November 2009 edition of John Weeks’ Integrator Roundup, a review of the latest integrative healthcare policy and research topics and media and industry news.
Academic Medicine and Education
Employers and Cost Issues
November and Thanksgiving
Corrections and Additions
Be heard now: NCCAM seeks stakeholder comments on strategic plan until November 19
Go to this website and let your views of what you believe NCCAM should focus on over the next 5 years be heard. The NIH National Center for Complementary and Alternative Medicine (NCCAM) is seeking comments on its 5 year strategic planning process via the NCCAM website. In an October 21, 2009 NCCAM Update, the Center noted that it has posted papers “on 3 ‘big picture’ topics” on which it is seeking feedback. The topics of the papers are: mission; priority setting and information and communication. The 3 NCCAM papers are each roughly 3 pages long. Here are the papers and the 3 questions each for which NCCAM seeks stakeholder responses.
Paper 1: NCCAM’s Mandate [from Congress] & Mission
Major features of the current CAM research landscape that are important in considering future strategic directions for NCCAM and the field of CAM research in general
Particular needs and opportunities of importance to NCCAM’s efforts in research capacity building
Opportunities, obstacles, and NCCAM’s future role in supporting research on approaches to improved states of general health and well-being
Paper 2: NCCAM Priority Setting — Framework and Other Considerations
The need for greater shaping of the Center’s research portfolio
The four factors (scientific promise, extent and nature of practice and use, amenability to rigorous scientific investigation, and potential to change health or health care practices) identified as key components of a framework for research priorities
The types and sources of information that must be included in an optimal priority-setting process.
Paper 3: Information and Communication about CAM Research and Decision-making about CAM Use
The major unmet needs of consumers and the general public in accessing, interpreting, and making use of research evidence about CAM
The major unmet needs of health care providers in accessing, interpreting, and making use of research evidence about CAM
Research needed to better understand how both health care providers and the general public make decisions about CAM practice and use.
A major shift in NCCAM funding under consideration is the priority setting. NCCAM’s direction under director Josephine Briggs, MD will likely focus on a very few key areas and to invest deeply in them and therefore essentially end support of other areas. The top areas of interest presently appear to be drug research on herbs and examination of mind-body medicine.
Comment: Prior to NCCAM’s publication of these papers, I wrote a column entitled Why We Should Seek to Influence NCCAM’s Next 5-Year Strategic Plan. My reading of these 3 papers underscores my concerns, expressed there, that NCCAM’s is at risk of making fear-based decisions “pushing NCCAM to act like all of the other agencies in that reductive, drug-and-device focused NIH culture.”
Those of you who have research questions relative to real world outcomes, costs, cost-offsets, and how integrative practices can become part of the payment and delivery systems and play a role in meeting the US medical crisis needs to speak out. Those of you who desire answers to questions regarding the value of whole practices of integrative care such as is consumed by the public
from over 100,000 practitioners of integrative medicine, naturopathic medicine, chiropractic medicine and acupuncture and Oriental medicine need to weigh in or be shut out entirely. We stand the risk of watching a door to the only significant research funding available to look at the real world value of integrative practices slam for 5 more years.
Ironically, in suggesting this real world focus, you would only be asking NCCAM to substantially align itself with the 1998 Congressional mandate in establishing NCCAM, which was the very practical charge to:
” … 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.” [Note: The NCCAM mandate will be published in its entirety on the Integrator website by November 12, 2009.]
**Those of you who desire answers to questions regarding the effectiveness and cost-effectiveness and health value of whole practices of integrative care such as is consumed by the public from over 100,000 practitioners of integrative medicine, naturopathic medicine, chiropractic medicine and acupuncture and Oriental medicine and others need to weigh in or risk being shut out entirely until 2015.**
Go, respond here to the survey!
: It was intriguing to see that the agenda for NCCAM advocated in the Integrator
, based on the real world integration challenges the Integrator
seeks to help resolve, was pretty well summarized near the end of Paper #1
as “one end of the spectrum” of pressures NCCAM faces. The NCCAM paper reads, interestingly, quite like an agenda one might follow if one sought to fulfill on the Congressional intent in establishing NCCAM (soon to be published in full on the Integrator
site). First, NCCAM’s Paper #1 writers describe the the position of NCCAM skeptics. Then:
“At the other end of the spectrum are claims that NCCAM research fails to evaluate CAM as it is actually used in ‘real-world’ CAM practice settings, that there is insufficient support of CAM practitioner involvement in the research process, that the field is dominated by reductionist scientific approaches or inappropriate methodology, that the peer-review process is biased against CAM, that most NCCAM research is designed or conducted with a goal of ‘debunking’ or disproving value, and that there has been insufficient focus on health and wellness.”
An academic medicine researcher colleague, aware of the Integrator
advocacy in this area, suggested, tongue well in his cheek, that I toss my hat in the ring for the newly advertised NCCAM position of Director, Office of Planning, Policy and Evaluation
. Knowing that all I lack are the requisite professional skills, I asked my colleague if a college drop-out such as myself qualified and he said: “In a world in which GWB can be president, anything is possible.”
IOM publishes report on the February 2009 National Summit on Integrative Medicine