John Weeks’ September 2012 Integrator Round-up covering news updates on research in integrative health care

NCCAM’s Briggs wonders about surprising practices that enter the mainstream

The director of the NIH National Center for Complementary and Alternative Medicine, Josephine Briggs, MD, recently used the NCCAM blog to talk out “Quirky Ideas from outside the Mainstream” that, “through a combination of clinical experience and scientific pursuit, led to changes in health care.” She specifically called out the contributions of Joseph Pilates (resistance training – 1915), Fernand Lamaze (childbirth practices -1940), Edwina Froehlich, La Leche League founder (breast feeding -1950s), and Saunders, Wald, Kubler-Ross, 1960s (palliative care). Briggs cites a defensive remark about exploring the unusual in a keynote from David Eisenberg, MD at the recent International Research Congress on Complementary and Integrative Medicine: “An act of inquiry is not an act of advocacy.” She concludes:  “Ultimately, being able to bring both an open mind and a skeptical eye to the long-term challenge of evidence building is crucial, and we must be willing to do so, no matter what perspective we bring to the scientific debate.”

Comment: Good for Briggs to walk into this debate and remind skeptics. Interestingly, this was something of a return to the memory of 1992 beginnings of the NIH’s formal examination of “unconventional medicine.” US Senator Tom Harkin secured funding by referencing non-conventional practices that had become mainstream. None that he referenced were actually CAM, to not tip off CAM’s opponents. Briggs’ is an interesting list that might have been expanded more broadly to note that stress, food, diet, a lifestyle are all practices first elevated in the “alternative medicine” universe as are appreciation of the impacts of toxins. Just as small businesses are credited with generating the lion’s share of innovation in businesses of all kinds, so the wild practices around the fringe of mainstream medicine have produced many of the most significant clinical changes linked to these determinants of health. What’s ‘quirky,’ frankly, is that mainstream medicine is taking so long to address the common sense about health, and that mainstream medical education continues to devalue education about nutrition and stress. Downright weird, if one only let’s go of our acceptance of the insanity of the familiar. Still, good for Briggs to defend the fecundity at the fringes.

 

Canadian research organization adds new measures to Outcomes Database

The Canadian research network IN-CAM has announced seven new tools in its remarkable contribution to integrative health research, the Outcomes Database (see www.outcomesdatabase.org ). 

The site was organized to put in one place “outcome measures of particular importance to Complementary and Alternative Medicine (CAM) and Integrative Health Care (IHC) effectiveness and efficacy research” according to an August 2012 notice to its members. Outcome measures included in the database are categorized into domains reflected in a holistic framework is applicable to the study of health interventions “framed within a whole person perspective and focused on health and well-being.” If you have an outcome measures to suggest for inclusion into the IN-CAM Outcomes Database, go to: http://www.outcomesdatabase.org/content/suggest-outcome-measure  

Comment: Integrative health and medicine and “CAM” discipline researchers would serve their fields to be talking up this remarkable resource. It’s a great site for bringing research closer to home and fostering in-office projects.

 

Peering in on “CAM” in pediatrics in Germany

The study is prosaically entitled “Utilization and costs of conventional and alternative pharmaceuticals in children: results from the German GINIplus and LISAplus birthvcohort studies.”  The study focused on estimating the prevalence and determinants of conventional, homeopathic and phytotherapeutic drugs and expenditures. Reported drugs use within the last four weeks were classified into the therapeutic categories of ‘conventional medicine’, ‘homeopathy’, ‘phytotherapy’ and ‘others’. The researchers found that 42.3% of the children reported drug use with 24.1% of the drugs homeopathic and 11.5% phytotherapeutic. Of all children, 14.3% took at least one homeopathic remedy during that time frame. Drugs prescribed by physicians were dominated by conventional medicine (76.5%), whereas in drugs taken over-the-counter, both homeopathy and conventional medicine accounted for 37% each. Girls used more homeopathics than boys. Family income showed only a weak influence on use patterns, but education had a strong effect in the likelihood of the use of phytotherapy. Cost analysis yielded less clear findings. The study looked at utilization of 3,642 children in two German birth cohorts. (Thanks to Mitch Bebel-Stargrove, ND, LAc for bringing the study to my attention. See his AANP award at the bottom of this Round-up.) 

 

Integrator “did not get it right” about new NCCAM pain leader Catherine Bushnell

A medical doctor and NIH-funded research leader in integrative medicine took umbrage with questions raised in the July 2012 Integrator Round-up about the fit of M. Catherine Bushnell, PhD for her new role as integrative pain research leader at NCCAM. The investigator wrote: “You really did not get this one right!!” Following the double exclamation, the researcher wrote of meeting Bushnell at a conference on acupuncture developed by the Department of Defense. Bushnell had been invited “to talk about potential neurological mechanisms for acupuncture modulation of pain.” Then: “She is a neuroscientist – not a practitioner – but if you listen to her presentations or talk to her or dig a bit more deeply into her published work you will see it is imbued with a strong interest in the fundamental mechanisms by which a variety of complementary treatments influence pain.” Some examples were offered: “Bushnell has studied hypnosis and written on studies using hypnosis as a means to modulate pain. She also studies the differences between emotion and attention as modulators of pain.” The corrective complaint continued with a note that Bushnell’s studies in her lab at McGill “to examine pain perception in yoga practitioners” were presented in the Milan 14th World Conference on Pain. The writer noted Bushnell is approachable: “Yes, she has strong ‘mainstream’ credentials. But no she is not a ‘conventional’  thinker in any way.”

Comment: The passionate defense of Bushnell does not address the fundamental point of the comment on the Bushnell appointment. This apparently brilliant and independently-minded researcher has not focused he life work where Congress mandated: less on mechanism and more on generative useful information on the real world outcomes of integrative pain strategies that will be useful in helping providers, health systems, insurers and employers to know about the value of optimal delivery. (See the NCCAM mandate here, and especially sections c and f.) What is needed is more about the success of integrative pain strategies on patient care, satisfaction, functionality, costs together with the interprofessional challenges of integration and economic challenges of payment. That said, I appreciate the heads up and will be contacting, and reporting, a dialogue with Bushnell.

I must also confess that I may be asking the impossible of Briggs and NCCAM. Where does one find the pain research leader who has any clinical experience in integrative medicine or integrative pain? We are short of skilled, experienced experts with a funded lifetime devoted to the ins-and-outs of integrative health research. Where will Bushnell direct things? Hopefully reading the NCCAM mandate is part of Bushnell’s orientation. Meantime, NCCAM sponsored an apparently real-world seminar August 13-14, 2012 to develop a “forward thinking research agenda” on chronically overlapping pain conditions