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N C C A M Research Blog

Reflections From IRCIMH

June 24, 2014
Portrait of Dr. Edwards
Emmeline Edwards, Ph.D.

Director, Division of Extramural Research
National Center for Complementary and Alternative Medicine

View Dr. Edwards' biographical sketch

Last month, I attended the International Research Congress on Integrative Medicine and Health (IRCIMH) meeting in Miami, which was convened by the Consortium of Consortium of Academic Health Centers for Integrative Medicine (CAHCIM). As CAHCIM tweeted: “Three days, 22 countries, 100 academic medical institutions, [and] 900 researchers, physicians, educators, and trainees…” Congratulations to the organizers of and participants in this successful event.

The poster sessions offered a great opportunity to meet many new investigators engaged in exciting research in the field of integrative health. Reflecting on some highlights of these sessions, I was brought to the realization that we could strive for better balance in the science featured in the IRCIMH poster presentations. The clinical research posters outnumbered the basic research presentations 3:1, and research on mind and body strategies dominated the research landscape. One concern is that many clinical research projects were not developed from adequate mechanistic studies and, hence, the outcomes from these projects may not be very informative, provide a well defined path for the next study, or give direction for future research programs.

At the IRCIMH meeting, NCCAM program staff took great care in articulating NCCAM’s goals for the Center’s clinical research portfolio: a strong focus on projects that are aligned with our Strategic Plan (symptom management, health promotion, disease prevention, etc.); research that is conducted at the appropriate stage based on current evidence; research that is statistically powered to assess clinically meaningful outcomes (when the evidence base is sufficient to support an efficacy trial); and research that proposes realistic timeframes and budgets and test hypotheses that will guide future research. We want to encourage our investigators to give strong consideration to the strength and quality of their preliminary data, the appropriateness of the proposed methods to answer their stated hypotheses, the feasibility of a clinical trial as designed, and the potential impact of trial outcome to shape future studies.

I urge clinical researchers to review our Framework for Developing and Testing Mind and Body Interventions, which describes various stages of research. I welcome your thoughts.

Comments

I am ethnographer who has spent a 25-year career exploring CAM (and later Integrative Medicine) and ethnomedical systems in vigorous use in the US.  I most earnestly recommend to NCCAM that your research agenda be expanded to include qualitative studies, particularly insofar as they explore Clinicians’ (conventional and CAM) and patients’ points of view on CAM, ethnomedical systems, and Integrative Medicine.  The goals and ‘clinically relevant’ endpoints of conventional medical practice and research are far from being the only important and valuable perspectives to understand in researching the de facto healthcare pluralism of the United States.  Outcomes that are considered clinically relevant from the conventional meical perspective are only one slice of this complicated pie.  What outcomes are clinically relevant to CAM providers, for example, on the basis of their underpinning theories and their therapeutic goals? What might conventional medicine learn from understanding patients, understanding CAM/IM usage patterns, and even understanding where, in patients’ estimations, the conventional system falls short?  And to what beneficial ends could such understanding be applied? And perhaps most importantly of all - since patients are actually the final treatment decision-makers - what outcomes are *personally and culturally* relevant to users of both conventional, CAM, and IM services?

I agree with Ms. O’Connor’s comment. The reductionist approach can only grap 10% of factors associated with CAM. More qualitative and complex system research is needed. Neither patients or therapists nor holistic treatments can be standardized in the real world.Interestingly, conventional medicine is adapting the science of the individual approach as CAM becomes more popular.

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