Why Senator Tom Harkin Should Be
Considered a Public Health Menace
David Gorski, M.D., Ph.D., FACS
In my opinion, no single legislator in the U.S. has done more to harm to the cause of promoting science- and evidence-based medicine than Tom Harkin. That's because it was primarily through Harkin's efforts that the National Institutes of Health, despite the fact that its scientists were not agitating for it, had the National Center for Complementary and Alternative Medicine (NCCAM) rammed down its throat in 1992, first as the Office of Alternative Medicine (OAM), then in 1998, when NIH Director Harold Varmus tried to place OAM under more scientific NIH control, by elevating OAM to a full and independent Center within the NIH. Thus was NCCAM born.
I've complained many times about how NCCAM funds studies that, let's face it, are of pseudoscience and quackery (homeopathy, anyone?) and even more about how it promotes unscientific medical practices. I've argued time and time again that there is no research that is funded by NCCAM that couldn't be dealt with as well or better by other Centers or Institutes within the NIH. I've even argued that NCCAM should be defunded and dismantled, allowing CAM grant applications to be evaluated by the most appropriate center. I've also pointed out Harkin and other CAM-friendly legislators created and managed to increase the funding of NCCAM to the tune of $120+ million a year not for the purpose of rigorous scientific evaluation of CAM practices, but rather to promote CAM and ultimately "integrate" it with scientific medicine. At this they have been enormously successful.
Let me clarify. What I meant is that NCCAM, along with the Bravewell Collaborative, has been very successful in popularizing CAM in medical academia; at "proving" that CAM works, not so much. Evidence that this is so comes from a recent observation that Senator Tom Harkin is very, very unhappy with NCCAM these days and has publicly said so recently, as pointed out by Lindsay Beyerstein, daughter of the late, great skeptical psychologist Barry Beyerstein. In February 2009, Harkin told a Senate panel, Integrative Care: A Pathway to a Healthier Nation, that he was disappointed that NCCAM had disproven too many alternative therapies. (His remarks begin about 17 minutes into the video on the webpage to which I linked.) In addition, Harkin's statements have also been posted to his Senate blog:
I am pleased to co-chair this morning's hearing with Senator Mikulski. And I am eager to hear our distinguished witnesses' ideas on using integrative care to keep people healthy, improve healthcare outcomes, and reduce healthcare costs.
It is fashionable, these days, to quote Abraham Lincoln. So I would like to quote from his 1862 address to Congress—words that should inspire us as we craft health care reform legislation. Lincoln said, "The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty . . . . As our case is new, so we must think anew, and act anew. We must disenthrall ourselves, and then we shall save our country.
Clearly, the time has come to "think anew" and to "disenthrall ourselves" from the dogmas and biases that have made our current health care system – based overwhelmingly on conventional medicine—in so many ways wasteful and dysfunctional.
I note that in the video, Harkin does not say "conventional medicine." In fact, he says "conventional allopathic medicine." Anyone who uses the term "allopathic" in such a contemptuous manner to describe conventional scientific medicine has clearly drunk the Kool Aid. But, consistent with how I've warned that CAM advocates would do their best to hijack any effort on the part of the Obama administration to reform the health care system by trying to link all manner of unscientific woo to "prevention," Harkin goes on to do just that:
It is time to end the discrimination against alternative health care practices.
It is time for America's health care system to emphasize coordination and continuity of care, patient-centeredness, and prevention.
And it is time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative.
This is about giving people the pragmatic alternatives they want, while ending discrimination against practitioners of scientifically based alternative health care. It is about improving health care outcomes. And, yes, it is about reducing health care costs. Generally speaking, alternative therapies are less expensive and less intrusive—and we need to take advantage of that.
Note the false dichotomy. It is not necessary to embrace pseudoscience in order to reform the health care system to emphasize "coordination, continuity of care, and prevention." Nor, I would argue, is it necessary to use placebo medicine as a coequal to scientific medicine in order to reduce costs (unless, of course, your goal is to reduce costs by not treating patients adequately), and, let's face it, placebo medicine is what the vast majority of the hodge-podge of unscientific and pseudoscientific practices that fall under the rubric of CAM are.
Most tellingly, Harkin makes is clear that CAM advocates will try to hijack health care reform by getting their feet in the door as "preventative" medicine as plain as can be. He prefaces his remarks by explaining how he decided he wanted to write the legislation that brought into existence the OAM and, later, NCCAM. Not surprisingly, his decision was based on an anecdote about a friend of his from the House of Representatives who had a serious illness, tried "alternative" approaches, and supposedly got better. Then, Harkin makes a startling admission:
One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.
Note what Harkin first says here. He doesn't say that the purpose of NCCAM was to investigate alternative approaches and determine if they work or not, regardless of what the results turned out to be. Rather, he states plainly that the purpose of NCCAM was to investigate and validate alternative approaches. His concept for NCCAM is that it would prove that his favored woo works. That's why he's so disappointed that the vast majority of the studies coming out of NCCAM are actually negative. Moreover, he clearly doesn't understand how science works. Hypothesis testing involves designing experiments or clinical trials that can be falsified; i.e., "disproved." If an experiment or clinical trial can't falsify the hypothesis that is being tested, then it is not really science. Falsification (attempting to disprove the hypothesis) is at the heart of how the scientific method works. But Tom Harkin does not want NCCAM to work by the scientific method. Not really. He has claimed that he does, but his statements above make it very clear that he only likes the scientific method when its results are what he wants them to be. Under NCCAM, many studies have been performed by believers under conditions quite favorable to producing apparently "positive results"; yet few and far between are any results resembling anything postive when it comes to NCCAM-funded studies, and they're firtually nonexistent for studies funded by NCCAM for the major favored CAM modalities, such as "energy healing," acupuncture, therapeutic touch. Only studies of herbs produce positive results, and such studies are nothing more than pharmacognosy, which could be done in virtually any Institute, depending upon what natural product is being studied. A special center for herbalism is not needed, and all the other CAM practices have, by and large, failed to stand up to even the favorable scrutiny of NCCAM-funded studies.
In any case, Harkin is now unhappy because NCCAM isn't proving what he wants it to prove. So what's his new strategy? Why, to "integrate" these therapies that have failed thus far to stand up to scientific scrutiny with scientific medicine! In fact, he makes it very clear that he plans on yoking any health care reform that President Obama tries to pass through the Congress to the addition of integrative medicine:
Since 1992 the field has evolved and matured. Today, we are not just talking about alternative practices but also the integration between conventional and alternative therapies in order to achieve truly integrative health. We need to have practitioners talking with each other, collaborating to treat the whole person. And this is the model we intend to build into our health care reform bill.
On several occasions, I have laid down a public marker, saying that if we pass a bill that greatly extends health insurance coverage but does nothing to create a dramatically stronger prevention and public health infrastructure and agenda, then we will have failed the American people.
Well, this morning, I want to lay down a second marker: If we fail to seize this unique opportunity to adopt a pragmatic, integrative approach to health care, then that, too, would constitute a serious failure.
That, my dear reader, is what we are dealing with. A very powerful, senior Senator invites "luminaries" of the CAM movement to testify in front of his Senate committee and states openly that he will consider any health care reform that doesn't include "integrative medicine" to be a failure. Funny, but as an advocate of science- and evidence-based medicine, I would consider a health care reform package that does includes the "integration" of unproven health care modalities with science- and evidence-based medicine to be a catastrophic failure of health care reform.
Dr. Gorski, a researcher and surgical oncologist at the Barbara Ann Karmanos Cancer Institute in Detroit, Michgan, is Associate Proifessor of Surgery at Wayne State University. e also serves aa board member of the Institute for Science in Medicine and as managing editor of Science-Based Medicine, a highly-respected blog that exposes nonscientific research and practices. This article is a slightly modified version of an article that Dr. Gorski posted to his blog in March 2009.
This article was posted on May 3, 2011.