Has been the foremost government agency funding research into quackery for the last 24 years, and, of course, that’s the reason we at
Not only funds studies of dubious “alternative” therapies, but it also promotes quackery by funding “fellowships” at various institutions to teach “integrative medicine, ” or, as we like to call it, “integrating” quackery with real medicine.
Indeed, back in 2009, when President Barack Obama first took office, Steve Novella and I both suggested that the time was ripe for
Grants & Funding Resource: \\
To be defunded and its functions allowed to revert back to the already existing Institutes and Centers of the National Institutes of Health. We were under no illusions that this would happen, given that
And guarding it against all attempts at defunding or, even worse, forcing it to do more rigorous science, woo-loving Senator Tom Harkin (D-IA). Harkin is no longer in the Senate, having retired at the end of 2014, but
Is still with us, and the nature of government makes it very much that, unless someone with power is willing to expend serious political capital to eliminate it,
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Was created to promote the “integration” of “outside of the mainstream” or “unconventional” treatments (the vast majority of which are quackery) into real medicine have to learn to live with
And, as much as it might gall us, to try make lemonade out of the lemon by prodding it to doing some actual rigorous science on “complementary and alternative medicine” that have at least a modicum of biological plausibility and avoid wasting taxpayer money on fairy dust treatments whose precepts either violate the laws of physics (e.g., reiki, homeopathy, and other “energy” medicine) or depend on nonexistent anatomy or physiology (e.g., reflexology, craniosacral, traditional Chinese medicine tongue diagnosis).
Director’s Blog late last week, a post by the director Josephine Briggs, Requesting Comments on NCCIH’s Draft Strategic Plan. Patriotic US citizen and advocate of
National Center For Complementary And Integrative Health (nccih)
That I am, how could I turn down such a request? Kimball Atwood didn’t shirk from such a request back when Dr. Briggs was asking for comments on the
I plan on discussing each objective in the plan, but before I do it’s useful to get the “bird’s eye” view and compare it to previous
. In fact, much of the new strategic plan draft sounds suspiciously similar to the old plan. Let’s take a look at the goals and objectives of the old strategic plan first:
National Center For Complementary And Integrative Health
In the place of overarching goals, the draft 2016-2021 plan now lists several scientific priorities, stating that this part of the plan will be a “living” document, to be “updated based on public health needs, new scientific opportunities, research results, changes in the Center’s grant portfolio, and budgetary considerations”:
One can’t help but notice the similarity between the two plans, at least in outline. For instance, Objectives 1 and 4 in the new plan are little more than a repackaging of Objective 4 in the old plan, all of which carry with them an implicit admission of how poor the science carried out by
Funded investigators has been over the years. Indeed, one of the sub-objectives of Objective 1 is to “Develop new and improved research methods and tools for conducting rigorous studies of complementary health approaches and their integration into health care.” Objective 5 is even more similar in both plans; the two even have almost identical wording. Meanwhile, Objective 3 in the old plan is basically the same as one of the scientific priorities, namely “Clinical Trials Utilizing Innovative Study Designs to Assess Complementary Health Approaches and Their Integration into Health Care.” Of course, whenever you see any sort of discussion of “innovative study design” with respect to
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Of course, there is nothing fundamentally wrong with a new five year plan strongly resembling the previous five-year plan. It does, however, make one wonder what progress has been made on the objectives shared by both plans and whether something new needs to be done to meet those objectives. For instance, as I said about the last plan, arguing for applying more rigorous science to just about anything is rather like arguing for mom, apple pie, and the flag; no one is going to contest that as a worthy goal. The problem, of course, is what one means by “rigorous science” and how one proposes to achieve that goal.
The mission of NCCIH is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care.
To address the need for objective evidence as to the safety and efficacy of many of these approaches, NCCIH supports rigorous scientific investigation to better understand how these interventions work, for whom, and the optimal methods of practice and delivery.
Solution: Wrd 27e Ex 25 15
One can’t help but note the language. It’s not “if” these interventions work, but “how, ” “for whom, ” and the “optimal methods of practice and delivery, ” all of which are putting the cart before the horse. The introduction also repeats the standard tropes about one-third or more of adult Americans using some form of
.” I refer to this as a “trope, ” because there is nothing alternative about any of this; it is simply a “rebranding” of what should be part of
NCCIH also seeks to identify strategies for promoting health and preventing disease. Behavioral risk factors, including an unhealthy diet, being overweight or obese, living a sedentary life, smoking or using tobacco products, and the excessive consumption of alcohol, are linked to increased rates of cardiovascular disease, cancer, and diabetes. Preliminary evidence indicates that some complementary health approaches may be useful in encouraging improved self-care, an improved personal sense of well-being, and a greater commitment to a healthy lifestyle. For example, analysis of the 2012 NHIS data indicates that many people who practiced yoga reported that it motivated them to practice healthier behaviors, including eating better and exercising more regularly. While causal relationships between the practice of complementary approaches and healthy behaviors have not been established, further research is needed to explore, clarify, and examine their relationship.
Hsrproj Interactive Data Visualizations
Once again, there is nothing “alternative” or “integrative” about any of this. Any primary care doctor worth his or her salt will counsel patients to eat healthier, lose weight, stop smoking, decrease alcohol intake, and get off their butts and exercise. I hear the part about losing weight, eating better, and exercising every time I see my doctor. (Fortunately, I don’t smoke and don’t overindulge in alcohol.) As for yoga, is there anything better about it that motivates people to practice healthier behaviors, beyond what any sort of exercise would accomplish? Again, none of this is in any way “alternative” or “integrative, ” and none of it needs a special center at the NIH to study it.
Is now emphasizing, as its key scientific priority, pain and difficult-to-control symptoms, in particular nonpharmacologic methods of relieving pain. While there is certainly a need for better research into how better to control pain without non-steroidal anti-inflammatory drugs or opioids, both of which have significant side effects and the latter of which is recognized as a significant cause of addiction and premature death, one can’t help but note that these are also problems where assessing the benefit of any therapy is very much compounded by placebo effects, regression to the mean, and the like. Yet, elsewhere in the plan,
Addresses how to do “innovative clinical trials” by using “pragmatic clinical trials to address questions about the integration of complementary health approaches into health care systems, or to study the effectiveness of complementary or integrative approaches in comparison to standard care.” Remember, pragmatic trials are trials that are done only after more rigorous trials actually show that an intervention works, with the intent to see how it works in the “real world.” Doing pragmatic trials of treatments not yet shown to work is putting the cart before the horse.
Nccih Strategic Plan 2016 2021, Or: Let's Try To Do Some Real Science For A Change
As a responsible steward of its publicly provided resources, NCCIH is highly selective in the choice of topics for major clinical trials. Decisions about which large-scale trials to support must be based on the strength, reliability, and reproducibility of signals from clinical experience and preliminary, smaller pilot studies, as well as on evidence of scientific plausibility obtained from mechanistic studies.
Hasn’t funded a study of homeopathy since 2008, as I have pointed out before, and the lack of further funding of homeopathy argues that
Remains with modalities like acupuncture and various modalities from traditional Chinese medicine (TCM) that are rooted in a prescientific understanding of physiology and disease, I can’t help but say to NCCIH: Plausibility. You keep using that word. I do not think it means what you think it means.
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As I said before, this objective is pretty much the “mom and apple pie” objective in that no one is going to argue against improving fundamental science and methods. The major problem with this objective is that it is so generic. It is an objective that pretty much any institute or center at the NIH would have. One of the key complaints we have about
Is that it doesn’t serve a purpose that couldn’t be just as