In 2002, the White House Commission on Complementary and Alternative Medicine (CAM) Policy included a primary recommendation. A CAM office should be created inside the U.S. government. Its role: "to coordinate Federal CAM activities and to facilitate the integration of safe and effective practices and products into the nation's health care system."
The view of this $1 million commission was that growing consumer use of these disciplines and practices, and the interests of public and private stakeholders, required a central clearinghouse.
Yet the recommendations of that Clinton-era initiative, funded in 1998, hit the streets during the George W. Bush presidency. The report was promptly buried and with it the idea of the center. A similar recommendation to policy makers from the National Policy Dialogue to Advance Integrated Health Care also fell on deaf ears.
A decade-plus later the U.S. is about to have a center that partially fulfills on that core recommendation. It won't be inside the federal government. Nor will it focus on "CAM." It will also be more limited, in its initial scope at least. But some of the language in a new Health Resource Services Administration (HRSA) grant program suggests that this new National Coordinating Center for Integrative Medicine (NccIM as HRSA calls it) may eventually have broad coordinating value for this emerging field.
On June 15, HRSA announced programs worth $3.3 million related to NccIM. The largest portion is $2.5 million that will be dispensed to some 16 preventive medicine residency programs in chunks of up to $150,000. The preventive medicine medical specialty is defined as focusing "on the health of individuals and defined populations to protect, promote, and maintain health and well-being as well as to prevent disease, disability, and premature death." The grant winners will offer programs to incorporate integrative medicine content into existing preventive medicine residencies, support faculty development, and assess outcomes.
The second, related HRSA program is the more remarkable. HRSA has dangled $800,000 before the burgeoning field of academic integrative medicine and other interested M.D.-led parties in a competition to host the NccIM. The core purpose will be to provide assistance and evaluation of the integrative medicine in preventive medicine residency programs.
A close reading of the funding announcement suggests that these parameters may constitute but a hint of the potential reach of this new center. First, the assistance and evaluation are explicitly "not limited to" the preventive medicine residencies. "Other interested residency programs" may also be helped. Presumably, the NccIM could assist integrative medicine in family medicine, for instance, where an integrative medicine residency program presently exists, or potentially in oncology, where interest in integrative medicine is taking off.
HRSA's guidance to the prospective host of the NccIM pushes these boundaries farther. The NccIM will engage in "analyzing the efficiency of integrative medicine." NccIM personnel will provide "guidance in the implementation of the integrative medicine projects." They will help in "demonstrating expertise in the field of evidence-based integrative medicine modalities for health professions disciplines." What will these be interpreted as meaning?
For pioneers in integrative medicine, the HRSA program must be viewed as a tremendous sign of arrival. Such a push of integrative medicine content into existing residencies empowers and emboldens. Smart money would bet on the University of Arizona Center for Integrative Medicine, founded by Andrew Weil, M.D. and directed by Victoria Maizes, M.D. Their group recently renamed their Integrative Family Medicine program to Integrative Medicine in Residency, as though to open itself to the two-year award.
For the so-called "CAM" professions and institutions whose role in U.S. policy, payment and delivery were front and center in charge to the White House Commission a decade ago, this announcement must be bittersweet. The robust activity in these fields from the late 1970s forward to build educational infrastructure and licensing in response to patient demand for higher-touch, more individualized and personalized care birthed the newer domain of "integrative medicine."
Now, like political figures air-brushed out of a historic photo, the disciplines of chiropractic, massage therapy, acupuncture and Oriental medicine and naturopathic medicine are nowhere to be seen in HRSA's language. Yet the advance into federal programs of the whole person-focused integrative principles these "CAM" disciplines also represent must be viewed as an advance for their mission if not directly for their guilds.
At best, the new NccIM will promote content in the new residency programs, and integrative medicine in general, that will embrace the fundamentally interprofessional future for health care supported by the 50-plus medical schools in the Consortium of Academic Health Centers for Integrative Medicine. That definition underscores the importance of integrating not just therapies but "mak(ing) use of all appropriate healthcare professionals and disciplines." The regulated CAM fields should have prominent roles.
One thing is a good bet. Any self-respecting, institution-building director of a federally-backed center with a title as encompassing as the National Coordinating Center for Integrative Medicine would be a fool to let that mantle slip when HRSA's $800,000 is spent down in two years. It doesn't take much imagination to think of a dozen worthy integrative -- and CAM -- projects such a coordinating center could house. One need look no further than the other unfulfilled recommendations of the 2002 report from the White House Commission.
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