Forum on NCCAM: Was the Integrator Irresponsible Printing the Clay Article on Jack Killen, MD?
Written by John Weeks
Forum on NCCAM's Direction: Was the Integrator Irresponsible in Printing the Clay Article on Jack Killen, MD?
Summary: Guest
writer Beth Clay's mention of homeopathy and her challenging of the
credentials of a top NIH NCCAM deputy, Jack Killen, MD, provoked strong
responses. I corresponded multiple times with an anonymous scientist
who was livid with the Integrator and Clay yet did not want his comments
published, even anonymously. I capture some of the exchange, as I
believe there may be many others who agree. Entrepreneur Taylor Walsh
wonders if the challenges to Killen are merited. Consultant David
Matteson, MPH credits the Integrator (and Clay) for the
discussion. Finally, author and homeopath Dana Ullman, MPH, details a
rebuttal to Killen's view, as quoted in Newsweek, that there is "no condition for which homeopathy has been proven to be an effective
treatment."
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The following comments arrived shortly after the publication of the Integrator special article ("Former NIH Staffer Beth Clay: Who is NCCAM Deputy Killen and Why is He Demeaning Homeopathy in Newsweek?" March 18, 2008). These constitute the 7th article in a series which followed publication of my Open Letter to Josephine Briggs, MD
following her appointment in late January 2008 to direct the National Center for Complementary and Alternative Medicine. We may be at the end of
this round of dialogue. Each article in the series is noted at the bottom of
these comments. 1. Integrator and Clay denigrated as "pot-stirring," NCCAM staffers defended
A scientist acquaintance of many years who has been involved with NCCAM
projects responded immediately, and vociferously, with a defense of
NCCAM's acting deputy director Jack Killen, MD and of NCCAM staffers in
general. The response started with a view that the perspective
expressed by Killen on homeopathy was a "statement of fact;" thus, to
the writer, Clay's article is no more than "an attack on the man." The Integrator was
therefore engaged in irresponsible "pot-stirring." The writer viewed
the article as a classic example of what the writer spoke about as
frequently heard "criticisms of NCCAM as a whole from people in the CAM
world who were more comfortable whining than pitching in to make a
difference." Printing the article does not offer constructive
suggestions and is "us versus them." The writer presents an experience of NCCAM staff as of "dedicated intelligent (for the most
part) people trying to do a difficult job."
When I followed up, I asked the writer if s/he had read what NCCAM had
said about homeopathy. My own view, as previously stated, was that the
Newsweek quote was not aligned with what NCCAM says. The writer had
not. The writer then turned to the frequent Integrator theme
of NCCAM focusing on reductive research designs which don't capture
integrative care as practiced and experienced in the community. The
writer opined: "If you want to argue against the reductive paradigm then why should
NCCAM be the particular target of it? Actually, isn’t NCCAM the best option to
help get a different approach off the ground at NIH? I believe that much more
would be gained through coming up with good ideas for NCCAM instead of
complaining how unCAMy it is."
Taylor Walsh, entrepreneur
2. Taylor Walsh: "Focus on Killen's tenure at DAID and homeopathy comments is displaced"
Taylor Walsh has commented frequently in the Integrator, most
frequently providing an excellent report on the NIH NCCAM meeting in
which the new director, Josephine Briggs, MD, introduced herself to her
new community. He wrote to Clay, copying me.
"I
was intrigued by the piece that John just published, but in a run over to the
sites you mentioned -- British Med Journal, NCCAM's homeopathy page -- I
couldn't find any information that would offset Killian's quotes in the
Newsweek article.
I can't find anything that states that homeopathy has been found to
be useful for any condition. Most of the content refers to the
difficulty in defining anything measurable for the treatment. (My
'survey' was limited only to those links in the article. Are there
other sources?) "The
issues of NCCAM non-compliance for director, staff and council membership, and
staffing intrigue, are one thing -- a serious thing, but without an obvious
repository of positive research on homeopathic treatments, the focus on
Killen's DAID tenure seems misplaced. His comments to Newsweek do not
appear to misstate the current state of the research, at least from what I can
see, although that is the suggestion."
Taylor
Walsh
Publisher, LifePageshttp://www.lifepages.net
Washington, DC
David Matteson
3. David Matteson: "So good to be calling a spade a spade ..."
David Matteson, MPM, MURP, MPS is a consultant in the integrative care and natural products worlds who is most known to Integrator readers as the individual who stimulated the ongoing Integrator dialogue on the optimal relationships between integrative care professionals and natural products firms.
"I so appreciate someone calling a spade a spade -- or at
least giving direct voice to what we're all thinking but are too polite and PC
to ask. Just because it causes an uncomfortable moment, does not mean it
is 'wrong.' On the contrary, if we avoid being uncomfortable
and practice working through it until we find a common place ... well, you get
the point.
"So, thank you, for opening and holding a space.
Strikes me that the Integrator is a perfect media for hosting a heads up
discussion."
David Matteson, MPM, MURP, MPS Early Edge Directions
Dana Ullman
4. Dana Ulman, MPH: Defending "the Rodney Dangerfield of alternative medicine"
Dana Ullman, MPH, has been a leader in the field of homeopathy for 30 years. He most recently published The Homeopathic Revolution which offers extensive information on the use of homeopathy by leading historic, political, sports and entertainment figures.
"I think of
homeopathy as a 'Rodney Dangerfield of alternative and complementary
medicine' because it doesn't get the respect that it deserves.
However, even worse than the lack of respect is the ignorance and
misinformation that exists on this subject. When leading representatives
of the NCCAM are ill- and under-informed about homeopathy, this is but a
symptom of a greater disease, though this dis-ease can be 'cured' relatively
easily with good and accurate information.
"The fact of
the matter is that the Lancet published a 'review' of clinical research in
homeopathy in 2005 that compared 110 homeopathic studies with a 'matching' 110
conventional medical studies (Shang, et al, 2005). They found 21
homeopathic studies that were 'high quality' research and only 9 (!)
conventional studies that fit this higher standard. Few media have
reported on this provocative fact that more than twice as many studies on
homeopathy were a high quality clinical trial. Strangely, however, the
researchers didn't compare these high quality studies. Instead, they selected
only 8 homeopathic trials and 6 conventional trials that used larger numbers of
patients (and they mysteriously left out several good and large homeopathic
studies). These studies were no longer 'matching' in any way, and 7
of 8 homeopathic trials tested only one medicine without any of the typical
individualization of treatment that is commonly used in homeopathy (for readers
to get a sense of how skewed the studies this group select was, one of the homeopathic
studies selected was testing its ability in weight-loss).
"The ill-informed
media and selected ill-informed representatives of the CAM community (including
Dr. Jack Killen, in this case) have echoed the 'junk science' reports and
turned this information into 'junk journalism.'"
- Dana Ullman, MPH
"This review
of research has been sounded and harshly criticized, and yet, the ill-informed
media and selected ill-informed representatives of the CAM community (including
Dr. Jack Killen, in this case) have echoed the 'junk science' reports and
turned this information into 'junk journalism.'
"For the
record, there are numerous meta-analyses reviewing the broad field of
homeopathy have found that the placebo response is an inadequate explanation
for the positive responses observed in controlled trials (Kleijnen J, et al,
1991; Linde, et al 1997). Further, several meta-analyses evaluating the
homeopathic treatment of specific diseases has also found positive results,
including in the treatment of allergic disorders (Taylor, et al, 2004),
post-surgical care (Barnes, et al, 1998), childhood diarrhea (Jacobs, et al,
2003), and influenza (Vickers, Smith, 2006).
"And for
those under-informed individuals who say that homeopathy may be helpful but
only for self-limiting conditions, I encourage them to do some simple
homework. Read about two studies conducted at the University of Vienna
Hospital. A randomized, double-blind, placebo-controlled study was
performed to assess the influence of the homeopathic medicine Kali
bichromicum (potassium dichromate) 30C on the amount of tenacious, stringy
secretions from the throat in critically ill patients with a history of tobacco
use and Chronic Obstructive Pulmonary Disease (Frass, et al., 2005). COPD is
the #4 reason that
"I
wholeheartedly agree with Beth Clay in asking Dr. Jack Killen to make a formal
apology to Newsweek and to the CAM community for his ill-informed statement
about homeopathy."
-Ullman
people in America die. In this study, fifty patients
received either Kali bichromicum 30C globules (group 1) or placebo
(group 2). The amount of tracheal secretions was reduced very significantly in
patients given the homeopathic medicine (P = <0.0001). Also, extubation
could be performed significantly earlier in patients given homeopathy (P =
<0.0001), and their length of stay in the hospital was significantly shorter
(4.2 days for homeopathic patients and 7.4 days for patients given a placebo).
"This group
of researchers also conducted on trial on patients with severe sepsis, a
hospital-borne condition in which 50% (!) of patients typically die.
However, in a double-blind placebo controlled trial those patients who were
given individually chosen homeopathic medicines had a 50 percent greater chance
of survival than those given a placebo (Frass, et al, 2005b).
"This short
review of research is just that, and there are many other studies that I could
review, and there are an even greater number of basic science studies and
reviews of research that I could also cite. "I
wholeheartedly agree with Beth Clay in asking Dr. Jack Killen to make a formal
apology to Newsweek and to the CAM community for his ill-informed statement
about homeopathy. I also ask Dr. Josephine Briggs seriously consider
showing some 'good faith' actions and what might be considered an 'affirmation
action' program towards homeopathy and homeopathic research. Clearly, the
NCCAM needs to make up for the many years in which it has not funded research
evaluating homeopathic medicine. Further, Dr. Briggs should consider providing
some in-service educational programs for its staff so that it
"As the NCCAM considers funding research evaluating homeopathic
medicines, such research must not only be good sound scientific investigations,
but it must also be respectful of the unique systems methodology that
homeopathic medicine embodies."
- Ullman
can become adequately
informed about homeopathy and homeopathic research and so that its website can
more accurately portray of body of evidence that exists for homeopathy.
Finally, as the NCCAM considers funding research evaluating homeopathic
medicines, such research must not only be good sound scientific investigations,
but it must also be respectful of the unique systems methodology that
homeopathic medicine embodies.
"Only when
the NCCAM takes a more holistic approach in dealing with its internal problems
and with its present under-educated and under-experienced staff will it be able
to externalize its wisdom for the benefits of the taxpayers who are funding
their existence."
Dana Ullman, MPH
Homeopathic Educational Services, Berkeley, CA.
References:
Barnes J, Resch K-L, Ernst E (1997). Homeopathy for postoperative ileus? A
meta-analysis. Journal of Clinical Gastroenterology, 25:628–633.
Frass, M., Dielacher, C., Linkesch, M., Endler, C., Muchitsch, I., Schuster,
E., and Kaye, A. Influence of Potassium Dichromate on Tracheal Secretions in
Critically Ill Patients, Chest, March 2005;127:936-941.
Frass, M., Linkesch, M., Banjya, S., et al. Adjunctive Homeopathic Treatment in
Patients with Severe Sepsis: A Randomized, Double-Blind, Placebo-Controlled
Trial in an Intensive Care Unit, Homeopathy, 2005b, vol. 94, pp. 75–80.
Jacobs J, Jonas WB, Jimenez-Perez M, Crothers D (2003). Homeopathy for
childhood diarrhea: combined results and metaanalysis from three randomized,
controlled clinical trials. Pediatric Infectious Disease Journal, 22:229–234.
Kleijnen J, Knipschild P, ter Riet G (1991). Clinical trials of homeopathy
British Medical Journal, 302:316–323. This review of research assessed 105
trials, 81 of them positive. The authors concluded: “Based on this evidence we
would be ready to accept that homoeopathy can be efficacious, if only the
mechanism of action were more plausible”, “the evidence presented in this
review would probably be sufficient for establishing homeopathy as a regular
treatment for certain indications”, and "the evidence of clinical trials
is positive but not sufficient to draw definite conclusions".
Linde K, Clausius N, Ramirez G, et al (1997). "Are the clinical effects of
homeopathy placebo effects? A meta-analysis of placebo-controlled trials".
Lancet 350 (9081): 834–43. Linde and colleagues analysed 89 trials and found a
mean odds ratio of 2.45 (95% confidence interval, 2.05–2.93), in favor of
homeopathy. When considering just those trials of “high quality” and after
correcting for publication bias, the findings actually remained statistically
significant. The main conclusion was that the results “were not compatible with
the hypothesis that the effects of homoeopathy are completely due to
placebo.”
Shang, A. Huwiler-Muntener, K., Nartey, L., et al. Are the Clinical Effects of
Homoeopathy Placebo Effects? Comparative Study of Placebo-Controlled Trials of
Homoeopathy and Allopathy, Lancet, 2005, 366:726–732.
Taylor MA, Reilly D, Llewellyn-Jones RH, McSharry C, Aitchison TC (2000).
Randomised controlled trials of homoeopathy versus placebo in perennial
allergic rhinitis with overview of four trial series. British Medical Journal,
321:471–476.
Vickers A, Smith C (2006). Homoeopathic Oscillococcinum for preventing and
treating influenza and influenza-like syndromes (Cochrane Review). In: The
Cochrane Library. Chichester, UK: John Wiley & Sons, Ltd. CD001957.
