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NCCAM Out of Compliance with Mandated Advisory Council Make-up: ACCAHC and IHPC Urge Correction PDF Print E-mail
Written by John Weeks   

NCCAM Out of Compliance with Mandated Advisory Council Make-up: IHPC and ACCAHC Urge Correction

Summary: The Integrated Healthcare Policy Consortium (IHPC) and Academic Consortium for Complementary and Alternative Health Care (ACCAHC) recently alerted the NIH National Center for Complementary and Alternative Medicine (NCCAM) that they are significantly out of compliance on a key Congressional mandate. NCCAM's advisory council is mandated to include among its members at least 50% who are licensed in CAM disciplines plus 3 consumer members. The current council has just 27% (4/15) of its members from chiropractic, acupuncture and Oriental medicine. naturopathic medicine and massage therapy. None are consumer representatives. Since alerting top NCCAM officials of concerns about the situation, ACCAHC and IHPC have since received assurances that NCCAM will work promptly to meet the requirements of the law.
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The Integrated Healthcare Policy Consortium (IHPC) and Academic Consortium for Complementary and Alternative Health Care (ACCAHC) recently alerted the NIH National Center for Complementary and Alternative Medicine (NCCAM) that they are significantly out of compliance on a key Congressional mandate.

Image ACCAHC and IHPC have since received assurances from top NCCAM officials that the NCCAM will work promptly to meet the requirements of the law.

Janet Kahn, PhD, IHPC executive director states: "We are pleased that NCCAM has expressed a commitment to come into compliance. These provisions in the law are critical to the proper functioning of NCCAM and its advisory council. IHPC and ACCAHC look forward to working with (acting director) Dr. (Ruth) Kirschstein and other NCCAM staff to assist them in meeting the letter and intent of the law as soon as possible. In our view there is no shortage of qualified candidates."

The Issue: Significant Under-Representation of Licensed CAM and Consumer Advisers

At issue is the make-up of the
the National Advisory Council on Complementary and Alternative Medicine (NACCAM). When NCCAM was created in 1998, Congress required that at least 50% of the members of NACCAM be licensed members of the disciplines NCCAM is charged to explore. In addition, three were to be consumer representatives.

Janet Kahn, PhD, IHPC executive director and former NACCAM member
However, the NCCAM website currently lists only 27% (4 of 15) members from what are typically viewed as licensed CAM disciplines (chiropractic, naturopathic medicine, acupuncture and Oriental medicine and massage therapy). If an osteopath who is a medical oncologist tumor specialist at the University of Michigan is counted, the representation rises to 33%. None of the members appear to be consumers.

States Kahn: "We are very pleased with some aspects of NCCAM's recent work, particularly the creation of programs to strengthen research capacity at CAM educational institutions in the maturation of their young investigators.
We salute NCCAM for those programs. But we cannot ignore the areas in which NCCAM is failing to meet its legal mandate." Kahn then links her organization's concern to the transition at NCCAM. The NCCAM is presently searching for a new director following the recent death of founding director Stephen Straus, MD. Kahn states: "At a time when the public has some uncertainty about NCCAM's future direction under its next director, lack of compliance is particularly problematic."

Recent Appointees Only Medical Doctors and PhD Researchers

Recent NCCAM appointees, announced this month, only make matters worse. In a June 20, 2007 press release, NCCAM announced six new members. Of these, 4 are medical doctors and 2 are PhDs from conventional academic institutions. None are licensed members of CAM fields. (See list below.) The NCCAM release did not suggest that any were consumer representatives. (By definition, one might assume that a practitioner or individual who is principally a researcher cannot also be a consumer representative. Those positions should reasonably be held by individuals whose primary role in healthcare research and delivery is that of patient/consumer or a stakeholder representing patients and consumers.)

David O'Bryon, JD,
a member of the executive committee of ACCAHC, represented ACCAHC's concerns at a June 20, 2007, NCCAM Stakeholder's Dialogue. He notes that of the 4 members who clearly meet the spirit of law, 3 - including the sole chiropractor, sole naturopathic physician and sole massage therapist - have terms that expired in June 2007. Each is presently serving on a 180 day extension until January 2008.

Said O'Bryon: "There is only one licensed CAM member presently whose term extends beyond 2007, and that is
an acupuncturist at Harvard Medical School. There is presently no member who is associated with a CAM academic institution. This is deeply disturbing, especially since the NCCAM enabling legislation requires NCCAM to build research capacity in our CAM schools."

ACCAHC learned from the staff member who oversees the NACCAM, Martin Goldrosen, PhD, that five new NCCAM members have been proposed and are in process of consideration by Secretary Michael Leavitt of the US Department of Health and Human Services. Four of the nominees, according to Goldrosen, are licensed CAM professionals. He did not share which disciplines are represented or when decisions could be made.

David O'Bryon, JD, ACCAHC executive committee member
O'Bryon, who is also executive director of the Association of Chiropractic Colleges, clarifies the situation: "Even if all 4 are appointed, NCCAM still loses 3 of its licensed CAM members after the 180 day extensions are over. Licensed CAM representation will still be way off of Congressional intent. Our best accounting is that we'll still have no more than 29% who meet the intent of the law. This is barely half of what Congress intended. And there are still no consumers."

The Mandate in NCCAM's 1998 Enabling Legislation
Pamela Snider, ND, discovered NACCAM's compliance issue in early May. Snider, a co-founder and active member of both IHPC and ACCAHC, was involved in the development of the legislation when language on licensed CAM representation was inserted. She provides content on the original legislation:
(b) ADVISORY COUNCIL- The Secretary shall establish an advisory council for the Center in accordance with section 406, except that at least half of the members of the advisory council who are not ex officio members shall include practitioners licensed in one or more of the major systems with which the Center is concerned, and at least 3 individuals representing the interests of individual consumers of complementary and alternative medicine. (bold added)
Pamela Snider, ND - ACCAHC co-founder helped draft NCCAM language
Snider notes that in the discussion at the time were the 5 licensed CAM disciplines which have a federally-recognized accrediting agency: chiropractic, naturopathic medicine, acupuncture and Oriental medicine, massage therapy and direct-entry (homebirth) midwifery. Representatives from each field were nominated. The initial NACCAM was in compliance. (In fact, IHPC's Kahn, a licensed massage therapist and PhD-level researcher who also directs the Massage Therapy Research Consortium, was a part of the founding NACCAM, which was in compliance.)

Snider states that the intent to include a focus on the licensed CAM professions was echoed in two other places in the NCCAM enabling legislation. One focuses on research that specifically looks at disciplines and systems:
(a) IN GENERAL- The general purposes of the National Center for Complementary and Alternative Medicine (in this subpart referred to as the 'Center') are the conduct and support of basic and applied research (including both intramural and extramural research), research training, the dissemination of health information, and other programs with respect to identifying, investigating, and validating complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems. The Center shall be headed by a director, who shall be appointed by the Secretary. The Director of the Center shall report directly to the Director of NIH.
The second, related piece of language is more explicit - a section that specifically relates to the importance of not only exploring therapies but also "disciplines and systems."
(e) EVALUATION OF VARIOUS DISCIPLINES AND SYSTEMS- In carrying out subsection (a), the Director of the Center shall identify and evaluate alternative and complementary medical treatment, diagnostic and prevention modalities in each of the disciplines and systems with which the Center is concerned, including each discipline and system in which accreditation, national certification, and a State license is available.
Snider notes that the disciplines who make up the core membership of ACCAHC are precisely those for which accreditation, national certification, and state licensing are all part of the landscape.

Getting Back on the Right Track

The NCCAM has its work cut out for it. If we include the osteopath (a problematic inclusion, since licensing and training for DOs is virtually identical to that for MDs), the next 7 appointees must all be from licensed CAM fields to gain compliance. And such a strategy will still leave the council without consumers.

O'Bryon, speaking on behalf of ACCAHC, states the case simply: "Congress wanted the NIH to explore the care that consumers were receiving in the marketplace. In their wisdom, the members sought to guarantee that the practitioners who were experienced in those fields would be deeply involved in shaping our complementary and alternative medicine research agenda. We look forward to NCCAM getting these licensed CAM members on board so they can get to work in helping NCCAM meet its charge."

Disclosure: Under others hats I serve as the part-time executive director of ACCAHC and as a volunteer member of the steering committee of the Integrated Healthcare Policy Consortium.

NCCAM Announces 6 New Advisory Council Members:
Not a Licensed CAM Practitioner Among Them

(On June 21, NCCAM mailed this announcement of the 6 new members.)

The National Center for Complementary and Alternative Medicine (NCCAM) welcomes six new members to the National Advisory Council for Complementary and Alternative Medicine (NACCAM). The Council serves as the principal advisory body to NCCAM, a component of the National Institutes of Health within the Department of Health and Human Services.

ImageThe Council, which meets three times a year, is composed of physicians, scientists, licensed complementary and alternative medicine practitioners, and representatives of the public who contribute their time and expertise over a 4-year term. Council members offer advice and recommendations on the prioritization, conduct, and support of complementary and alternative medicine research, including research training and disseminating health information derived from NCCAM's research.

New NACCAM members include:

  • Lori Arviso Alvord, M.D., Dartmouth Medical School, Hanover, NH
  • Stephen Barnes, Ph.D., University of Alabama at Birmingham, Birmingham, AL
  • Sheldon Cohen, Ph.D., Carnegie Mellon University; University of Pittsburgh School of Medicine; and Pittsburgh Cancer Institute, Pittsburgh, PA
  • Fabio Cominelli, M.D., Ph.D., University of Virginia Health System, Charlottesville, VA
  • Margery L.S. Gass, M.D., University of Cincinnati, Cincinnati, OH
  • Frank M. Torti, M.D., M.P.H., F.A.C.P., Wake Forest University School of Medicine, Winston-Salem, NC

Lori Arviso Alvord, M.D. is the Associate Dean for Student Affairs and Multicultural Affairs and an Assistant Professor of Surgery and Psychiatry at Dartmouth Medical School. Her research examines surgical outcomes in American Indians. A Navajo, her autobiography "The Scalpel and the Silver Bear" describes her work to create culturally competent healing environments. Dr. Alvord has received honorary degrees from Albany Medical College and Drexel University. She has also received a Governor's Award for Outstanding Women from the State of New Mexico.

Stephen Barnes, Ph.D. is a Professor in the Department of Pharmacology and Toxicology, as well as the departments of Biochemistry and Molecular Genetics, Environmental Health Sciences, Genetics, and the Vision Sciences at the University of Alabama at Birmingham. Dr. Barnes' research focuses on the biochemistry, chemistry, and analysis of bile acids; the role of isoflavonoids in preventing chronic diseases; and the application of mass spectrometry to biomedical research. He received a Lifetime Achievement Award from the 5th International Symposium on the Role of Soy in the Prevention and Treatment of Chronic Disease.

Sheldon Cohen, Ph.D. is the Robert E. Doherty Professor of Psychology at Carnegie Mellon University. He is also Adjunct Professor of Pathology and of Psychiatry at the University of Pittsburgh School of Medicine and a Member of the Pittsburgh Cancer Institute. His research currently focuses on how interpersonal dispositions and behaviors influence immunity and host resistance to infectious disease. Dr. Cohen has received awards for career contributions from the American Psychological Association, the American Psychological Society, and the American Psychosomatic Society. He is a member of the Institute of Medicine of the National Academies.

Fabio Cominelli, M.D., Ph.D. is the David D. Stone Professor of Internal Medicine, Director of the Digestive Health Center of Excellence, Professor of Microbiology and Immunology, and Chief of the Division of Gastroenterology and Hepatology in the University of Virginia Health System. Dr. Cominelli researches mucosal immune responses and intestinal inflammation to determine the molecular mechanisms of intestinal inflammation and develop new therapies. He is a member of the American Society for Clinical Investigation and the American Association of Physicians. He has received an NIH Merit Award and the Clinical Excellence Award from the University of Virginia Department of Medicine.

Margery L.S. Gass, M.D. is a Professor of Clinical Obstetrics and Gynecology and Director of the University Hospital Menopause and Osteoporosis Center at the University of Cincinnati Department of Obstetrics and Gynecology. Her research areas include menopause, osteoporosis, and female sexual function. She is a principal investigator for the Women's Health Initiative and is a past member of the Executive Committee for the study. Dr. Gass is a past president and board member of the North American Menopause Society and has been cited in Best Doctors in America.

Frank M. Torti, M.D., M.P.H., F.A.C.P. is the Charles L. Spurr Professor of Medicine and Chairman of the Department of Cancer Biology at Wake Forest University School of Medicine. He is also the Director of the Comprehensive Cancer Center of Wake Forest University. Dr. Torti has studied the molecular action of oxidants and cytokines (cellular messengers) and their relationship to cancer and the balance of iron in the body. He is a noted researcher and clinician in the area of genitourinary (GU) malignancies, and is the GU oncology section editor of Current Opinion in Oncology. He recently received an NIH Merit Award.
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