The mission of the National Institutes of Health’s (NIH) 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 the 2 decades since the center was created (initially with the name of the Office of Alternative Medicine), NCCAM has spent $1.6 billion funding studies and has a current annual budget of $130 million.
In a Viewpoint appearing today in JAMA, Paul A. Offit, MD, chief of the division of infectious diseases and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, argues that NCCAM-funded scientific investigation has failed to uncover many successful uses for complementary and alternative medicine, and these negative findings have had little effect on changing certain practices and patient perceptions. He notes that NCCAM has spent $374 000 to find that inhaling lemon and lavender scents does not promote wound healing; $750 000 to find that prayer does not cure AIDS or speed recovery from breast reconstruction surgery; and $700 000 to find that magnets do not offer relief from arthritis, carpal tunnel syndrome, or migraine headaches. At best, he said, many of these studies reaffirm the placebo effect among certain patients undergoing these therapies.
Offit suggests that NCCAM should refrain from funding studies for interventions that lack sound biological underpinnings, such as distance healing, purgings, and prayer; refine its mission to better understand the physiology of the placebo response; or shift its resources to other NIH institutes.
In an interview with news@JAMA, Offit, who is also a coinventor of the rotavirus vaccine and author of 4 books, including Deadly Choices: How the Anti-Vaccine Movement Threatens Us All (Basic Books, 2011), explains why he thinks NCCAM should redefine its mission:
“Any agency that receives public funding should maintain high standards. If you’re going to test something, it should have a strong biological basis. Much of what NCCAM tests is not based on sound biology. Prayer for curing AIDS is not based on sound biology.
“There could be a place for NCCAM to study the placebo effect. There are people who swear by homeopathy, but it’s no different than just taking a teaspoon of water—but for them, this placebo effect is real. I think there’s a physiological response and that’s worth studying, to understand the best way to use placebo. But placebo has limits and shouldn’t be used when there’s a drug that works.”
Offit also offered his thoughts as to why there has been support for allocating millions of taxpayers’ dollars to fund studies of therapies with little chance of providing cures or easing symptoms:
“I think there is a distrust of modern medicine, and as a consequence, people have flocked to alternative medicine because they perceive it as safe and more natural. But there are harms, and [alternative therapies] should be evaluated as regular medicine. What’s odd about alternative medicine is that it isn’t regulated by the [Food and Drug Administration], which requires companies producing drugs and biologics to have to prove their safety and effectiveness before they get to sell their products to the public. NCCAM will sometimes, but rarely, test alternative medicines after they’re on the market. It’s a very weird situation, and people need to be careful and think about this to understand that some of the promises of safety and efficacy may be incorrect.
“It’s also unfair to say that this debate is between alternative medicine proponents on one side and physicians on the other because the line has clearly blurred. We now have Reiki masters practicing in hospitals. This is sad because medicine has become a marketplace, and the thinking is to provide the patients what they want. But that’s not our role; our role as clinicians is to have a standard of professionalism that’s science based. The degree to which we promote magical thinking or quackery hurts us all.”
For more information on this topic, a JAMA audio interview with Dr Paul Offit is available here.