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Re-Naming NCCAM: Taylor Walsh Covers Discussion of "NCRCI" at the National Advisory Council for CAM PDF Print E-mail
Written by John Weeks   

Re-Naming NCCAM: Taylor Walsh Covers Discussion of "NCRCI" at the National Advisory Council for Complementary and Alternative Medicine

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New name under discussion at NACCAM
The proposed re-naming of the NIH National Center for Complementary and Alternative Medicine is a powerful cultural moment for the field. Some of the vehemence in diverse opinion are touched upon in
"A perspective on the reason to keep 'alternatives' from Nancy Gahles, DC, CCH" included in the June 2014 Integrator Round-up and also in the article NCCAM Name Change: IHPC/Partners Weigh in, plus Integrator on the Name is Not the Mandate.

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Taylor Walsh
Integrative health and medicine consultant and
Integrator columnist Taylor Walsh captures the moment well in this title: "Naming NCCAM 2.0." His well-reported coverage here of the dialogue on the topic at the June 2014 meeting of the National Advisory Council for Complementary and Alternative Medicine includes comments by Josephine Briggs, MD, Brian Berman, MD, Dan Cherkin, PhD, Scott Haldeman, MD, DC, Tracy Gaudet, MD, and others.

Walsh is a former online service entrepreneur and pioneer in social media who presently consults and writes in the integrative health and digital media space as Integrative Health & Wellness Strategies. Based in Washington, DC, Walsh combines two passions that are of immense benefit to Integrator readers. He sees the importance of transformation of our medical system and the value of integrative practice philosophies and model in that process. In addition, Walsh has a good old-fashioned passion for Beltway politics and is involved more deeply presently as a principal in the Integrative Health Care Policy Consortium's CoverMyCare campaign. His prior coverage of NIH NCCAM includes NCCAM's Direction Clarified in Advisory Council Meeting; Council Member Janet Kahn, PhD Responds (February 2010, and Who Are We? Taylor Walsh Reports Give-and-Take as NCCAM Advisers Discuss Proposed Strategic Plan (September 2010). His prior Integrator commentary and columns are here. You can contact him at or via Twitter: @taylorw.
___________________________________

Naming NCCAM 2.0 

Taylor Walsh
Integrative Health & Wellness Strategies

Twitter: @taylorw

As always, an integrative man ahead of his time. When Sen. Tom Harkin addressed the 2009 national "Summit on Integrative Medicine and Health of the Public" he recalled his efforts that established the National Center for Complementary and Alternative Medicine, NCCAM, at NIH.  Given the focus of the summit, he wondered if the center might be more properly known as the National Center for Integrative Medicine. 

   
  "The new name that NCCAM had proposed
is the National Center for Research on
Complementary and Integrative Health
,
to be known as NCRCI."

-- Taylor Walsh
  

On the first Friday of June, a year-long conversation about the idea of changing the name of NCCAM concluded with a discussion among the members of NCCAM's National Advisory Council during a bi-annual meeting at NIH in Bethesda, MD. 

Director Josephine Briggs, MD led this discussion.  She reported that a public comment period that concluded that Friday had drawn more the 500 responses posted privately through the NCCAM web site.  Two-thirds, she said, were positive. 

The new name that NCCAM had proposed, and which Briggs described during the video that accompanied the public comment page, is the National Center for Research on Complementary and Integrative Health, to be known as NCRCI. 

Because the public comment period closed that day, proposed names from public commentators were not presented. The conversation among council members, however, trended strongly toward Harkin's 2009 suggestion, although as Briggs noted, the term "medicine" was eliminated. "Because so many practitioners are not medical doctors," she said. 

   
"Conversation among council members
trended strongly toward 'integrative medicine'
Harkin's 2009 suggestion."

-- Taylor Walsh

   
Of the variations NCCAM had fielded, Briggs herself noted that, "National Center on Integrative Health might be crisper."

She reported that during the consideration of a new name, NCCAM determined that the terms "alternative" and "complementary" were not used by consumers.   She also noted that the public's opinion for retaining "complementary" was "very mixed," but that NCCAM still considered it valuable as a way to reflect what is considered a transitional period.  

Scott Haldeman, MD PhD, DC agreed, noting that, "Those not in medicine are worried that they will be left out.  If complementary were take out there would be negative concerns."  Haldeman is at the School of Public Health at the University of California, Irvine.

As the conversation proceeded, however, the sense of most council members gravitated toward "integrative health."

Ex-officio council member Tracy Gaudet, MD, Director of the VA's Office of Patient-Centered Care and Cultural Transformation and former executive director at Duke Integrative Medicine, recalled a similar conversation when she arrived in the VHA. The decision there was made to use integrative health, she said, because it suggested the broadest approach to care.

   
   
Brian Berman, Tracy Gaudet
and David Borsook were among
those who spoke up for
the focus on "health" rather than
on "medicine."

 
Brian Berman, MD Director of the Center for Integrative Medicine at the University of Maryland School of Medicine, and founder of the independent research organization The Institute for Integrative Health agreed with this expansive view.  "This is an opportunity to start to look at the research agenda in a broader context," he suggested.

(Recently TIIH has linked its research to direct, real-world applications of evidence-informed lifestyle interventions.  Notably TIIH is about to enter a second year co-producing the Mission Thrive Summer program with the City of Baltimore.  High school students participate in a program of multiple activities including garden/farm work, yoga, movement and fitness for stress reduction.   Although Berman did not mention the program at the council meeting, the inclusion of integrative research practice as part of lifestyle intervention is emerging as an area of focus.  Samueli Institute, for example, recently reported its participation in a June community event in the Anacostia neighborhood of Washington, DC, focusing on local produce, nutrition and wellness.)

David Borsook, MD PhD, director of the P.A.I.N. Group at Boston's Children's Hospital was unambiguous in his recommendation: "It is time to get rid of conflicts and make this a center without reference to 'complementary.'  It is a negative.  National center for integrative health makes it much more defining for the future."

Dan Cherkin, PhD of Group Health Research Institute in Seattle and past director of research at Bastyr University Research Institute, attending his last meeting as an advisory council member said initially that "integrative health" was too ambiguous for his taste.  By the end of the discussion he offered this: "From the patient perspective, they want to go where the best options are available in an integrative fashion."

   
"Cherkin's comment is reflective
of the growing formation of new
or transformed MD-led clinics in
which integrative practitioners and
concepts are becoming more deeply
embedded into the practice."

-- Taylor Walsh
  
 
Noting the now strong majority of MDs among the members of the council (including those like Berman and Gaudet, and new council member Eric Schoomaker, MD, PhD, who have been integrative leaders for years, Cherkin's comment is reflective of the growing formation of new or transformed MD-led clinics in which integrative practitioners and concepts are becoming more deeply embedded into the practice.  In these cases, practices are offering greater emphasis on wellness and prevention, hoping perhaps, for the fulfillment of the Affordable Care Act promise of financial benefits that will come from keeping patients healthy.

This would appear to be the real world landscape that lies ahead for the new NCRCI (or NCIH) as it retains its focus on the services delivered by CAM/holistic/natural/and other "integrative" practitioners. 

The decision on the center's name ultimately awaits approval of NIH Director Francis Collins, MD.  Because the name change does not come with mission change, it is considered an administrative action and thus does not require congressional approval.  NCCAM is not certain when a final decision will be made and has no public schedule for implementation.

Comment
: An interesting discussion. As I shared in my comments
here, I am full-on wishy-washy on this topic. Don't look to me for guidance. Rather, I look in on this dialogue more a "sniper," a category of co-workers or family members to avoid, as my colleague, author and speaker Rick Kirschner taught me via his Dealing with People You Can't Stand. Be forewarned. Walsh's accounting stimulated these responses.

First, I was stunned by this:
"(Briggs) reported that during the consideration of a new name, NCCAM determined that the terms 'alternative' and 'complementary' were not used by consumers." This may be true of the "public" that responded to the proposal. But the "consumer"? I will bet good money that many times more individual human beings in the United States recognize the general fields NCCAM is charged, in the public service, to explore, recognize "alternative" more readily than either "complementary" or "integrative."

   
  Leaving out reference to anything "CAM "
may "get rid of conflicts" with deans
of medical schools and medical directors
of health systems. It may also be a way to
  ensure that "CAM" practitioners
are airbrushed from history.

 
Assuming this was correctly reported, one wonders how NCCAM came to this conclusion? If the "consumer" is limited only to those with a standing interest in the field who were drawn to comment on the NCCAM site, well, this is akin to assuming that the landed aristocracy represents all the vote-less peasants and miners. "Alternative medicine" is still what most people talk about.

Second, a related perspective regards the extent that open dialogue in NACCAM presently reflects all of the complementary and alternative fields NCCAM is charged to examine. To a very great extent, NCCAM has shunted aside its "CAM" advisers that are required by Section (b) of the NCCAM legislation
in favor of medical doctors and their academic medical center researcher colleagues. The section in the NCCAM mandate requires 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." Presently, 2 of 18 (11%) strictly fit this requirement. It is my best  judgement that 11% is less than "at least half."

Notably,
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, spoke up.
Note/Correction: following publication I heard from Guiltinan who said she did in fact speak out. She covered this ground in her comments: "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." My apologies to Guiltinan for not having included her perspectives in the original.
Thus what we hear in this discussion, interesting as it is, may be akin to a report on the views of Congress that come from only one side of the aisle. In the dialogue on which Walsh reports, the practitioner categories frequently called "complementary" or "alternative" - and who often view (rightly or wrongly) view "integrative medicine" as an MD fiefdom - had but token representation. That's a shame.

This leads me to my third comment, a pure pot-shot of a snipe, regarding the quote from Borsook that "it is time to get rid of conflicts and make this a center without reference to 'complementary.'"

   
Ironically, it is Briggs - who must
assume the greatest responsibility for the
under-representation of "CAM" practitioners
on NACCAM - who is here speaking up
for these disenfranchised.

 
 
For the past decade, newly minted and some elders among integrative MDs across the US have been slowly erasing "complementary" and "alternative" from integrative medicine's CV and its birth papers, even as in the same period these "CAM" practitioners have allowed themselves to be systematically shunted off their legal positions on NACCAM.

This renaming may "get rid of conflicts" with deans of medical schools and medical directors of health systems. It certainly paves the way to reshape "integrative medicine" as care that includes some mind-body interventions, fish oil, chamomile and integration of MDs, PTs, dieticians and psychologists.
Meantime, core conflicts that continue between the dominant school of medicine and the still largely excluded "CAM" professions relative to dominance, respect, inclusion, control and of direction of NCCAM, for that matter, of what we call 'health care,' are thereby airbrushed away. Buh-bye. 

Ironically, it was Briggs, during whose time as director invitations to serve on NACCAM to scientists from "CAM" disciplines has further atrophied, who is here speaking up for the disenfranchised.


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