Why the National Center for Complementary and
Alternative Medicine (NCCAM) Should Be Defunded

Wallace I. Sampson, M.D.

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 evidence of ineffectiveness of some methods that we knew did not work before NCCAM was formed. NCCAM proposals for 2002 and 2003 promise no more. Its major accomplishment has been to ensure the positions of medical 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 misrepresented as "alternative medicine." Using obscure language and misleading claims, their advocates 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 presented as a scientific vehicle to study alternative medicine's anomalous methods. But it actually promotes the movement by assuming that false and implausible claims are legitimate things to study.

In 1992, Senator Tom Harkin (D-Iowa) assigned $2 million of his discretionary funds to establish NCCAM's first incarnation: the Office of Unconventional Medicine, which was renamed the Office of Alternative Medicine (OAM). The new NIH office was assigned to investigate "alternative" methods that medical science considered false or implausible. Soon afterward, at a Congressional hearing, Harkin revealed that he was convinced bee pollen had cured that his allergies.

The first OAM director resigned under Sen. Harkin's pressure, having objected to Harkin's OAM Council nominees who represented cancer scams such as Laetrile and Tijuana cancer clinics [1]. 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 OAM. Responding to objections from the scientific medical community, 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. The table to the right shows how the allocation has steadily grown.  

Scientists look at 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 as 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 add to the cost medical care but do not improve its outcome.

We already know that these aberrant methods do not work, or are so unlikely to work that more clinical trials are not reasonable. Why should research be limited? 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, and 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 many trials, chiropractic manipulation has not been proven to influence the course of any disease and has not even been proven effective for treating back pain [2]. 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 many ingredients 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, Steven Straus, M.D., 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 many years of projects and over $200 million spent, NCCAM and advocates have not proved any method to be effective [3]. 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 can 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. It 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.

References

  1. Marshall E. The politics of alternative medicine. Science 265:2000-2002, 1994.
  2. Koes BW and others. Spinal manipulation for low back pain: An updated systematic review of randomized clinical trials. Spine 21:2860-2873, 1996.
  3. Green S. Stated goals and grants of the Office of Alternative Medicine/National Center for Complementary and Alternative Medicine Policy. SRAM 5:205-207, 2001.

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.

This article was posted on December 10, 2002.

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