The NIH Fails to Comply with Congress’ Design
“R.T.P. son, R.T.P. Read the problem.” Congress’ recommendations appear to successfully apply this adage to how best to return quality information to US citizens and healthcare stakeholders on the best use and inclusion of complementary and alternative health and medical approaches. Perfect design, however, can miss certain human and power elements. Congress forgot to read the problem called institutionalized investment and practice. Here’s what happened.
The first Advisory Council, named in 1999, essentially met Congress’ mandate that at least half be licensed in at least one system that the Council concerns: Of its 17 members, just three represented consumers. Of the remaining 14 researchers, seven met the practitioner mandate: two licensed chiropractors, two licensed massage therapists, one licensed acupuncturist, one licensed naturopathic doctor, and one professional licensed in both naturopathic medicine and acupuncture and Oriental medicine. Most had additional doctorates or masters' degrees related to research.
Since 1999, membership of these licensed practitioners on the Advisory Council has steadily declined. From 2012 to 2015, the Council had just two: one chiropractor and one naturopathic physician. Beginning in June 2015, with 18 members, the Advisory Council will have just one from these licensed professions. This is 5 percent, not 50 percent. The Council has zero members intended to meet the consumer criterion.
The Council’s adherence to how Congress told it to spend its money is, if anything, worse.
In the first seven years, the NIH simply disregarded Congressional intent. A 2006 report found that less than 1 percent (0.64 percent) of the National Center for Complementary and Alternative Medicine's (NCCAM) budget focused on studies that “examine(s) how people get access to health care, how much care costs, and what happens to patients as a result of this care.” The “outcomes” and “health services” outlays, listed as the first and third priorities by Congress, were actually down from 2002. It peaked for that period at a dismal 1.2 percent. The percent has likely bounced upward in recent years but estimates put such investments still at less than 5 percent overall.
Not surprisingly, direct grants to the research infrastructure of the academic centers for these licensed practitioners have also been minimal. A 2010 analysis by the Academic Consortium for Complementary and Alternative Health Care found only 4.6 percent of agency dollars went to any of the more than 180 accredited programs and institutions associated with these schools. A subsequent analysis found the percent declining.
We can wonder at the tremendous value that might have been created had Congress’ mandate been followed these past 17 years, in which nearly $2 billion has been spent. Think of the data on hospital inclusion, on coverage, cost, and effectiveness. Think of the robust research centers led by whole-person and whole-system practitioners.
Better than regret is to hold those imagines and to urge these practitioners, the organizations that represent them, and the human beings who use their services (you!) to stand up for the rule of law and demand that that these experts lead the efforts to understand their value to human health.
The law of the land that is referenced in this column is still on the books.
John Weeks is the editor of The Integrator Blog News and Reports