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Cancer Complementary and alternative medicine Medicine Quackery Science

In which the NCCIH is questioned…

Orac’s vacation continues apace.

Well, not quite. The main reason I’m in London right now is because I was invited to give an actual scientific (as opposed to skeptical) talk at a conference about—of all things—ion channels in cancer. That’s where I am right now, at the Sir Alexander Fleming Building at Imperial College London, and that’s where I’ll be all day today and much of tomorrow. Having been invited, I decided to make a vacation of it. Basically, it’s a big science sandwich, with two science days in the middle of two slices of vacation bread. I would also be lying if I didn’t admit to a bit of trepidation, given that I’m a surgeon who’s a relative neophyte and novice in the area of ion channels, having been dragged kicking and screaming to the topic by the direction the data generated by my lab’s research took. Such is science sometimes. At the very least, it’ll be cool to learn more about the topic, so as not to approach the problem of whether a drug I’m testing against cancer as simplistically as I have been doing.

Be that as it may, there is material for me to provide that requires little or no commentary. For instance, over at Reason, Todd Krainin has provided us with a report on The Alternative Medicine Racket: How the Feds Fund Quacks:

I’m told that the resources provided by my not-so-secret other blog were used to assist in the research for this report. It’s well worth checking out the video and the story. My only quibble is what the story says about Steve Jobs and his having foregone effective cancer treatment for several months in order to pursue “natural” therapies before coming back to science-based medicine; i.e., repeating the almost certainly erroneous line that Jobs might be alive today if he had been treated right away. I explained in detail why that take on Jobs’ decision, which very attractive to medical skeptics who support SBM, is almost certainly not correct. Don’t get me wrong; Jobs did himself no favors by delaying attempted definitive treatment, but, given lead time bias and the likelihood that his disease was already metastatic at the time of diagnosis, the outcome probably wouldn’t have been much different if he had undergone treatment right away. Probably.

Aside from that quibble, which I have a hard time not mentioning whenever I read about Steve Jobs, Reason has done a nice job of summarizing just what is wrong with the National Center for Complementary and Integrative Health (NCCIH). Here’s hoping it gets the attention of even larger media outlets, although I’m not that hopeful. After all, NBC has Nancy Snyderman, who, for all her strong advocacy of vaccines, has become completely enamored of quackademic medicine.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

18 replies on “In which the NCCIH is questioned…”

Orac’s vacation continues apace.

I prefer vacations that precede no faster than a slow jog trot, myself, but to each his own, I suppose.

I thought the bit about Jobs in the video above was a little bit fishy when I watched it a few days ago, if in part because it seemed to be so perfectly crafted for maximum emotional response, what with Steve Jobs being pretty popular with the kids these days and all. (I dunno, I always had a lot more admiration for Wozniak.)

Enjoy the rest of your stay, in any case. Never been to the UK myself, but would love to go. (Particularly to Scotland, actually.)

Ion channel cancer drugs? Oooh, you will really be more directly connected to big pharma if that plays out well.

Good luck 🙂

Response to #4: Ernst seems an odd bird. He claims to be both a practitioner and skeptic of alt med. His bio at the web site is confusing and contradictory. Any clarification about him? His alphabet soup of honorifics is not explained anywhere, although he does have conventional credentials and has been in academic medicine for a while.

Have a nice holiday, Orac. London is great, I spent there 10 days this summer and came to realize that I would need at least a month to see all that I wanted. But even a few days is worth it.

Anything from that Ayn-Rand-loving rag makes me suspicious. I was waiting for the anti-Obama and anti-Obamacare take, and yup, it showed up at 13:28. Per this video, Tom Harkin alone is to blame for the rise of Alt-Med. At 8:02, Steven Salzburg says Harkin “enacted in the Senate” the ‘elevation’ of the Office of Alternative Medicine into NCCAM, and “he gave it it’s own line item in the NIH budget, and dramatically increased its funding” (my emphasis). Salzburg seems to know less about government than Harkin knows about medical science. Uhh, Harkin may have authored a bill, but on his own he can’t get it out of committee, much less passed in the Senate, and of course the House has to go along, too.

Almost NOTHING happens in U.S. politics unless wealthy donors grease the wheels. Harkin was just the willing mouthpiece for powerful interests in the private sector – maybe a few well-to-do scammers themselves (there are a lot of alt-med entrepreneurs in Iowa, believe it or not, thanks to the draw of the Maharishi School of Management), but more likely billionaire fans of miracle cures.

But, Reason being Reason, has to blame everything on “Big Government”. Sure, it’s valid to question the Federal funding for NCCIH – though the vid suggests that even under Dr. Briggs, it’s been a source of studies that add to the ammo against CAM – but in typical ‘Libertarian’ fashion, Reason acts like government runs everything and is the only source of social power impinging on our lives.

I’m not holding my breath for Reason to come out with exposes of the various alt-med entrepreneurs bilking not ‘taxpayers’, but their patients and customers, or for Reason to call for tighter regulation of CAM, or strengthening of the FDA.

BTW, a quick Google shows three writers for Reason taking positions on vaccine policy. Ronald Bailey advocates the abolition of Medicaid and urges parents to home-school, but admits that as long as Medicaid exists parents choosing public schools should vax their kids. Jeffrey A. Singer “doesn’t support mandatory vaccinations as a precondition for admission to public school. I favor opt-outs for religious or personal belief reasons…” And Sandy Reider says “The science is not settled,” and thus:

Given the sheer volume of vaccine promotion and propaganda, coupled with the cozy relationship between government, industry, and media, there are sufficient grounds for a healthy skepticism. Individual parents have become the last line of defense…, and their choices should be respected and preserved.

Why do I have the feeling if not for NCCIH, Reason wouldn’t be covering CAM at all? (If anyone here reads the print edition, do they run ads for supplement slingers and other dubious ‘health’ con-artists?)

To be fair, there’s no doubt that Tom Harkin was the driving force behind the original Office of Alternative Medicine and ultimately used his influence to have the Office turned into a full-fledged center in 1998 when then-director of the NIH Harold Varmus tried to rein in the Office and make it more scientifically rigorous. There’s also no doubt that Tom Harkin was NCCAM (now NCCIH’s) patron and staunchest defender for 20 years, until his retirement at the end of the 2013-2015 Congressional term. It’s also been well-documented that Harkin frequently meddled in NIH affairs vis-a-vis NCCAM in order to prevent those who wanted it to be rigorously scientific, after having made sure to set the rules so that the NCCAM Advisory Committee was stacked with CAM advocates. Again, these are all well documented occurrences. It may or may not be true that no Tom Harkin no NCCAM (although I suspect that some other woo-friendly legislator would have pushed something like it through eventually but that it would have taken years). Yes, he couldn’t have done it alone, but he had a lot of influence and was willing to use it to get enough legislators to go along with him.

As for Reason, it’s not as though I haven’t written about its anti-science tendencies from time to time, particularly how at home antivaxers are with Libertarianism.

https://www.respectfulinsolence.com/2013/12/18/why-are-antivaccinationists-so-at-home-with-libertarianism/

Ron Bailey is actually one of the more reasonable Libertarians on this topic, and he got taken to the woodshed for it.

Then there’s its truly brain dead anti-FDA tendencies:

https://www.respectfulinsolence.com/2014/10/28/ebola-right-to-try-laws-and-placebo-legislation/

And its defense of the medical neglect of Sarah Hershberger:

https://www.respectfulinsolence.com/2014/03/12/reason-com-defends-the-medical-neglect-of-sarah-hershberger/

By Post Author

I think two xes because it follows the same pronunciation rules as the two cs in ‘vaccine’

It looks better too.

The cop out at NCCIH continues from its days as NCCAM with the recent announcement by program director and pharmacognosist Craig Hopp, PhD, in HerbalGram (issue 107, 2015) that it has arrived at the decision to “consider research focused on disease treatment a low priority.” As to why, he gave two reasons: 1) the NIH has other branches that “focus specifically on individual diseases, and 2), surveys had consistently shown that people who take dietary supplements do so primarily for the promotion of “general health”, rather than the management of disease. To what extent the use of vitamins and minerals weighted the results of the surveys would need to be closely examined. IMO, it would be highly unlikely for anyone to take St. John’s wort and sundry other specific herbal products if they were not treating or managing a disease. More in keeping with Orac’s points concerning Harkin, NCCIH conducted clinical trials of many of the most popular herbal products marketed in the U.S. only to find them ineffective for their intended use (e.g., ginkgo for Alzheimer’s or dementia or cognitive decline in the elderly; garlic on serum lipids; saw palmetto for benign prostatic hyperplasia; echinacea for the common cold in adults and children; black cohosh for vasomotor symptoms in menopausal women; and in a botched trial, St. John’s wort for the treatment of major depression). There is no question that the results of the studies dampened sales of the respective products. I don’t recall where I read the comment, but before the announcement of Hopp, there was some recent mention of the NCCIH taking the position that the rigorous criteria applied to clinical trials of prescriptions drugs are not appropriate for dietary supplements. Gimme a break!

More to the cop out, Hopp states that “For the most part, the results failed to support the hypothesized benefits of the botanical products. Hwever, once the studies were published, their designs were criticized by some for failing to use what critics considered the optimal formulation and/or dose. Furthermore, for the most of the products, the mechanisms of action by which they exerted their hypothesized activity was unclear, making it difficult to make definitive statements about the biological activity of the products even at the conclusion of the studies. Consequently, the Center chose not to initiate large clinical studies for natural products unless the mechanistic underpinnings of their hypothesized activity were clearly established.”

Considered the fact that the mechanisms of activity for 1000s of botanical medicines have yet to be established, exercising the paltry excuse to abstain from well controlled clinical trials of botanical products on the basis of poorly or incompletely elucidated mechanisms of action, the NCCIH fails to live up to their mandate. At the same time, they can no longer be accused of contributing to a future negative impact on the sale of the same products.

I wrote to Salzberg at his blog when he first wrote about Jobs’ death. I cited your posts specifically. I believe he responded and seemed to understand, so I was surprised to see him trotting this out again in the video. I agree that it is very tempting for skeptics to used Jobs as a meaningful example, but I promise you, I always take the time to elaborate when it comes up. The response when I do so goes a ways to show that even skeptics are reluctant to change their minds. I get a lot of well…..who told you all that, and who’s the Orac anyway? A box of blinking lights doesn’t cut it I’m afraid and I’m usually compelled to out you and try to recite your CV as completely as possible. 🙂

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