Dr. Josephine Briggs (Jonathan Ernst / Chicago Tribune / December 5, 2011) |
Thanks to a $374,000 taxpayer-funded grant, scientists now know that inhaling lemon and lavender scents doesn't do a lot for our ability to heal a wound. For $666,000 in federal research money, we can be certain that distant prayer cannot heal AIDS. Americans also paid $406,000 to learn that squirting brewed coffee into someone's intestines doesn't help treat pancreatic cancer and $1.25 million to discover that massage makes people with advanced cancer feel better.
These and other dubious investigations were funded by the government's National Center for Complementary and Alternative Medicine. NCCAM, a small, little-known branch of the National Institutes of Health, was launched a dozen years ago to study alternative treatments that are used by the public but are not accepted by mainstream medicine.
Since its birth, the center has spent $1.4 billion, most of it on research. Millions of those dollars have been used to fund studies with questionable grounding in science, according to a review of hundreds of NCCAM grants and other documents reviewed by the Chicago Tribune.
"Some of these treatments were just distinctly made up out of people's imaginations," says Dr. Wallace Sampson, clinical professor emeritus of medicine at Stanford University.
"How can we justify wasting money on something like this when there are so many other things that are much more plausible and much more likely to result in real benefit?" adds Dr. David Gorski, a breast cancer researcher at Wayne State University in Detroit and vocal critic of NCCAM.
The director of the center and other advocates say it is worthwhile to use taxpayer dollars to study certain alternative treatments. "They deserve scientific attention," says NCCAM Director Josephine Briggs, a respected NIH researcher and physician who has headed NCCAM for nearly four years.
Briggs says that she's dedicated to evidence-based medicine and that the center, under her leadership, is committed to rigorous scientific studies. Besides, she says, the center's $128-million annual allotment amounts to less than half a percent of the total NIH budget.
The center's recently adopted strategic plan focuses on studies of supplements and other natural products, along with the effect of therapies like yoga, massage and acupuncture on pain and other symptoms. Studies of energy healing or distant prayer likely would not get funded by NCCAM today, Briggs says: "We are not your grandmother's NCCAM."
Yet many treatments that are being studied, like qigong and acupuncture, also involve the purported manipulation of a universal energy or life force that is incompatible with scientists' understanding of how the body works.
NCCAM's continuing interest in acupuncture comes even though many of its studies have found that acupuncture and similar therapies are no better than sham treatments at easing symptoms like pain and fatigue. To most scientists, that's a sign the treatments don't work — after all, drug companies can't sell medicines that work no better than a sugar pill.
Critics of the center say it's telling that NCCAM was conceived not by scientists clamoring to study alternative medicine but by Sen. Tom Harkin (D-Iowa), a member of the Senate subcommittee that helps oversee the NIH budget. In a 1998 speech, Harkin described watching acupuncture and acupressure ease the pain and violent hiccups of a brother dying of thyroid cancer.
"These are things I have seen with my own eyes," said Harkin, who also lost three other siblings to cancer. "When I see things like this, I ask, 'Why? Why aren't these things being researched?'"
NCCAM was created a few months later. The center's main mission was clear: Study alternative therapies and how they could be integrated into conventional treatment.
$43 billion a year
About 4 out of 10 American adults use some sort of alternative treatment, according to a 2007 survey by the U.S. Centers for Disease Control and Prevention. Mostly they reported taking supplements, practicing deep breathing exercises, going to a chiropractor or osteopath for spinal manipulation, meditating or getting massages. The out-of-pocket bill for these therapies adds up to about $43 billion a year, the survey found.
Conducting scientific studies to determine whether these treatments work is a valuable service, says Dr. Steven DeKosky, who sits on the NCCAM advisory council and is dean of the University of Virginia medical school. "I don't know who else would do that other than NCCAM."
DeKosky, a neurologist, received $25 million from NCCAM to help fund a study on whether ginkgo biloba can protect against dementia and Alzheimer's disease. He concluded that the popular supplement did not reduce the overall incidence of either condition in elderly people who were normal or already had mild cognitive impairment.
Such studies are conducted by randomly assigning some people to take the supplement being tested and giving others a placebo; volunteers don't know which group they're in, so that knowledge can't bias the results. Researchers compare the outcomes for both groups to see whether those who took the supplement were better off than those who took the dummy pill. This approach is widely accepted in the medical research community.
But when looking into "mind and body" medicine, NCCAM often argues that a treatment is valuable if patients report that it helped them — even if others receiving a sham treatment said the same.
For example, the center has spent millions on studies of acupuncture, in which tiny needles are inserted shallowly into the body to unblock the "vital energy" called qi, according to NCCAM's website. Many of those studies have found that true acupuncture performs no better than sham acupuncture, in which a person is fooled into thinking he is getting the real thing through the use of retractable needles or even toothpicks twirled on the skin.
People often report feeling less pain or being less fatigued regardless of whether they receive real or fake acupuncture, suggesting a placebo effect is at work. Yet NCCAM is pouring more research money into acupuncture.
"The intellectual dishonesty is just astounding," says Dr. Steven Novella, a neurologist at Yale School of Medicine and an NCCAM critic.
Briggs says it's difficult to design trials of complex therapies like acupuncture. "It is generally impossible to isolate a single element. A sham control in a mind-and-body study could easily miss answering the most important question of whether the patient experiences benefit."
Physicians who treat patients in pain say they welcome any new tools, especially ones without the side effects of narcotics. If that means offering a treatment that may be a placebo, so be it.
"We have lots of people out there with a problem that isn't being addressed with conventional approaches," says Daniel Cherkin, who researchers alternative medicine in Seattle and sits on the NCCAM advisory council. "What do we do with those people? To say we shouldn't do these things because it is a placebo denies them something safe and available and works."
Critics respond that it's not right to charge people hundreds or thousands of dollars for treatments that amount to nothing more than an elaborate placebo.
"It is essentially deluding somebody," says Sampson of Stanford. "In other parts of our social life, it is a crime."
ttsouderos@tribune.com
These and other dubious investigations were funded by the government's National Center for Complementary and Alternative Medicine. NCCAM, a small, little-known branch of the National Institutes of Health, was launched a dozen years ago to study alternative treatments that are used by the public but are not accepted by mainstream medicine.
Since its birth, the center has spent $1.4 billion, most of it on research. Millions of those dollars have been used to fund studies with questionable grounding in science, according to a review of hundreds of NCCAM grants and other documents reviewed by the Chicago Tribune.
"Some of these treatments were just distinctly made up out of people's imaginations," says Dr. Wallace Sampson, clinical professor emeritus of medicine at Stanford University.
"How can we justify wasting money on something like this when there are so many other things that are much more plausible and much more likely to result in real benefit?" adds Dr. David Gorski, a breast cancer researcher at Wayne State University in Detroit and vocal critic of NCCAM.
The director of the center and other advocates say it is worthwhile to use taxpayer dollars to study certain alternative treatments. "They deserve scientific attention," says NCCAM Director Josephine Briggs, a respected NIH researcher and physician who has headed NCCAM for nearly four years.
Briggs says that she's dedicated to evidence-based medicine and that the center, under her leadership, is committed to rigorous scientific studies. Besides, she says, the center's $128-million annual allotment amounts to less than half a percent of the total NIH budget.
The center's recently adopted strategic plan focuses on studies of supplements and other natural products, along with the effect of therapies like yoga, massage and acupuncture on pain and other symptoms. Studies of energy healing or distant prayer likely would not get funded by NCCAM today, Briggs says: "We are not your grandmother's NCCAM."
Yet many treatments that are being studied, like qigong and acupuncture, also involve the purported manipulation of a universal energy or life force that is incompatible with scientists' understanding of how the body works.
NCCAM's continuing interest in acupuncture comes even though many of its studies have found that acupuncture and similar therapies are no better than sham treatments at easing symptoms like pain and fatigue. To most scientists, that's a sign the treatments don't work — after all, drug companies can't sell medicines that work no better than a sugar pill.
Critics of the center say it's telling that NCCAM was conceived not by scientists clamoring to study alternative medicine but by Sen. Tom Harkin (D-Iowa), a member of the Senate subcommittee that helps oversee the NIH budget. In a 1998 speech, Harkin described watching acupuncture and acupressure ease the pain and violent hiccups of a brother dying of thyroid cancer.
"These are things I have seen with my own eyes," said Harkin, who also lost three other siblings to cancer. "When I see things like this, I ask, 'Why? Why aren't these things being researched?'"
NCCAM was created a few months later. The center's main mission was clear: Study alternative therapies and how they could be integrated into conventional treatment.
$43 billion a year
About 4 out of 10 American adults use some sort of alternative treatment, according to a 2007 survey by the U.S. Centers for Disease Control and Prevention. Mostly they reported taking supplements, practicing deep breathing exercises, going to a chiropractor or osteopath for spinal manipulation, meditating or getting massages. The out-of-pocket bill for these therapies adds up to about $43 billion a year, the survey found.
Conducting scientific studies to determine whether these treatments work is a valuable service, says Dr. Steven DeKosky, who sits on the NCCAM advisory council and is dean of the University of Virginia medical school. "I don't know who else would do that other than NCCAM."
DeKosky, a neurologist, received $25 million from NCCAM to help fund a study on whether ginkgo biloba can protect against dementia and Alzheimer's disease. He concluded that the popular supplement did not reduce the overall incidence of either condition in elderly people who were normal or already had mild cognitive impairment.
Such studies are conducted by randomly assigning some people to take the supplement being tested and giving others a placebo; volunteers don't know which group they're in, so that knowledge can't bias the results. Researchers compare the outcomes for both groups to see whether those who took the supplement were better off than those who took the dummy pill. This approach is widely accepted in the medical research community.
But when looking into "mind and body" medicine, NCCAM often argues that a treatment is valuable if patients report that it helped them — even if others receiving a sham treatment said the same.
For example, the center has spent millions on studies of acupuncture, in which tiny needles are inserted shallowly into the body to unblock the "vital energy" called qi, according to NCCAM's website. Many of those studies have found that true acupuncture performs no better than sham acupuncture, in which a person is fooled into thinking he is getting the real thing through the use of retractable needles or even toothpicks twirled on the skin.
People often report feeling less pain or being less fatigued regardless of whether they receive real or fake acupuncture, suggesting a placebo effect is at work. Yet NCCAM is pouring more research money into acupuncture.
"The intellectual dishonesty is just astounding," says Dr. Steven Novella, a neurologist at Yale School of Medicine and an NCCAM critic.
Briggs says it's difficult to design trials of complex therapies like acupuncture. "It is generally impossible to isolate a single element. A sham control in a mind-and-body study could easily miss answering the most important question of whether the patient experiences benefit."
Physicians who treat patients in pain say they welcome any new tools, especially ones without the side effects of narcotics. If that means offering a treatment that may be a placebo, so be it.
"We have lots of people out there with a problem that isn't being addressed with conventional approaches," says Daniel Cherkin, who researchers alternative medicine in Seattle and sits on the NCCAM advisory council. "What do we do with those people? To say we shouldn't do these things because it is a placebo denies them something safe and available and works."
Critics respond that it's not right to charge people hundreds or thousands of dollars for treatments that amount to nothing more than an elaborate placebo.
"It is essentially deluding somebody," says Sampson of Stanford. "In other parts of our social life, it is a crime."
ttsouderos@tribune.com
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