On April 2, Steve Novella, Kimball Atwood, and I visited the National Center for Complementary and Alternative Medicine (NCCAM) to meet with its director, Dr. Josephine Briggs. I’m not going to rehash what was said because we agreed that Steve would handle that task, and he did so admirably last week. I agree with Steve that it was encouraging that Dr. Briggs apparently reads this blog and shares many of our concerns about NCCAM, the poor science that it has funded, and its use by promoters of unscientific medicine to promote their quackery. Most heartening of all was that she appeared to recognize how much CAM is infused with anti-vaccine beliefs and, worse, the promotion of these beliefs to the detriment of public health.

Those positive reactions to what was a friendly but frank exchange of views notwithstanding, as we were sitting in a conference room next to Dr. Briggs’ office, I couldn’t help but wonder what the reaction of CAM promoters would be when they found out about this meeting. Now I know. John Weeks over at The Integrator Blog is not happy:

Novella’s posting reads like a Fox News interview: 95% his team’s point, then a brief NCCAM response. That Briggs asked for the meeting likely grew out of an early March conference at Yale at which Novella and she both participated. For this, she deserves the Barack Obama Big Tent award for her proven interest in sitting down with everyone, no matter which party affiliation or belief. (Some have said this was proven in early 2008 when Briggs met with me.) Arguably, Briggs takes her openness to dialogue further than the President. While Obama has kept arms length from leaders who call for the demise of the United States, Briggs has now met with those who have been lobbing bombs at her professional home for years, calling steadily for NCCAM’s destruction.

Because our previous calls for the closing of a relatively small government institute because we view it as a poor use of taxpayer money is just like calling for the downfall of the United States government. Weeks clearly likes ridiculously overblown hyperbole. Interestingly enough, what appeared to upset Mr. Weeks the most was our discussion of homeopathy with Dr. Briggs. As Steve put it:

Dr. Briggs pointed out that it is not the job of the NCCAM to make final pronouncements about any treatment or medical claim. This is fair enough — but depends on context. The NCCAM is responsible for informing the public about so-called CAM modalities, and that should include a fair assessment of the science. If the science says a treatment is worthless, the NCCAM should not be afraid to say so.

Further, the NCCAM does determine what studies the NCCAM funds. The NCCAM accepts applications for research into homeopathy, but have not funded any in several years. What does this mean? Will they consider funding homeopathy research, and if so they are basically saying that they do not close the door on any medical modality, no matter how implausible or damned by negative evidence.

If they will not consider funding homeopathy, then why are they accepting grant applications for homeopathy research? This could be construed as disingenuous — perhaps a way to not fund homeopathy research without having to say they will not fund homeopathy research.

Steve is correct. The NIH can never totally close the door on any line of research. It can, however, set priorities. It could decide that, given the homeopathically diluted prior plausibility of homeopathy based solely on physics, chemistry, and biology, homeopathy is not a priority. It can make sure that only reviewers with the relevant background in basic and clinical science — not “homeopathic” science — make up the study sections that review NCCAM grants. Indeed, I was much heartened to learn from Dr. Briggs that she had already moved peer review of CAM grants out of NCCAM-sponsored study sections and into regular standing NIH study sections run by the Center for Scientific Review, which is where the vast majority of NIH grants are normally reviewed.

As a sort of counterpoint to our message, Mr. Weeks described in the same post a meeting that Dr. Briggs had with an “international homeopathic team.” Besides the amusement I felt at the word choice (is a homeopathic team a team so diluted that there is no one there?), the content itself was at the same time both disturbing and full of hilarious howlers. For instance, this passage concludes the section discussing our visit:

That said, what would have been especially interesting is if Briggs’ scheduler crossed wires and the anti-NCCAM bloggers and homeopathic researchers had showed up for the same meeting time.

I can’t speak for Steve or Kimball, but I assure Mr. Weeks, that I probably would have enjoyed such an encounter thoroughly, although we would have been disappointed that we wouldn’t have been able to have the discussion that we had planned on.

But how did the meeting between Dr. Briggs and the homeopaths go? This is how Mr. Weeks describes it:

Gahles, in a report to the Integrator, assessed that the meeting went “very well.” In her view, a presentation by Chaplin and Roy on chemistry and slides that “showed activity of homeopathic remedies on basophils and IgG” seemed to be particularly compelling to the NCCAM team in suggesting mechanism of action. Gahles underscored that conventional bio-markers seemed to be key in stimulating interest from the NCCAM team.

On the other hand, a presentation on quantum physics and energy medicine seemed to be less useful in making in the case. At one point, an NCCAM team member who said he found the presentation “powerful” asked what the community of top scientists would think. Those in the meeting responded: “We are the leading scientists in the field.”

More like the leading pseudoscientists in the field. The thought of a homeopath claiming to be a leading scientist, particularly when it comes to physics and energy brings to mind Dr. Charlene Werner’s tortured attempt to explain homeopathy through physics or John Benneth’s attempt to explain it as “nanocrystalloids.” Maybe they’re the “leading scientists” of the field of homeopathy. Or perhaps Mr. Weeks means Dana Ullman. Or maybe Jacques Benveniste. In any case, it’s disturbing that an NCCAM team member apparently found the presentation “powerful.” Anyone who finds the clinical research on homeopathy “powerful” does not understand the true tenets of homeopathy and what pseudoscience they are. Such attitudes will tend to stand in the way of attempts to bring more rigorous science to the study of CAM.

Still, Mr. Weeks has done us an unintentional favor — two, actually. First, he has demonstrated clearly that the CAM community wants its pseudoscience, not rigorous science, to guide NCCAM’s research efforts. This has only reinforced my appreciation of Dr. Briggs’ delicate situation. Every move she makes towards bringing rigorous science to the study of CAM is certain to enrage supporters of the purely pseudoscientific CAM modalities such as homeopathy, reiki, and various “energy healing” modalities that are no better than faith healing under different belief systems than Christianity.

Second, Weeks actually points out the heart of the conflict at the heart of NCCAM. Dr. Briggs is clearly trying to move NCCAM in a direction that we at SBM would approve of, namely towards a more drug discovery-oriented approach towards herbal and botanical remedies and various supplements, as well as the study of exercise and various relaxation techniques. After all, these are the most plausible remedies that fall under the general rubric of CAM, and a pharmacognosy approach is the most likely to yield useful information and scientific advances. But that is not what CAM proponents want. Indeed, they resent this approach, as Weeks demonstrates:

One of the perverse pleasures that comes from the disposition of the NIH to hire NCCAM leaders who have no prior experience in alternative or integrative medicine is to think of the culture shock when they move from a zone of relative comfort — drug research on fractions of botanical — into the far reaches such as homeopathic theory and practice. In truth, forms of energetic thinking and practice are infused throughout the “CAM” universe; homeopathy’s dance with Avogadro’s number merely makes it, with distant prayer, the most challenging.

“Challenging” is putting it mildly. But this is the kicker:

It is probably good that Briggs’ extensive and admirable self-education process over the last 2 years preceded this meeting. The culture shock may had this meeting been in her first months.

I rather suspect that Mr. Weeks is correct here, only not in the way he thinks. I’m willing to bet that it was a major culture shock for Dr. Briggs to find out just how much magical thinking, religion, and pseudoscience underlie so much of CAM. What Weeks calls a “comfort zone” is in reality nothing more than staying within what can be studied and demonstrated scientifically, which is what scientists do. If homeopaths could produce anything more than centuries-old magical thinking to support their quackery, if they could produce actual science in the form of physics, chemistry, and biology to support their mystical beliefs in the “memory” of water and that “like cures like,” then their discipline would enter the realm of science, rather than being relegated to the realm of pseudoscience. The problem, of course, is that homeopathy and the “energy healing” modalities are so removed from science that this is about as unlikely to happen as there is likely to be a single molecule of active remedy left in a 30C dilution.

Therein lies the conflict at the heart of NCCAM, and, although I approve of Dr. Briggs’ attempts to increase the scientific rigor of NCCAM and, given that NCCAM isn’t going anywhere, see that as the best path towards trying to make NCCAM a useful center in the NIH, I’m afraid that her actions will only exacerbate the conflict. It’s the institution and the laws that created it that are the problem, and Dr. Briggs won’t be there forever. Her successor might not be as dedicated to science as she is. (In fact, if people like John Weeks get their way, you can count on it.) No matter how much Dr. Briggs may change the culture of NCCAM under her stewardship, all it takes is a new director to change it right back. Directors come and go, but institutions last for generations.