Another reason why NCCAM can never be truly scientific

I’ve frequently been critical fo the National Center for Complementary and Alternative Medicine (NCCAM) for funding dubious studies of pseudoscience and, in essence, promoting unscientific quackademic medicine (is there any other kind?) by giving it the patina of seeming respectability. I can’t recall how many times I’ve seen promoters of woo justify their woo by saying, “Well, NCCAM funds it.” As far as apologetics for quackademic medicine, “NCCAM does it” is right up there with “Harvard does it.” Unfortunately, Harvard really does do it, as do too many other bastions of science-based medicine that have betrayed their trust and allowed pseudoscience to infiltrate them in the form of “integrative medicine.” And NCCAM leads the way, your tax dollars funneled into it going towards funding woo.

NCCAM is a bizarre beast. More than anything else, it owes its creation to Senator Tom Harkin (D-IA), who is also a bizarre beast in his own right. A champion of the National Institutes for Health, so much so that he has been honored as such, Harkin is, alas, also very much into quackery and remains, 20 years after NCCAM’s beginning as the Office of Alternative Medicine, its primary patron, protecting it from all legislative slings and arrows and occasionally chastising it for not having validated more quackery. Ostensibly charged with the rigorous investigation of modalities considered “alternative,” NCCAM all too often applies state of the art science to what is at its heart, prescientific mysticism, such as various “energy healing” techniques, acupuncture, and even homeopathy, a practice that Harriet Hall once aptly dubbed “Tooth Fairy science.” Unfortunately, the current director of NCCAM, Dr. Josephine Briggs, seems like a sincere scientist but also seems as though she doesn’t realize that she has been put in charge of the good ship Tooth Fairy. As a result, she gamely tries to get NCCAM to do the very best Tooth Fairy science she can.

She’s also in a difficult spot. Caught between the Scylla of scientists and physicians practicing science-based medicine and the Charybdis of her alt-med constituency, led by her center’s powerful Congressional patron, Dr. Briggs really is in a virtually no-win situation. Worse, she also has to please the National Advisory Council for Complementary and Alternative Medicine (NACCAM), the external body charged with the “responsibility of advising, consulting with, and making recommendations to the Director, NCCAM, on matters relating to the research activities and functions of the Center.” It turns out that just yesterday four new members of NACCAM were announced in a press release. The new members of the advisory council include Brian M. Berman, M.D.; Daniel C. Cherkin, Ph.D.; David G.I. Kingston, Ph.D.; and James Lloyd Michener, M.D. Much like the seemingly schizophrenic nature of NCCAM, these appointments show the classic “split personality.” Dr. Kingston, for example, appears to have a stellar record as a natural products chemist while Dr. Michener appears to be in the science-based camp of physicians. Dr. Cherkin, on the other hand, is seriously into acupuncture and various other woo, to the point of being program chair for the 2009 North American Conference on Complementary and Integrative Medicine.

Then there’s Dr. Berman, who is described in the press release thusly:

Brian M. Berman, M.D., is a professor of family medicine at the University of Maryland, Baltimore, and the founder and director of the University of Maryland Center for Integrative Medicine. He is a practicing family physician and pain management specialist. He chaired both the ad hoc advisory committee to the NIH Office of Alternative Medicine as well as the Consortium of Academic Health Centers for Integrative Medicine. Dr. Berman also co-founded the complementary medicine field within the Cochrane Collaboration, an international organization that evaluates medical practices through systematic reviews of research literature. In addition, Dr. Berman is trained in homeopathy and has a membership in the Faculty of Homeopathy, has a diploma from the London School of Traditional Chinese Medicine, and is a licensed acupuncturist.

A homeopath. NCCAM just named a homeopath to its major advisory committee. Lovely.

We’ve met Dr. Berman before. Just last summer, he somehow managed to get a credulous review article/editorial about acupuncture into the New England Journal of Medicine, thus demonstrating conclusively that there is no bastion of science-based medicine that can’t be breached with pseudoscience. In any event, Dr. Berman is the founder of the University of Maryland Center for Integrative Medicine, which offers the following services:

  • Acupuncture
  • Nutrition
  • Massage
  • Homeopathy
  • Reflexology
  • Life Coaching
  • Reiki
  • Yoga
  • Qi Gong
  • Tai Chi
  • Acupuncture

That’s right, the University of Maryland offers rank quackeries like homeopathy, reflexology, and reiki, along with modalities whose potential benefits are frequently oversold by woo-meisters, such as yoga and tai chi. And, yup, there’s Dr. Berman himself offering homeopathy:

Homeopathic physicians seek to cure their patients on the physical, mental and emotional levels; and, each treatment is tailored to a patient’s individual needs. Remedies are chosen by the law of similars (i.e., let like cure like). Homeopathy is generally a safe treatment, as it uses medicines in extremely diluted quantities. There are usually minimal side effects.

Of course there are minimal side effects from homeopathy. It is, after all, water. Meanwhile, certified life coach, reiki master, and reflexologist Jean Wehner plies her skills on the credulous right in University of Maryland facilities. That’s not all that goes on at the University of Maryland. Even the hallowed halls of the once hard-core science-based trauma program at the University of Maryland’s Shock Trauma Center has succumbed to the pure religion-inspired quackery that is reiki. It’s so bad at the University of Maryland that, even from another campus, faculty member Steve Salzberg expressed extreme dismay, and I likened Maryland to Hogwarts. In retrospect, I realize that was a bit of an insult to Hogwarts. At least at Hogwarts, magic worked. It had observable, quantifiable effects. Not so at Maryland.

Here’s the reason why NCCAM can never rise above the level of Tooth Fairy science. Credulity towards quackery is built into its very DNA through its advisory council. It’s right there in the NACCAM charter:

The Council will consist of 18 members appointed by the Secretary and 5 nonvoting ex officio members: the Secretary; the Director, NIH; the Director, NCCAM; the Chief Medical Director of the Department of Veterans Affairs; the Assistant Secretary of Defense for Health Affairs (or their designees) and any additional officers or employees of the United States as the Secretary determines necessary for the Council to effectively carry out its functions. Of the 18 appointed members, 12 will be selected from among the leading representatives of the health and scientific disciplines (including not less than 2 individuals who are leaders in the fields of public health and the behavioral or social sciences) relevant to the activities of the NCCAM, particularly representatives of the health and scientific disciplines in the areas of complementary and alternative medicine. Nine of the members will be practitioners licensed in one or more of the major systems with which the Center is involved. Six of the members will be appointed by the Secretary from the general public and will include leaders in the fields of public policy, law, health policy, economics, and management. Three of the six will represent the interests of individual consumers of complementary and alternative medicine.

In other words, the council by design is dominated by practitioners of and believers in alternative medicine, with at least half the voting members of the council being made up of practitioners and 2/3 by either true believers or people tending to believe in alternative medicine. In this environment, it makes perfect sense to appoint a Brian Berman or a Daniel Cherkin. The former is both a practitioner and a leader in his field, while the latter is a practitioner. They fit in quite nicely with other members, such as Timothy Birdsall, Vice President, Integrative Medicine, Cancer Treatment Centers of America; Adam Burke, Director, Institute for Holistic Health Studies; and Xiaoming Tian, Director, Academy of Acupuncture and Chinese Medicine.

This is the reason why Dr. Briggs, try as she might to bring rigorous science to NCCAM, can never succeed. She has to answer to the advisory council. If she goes too far in the direction of bringing actual science, rather than Tooth Fairy science, to NCCAM, she’ll have to answer to the likes of Brian Berman.