The Integrator Blog
Home
Share |
about
Contact Me, Experience, Mission, Sabbatical in Central America, plus
Editorial Advisory Board
Columnists
Bill Benda, MD
Michael Levin
Taylor Walsh
Daphne White, CHTP
background resources in PDF
Insurance, Integrative Clinics, Industry Summit Reports, News Files '99-'04
some organization links
Professions, Academia, Research, Policy
some CAM/IM publication links
Electronic, Peer-Reviewed, Blogs, More
Bradly Jacobs, MD, MPH, Revolution Health Blog
supported conference
Institute for Health & Productivity Management - Integrative/Complementary Healthcare
Organizations on NCCAM's Strategic Plan: IHPC, ACCAHC, AHMA, AANP, IAYT, NCH, AANMC and MTF PDF Print E-mail
Written by John Weeks   
Tuesday, 01 December 2009

Organizations on NCCAM's Strategic Plan: IHPC, ACCAHC, AHMA, AANP, IAYT, NCH, AANMC and MTF

Summary: That NCCAM's 2011-2015 strategic plan is critically important to the future of the integrative practice field is clear from this set of stakeholder responses. Together, these 8 organizations represent over 360,000 licensed practitioners: Integrated Healthcare Policy Consortium, Academic Consortium for Complementary and Alternative Health Care, American Holistic Medical Association, Association of Accredited Naturopathic Medical Colleges, International Association of Yoga Therapists, Massage Therapy Foundation, National Center for Homeopathy and American Association of Naturopathic Physicians. (The two consortia represent 22 separate partner or member organizations.) Notably, their comments are almost entirely supportive of the direction Congress mandated but in which NCCAM poorly invested under its first director. If this input is valued, NCCAM has significant stakeholder backing for complying with Congress' real pragmatic research mandate. 
Send your comments to
for inclusion in a future Integrator.

Related articles:

Image
The direction the NIH National Center for Complementary and Alternative Medicine takes with its 2011-2015 strategic plan is the most significant decision point for the integrative practice field since complementary, alternative and integrative medicine arrived on the national scene 15 years ago. The two articles above are evidence of the importance the Integrator gives the topic. This article, with full length submissions from 8 significant organizations - one of which is a consortium of 15 national organizations and another with 7 partner organizations - provides a significant look at NCCAM's most significant stakeholders. The submissions are from the:

  • Integrated Healthcare Policy Consortium
  • Academic Consortium for Complementary and Alternative Health Care
  • Association of Accredited Naturopathic Medical Colleges
  • International Association of Yoga Therapists
  • Massage Therapy Foundation
  • National Center for Homeopathy
  • American Association of Naturopathic Physicians

These responses are offered in full so community leaders can see the depth of their alignment. look for your own points of continuity. I offer some brief comments at the end.

Note: I have sought the submission from a variety of organizations, including the influential Consortium of Academic Health Centers for Integrative Medicine (which was the only organization which merited NCCAM mention in the strategic planning white paper) but the response was not available prior to this publication.

_________________________________________


Image1.  Integrated Healthcare Policy Consortium
(IHPC)

Synopsis: Integrated Healthcare Policy Consortium (IHPC) sent an "Alert" to their list with these key points: Now is the time for "tough love" as NCCAM should support research that facilitates the integration of CAM into mainstream healthcare and hasn't been; promotes more licensed complementary and alternative medicine practitioners on the NCCAM advisory council; urges funding for pragmatic, outcomes-based research that gathers "data on costs and other factors that payers and policymakers use when deciding what to include in their plans."
Dear [IHPC Alert recipient]:

NCCAM is listening...make your voice heard!


Right now, in the midst of Thanksgiving celebrations, we have an opportunity to influence the direction of what is arguably the most important federal agency for the field of integrated health care
.

   
  NCCAM is not just supposed to
support rarified reductionist science.
NCCAM is supposed to support research
that facilitates the integration of CAM
into mainstream healthcare. 

 
Most of you already know what NCCAM is, but let me remind us all. The National Center for Complementary and Alternative Medicine (NCCAM) at NIH is the ONLY Federal body whose primary job is exploring not only the effects of complementary and alternative medicine, but also its integration.  That is right, the legislation that created NCCAM says explicitly that this agency is charged with studying, “…the integration of alternative treatment, diagnostic and prevention systems, modalities, and disciplines with the practice of conventional medicine…and into health care delivery systems in the United States.”  NCCAM is not just supposed to support rarified reductionist science exploring the effect of a single herb out of a complex formula --  NCCAM is supposed to support research that facilitates the integration of CAM into mainstream healthcare. 

Take action now to help them remember that charge!


At IHPC we believe that NCCAM is a vital part of the movement for integrated, wellness-oriented healthcare. Members of the IHPC board were instrumental in the creation of NCCAM.

   
 
Time for tough love

We support NCCAM. And sometimes
support takes the form of tough love,
and now, while NCCAM is completing
Strategic Plan it is important for us to
help them fulfill their mission with some
forthright advice.

 
Please join us by sending a letter to NCCAM’s Director, Dr. Josie Briggs, and tell her that NCCAM needs to fulfill its mission in two important ways – and we have supported it ever since.  Sometimes support takes the form of tough love, and right now, while NCCAM is completing its next 5-year Strategic Plan and is calling for public comment it is important for us to help them fulfill their real mission with some forthright advice.

1)  As we have told them before, NCCAM must adhere to the law that created them and that specified that “… at least half of the members of the advisory council who are not ex officio members shall be licensed practitioners of 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.” The legislators required that NCCAM be advised not only by researchers, but mostly by patients and providers of complementary and alternative health care.  That was a stroke of wisdom when they wrote it, and it still is.

   
 
 NCCAM must start funding the pragmatic,
outcomes-based research that gathers
data on costs and other factors that
payers and policymakers use.

2)  NCCAM must start funding the kind of research that will facilitate the integration of CAM into mainstream health care delivery. This means pragmatic, outcomes-based research that gathers data on costs and other factors that payers and policymakers use when deciding what to include in their plans.

Both of these issues are named in the legislation that created NCCAM 10 years ago.  Now the legislature and you and I must hold NCCAM to their mandate. 

Take action now – by the end of Monday, November 30th – and send a clear message to both Dr. Briggs and to Senator Harkin, the Chair of the Senate HELP Committee which oversees NCCAM and its funding.

The action we take today will directly influence the direction NCCAM takes for the next five years.  Let’s create something now that we can all be thankful for in November of 2010, 2011, 2012, 2013 and 2014!

And thank you, for working with us on this.

Janet Kahn, PhD
Executive Director

Image2.  Academic Consortium for Complementary and Alternative Health Care (ACCAHC)


Synopsis:
Academic Consortium for Complementary and Alternative Health Care (ACCAHC) - Three main points: research on whole practices; research on "costs, cost-effectiveness, cost-offsets and cost-savings" and, third, investment in capacity in the licensed CAM fields, in "the expansion of investment in the development of researchers who are graduates of complementary and alternative medicine programs, particularly those who have a continued association with the accredited CAM schools."
Dear Dr. Briggs and Strategic Planning Team Members:
We are writing in response to your October 2009 solicitation of stakeholder input on the next strategic plan for the NIH National Center for Complementary and Alternative Medicine (NCCAM). Thank you for your preliminary work and for this opportunity to respond.

The 12 core ACCAHC member organizations (see left column) serve the distinctly licensed complementary and alternative healthcare disciplines of chiropractic medicine, acupuncture and Oriental medicine, naturopathic medicine, massage therapy and direct-entry midwifery. In addition, ACCAHC’s members include 3 organizations from non-licensed Traditional World Medicines fields of yoga and Ayurvedic medicine that are engaging in self-regulatory efforts. The ACCAHC disciplines provide the majority of the complementary and alternative medicine and integrative services for consumers in the United States. Similarly, 187 of our universities, colleges and programs are accredited through specialized U.S. Department of Education-recognized accrediting agencies. These institutions are the educational providers for the vast majority of future integrative practitioners. We view ourselves as a significant NCCAM stakeholder.


We have identified the following three areas as the top, shared priorities for research investment across our licensed professions. We believe that investment in these three areas will have the most potentially positive impact on US healthcare.


   
 We need to learn more about
the real world outcomes of these
disciplines in order to understand
the experience of consumers and
the value of these practices in
healthcare delivery.

 
1. Research on whole practices– We need to learn more about the real world outcomes of these disciplines in order to understand the experience of consumers and the value of these practices in healthcare delivery. We urge the evaluation of the effectiveness of the actual, multi-dimensional practices of the members of these disciplines. A subset of this exploration could include evaluating the preventive outcomes of the clinical approaches that are a common orientation of integrative healthcare practitioners in the ACCAHC disciplines. These whole practices frequently include many of the lifestyle-related interventions that are recommended to combat numerous chronic diseases.

2. Costs, cost effectiveness, cost-offsets and cost-savings – Cost to consumers and to third-party payers is a critical issue regarding access to integrative healthcare/integrative medical services provided by practitioners from the ACCAHC disciplines. Cost implications of including the services of members of these disciplines are central components of decision-making processes for insurers, employers, legislators and government agencies as well as administrators and medical directors of hospitals and clinics. These stakeholders would find significant, practical value in information on costs, and particularly cost-offsets, as they continue to expand the integration of the services of these licensed practitioners into payment and delivery systems.

   
  Insurers, employers, legislators and
government agencies as well as
administrators and medical directors
of hospitals and clinics would find
significant, practical value in information
on costs, and particularly cost-offsets
.
 
3.  Capacity – We urge the expansion of investment in the development of researchers who are graduates of complementary and alternative medicine programs, particularly those who have a continued association with the accredited CAM schools. Our disciplines have gained significant new experience from programs supported by conference grants and by the education awards that assisted the development of evidence-based medicine curriculum, research activity in our faculty and students, and partnerships with conventional academic health centers. Graduates of a growing number of our universities, schools and programs are benefitting from NCCAM’s development awards. These have been extremely meaningful, even as NIH investment in conventional academic health centers starting a half-century ago has transformed those institutions. One focus of grants and awards could be on developing expertise in methodologies and practices for evaluations in the areas recommended in #1 and #2, above.

The NCCAM’s 1998 mandate from Congress appears to be remarkably supportive of these priorities. We note Congress’ prioritization of evaluation of outcomes and health services research. Congress calls repeatedly for the evaluation of each of the licensed CAM disciplines and, specifically, their integration with conventional medicine and into delivery systems. The mandate urges evaluation of preventive approaches, and also notes the importance of investment in personnel as a necessary means to all of these ends.

A number of healthcare trends, beyond the common interests and needs of the ACCAHC disciplines, support these recommendations for NCCAM’s strategic plan.  Among these are an increased awareness of the multi-factorial nature of care for costly chronic diseases, the heightened focus on healthcare costs and the importance of comparative effectiveness research.  In addition, the emergence of “integrative medicine” in conventional medicine has prompted an overlapping interest in the evaluation of whole practices, whole systems, interventions related to wellness and healing, and factors related to their appropriate integration with delivery systems.

   
The timing is auspicious for these
priorities because a growing number
of researchers directly related to
these disciplines now have experience
of the NIH culture and have participated
in the NIH mission as advisers,
reviewers, applicants for grants
and as funded researchers.
 
 
Finally, this timing is auspicious for these priorities because a growing number of researchers directly related to these disciplines now have experience of the NIH culture and have participated in the NIH mission as advisers, reviewers, applicants for grants and as funded researchers. Researchers and institutions associated with ACCAHC disciplines are better equipped than they were in 1998 to partner, counsel and lead these evaluations which Congress urges. We anticipate that such a prioritization will continue to excite increasing interest in research endeavors among the students, faculty and clinicians from the ACCAHC disciplines.

Thank you for this opportunity to participate. Please do not hesitate to contact us if we can provide you with further information that will assist NIH NCCAM’s strategic planning process.


Sincerely,

Elizabeth A. Goldblatt, PhD, MPA/HA             David O’Bryon, JD
ACCAHC Chair                                            ACCAHC Vice-Chair 

Image3.  American Holistic Medical Association (AHMA)


Synopsis:
American Holistic Medical Association (AHMA): Shift to outcomes-based research from the past; promotes name for NCCAM change to "something like" National Center for Integrative Medicine; states "fundamental research on application of integrative holistic practices to produce positive health outcomes" should be NCCAM's focus; speaks to importance of use of systems research methodologies to address systemic problem; plus, "enhanced development of the researcher pipeline and a focus on cost issues with respect to holistic/integrative/CAM coverage."
Dear Dr. Briggs and NCCAM Committee:  
We are writing in response to your call for stakeholders in the field of CAM to provide input regarding the next Five-year Strategic Plan for NCCAM.  We want to thank you for this consideration and the opportunity.

The American Holistic Medical Association has been in existence for 31 years, and our mission and purpose continues to be the transformation of the health care system to a more holistic, integrated and sustainable system focused on health and wellness.  Our focus is both holistic, in the sense of emphasizing the interconnectedness between all aspects of one’s being, and integrative, supporting the inclusion of scientifically sound, grounded CAM approaches to our healthcare services.  Our leaders have consisted of many of the pioneers in the field – Norm Shealy, Bernie Siegel, Christiane Northrup – and we remain committed to this same path of leadership.

In recent years, we have taken the lead in establishing collaborative partnerships within the ever-expanding arena of integrative health organizations, and we have sought to move the integrative ball forward by broadening our membership from a historically MD/DO organization to an inclusive membership model that embraces all doctorate level practitioners and licensable CAM practitioners.
 
   
 NCCAM has fallen short on some
essential areas.  Research has largely
along the lines of standard NIH policies
or reductionism, looking for mechanisms
of action, and randomized double-blind
placebo-controlled trials.

The very nature of integrating multiple
modalities into standard medicine and
then looking for long term positive
results on health requires patience and
a new look at outcomes research.


 
We are appreciative of many of NCCAM’s efforts over the past decade, particularly in the areas of legitimizing research in the area and providing public information.  However, NCCAM has, in our opinion, fallen short on some essential areas.  First, research has largely been along the lines of standard NIH policies or reductionism, looking for mechanisms of action, and randomized double-blind placebo-controlled trials. Many of these policies, particularly the research standards, are not amenable to much of what defines integrative or holistic practice.  There are numerous papers available to offer ways to pursue more meaningful research in integrative medicine.  Much of this will be in the areas of multiple holistic approaches to reach a positive measurable endpoint, not merely just testing a single modality or agent.  Second, the public information being listed as “complementary or alternative medicine (CAM)” is counter to our philosophy.  We realize “CAM” is in your title but believe it should be taken out for a better term such as National Center for Integrative Medicine”. CAM is a marginalizing term put forth by standard allopathic medicine and our intent is to remove this term in favor of integrating what works into mainstream medicine.  The public certainly doesn’t look at these modalities as marginal to their health and they speak strongly with their personal income choices.

The very nature of integrating multiple modalities into standard medicine and then looking for long term positive results on health requires patience and a new look at outcomes research.  Our current healthcare system is in trouble in that we continue to apply quick fixes, at great cost, where fundamental (but time delayed) solutions are called for.  We believe fundamental research on application of integrative holistic practices to produce positive health outcomes is where the basic focus of NCCAM should be.  In fact, our reading of the original mandate from Congress supports this direction.

To that end we would like to offer strong support for a shift toward Outcomes-Based Research.

As our healthcare and political systems have wrestled over the last decade with the role of CAM, much of the focus has been on research for specific therapeutic interventions, and NCCAM’s agenda has appropriately mirrored this perspective.  However, we feel that an increased emphasis on outcomes research serves the NCCAM Congressional mandate more directly, serves the CAM field more accurately, and serves the future of healthcare in America more appropriately.

Currently, we have a much stronger national discussion emerging on the links between health outcomes and lifestyle, and we believe that outcomes research can more appropriately address these issues.  The current administration has championed the theme of funding “what works” as a centerpiece of new healthcare directions, and the data is unequivocal that the overwhelming majority of health conditions driving healthcare dollars are primarily creations of lifestyle.  Heart disease, diabetes, pain syndromes, respiratory disease – we all know the list.  They have escalated in prevalence due to the skyrocketing rates of obesity, sedentary lifestyle, lack of sleep, poor stress management tools, and lack of support and social interconnectedness in an increasingly fragmented world.

   
  Lifestyle issues are inextricably woven
together, interconnected in a way
that a reductionist philosophical approach
simply cannot adequately address.
 

The current research avenues that are philosophically and methodologically grounded in a reductionist model serve the aspects of health and illness that the conventional medical system addresses quite well:  trauma, emergency medicine, acute disease.  But, lifestyle issues are inextricably woven together, interconnected in a way that a reductionist philosophical approach simply cannot adequately address.   We eat poorly because we’re stressed and tired; we don’t exercise because we’re tired and aren’t sleeping well… The problem itself is a systems problem, so the methodology to address it must be a systems methodology.  This is the real world of healthcare delivery that has been so systematically de-emphasized over the past decades in the form of decreased time spent with patients and compartmentalized sub-specialization.

You have outlined in the 2009 NCCAM White Paper that outcomes research is indeed a priority and suggested that one of the primary obstacles is this long-standing emphasis on basic, reductionist biochemical research as espoused by a significant number of voices within the NIH and the mainstream community.  We are suggesting that a possible way out of this polar debate is a re-framing of the argument that emphasizes the enormous contribution that outcomes research would make toward solving the current healthcare crisis.  It should be seen as an approach that serves not just the potential integration of CAM modalities and treatments into our healthcare structure, but as one that directly and most appropriately addresses the core issue already identified as the root of the problem:  how we systematically support and promote healthy lifestyle change.

Further, an emphasis on outcomes-oriented research actually conforms to the original charge given to NCCAM.  The charge to have at least 50% of the Advisory Council consist of clinical practitioners (in addition to consumer advocates), the listing of “Outcomes Research and Investigations” at the very top of the activity goals, and the repeated emphasis on “research on prevention modalities and systems” underscore the political mandate available.

   
We echo the calls from other
stakeholders for increased investment
in researcher development via
accredited CAM/Integrative
training programs.

 
Additional support structures for an emphasis on outcomes research would include enhanced development of the researcher pipeline and a focus on cost issues with respect to holistic/integrative/CAM coverage.  We echo the calls from other stakeholders in this discussion, such as the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), for increased investment in researcher development via accredited CAM/Integrative training programs, as well integrative practitioner centers, to provide additional means through which this research can be accomplished.  At NCCAM’s inception “integrative centers” were just organizing and becoming functional, and organizations such as the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) did not even exist.  There is a growing abundance of facilities and centers for outcomes research, not to mention extensively developed systems research approaches that can address the previously difficult barriers to application for healthcare treatments.  This brings up another possibility of initiating cooperative group research, modeled after the highly successful cancer cooperative groups such as ECOG for adults or COG for children.  Such cooperative research in integrative medicine would accumulate numbers faster and in a more standard fashion and allow multiple studies to proceed simultaneously.

The cost issues relate to the research issues in a mutually supportive way.  Emphasis on outcomes research can provide the needed data to support appropriate extension of cost coverage into the holistic/integrative/CAM arenas, and improvement in these cost issues in turn helps create financially sustainable centers and programs for further research.

We appreciate greatly the work that NCCAM is continuing to accomplish, and we are excited about the potentials and new directions now being discussed.  We believe the current climate may provide fertile ground for further success, and we look forward to the changes of these coming years.

We consider ourselves a willing collaborative partner, and if we can be of any assistance in NCCAM’s needs and goals, please contact us.

Sincerely
,

J. David Forbes, MD

President, American Holistic Medical Association

4.  Association of Accredited Naturopathic Medical Colleges
(AANMC)

Synopsis:
Association of Accredited Naturopathic Medical Colleges focused on: preventive-oriented services and complexity of related research; research on the whole systems of treatment i9ncluding a short list of studies exemplifying the outcomes approach); research on the cost-effectiveness of naturopathic treatments; and a request for research on naturopathic care for two specific conditions, diabetes and oncology.
Dear Dr. Briggs and Strategic Planning Team Members:

I am writing on behalf of the Association of Accredited Naturopathic Medical Colleges (AANMC) in response to your October 2009 solicitation of stakeholder input on the next strategic plan for the NIH National Center for Complementary and Alternative Medicine (NCCAM). Thank you for the opportunity for input, and the leadership that you are demonstrating in assessing and guiding research needs within the complementary and alternative medicine field.

   
 The medical system requires a greater
focus on preventive care and the boosting
of the overall level of health of American citizens. 
The most effective therapies to achieve this
are frequently complex to research.

 
The AANMC is an organization in which membership is limited to institutions that have been accredited by, or are in candidacy status with, the Council on Naturopathic Medical Education, the programmatic accrediting agency recognized by the Department of Education.  Naturopathic medicine is a system and philosophy of medicine that has been in use for over 100 years.  Graduates of these programs have completed four-year intensive medical training and are qualified to serve as primary care physicians, having comparable knowledge and skills in the basic and clinical sciences to conventional medical doctors. In addition, NDs receive training in a variety of core treatment methods including nutrition, botanical medicine, homeopathy, pharmacology, physical therapy, and minor office surgical procedures.

There is no question that the medical system requires a greater focus on preventive care and the boosting of the overall level of health of American citizens.  The most effective therapies to achieve this are frequently complex to research within an environment in which reductionist techniques aimed at single agents or single treatments are easier to study.  Nonetheless, the rigor of whole systems methodologies have developed to where the results of these studies are providing strong evidence for the efficacy of these approaches.  Furthermore, the outcomes data from these studies can be used for further research on the comparative costs and benefits of these approaches. See:
Cooley K, Szczurko O, Perri D, Mills EJ, Bernhardt B, et al. (2009) Naturopathic Care for Anxiety: A Randomized Controlled Trial ISRCTN78958974. PLoS ONE 4(8): e6628. doi:10.1371/journal.pone.0006628

Szczurko O, Cooley PK, Mills EJ, Zhou Q, Perri P, Seely D. Naturopathic Treatment of Rotator Cuff Tendonitis Amongst Canada Post workers: A randomized controlled trial. Arthritis Rheum. 2009 Jul 30; 61(8):1037-1045.

Szczurko O, Cooley K, Busse JW, Seely D, Bernhardt B, Guyatt GH, Zhou Q, Mills EJ. Naturopathic care for chronic low back pain: a randomized trial. PLoS ONE. 2007 Sep 19; 2(9):e919.

Cramer EH, Jones P, Keenan NL, Thompson BL. Is naturopathy as effective as conventional therapy for treatment of menopausal symptoms? J Altern Complement Med. 2003 Aug; 9(4):529-38.

Herman PM, Szczurko O, Cooley K, Mills EJ. Cost-effectiveness of naturopathic care for chronic low back pain. Altern Ther Health Med. 2008 Mar-Apr; 14(2):32-9.
In support of research of this nature, the AANMC would recommend the following priorities:

  •    
     
    For a medical system based on expenditure,
    change generally only occurs where there is
    a financial advantage that can be gained. 

    Nonetheless, there is surprisingly little
    research assessing the economic impact
    of systems of treatment.

    Research on whole systems of treatment.  As noted above, the sum is frequently much greater than the parts.  However, it is not true that all whole systems treatment is more effective, or indeed effective at all.  Determining what should be supported requires high-quality outcomes based research focused on systems of treatment.

  • Research on the cost effectiveness of naturopathic treatments.  For a medical system that is based on expenditure, meaningful change generally only occurs where there is a financial advantage that can be gained.  Nonetheless, at this point there is surprisingly little research assessing the economic impact of systems of treatment.

  • Research related to the impact of naturopathic treatments on diabetes.

  • Research related to the burgeoning field of naturopathic oncology.

Thank you again for the opportunity to provide input to the development of the strategic priorities for NCCAM.

Sincerely,

Bob Bernhardt, BSc, Med, LLM, PhD
President

Image5.  International Association of Yoga Therapists
(IAYT)


International Association of Yoga Therapists: specifically supports ACCAHC's 3 recommendations; stresses “real world” priorities for research on Yoga based upon two factors in the NCCAM solicitation ("scientific promise" and "extent and nature of practice and use").
Dear Dr. Briggs and the Strategic Planning Team,

We are writing in response to your solicitation of stakeholder input into Priority Setting for the next strategic plan for the NIH National Center of Complementary and Alternative Medicine. The International Association of Yoga Therapists (IAYT), with 2,300 members in the U.S. alone, serves as a professional organization for Yoga teachers and Yoga therapists worldwide. Membership has tripled since 2003. We have published the International Journal of Yoga Therapy since 1990, the only professional and scientific journal dedicated to Yoga as a healing practice. IAYT has also hosted an annual Symposium on Yoga Therapy and Research (SYTAR) since 2007, attracting an average of over 600 participants each year. We see ourselves as a significant stakeholder in NCCAM.

   
We note the role Yoga can play
in integrative approaches to healthy lifestyle
changes, including stress management.


 
First, we are writing in support of the top shared priorities identified by the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). They apply to Yoga as well as the licensed CAM disciplines.
• Research on whole practices
• Costs, cost effectiveness, cost off-sets and cost savings
• Infrastructure and capacity – including the development of researchers in both licensed and unlicensed fields
Yoga therapy is an emerging profession in the U.S., actively engaged in the self-regulatory process. IAYT has been a member of the ACCAHC since 2006. Together with the Yoga Alliance (YA) and the National Ayurvedic Medical Association (NAMA), we are the Traditional World Medicines Group within ACCAHC.

Second, we are writing to stress the “real world” priorities for research on Yoga based upon two key factors identified in the solicitation – Scientific Promise and Extent and Nature of Practice and Use.

Scientific Promise

First, we note the role Yoga can play in integrative approaches to healthy lifestyle changes, including stress management. Perhaps the most well known example is in the work of Dean Ornish, MD, and colleagues at the Preventive Medicine Research Institute. Yoga inspired the practices for stress management - stretching, deep breathing, meditation and deep relaxation. Those lifestyle changes have been shown to reverse coronary heart disease and effect the progression of early low grade prostate cancer. (1) As Dr. Ornish recently testified, the potential for such integrated approaches for disease prevention is enormous. “Last year, $2.1 trillion were spent in this country on medical care, or 16.5% of the gross national product and 95 cents of every dollar were spent to treat disease after it had already occurred. Heart disease, diabetes, prostate cancer, breast cancer and obesity accounts for 75% of these health care costs, yet these are largely preventable and even reversible by changing diet and lifestyle.” (2)

   
  There are numerous opportunities for
explicit uses of Yoga for mental health,
cardiovascular health, musculoskeletal
and neurologic disorders, coping with
cancer and other life threatening diseases
and much more.


   
   
Second, as presented at a recent scientific Symposium on Yoga as a Therapeutic Intervention at the May 2009, North American Research Conference on Complementary and Integrative Medicine (NARCCIM), there are numerous intriguing opportunities for explicit uses of Yoga for mental health, cardiovascular health, musculoskeletal and neurologic disorders, coping with cancer and other life threatening diseases and much more.(3) While the popular practice of Yoga has passed the “market test”, these therapeutic applications of Yoga need more research in order to gain a deeper scientific understanding and support for wider acceptance and utilization by our healthcare system.(4) There is significant interest in Yoga research. There were 100 people in the audience at that Yoga symposium at NARCCIM. At IAYT’s own annual Symposium on Yoga Therapy and Research, the research track has drawn about 50 attendees three years in a row (2007-2009), mostly Yoga researchers. In the past two conferences, over 40 research abstracts were submitted each year for oral or poster presentation. There is also widespread and growing scientific interest in meditation for health purposes. For example, note that on July 8–9, 2008, NCCAM held a 2-day workshop in Bethesda, Maryland on meditation for health purposes. It was co-sponsored by the National Cancer Institute (NCI), the National Institute on Aging (NIA), the NIH Office of Behavioral and Social Sciences (OBSSR), and the Canadian Institutes of Health Research (INMHA, ICRH). (5)

Extent and Nature of Practice and Use.

Yoga is a well known and popular CAM therapy, practiced by 6.1% of the adult population.(6) Two other classic Yogic practices are also very popular, deep breathing, at 12.7 %, and meditation at 9.4%. Moreover, these practices represent three out of four top ten CAM therapies that showed significant increases from the same study done five years earlier. (7) Yoga can be a fitness practice, a wellness practice, a therapeutic practice and/or a spiritual practice. While Yoga is not “healthcare” as conventionally viewed, the practice is used by over 15 million adults as an enjoyable and low cost means to help maintain their health and complement their healthcare. (8) As an example, we are pleased to note that pictures of individuals practicing Yoga are prominently featured on the NCCAM website.

Thank you for the opportunity to participate. Please feel free to contact us if we can provide you with further information that will assist the NIH NCCAM strategic planning process.


Sincerely,

John Kepner, MA, MBA                                      Matthew J. Taylor, PT, PhD
Executive Director                                            President, Board of Directors
1 Preventative Medicine Research Institute website. www.pmri.org/research.html. November, 28, 2009.
2 Dean Ornish, MD. US Senate Healthcare Reform Testimony on Integrative Care: A Pathway to a Healthier Nation. February 26, 2009. Reprinted in the International Journal of Yoga Therapy, No 19, (2009), pp 43-46.
3 Khalsa, Sat Bir Singh. Presentation at the Symposium on Research on Yoga as a Therapeutic Intervention, May 13, 2009, North American Research Conference on Complementary and Integrative Medicine.
4 Khalsa, Sat Bir Singh. “Why Do Yoga Research: Who Cares and What Good is It?” International Journal of Yoga Therapy, No 17, (2007), pp 19-20.
5 Meditation for Health Purposes Workshop — July 8–9, 2008. Executive Summary. NCCAM website, November 28, 2009.
6 Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007, Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12, 2008.
7 Khalsa, Sat Bir Singh. Presentation at the Symposium on Research on Yoga as a Therapeutic Intervention, May 13, 2009, North American Research Conference on Complementary and Integrative Medicine.
8 Yoga Journal releases 2008 “Yoga in America” market study, Yoga Journal press release, 2/28/2008.

Image6.  Massage Therapy Foundation
(MTF)


Synopsis: Diana Thompson, LMP, president of the Massage Therapy Foundation (MTF) responded to NCCAM via the NCCAM website. MTF is the leading research voice for the massage field and sponsors the most significant research meeting for the field. Thompson re-constructed her comments, based on the questions asked on the NCCAM site, for the Integrator. MTF made these key points: said there was a "greater and more immediate" need for outcomes research than for basic research; reductionist methods don't capture massage as practiced; value of massage goes beyond the pain focus of interest at NCCAM; requested support to mentor massage therapists as researchers; and sought programs to help massage therapists get access to scientific evidence.
Response to NCCAM Paper One

1. NCCAM statement: Major features of the current CAM research landscape that are important in considering future strategic directions for NCCAM and the field of CAM research in general: 
   
 
While basic/mechanics studies contribute
to the body of knowledge, there is a greater and
more immediate need for outcomes research.

While basic/mechanics studies are informative and contribute to the overall body of knowledge, there is a greater and more immediate need for outcomes research. Consumers are already using CAM therapies and while use may shift slightly from one herb to another with more basic science information, choices to incorporate most body-based or body-mind therapies will continue as is. Safety is also less of a pressing issue with these modalities. The public may benefit more from comparative, cost effectiveness, and integrative studies. There is a need to educate the medical system on how to refer, when to refer, and to whom and to educate the public on which therapies may best contribute to their goals for health.

2. NCCAM statement: Particular needs and opportunities of importance to NCCAM's efforts in research capacity building:
   
A mentorship program could be
established to reward research
institutions for engaging
practitioners into existing
research opportunities.
 
 
Professions that are not based in traditional academic institutions do not have access to traditional research training. For example, massage therapists seeking a PhD find themselves in programs often unrelated to their clinical practices, such as nursing, sociology and psychology. While the R25 offers many possibilities, a mentorship program could be established to reward research institutions for engaging practitioners into existing research opportunities and stimulating interest in pursuing advanced degree programs that can find a way to fit into their professional interests.

3. NCCAM statement: Opportunities, obstacles, and NCCAM's future role in supporting research on approaches to improved states of general health and well-being:
   
  The current reductionist method
of research does not adequately
address many CAM therapies, in
particular, it does not represent
massage therapy as practiced.
 

The current reductionist method of research does not adequately address many CAM therapies, in particular, it does not represent massage therapy as practiced. Disease is often complex, patients are often complex, and treatment must be modified to address the needs of each individual. In addition, rarely do patients choose one or another modality, but rather create a palette of complementary therapies, each addressing one aspect of their needs or building on each other to provide a desired result. Realizing that this is an expensive proposal, perhaps NCCAM can devote funds to study “add-ons”, for example, diet, exercise, and massage therapy, with the hypothesis that people make better choices if self-worth is improved. Studies on adherence or compliance could be valuable in complex settings or in wellness and prevention studies. Massage therapy is currently being relegated to pain management studies, a role massage plays a part in, but there is much more that massage can contribute—to integrative medicine, to public health, etc. Studies are demonstrating the role of massage in relieving depression and anxiety, more so than pain, and more can be explored in regards to the role of massage in improving self-worth, self-esteem, and people’s ability to make healthy choices.
Response to NCCAM Paper Three

2. NCCAM statement: The major unmet needs of health care providers in accessing, interpreting, and making use of research evidence about CAM:
Massage therapy research is published in a myriad of professional journals: orthopedic, neurological, and nursing to name a few, even though there are now two publications specific to massage and bodywork research. In addition, massage education does not take place in traditional academic institutions, making access to these journals cost prohibitive and nearly impossible. There could be funding to allow universities to share database access to CAM educational institutions not already aligned with public academic institutions.

Image7.  National Center for Homeopathy (NCH)

Synopsis
:
National Center for Homeopathy (NCH): specific program announcement on basic, preclinical and clinical/outcomes research on homeopathy; use of reviewers experienced in homeopathy; scientific information about homeopathy on the NCCAM website; opportunity to submit names for possible appointees to the NCCAM advisory council.
Dear Dr. Briggs, members of the Strategic Planning Team, Ms. Thompson,

As President of the National Center for Homeopathy, I am writing on behalf of my organization, in response to your request for stakeholder input for the 2010 strategic plan of NCCAM.

   
NCCAM has a Congressional mandate
to identify, investigate and validate
complementary and alternative treatment,
diagnostic and prevention modalities,
disciplines and systems.
 
 
The National Center for Homeopathy is an open membership organization that supports and promotes the cause of homeopathy in the United States. We do this through educating about homeopathy, publicizing the effectiveness and therapeutic benefits of homeopathy and ensuring that access to homeopathic medicines is protected. Our members are 5,000 strong and growing daily in response to the trend toward self care using safe and effective medicines for self limiting conditions and for primary care providers who practice prevention and wellness in an integrative environment. Our members represent those stakeholders whose interests echo those of the recent IOM summit attendees. They want patient centric, individualized medicine. They want an integrative model and they want cost effectiveness. Your recent NIH study revealed that some $33 billion are spent out-of-pocket yearly on CAM products, homeopathy included. The NCCAM has a Congressional mandate to identify, investigate and validate complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems. Homeopathy is listed on the NCCAM website as a whole system of medicine and, in my opinion, must be a priority consideration. The NCH has a moral mandate to ensure that our members, consumers and practitioners are the recipients of homeopathic research and the dissemination of educational materials based on existing research and evidence.

Our suggestions for implementation into the 2010 Strategic Plan are as follows:

  • The writing of a specific program announcement around basic, preclinical and clinical research on homeopathy. For example, in basic science, methodology-oriented grant proposals. In clinical research, methodological approaches such as those  by Frei (pre-testing subjects and showing clinical responsivity before allocating subjects into double-blind placebo controlled trials) and Walach (open label studies to avoid entanglement, specific analytical approaches to differentiate active from placebo and Bell ( psychophysiology during intervention).  Large scale observational studies such as those done by Claudia Witt are critical to showing effectiveness in the real world.  There could be a program announcement specifically on outcomes research with observational longitudinal design, cost effectiveness and safety issues as the focus. It is equally important to consider reviewers with scientific homeopathic background.

  •    
     
    We suggest the writing of a specific
    program announcement around basic,
    preclinical and clinical research
    on homeopathy.

    Public Law 105-277, the NCCAM mandate, SEC. 485D, (b) calls for an Advisory Council members of whom are not ex officio “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.”  The membership of the National Center for Homeopathy is unique in that it includes licensed practitioners, nationally certified practitioners and consumers.  As such, the NCH would respectfully request the opportunity to submit a roster of names for consideration for placement on this Advisory Council.

  • SEC.485D, (g), Clearinghouse (1) DATA SYSTEM, - calls for the Director to establish a bibliographic system for the collection, storage, and retrieval of worldwide research relating to complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems. Such a system shall be regularly updated and publicly accessible.” Currently, there is no such information on homeopathy available although a plethora of such research does exist. We suggest that updating the data be a priority for the 2010 Strategic Plan so that consumers have access to information that both educates them and allows them to make informed decisions regarding their health care.

On behalf of myself and the membership of the National Center for Homeopathy, I want to thank you for the opportunity to participate in the planning process.  Please be assured that we stand ready to be of assistance to you at any time should you so require.

Respectfully submitted,

Nancy Gahles, D.C., CCH, RSHom(NA)
President, National Center for Homeopathy

Image8.  American Association of Naturopathic Physicians (AANP) 

Synopsis:
American Association of Naturopathic Physicians urged: Development and funding of outcomes-based research initiatives that demonstrate how (primary care organized on naturopathic principles) will enable the "transformation of our disease-based system into one that is rooted in sustainable health and wellness;" research utilizing practice-based research networks; inclusion of appropriately trained professionals on NCCAM's advisory council and in peer review; and examination of cost issues.
Introduction

While conventional medicine’s focus on treatment of disease has produced many benefits, especially in acute and life-threatening conditions, its effectiveness for the treatment of chronic disease or the promotion of health is limited. This limitation has been a major cause of the out-of-control healthcare costs plaguing the nation.

   
What is required is the funding of
outcomes-based research initiatives
that demonstrate how this care will
enable the transformation of
our disease-based system.
 
 
There is, at present, a severe shortage of primary care physicians. A number of proposals have been put forth as to how to fill that shortage and many of these are aimed at increasing the number of medical students going in to primary care.  However, there are also a number of proposals to utilize the skills of other licensed healthcare practitioners to  expand access to patient-centered primary care in both federally funded and private health care offerings—e.g., naturopathic physicians (NDs).  What is now required is the development and funding of outcomes-based research initiatives that demonstrate how this care will enable the transformation of our disease-based system into one that is rooted in sustainable health and wellness.

Naturopathic medicine is a system and philosophy of medicine that has been in use for over 100 years. The American Association of Naturopathic Physicians (AANP) represents licensed naturopathic physicians who are trained at fully accredited four-year, residential medical programs.  Graduates of our medical schools serve as primary care physicians and have the same training in the basic and clinical sciences as conventional medical doctors. In addition, NDs receive training in a variety of core treatment methods including nutrition, botanical medicine, homeopathy, pharmacology, physical therapy, and minor office surgical procedures. Some licensed naturopathic physicians are also trained in traditional Chinese medicine, acupuncture and Ayurvedic medicine as well as clinical specialties such as natural childbirth. Therefore, naturopathic medicine and NDs provide the ideal laboratory to test a complement to the present primary-care-deficient model of health care.

The Changing Role of Natural Medicine

As NCCAM evaluates its existing strategic direction for the next five years, it is essential to recognize the dramatically changing landscape of the “complementary and alternative” (CAM) world.  Terminology and practices are shifting daily, opening new doors and breaking down barriers.  Practitioners of natural medicine and alternative therapies continue to organize themselves professionally and academically.  In addition, there is growing acknowledgement and acceptance of these practices in the more conventional environments, as is evidenced by the utilization of terminology that includes integrative medicine and integrative health – terminology that is utilized by conventional and non-conventional providers alike.

   
   How NCCAM responds to integration of
‘alternative’ and ‘conventional’ medicines
stands to dramatically impact the
development of a sustainable health
care system.
How the research community and NCCAM itself respond to integration of ‘alternative’ and ‘conventional’ medicines stands to dramatically impact the development of a sustainable health care system. 

Integration holds the potential for a newly defined worldview of wellness, increasing acceptance of treating the whole person and systemically valuing true prevention and the body’s ability to heal at a time when chronic disease promises to cripple our financial future.  Yet it is essential to note, research initiatives that are successful in demonstrating effective integration of conventional and natural medicine will require continued commitment to educational and testing standards by the professions, and established research protocols that recognize the underlying principles associated with each profession.  The Commonwealth Working Group on Traditional Complementary Health Systems at the University of Oxford, in a study of developing countries across Asia, India and Africa, found that successful integration of CAM and conventional medical systems requires the professions to first self-regulate standards of practice and training (Bodeker, 2001). 

AANP, along with many of the other CAM professional organizations, stand committed to establishing standards on par with that of their allopathic counterparts.  In addition, the study concluded that the central regulation of natural products through good manufacturing practices and sound research is essential to effective integration efforts (Bodeker).  Viable pathways towards effective integration of ‘alternative’ care into the conventional paradigm should be viewed with careful consideration.  Why?  In China, it was demonstrated that domination of conventional medicine can result in the dilution of traditional philosophies and practices, compromising the quality of education (Bodeker, 2001).  Today, existing research initiatives fail to incorporate the relevance of philosophy to both the practitioner and the health care outcomes of the patient – ergo, the relationship of the naturopathic physician to his or her patient is undervalued in the current effectiveness evaluation scales.

We strongly encourage thoughtful development of research paradigms that are 1) outcomes-based, 2) incorporate the importance of philosophy and education, 3) evaluate the provider/patient relationship, and 4) serve to redefine and quantify the standard interpretation of health and wellness programs.

NCCAM Capacity to Conduct Effective and Representative Research

   
 NCCAM has an enormous opportunity to
meet its stated mission on the composition
of the Advisory Council, availing itself of
“appropriate expertise” and including accredited
and licensed professions in the evaluation
of alternative and complementary treatment.

 
The Center has an enormous opportunity over the course of the next five years to meet its stated mission relating to 1) the composition of the Advisory Council, 2) availing itself of “appropriate expertise” from the CAM scientific realm, and 3) the call to include accredited and licensed professions in the evaluation of alternative and complementary treatment.  In the naturopathic medical field alone, the number of qualified researchers, the research programs at accredited institutions and the number of naturopathic physicians practicing in integrative environments has grown dramatically.  NCCAM, and the federal agencies that are best suited to partner in CAM research initiatives, should avail themselves of the numerous high-quality, cost-effective medical practice patterns of highly skilled physicians and practitioners for the purpose of conducting quality, outcomes-based research.  Expanding NCCAM’s worldview of developing research initiatives and private sector offerings, could significantly impact the types of projects undertaken across federal agencies, and substantially add to the growing body of research on outcomes and effectiveness of naturopathic treatment.

In April 2009, the AANP submitted testimony to the Federal Coordinating Council for Comparative Effectiveness Research on its commitment to outcomes research, the determination of best practices and the need to fund evaluation of alternative systems of healthcare.  We specifically proposed funding of health information technology and electronic medical records in a practice-based research network (PBRN) containing both conventional and naturopathic medical practices to compare “real world” effectiveness and cost-effectiveness for type 2 diabetes.  Creation of this PBRN has been initiated, and will include collaboration with other private and public sector research and academic institutions.  The proposal calls first for retrospective and pilot prospective studies to test the feasibility of protocols based on an informatics approach to naturopathic medicine outcomes research and to characterize the populations before going on to more definitive study.  If there are positive results with comprehensive treatment, the treatment and the outcomes data can be examined for factors associated with improvement.

Comparative Effectiveness Research:  A Case Study

The initial proposal is for a study on type 2 diabetes (T2D). T2D is epidemic and often inadequately controlled (only 37% in adequate glycemic control) by approved treatments.  Nearly half (47.9%) of US diabetes patients also use complementary and alternative medicine (Garrow & Egede 2006; Yeh, Eisenberg, Davis & Phillips, 2002). The Diabetes Prevention Program (DPP) conclusively demonstrated that diet and lifestyle changes could prevent diabetes more effectively in a susceptible population than metformin (58% reduction in incidence versus 31%). The DPP lifestyle intervention used lifestyle coaches and a focus on weight loss and exercise, and although it proved less expensive per case of diabetes prevented than pharmacological management alone, it still presents a substantial cost to implement. ND practices will be used to test modifications to this model that include a primary care setting allowing diabetes prevention to be incorporated into patients’ overall focus on health.  It may be even more effective, e.g., through the inclusion of nutritional supplementation (Bartlett & Eperjesi, 2008; Farvid, Jalali, Siassi & Hosseini, 2005; Bonnefont-Rousselot, 2004)), and potentially, more cost-effective.

Diabetes is paradigmatic of endemic chronic diseases for which NDs have specific well rationalized treatment protocols of which the elements, individually, show promise but have not been tested in combined practice.  This PBRN proposal can be used to test components of primary care that can also be incorporated into conventional practice.

Diabetes is an important chronic condition but it is only one of many conditions toward which the informatics-based research infrastructure that we propose can be targeted.  NCCAM funding of such systems could enable the determination of the best approaches to general primary care/family practice, pain, and other chronic disease conditions.

Opportunities and Obstacles for Outcomes-Based Research

   
  NCCAM has not fully availed itself
of the unique opportunities
associated with cost-effectiveness
research across the naturopathic
profession.  


NCCAM’s original mandate reads “the Director of the Centers shall identify and evaluate alternative and complementary medical treatment, diagnostic and prevention modalities in each of the disciplines and systems which the Center is concerned, including each discipline and system in which accreditation, national certification, or a State license is available.”  The AANP would assert that NCCAM has not fully availed itself of the unique opportunities associated with cost-effectiveness research across the naturopathic profession.  Federal funding for health research in many agencies remains restricted to those professions identified in the Social Security Act, overlooking the other primary care providers licensed in many states across the country.  And, despite the fact that corporations are experiencing enormous success in the implementation of even the most basic wellness programs, Congress and many policy makers remain unconvinced and unable to attribute savings for these programs.  Thus, federal law  and the current health insurance reform efforts are not able to avail themselves of programs that stand at the forefront of reducing the prevalence of chronic disease, and transformation from a disease-based system.

Cost-effective, Quality Outcomes

One such example of how naturopathic medicine is transforming outcomes in the private sector exists in Vermont with the “Jump Start To Better Health” program for employees of a statewide association.  The program uses an approach to improving employee wellness that includes fitness and weight loss challenges, a monthly newsletter, on-site flu immunization clinics, on-site health awareness screenings, a smoking cessation program, online wellness center, the FirstLine Therapy Therapeutic Lifestyle Change program, and a comprehensive incentive program with $10,000.00 in cash prizes.

The “Jump Start To Better Health” program was designed by a naturopathic physician, Dr. Bernie Noe. It has dramatically improved the health of association members, and has helped cut healthcare costs. In the first two years of the program, the occurrence of high blood pressure decreased by 49 percent, while the occurrence of high cholesterol decreased by 26 percent. The occurrence of smoking, physical inactivity, and multiple risk factors for cardiovascular disease, all decreased by more than ten percent. The Association estimates that during the program’s first two years, it saved an average of $8.20 in health care costs for every $1.00 invested in the program. This translates into an overall savings of $1,421,000 in direct and indirect health costs during that time period.

   
The naturopathic model was cost
effective and had the added benefits
of improving health outcomes and
lowering other medical costs.
 
 
Another powerful example of the direct correlation between patient access to a wide range of healthcare provider options and more efficient, cost-effective healthcare has been demonstrated in a study funded by NCCAM. In the study, Patricia Herman, ND, compared conventional and naturopathic lower back pain treatments. Dr. Herman found that the naturopathic model of care was less costly than conventional treatment, when accounting for absenteeism. The naturopathic model also had the added benefits of improving health outcomes and lowering other medical costs.

A second study by Dr. Herman, also funded by NCCAM, found that integrative care can reduce reliance on conventional drugs in a study of patients with eating disorders. A comparison of patients treated conventionally, and those treated with added integrative therapies including dietary supplements, acupuncture and massage showed that patients receiving integrated treatments generally had decreased symptoms and reliance on conventional medications. Two common conditions in eating disorder patients, constipation and sleep disorder, reduced significantly. In fact, reliance on sleep medications was reduced from 55 percent to 11 percent in the integrated patient group. Naturopathic therapies, in place of or in conjunction with conventional care, can provide increased health outcomes at reduced costs. NCCAM funding of studies such as these is evidence that utilization of naturopathic expertise can greatly ease the burden on our nation’s healthcare system.

Conclusion

In fall, 2009, the Department of Labor issued a custom report defining the role of a naturopathic physician to read: 
“Diagnose, treat, and help prevent diseases using a system of practice that is based on the natural healing capacity of individuals. May use physiological, psychological or mechanical methods. May also use natural medicines, prescription or legend drugs, foods, herbs, or other natural remedies.  Sample job titles include Naturopathic Physician, Naturopathic Doctor, Physician, and Doctor of Naturopathic Medicine. (Occupational Information Network, 2009) “ 
The world of medicine is rapidly changing through the promulgation of regulation, the passage of legislation and in the daily practice of medicine itself.  Naturopathic physicians, acupuncturists and yes, our conventional partners, the advanced practice nurses, are a growing force in the transformation of our healthcare system.  It is a force that is driven by consumer experience and increased consumer demand.  It is medicine that demands increased research.  There is enormous opportunity in recognizing the redefinition of how primary care is provided in this country.  Enhancing research efforts on the work of those previously designated as alternative, and now quickly becoming mainstream, is a precursor to true health care reform.

The AANP stands ready to support NCCAM’s efforts to enhance infrastructure, expand research opportunities in the naturopathic field, and advocate for funding of outcomes-based research initiatives that demonstrate the effectiveness and sustainability of natural medicine and patient-centered care.
Bodeker, G. (2001). Lessons on Integration from the Developing World’s Experience. British Medical Journal, 322, 164-167. doi:10.1136/bmj.322.7279.164
 
Bonnefont-Rousselot, D. The Role of Antioxidant Micronutrients in the Prevention of Diabetic Complications. Treatments in Endocrinology. 3(1): 41-52, 2004.

Bartlett H, Eperjesi F. Nutritional supplementation for type 2 diabetes: a systematic review. Ophthalmic & Physiological Optics [serial online]. November 2008;28(6):503-523.

Farvid MS, Jalali M, Siassi F & Hosseini M. Comparison of the effects of vitamins and/or mineral supplementation on glomerular and tubular dysfunction in type 2 diabetes. Diabetes Care. 2005 Oct;28(10):2458-64.

Garrow D, Egede LE.  National patterns and correlates of complementary and alternative medicine use in adults with diabetes.  J Altern Complement Med. 2006b Nov;12(9):895-902.

Occupational Information Network. (2009).  29-1199.04 - Naturopathic Physicians. Retrieved November 11, 2009, from the Occupational Information Network website: http://online.onetcenter.org/link/details/29-1199.04#Education

Yeh GY, Eisenberg DM, Davis RB, Phillips RS. Use of complementary and alternative medicine among persons with diabetes mellitus: results of a national survey.  Am J Public Health. 2002 Oct;92(10):1648-52.
_____________________________

Comment
: The connective threads here are clear: real-world, pragmatic research, attention to balance on the NCCAM advisory council, research on costs, and support of infrastructure. The outcomes arena is unanimously identified in all of these responses. Notably, this is an area Congress identified the 
#1 priority as an "activity" for research, but is also a place where NCCAM has invested less than 1% of its funds. Basic research and RCTs are recognized as valuable but not recommended.

   
The job of NCCAM director Josephine
Briggs, MD is getting easier. It's time
for her to get it right and place NCCAM
in a radical realignment with both
Congress and these significant
NCCAM stakeholders.

 
The big gap in this group, as a representative sampling, is the conventionally-based integrative medicine community. How will the influential Consortium of Academic Health Centers for Integrative Medicine weigh in? I know that the integrative practitioner subset of that community also has much use for outcomes, whole practice/whole systems rand cost-related research.

Some allied organizations are on the record as recommending outcomes and effectiveness directions. Certainly the Bravewell Collaborative has an agenda which would benefit from this funding. (In fact, shifting NCCAM's investment to create capital to help them prove the value of integrative medicine might be viewed as the best fund-raising they could be doing right now to transform US health care.) Key entities like the Institute for Integrative Health, led by NCCAM-funded researcher Brian Berman, MD and the Samueli Institute, led by Wayne Jonas, MD, the former director of the NCCAM predecessor, have promoted outcomes approaches. But I am not aware if they have formally submitted.

These gaps in the presentation here notwithstanding, the way I look at it, the job of NCCAM director Josephine Briggs, MD is becoming easier. It's time for her to get it right and place NCCAM in a radical realignment with both Congress and these significant NCCAM stakeholders rather than with the reductive and basic researchers who have shaped NCCAM's investment to date. The challenge is significant. It will take a sort of patricide to do it. But the benefits will flow to the consumers - the citizens that is - whom government agencies are supposed to serve.


Send your comments to

for inclusion in a future Integrator.

 


Last Updated ( Friday, 04 December 2009 )
< Prev   Next >
Subscribe to the Newsletter
Search
Advertisement
Advertisement
 
 
Advertisement
Sponsors
NCMIC Group
AMI Group
Integrative Practitioner
voluntary contributions
Support the work!
Archive
All Integrator Round-ups
Integrator Top 10 Lists 2006-2013
Issues #116-#118 - Oct-Dec 2013
Issues #113-#115 July-Sept 2013
Issues #110-#112 April-June 2013
Issues #108-#109 Jan-March 2013
Issue #105-#107 Oct-Dec 2012
Issues #102-#104 - July-Sept 2012
Issues #99-#101 - April-June 2012
Issues #96-#98-Jan-March 2012
Issues #94-#95 Nov-Dec 2011
Issues #92-#93 Sept-Oct 2011
Issues #90 and #91 - July-Aug 2011
Issues #88 and #89 - May-June 2011
Issues #86 and #87 - March-April 2011
Issues #84 and #85 - Jan-Feb 2011
Issues #82 and #83 - Nov-Dec 2010
Issues #80 & #81 - Sept Oct 2010
Issues #78 & #79 - July August 2010
Issues #76 & #77 - May June 2010
Issues #74 & #75 - March-April 2010
Issues #73 & #73 - Jan-Feb 2010
Issues #69, #70 & #71 - Nov-Dec 2009
Issues #67 and #68 - Sept-Oct 2009
Issues #65 and #66 - July-August 2009
Issues #63-#64 - May-June 2009
Issues #60-#62 - March-April 2009
Issues #57-#59 - Jan-Feb 2009
Issues #55-#56 - Nov-Dec 2008
Issues #51-#54 - Sept-Oct 2008
Issues #47-#50 - July-August 2008
Issues #46 & -#47 - May-June 2008
Issues #43-#45 Mar-April 2008
Issues #41 & #42 - Feb 2008
Issues #39 & #40 - Dec-Jan '08
Issues #37 & #38 - Nov 2007
Issues #35 & #36 - Oct 2007
Issues #33 & #34 - Sept 2007
Issues #30-#32 - July-Aug 2007
Issues #28 & #29 - June 2007
Issues #26 and #27 - May 2007
Issue #25 - April 2007
Issues # 23 & #24 - March 2007
Issues #21 and #22 - Feb 2007
Issues #19 and & 20 - Jan 2007
Issues #17 and #18 - Dec 2006
Issues #15 and #16 - Nov 2006
Issues #13 and #14 - Oct 2006
Issues #11 and #12- Sept 2006
Issues #9 and #10 - Aug 2006
Issues #7 and #8 - July 2006
Issues #5 and #6 - June 2006
Issues #3 and #4 - May 2006
Issues #1 and #2 - April 2006
All Articles by Subject: 2006
All Articles by Subject: Jan-June 2007
IAYT-Sponsored Series on the Future of Yoga Therapy