Was Your Discipline Present at the NIH NCCAM Stakeholder Dialogue?
Written by John Weeks
Was Your Discipline
Present at the NIH National Center for Complementary and
Alternative Medicine Stakeholder Dialogue?
Summary: On June 20,
2007, the NIH National Center for Complementary and Alternative
Medicine held a Stakeholder Dialogue. I thought it would be
interesting to do a little analysis of the attendees to see who showed
up. How many from conventional medical institutions? How many from the natural healthcare institutions? Was your discipline represented in this dialogue over how the biggest money in integrative medicine is dispensed? Do you consider yourself or your
discipline a "stakeholder" in NCCAM? If not, why not? Here is the chart, plus some observations. What are yours?
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for inclusion in a future Your Comments forum.
Note: Since publishing this article, NCCAM sent out a report
on the outcomes of the Stakeholder Dialogue. It can be accessed here: http://nccam.nih.gov/news/newsletter/2007_summer/stakeholders.htm
On June 20, 2007, the NIH National Center for Complementary and Alternative Medicine (NCCAM) held a Stakeholder Dialogue. The full-day meeting was convened by acting director Ruth Kirschstein, MD to gather public input on the opportunities and challenges in CAM research, as well as on "the impact will CAM research have on trends in integrative medicine."
The NCCAM annually
spends just over $120-million, making it perhaps the most significant
economic force, other than direct consumer cash payments, in the
integrative medicine and integrated healthcare processes.
So who were the self-appointed "stakeholders" who chose to make the
trip to Bethesda, Maryland, to attend? The following table represents a rough approximation, based on names
from a list of registered attendees which NCCAM provided on site and which attendee David O'Bryon, JD, later provided me. The
list included names, degrees and institutional affiliations. The chart below, which I constructed based on categories I created, places some in more than one category. For instance, a participant may be registered in both a discipline and in an educational category.
Is your
discipline here? What do you think of the mix? Here is a rough analysis.
_________________________
Participants in the NIH NCCAM Stakeholder Dialogue
by Category
An estimation from a list of 159 names. Many are listed in
more than one category, so the total is over 159.
Totals represent individuals, not distinct institutions.
Category
Estimated
# of
people
NCCAM Staff
37
Other Federal Agencies
13
Conventional Academic Health
Educators and Centers (1)
26
CAM educators and institutions (1)
33
Conventional medical associations
3
CAM/integrative professional
associations and foundations
18
Conventionally-trained
25
Medical doctors
13
Osteopaths
7
Nurses
4
Physical therapist
1
Complementary healthcare-trained
40
Chiropractors
15
Acupuncturists
11
Massage therapists
7
Naturopathic physicians
2
Homeopaths
2
Other -Rolfer, Trager, MA-psych
3
Herb industry
7
Hospitals/health systems
3
Media
1
Employers
0
Insurers/managed care
0
Unsure/other
11
(1) The same names are listed by discipline, if
the participant's licensing/training was noted.
_________________________
Attendees had opportunities to directly express their opinions during a morning session, then participate in a set of break-outs. Diverse views were reportedly voiced, reflecting the breadth of stakeholder interests. O'Bryon, for instance, shared concerns regarding the low representation on the NCCAM advisory council of licensed members
of the systems NCCAM is charged to study. (See related Integrator article.) Demara Stamler, CMT, executive director of the Potomac Massage Training Institute, told the Integrator that her voice was among several that urged the NCCAM to spend more of it resources on researching whole systems and whole practices. NCCAM has not notified the public of any formal report from the meeting.
Comment: At least one long-time observer of federal government operations inside the Beltway dismissed the meeting as little more that "an open meeting to meet a bureaucratic requirement." This observer didn't expect that NCCAM would take much of a lead from the voices heard. So why bother attending, or analyzing stakeholder participation for that matter?
The reason to be present is that the staff at NCCAM has repeatedly shown itself to be open to influence from its stakeholders.
The answer is that the staff at NCCAM has repeatedly shown itself to be open to influence from its stakeholders. Such openness has cut in multiple directions. Competitive challenges faced by new, less experienced researchers from the complementary healthcare disciplines have led to program changes which have assisted these young investigators and their institutions in securing grant support. Meantime, NCCAM's resident stakeholder, the powerful presence of the conventional research establishment, has proved to be a factor in the NCCAM's systematic diminution of CAM practitioner presence on its National Advisory Committee. A stakeholders action and involvement with NCCAM can make a difference.
The list here prompts a few comments. First, the chiropractors among the complementary healthcare disciplines are once again showing their political savvy by the level of their presence. You've got to show up to play. Second, it is interesting that the conventional academic health center stakeholder, which most benefits from NIH grants, fielded a smaller contingent than did the CAM academic.
From the apparent disinterest of hospitals, employers and payers, one might
conclude that these have little belief that either NCCAM or CAM and
integrative medicine have any part to play reshaping US health care.
It would be nice if we could do something about that.
Perhaps this reflects the desire of the CAM newcomers to enter doors inside which the former already are dining. The conventional stakeholders may have found the expenditure of time and energy to come to the meeting a lower priority.
Finally, observe the minor presence of the major hospitals and health systems (3 individuals) which operate most of US healthcare delivery. Note with this the two categories I added, employers and insurers, each of which had no obvious representation. These 3 stakeholders are those with the highest stake in the growing pressure for significant healthcare reform. Yet from their apparent disinterest, one might conclude that these have little belief that complementary and integrative medicine has any part to play in healthcare reform. Or, alternatively, their absence may suggest that they have little belief that NCCAM's $120-million a year budget will make a meaningful contribution to reform solutions. It would be nice if we could do something about that.
Send your comments to
for inclusion in a future Your Comments forum.
On June 20, 2007, the NIH National Center for Complementary and Alternative Medicine (NCCAM) held a 
