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

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

Taylor Walsh

Integrative health and medicine consultant and

Naming NCCAM 2.0 

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.

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.