January 26, 2009

Trim The Quack Fat

A theme I've been hitting for months (indeed, since before the election) is that the government is simply spending far too much money -- for the very good reason that "too much" means "more than is collected in taxes, by a significant margin." We've got to cut spending somewhere or face a painful tax increase. If you think that not stimulating the economy now would be bad, just think about how it would be if we couldn't do it at all and had to raise taxes at the same time.

That's what we're setting ourselves up for the next time around. Either that, or a default on our debt, which would be even worse.

So here's one place we can cut funding. A division of the National Institutes of Health is called the National Center for Complementary and Alternative Medicine. You don't have to get past the splash page of this agency's website to see that it is spending your taxpayer dollars on woo. Acupuncture, varied forms of herbal therapy, echinacea for everything, green tea for rheumatoid arthritis -- and that's just on the first page. As might be expected, since its establishment in 1993, NCCAM has yet to produce a single proven alternative method treatment regimen that has survived double-blind testing or even preliminary critique from the peer review process. Of course, the researchers there have identified all sorts of "promising areas" upon which money must be spent and their own nonsense-based employment prolonged.

NCCAM is budgeted at around $121 million a year. Not a lot, but it's a start. NCCAM also gets major funding from a similar sub-division of a different branch of NIH, the Office of Complementary and Alternative Medicine of the National Cancer Institute, which is also funded at about $121 million a year. So now we're talking a quarter of a billion dollars, which is approaching the realm of real money. A more careful search through other NIH and other kinds of HHS and Agriculture funding could probably reveal some other places where government money is spent on woo. I wouldn't be surprised if a reasonably thorough search of government programs could double that number and take us to nearly a full billion dollars a year spent on pseudoscience and quackery.

At least as importantly, defunding this government-funded quackery will serve to de-legitimize it. Whether or not it has a budgetary impact -- and I submit that saving a billion dollars of government money is not insignificant -- it also cloaks sixteen years of failure to produce scientifically validatable results in the legitimacy of the Federal government. (Skeptic: "Magnet therapy doesn't do a thing for the human body." Believer: "But the government thinks it's a promising enough field of research to fund a scientifically rigorous study of it!")

In his inaugural address, President Obama promised that "We will restore science to its rightful place, and wield technology's wonders to raise health care's quality and lower its cost." He also promised "The question we ask today is not whether our government is too big or too small, but whether it works — whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified. Where the answer is yes, we intend to move forward. Where the answer is no, programs will end." Spending half a billion to a billion dollars less on researching quack medicine would be a good start towards that goal.

Cutting Medicare funding for quack medicine would be the next step. That would multiply the cost savings significantly -- and at no detriment whatsoever to public health since we're talking about stuff that doesn't work anyway. No more taxpayer funding of treatment modalities like acupuncture, chiropractic, or homeopathy. The only political pain suffered would be the squawks of the alternative medicine providers who would have to go look for real jobs, and the patients breaking themselves of their placebo addictions. The benefit realized in return would be tens, if not hundreds, of billions of dollars worth of savings.

Frankly, I don't see how we can afford not to do this.

Hat tip to Dave Gorski at Science-Based Medicine.


Yogi said...

Well, OK, except that acupuncture helped both me and my wife (I know, I know, anecdata) but I paid for it myself, anyway.
But since there's also no favorable data on stents, how about we get rid of them, too? Coronary bypass? I mean, once you start REALLY looking (and I'm all for it, BTW) where do you stop? "We've been doing it for 40 years" doesn't seems like a good measure, but there are literally hundreds of procedures that have no demonstrated benefit. Read Jerome Groopman's book on cancer treatment for more; he includes endless references.

Burt Likko said...

1. As for stents and bypasses, it seems to me if you've got total coronary artery blockage, you don't have time to wait for drugs to work. That leaves you with three choices, and "stent" and "bypass" are two of them. The other is "death," so I'd call that a objective patient advantage coming from the procedure. If you know of a fourth alternative, I'd love to hear about it since my family has a history of heart disease.

2. As for your experience with acupuncture, good for you. As you know, anecdata is not the sort of thing that science is based on.

3. As for a criterion for what the government should research with prudence and scientific reliability, how about this as a starting point for the discussion -- if it can't gain approval from a panel of Ph.D.s in the relevant specialty, then a preliminary analysis should show that the proposed treatment produces results at least one standard deviation better than either a placebo or no treatment at all.

Yogi said...

Well, the data we have on stents is that >50% of the time, they are no more effective than drug treatment in anything but the very short term, and there are issue with that as well... So that's a problem. As for bypass, no amount of reconnection is going to make the dead parts of the heart perk up again, so its primary use is to reduce angina and, hopefully, head off other problems.
However, we don't have good data for either of these, for obvious reasons: we can't run real blind tests and find out.

As far as the criterion goes, I'm all for it, provided you can find people who don't have an axe to grind in either direction, or at least have enough people on the panel with competing interests to even it out.

Right now, most of this is done by drug and medical device mfrs. Not the most even-handed treatment possible. Really, go read Groopman on cancer, he's fascinating, if somewhat depressing.

If you want to read about the most obviously fraudulent "medicine" being practiced these days, look into why we have an "epidemic" of obesity, since 10 years ago. And who paid for the studies, and who funds the hospitals doing the bariatric procedures. At most hospitals, open-heart surgery has a better risk profile than the Roux-en-y. Scary.

FYI, when my wife was diagnosed with breast cancer 7 1/2 years ago, she went with very traditional therapy: surgery, chemo and radiation. Also acupuncture to control her nausea (as the drugs weren't enough, she used them too). So we're not woo-people.

Burt Likko said...

Agreed that many review panels are not unbiased and that this is a problem. Also agreed that the "obesity epidemic" is nothing of the sort. Prof. Paul Campos, one of the contributors to Lawyers, Guns, and Money has done some really good work on that point. I've had my eye on Groopman's book How Doctors Think for some time now.

And my sincere congratulations to your wife for seven and a half years of surviving, and to you for standing with her while she went through the therapy.