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National Center for Complementary and Alternative Medicine (NCCAM)
According to a nationwide government survey released in May 2004, 36 percent of U.S. adults aged 18 years and over use some form of CAM. CAM is defined as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional [i.e., scientific] medicine. When prayer specifically for health reasons is included in the definition of CAM, the number of U.S. adults using some form of CAM in the past year rises to 62 percent. --NCCAM
NCCAM has spent more than $1.3 billion in grants and has nothing to show for it.
The National Center for Complementary and Alternative Medicine (NCCAM), formerly the Office of Alternative Medicine (OAM), is a division of the National Institutes of Health (NIH). The NIH has played an important role in improving the health of U.S. citizens for over a century. It traces its roots to 1887 with the creation of the Laboratory of Hygiene at the Marine Hospital in Staten Island, New York, for research in cholera and other infectious diseases. Like many other evidence-based programs under government control, the NIH has been politicized.*
In 1991 Iowa Sen. Tom Harkin (D-IA) was a main figure on the appropriations subcommittee in charge of the NIH. (In 2010, he still is.) In 1992 Harkin slipped a line in the report accompanying the NIH appropriations bill that created the NIH Office of Alternative Medicine with $1 million in seed money. Never mind that there is no such thing as "alternative" medicine. If we have an Office of Alternative Medicine, who could question it? In 1999 President Clinton signed into law an appropriations bill that gave the OAM its current name and pumped up its budget to $50 million a year so it could establish a new National Center for Complementary and Alternative Medicine at Bastyr University, a naturopathic college outside of Seattle.*
Harkin got the bug for alternative therapies when he came to believe that his hay fever had been cured by bee pollen. He and a few other political buddies wanted to fund research that would prove the effectiveness of bee pollen and other quackery. Iowa representative Berkeley Bedell believed that Anablast (created by a quack named Gaston Naessens; the stuff is also called "Naessens Serum") had cured his prostate cancer and that cow colostrum had cured his Lyme disease. Cow colostrum doesn't cure anything and Anablast is pure quackery. There is no evidence in the scientific literature that bee pollen cures allergies or has any beneficial effect. Worse, bee pollen can cause life-threatening allergic reactions in some people. Nevertheless, Harkin and the promoters of unproven practices wanted the NIH to find the science that would prove the benefits of specific treatments.
However, the OAM's first director, Dr. Joseph Jacobs, was no lapdog. When the OAM couldn't come up with any good science for any so-called "alternative" treatment, Harkin attacked Jacobs in a public hearing. That was in June 1993. Harkin then "handpicked four alternative-medicine advocates" and had them appointed to the OAM's advisory board (Satel and Taranto: 1996). If real science wasn't going to get results, maybe pseudoscience would.
Jacobs called the alt med advocates "Harkinites" and they soon attacked Jacobs for trying to set up proper scientific research centers. Such evidence-based research would be "hostile" to CAM, they said. The Harkinites won out. The OAM set up research centers at the University of Minnesota's Center for Addiction and Alternative Medicine Research and at Bastyr University. The Harkinites were so resistant to good science that Jacobs resigned in September 1994. "It's pathetic," he said. "They were so naive about science. I wouldn't trust anything coming out of the OAM as long as the Harkinites are micromanaging it" (Satel and Taranto: 1996). In 1993 the maker of the bee pollen capsules that "cured" Harkin—Royden Brown of the CC Pollen Co.—paid the Federal Trade Commission $200,000 in a consent decree "for making false claims about his product's curative powers" (Satel and Taranto: 1996).
In 1995 Harkin crony Wayne Jonas, M.D., became director of the OAM. Jonas stayed until 1999. In 1996 Jonas co-authored Healing With Homeopathy: The Complete Guide. Two years later he co-authored Healing With Homeopathy: The Doctor's Guide. To his credit, Jonas wrote that the effectiveness of homeopathy might be due to the placebo effect. Since there aren't any active ingredients in homeopathic remedies, I'd say Jonas made a pretty good guess. I'd also say that it is highly likely that the most important discovery that will emerge from Harkin's efforts is a better understanding of the placebo effect.
In 2007, Bill Clinton referred to Sen. Harkin as "a great friend of scientific research." To be fair, Harkin has also been an advocate for the hearing impaired (his brother, Frank, was deaf) and some of the research he's supported (e.g., for cochlear implants) is evidence-based.
It is impossible to say what the impact of the existence of the NCCAM has been on public opinion. David M. Eisenberg, M.D., of Beth Israel Deaconess Medical Center in Boston, and his colleagues surveyed 2,055 adults by telephone in 1997 and compared the results to their similar 1990 telephone survey of 1,539 adults. Eisenberg reported that the "use of at least one of 16 alternative therapies increased from 33.8 percent in 1990 to 42.1 percent in 1997. The therapies that saw the largest increase in usage included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing and homeopathy. Prayer and acupuncture continue to be two of the most popular forms of "alternative" therapy. We've been waiting for sixteen years for the NIH to announce some major breakthrough in health care that has emerged from NCCAM. Unfortunately, most of the "alternative" research is driven by faith, hope, and ideology rather than science. As Dr. Wallace Sampson noted: the NCCAM "is the only entity in the NIH [among some 27 institutes and centers] devoted to an ideological approach to health."*
* Other examples of politicization in the name of consumer protection include the action of Sen. Royal Copeland (1868-1938), a homeopath, who sponsored the 1938 Food, Drug, and Cosmetics Act that effectively exempts all homeopathic potions from FDA oversight; and Bill Clinton's appointment of James S. Gordon, M.D., to head the White House Commission on Complementary and Alternative Medicine Policy, which led to the 1994 Dietary Supplement and Health Education Act. This law "allows 'natural' substances to be marketed over-the-counter without proof of efficacy or purity as long as the maker doesn't promise to cure anything" (Park 2008: 177).
In 1938, Sen. Royal Copeland of New York, the chief sponsor of the Food, Drug, and Cosmetic Act and a homeopathic physician, wrote into the law a recognition of any product listed in the Homeopathic Pharmacopeia of the United States. The Homeopathic Pharmacopeia includes a compilation of standards for source, composition and preparation of homeopathic drugs.
FDA regulates homeopathic drugs in several significantly different ways from other drugs. Manufacturers of homeopathic drugs are deferred from submitting new drug applications to FDA. Their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength. Homeopathic drugs in solid oral dosage form must have an imprint that identifies the manufacturer and indicates that the drug is homeopathic. The imprint on conventional products, unless specifically exempt, must identify the active ingredient and dosage strength as well as the manufacturer.
"The reasoning behind [the difference] is that homeopathic products contain little or no active ingredients," explains Edward Miracco, a consumer safety officer with FDA's Center for Drug Evaluation and Research. "From a toxicity, poison-control standpoint, [the active ingredient and strength] was deemed to be unnecessary."
Another difference involves alcohol. Conventional drugs for adults can contain no more than 10 percent alcohol, and the amount is even less for children's medications. But some homeopathic products contain much higher amounts because the agency has temporarily exempted these products from the alcohol limit rules.
"Alcohol is an integral part of many homeopathic products," says Miracco. For this reason, the agency has decided to delay its decision concerning alcohol in homeopathic products while it reviews the necessity of high levels of alcohol.
"Overall, the disparate treatment has been primarily based on the uniqueness of homeopathic products, the lack of any real concern over their safety because they have little or no pharmacologically active ingredients, and because of agency resources and priorities," explains Miracco.
However, homeopathic products are not exempt from all FDA regulations. If a homeopathic drug claims to treat a serious disease such as cancer it can be sold by prescription only. Only products sold for so-called self-limiting conditions--colds, headaches, and other minor health problems that eventually go away on their own--can be sold without a prescription (over-the-counter).
I feel better already.
See also alternative medicine, complementary medicine, energy, frontier medicine, hidden persuaders, integrative medicine, holistic medicine, and Short and Irreverent E-dition, part 1, sCAM (so-called Complementary & Alternative Medicine).
I have written several articles and short pieces about alternative-health related topics. The following is a list of those I think are most relevant to the article above.
Review of R. Barker Bausell's Snake Oil Science: The Truth about Complementary and Alternative Medicine
books and articles
Satel, Sally M.D. and James Taranto. (1996). "The battle over alternative therapies," Sacramento Bee, January 3. First published in The New Republic.
websites and blogs
NIH Director Francis Collins doesn’t understand the problem with CAM by David Gorski: "I realize that “complementary and alternative medicine” (CAM) or, what quackademics like to call it now, “integrative medicine” (IM) is meant to refer to “integrating” alternative therapies into SBM or “complementing” SBM with a touch of the ol’ woo, but I could never manage to understand how “integrating” quackery with SBM would do anything but weaken the scientific foundation of medicine. Moreover, weakening those foundations would have more consequences than just “humanizing” medicine; weaker scientific standards would allow not just ancient quackery like traditional Chinese medicine (TCM) into academia, but it would also provide an opening for drug and device companies to promote their wares under less rigorous requirements for evidence."
Culling Non-Science From Scarce Medical Resources by Eugenie V. Mielczarek and Brian Engle NCCAM has awarded $1.3 billion from 2000-2011. So far there have been no discoveries that would justify this waste of money.
Let's do some real science for a change! The NCCAM Strategic Plan 2011-2015 Orac speaks: "I've made no secret about the fact that I am not a fan of the National Center for Complementary and Alternative Medicine (NCCAM). I consider it a useless, redundant center within the National Institutes of Health because it does nothing that could't be done as well or better in the institutes and centers of the NIH that existed before woo-friendly Senator Tom Harkin (D-IA) created NCCAM's precursor and then saw to it that it grew to a full center, with a budget in the $125 million a year range. Personally, if something has to be cut fromt the government in this time of fiscal austerity, I couldn't think of any better place to start in the NIH than to eliminate NCCAM."
Vaccine Wars: the NCCAM Drops the Ball Published by Kimball Atwood at Science-Based Medicine 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.” But the website has nothing about the anti-vaccination element at the heart of sCAM, much less any positive information on the proven efficacy and value of vaccines.
Our Visit with NCCAM Steven Novella and two colleagues from Science-Based Medicine are invited by Josephine Briggs, the current director of the NCCAM, to a face-to-face meeting to discuss SBM's concerns about NCCAM. Novella gives us his take on the meeting.
article in The Iowa Republican is headlined:
Sen. Tom Harkin (D-Herbalife) gets cash for institute after legislative favors. Patch details a recent infusion of funds to the Harkin Institute of Public Policy at Iowa State University in Ames. The gift (bribe?) pledged by Herbalife's chief lobbyist seems like chump change compared to other donors to Harkin's pet projects.
In 1994, Harkin authored the Dietary Supplement Health and Education Act, which allows supplement makers to voluntarily test their products before they put them on the market. The U.S. Food and Drug Administration is allowed to intervene only after the product allegedly harms people.
Hedge fund manager William Ackman calls Herbalife “the best-managed pyramid scheme in the history of the world.” Harkin has been helping Herbalife for decades and is expected to protect the company as it faces a federal investigation. The Wall Street Journal reported that the U.S. Securities and Exchange Commission has opened an investigation into the company. The company is also appealing a 2011 ruling by a European court designating Herbalife an illegal pyramid scheme.
Federal center pays good money for suspect medicine by Trine Tsouderos, Chicago Tribune reporter "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."
Troubled study at heart of therapy debate by Trine Tsouderos, Chicago Tribune reporter "With $30 million of taxpayer money, researchers set out to conduct one of the largest studies ever of an alternative medical treatment, a controversial therapy [chelation] for coronary artery disease. The project was marred with problems from beginning to end. Because the treatment was so out of step with mainstream medicine, it was difficult to find enough patients to take part. The researchers failed to inform the subjects that one risk of the treatment was death. In consent form documents, they made a confusing statement about the study drug, implying it was safer than it was."
Energy healing sparks debate by Trine Tsouderos, Chicago Tribune reporter "Energy healers say they can detect and channel a "universal energy" and even manipulate this energy within another person. Science has not proved that this energy exists, that anybody can detect it or manipulate it, or that it has anything to do with disease. In fact, proving the existence of such energy would require a dramatic transformation in what is known about disease and how the human body works. Yet the National Center for Complementary and Alternative Medicine has funded studies of energy healing for everything from fibromyalgia (a $300,000 grant) to prostate cancer (a $370,000 grant) to rats stressed out by white noise (a $370,000 grant)."
$2.5 billion spent, no alternative cures found (Big, government-funded studies show alternative health treatments work no better than placebos. "It's the fox guarding the chicken coop," said Dr. Joseph Jacobs...."This is not science, it's ideology on the part of the advocates.")
Critics Object to 'Pseudoscience' Center ("The impending national discussion about broadening access to health care, improving medical practice and saving money is giving a group of scientists an opening to make a once-unthinkable proposal: Shut down the National Center for Complementary and Alternative Medicine at the National Institutes of Health.")
Statement by Senator Tom Harkin At the Hearing on the Use of Integrative Care to Keep People Healthy ("I am eager to hear our distinguished witnesses’ ideas on using integrative care to keep people healthy, improve healthcare outcomes, and reduce healthcare costs....The time has come to 'think anew' and to 'disenthrall ourselves' from the dogmas and biases that have made our current health care system – based overwhelmingly on conventional medicine – in so many ways wasteful and dysfunctional. It is time to end the discrimination against alternative health care practices....it is time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative." Suggestion: Please let Sen. Harkin know that there is no such thing as scientifically-based alternative medicine. If it's scientifically based medicine, it is not alternative medicine, it's medicine.)
Alternative therapy use documented in new survey "Nearly 40% of adults and 12% of children in the U.S. use herbal supplements, meditation, chiropractic services or acupuncture....nearly 18% of adults reported using fish oil/omega 3 DHA, glucosamine, echinacea, flaxseed oil or pills and ginseng. Nearly 13% practiced deep breathing exercises, more than 9% meditated, nearly 9% used chiropractic or osteopathic manipulation, 8% received massages and 6% practiced yoga."
"Comparison of the data from the 2002 and 2007 surveys suggests that overall use of CAM among adults has remained relatively steady—36 percent in 2002 and 38 percent in 2007.....Adult use of CAM therapies for head or chest colds showed a marked decrease from 2002 to 2007 (9.5 percent in 2002 to 2.0 percent in 2007)." See NCCAM press release.