Defund NCCAM? Don’t Throw the Baby Out With the Bathwater!

By Dr. Carlo Calabrese ND, MPH

Since 38% of US adults and 1 in 9 children use Complementary and Alternative Medicine (CAM) for a variety of health conditions, it behooves our society to attend to whether CAM products and practices are safe and effective. The public finds value in them. There are billions of users worldwide of what can be called CAM and millions of practitioners, often with long clinical traditions comprising enormous empirical databanks. People who use it aren’t stupid. Its practitioners are not entirely charlatans and the deluded.

CAM use is a variant of health care from orthodoxy. It is entirely reasonable that a society should spend its resources in the center of its epistemological orthodoxy. Funding of study of the “-omics” and much drug research is seen as well justified by informed CAM and CAM research advocates. But we are looking for new answers for intractable problems. Some of the future answers will be found in what is not now considered orthodox. This has happened many times in human history and will continue to happen. Thus, in a systematic search for novel solutions, it would be foolish to look at only a limited set of options with only a limited set of tools.

The proportion of dollars of research to care dollars spent is slanted steeply towards the funding the epistemology of orthodoxy, as we might expect. Even generously estimating $300 million for CAM research at NIH is just 1% of the NIH budget, a proportion that doesn’t reflect CAM use. The new funds for NCCAM in the recovery package are only 2/10 of 1% of the increase to NIH. Even critics indicate that most of this is arguably justified as most NIH CAM funding falls in journalist David Brown’s list of the “more plausible interventions.”

The irresponsibility is not in funding CAM research as suggested by its critics, but in putting it primarily in the hands of people like Dr. Salzberg who simply haven’t a very good idea of the range and character of CAM. “Reductionists” are interested in finding magic bullets while forgetting the basics. The basics, for example, are in health practice (the Obama administration calls it “wellness”), rather than disease practice. Measuring our progress towards health requires somewhat different tools— especially in clinical research— than measuring our distance from disease and death. Yet the grant application review system, even at NCCAM, is run by well-meaning orthodox scientists who don’t know the field and its potential and therefore support studies that are designed to answer the wrong questions. No wonder its performance disappoints Senator Harkin.

CAM practices, in reality, are many and diverse. How will we know what is worth studying and adopting if we don’t examine the “fringe” systematically. How will we know the field unless we attend to it as a category?

I am naturopathic physician and a scientist and have authored studies both positive and negative about CAM practices. The best CAM studies, the ones on the right questions, have provided evidence of the value of properly applied CAMs. These studies already call for change in current medical practice and policy.

With continued research at an appropriate level of funding, different CAM practices will either fall away or be integrated into general practice. This is what is happening now and what should be happening. Defunding NCCAM would be an abrogation of scientific and political responsibility.

What do you think about NCCAM?

You can vote on the subject of defunding NCCAM here.