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uppose you needed to have a CT scan for a sudden, severe headache and partial loss of vision and your doctor asked a nutritionist to read it, rather than a radiologist. Would you trust the diagnosis? Evaluation by a different — and what most would consider a lesser — standard is essentially how a significant amount of research funding is approved by one component of the National Institutes of Health.

Let me step back for a minute before plunging ahead. Federally funded scientific research runs the gamut from studies of basic physical and biological processes to the development of applications to meet immediate needs, such as the development of a universal flu vaccine or clinical trials for Alzheimer’s disease. Government funding is especially essential for providing the scientific knowledge that underlies new medical treatments. The NIH, the nation’s major funder of nonmilitary research, has generally been a reliable supporter of high-quality research, conducted at its Bethesda, Md., campus and at universities and research institutes across the U.S.

Much of the substantial NIH budget, currently about $35 billion, goes to fund grant proposals from researchers across the country. Judgments about the merit of these proposals are made by discipline, correlating with the NIH’s 27 institutes and centers — cancer, aging, vision, heart disease, nursing, and so on.

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But there is a glaring, systematic exception, and it resembles the example above. One branch of the NIH is far less equal — in the sense of both scientific rigor and importance — than the others: the National Center for Complementary and Integrative Health (formerly the National Center for Complementary and Alternative Medicine). The brainchild primarily of then-Sen. Tom Harkin (D-Iowa), who held views of health and medicine that were unconventional (to be charitable), this center is the dirty little secret of the research community and Congress.

The mission of the National Center for Complementary and Integrative Health is “to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care.” But complementary and integrative health — which is sometimes referred to as alternative medicine — often means implausible and unworthy.

Peer review of grant proposals submitted to the National Center for Complementary and Integrative Health is performed by practitioners or promoters of alternative medicine, not by experts in in the disease or condition under investigation. This makes possible the funding of projects that are trivial or poorly designed. Many of the interventions have proven to be worthless. For example, a study supported by the center found that cranberry juice cocktail was no better than placebo at preventing recurring urinary tract infections — even though at the time the center’s own website listed the results of many studies showing that cranberry juice is of limited value for urinary tract infections.

Other supported studies include “Long-Term Chamomile Therapy of Generalized Anxiety Disorder,” “Mindfulness Training to Improve ART Adherence and Reduce Risk Behavior Among Persons Living with HIV,” and “Restorative Yoga for Therapy of the Metabolic Syndrome.” This is what happens when the inmates run the asylum.

Grant proposals for complementary and integrative health studies could be evaluated more effectively by other NIH institutes or centers, such as the National Institute of Neurological Diseases and Stroke, the National Institute of Mental Health, or the National Heart, Lung, and Blood Institute, where they would receive more rigorous and impartial peer review.

In 2016, the NIH was able to fund fewer than 20 percent of the investigator-initiated research grant proposals it received. The fact that the National Center for Complementary and Integrative Health was allowed to spend $130 million in fiscal year 2016 is an affront to the NIH-funded researchers (and aspirants) who are at the cutting edge of their disciplines but face increasing difficulty getting federal funding for studies that rank high on scientific merit.

The National Center for Complementary and Integrative Health isn’t the only NIH set-aside, a term that means funds must be spent for a certain purpose or discipline. Another boondoggle, started almost three decades ago as part of the NIH’s Human Genome Project, set aside a portion of the project’s budget to establish the Ethical, Legal, and Social Implications (ELSI) Research Program. It has created a kind of cottage industry — paid for by more than $335 million in grants over its lifetime — among ethicists, sociologists, and others at the fringes of the research establishment whose work wouldn’t have had a prayer for funding if it had to compete with mainstream scientific disciplines. Much of their output has focused on the need for excessive, unscientific regulation of important research or clinical applications.

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The prodigious benefits of basic research won’t come from spending on the kinds of projects favored by the NCCIH and ELSI. International research and development is highly competitive. The Paris-based Organization for Economic Cooperation and Development has projected that China will overtake the United States in research and development spending by around 2019.

To prevent America’s scientists and businesses from becoming also-rans in the kinds of technological innovation that keep the U.S. economy competitive — in fields ranging from biomedicine, materials science, and chemistry to robotics and nuclear engineering — we need to increase overall spending. But we also need to be more discerning about our research priorities, which will require the scientific community and politicians to condemn the funding of projects simply because they are politically correct or a sop to lesser disciplines.

Henry I. Miller, a physician and molecular biologist, is the Robert Wesson Fellow in Scientific Philosophy and Public Policy at Stanford University’s Hoover Institution. He was the founding director of the FDA’s Office of Biotechnology. He has never applied for or received an NIH grant.

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  • I guess the person who wrote Miller’s comments for him (and let’s be honest with his history of getting companies to write his pieces for him we can’t assume he actually wrote this) doesn’t seem to realize is that NCCIH’s standards for peer review are subject to the same rigor as every other institute at NIH. So, in effect, Henry (or his writer) have a problem with NIH’s review process. That’s a pretty big hill to climb.

    The country spends $35 billion per year on complementary and integrative health. NCCIH’s $100 million budget is a good investment to determine safety and efficacy. And, if Miller looked beyond the very old, cherry picked studies he cited, he’d realize that too.

    Shame on STAT for even publishing someone who has been barred from other outlets because of questions about his integrity.

  • “I am surprised by this essay, which confounds topic and methods and fails to both accurately understand and appreciate the key importance of rigorous alternative medicine and ethics research. Given that 40% of Americans use some form of alternative medicine and given the history of ethical abuses in research, it is clear we need more, not less of these activities.
    The fact that topical experts sit on review groups does not reduce but enhances the review process. Would Dr. Miller recommend that a surgical research application never be reviewed by someone with experience in surgery? No application is judged by a single reviewer and as someone who has both organized and been on NIH review panels, I know firsthand the rigor and care they take in constructing these panels. That includes the National Center for Complementary and Integrative Health (NCCIH), which follows standard NIH procedures.
    The fact that a study result turns out negative is even more evidence that the study was done rigorously and not by advocates, therefore, Dr. Miller’s conclusion does not follow logically from his example. For every negative study NCCIH has funded there are many that have turned out positive and now form a body of evidence being recommended in national guidelines for non-pharmacological treatments for pain as alternatives to opioids like that being recommended by the American College of Physicians. Again, we need more, not less of this research.

  • Bravo and kudos. Well said.
    Of course the alt med people will swarm to bring out the knives now.
    There is no such thing as alternative, complementary or integrative medicine. There is only medicine. The standards need to be singular.
    “Many of the interventions have proven to be worthless.” “Many”? Name 3 that have been proven to have real-world worth.

    • You are so misinformed as is Henry miller, an FDA hack. Medical docs rarely bother to look at the voluminous studies affirming the utility of alternative medicine. This may be why so many patients have migrated away from conventional medicine and pharmaceuticals, with excellent results.

  • This article is founded on a fundamental misunderstanding:
    ‘…complementary and integrative health — which is sometimes referred to as alternative medicine…’
    Herein lies the problem.
    They are fundamentally different concepts, and research is vital in order to separate clinically valuable interventions from quackery. One cannot compare shamanism to massage delivered within a multidisciplinary care team.

  • My, my, the very same author that was dropped by Forbes for ghostwriting for Monsanto. This seems to be a catch-22 situation. Constant clamoring for evidence based claims, but when 0,37% of the NIH budget is used for that very reason, more clamoring.

  • I must say it would appear, from your comments, that you have quite a bias against alternative or complimentary practices in healthcare. As a very experienced primary care physician, and now a senior executive with a moderate sized healthcare provider in Population Health, I think it is our responsibility to review and study alternatives to our extremely expensive, poor quality healthcare system. When I was working, several years back, with a large insurance company, I discovered that 60% or our members with back pain first sought out chiropractors for their care, unknown to me or our company. They did that because we were not offering what they wanted, or needed. Is that good? Shouldn’t we review the outcomes for our members? We did and guess what. They were right. Chiropractors provided way less expensive( as measured by claims using Episode Treatment Groupers), better outcome, much better experience care that conventional treatment. Just because we do it, and get paid for it, does not mean it is the best care available. You write well, it would be nice if you realized there is value to non-conventional approaches to healthcare. What we are doing now is unsustainable.
    Jim

    • (Author response) Thank you for the thoughtful comment. I am not against low-tech, non-pharmaceutical approaches to medical care — see, for example, http://www.newsweek.com/low-tech-revolution-transforming-medicine-786275. But the point of the article is that NCCIH’s set-aside means that the complementary medicine community — much of whose work is pedestrian, trivial, or worse — are competing only against one another while much genuinely important research that could lead to medicine’s Next Big Thing is going unfunded.

    • Well said. The body is more like a musical instrument than a digital device. The complexity ( 1B proteins per cell) is mind boggling. So tech med is very, very far removed from understanding, and likely never will.

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