For those of us in biomedical research, the last 12 years or so have been grim, very grim. In inflation-adjusted dollars, the budget for the NIH has been flat or declining. Indeed, between 2003 and 2015, the trajectory was almost unrelentingly downward in terms of NIH purchasing power. That meant that research grants got harder and harder to get, with the odds of success becoming longer and longer. In such an environment, only the well-connected or truly brilliant could maintain stable funding. The rest of us were left to cobble together what funding we could for ourselves. For me, at least, it’s been rough. It’s still rough.
So I was quite happy to see that the omnibus budget bill recently passed boosted the NIH budget significantly. Indeed, for the first time since 2003, this means three consecutive years of funding increases that are real in that they are more than the rate of inflation. I must admit that this was an unexpected turnabout after President Trump’s budget proposed cutting the NIH budget $6 billion, nearly 20%. The NIH budget is now $37 billion, an 8.3% increase, the highest its budget has ever been in actual dollars.
There’s just one problem, as I learned yesterday. The budget for the beating heart of quackademic medicine in the US, the National Center for Complementary and Integrative Health (NCCIH), which got an even bigger increase in its budget than the NIH as a whole, to $142.2 million from $130.5 million, a whopping 9% increase. The NCCIH budget had, in inflation-adjusted dollars, been relatively flat or decreasing, just like the NIH budget as a whole. Indeed, its budget hardly changed at all in FY2016 and 2017. Now it’s taken a jump.
I have a long history being critical of the NCCIH, which used to be known as the National Center for Complementary and Alternative Medicine (NCCAM, a pithier acronym that tripped off the tongue more easily than the Center’s current name). Of course, consistent with the overall trend among those seeking to “integrate” quackery with science-based medicine, NCCAM was renamed NCCIH a few years ago, the better to get rid of the term “alternative” and replace it with the more Orwellian word “integrative,” or, as I like to call the name change, polishing the turd.
Basically, integrative medicine is a strategy for mainstreaming alternative medicine, even though the vast majority of alternative medicine has either not been proven scientifically to be efficacious and safe, has been proven not to be efficacious, or is based on physical principles that violate laws of physics (such as homeopathy or “energy healing). Indeed, if the term “integrative medicine” were not thus, it would be a completely unnecessary moniker. The reason is, to paraphrase Tim Minchin, Richard Dawkins, John Diamond, Dara Ó Briain, and any number of skeptics, there is no such thing as “alternative” medicine because “alternative” medicine that is shown through science to work becomes simply medicine. Thus, newly validated medical treatments have no need to be called “integrative” because medicine will integrate them just fine on its own. That’s what medicine does, although admittedly the process is often messier and takes longer than we would like. Integrative medicine, like alternative medicine before it, is a marketing term that is based on a false dichotomy. Only unproven or disproven medicine needs the crutch of being “integrative,” a double standard that asks us to “integrate” unproven treatments as co-equal with science-based medicine even though they have not earned that status. The name change from NCCAM to NCCIH was just part of that process.
Of course, I’ve discussed the history of NCCIH on multiple occasions, mainly to counter revisionist historical narratives about it. The CliffsNotes version is simple. In 1991, Senator Tom Harkin (D-IA) used the used his power as the chair of the Senate Appropriations Committee to create the precursor to the NCCIH, the Office of Unconventional Medicine, which soon became the Office of Alternative Medicine (OAM). Its original budget was a mere $2 million. Harkin, of course, was a great believer in unconventional medicine, having come to believe that he had cured his allergies with bee pollen capsules, and he was in the pocket of quacks, two of whom urged him to take this step.
Harkin protected the new Office as well, and even designed it to make sure it remained sympathetic to alternative medicine. The office was initially set up with an acting director and an ad hoc panel of twenty members, many of whom Harkin hand-picked, including advocates of acupuncture, energy medicine, homeopathy, Ayurvedic medicine, and several varieties of alternative cancer treatments. Deepak Chopra and Bernard Siegel were also included. Critics of quackery were consulted and considered for panel membership but—surprise, surprise!—were not selected. These pro-alt med panel members became known in the OAM as “Harkinites.” The first director of the OAM, who, although hand picked by Harkin because he thought there might be something to some alternative medicine modalities, nonetheless frequently butted heads with the Harkinites and their patron Sen. Harkin. Ultimately he resigned in frustration (and under pressure from Harkin). In 1998, Harkin introduced legislation to elevate the OAM to a full center, and thus NCCAM was born. Not in the least bit coincidentally, the NIH Director has far less power over Centers than offices in the NIH.
Steve Salzberg notes that, over its entire history, from its start as a mere office to its 20 years as a full Center, NCCIH has spent a total of $2.366 billion dollars and asks:
What have we learned for our $2.4 billion? Have new cures been developed, new medicines been discovered? Has NIH provided good scientific evidence that any of the “alternative” methods–which include acupuncture, homeopathy, naturopathy, Ayurveda, therapeutic touch, reiki, aromatherapy, and others–actually work? The answer to all these questions is no.
Correct. Steve also notes the common refrain from apologists for NCCIH, namely that its budget is only around 0.4% of the entire budget of the NIH and has never been more than 0.5% of its budget. However, he also notes:
To those who argue that it’s only a small percentage of the NIH budget, I would point out that a typical NIH research grant is under $500K. This means we could fund at least 300 additional biomedical research projects every year if we got rid of this giant special-interest earmark that has utterly failed to produce anything useful.
Instead, someone in Congress managed to sneak in the largest budget increase that NCCIH has seen in 15 years. What a waste.
It’s actually a little more complicated than that. I could go into how multiyear NIH grants are in reality multiple single-year NIH grants, but you don’t need to know that to get the point. A lot of biomedical grants that might actually result in improvements in patient care could be funded with money devoted every year to the boondoggle that is NCCIH.
Me being me, I can’t help but point out that Steve missed another huge problem with NCCIH, other than its having wasted over two billion dollars. To do that, I have to point out that not all of the money spent by NCCIH on research has been wasted, but that’s not because homeopathy is promising, acupuncture works, or various herbal supplements have been validated as effective treatments for much of anything. Rather, it’s because NCCIH, just as all “integrative medicine does,” co-opts legitimate science-based medicine, such as dietary interventions and exercise, as being somehow “alternative,” as being in its bailiwick.
I’ve discussed examples of this before. For instance, NCCIH funded research that resulted in the engineering of a yeast strain that can make opioids. Why this is in any way “integrative” or “alternative,” I have no idea. Another example is how NCCIH has cclaimed basically all nonpharmacological treatments for pain as its own, as being “integrative,” to the point where it’s made such a cooptation the centerpiece of its latest five year plan, or, as I describe it, let’s do some real science for a change. Even worse, NCCIH continues to fund scientifically useless and unethical studies, such as son of TACT, which will examine whether chelation therapy is useful for cardiovascular disease. (Hint: It’s not, no matter how much its advocates try to spin it otherwise.)
In the end, it’s a good thing that the NIH budget, after literally 15 years of stagnation or slow decline in inflation-adjusted dollars, is on an upward trajectory again. I sincerely hope that this continues, and I don’t say that just because it would increase my chance of being funded again. However, it’s not a good thing that the NCCIH budget is also on a parallel upward trajectory. NCCIH should be defunded.
I’d really love to know who made sure that the NCCIH budget has been increased so much. That legislator, whoever it might be, could well be the successor to Sen. Harkin, who is now retired. My guess? It’s got to be someone belonging to the Congressional Dietary Supplement Caucus. Yes, there really is such a thing, and likely the new Tom Harkin and Orrin Hatch, members of the old guard who support funneling government money to fund pseudoscience, will come from this caucus. Same as it ever was.