NCCAM = National Scam

Posted February 16, 2009

Reading the blogs of others I have noticed that one entry often sparks another and chains of commentary develop. I now understand how this works; one quickly has more to say than is appropriate for a simple comment when a hot topic is discussed. This, IMO, is a great way to converse and spread the word about important issues that warrant wide attention. Alternative medicine is certainly one of these areas and a recent post stirred my anger.

Today I read a blog entry by Z at It’s the Thought That Counts which was apparently inspired by yet another blog entry by Orac, at Respectful Insolence. Z’s links then led me to some findings of my own that I feel compelled to share.

When I first heard of the National Center for Complementary and Alternative Medicine (NCCAM), I thought it was a good thing. I believed that an agency governed by the NIH would be responsible. I believed that good science which investigated the claims made by these snake oil salesmen would be conducted, and public education regarding these products would be the result. I now think that I was wrong. I am angry that my tax dollars are being spent propagating propaganda and ignorance, spreading BS and allowing swindlers make money off of the American public.

What changed my mind? Well, you can read about where the money is going and about the types of studies funded by the agency by going to the blog entries I mentioned. In the meantime, let me tell you about the “educational information” being produced by this government agency.

One of the NCCAM’s four “primary areas of focus” is “sharing news and information”. Their website describes their approach to this task:

We provide timely and accurate information about CAM research in many ways, such as through our Web site, our information clearinghouse, fact sheets, Distinguished Lecture Series, continuing medical education programs, and publication databases.

This got me thinking. What information are they sharing? Are they sharing, in their fact sheets for example, the reason why these things are classified as “complementary” or “alternative” to conventional medicine? The difference is simple to explain — medicine that has been shown through scientific evidence to the safe and effective is conventional medicine. Everything else is “alternative” (it is considered “complementary” when conventional medicine is also used). When and if evidence suggests that any treatment is effective, it is no longer considered “alternative”; it becomes “conventional”.

Let me note, however, that some of the dictionary definitions are inaccurate. For example, American Heritage Dictionary defines “alternative medicine” as:

A variety of therapeutic or preventive health care practices, such as homeopathy, naturopathy, chiropractic, and herbal medicine, that do not follow generally accepted medical methods and may not have a scientific explanation for their effectiveness.

which is misleading in that it clearly implies that these practices are effective; we just don’t know why. That’s simply untrue. There are many conventional medicines and practices that are effective, but lack strong scientific explanations for their effectiveness. The causal agents in the successful treatment of rosacea with antibiotics and many of the uses of antidepressants are not well understood, but we hardly classify them as “alternative”. That term is reserved for unproven treatments of any kind.

This definition makes one of the NCCAM other primary areas of focus utterly moot. “Supporting integration of proven CAM therapies” (never mind that they do not state what they mean by integration) is described as follows:

Our research helps the public and health professionals understand which CAM therapies have been proven to be safe and effective.

Um, by definition this statement is self-contradictory.

So, which of these therapies are they claiming are safe and effective (and should then be reclassified)? To find out, I took a look at some of their fact sheets.

Under “Herbs at a Glance”, I started with the first entry that is not considered conventional, Astragalus.

The fact sheet includes a section titled What the Science Says. There were three bullet points:

  • The evidence for using astragalus for any health condition is limited. Results from small or preliminary studies suggest that astragalus may benefit heart function and help the immune system fight infections.
  • A few studies have shown potential benefits for using astragalus—in combination with another herb, glossy privet (Ligustrum lucidum)—as an adjunctive therapy for cancer. In general, however, these studies were not well designed.
  • NCCAM-funded investigators are studying the effects of astragalus on the body, particularly on the immune system.

The third point hardly tells anyone “what the science says”. The first two, however, immediately threw up red flags. Despite the careful wording (I may sprout wings and fly, too), it is misleading at best. Where did this information come from?

The fact sheet sites three sources, none of which are research reports published in peer-reviewed academic journals:

  • Astragalus. Natural Medicines Comprehensive Database Web site. Accessed May 10, 2007.
  • Astragalus (Astragalus membranaceus). Natural Standard Database Web site. Accessed May 9, 2007.
  • Upton R. Astragalus. In: Coates P, Blackman M, Cragg G, et al., eds. Encyclopedia of Dietary Supplements. New York, NY: Marcel Dekker; 2005:25–30.

Could these be biased? Maybe a little?

Okay, let’s try another. How about feverfew?

Under What the Science Says we find:

  • Some research suggests that feverfew may be helpful in preventing migraine headaches; however, results have been mixed and more evidence is needed from well-designed studies.
  • One study found that feverfew did not reduce rheumatoid arthritis symptoms in women whose symptoms did not respond to conventional medicines. It has been suggested that feverfew could help those with milder symptoms.
  • There is not enough evidence available to assess whether feverfew is beneficial for other uses.
  • NCCAM-funded researchers are studying ways to standardize feverfew; that is, to prepare it in a consistent manner. Standardized preparations could be used in future studies of feverfew for migraines.

And again the sources cited fall far short of reliable or reputable:

  • Awang DVC, Leung AY. Feverfew (Tanacetum parthenium). In: Coates P, Blackman M, Cragg G, et al., eds. Encyclopedia of Dietary Supplements. New York, NY: Marcel Dekker; 2005:211–217.
  • Feverfew. Natural Medicines Comprehensive Database Web site. Accessed on July 5, 2007.
  • Feverfew (Tanacetum parthenium L. Schultz-Bip.). Natural Standard Database Web site. Accessed on July 3, 2007.

Can you imagine citing resources like these to support your theory in application for a research grant? Or in a scientific journal article? Any otherwise respectable researcher would lose all credibility.

The fact sheet on Echinacea presents the findings as mixed:

  • Study results are mixed on whether echinacea effectively treats colds or flu. For example, two NCCAM-funded studies did not find a benefit from echinacea, either as Echinacea purpurea fresh-pressed juice for treating colds in children, or as an unrefined mixture of Echinacea angustifolia root and Echinacea purpurea root and herb in adults. However, other studies have shown that echinacea may be beneficial in treating upper respiratory infections.
  • Most studies to date indicate that echinacea does not appear to prevent colds or other infections.
  • NCCAM is continuing to support the study of echinacea for the treatment of upper respiratory infections. NCCAM is also studying echinacea for its potential effects on the immune system.

And, finally, it actually cited two peer-reviewed research reports among the six sources. However, both reported null findings (must be those pesky studies they funded, so they had to cite them). One published in JAMA also noted an increased risk of rash and children ages 2 through 11. Findings are not “mixed” when quality research agrees and one must consult pseudoscience or research of questionable quality to find disagreement.

What I found next was comical. I followed a link to “10 things to know about evaluating medical resources on the Web“. I’ll let you peruse that on your own.

The NCCAM’s annual budget has been around $120 million for the past few years and, although I do not know how funds in the new “stimulus package” will be distributed (does anyone?), there is money for science and it seems unlikely that the NCCAM’s budget will be cut.

I wonder about NCCAM’s history and the guise under which it was built. If a special interest lobby — namely the dietary supplement and CAM industry — was primarily responsible for its birth, then it is no wonder that the only thing this agency has accomplished so far is lending false credence to the products of that industry.

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