Government Funded Science Inherently Politicized: Chinese Herbal Remedy Edition

Over in the Science Based Medicine blog, Wallace Sampson is expresses outrage that the National Institutes of Health has announced an initiative to fund “research” into Traditional Chinese Medicine:

I have pointed out that scientific characteristics were never a part of TCM. It lacked objective observation, consistency of observation, classification of observed phenomena, information storage, rationality and logic, consistent written transmission, objectively descriptive language, and a method for analysis or for interpretation. The system of elements , q’i, and yin/yang did not include a method for developing theories or independent natural conepts. TCM depended on empiricism, unreliable observation, was plagued by post hoc reasoning and causality error. It lacked a concept of error and a system for self-analysis to correct error. In fact, the culture discouraged analysis and criticism, considered to be bad form and disrespectful. TCM depended on individuals who rarely communicated in a formal, direct, manner. Add to that a system that accepted manipulation to suit the mood and concept of the observer or authority. I conclude that there is nothing in TCM to study scientifically. So now they want to develop scientific criteria to apply to their observations? Proteomics? On what? Actions of herbs? Words again fail me at the glaring presumptuousness and ignorance required to conceive such a project....

nothing but a jangling confusion of borderline and conflicting findings will result from further study. Unless they appoint people with critical analysis experience, a wide reading knowledge of the history and use of TCM, and a scientific view, their research conclusions will be indeterminate over the next 10 years or more. They will continue to rely on ideologues, advocates, self-deluded practitioners, and politically correct academics for advice and pronouncements.

They will probably exclude scientific or skeptical analysts, so there is no way they will develop a credible commentary on how best to integrate TCM and improve the health of the American and Chinese people. Well, they got it backwards again. It’s China that has to integrate scientific medicine over there. Their scientists and physicians clamor for it. The Chinese can begin with public health principles like inhibiting spitting in the streets, cleaning up their air (finally but it took the Olympics) personal hygiene, cleaning their toilets, improving their food handling methods, and other systematic changes...

What is HHS doing, using a cover of medical science and for what? The government doesn’t do such things without pressure from some group or perceived self-interest in negotiation. In this case, what are the respective interests? There could be several.

For China, the most apparent is awakening the American population to the hidden miracles of TCM - and the marketing of supplements. Ka Kit Hui, a practitioner in Santa Monica, Calif., been promoting TCM herbs for several decades. I debated him on the subject at Stanford in 1995 or so at which time he extolled the undiscovered miracles in TC herbal medicine. Again in a letter to the editor to JAMA in 1997 he predicted that TCM herbals would be the prime economic product of the 21st century. I dismissed the statement in a response, but here we are, nearly 1/10th the way through the century, and here is TCM herbalism making inroads. China must see a large market, a population at least a third of their’s, and in view of the differences in income, living standard, and disposable income, a market that is at least as large in dollars/yuens as China has at home - probably greater.

What motivates the US? For one, TCMers may be behind the effort. They are on a path toward legitimizing the OMD degree and licensing of TCM practice. They already have acupuncture licensure in a plurality of states. They have a dozen or more schools of TCM. The California state legislature several years ago dropped an attempt to standardize teaching in the California schools - a first step to a standard exam and thus an academic standard for licensure. But they will be back. It took naturopaths over 15 years to get their licensure and degree recognition - another history familiar to Kim Atwood and others. The rest of the ulicensed hordes are following through an accompanying though crippled series of Access to Medical Treatment Acts. They persist - getting bits here and there and then, in an alignment of the planets minute, achieving passage of licensure legislation that imprints their initials in gold.

The formation of the NCCAM was a major step for TCMers. Now an HHS officially- sanctioned 2 day conference opens the plausibility of studying more TCM just as acupuncture systematic reviews are showing indeterminacy to ineffectiveness, herbs are being found more dangerous than helpful, and products from the PRC being found adulterated with metals and with standard pharmaceuticals. A fly on the wall of certain congressmen and senators and of HHS director Leavitt could tell us a lot. (Here we go again with a FOI request.)

As for government sourced motives, as Ms. Woeckner suggested, we probably had to pay a price for the stationing of FDA offices in Chinese cities. I still fail to see what they can do about adulteration of products, much of which could be shifted to way stations in Taiwan or in the US.

While insightful, Dr Sampson fails to dig down to the real sources of the problem:

If the NIH wastes money on quackery, its officers do not suffer a loss. They don’t have to justify their spending to donors or shareholders. The money extracted at gunpoint from the citizenry will continue to flow in regardless of the junk science the NIH produces. In fact, inconclusive junk science can benefit NIH officials - larger staff and larger budgets will lead inevitably to higher salaries for managers - with no end in sight to the enterprise.

Furthermore, by having the government license medical treatments and practitioners, the medical industry has fatally undermined the ability of people to have reliable mechanisms to root out quackery. Again, publicly funded licensure boards will continue to be funded regardless of how bad a job they do. Their presence will inhibit the formation of private enterprises that are dependent on donor perceptions of effectiveness to continue operations - just as the creation of the FDA ended the drug testing research of Consumer Union. The public looks at a government license as a mark of quality - and there is no one to tell them otherwise. Suspicions allayed, most people in the market for medical care will accept advertising at face value.

The sad fact is that when the AMA was founded in the late 19th century, most doctors made a deal with the devil. The state licensure boards - which were successful in their mission to keep competition low and prices high - not only created a pool of underserved consumers for quacks to prey upon, it also created traditions and political framework that quacks and junk scientists can use to provide cover for their fraudulent activities.

So long as proponents of quality in medical care continue to pin their hopes on an organization that can extract money by force regardless of how crummy a job it does, they are doomed to failure.

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