section on that web-site. I do admire the regulars who are very blunt with those who have stage III & IV who want to go the “natural” route. I actually read “you will die if you don’t get appropriate treatment.”

It also makes me sad to read the supporters section where people are sad/angry that their loved one refuses to listen to reason.

How could you trust a webpage with references that are over ten years old? Why is it that many crow the deficiencies of the regular health care field and demand that it change whereas they are willing to continue to support bogus and equally harmful treatments by quacks?
I don’t think anyone ever said science-based medicine was perfect but I applaud the fact that we are constantly learning. Will people be injured and die from mistakes? Yes. Does that mean we should toss the whole system? Not a chance. I work on the front lines of health care. Trust me, people are well taken care of, but many in the health care system are old and frail. They die. It is tragic and I feel for the families, but there is a limit to what we can do. I have yet to meet anyone who is immortal and it looks unlikely that this will occur soon. People will continue to die. We must face this fact before we condemn honest medical treatments. Really, I am frothing!!!

I’m not sure a site called “” is likely to be especially unbiased, quite honestly.

Still, I fail to see the connection. Things have gone horribly wrong with people using mainstream medicine. Yes. A crucial question is this: is alt med any better? From where I’m standing, alt med seems to be better only in that as most of its therapies are useless, it primarily kills by inaction. This does not make it better.

BTW, I’m actually not surprised that so many children are admitted with drug reactions. OTC drug overdose is a very serious problem in young children, and the industry and social response has been . . . poor. The short version is that it’s very easy to accidentally overdose a small child. The withdrawal of most products containing pseudephedrine helped; way fewer cases of pseudephedrine overdose. It’s as easy as two sleep-deprived parents both trying to keep a congested toddler comfortable, and not realizing that the other parent already gave the medicine.

It’s a real problem, but it’s pretty silly to take that and say “therefore alternative medicine is reasonable”.

1: Ms. Tsouderos is my heroine.

2: Tangential to this post, but as it was discussed here previously – Chicken Pox Lollies made The Colbert Report last Thursday.

“Chicken pox lollipops. It’s got the delicious taste kids love, with the proven effectiveness of something licked by a stranger. And they are guaranteed not to harm your kids’ mental development. Although if you are giving them mail-order lollipops licked by a stranger, your kids’ mental development may not be the main concern.”

That bit got a good cheer from the crowd, which made me feel better. The whole segment was pretty fantastic, as he went on to show Prescott Pharmeceuticals’ new line of tainted candy.

@ lurker: You should have read the footnote (1) citation (JAMA, April 15, 1998) for your statement from Worst My very basic math skills inform me that this statement was lifted from an article in JAMA that is 13 years old. Color me unimpressed with data collected years ago and with some heavy duty medications that are used for serious medical conditions.

Kudos again to Trine Tsouderos for her insightful thorough reporting about the sheer waste of public tax dollars spent on NCCAM. It’s not as if we have budget surpluses, to spread the extra $ for a an elected Federal legislator to fund a pet project or a supplements manufacturer in his/her district.

How could you trust a webpage with references that are over ten years old?

They seem to improve with age, or something. The occasional references for sodium ascorbate as a pertussis treatment petered out something over half a century ago, but it’s all the rage in certain circles.

I think the alties look at medicine like a fine wine – it doesn’t become obsolete, far from it! It improves with age.

It’s too bad that they’re trying this with the equivalent of MD 20/20 and Boone’s. Wait, I take that back – that’s an insult to both those beverages, as they actually do what they claim (i.e., get you drunk). It’s more like they’re laying down O’Doul’s and expecting Scotch at the end.

Certainly there are avoidable daths from the side effects of medication. What is not noted in abbreviated quotes like the one from lurker concerning deaths from the side effects of drugs is that a large percentage are from drugs of last resort. For example, in a person who is dying from a painful terminal illness and pain medicine dosages are pushed to the maximum to maintain comfort, but the end effect is respiratory suppression or side effects from chemotherapy in a patient with no other option. But let’s not let the truth stand in the way of a good story.

Lurker (#43):

“Although some adverse drug reactions (ADR) are not very serious, others cause the death, hospitalization, or serious injury of more than 2 million people in the United States each year, including more than 100,000 fatalities. In fact, adverse drug reactions are one of the leading causes of death in the United States.”

Original source:

Lazarou et al. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998 Apr 15;279(15):1200-5.

This has got to be one of the most popular “alt-med” citations in the entire scientific literature. And no wonder, as the authors estimate that around 2 million hospitalised patients suffered from serious adverse drug reactions in 1996.

This is a very serious issue and – as publication of this article attests – one that real medicine takes very seriously. However, before we conclude from this that “real medicine is bad; fake medicine is good” – as “Lurker” would have us do – we should at least consider the “flip side” of real medicine: it actually works.

So far as I can tell, there are no published studies looking at how many people would have died in any given year without real medical treatments, but I think that it’s safe to say that it would also be a large number. In 2009, there were over 500,000 people in the US on haemodialysis, most of whom would be dead in a month if they were switched to homeopathy, chiropractic or “herbal” medicine. In 2011, there were 25.8 million people with diabetes, many of whom rapidly become dead without real medical treatment.

Granted, some of these people are victims of their own poor lifestyle choices, as are some of the people who every year experience myocardial infarction and hypertension. However, I have yet to see a study showing that compliance with diet and exercise recommendations is higher when that advice comes from a naturopath, homeopath or chiropractor.

As was mentioned above, real medical interventions – drugs, surgery, etc. – have real risks and real side effects. For a lot of fantasy-based (“alternative”) medicine, there is little risk from the “therapy” (naturopathy and chiropractic being possible exceptions); the bulk of the risk from “alternative” medicine is the failure to get real medical care in a timely fashion.

As my internist said when I asked her views on about “alternative” medicine: “You can see my first, when the problem is easier to deal with, or you can see me last, when it’s a whole lot worse. Either way, you’ll eventually end up in my office.” To which I would add – “If you’re lucky!”



I really think it’s the jab that bothers a lot of anti-vax nuts and nothing else. If vaccines were administered by having a doctor come in and wave a magic wand over the patient, a LOT fewer people would have a problem with it.

And then you’d be able to get NCCAM funding to boot.

Prometheus writes about *delays* in treatment because the patient tried alt med first.
Mis-information about the “hazards” of pharmaceutical products and fear of side-effects may encourage people to try alt med nostrums that could be in-effective, merely time-wasters, or truly dangerous in-of-themselves. Here though is one prescription I heard recently ( November) that quickly had me prick up my ears: since we all *know* how “dangerous” antibiotics are ( quoted from woo-ful scripture, chapter and verse), if you have MRSA don’t use those Pharma poisons, opt instead for HBOT and ozone.
If you have MRSA….. ( ProgressiveRadioNetwork)
And stay out of hospitals, they are such dangerous places.

@ice skater,

I hate that section of I really do. Because of all the fighting they now have two sections: Complimentary and Alternative. The alties are now claiming that the alternative thread is thiers and they should be able to post whatever fairytale of the day that they want to make up and not be challenged on the validy of that fairy tale. is a magnet for newly diagnosed patients and there is very dangerous information posted as fact, when it really is some idiot’s fabrication.

There is a women that started that infamous “fungal theory” thread that was stage one, Her2+, just a short time ago. She is now stage 2 and her breast cancer has spread to her lymph nodes. She thinks it’s her fault because she ate sugar. She has now found this quack clinic in Oklahoma and is getting laetrile, vitamin C and DMSO infusions.

They put in a picc line and sent her home to administer her own treatments and are charging her thousands of dollars.

I will be posting brutaly honest and not so nice messages to her. I hope I can get through to her this time. I have sent her many of Orac’s blogs dealing with her “cancer is a fungas” and Robert O Young is a genious posts. She’s responded that reading only the first 3 lines of Orac’s posts is all that she needs to figure out that he is a “character that grates on the nerves” She also claimed that she thinks success has gotten the better of Robert O Young.

The problem I see here with her and other alties on that site is that when they are presented with facts and the truth, they will cover their ears with their hands and chant la, la, la, la, la, la until those nasty thoughts are out of their heads. Because everyone that has read “The Secret” knows that negative thoughts can cause your cancer to spread.

First of all – our goverment spends the most amount of $$$ on military and then the IRS. Lobbies effect our food and water resources so that we have to take medicine…$$$ Pharmacies. I’m all for support of natural remedies – we’ve been here for more than 10,000. Its just in the last 100 years or less that we now have synthetic. When considering the “scientific study” there is no true “placebo” when you get down to it.

Here’s a recent study for you on Acupuncture to consider.

I want to add that none of us on have the knowledge of orac and a lot of his commentators. We would love to have you come over to our site and help us weed out the science from the psuedoscience.

I know that you all have full lives but this is an appeal to lilady, Dennis Walter, Queen, Promethues and Dangerous Bacon.

All of you could help save lives.

A two year old report in a newpaper is not much to hang your hat on. Besides, if you look at the article it falsely states that ‘we don’t know what c-fibers are for’. Even Wikipedia knows what they are for. Seriously, read something else because what you quoted won’t get you very far.

First of all – our goverment spends the most amount of $$$ on military and then the IRS.

Oh, great, complete detachment from reality. The appropriation for the IRS for FY2011 was about $12.5 billion. You might have missed a few pieces in between, Julie.

When alties throw up the iatrogenic deaths tu quoke fallacy I always think of the difference between SBM handles iatrogenic deaths versus how CAM handles them. When a couple of people were killed by inadvertent KCl in an IV in the Foothills Hospital in Calgary, there was an inquiry and the labeling and storage of the KCl was changed to prevent future errors.

In a Toronto hospital a few years ago deaths of immune compromised patients were traced to a bad sink and faucet design. The faucet was positioned directly over the drain so that bacteria from the P trap were being sprayed into the air. You never see this level in of self examination in CAM. Instead, the usual response is denial followed by “Western/Conventional medicine kills (insert inflated number here) people per year.

The second example illustrates why iatrogenic death numbers are misleading. Hospitals are full of compromised (immune and otherwise) people who are vulnerable to things that wouldn’t harm a healthy person.

Why do lurker’s comments strongly remind me of the people who are arguing for/currently recommending “natural/herbal” remedies (especially “medical” marijuana) for my chronic headaches?

“First of all – our goverment spends the most amount of $$$ on military and then the IRS.”

First of all, Julie…During FY 2010, the U.S. Government spent 20 % of the Budget on Military ($ 689 billion dollars)…which was exceeded by the 23 % of the Budget on Medicare and Medicaid ($ 793 billion dollars).

Second of all, Julie…During FY 2010, the IRS collected $ 2.6 trillion dollars…42 % collected from individual tax payers, 40 % Social Security/Social Insurance taxes, 9 % corporate taxes and the remainder collected as federal excise, estate and gift taxes.

The link you provided discusses “Battlefield Acupuncture”…I suggest you check out the hilarious YouTube videos on this “treatment”.

Make certain Julie, that if you ever end up as patient in a trauma unit, to specify acupuncture, when the treating physician tries to give you a shot of morphine.

I’m all for support of natural remedies – we’ve been here for more than 10,000. Its just in the last 100 years or less that we now have synthetic.

Ah, yes. The good, old times when 1-2 kids out of 10 lived into adulthood. You have noble goals here, julie. Protecting the world from overpopulation. Way to go.


The biggest single pot of money in the US federal budget is for the military. But the second biggest is not the IRS. I refer you to the excellent and easily accessible resource Death and Taxes:

Unfortunately, the 2012 poster is a bit misleading because of all the insanity of the last few months of budget fighting — we *still* don’t really know what the details of the 2012 budget are going to be, which is pretty damn pathetic if you ask me. But it’s a pretty good look all the same at how our government tends to parcel out money.

60% of the budget is for national security. That alone is pretty staggering. The world’s largest federal budget is spent predominantly on the military. The second biggest piece is Social Security. This is not funding the IRS; this includes funding the SSA’s day-to-day operations but mostly is disbursement of SSA funds. These are the moneys withheld from your paycheck and which you can draw from if you become disabled or reach retirement age. The next biggest bubble is “income security and other” — unemployment and things like that. It goes through the Department of Labor. The fourth biggest bubble is Medicare — $468 billion. Then it’s “non-national security”, which would include the day-to-day operations of the IRS but also things like NASA, the Department of Education, the Department of Transportation, the Department of Justice, etc. Medicaid comes next, and then it’s the interest on our national debt. That covers the expenditures.

So while you are completely correct that the military (and associated things like homeland security) is our biggest single expenditure, the IRS isn’t even close to second. It’s funded through the Department of the Treasury and under the originally proposed budget, was going to get $13.285 billion — easily the largest budget within the Treasury (with the biggest piece of that spent on enforcement), but for perspective, it’s less than what NASA was going to get ($18.724 billion).

Blackcat @63 – I’m not really one of the ‘regulars’ here, but I’ll try to do what I can. Do you have any links to threads that are particularly in need of help? Breast cancer isn’t something that I know too much about off the top of my head, but I should be able to at least provide Pubmed links and debunk some of the more outrageous claims.


“”CAM” appropriates science-based modalities (such as diet, exercise, natural products medicines, and massage) and labels them as “complementary” or “alternative” in order to provide plausibility to the rest of real woo. It’s the “bait and switch.” Or, as I like to say, the plausible stuff is the Trojan horse hiding the quackery.”

Oh, zing. Exactly.

It looks like NCCAM’s very foundation is a logical fallacy – The Argument from Spurious Similarity, i.e. some resemblance is proof of relationship.

So grants are awarded simply because integrative therapy 1 was such a success integrative therapy 2 must be the logical next step.

Can they not see this? I bet they can.

First page of the Altie forum, and I’ve got the makings of a decent sandwich (Oil of oregano + watercress) but nothing that resembles actual science. It’s kind of depressing how much of a echo chamber that place is – like an entire forum of Thingies, backing each other up.

Clarification of my above — I said that the military was getting 60% of the budget. This is true — if you are only looking at the discretionary budget. When I went on to discuss what percentage of the budget goes to what after that, I erroneously went to a section that included more than the discretionary budget, and also included Social Security, Medicare, and Medicaid. These are not part of the discretionary budget. Neither is the interest on the federal debt. So my numbers are a bit misleading because of that. Anyway, go to Death and Taxes for the source; it’s a very cool infographic.


I’m sure Thingie is there as they all have the same mindset. Most of those alties have had evidence based treatment but prop up and cheer on the few that haven’t. Most of them are also DCIS or stage 1.


I’m sorry, I did not see #71. If you are still willing to go back there after seeing what a depressing mess it really is, Impositive is the one that is in the most danger. She is the one that has progressed to stage 2 with lymph node involvement. Any information on studies done concerning laetrile, vitamin C and DMSO on curing cancer would help.

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