Map of life expectancy at birth from Global Education Project.

Tuesday, November 02, 2010

I have to be very careful . . .

. . . about what I say here. I am a member of an NIH Scientific Review Group (SRG) -- these are the peer review panels that score proposals for NIH-funded research -- that will meet at the end of this month. That is a matter of public record -- the rosters of all SRGs are posted openly on the NIH web site. The text of the so-called Funding Opportunity Announcement that we will be reviewing -- in this case, a so-called PO1 or research program announcement -- is also posted for all to see. It's called RFA-AT-10-002, and it is issued by the National Center for Complementary and Alternative Medicine (NCCAM). Beyond that, however, I am pledged to absolute secrecy about the content of the proposals, my own critiques, and the SRG's discussions about them.

I doubt that Orac would be happy if he knew I was doing this. He, and many other advocates for science-based medicine, do not feel that the NCCAM should exist. They argue that there is essentially no such thing as "complementary" or "alternative" medicine. If an intervention is shown to work by convincing evidence, then it's medicine, i.e. doctors will use it and insurers will pay for it. It's only "alternative" if it hasn't been shown to work, and that's a pretty silly kind of alternative.

And indeed, NCCAM has spent a lot of money over the years evaluating "alternative" medicine and it has not found a single thing that actually works. You may say that's fine, people are spending money on all that jive, so if we show that it doesn't work, maybe they'll stop. Unfortunately, that doesn't happen. The snake oil salesmen going on selling, and the people go on buying.

However, I figure these funds are going to be awarded, so somebody might as well review the proposals on their scientific merit. In other words, it's dirty work, but somebody has to do it. And there may be some merit in this particular effort, to fund "Centers of Excellence for Research on CAM for Pain." Chronic pain often has no detectable physical cause; and people report benefit from techniques such as acupuncture, meditation, chiropractic, etc. Maybe these are so-called placebo effects, but okay, something about them seems to work, so we might as well try to figure out what that is.

Is that the best use of limited NIH dollars? I may not think so but Congress has decided that it is -- NCCAM is specifically funded by its own line item. So I will read with a critical eye and judge whether the proposed research is good science, and whether it can answer important questions. I hope that all the SRG members will do the same and that the proposers assigned to me are not disadvantaged by catching a skeptical reader. Am I doing the right thing?


robin andrea said...

I think you are absolutely doing the right thing. The proposals presented by the NCCAM should be reviewed with the same rigor as any other proposal presented to the NIH. I'm glad you're looking at them and trust you will evaluate it them appropriately. By that I mean with an eye to their scientific merit, and not to the arguments of whether they should even exist.

kathy a. said...

yes, you should do it. perhaps this can root out things that are damaging, and provide data for things that don't work but are expensive.

and chronic pain is a real problem. invisible, but debilitating. if there are actually some methods that provide relief, that would be good to know.

kathy a. said...

* by relief -- well, i guess that is something that needs definition, something short of 100% recovery. people with that kind of pain look at fewer and shorter episodes as a victory, something that allows them to function more normally.