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The Integrator Blog. News, Reports and Networking for the Business, Education, Policy and Practice of Integrative Medicine, CAM and Integrated Health Care. - Research: NIH $ Decline, AHRQ's Rise; SPARC; Whole Systrems in Wikipedia; NIH Invites Stakeholders
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Research: NIH $ Decline, AHRQ's Rise; SPARC; Whole Systrems in Wikipedia; NIH Invites Stakeholders PDF Print E-mail
Written by John Weeks   

Research Shorts: New Investigators May Take Hit as NIH Funds Decline; Health Services a Bright Spot; Portland SPARC's Multi-Disciplinary Collaboration; NIH Stakeholders Meeting; Whole Services Research in Wikipedia

Summary: Oregon Health Sciences University (OHSU) researcher Lynne Shinto, ND, MPH, reports the shrinking opportunities for clinical research at the NIH. Hardest hit will be new investigators - a category which includes most of the researchers from the complementary and integrative medicine fields who have clinical experience in complementary and integrated care. The bright spot is health services research ... The nation's top multi-disciplinary, collaborative research laboratory, involving OHSU, Oregon College of Oriental Medicine, Western States Chiropractic College and National College of Natural Medicine, and other Portland institutions holds its annual research meeting June 9, focusing on collaborative research .. Whole systems research is now on Wikipedia, and ready for your edits ... NIH NCCAM invites you to a June 20, 2007 Stakeholders Dialogue ...
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1.    NIH Budget to Shrink, New Researchers Likely Hardest Hit

Conventional medical leaders who question the value of complementary, alternative, integrative and natural health approaches are fond of pointing advocates of these approaches to the door marked "research." Pass through successfully and ye shall be accepted.

ImageThat door, never very large and always a tough fit for the polymorphous shape of whole person care, is in the process of shrinking.
Overall NIH funding will go down 1.7% in 2008, after years of significant increases. With the number of investigators and would-be investigators growing, NIH-wide success rates on grant applications will drop to 9% over-all. (The Integrator has heard from other sources that the success rate for grant applications through the National Center for Complementary and Alternative Medicine may fall as low as 7.5%.)

The Integrator viewed this information in an article in the May 2007 issue of the School of Medicine News/Dean's Update at the Oregon Health Sciences University. The articles states that Elias Zerhouni, MD, director of the National Institutes of Health, urges academic health centers that wish to grow to push hard for funding from other sources. "Young new investigators"  - that is, the vast majority of researchers with training in distinct complementary disciplines or with significant clinical experience in integrative care - are also urged to not rely on the NIH to fund their budding career paths. These too are urged to find other sources. One non-governmental source is noted: a program funded through a pharmaceutical giant, the Burroughs Welcome Fund.
Lynne Shinto, ND, MPH
Likely Hardest Hit: CAM-IM Researchers with Clinical Experience in the Field

The article was written by one of these young investigators, Lynne Shinto, ND, MPH. Shinto has multiple appointments at OHSU and represents OHSU in the clinical working group of the Consortium of Academic Health Centers for Integrative Medicine. Wrote Shinto: "As a new investigator (starting year 4 of my [mentored independent] K23 award) I found these talks very sobering. I can't help being concerned about a future career in clinical research with such limited resources available."

Shinto's report in the OHSU publication also included
information from an April 25, 2007 "Young Investigator's Workshop on Clinical Research Advocacy" which she attended. The main point of the workshop was a kind of high-level lobbying. Attendees were being taught that, to keep research dollars flowing from taxpayers and other sources, investigators need to be more visible, develop relationships with the media and their political representatives. They must become advocates. Shinto points out that such tendencies are not the long suits of many researchers.

2.    Bright Spot: Health Services Research

Image Shinto also reported that while clinical research funding via the NIH is dropping, as is that of the Center for Disease Control and Prevention (down 4.4%), one area reverses this trend. Funding for outcomes research through the Agency for Healthcare Research and Quality (AHRQ), the center of exploration of real world applications and costs, will go up 3.9%.

I asked Shinto if there was mention at her conference as to whether the increase at the AHRQ is related to health reform issues. Might priorities be reflecting the Nation's need to see if our health care is actually creating healthier, happier people at lower cost? Shinto said the idea wasn't broached. "Most of us were clinical trialists, so our focus was on the NIH funding going down," she said. Then she laughed: "The health services researchers, traditionally a small group, were probably pretty happy."

The news Shinto reports is mixed. On the simply bad side, the clinical trial-based research doorway to integration is narrowing at a time when cost-pressures means that stakeholders such as employers and insurers are less likely to use lack of scientific evidence as a barrier to entry. The impact on integration of care of shrinking resource, over the long term, will be significant.

Uglier yet is that this closure hits when a nascent generation of new researchers is seeking to elbow its way into the research world. Intensified competition will surely favor experienced researchers with long NIH resumes. These have been dipping into the NCCAM pool which has bubbled up like a happy geyser into their NIH homeland since 1999. Many of these individuals have received grants regardless of whether they have any personal interest or clinical experience with integrative approaches. Meantime, the new researchers who are likely to best understand the "new medicine" (and particularly the "new health care") will be scratching at each other to try to make the grade. In this environment, the newbies will increasingly model their projects on reductive strategies that are surer bets than taking a risk on projects with more complex methodologies which fit whole person practice (ie, the "new health care"). Yet it is these innovative models which are most likely to show ways that integrated care can make a contribution to health care reform.

Meantime, the news about AHRQ is good, in the abstract at least. Real world, global outcomes on cost, satisfaction, reduced utilization have always been the best measures for capturing the promises of the integrated care movement. Maybe the time is right for the complementary and integrative care  researchers to begin cozying-up to the AHRQ. Maybe it is a time to form a partnership and go to Congress with a message that funding AHRQ with set-asides to look at integrated care approaches may be the best way to insure that tax dollars for outcomes research are working toward directly solving our healthcare cost crisis.

3.    Symposium of Portland Area Researchers on CAM (SPARC) Focuses on Collaboration

When did you ever see a brochure with a list of continuing education credits that is as diverse as this:

  • DC - 7.5 hours
  • LAc - 7 hours
  • MD/DO - 5.75 hours
  • ND - 7 hours (3 in ethics)
  • RN - 7.58 hours
Heather Zwickey, PhD
This list, which suggests significant integration in continuing education, is on the brochure for
the annual Symposium for Portland Area Research on CAM (SPARC) which be held on June 9, 2007. A note from Heather Zwickey, PhD, director of the Helfgott Research Institute, associated with National College of Natural Medicine (NCNM), reminded the Integrator that this unique gathering was taking place.

The theme this year is on collaboration. And collaboration is in practice here. The SPARC partners
include Western States Chiropractic College (chiropractic and massage), Oregon College of Oriental Medicine, NCNM (naturopathic medicine and classical acupuncture) Oregon Health and Sciences University, Portland State University (which has a nursing program) and Kaiser Permanente Center for Health Research (a touch of the real world).

This year SPARC is working to get practitioners to the meeting. Zwickey wrote in an email:

"The reason we want practitioners is two-fold. First, we're working on establishing a practice-based research network. We think that CAM practitioners need to start collecting data in their clinical practices so that we can provide evidence of who goes to CAM practitioners, and how it works, etc. Secondly, our topic this year is about collaboration-- mainly collaborative research projects between researchers at educational institutions and docs in practice."
The brochure for the meeting is also available via www.helfgott.org.  Last year the SPARC meeting focused on whole systems research models.

: Apologies for not publishing this earlier; the meeting is in two days from this publication. I do plan to attend and will report on it. If anyone is interested in learning more about this inter-institutional collaboration, organized as the Oregon Collaborative for Complementary and Integrative Medicine, take a look at page 33 of the Progress Report of the National Education Dialogue to Advance Integrated Health Care: Creating Common Ground.

Image 4.
  NIH NCCAM Invites Stakeholders to Dialogue on June 20, 2007

Want to gain understanding of NCCAM and help shape its future? Stakeholders are invited to a dialogue on Wednesday, June 20, 2007, in Bethesda, from 9 a.m. to 3 p.m. Those who attend will meet acting director Ruth Kirschstein, MD. Kirschstein is scheduled to lead a two-hour dialogue in which questions on the challenges and opportunities and trends in integrative medicine research will be considered.  Afternoon breakouts on research, research training and communication and outreach will be offered,as well as a time for networking. The meeting is open to all comers.

5) Whole Systems Research Arrives in Wikipedia

The June 7, 2007 Issue of the Canadian
Interdisciplinary Network for Complementary and Alternative Medicine (IN-CAM) announced that whole systems research (WSR) is now an official entry in Wikipedia. The content appears to have been developed by the whole systems team whose work has been featured in the Integrator. Wikipedia is the largest, multilingual free-content encyclopedia on the internet. The entry can be found by going to searching on “whole systems research”, or, visiting the site.

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