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Why Non-Scientists Should Not Direct Scientific Efforts: Senator Harkin’s Misguided Beliefs Exposed

I’ve been blogging a lot recently about the problems caused by health policy makers who don’t appear to understand medicine or science. I’ve also been lamenting the relative lack of physician input at the highest level of health reform. But today I’d like to present a prime example of the perfect storm in health policy: when willfulness, ignorance, and magical thinking combine to push an agenda despite billions of tax payer research dollars proving the futility of such efforts.

In this video, Senator Tom Harkin describes the impetus behind the creation of the National Center for Complementary and Alternative Medicine (NCCAM). Harkin suggests that he single-handedly introduced legislation in 1992 that created the Office of Alternative Medicine at the National Institutes of Health (NIH). This office paved the way for an entire new branch of research at NIH devoted to exploring the potential validity of non-science based medical practices such as homeopathy, acupuncture, traditional Chinese medicine, energy healing, meditation and more. He introduced the legislation because a friend of his experienced a substantial health improvement after trying one of these non-science based therapies. Essentially, an entire branch of the NIH was founded on an anecdote.

What’s worse is that after a decade of careful analysis of these alternative therapies, science has shown that not a single one of them appears to be efficacious beyond placebo. One would think that Senator Harkin would be embarrassed by the colossal waste of tax payer resources spent on this pet project of his. But no, instead he chastises the scientists who did the research, saying that they had failed to do their job of “validating” the therapeutic modalities. Wow. I guess he was never interested in finding out the truth about what works and what doesn’t – because when objective analysis reveals that these modalities don’t work, then the science must be flawed.

Now don’t get me wrong – healthy eating, regular exercise, emotional and psychological support are critical factors in good healthcare, and I fully believe that America needs to become a “wellness culture” in order to prevent chronic diseases and improve quality of life. I also believe that Americans are often over-treated and over-medicated when lifestyle interventions might be their best treatment option. However, in encouraging behavior modifications, we don’t need to foist placebo therapies on them under the banner of science. The problem with “integrative medicine” is that it takes some good medical principles and infuses them with scientifically debunked and outdated systems of thought (debunked repeatedly by NCCAM, the very scientific body that Harkin hoped would validate them.)

What we really need to do is stop splitting the practice of medicine into “integrative” vs “non-integrative” and simply follow scientifically vetted best practices. Patients need a comprehensive approach to their health, a medical home with a good primary care physician coordinating their care, reliable health information to support their decision-making, a strategy to eat well and exercise regularly, and mental health services as needed.

Senator Harkins’ plan to continue flogging the alternative medicine “dead horse” is not helpful – it’s not good science, and it’s not a good way to spend our tax dollars. I can only hope that one of the positive effects of Comparative Clinical Effectiveness Research will be to put an end to the promotion of the ineffective therapies that Harkin fervently hoped would be validated. I also hope that the new Federal Coordinating Council will not support funding to pet projects that are founded upon anecdotes, pseudoscience, and wishful thinking. Now more than ever we need good science underpinning our healthcare spending, and we need informed scientists advising our government on priorities for America’s health.

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Addendum:

More outrage from the medical blogosphere over Harkin’s views:

1. Dr. David Gorski:  Senator Tom Harkin: “Disappointed” that NCCAM hasn’t “validated” more CAM

2. Dr. Peter Lipson: Harkin’s War On Science


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4 Responses to “Why Non-Scientists Should Not Direct Scientific Efforts: Senator Harkin’s Misguided Beliefs Exposed”

  1. maverickny says:

    “failed to do their job of “validating” the therapeutic modalities” ummm, isn't science about fact and proving (or disproving) hypotheses, not validating cranky ideas?

    The last thing we need is more snake oil in science, especially from politicians. I don't think I have ever seen a single study that showed any significant improvement in symptoms or disease alleviation from alternative medicine in controlled clinical trials.

    We should put a stop to this nonsense and waste of taxpayers money immediately.

  2. maverickny says:

    “failed to do their job of “validating” the therapeutic modalities” ummm, isn't science about fact and proving (or disproving) hypotheses, not validating cranky ideas?

    The last thing we need is more snake oil in science, especially from politicians. I don't think I have ever seen a single study that showed any significant improvement in symptoms or disease alleviation from alternative medicine in controlled clinical trials.

    We should put a stop to this nonsense and waste of taxpayers money immediately.

  3. alan dappen says:

    I couldn't agree more with your comments. Policy makers “fixing health care” is magical thinking. But my experience about the lack of physician involvement and leadership advocating for health care changes hinges on the singularity protecting their income.

    Physicians are and should be the leading proponents of change. They have all the scientific training, the experience, the know-how, the legal authority, the intelligence and enough financial security to push change. They even continue to enjoy the privileged moral high ground and status by most of society. Yet for 60+ years we have become accustomed to letting 3rd party payers pay as much as we (and everyone else) could get away with.

    In my 8 years of practicing under a the new medical business paradigm (http://www.doctokr.com) which delivers immediate and continuous care for half the current system cost by eliminating all parties that interfere with the doctor-patient relationship (e.g. insurance) or increase costs (e.g. lots of staff.) I have seen many colleagues get interested even excited about our paradigm changing idea until the fateful question, “ How much money can I make?” The interview ends with dashed hopes.

    “Lets see,” I think, the patients’ kiss of death question is, “Doctor, are you still a preferred provider?” because the doctor’s kiss of death question is, “How much money can I make?
    If physicians aren’t willing to stand up and invest in a new future, to do the right thing for the right reason at the right price, then we should stop begrudging anyone else who is willing to invest in a future where physicians are subordinate to their new paymaster. We wont like it, it will mandate us to do stupid things, but pay us enough and we’ll keep doing that too.
    Alan Dappen MD

  4. alan dappen says:

    I couldn't agree more with your comments. Policy makers “fixing health care” is magical thinking. But my experience about the lack of physician involvement and leadership advocating for health care changes hinges on the singularity protecting their income.

    Physicians are and should be the leading proponents of change. They have all the scientific training, the experience, the know-how, the legal authority, the intelligence and enough financial security to push change. They even continue to enjoy the privileged moral high ground and status by most of society. Yet for 60+ years we have become accustomed to letting 3rd party payers pay as much as we (and everyone else) could get away with.

    In my 8 years of practicing under a the new medical business paradigm (http://www.doctokr.com) which delivers immediate and continuous care for half the current system cost by eliminating all parties that interfere with the doctor-patient relationship (e.g. insurance) or increase costs (e.g. lots of staff.) I have seen many colleagues get interested even excited about our paradigm changing idea until the fateful question, “ How much money can I make?” The interview ends with dashed hopes.

    “Lets see,” I think, the patients’ kiss of death question is, “Doctor, are you still a preferred provider?” because the doctor’s kiss of death question is, “How much money can I make?
    If physicians aren’t willing to stand up and invest in a new future, to do the right thing for the right reason at the right price, then we should stop begrudging anyone else who is willing to invest in a future where physicians are subordinate to their new paymaster. We wont like it, it will mandate us to do stupid things, but pay us enough and we’ll keep doing that too.
    Alan Dappen MD

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