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"Inspiring" and Robust Research Conference on CAM-IM - First Impressions PDF Print E-mail
Written by John Weeks   

Image"Inspiring" and Robust North American Research Conference on CAM-IM

Toward the end of the second evening of the North American Research Conference on Complementary and Integrative Medicine, I encountered a colleague and friend of 20 years, Jane Guiltinan, ND, on the streets outside the hotel.  The sky in Edmonton, Alberta, remains light until dangerously late this time of the year. Everyone seemed to be using all of the "extra" hours, and Image more, to take advantage of the conference's overflowing cornucopia of presenters, posters, sessions, ideas and colleagues, new and old, across a dozen disciplines. Some 650 souls chose to fly north to participate in the meeting.

I asked
Guiltinan - while attempting, of course, to eliminate all interviewer bias - how she was finding the conference. Guiltinan, the current president of the American Association of Naturopathic Physicians, paused, just off the curb, to respond. This integrated healthcare leader has 20 years of CAM-IM research experience, through Bastyr University, her base, as well as with the University of Washington, and the Group Health Center for Health  Studies.
Image
Her experience reaches back to the dark ages for research funding - pre-Congressional action which forced the NIH's hand. She was part of an ambitious, largely volunteer HIV-AIDS research project that received an international award in 1990 and led, four years later, to Bastyr's receipt of one of the NIH's first CAM center grants.

Guiltinan considered my question. For many participants, the historic nature of this focused, scientific conference, sponsored by the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) was provoking reflection on the state of the CAM-IM research endeavor, and the broader movement in health care with which it is associated. Guiltinan seemed to be looking at me across two decades of action. She answered simply and thoughtfully: "Inspiring."


Enthusiasm
  for the meeting 
cut across the
disciplines
.
 
The Excitement and Six-Ring Circus of 650+ Researchers

I took in Guiltinan's one-word summation. I often find myself at odds with the direction of NIH funding - my work with health care payment and delivery and with practitioners biases me toward health services and whole practice directions which are typically under-funded. Yet I strongly agreed. "Inspiring" fit my experience of the robust event.

I tried out this word, now with significant interviewer bias, on many others in the course of the next two days and found strong resonance. Enthusiasm for the meeting cut across the field, from researchers like Brian Berman, MD, who developed the first IM program in a conventional medical school at the University of Maryland, to Daniel Cherkin, PhD, whose back pain research associated with staff-model HMO Group Health Cooperative crossed him into the CAM-IM world, to Janet Kahn, PhD, director of research at the Massage Therapy Research Consortium, to Richard Hammerschlag, PhD, long-time leader with the Society for Acupuncture Research, and to funder Penny George, of the Bravewell Collaborative, which kicked in significant conference support.

Image
Margaret Chesney, PhD, NCCAM Deputy Director
This introductory posting, and others to follow, will attempt to give you some of the flavor, and a taste of some intriguing developments, amidst an evaluation of research's role in the emergence of integrated health care. A caveat: Any participant could only describe a part of this elephant. I was able to take in only a small fraction of the 300+ presentations and posters.

A month ago, when IBN&R ran a feature on the conference, program director Adi Haramati, PhD, promised over 500 attendees. By the conference's opening, the participant list jumped to 650+, according to planning team member Robb Scholten. Many sessions were delivered to overflow audiences. The vining aisles of facing posters produced clusters of intrigued attendees at all four poster sessions.

Image
Brain Berman, MD: NCCAM success story
The N of researchers and would-be researchers in this field is jumping significantly. The professional and cultural diversity of those interested was on display. The core participation of North American academic health centers was enhanced by strong contingents from the chiropractic, acupuncture and Oriental medicine, naturopathic medicine and massage therapy academic institutions. Scores of Asian, British, German, Israeli and other international visitors swelled the US and Canadian presence.

The good news for those who didn't attend is that some early foundation backing may be

The good news is we
 may see a second meeting
in just two, rather than
 the 3-4 years the sponsors
projected as recently
as a month ago.

 
stepping up to promote a second meeting in just two, rather than the 3-4 years the sponsors were projecting as recently as a month ago.

Competition, Bias, the "F-word" and Other Challenges Ahead

The downside of the excitement is that funding for CAM research has stopped its growth curve and is increasingly competitive and more difficult to find. The success rate for NIH NCCAM submissions has dropped to 9%, lower than the NIH average which is 13-14%. (Ironically, at least one of the NCCAM's favorite success stories had too poor of a score from its reviewers to receive funding today.) The resulting environment is challenging.

  • Funding The opening plenary session on Thursday morning featured a presentation which had, as its refrain, reference to research's "f-word" - funding. Throughout the meeting, this pressing need was repeatedly referenced. Unfortunately for researchers, though understandably, philanthropists in IM (significant philanthropy still barely exists in CAM), tend to prefer to focus their dollars on clinical projects. Increasing funding will require concerted political action.
  • Image
    Conference program chair, Consortium founding co-chair and NED cofounder Adi Haramati, PhD, and ACCAHC and massage educator Jan Schwartz, LMT
    Long-term research strategies 
    Deputy director of NCCAM, Margaret Chesney, PhD, delivered a rousing speech on the opportunities and challenges for integrative medicine. She urged participants to take a long view. She underscored the laborious step-wise development from small trials to a large-scale, randomized controlled trial (RCT). Chesney highlighted the 15 year oddessy of acupuncture for osteoarthritis successfully undertaken by University of Maryland researcher
     
    The downside of the
    excitement is that
    funding for CAM
     research has stopped 
    its growth curve and
    is increasingly
    difficult to find.

    Brian Berman, MD and his multi-disciplinary group. The journey of Berman's group, the subject of a separate, fascinating plenary session, could only sober the rejected 91% who could afford the airfare to attend the meeting. Chesney would have provided added value had she attached what lawmakers call a "fiscal note" to each of Berman's studied steps.  Now project into the future: How many gold rings can be found to power these Herculean labors? How slow will integration unfold if it is to rest on such a laboriously crafted brickwork?
  • The costs of war  A cost of war that does not typically make the media coverage of iraq-Afghanistan is that the happy half decade of historic funding increases across the entire NIH - an all boats rising milieu - has ended.
 
  • Testing bias against whole practice/whole systems research  The research
    Image
    CAM consortium and AOM educator Liza Goldblatt, PhD and conventional consortium secretary Anne Nedrow, MD
    community has a growing, but yet informal, whole practice/whole systems "caucus" which seeks to elevate the NCCAM support for funding this part of the research agenda. The rising involvement of schools and researchers in the CAM disciplines, and the newly attracted IM researchers, bodes well for deepening this research conversation. Yet how will these compete against single intervention trials which more easily score highly on NIH criteria. (Berman acknowledged the difficult moment in his decision process when, amidst a heated debate with his licensed acupuncturist collaborator, Lixing Lao, PhD, LAc, they chose to follow a needles-only trial rather than one which researched the value of the whole practice.) Like students well-prepped for standardized scholastic tests, such simplified trials have a proven ability to get good scores. But do these scoring practices support the framing and creativity which may lead to the research which will be the most useful to advance integrated health care? Perhaps the NIH, like progressive colleges, must include more diversity in their acceptance mix. NCCAM advisory council member Carlo Calabrese, ND, MPH, suggests that a solution may be a focused NCCAM funding project on whole practice research.

In the midst of recurrent talk in the meeting about Type 1 and Type 2 research errors, one wonders about the "type" of error NCCAM may be making institutionally by basing funding decisions on reductive scoring methods.



Historic Meeting of Exec Committees of Conventional and CAM Educator Consortia

Image
Historic meeting: Conventional (*) and CAM Consortia (^) exec teams gather in Edmonton: Back row - Adam Perlman, MD, MPH*, Don Warren, ND, DHANP^, Brian Berman, MD*, David O'Bryon, JD^, Kathleen Healy, David Eisenberg, MD*; Middle row- Reed Phillips, DC, PhD^, Adi Haramati, PhD*, Bradly Jacobs, MD, MPH*, Janet Kahn, LMT, PhD^, Mary Jo Kreitzer, RN, PhD*, Rita Benn, PhD*, Vic Sierpina, MD*; Front row - Pamela Snider, ND^, Susan Folkman, PhD*, John Pan, MD*, Anne Nedrow* MD*, Liza Goldblatt, PhD^; photo - John Weeks, National Education Dialogue

As happens, and despite and because of the tremendous richness of the scientific presentations, as much action took place in the hallways, meals, receptions and ancillary meetings of the conference as in the organized sessions. Among these was a Steering Committee meeting of the organization of conventional IM educators who sponsored the meetings, the now 32 member Consortium of Academic Health Centers for Integrative Medicine, March 24th. (For more on the Consortium, see related IBN&R interview with chair Susan Folkman, PhD.)

Image
NED director John Weeks, conventional Consortium leader and Ben Kligler, MD, MPH, and David O'Bryon, JD, ACCAHC chair
To strengthen relationships across disciplines, the executive committee of the Academic Consortium of Complementary and Alternative Health Care (ACCAHC), the parallel organization of CAM educators, also chose to meet in Edmonton on the 24th. The core of this body is representatives of the councils of colleges and accrediting agencies of the five CAM disciplines with federally-recognized accrediting agendies (chiropractic, massage therapy, acupuncture and Oriental medicine, naturopathic medicine and direct entry midwifery).

ACCAHC, under the leadership of chair Reed Phillips, DC, PhD, and executive director Pamela Snider, ND, served as a Participating Organization with the meeting.  ACCAHC worked
Image
Conference chair and USCF Osher Center director Susan Folkman, MD, and Bradly Jacobs, MD, MPH
to promote the CAM researcher turnout. In one oral presentation, a crowd of 125 attendees heard Snider present outcomes of a modified Delphi survey of CAM educators regarding a paper on competencies in integrative medicine, endorsed by the conventional Consortium and published in Academic Medicine (May 2004). The work led to a May 2005 change in the conventional Consortium's definition of "integrative medicine" which now highlights the importance of integrating "healthcare professionals and disciplines" as well as "approaches".

On Wednesday evening, a reception, organized through the National Education Dialogue to Advance Integrated Health Care: Creating Common Ground (NED) brought together executive committee members of the two consortia. ACCAHC executive Snider told the conventional Consortium members that "the word on the street" among the CAM disciplines is that the conventional group practiced a new level of inclusion of the CAM fields while preparing for the meeting and selecting presentations. A conventional Consortium member immediately responded

Discovering an enhanced
role for CAM-IM amidst
the staggering problems
in the mainstream system
  may well require new kinds 
of political as well as
educational and research
collaboration.


with: "That's the best thing that you could have shared with us." Another conventional Consortium leader, Vic Sierpina, MD, co-chair of the Consortium's Education Task Force, and NED planner, later noted that future meetings would strive to include more CAM discipline participation in the plenary meetings.

Comment: The Edmonton meeting showed a maturity of research, and of political connectivity, which was almost unimaginable 10 years ago when Wayne Jonas, MD, then director of what was called the NIH Office of Alternative Medicine, began developing a
Image
NED chair David O'Bryon, JD, and conventional Consortium steering committee member and NED planner Adam Perlman, MD, MPH
five-year plan for NIH research on CAM. The culture's broader integrated healthcare discussion was only beginning to gain steam. Neither consortia existed, nor did the Bravewell Collaborative consortium of philanthropists which has meant so much to this meeting as well as other key developments in the field. Nor, in fact, did NCCAM yet exist.

That new relationships were forming and solidifying in Edmonton, even as research challenges came into bold relief, was reassuring and, well, inspiring. And not a moment too soon. Optimizing the role of the CAM-IM research in helping us discover an enhanced role for CAM-IM amidst the staggering problems in the mainstream system may well require new kinds of political as well as educational and research collaboration.




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