A study of federal funding advancing naturopathy, acupuncture, chiropractic, and energy healing as acceptable medical protocols finds troubling misuse of taxpayer dollars.
When ill, most of us choose to see a physician. If your doctor is caught practicing medicine without a license, he or she may need a criminal defense lawyer. But in 2007 about 40 percent of Americans chose unproven therapies offered by an alternative medicine practitioner, including herbs, spinal manipulation, acupuncture, and energy healing (www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf). Incredibly, some Americans even reject the safety of vaccines (Offit 2011; 2013).
Currently seventeen states, the District of Columbia, Puerto Rico, and the Virgin Islands license naturopaths. All fifty states, D.C., Puerto Rico, and the Virgin Islands license chiropractors. Forty states license acupuncturists, and New Mexico, California, and Florida legally allow acupuncturists to serve as primary care providers1. At the national level the acupuncture lobby urged members to petition the Department of Health and Human Services to have acupuncture declared an essential medical service. Federal tax instructions for 2012 provide a line for acupuncture under medical deductions. Because the Affordable Health Care Act mandates coverage of “state licensed alternative medicine practitioners,” “wellness” clinics can be set up under a state licensed practitioner who can employ energy healers and herbalists. What can we expect from their services?
In 1992, Congress, persuaded by personal anecdotes, emboldened by fiduciary interests and the Executive Office, responded to the myth that Americans were in need of alternative medicine by creating an Office of Alternative Medicine (OAM) at NIH. There was no compelling statistical evidence to support this action. From its inception, NIH’s Office of Alternative Medicine and its offspring, the National Center for Complementary and Alternative Medicine (NCCAM), have funded schools of non-evidenced-based, so-called alternative medicine treatments such as naturopathy, oriental medicine, and chiropractic. The OAM archives from 1992–1999 show that chiropractic received $4 million, and naturopathic $2 million. The total funding for alternative medicine between 1993 and 2000 was $110 million (Green 2001). The yearly funding for OAM grew from $2 million in 1992 to $20 million in 1998 (NCCAM archives first meeting). Since elevation to the status of an NIH center, NCCAM’s annual funding has grown to $128 million. Total funding for NCCAM from 1999–2012 was over $2 billion.
Initiatives established at the first meeting of the National Advisory Council for Complementary and Alternative Medicine (http://nccam.nih.gov/about/naccam/minutes/1999aug.htm) focused on awarding grants for training and career development for alternative medicine practitioners. A reading of these minutes details the council’s presumption that even though the efficacy of non-evidenced based protocols had not been demonstrated, funding for teaching these protocols would proceed. However, the expectation that research publications would verify or strike down the success of a protocol was never voiced. The normal expectation of federal science agencies such as the National Science Foundation is that its principal investigators will disseminate their results by publishing in peer-reviewed journals. For years, evidence has been cited showing that publication bias in favor of studies with positive results and strongly against those with negative is common in the field of medicine (Ionnidis 1998; Goldacre 2012). However, because NCCAM researchers are testing non-evidenced based protocols they should be more circumspect about posting trial results. But a posted result for a NCCAM clinical trial is rare, and substantiation or negation of a CAM protocol arising from clinical trials is seldom published (Mielczarek and Engler 2012; Ross et al. 2012). One of the characteristics of the few published results is an aversion to precise statements. To those familiar with the lack of efficacy of many non-evidenced based protocols, this may not come as a surprise. Nevertheless, NIH’s NCCAM continues to funnel taxpayer funds into dubious research on these unproven—even disproven—alternative medicine protocols2.
Our study of $2 billion in research grants to test the success of CAM yielded no positive result that would alter current evidenced-based medical practice (Mielczarek and Engler 2012). But lack of positive results did not deter continued expenditure of public money for these protocols. In 2000, NCCAM intensified the marketing of unproven therapies by embarking on a twelve-year focus to train non-evidenced based practitioners. From 2000 to 2012, over $76 million was awarded to medical schools and alternative medicine schools to initiate or enhance efforts for teaching CAM.
Our second study, “Nurturing Non-Science” (Mielczarek and Engler 2013) focused on several of these respected medical schools. We tracked the intrusion of these federally funded non-evidenced based protocols into the community clinics and hospitals they served. In addition to the usual litany of acupuncture, bioenergy, herbs, and homeopathy, some of the clinics associated with these respected medical schools featured curious concepts such as “holographic sound healing,” Noetic consultants, and Tibetan energy medicine. These are only a few examples of unbelievable protocols offered by clinics associated with medical schools certified by Association of American Academic Medical schools, AAMC. Specialized medical services for children included Reiki, offered for pediatric heart transplant patients and in a children’s cancer clinic, and a course teaching Reiki to children “even children can heal” (Mielczarek and Engler 2013). Reiki is one of several “hands off, hand waving” healing protocols. This concept violates the laws of physics (Mielczarek and Araujo 2011), yet is now offered in respected medical schools such as Harvard, Georgetown, and Minnesota. Major scientific societies have been remiss in failing to bring NCCAM’s lack of scientific knowledge to public attention. What university would allow a Department of Engineering to market perpetual motion machines or a Department of Astronomy to employ astrologers?
Figure 1The money to install non-evidenced-based curricula in fifty-three formerly respected medical schools totaled $67 million. But the funding went beyond respected medical schools. Included in the twelve-year focus was $8.6 million for curriculum and training at seven schools that graduated alternative medicine practitioners. From 1999, schools for naturopaths, acupuncturists, chiropractors, and oriental medicine practitioners have been recipients of federal funding. Figure 1 shows expenditures for both research training grants and curriculum grants for these institutions. For example Bastyr University received $827,000 for curriculum enhancement. But curriculum grants were only a small part of its NIH funding. Research and training grants bring Bastyr’s total funding for these twelve years to $14 million.
After twenty years, millions in NIH funding, and no evidence documenting success for protocols such as acupuncture, energy healing, or treatment by spinal manipulation, what do these alternative medicine schools and their faculty practitioners currently advertise?
This article examines how taxpayer dollars are used to advance naturopathy, chiropractic, acupuncture, energy healing, and herbal potions into American culture as acceptable medical protocols. What is their current support by NIH, our federal agency charged with maintaining health through evidenced-based research and information? We answered this question by studying the websites of these schools, NIH’s Project Reporter, and the NIH database clinical trials.gov looking for publications in peer-reviewed medical journals and for results of their clinical trials funded by NCCAM monies. Alternative medicine organizations’ websites advertise their support from NIH, implying that these medical misconceptions are successful medical protocols and that these programs will lead to successful careers competing with MDs. Profiles of these organizations illustrate how their advertisements for students implies federal acceptance of their curriculum, and how this conjunction helpfully markets their products.
The National University of the Health Sciences
NCCAM support 2000–2013: $3.4 million, seventeen grants, twenty-seven clinical trials, fifteen completed, no posted results.
The National University of the Health Sciences in Lombard, Illinois, with a branch in Florida, is a school of acupuncture, chiropractic, oriental medicine, and massage, with over fifty faculty members. They “. . . prepare students to become first-contact, primary care physicians who are fully qualified to diagnose, treat and manage a wide range of conditions.” “From 1995-2010, National University has received $5 million in federal grant funding for research, and remains in the upper tier of complementary and alternative medical (CAM) institutions in the research field.” They were “The first institution offering a chiropractic program to receive a National Institutes of Health RO1 grant, and continue(s) to be one of the highest producers of original research in chiropractic medicine.” But its advice for the flu is suspect: “Since each case is different, there is no one single oriental herbal prescription or acupuncture treatment prescribed for every case of cold or flu. An oriental medicine clinician will make a careful diagnosis to determine the exact nature of the energy imbalance in each individual, and prescribe specific herbs that correspond to each patient’s unique imbalance that caused them to contract a cold or flu” (http://www.nuhs.edu/news/2013/1/how-oriental-medicine-views-a-cold-or-flu/). No mention is made of immunizations with the flu vaccine. Their twenty-seven clinical trials studied a range of protocols from Echinacea for treating children with “Recurrent Otitis” to yoga as a relief for multiple sclerosis. Although no posted results have been published for any of their completed trials, four new trials funded by NCCAM are in progress.
Bastyr
NCCAM support 2000–2013: $14 million, fifty-eight grants, twenty-two clinical trials, thirteen completed, three posted results; Lombard, WA, and San Diego, CA.
Bastyr’s faculty advice for the flu is similar: “Being a naturopathic physician, I believe in the body’s ability to heal itself. The body can do this very effectively when it is kept healthy. By taking extra good care of yourself and possibly working with a natural health practitioner, you can stay resistant to colds and the flu every winter. Remember, there are many routes to immunity besides obtaining a flu shot” (http://www.bastyrcenter.org/content/view/198/). In stark contrast, the Center for Disease Control’s advice for the flu is an imperative: “All persons aged 6 months and older should be vaccinated annually” (http://www.cdc.gov/flu/protect/whoshouldvax.htm). Bastyr also offers advice for asthmatic children: “Children suffering from asthma might benefit from taking extra magnesium.” But this advice is not well substantiated.
One of the more creative uses of almost a million dollars of taxpayer monies has been three years of grants to Bastyr (H35B11, 4R00AT004711-03) for a clinical trial to determine whether a sauna reduces the “human chemical burden” and promotes “general wellness, detoxification and pain reduction.” There are no posted results or publications revealing the success or failure of this protocol.
Bastyr’s vice president, Leanna Standish, was an original member of NCCAM’s council. From 1994–2000 she was awarded $2 million (Green 2001) and from 2000 to 2013 she was awarded $9.1 million for twenty-two grants. Her NCCAM grants included a study using garlic therapy; a study that concluded that humans could transmit brain wave information to each other; and a collaboration with an Ayurvedic consortium in India: “Many alternative medical systems like Ayurveda, which are becoming popular in the U.S. have originated or are traditional in other countries. Ayurveda is an ancient, multifaceted, holistic medical system from India . . . (the) broad goal of this research is to develop collaborative relationships among researchers from the U.S. and scientists and practitioners in India to develop an international center for CAM research in India to study Ayurveda.” Her clinical study on the “evaluation of Garlic in HIV disease,” four awards totaling $801,000 were withdrawn.
In 2012, seven awards to Bastyr totaled $2.5 million. This money was for use of an intranasal spray for Parkinson’s, using herbs for alleviation of iron overload, and an Asian mushroom Trametes versicolor (PSK) to alleviate discomfort from breast cancer surgery. The latter, a joint study with the University of Minnesota, cost $3.9 million. There were no results posted for the clinical trial testing of eleven women for possible side effects. Total NCCAM funds awarded to several universities to study this mushroom have exceeded $9 million.
Bastyr’s online newsletter informs its students and prospective students how the Affordable Health Care Act can extend the role of naturopathic medicine. Bastyr’s website links to the full text of this provision in the law (http://www.bastyr.edu/news/general-news/2013/01/health-care-law-creates-openings-cam-fields). Naturopathic policy-watchers rejoiced when Sen. Tom Harkin, D-Iowa, inserted into the law a section stating that insurers “shall not discriminate” against care providers acting “within the scope of that provider’s license” (See http://theintegratorblog.com/site/index.php?option=com_content&task=view&id=658&Itemid=189%5C.)
The National College of Natural Medicine
NCCAM support 2005–2012: $2.4 million, fifteen grants, two clinical trials, one completed, no posted results.
The National College of Natural Medicine (www.ncnm.edu) a School of Naturopathic and Classical Chinese Medicine, is located in Portland, Oregon. Its twenty community clinics handle 17,000 patient visits a year and offer treatment by naturopaths and Chinese medicine practitioners. Its website gives specific advice for nasal conditions: “warming socks which draw the congestion from your head” and “homeopathic remedies.” The college’s Helfgott Institute advertises research on magnets, acupuncture, skin resistance, house plants effects on heart rate, and Ayurvedic medicine (http://www.ncnm.edu/helfgott-research/projects.php; http://www.ncnm.edu/about-ncnm/getting-to-know-ncnm/history.php). The college was funded to conduct two clinical trials. One, with sixty participants that was started in 2006, tested whether 450-gauss magnets alleviate carpel tunnel syndrome. No results were posted, but the authors concluded (Colbert et al. 2010) that “the dosages were safe” but they “were unable to inform patients whether the static magnet field was effective or ineffective.” Interestingly NCCAM funded this award after the Federal Trade Commission’s “Operation Cure All” forced purveyors of magnets to cease advertising. Nor were results posted for a second award comparing a “Naturopathic Anti-Inflammatory Diet” to the standard diabetic diet suggested by the American Diabetes Association.
Awards from NCCAM from 2007–2012, to its dean, Heather Lea Zwickey (http://www.ncnm.edu/helfgott-research/research-faculty-staff.php), were $1.1 million for research and training “building a foundation for a naturopathic health services research career. In line with the mission of the AHRQ (Agency for Health Care Research) this program of research investigates naturopathic care as a means to improve the quality, safety, efficiency, and effectiveness of health care delivered in low-income and uninsured populations at the community level.” Its curriculum includes courses in homeopathy, and its clinics offer homeopathic treatment. Courses of study in Chinese medicine train the naturopathic physician in the essentials of manipulating qi and the use of moxibustion at specialized qi points. A course in the “Game of Go” is designed to enhance a student’s qi (http://www.ncnm.edu/images/Publications/2008-2009_NCNM_Catalog_web.pdf).
The school promotes Unda homeopathic remedies: “. . . a type of energetic medicine using diluted doses of substances to effect changes in the body and are reportedly effective for both acute ailments and for chronic, degenerative diseases” and “…homeopathic remedies that are used in Biotherapeutic Drainage,” a technique that purports to help the body’s own physiology eliminate toxins that are claimed to interfere with normal physiological functions. To facilitate memorizing the uses of homeopathic remedies the school recommends its homeopathic flash cards (http://quizlet.com/16683740/ncnm-homeopathy-iii-2012-part-1-flash-cards/). NCCAM’s support of an institution that supports homeopathy is not a new venture. Over the last twelve years NCCAM has funded $57 million for awards that do not recognize that a homeopathic dilution cannot provide a medical protocol (http://scienceblogs.com/insolence/2012/11/19/the-success-of-nccam-grants-on-homeopathy/).
Oregon College of Oriental Medicine
NCCAM support 2001–2011: $1 million, seven awards, three clinical trials, two completed, no posted results.
Oregon College of Oriental Medicine (http://ocom.edu/), Portland, Oregon. “OCOM’s academic programs provide students with a solid foundation in acupuncture, Chinese herbal medicine, therapeutic massage, and qi cultivation, as well as a focus on collaboration between Chinese medicine and Western biomedicine. OCOM’s teaching clinics provide affordable care for general wellness and hands-on experience for students, as well as advanced specialty care for patients facing health challenges.” In addition to acupuncture and electroacupuncture treatment, their clinics feature: herbal medicine, Japanese massage (Shiatsu), Chinese massage (Tuina), moxibustion, gua sha, (scraping the skin), and cupping. Cupping is a suction therapy that supposedly draws out pathogens and increases both qi and blood flow to an area. Movie stars with cupping scars are featured on websites advertising cupping. The Oregon College of Oriental Medicine advertises support received from NCCAM for clinical trials conducted by its faculty or in conjunction with the Oregon Health and Sciences University. The college recently completed a four-year NIH/NCCAM grant, “Acupuncture Practitioner Research Education Enhancement (APREE)” to enhance research literacy and research appreciation in academic and clinical training (http://research.ocom.edu/index.php?option=com_content&view=article&id=45&Itemid=55).
From 2001 to 2011, the seven NCCAM awards totaling $1 million for training acupuncturists included a clinical trial enrolling fifty women to determine whether Chinese acupuncture and herbs are as effective as hormone therapy for alleviating endometriosis-related pelvic pain. Clinical trials list it as completed in 2006 with no posted results. The college’s funding also included a clinical trial on multiple sclerosis sponsored by NCCAM in collaboration with Oregon Health and Sciences University: “Acupuncture and herbs study for MS and other medical problems” (http://research.ocom.edu/index.php?option=com_content&view=article&id=49&Itemid=125). Their website advertises the college’s own brand of herbal medicines, formulations for pain, cough syrups, and liniments (http://ocom.edu/index.php/Patient-Care/herbalmedicinary.html). “Feng shui” principles of healing were a basis of design for their new building opened in 2012.
Chiropractic Organizations
NCCAM’s support for non-evidenced based medicine included three schools whose primary focus is chiropractic: Northwestern Health Sciences University, the University of Western States, and Palmer. From 1999–2012 NCCAM awarded these organizations $29.7 million for seventy-five grants to strengthen their curricula and training. Included were clinical trials, testing spinal manipulation velocity and manipulation for lock jaw, back pain, leg pain, and headaches. Age groups ranged from adolescents to seniors.
Northwestern Health Sciences University, Bloomington, MN
NCCAM support 2001–2012: $2.7 million, twelve grants, one clinical trial recruiting.
Northwestern advertises a recent generous joint award. “We are proud to announce the funding of another large research study that will help determine the optimal number of chiropractic treatments for neck-related headaches. Northwestern Health Sciences University, in collaboration with the University of Western States, was awarded $3.3 million from the National Institutes of Health, National Center for Complementary and Alternative Medicine. The funding of this study is truly remarkable in these tough economic times. We are very proud of the study’s lead scientists Dr. Gert Bronfort, Northwestern’s vice president of research, and Mitchell Haas, Western States, whose perseverance and commitment to quality are a true testament to leadership and research excellence.” The study’s purpose is “determining the number of visits to a chiropractor for spinal manipulation and light massage necessary for the optimal relief of cervogenic headache” (that is, headache with associated neck pain) (www.nwhealth.edu/research/news/headache-grant/). However, recent published results of Gert Bronfort’s previous NCCAM-funded study of 272 subjects concluded that in the long term, home exercise with advice was as effective as spinal manipulation (Bronfort et al. 2012). It’s not clear why NIH has committed $3 million to restudy this non-evidenced based protocol. Northwestern staffs several clinics with a wide range of specialties. Its chiropractic clinic advertises that they treat any sports related injury and children with colic and middle ear infections (www.nwhealth.edu/bloomington-natural-care-center/clinical-services/chiropractic/). Another clinic sells their product line of medicinal teas, tinctures, and essential oils (www.nwhealth.edu/woodwinds/supplements-and-products/).
University of Western States Chiropractic College
NCCAM support 2005–2012: $6 million, sixteen grants, twenty-two clinical trials, one posted result.
University of Western states, in Portland, Oregon (http://www.uws.edu), mentions NIH’s NCCAM as a research partner (https://www.uws.edu/evidence-informed-practice-resources/). Six clinics offer chiropractic services, massage, and acupuncture.
Palmer College of Chiropractic
NCCAM support 1999–2012: $16.8 million, forty-four grants, three clinical trials, no posted results.
Palmer is located in Davenport, Iowa; San Jose, California; and Florida. Funds from NIH NCCAM include an award for a $3.5 million center. (U19 AT00466301----06) (http://www.palmer.edu/Research/GrantsandProjects/).
Medical advice from chiropractic organizations can be confusing, creating medical misconceptions. “Make sure you educate your patients every chance you get. An example of this is letting parents know that ‘chiropractors don’t treat ear infections; we take care of subluxations that may help with ear infections. By adjusting the spine, we do several things that may help ear infections, such as help with lymphatic drainage and allow the Eustachian tube to drain properly...It’s helpful to use analogies, such as comparing an ear infection to a blocked sink’” (http://www.palmer.edu/Palmer/Pages/NewsItem.aspx?id=865). And from Western States: “... many patients use chiropractic care for the successful treatment of their non-musculoskeletal conditions such as allergies, high blood pressure, digestive disorders and otitis media” (http://www.healthcentersofuws.com/chiropractic-services/). However, the American Academy of Pediatrics in its report on parental use of CAM for otitis states, although “most (CAM) treatments are harmless, some are not. Some treatments can have a direct and dangerous effect, whereas others may interfere with the effects of conventional treatments. Clinicians should become more informed about CAM, ask whether they are being used. To date there are no studies that conclusively show a beneficial effect of alternative therapies used for Acute Otitis Media” (http://pediatrics.aappublications.org/content/113/5/1451.full).
Figure 2Figure 2 tracks the progress of seven clinical trials funded by NCCAM testing spinal manipulation as a protocol. The sidebar specifies the awards associated with these trials. A taxpayer suffering from headaches or low back pain who is considering chiropractic manipulation for relief from their pain might search clinicaltrials.gov for information regarding the success or failure of a manipulation protocol. However, upon viewing the lack of posted results for completed trials involving hundreds of subjects, reasonable people would probably reject manipulation as a medical choice. They might also question the uninterrupted expenditure of government monies initiating each set of new trials. By searching Project Reporter they would learn that for the last thirteen years at a cost of $29.7 million NCCAM has sponsored grants for spinal manipulation in creatures from cats to people, compared manipulation with yoga, sham procedures, mechanical versus manual, covering fourteen states and Canada, in hospitals and medical schools, with no conclusions about the usefulness of this endeavor. Funded were one hundred projects that included nine clinical trials.
The expenditure of $8.6 million supporting schools educating practitioners of non-evidenced based protocols competing with physicians is an unwarranted use of America’s scarce medical resources. Taxpayer dollars are being directed to a social comfort marketed by a billion-dollar industry. Because websites of these institutions list NIH’s support of their non-evidenced protocols they are effectively marketing acupuncture, naturopathy, chiropractic, and oriental herbal practices as reasonable choices for medical care.
Congress refuses to recognize that endorsing these non-evidenced-based protocols supports a commercial enterprise that has no documented history of solving medical problems. These institutions sell their patients non-evidenced-based protocols even when they violate the laws of physics and chemistry. This is not the path to health care. Is there a congressman who, injured in a car accident or suffering a heart attack, rejects EMTs from the local hospital and insists on calling a licensed alternative medicine practitioner? Would a congressman exposed to hepatitis or SARS virus choose a state licensed naturopathic or oriental medicine practitioner rather than an MD? Surely no members of Congress caring for his or her family would be persuaded by advice that “. . . naturopathic physicians and acupuncturists can meet the health care needs of your entire family . . .” (http://bastyrcenter.org/content/section/4/95/).
A prime example of the failure of alternative medicine in recent history is the well-documented explosion of AIDS in South Africa. Exacerbated by the medical instructions of its prime minister, Thabo Mbeke, South Africa’s government promoted a naturopathic solution to AIDS: a diet that included lemons, garlic, and beet root. Naturopathy, acupuncture, herbs, spinal manipulation, and ethnic medicine provide a mythical comfort but cannot address bacterial or viral infections or diagnose heart disease or cancer. Health problems at the global level are emerging diseases from animal populations (zoonosis), coronavirus (SARS), drug-resistant tuberculosis, and mosquito-transmitted West Nile fever. Does anyone believe these will be solved by herbal potions, spinal manipulation, or warm socks? Improving health in all parts of the globe will come not from wishful thinking but as a result of scientific research.
For centuries, humans traveled to the tops of volcanoes, returned with holy water from Lourdes, bathed in the Ganges on specified days, or climbed the steps of a shrine on their knees. The extent of present-day alternative medicine may not be so colorful but now it is supported by our taxes.
This inconceivable focus on non-science-based medicine betrays the administration’s intent to bring medical care to the poor and less educated. Most Americans do not realize how deeply the Federal government is an enabler of this $34 billion dollar industry. Belief in non-evidenced based protocols, some of which are popular in other cultures, provides a social comfort that NIH has confused with medical progress.
Notes
1. The posts of Jann Bellamy, JD, published on www.sciencebasedmedicine.org provide the most complete and current information on state licensing of alternative medicine practitioners.
2. The studies of Edzard Ernst and collaborators such as “Complementary Medicine. The Evidence So Far. A documentation of our clinically relevant research. 1993–2010 (last updated January 2011)” are downloadable from (www.quackwatch.org/08Misc/ernst_cam.pdf).
References
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———. 2013. Nurturing non-science: Startling concepts in physician education. Skeptical Inquirer 37(3): 32–39.
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