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NCCAM Blasted, Defended, in Science Magazine (July 21, 2006) PDF Print E-mail
Written by John Weeks   

ImageNCCAM Blasted, Defended, in Science Magazine (July 21, 2006)

Summary:  Two long-time CAM antagonists led by Baylor's Donald Marcus, MD, call for an outside review of the NIH National Center for Complementary and Alternative Medicine in Science magazine. Will conventional organizations rally to ask, if not for NCCAM's head, for a chance to ask for NCCAM's head? This is what the critics request. NCCAM's leadership, in an invited response, ably parried the criticism.

In a Science magazine article entitled "Review for NCCAM Is Overdue," two medical doctors with significant anti-CAM portfolios challenged the Center's ongoing existence. Following a two page argument, Donald Marcus, MD, and his co-author, Arthur Grollman, MD, concluded that "scientists and professional organizations should communicate to Congress and to Elias Zerhouni, the director of the NIH, their strong support for an external assessment of NCCAM."

The two state their case as follows:

 
"We believe that NCCAM funds proposals of dubious merit;
its research agenda is shaped more by politics than by science;
and it is structured by its charter in a manner that
precludes an independent review of its performance."

- Donald Marcus, MD, and Arthur Grollman, MD
Science, Vol 313, 21 July 2006; 301-302


Image
Donald Marcus, MD, challenging NCCAM's value
Particular targets of their ire are the inclusion of representatives of CAM professions on the NCCAM Advisory Panel; the "finance of expensive clinical trials of plant extracts" following the findings of lack of effectiveness, against placebo, of St. John's wort, echinacea and saw palmetto; failure to show "scientific plausibility and promising preliminary data" before engaging trials of the EDTA chelation therapy and the Gonzalez cancer regime; and an over-arching view that NCCAM has moved ahead through guidance of only a small, self-referential group of a couple dozen interested professionals.

Science Offers NCCAM's Strauss and Chesney a Chance to Respond

The editors at Science offered NCCAM director Stephen Strauss, MD, and deputy director Margaret Chesney, PhD, an opportunity to rebut the charges from Marcus and Grollman. The NCCAM leaders open with a quiet assertion that they are seeking to "bring fact and clarity to this discussion, just as we seek to bring science to the assessment of CAM."

Image
Stephen Strauss, MD, NCCAM director
They then respond to the Marcus-Grossman case point by point. In doing so, they offer some interesting data about the Center.

  • Involvement of others The NCCAM strategic plan involved meetings on both coasts, a strategic planning workshop involved 80 conventional and CAM representatives, plus direct "input from over 1500 individuals and organizations."
  • Agency control  To counter assertions that NCCAM closely directs what it funds, they note that over the last three years 87% of NCCAM-funded grants are unsolicited.
  • Botanicals   NCCAM currently selects the botanicals it studies based on a review of over 20 factors for the plant "including product characterization, standardization, contamination, consistency and stability that could effect the outcomes of research."
  • Advisory council quality   Current membership of 17 has published 414 peer-reviewed articles, received 35 NIH grants from 2001-2006, with 23 of the latter awarded not by NCCAM but by other NIH institutes

Image
Margaret Chesney, PhD, co-authoring the defense
Straus and Chesney end by underscoring their support of the recommendation of the Institute of Medicine that "the same principles and standards of evidence apply to all treatments, whether labelled as CAM or conventional."


Comment: Marcus and Grollman are old warriors against CAM. They have co-published repeatedly, and antagonistically, on botanicals. Grollman serves on the editorial advisory board for the Scientific Review of Alternative Medicine and Aberrant Medical Practices. Marcus has independently argued against the value of including more mind-body training into conventional medical education. And in 2002 Marcus challenged an important 2002 Archives of Internal Medicine article by Ralph Snyderman, MD, then chair of the council of deans of the Association of American Medical Colleges, and Andrew Weil, MD. The Snyderman-Weil piece was entitled
"Integrative medicine - bringing medicine back to its roots". Nine months after the publication in Archives, Marcus responded with a warring metaphor: "Integrative medicine is a Trojan Horse."

Straus and Chesney do what feels to be a solid job of maintaining a balanced tone while successfully parrying the charges. The reader can hardly hold one's own tongue. Do we then remove cardiologists from cardiology advisory panels? It must have been hard for Straus and Chesney to not directly note that Marcus himself is an example of NCCAM's extending itself to include conventional and critical physicians and researchers. Marcus is among those acknowledged for his contribution to the NCCAM's Research Report on Rheumatoid Arthritis and CAM. Perhaps there is a story there.

Meantime, for some, clearly the
political-economic-cultural-religious battle over "alternative medicine" may be as intractible, without resolution, and as ancient, as problems in the Middle East. Just when we think we might focus on bettering life, someone sacrifices himself, or others, for their god. And the battle mode heats up again. Readers of the Integrator Blog will know that this call, effectively, for the dissembling of NCCAM echoes the successful dismantling of the US Agency for Health Care Policy and Research in the mid-1990s. That federal agency was, through multi-disciplinary, exhaustive reviews of the evidence, also enhancing the "legitimacy" of the descendents of that great warrior goddess (not), Hygeia. Of course, the call for an outside review is the most frequent form that Trojan horses take.

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