NIH NCCAM Stakeholders Meeting Summary

Executive Summary:

On June 20, 2007, the National Center for Complementary and Alternative Medicine (NCCAM) held a “Stakeholder Dialogue” at NIH in Bethesda, MD where members of the CAM community met with the director of NCCAM to discuss the Center’s activities and priorities. The key questions addressed in the dialogue were:

1. What are the greatest opportunities for research in the next few years?
2. What are the greatest challenges to conducting CAM research?
3. Do you see CAM research having an impact on trends in integrative medicine?

Dr. Ruth Kirschstein, acting director of NCCAM began the meeting by commenting how far the “Office of Alternative Medicine” (original name of NCCAM) since the early 1990’s in terms of breadth of study and funding. She explained that NCCAM was established in 1999 to:

• Conduct CAM research
• Train CAM researchers
• Inform and educate the public and health professionals

The primary goal according to their Strategic Plan (available online at www.NIH.gov) is to integrate Western Medicine and CAM strategies into comprehensive care.

They break the CAM domains into:

1. Biological based practices (the largest area studied)
2. Botanicals & dietary practices
3. Mind-body medicine
4. Acupuncture and Neurological effects
5. Energy Medicine
6. Tai Qi
7. Manipulative/body-based therapies

Below is a general funding profile from 1992 to 2007 (Based on a sketch – just get the point that they went from $2M up to roughly $120M.

The general feel of the conference was one of open communication. The participants had a number of constructive criticisms ranging from suggesting they study HEALTHY people –“ it’s supposed to be National Institutes of Health, not National Institutes of Disease…” to advocating practitioner involvement from inception of the study through to its publication. The second half of the day had three breakout sessions focused on the areas of Research, Outreach, and Research Training. I participated in the Research group where I suggested they focus more on Clinical relevance as opposed to the mechanistic view studying minute changes in hormones, neurotransmitters, etc., with outcome measures such as Quality of Life. Additionally I clarified that even though “Insomnia” has one diagnosis in Western medicine, it has six or more differential diagnoses in Chinese medicine. You can’t expect to get good results from ONE point combination if you’re treating a myriad of insomnia syndromes.

Details:

In the morning session, participants suggested the following:

• Use community resources for controlled clinical trials
• Study combination treatments (suggested by an ND)
• Use patient advocacy community for support
• AOM practitioner wanted to offer her personal treatment strategies for study
• Study healthy people to help with chronic disease prevention
• Have practitioners “in” on study design
• Focus on AIDS
• Study Ginseng and Mushroom properties
• Do more Pediatric studies
• Divert grants to professors for research
• Band together multiple GPs in network for inferential research
• Demonstrate herbal products in mitigating side-effects of Chemo, etc.
• Create “Scientific Standards” with botanical products reflecting proper traditional preparations
• Study pre-clinical markers before illness occurs
• CAM doesn’t seem to “trickle down” into conventional medicine culture or med school curricula
• RCT is too narrow – need more observational and descriptive results
• Since there’s a potential challenge for future funding – partner with other institutions
• Study placebo effect (NIH response – already done, Lisa Engle PI)
• Should place a moratorium on Sham Acupuncture (Richard Hammerschlag)
• CAM culture vs. researcher culture is disparate
• Do more “cluster” studies
• Emphasize cost effectiveness in your studies
• Standardize adverse incidents across the board of CAM studies
• If MDs make incorrect statements to the media, issue a response to correct it!

In the afternoon breakout session, Richard Nahin (Director of Scientific Research) and Jack Killen (Director of International Research) discussed the strategic plan in an open forum with the participants.

NIH identified 36 goals and 85 objectives, although did not elucidate on how to reach these goals. The research priorities included in the strategic plan are:

• Wellness and prevention
• Mechanisms of action
• Optimal dosing
• Safety and efficacy
• Active ingredient identification
• Bioavailability

Some of the conditions to be studied, and their response to CAM therapies are:

• Anxiety and Depression
• Immune Modulation
• IBS
• Insomnia
• Liver Disease
• Obesity/Syndrome X/Diabetes
• Infectious Respiratory disorders
• Ethnomedicine (not sure why this is listed under “conditions”…)

The Directors explained the research community is working toward a “whole system approach” to studying disorders and CAM modalities in the treatment of those issues and mentioned that an automated questionnaire is under development called “PROMIS” (Patient Reported Outcome Measurement Information System) that will encompass a greater number of health aspects compared to previous surveys that will “dig deeper” in areas that require more specifics and gloss over those not pertinent to the patients’ condition(s).

As the suggestions/comments rolled in, the Directors did their best to address the practitioners’ concerns and stated future research will reflect the suggestions of the audience.