MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

By guest blogger Dr Richard Rawlins (Orthopaedic and trauma surgeon and author of Real Secrets of Alternative Medicine)

The National Center for Complementary and Alternative Medicine (NCCAM) was the US Federal Government’s lead agency, under the auspices of the US National Institutes of Health (NIH), for scientific research on complementary and alternative medicine (CAM). Originally set up in 1991 as the Office for Alternative Medicine (OAM), its first Director, Dr Joseph J. Jacobs had impeccable scientific credentials and intentions but resigned two years later, telling Science he “blasted politicians – especially Senator Tom Harkin…for pressuring his office, promoting certain therapies and attempting an end run around objective science”, and expressing his concern he was expected to “dance to the tune of the alternative medicine lobby.” OAM changed its name to NNCAM in 1998 continuing with a remit “To answer important scientific questions about natural products, mind and body practices and pain management.” It has failed. It has become directed by those who have no intention of enquiring into any scientifically derived evidence as to whether CAMs have a beneficial effect on any specific condition, and is now directed by doctors who believe that they do, and who want to have CAM (SCAM/camistry – by whatever name known), integrated with regular orthodox progressive medical practice. Apparently still dancing to lobbyists’ tunes.

NCCAM even rebranded itself a couple of years ago, dropping any suggestion it might critically consider ‘alternative’ medical approaches such as chiropractic, osteopathy, acupuncture or homeopathy (all of whose founders or original proponents stated that their modalities were ‘alternative’ to the regular medicine of their day) – and is now styled as the ‘National Center for Complementary and Integrated Health’ (NCCIH).

Ad hominem commentary is normally best avoided, but when the NCCIH’s current Director speaks, we should take note. The 2019 New Year’s Message from Dr Helene Langevin M.D. allows us critical insight into her state of mind, her facility with logical fallacies, and her lack of critical thinking. All of which is important considering that the Center has spent $2.5B over the past ten years on research, and found no benefit from the modalities studied beyond the placebo. The Center’s current budget is $142M p.a.

Here follows Dr Langevin’s ‘2019 New Year message’, and a slightly more critical review (in italics) than her own insights and editing offered:

”It has been my longstanding conviction that integrative health care is more than just the sum of conventional and complementary health approaches. When combined, these approaches provide a frontier of new insights into the physiology of health and the pathophysiology underlying diseases and disorders. Dr. Straus, Dr. Briggs, and Dr. Shurtleff have built a strong foundation for NCCIH’s strategic priorities and partnerships.”

Dr Langevin fails to mention her predecessor Dr Josephine Brigg’s opinion when, as Director of the US National Center for Complementary and Alternative Medicine she said: “Integrative medicine represents an invasive rebranding of modern equivalents of ‘snake oil’ by practitioners who raise unrealistic hopes and promote approaches that are not sensible, supported by evidence or proven safe.”

“I plan to help the Center continue to reach beyond its walls and across NIH, encouraging an emphasis on health promotion, whole person care, and nonpharmacologic treatments, especially for pain management.”

What she plans is the integration of implausible pseudo-scientific modalities with regular medical practices. She ignores the wise words of Dr Mark Crislip: “If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.”

“Our current approach to patient care, in general, is fundamentally limited. It often emphasizes the treatment of disease alone, while it many times neglects the promotion, support, and restoration of health.”

That may be a valid critique of ‘our current approach’, but that need not be the case. Orthodox treatment can adopt the other dimensions Dr Langevin identifies without having to ‘integrate’ with CAM modalities.

“Integrative health care can help correct this limitation by giving more consideration to the patient’s long-term recovery and overall health when treating an acute illness or injury.”

But can only do so within a framework of implausible pseudo-science.

“Another limitation of the conventional medical approach is its specialization, based on the basic organization of the body into physiological systems, which can lead not only to fragmented health care, but also fragmented research.”

That is because as ‘medicine’ has advanced since the 16th century Enlightenment, and specialisation has allowed the more focussed scientific consideration and attention to detail that is necessary to advance understanding. The CAM modalities have failed to ‘move on’ and are anachronistic. Any perceived fault of ‘the conventional medical approach’ leading to ‘fragmented health care’ can be remedied by greater co-operation and collaboration amongst conventional doctors. ‘Integration’ with camists (who practice CAMs) is simply not necessary, and proves a distraction.

“In contrast, many traditional healing systems, especially those based on Eastern philosophies, emphasize an understanding of the person as a whole.”

That may be their emphasis – given the lack of scientific endeavour in ‘traditional’ systems, they can hardly do otherwise – they have little else to offer. But conventional medicine is doing all it can to ‘understand the person as a whole’, without the encumbrance of outmoded approaches.

“Further, the widespread role of pharmaceuticals as the default means of medical treatment is an important issue, and nowhere is this more urgent than for pain management.”

So, don’t use them! Conventional medicine can change its ‘default mode’, and does so in the face of scientific evidence.

“NCCIH is playing an increasing role in finding solutions to the current opioid crisis with research on non-drug approaches for pain.”

We must all look forward to published evidence of the benefit arising from NCCIH’s approach to pain management.

Happy New Year, and may the Wu be with you all. (Wu: Chinese, nothingness – wherein CAM resides.)

15 Responses to A review of “A New Year’s Message” from NCCIH’s Director: Helene Langevin M.D. January 2019.

    • @Tom Kennedy

      I like cow pie.

      We have already noted your aberrant taste, Tom.
      What we have criticised and discouraged through the years of acquaintance, is your practice of selling “cow-pie infused apple-pie” to unsuspecting customers under the pretense of unspoiled qualities 😉

      • @Björn, I don’t see my customers as ‘unsuspecting’ – I give them more credit and respect than that. I offer them my honest opinions, and point them in the direction of various resources (including this blog) so they can make their own informed decision about how to approach their health.

  • @Tom “cow feces” Kennedy: indeed, we typically enjoy things that remind us of who we really are.

  • Langevin is a real doctor, right? As such, one would assume she must be familiar with science.

    How does one, after a good bit of medical school, go so off the rails? I could see it if she were uneducated or suffering from a mental illness but—again, one assumes—if either of these were the case, she would not have been hired. The part of my brain that houses common sense tells me this is bizarre.

    Switching gears. . .

    Admittedly, I already love metaphors. This, however, is priceless:

    “. . .the wise words of Dr Mark Crislip: ‘If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.’”

  • How ancient remedies are changing modern medicine — Long overlooked by Western science, traditional Chinese treatments are yielding cutting-edge cures https://www.nationalgeographic.com/magazine/2019/01/ancient-chines-remedies-changing-modern-medicine/?fbclid=IwAR2HJA4D0Xbv2Q4Ng3gsqhUDgNAaJi070mmOuvIotXrBOWaVX34ozyhvvrI

    • Oh dear.

      Traditional Chinese medicine is science, ma-an! National Geographic promotes quackery

      Dammit. Traditional Chinese medicine is science, ma-an! Except that it isn’t. I groaned as I read the conclusion of this article. I’m sorry that Gwin’s father died, but qi doesn’t exist. The five elements don’t exist, not in the way TCM claims they do. Acupuncture doesn’t work. A few TCM herbal remedies might work, but that doesn’t justify TCM. Again, I find it particularly telling the Gwin didn’t bother to interview a single skeptic. It’s almost as though he’s a believer in TCM himself.

      No matter how much advocates try to claim that TCM is science, ma-an, it’s not. Unfortunately National Geographic has jumped on the TCM propaganda bandwagon to promote its prescientific, pseudoscientific, and mystical nonsense.

    • How ancient remedies are changing modern medicine

      What do you mean? There is no change going on in modern medicine, that can be attributed to archaic oriental healing practices. Modern medicine is based on scientific progress and sensible attention to falsifiable knowledge. It has shown steady progress for a long time and continues to do so. Oriental archeological medicine does not and is not. The introduction of a stupid person to a group of sensible people will not alter their intelligence. No more will the addition of useless products and methods change modern medicine itself.
      The only health related change going on that can be attributed to the intensified marketing of this “export” from china is deleterious contamination of public health care.
      Here is a well worded critique of this credulous article

      • An interesting review.

        I suspect that the reason Chinese medicine has five elements rather than four is that the number four is considered bad luck in China and other parts of the far east. This is because the Mandarin word for four (shi) has a similar sound to the word for death. This is also true in Japanese, though I am insufficiently familiar with other oriental languages to generalise. I stayed in a hotel in Bangkok last year which didn’t have a fourth floor (like European hotels which might not have a thirteenth), and you will have trouble buying sets of four of anything in Japan.

        The Chinese are remarkably superstitious, and many of the things they eat are for supposedly beneficial effects on their health and fortune. Often this seems to be based on some kind of pun on the name of the item, an example in English might be the notion that eating goldfish could increase your wealth.

        • goldfish is ok – but only in salary sauce

        • Julian,

          I’m hoping Gorski is making a joke with the 4 vs 5 element thing. He’s done some similar “twisting” of Chinese med theory on other posts, either for humorous effect or maybe he really doesn’t understand them. Either way, what is normally called “five elements” in Chinese med (and Japanese & Korean) is totally different from Greek or Buddhist four element theory.

          Gorski, Hall, Novella, and their clan should be taken with a big grain of salt. As a general rule, if you read something here about Chinese med and think “well, THAT’s weird”, you can probably trace it back to one of them.

    • My own take on the National Geographic article.

      Ancient remedies are not changing modern medicine. Modern medicine is improving ancient remedies and has been doing so for some time. Aspirin.

      Regarding TCM a scientific gulf separates acupuncture and herbalism.

      Herbal remedies contain the stuff of chemistry. Modern science can distinguish the chemistry responsible for medical benefits from the chemistry which isn’t. A traditional remedy containing many superfluous or harmful ingredients can be purified and turned into a drug.

      Acupuncture involves piercing flesh at traditionally specified points. Piercing (or pressuring) flesh has physiological consequences. Traditionally acupuncture is claimed to provide benefits for many ailments. Simply by changing the places where needles are inserted many conditions may be treated. Can the subtle differences in physiological consequences of puncturing flesh at different points on the body benefit scores/hundreds of medical conditions? Some handwaving attempts to suggest how it might do so for pain exist but the evidence for it is poor .

      The article explains how science can transform traditional herbal treatments into far superior treaments in the case of herbal remedies like aspirin and artemisinin.

      It’s conceivable that bear bile and other animal parts may have chemistries capable of being tapped for medicinal use. Time will tell.

      Acupuncture is different. The article quotes James Harrison saying that acupuncture makes him “feel good” so he doesn’t need scientific proof. Stuff like that is not changing modern medicine. Popularity of treatment is no proof of medical efficacy.

      Aspirin and artemisinin et al. ARE scientifically validated modern medicines. The mass of traditional treatments are NOT. The fact that they are big business is not changing modern science based medicine.

      The article goes off the rails when it talks about the hypocrisy of of criticising TCM for endangering wild animal species whilst ignoring other problems in medicine. Such hypocrisy is bad. Endangering wild animal species is bad. The diversion seems to be a gratuitous attempt to belittle critics of TCM.

      The article is not nearly so questioning of Omega-3s usefulness with depression as it is of antidepressants. Why not?

      As for other possible TCM candidates in the science pipeline, we shall have to wait and see. Science is rendering TCM treatments into far more effective treatments where they are effective and leaving those which are not to TCM.

  • $2.5 billion dollars searching for something for nothing. The USA is nothing if not a land of wealth and absurd faith. The search will go on.

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