Offit’s lead editorial in the May issue of JAMA – profound

Paul Offit’s editorial in The Journal of the American Medical Association (JAMA. 2012;307(17):1803-1804.)  goes through the history of the National Center for Complementary and Alternative Medicine(NCCAM) and nicely points out that studies funded by NCCAM have failed to prove that complementary or alternative therapies have any more benefit than placebos.

Offit points out how NCCAM spent $374,000 proving lemon and lavender scents do not promote wound healing, $750,000 to prove that prayer does not cure AIDS, or improve recovery from breast reconstruction; $390,000 to find that ancient Indian remedies do not control type 2 diabetes, $700,000 to find that magnets to not treat arthritis or even carpal tunnel syndrome; and $406,000 to show that coffee enemas do not cure pancreatic cancer.

As much as we would love to find the new treatment that is available in your grocery store, or Ace Hardware, or Starbucks – it just has not been found.

Still, proponents of acupuncture, homeopathy, naturopathy, and even HCG diets, insist they have proof it is always in their own journals, with less than rigorous studies, and never reproduced in major medical journals. But clearly, science is less important to those who take these “treatments” than the potential of placebo effect.

This Month’s art is called “Circus Side show” Appropriate for NCCAM

Offit points out that while many drugs today were originally derived from plants (aspirin, quinine, digitalis, and artemisinin ) – the funding from NCCAM is not about finding the next great herb, isolating the ingredient, and then working out the chemistry. Instead NCCAM seems to be spending money on studies that reasonable people would laugh at, and know that they will lead to no improvement in the health and well being of our citizens.

Projects that funded programs are recruiting for include:
So I went to NCCAM website to see what sorts of programs they are funding and would they be, on the simple sniff test, something that would make sense in an era when we have a limited number of research dollars. Here is what I found:

A Pilot Study of Acupuncture Treatment for Dysphagia:
No study to date has found a use for acupuncture, why they keep looking is beyond me.

Antioxidant Therapy to Reduce Inflammation in Sickle Cell Disease:
Science is clear that most antioxidants are inactive when they leave the stomach, basic chemistry 101, and antioxidants have never been proven beneficial in any disease yet so why we continue to put money into this is proof that Snake Oil Salesmen abound.

Hypnosis for Hot Flashes Among Postmenopausal Women in a Randomized Clinical Trial:
How you randomize for this, do you have non-hypnotized women?
Patient Response to Spinal Manipulation – Pilot Study:
Spinal manipulation again, while massage has proven worth, spinal manipulation never has and it is an embarrassment that we allow chiropractors to be anything more than a historical footnote.
Probiotic Lactobacillus GG (LGG) in Patients with Minimal Hepatic Encephalopathy:
So you get a bunch of bad liver patients together, give them a dose of bacteria that won’t reach the colon and think you have a study. Amazing how probiotics have caught the attention of the public and marketers when we know  they are essentially useless unless done through a fecal transplant via colonoscopy.

Quantification of Outcome Measures for Mind-body Interventions:
How do you quantify the mind? What is mind over matter – and how come it doesn’t work when you have a real issue like an automobile accident or traumatic stab wound to the heart

Sauna Detoxification Study: Pilot Feasibility:
Ok, my ancestors from Norway love Saunas, but they detoxify nothing. Sweat glands in saunas cool people by simple sweat that is sodium chloride- there have never proven to be toxins in any sweat, in spite of what “ancient Chinese medicine” might think

We need regulation for supplements and Alternative Medicines

Better yet, if NCCAM would develop a registry where various herbal supplements that are sold would be noted, and tested to see if there is actually the ingredients that they state are. Then serve as a registry for adverse events, something the FDA is prohibited from doing. Because of the Dietary Supplement Health and Education Act of 1994 the FDA has no role in regulation of these items. But having a registry where reports of adverse events could be noted would be helpful. Manufacturers are not required to submit safety information before marketing “dietary supplements,” so only after multiple adverse events can the FDA act. Since the FDA is prohibited from monitoring and regulating Alternative medicine products, the public is virtually unprotected against supplements and herbs that are unsafe.

The article goes on to show that clear evidence that there is no efficacy or therapeutic value to these supplements does not stop people from buying them. This is further need that those individuals will consume anything with a label of “natural” or “organic” or perhaps endorsed by their guru, be it Mercola, or Dr. Oz, or Dr. Weil.  Regulation to allow these supplements to be tested, standards of manufacturing to avoid contamination, and a registry where health problems from the supplements occur may help protect these individuals from their worst enemy – themselves.

We as physicians, however, have a duty to our patients- a strong ethical duty of beneficence. Some mistake our ethic as “do no harm,” but it is not that. Treatments (medications, surgery) have known side effects and a risk-benefit ratio. Having a side effect does not violate beneficence as they are expected. However, if we prescribe a treatment that we know has no beneficial effect, we violate one of the basic tenants of a physician’s ethics. While government agencies do not have  ethics- physicians do, and I hope the physicians who sit on NCCAM take their ethics seriously.