January 2012 Integrator Round-up on Media: Ted Kaptchuk’s work on placebo ; author skewers NCCAM; focus on integrative health care in the military
The title of the article is “The Power of Nothing: Could studying the placebo effect change the way we think about medicine?” Featured is Ted Kaptchuk, OMD, described as “the most knowledgeable person in the world on all matters placebo” by a quoted NIH senior faculty member in bioethics. Kaptchuk, an early colleague at Harvard with David Eisenberg, MD, began an acupuncture practice in 1976. He has since terminated his practice as his study of the placebo has increased. Kaptchuk offers a significant, practical twist on the value of placebos. He references “a study that demonstrated that, without a change in objective data, you still get incredible subjective improvement … So, is the Doctor supposed to say, ‘Gee, the patient is really feeling good, but I better ignore that and go by the numbers.'” Kaptchuk believes that much of the antagonism to proactively using placebo is “ethical judgment masquerading as science.” Kaptchuk has recently established an Institute to further the study of placebo.
Comment: This piece offers, among other things, an excellent brief on the recent history of placebo. Somewhere in this placebo discussion is this challenge for an evidence-informed practice: If a practitioner has excellent evidence of the power of an approach to suppress a symptom, but only light evidence of what it is that will move a person toward health, what is the practitioner to choose? No wonder patients as well as practitioners are willing to choose the unknown behind the screen rather than what’s in the jar.
The second half of December brought a holiday gift to the anti-CAM polarizers who thrill to the idea of shutting down the NIH National Center for Complementary and Alternative Medicine (NCCAM). Award-winning Chicago Tribune science and medical reporter Trine Tsouderous has a sense of responsibility to objectively report on NCCAM that: 1) leads with aromatherapy, clairvoyants and coffee enemas and the 2) moves directly to comments from long-time NCCAM antagonists Wallace Sampson, MD and David Gorski, MD. The article, widely picked up and re-published, is called “Federal center pays good money for suspect medicine.” The internet tab is “CAM: Taxpayer money spent on studies with questionable scientific value.” Gorski goes after NCCAM’s funding: “Lots of good science and good scientists are going unfunded.”
The article subsequently includes comments from NCCAM director Josie Briggs, MD, and two of the Center’s researchers with the highest funding, Brian Berman, MD and Daniel Cherkin, PhD. Each are presently on the NCCAM Advisory Council. Berman posted a follow-up letter-to-the-editor on December 16, 2011. He begins this way: “Trine Tsouderos’ article on NCCAM is off base. Applying rigorous research to evaluate therapies that are widely used but not a part of mainstream medicine is not only a wise use of resources; it is also good science and essential for providing optimal clinical care.”
Comment: Tsouderous appears to have known the story she wanted to write before she began reporting it. The most-important choices for a journalist are in what, in broadsheet terms, was called the “above the fold” content. If one reads no further, that’s the whole story. In the internet format for a feature, the parallel is the first page, before one decides whether or not to click through. Page 1 of the 4 devoted to this feature is virtually all a rump caucus. Briggs is pinned to the wall before the readers meet her. One recalls at moments like this that NCCAM could benefit from an active “friends” organization to support it, and its ongoing funding, in the way that such a group exists to back the Agency for Healthcare Research and Quality. Grassroots action may be necessary to save NCCAM before long as federal budget worries and competition at the NIH deepens.
The title of a December 23, 2011 feature in Wired magazine is Inside the Pentagon’s Alt-Med Mecca, Where the General’s Meditate. The article, based in part on presentations at a Samueli Institute October 2011 event, includes significant coverage of the Institute’s work. One revelation: “More than half of the Institute’s $13.5 million in annual funding is provided by congressional funding (or ‘earmarks’) from the Department of Defense and Veteran’s Affairs.” Huffington Post blogger Alison Rose Levy posted another useful feature, Integrative Health Care: The New Military Strategy. Levy’s piece is based on the Integrative Medicine in Action event sponsored by the Bravewell Collaborative in November 2011.