Surprising Thoughts on NCCAM

According to their website, the mission of the National Center for Complementary and Alternative Medicine (NCCAM) is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care.

In my view, NCCAM is more of a politically driven organization than a serious scientific establishment. The fact is that it has spent more than $1 billion on research with limited results, with positive results being from rather poor quality studies (size, blinding, methodology, etc.) and mostly on subjective reported results (pain).  The most celebrated recent headline grabbing meta-analysis on acupuncture (Vickers et al.) did conclude a very modest advantage on certain types of pain.  However from my understanding, the treatment efficacy when compared to placebo is only about 30-40% better than what you would get by randomly poking yourself with a needle or toothpick.  Honestly it is not what I would write home about but hey, everybody has different standards.

I surprise myself as I write the following, but this is how I currently feel:

Although it has been so far unproductive and arguably wasteful, contrary to what one might think, I actually have very little problem with the NCCAM’s existence, as long as it adheres to scientific methods. From a business point of view, this is simply a pet project, the cost of doing business. Their annual budget is less than $150 million, which is about what the US pays on interest alone on its national debt every 3 hours, in other words, petty cash. It is a relatively small price to pay to give a punching bag to a senator who has the view that “It is not necessary for the scientific community to understand the process before the American public can benefit from these therapies”. This statement makes the assumption that the therapy (bee pollen for allergy) is beneficial (not supported), is safe (not true, a 10 second search yielded this and this, ironically allergy-related), and needs no scientific evidence for the general public to use. Strangely enough, under DSHEA, bee pollen is a supplement and can already be used by the general public; you can take all you want, but simply cannot make claims that it can treat allergies. I find it sad and disturbing that someone with this thinking methodology is the chairman of the Senate Committee on Health, Education, Labor and Pensions.

Of course, there are moral implications. The layperson could take an investigation of a treatment (however implausible), hell, even the organization’s existence, and mistake it for an illusional, official endorsement. For example, if there were an official “National Center for Bigfoot Affairs” under the US Fish and Wildlife Service, it would not be unreasonable for the layperson to presume that Bigfoot existed.

I see it as part of the inefficiencies of the system.  For example, in a corporation, there are internal and external inefficiencies, key personnel get certain perks and privileges, pet projects, reciprocal back-scratching, you name it.  Yet often nothing is done about it, because the hidden cost of eliminating some of the inefficiencies far exceed the savings.  The savings realized by nickel and diming your employees to death are far exceeded by the price paid in lost productivity and loyalty.

Even though I have no problem with the NCCAM budget, it pales in comparison with the true cost, which is the enormous amount on money spent on CAM by the public under the misguided implicit endorsement of NCCAM.  I argue that the money would be spent anyway, with or without NCCAM.  I believe that most money spent on CAM is spent to feel good, to feel empowered, to feel that they are taking charge of their health, to feel liberated against Big Pharma, Big Government, Big Food, and Big Whatever.  The therapeutic value lies more in the patient/care provider interaction, a healthy dose of blissful ignorance, and reinforced by the act of spending itself (based on cognitive dissonance theory), rather than a measurable physiological effect.  Evidence-Based Medicine and Science-Based Medicine would likely disagree, but from a business, utilitarian, moral-free viewpoint, an immeasurable but nevertheless real benefit (unit of happiness, perception of pain relief) being traded for money voluntarily seems like a fair trade to me.

The real moral quandary is when people delay or forgo proven treatments due to their belief in CAM and cause real harm.  Too many of these happen unfortunately.  Although many can be considered Darwin Awards winners, many happen to babies, children, and those relying on help.  Those unable to care for themselves and most in need of help, through no fault of their own, are put in harm’s way by well-intentioned but ill-informed caregivers.  As tragic as the situation is, I callously argue that the existence, or lack thereof, of NCCAM would not likely significantly alter the situation.  The majority of decision-makers who chose the path to CAM-related serious harm and deaths likely possess a pathological mindset far too extreme to have their behavior influenced by the mere existence of a government organization.  A Taliban suicide bomber is unlikely to take off his bomb suit just because the Pakistani government opened up a National Center for Religious Tolerance.

In an ideal world, complementary and alternative medicine would be proven or rejected solely based on merit and high scientific standards.  In reality, CAM relies on a sympathetic governmental agency in which many would like to discount and discard the careful, rigorous examination process (not conducive to positive results) and treat opinions and anecdotes as data.  This is not an ideal world, and I settle for this.  I say let those that want to explore mysterious, unproven, implausible modalities do so.  If an effective therapy or modality emerges, great.  I await that day.

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