NCCAM’s 3rd Strategic Plan announced, shows signs of embracing clinical and “real world” focus of original mandateComment On February 4, 2011, the NIH National Center for Complementary and Alternative Medicine released its 3rd Strategic Plan. This 2011 2015 plan, is

NCCAM’s 3rd Strategic Plan announced, shows signs of embracing clinical and “real world” focus of original mandate  

Comment: On February 4, 2011, the NIH National Center for Complementary and Alternative Medicine released its 3rd Strategic Plan. This 2011-2015 plan,\ is the first under the leadership of NCCAM director Josephine Briggs, MD and her deputy director Jack Killen, MD. Killen had the lead in marshaling the plan, developed through inputs from a multitude of sometimes oppositional stakeholder perspectives, into being. Among these competing influences are the natural products industry, the conventional academic health centers that received most of the agency’s funding from 1999-2010, and the licensed “CAM” and integrative practice disciplines that appear, under Congress’s 1998 mandate, to have been a core interest. Which brings up another significant set of competing forces with which NCCAM must contend: on the one hand Congress, which gave NCCAM a real world, outcomes and integration-focused mandate; and on the other, the NIH itself, which tends to demean such messy real world questions (one would rather that they’d relish the challenges) in lieu of the of basic research and clinical trial approaches into which they’ve been trained, Congress be-dammed.

The good news in this plan is that Briggs, herself clinically inexperienced in integrative care, appears to have listened a good deal to stakeholders outside of NIH. The new strategic plan can be read as the beginning of a course correction. Strategic Objective #3 reads: “Increase understanding of ‘real world’ patterns and outcomes of CAM use and its integration into health care and health promotion.” Here we see not only a prioritization of “outcomes” and “integration” (Congress’ chief interest). We also see, for the first time, acknowledgment that patients use CAM modalities and practitioners in promoting their health rather than only to combat disease or symptoms. Similarly, CAM/integrative disciplines claim health promoting outcomes. The interest in health outcomes was also urged by Congress in NCCAM’s enabling act. Here is Congress’ first directive:

 “The Director of the Center shall, as appropriate, study the integration of alternative treatment, diagnostic and prevention systems, modalities, and disciplines with the practice of conventional medicine as a complement to such medicine and into health care delivery systems in the United States.” (Italics added.)

 One remarkable change, between the draft plan’s release in August 2010 and the final document is that for the first time in NCCAM’s history we see a routine inclusion of “disciplines” as a unit of inquiry. This reflects Congressional language. The idea of examining the value of disciplines appeared only once in the draft but appears 36 times in the final. For this reason, integrative clinicians and their professions would be served to once again consider this agency as potentially interested in the whole person approaches they represent, and which they urged. Briggs and team are to be commended for the direction set here. No doubt the NIH remains a fairly inhospitable ground for these directions to take seed and flourish. According to the plan, however, “CAM practitioners are the key holders of knowledge related to the potential application of CAM interventions and disciplines.” The message to clinicians and their institutions and organizations: There is an opening here. Show up. Don’t leave research to the researchers.  
CAHCIM’s 2012 research conference now the “International Research Congress on Integrative Medicine and Health” 

In  2006 and 2009, the now 46-member Consortium of Academic Health Centers for Integrative Medicine (CAHCIM), sponsored the most significant international research meeting in this field. The brand: North American Research Conference on Complementary and Integrative Medicine (a.k.a. NARCCIM). In part because that meeting has indeed been international, the Consortium chose to rename the May 15-18, 2012 event in Porltand, Oregon as the International Research Congress on Integrative Medicine and Health. (IRCIMH)

Conference chair Adi Haramati, PhD, integrative medicine leader at Georgetown, explained that the name change was part of “an effort to reach out globally to individuals and organizations working in the complementary and integrative medicine and health care field.” The conference’ tagline is: Strengthening Research in Integrative Healthcare Around the World. Haramati adds that the name change also aligns with the conferences sponsored by the International Society of Complementary Medicine Research that rotate between Europe and Asia when not in North America. (The next one is in Chengdu, China, May 6-9, 2011.)  The IRCIMH program committee, chaired by Rick Hecht, MD from the Osher Center at UCSF, will issue the call for proposals for sessions and research abstracts in May 2011.

Comment: The name-game has always been a side-sport in the integrative practice field as “alternative medicine” has migrated in various forms into conventional practice. The big changes here, besides moving to an international focus, are the deletions “complementary” and the addition of “health.” The latter is aligned with Strategic Objective #3 of the new NCCAM Strategic Plan, which appreciates the health-promoting uses of “CAM” for the first time. (See note this Round-up.) The dropping of “complementary” appears to be aligned with a long-held perspective of the Consortium’s founding backer, the Bravewell Collaborative, that integrative medicine is not CAM.    

Palmer-Samueli-RAND receive $7.4-million for study of chiropractic treatment for military readiness
A powerful consortium of the Palmer Center for Chiropractic Research (PCCR), the RAND Corporation and the Samueli Institute were recently awarded a $7.4 million grant for a 4-year research project “to assess chiropractic treatment for military readiness in active duty personnel.” The funds came through the the Congressionally Directed Medical Research Program. The grant is the largest single award for a chiropractic research project in the history of chiropractic. Ian Coulter, PhD, the Samueli Institute Chair in Policy for Integrative Medicine at RAND Corporation, is the research project’s principal investigator. Christine Goertz, DC, PhD, Palmer’s vice chancellor for research and health policy, is a co-PI. Goertz will oversee the design and implementation of the three clinical trials funded by this award, for which the Palmer Center for Chiropractic Research will receive approximately $5.1 million. Samueli Institute medical research head Joan Walter, JD, is also a co-principal investigator.

Via 3 clinical trials, the study will assess chiropractic’s effectiveness in: relieving low back pain and improving function in active duty service members; evaluating the effects of chiropractic treatment on reflexes and reaction times for Special Operations forces; determining the effect of chiropractic treatment on strength, balance and injury prevention for members of the Armed Forces with combat specialties; and, assessing the impact of a chiropractic intervention on smoking cessation in military service members.

Comment: Coulter-Goertz-Walter are truly a sterling, deeply interconnected, A-team of researchers for a project of this magnitude. Recent reports on the awful 70-80 pound loads US troops are routinely carrying only begin to suggest the value in investing in this project.  

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