The NIH Fails to Com­ply with Congress’ De­sign

Alternative Medicine - - The Big Picture -

“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

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