Congress polishes the turd that was NCCAM


With the way our dysfunctional federal government works, it’s not uncommon for the end of a fiscal year to come and go without there being a budget for the next fiscal year in place. This phenomenon is particularly common during election years, and this year was no different. September 30 came and went, followed by the beginning of FY2015 on October 1 with no budget in place, just a continuing resolution. Finally, this week, Congress acted and passed a budget, but, as is often the case given that the President does not have line item veto power, the omnibus spending bill funding the government for the rest of the fiscal year was loaded down with unrelated clauses doing this or that for various interest groups.

Oddly enough, one of those bits of oddity larded onto the omnibus bill had something to do with a government institution (a Center at the National Institutes of Health, if you will) that is a frequent target topic of this blog. I’m referring, of course, to the National Center for Complementary and Alternative Medicine, a.k.a. NCCAM. Actually, it’s no longer NCCAM. Thanks to a clause in the omnibus spending bill, NCCAM has been reborn. Gone is the word “alternative” or any hint that this is a center that’s funded a whole lot of pseudoscience. In its place is the National Center for Complementary and Integrative Health (NCCIH). Goodbye, NCCAM! Hello, NCCIH! Sadly, the term NCCIH doesn’t have quite the je ne sais quoi that NCCAM did. Maybe it’s because it’s harder to say than NCCAM, which was often pronounced “n-cam.”

Issues of pithy abbreviations being lost aside, though, what does this mean? You might remember that back in May I commented on NCCAM’s desire to rename itself and how its director, Dr. Josephine Briggs, had asked for public comment. At the time, the new proposed name was the National Center for Research on Complementary and Integrative Health (NCRCIH), and I referred to the whole endeavor as “polishing a turd.” Well, the turd has been polished. Or, at least, NCCIH has tried and failed to polish the turd. Interestingly, sometime between May and now, the “research” part was lost. One wonders why. Perhaps it’s because, contrary to what its proponents said, NCCAM was never just about research; it was about promoting “complementary and alternative medicine” (CAM), now “integrative medicine” through educational grants to various universities and training programs.

So what does the NCCAM/NCCIH say about this name change? (Damn, I’m going to have to get used to stop typing “NCCAM” and to using the new name. I also might have to go back and tag all my NCCAM posts with the terms “National Center for Research on Complementary and Integrative Health” and “NCRCI.” Whoa. That’s a lot of posts.) Let’s just say, it’s more of the same from NCCIH:

Large population-based surveys have found that the use of alternative medicine — unproven practices used in place of conventional medicine — is rare. Integrative health care, defined as a comprehensive, often interdisciplinary approach to treatment, prevention and health promotion that brings together complementary and conventional therapies, is more common. The use of an integrative approach to health and wellness has grown within care settings across the United States, including hospitals, hospices, and military health facilities.

“Since its establishment 16 years ago, the center has funded thousands of important research projects. Without this work, the American public would lack vital information on the safety and effectiveness of many practices and products that are widely used and readily available,” said NIH Director Francis S. Collins, M.D., Ph.D. “This change by Congress reflects the importance of studying the approaches to health and wellness that the public is using, often without the benefit of rigorous scientific study.”

“The intent of an integrative approach is to enhance overall health status, prevent disease, and alleviate debilitating symptoms such as pain and chemotherapy-induced nausea, among others. However, the scientific foundation for many complementary approaches is still being built,” said Josephine P. Briggs, M.D., Director of NCCIH. “The mission of NCCIH will remain unchanged. We will continue to focus on the study of the usefulness and safety of complementary and integrative interventions, and provide the public with research-based information to guide health care decision making.”

The name change is in keeping with the center’s pre-existing congressional mandate and is aligned with the strategic plan guiding the center’s research priorities and public education activities. Public comments on a revised name were invited in May and June 2014 and indicated overall support for the change.

It’s the same ol’ same ol’. Note the trope that the use of alternative medicine (i.e., unproven medicine) alone is rare. That is, of course, true. No one is arguing with that—or has been—although we frequently feature stories of people who have actually chosen to rely on alternative medicine to deal with serious diseases, often with tragic results. Of course, when NCCAM started, it was first called the Office of Alternative Medicine before being raised to full Center status in 1998, thanks to Senator Tom Harkin (D-IA), NCCIH’s patron and chief proponent in Congress since the early 1990s and the legislator most responsible for having created and maintained this bastion of pseudoscience in the NIH. One has to wonder if this name change is one last gift from Harkin before he retires. I don’t know if that’s what happened, but it’s totally plausible that Harkin slipped this into the omnibus bill as a last act before he retired. Did he do it? Who knows?

Be that as it may, the objection to NCCIH does not depend on a small number of people using alternative medicine instead of scientific medicine. In fact, the threat of NCCIH and other government entities promoting dubious science is not so much that. Rather, it’s how NCCIH facilitates the “integration” of quackery into conventional medicine by giving cover to alternative medicine modalities that are either so implausible as to be worth no further study (such as “energy healing”) that are commonly lumped into the category of “integrative medicine.” Similarly, it’s how NCCIH facilitates the “rebranding” of modalities, such as nutrition and exercise/lifestyle, that are easily within the domain of science-based medicine and need no special “branding,” the better for advocates of actual quackery to lump them together with nonsense like “energy healing” and traditional Chinese medicine, thus giving them the appearance of plausibility by association.

Also, there’s the issue of spending our taxpayer money on studying and promoting pseudoscience. While it’s true, as far as I can tell perusing NIH RePORTER, that NCCIH hasn’t funded a study of homeopathy since 2008, it still funds lots of studies on acupuncture, which is only marginally less ridiculously implausible, and traditional Chinese medicine (TCM), a retconned version of old Chinese folk medicine. It also funds studies on healing touch, reiki’s “Western” bastard child, as far as “energy medicine” goes. There’s nothing in the name change that will likely change that, given that acupuncture and TCM are highly popular, arguably among the most popular bits of quackery frequently “integrated” into SBM. Similarly, naturopathy is a veritable cornucopia of quackery based on prescientific vitalism.

The press release basically concludes:

The center’s research priorities include the study of complementary approaches — such as spinal manipulation, meditation, and massage — to manage pain and other symptoms that are not always well-addressed by conventional treatments. The center’s research also encourages self-care methods that support healthier lifestyles and uncovers potential usefulness and safety issues of natural products. The practices and products studied by the center are prioritized by four guiding principles: scientific promise, amenability to be studied using the highest quality research methods, use by the American public, and the potential impact on public health.

Back when a name change for NCCAM was first proposed in May, there was a lot of joking about what the new name should be, because the proposed name (or the actual new name) don’t truly describe what NCCAM did (and NCCIH will continue to do). I saw proposed names such as the National Center for Research on Supplements, Complementary and Alternative Medicines (SCAMs), the National Center for Research on Tooth Fairy Medicine (I liked this one), National Center for Research on Snake Oil and Science Denial, National Center for Unprovable Therapies, and National Center for More Research is Needed. (I suggested a slight alteration to this one to National Center for More Research Is Always Needed, No Matter How Implausible the Treatment or Negative the findings. Unfortunately, that name is too long and doesn’t lend itself to a pithy abbreviation less than five letters.) Personally, I liked Harriet Hall’s suggestion, seen on the HealthFraud mailing list, of Center for Studying Things Scientists Wouldn’t Otherwise Bother Studying, which pretty much nailed it. Remember, NCCAM (now NCCIH) was not created due to an overwhelming demand in the scientific community to study acupuncture, reiki, and coffee enemas. After all, the seemingly plausible modalities that fall under the CAM/”integrative medicine” rubric could already be studied (and were already being studied) as conventional modalities. For instance, studying herbal medicine requires nothing more than pharmacognosy, or natural products pharmacology, and there is nothing “alternative” about studying the effects of nutrition and diet on disease.

In the end, it really doesn’t matter very much what NCCAM is called. NCCAM, NCCIH, whatever. Sure, removing “alternative” and adding “integrative” somewhere in the name might make it less offensive to its stakeholders, the alternative medicine practitioners whose purpose it serves, and make it somewhat more palatable for a different reason to science-based physicians, but unless the underlying mission and structure are changed radically, it’ll just be putting lipstick on a pig or polishing a turd, or whatever metaphor you like for trying to make something that is fundamentally flawed beyond redemption seem attractive or reasonable.