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Is taxpayer money well spent or wasted on alternative-medicine research?

Study after study funded by NCCAM has “failed to prove that complementary or alternative therapies are anything more than placebos,” writes Dr. Paul Offit.

If a Senator believes bee pollen holds the cure for hayfever, is it worth spending federal research dollars on?

In 1992, two Democratic politicians from Iowa, Sen. Tom Harkin and former Rep. Berkley Bedell, persuaded Congress to create the Office of Alternative Medicine (OAM) “to explore complementary and alternative healing practices in the context of rigorous science.”

Both men cited personal anecdotes as their motivation to launch the new agency. Harkin said bee pollen had cured his hayfever, and Bedell believed cow colostrum had cured his Lyme disease.

In 1999, OAM was renamed the National Center for Complementary and Alternative Medicine (NCCAM) and housed within the National Institutes of Health (NIH). Its annual budget climbed steadily during the ensuing years, to $130 million in 2012. Together, OAM and NCCAM have spent $1.6 billion since their inception.

But has that money been well spent?

Just ‘placebos’

No, says Dr. Paul Offit, a pediatrician and infectious disease expert at the University of Pennsylvania (and a leading critic of the anti-vaccine movement), in a commentary published Wednesday in the Journal of the American Medical Association (JAMA). Study after study funded by NCCAM has “failed to prove that complementary or alternative therapies are anything more than placebos,” he writes.

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In fact, many of the studies are biologically nonsensical, “which should be an important requirement for funding,” he adds.

For example, NCCAM officials have 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 hasten recovery from breast-reconstruction surgery; $390,000 to find that ancient Indian remedies do not control type 2 diabetes; $700,000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406,000 to find that coffee enemas do not cure pancreatic cancer.

No change in behavior

Studies that turn up negative results can, of course, be helpful. A good example, says Offit, are the epidemiological studies (not funded by NCCAM) that found no association between the measles-mump-rubella vaccine and autism. Those studies have helped doctors reassure frightened parents — and, thus, changed behavior.

But, asks Offit, “does the same value of rigorously conducted negative studies hold for studies of complementary and alternative therapies? Have negative studies changed behavior?”

Unfortunately, no, as Offit points out:

Several studies have shown that garlic does not lower low-density lipoprotine cholesterol, St. John’s wort does not treat depression, ginkgo does not improve memory, chondroitin sulfate and glucosamine do not treat arthritis, saw palmetto does not treat prostatic hypertrophy, milk thistle does not treat hepatitis, and echinacea and megavitamins do not treat colds. Moreover, some studies have found that megavitamins increased the risk of cancer and heart disease.

Yet, despite these findings, people continue to “believe what they want to believe, arguing that it does not matter what the data show: They know what works for them,” says Offit.

A weak regulatory system exacerbates the situation, Offit adds:

Because the vitamin and supplement industry is not regulated by the US Food and Drug Administration (FDA), negative studies have not precipitated FDA warnings or FDA-mandated changes on labeling; as a consequence, few consumers are aware that many supplements have not delivered on their claims. In 2010, the vitamin and supplement industry grossed $28 billion, up 4.4% from the year before. “The thing to do with [these studies] is just ride them out,” said Joseph Fortunato, chief executive of GNC Corp. “We see no impact on our business.”

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A need for change

Offit concludes his commentary with a call for change:

Because negative studies do not appear to change behavior and because studies performed without a sound biological basis have little to no chance of success, it would make sense for NCCAM to either refrain from funding studies of therapies that border on mysticism such as distance healing, purgings, and prayer; redefine its mission to include a better understanding of the physiology of the placebo response; or shift its resources to other NIH institutes.

You can read Offit’s JAMA commentary here. You can also listen to Offit discuss the commentary with a JAMA editor here.