August 2014 John Weeks Integrator Round-Up: Research
by John Weeks, Publisher Editor of The Integrator Blog News & Reports NCCAM ipedia agency responds to corrective appeal on acupuncture and chronic pain When New York Beth Israel acupuncturist Arya Nielsen, PhD, Ac, reviewed the NCCAM website on chronic painby John Weeks, Publisher/Editor of The Integrator Blog News & ReportsNCCAM-ipedia - agency responds to corrective appeal on acupuncture and chronic pain When New York Beth Israel acupuncturist Arya Nielsen, PhD, Ac, reviewed the NCCAM website on chronic pain last March she concluded that the site did not fully reflect present evidence, to the detriment of her field: “It seemed dated and oddly biased.” Rather than simply complain, Nielsen, who in 2013 instigated the campaign to get the Joint Commission on Accreditation of Healthcare Organizations to re-open its guidelines on non-pharmacological approaches, put together what she called a “lit review” case for a change. On August 7, 2014, Nielsen shared with the Integrator that “we heard this morning they have updated their page informed by what we sent.” The site now includes reference to two meta-analyses “that conclude acupuncture is effective for chronic pain beyond the placebo effect.” She adds, however, “that the site doesn’t exactly reflect it.” She and her colleague are responding again. Nielsen also serves as director of the Acupuncture Fellowship for NY Beth Israel.Comment: Someone should give Nielsen an action award for, in this 12 month period, getting both the Joint Commission and NCCAM to engage changes in their documents. Thank you, Arya. And credit NCCAM for its responsiveness to good, if formerly overlooked, data.Regarding Christine Goertz, PhD, the “licensed integrative health practitioner” on the PCORI board of governorsWhen the Patient Centered Outcomes Research Institute (PCORI) was formed, via the Affordable Care Act, Congress required the agency to have at least one “state licensed integrative health practitioner” on the agency’s Board of Governors. Christine Goertz, DC, PhD has been that person. Goertz’ has since held a sequence of important roles at PCORI. She was first chair of the PCORI Program Development Committee. More recently, she began serving in the same capacity as chair of the PCORI Science Oversight Committee. According to its charter, this committee “provide(s) recommendations to the Board on the strategic goals to produce quality, timely, usable, and trustworthy comparative research information.” This is in such areas as “research and scientific program priorities and topics, merit review process for applications, designation of specific research projects for funding and active portfolio management by staff.”Comment: A challenge to the “state licensed integrative health” disciplines is to put forward candidates for this type of responsibility, relative in this case to a $650-million annual PCORI budget, who have the bandwidth and background to hold their own in a group of experts from professions whose institutions – and careers – have been powered by three generation of billions in NIH funding. Goertz is one such. Is there a PCORI “program priority” available to explore cloning her?NCCAM advisor Jane Guiltinan, ND and Bastyr University on the NCCAM’s proposed name changeThe recent Integrator article by Taylor Walsh on the proposed name change for the NIH National Center for Complementary and Alternative Medicine (NCCAM) included this statement in the comment field: “Notably, [Scott] Haldeman, an MD-DC, spoke to the exclusion he feels is implicit in not including ‘complementary’ in the title. Walsh did not report whether Jane Guiltinan, ND, the only other member who meets the criterion [as a licensed ‘CAM’ professional] spoke up.” Guiltinan sent the Integrator the following clarification:“I did indeed speak to this issue … In my comments I agreed with Scott Haldeman, and expressed my concerns that eliminating any reference to ‘CAM’ in the name would move us further down the road to less visibility and more exclusion for CAM disciplines and practitioners in the public’s eye. I stated my support for using the word health or health care instead of medicine, my support for omitting the word research, and finally, expressed my support for the name ‘National Center for Complementary and Integrative Health.’ Further, I advised Bastyr’s Chief of Staff on these matters and helped her craft the public comment made by Bastyr University.”Guiltinan subsequently shared the formal comments submitted by Bastyr University, for which she serves as dean of naturopathic medicine. Bastyr’s perspective is particularly of interest as a 2010 analysis found that it was, at that time, a recipient of roughly 33% of all NCCAM grants to “CAM” institutions. The Bastyr letter, signed by Coquina Deger, MBA, chief of staff at Bastyr, said:“On behalf of myself and the academic leadership of Bastyr University, we thank you for opening the door to feedback in response to NCCAM’s proposed name change. We are in support of the direction that NCCAM has taken with its newly proposed name, ‘The National Center for Research on Complementary and Integrative Health (NCRCIH).’ After some contemplation and discussion, we have one suggestion to offer up for your consideration, and this is to consider dropping the words ‘Research on.’ This would result in a shorter and more approachable title: ‘The National Center for Complementary and Integrative Health (NCCIH).’“While we undoubtedly agree that the research objective is crucial to the activities carried out through NCCAM, our reasoning for this suggestion is largely for consistency among other NIH agency names. For example, NIDDK and NHLBI do not mention research in their title, even though research is at the core of what they do. Please note that we appreciate your recognition that ‘alternative’ no longer serves to accurately describe what this Center does. We also appreciate your replacing the term ‘medicine’ with ‘health.’”Comment: First, an apology to Guiltinan for not including her perspective in the original article. It is notable that Guiltinan and Bastyr are aligned with both Haldeman and NCCAM director Josephine Briggs, MD in underscoring the importance of keeping “complementary” as the agency’s connection to the five disciplines it is most responsible for researching. The dominance of integrative medical doctors on the advisory panel appeared to be linked to a majority view that “complementary” was not necessary and should be discarded. The NCCAM decision is expected by the Fall 2014 meeting.