International Research Conference Highlights Progress, New Directions
The North Saskatchewan River Valley in Edmonton, Alberta, Canada, was the panoramic setting for the North American Research Conference on Complementary and Integrative Medicine, held May 24-27, 2006. Close to 650 researchers, health care practitioners, representatives of government agencies and nongovernment organizations, students, and other attendees came to Edmonton from 22 countries and 210 institutions to share information and perspectives on complementary and alternative medicine (CAM) and integrative medicine (IM).
The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM), a group of 32 medical centers in North America affiliated with academic institutions, sponsored the conference. CAHCIM's goal is to "make a qualitative difference in people's health by advocating an integrative model of health care, incorporating mind, body and spirit."
Representing the Rich Diversity of CAM
The Edmonton event had over 300 offerings--keynote and plenary addresses, oral abstracts, workshops, discussions, symposia, and posters--in five major areas of science: basic science, clinical studies, methodology, health services, and education. NCCAM was one of the conference's funders and participated on the planning committee.
Margaret A. Chesney, Ph.D.
Margaret A. Chesney, Ph.D., Deputy Director of NCCAM and Director of its Division of Extramural Research and Training, delivered one of the keynote addresses. She opened by discussing why there is intense public interest in CAM and in a new, more integrated medicine. For example:
- The population is aging.
- Information on health has become much more available (e.g., through the Internet).
- The consumer now has a more important role in health care.
- People have complaints about conventional care (e.g., when cures are elusive, side effects are problems, providers have very limited time, or care is fragmented among specialists).
- Many people find CAM and IM appealing (e.g., they feel these offer more "natural" treatment alternatives, emphasize patient-provider relationships, and allow individuals to take more responsibility for their health).
This interest in CAM and IM commands a "bold" research effort, Dr. Chesney said, but caution as well:
- There are many therapeutic claims that are attractive but unsupported by research. To illustrate, she presented an array of advertisements dating back to the 19th century and noted, "The plural of claims is not evidence."
- Media reports may oversimplify study findings, resulting in headlines that fail to communicate the value of the research.
- Methodological challenges and pitfalls exist in the research endeavor.
"We have a long way to go," she said, "but there is much to discover, and we have an agenda rich in research challenges."
Dr. Chesney set forth her vision for continued progress. "Be bold in what you try," she urged, "cautious in what you claim, and thoughtful about what you do. Express your purpose in a way that inspires commitment, innovation, and courage. We need you to contribute your part to the whole, as we work together to add to the fabric of knowledge about CAM and create a new, comprehensive health care." Drawing upon the Institute of Medicine's 2005 report on CAM, she described this care as being based on the best science available, recognizing the importance of compassion and caring, and encouraging people to actively participate in choices that enhance resilience, prevent illness, and improve quality of life.
In addition to Dr. Chesney, other keynote speakers were:
- Brian M. Berman, M.D., professor of family medicine at the University of Maryland School of Medicine and director of its Center for Integrative Medicine. Dr. Berman described his journey from carrying out pilot research to a major clinical trial of acupuncture for osteoarthritis (most of this work was funded by NCCAM or its predecessor, the NIH Office of Alternative Medicine).
- Richard Davidson, Ph.D., an NCCAM grantee who is professor of psychology and psychiatry at the University of Wisconsin-Madison and director of the Keck Laboratory for Functional Brain Imaging and Behavior. Dr. Davidson spoke about meditation and its possible influence on the brain, including his research on Buddhist monks who are longtime meditators.
- Peter Lipsky, M.D., chief of the Autoimmunity Branch in the Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH. Dr. Lipsky described his research on thunder god vine (Trypterygium wilfordii hook F), a traditional Chinese remedy that is showing some potential benefit in studies for rheumatoid arthritis.
- David Moher, Ph.D., director of clinical research and the Chalmers Research Group at the Children's Hospital of Eastern Ontario Research Institute, and Faculty of Medicine, University of Ottawa. Dr. Moher offered his perspective on challenges in generating, synthesizing, and reporting evidence on CAM.
Focus on Research Findings
All abstracts (brief summaries) of the conference's sessions, presentations, and posters are posted on the Web site of the journal Alternative Therapies in Health and Medicine. Here are a few examples from this diverse collection. An asterisk (*) indicates that work was supported fully or partially by an NCCAM grant.
- Basic Science Content Area. Vitaly Napadow, Ph.D., of the Martinos Center for Biomedical Imaging, Massachusetts General Hospital, presented a pilot study of acupuncture for carpal tunnel syndrome (CTS). He found interesting changes not only in CTS symptoms but in brain activity (observed through fMRI, functional magnetic resonance imaging--a noninvasive tool used to observe functioning in the brain or other organs by detecting changes in chemical composition, blood flow, or both; see images below). Initially, Dr. Napadow's team saw differences between the brain responses of CTS patients and healthy controls when they received nonpainful stimulation of their fingers. After a few weeks of acupuncture treatment, however, the CTS patients experienced improvements not only in their grip strength, symptoms (such as pain, numbness, and tingling), and nerve function at the wrist, but in how their brains processed nonpainful stimuli to the fingers.
- Clinical Studies Content Area. Sat Bir A. Khalsa, Ph.D.,* of Brigham and Women's Hospital, Boston, performs research on sleep disorders and the functioning of the autonomic nervous system. A major area of his work is yoga. Historically a spiritual discipline, yoga is also being used to address some medical disorders (in which cases it is called yoga therapy). There is evidence for the theory that chronic insomnia (chronic trouble in initiating and maintaining sleep) may not be an actual sleep disorder, but rather a disorder of hyperarousal--in these disorders, a person has a high level of arousal of his mind and body, usually associated with sustained activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. There is also evidence that yoga reduces this type of activation and arousal. Like meditation and relaxation exercises, yoga might help insomnia, in part by inducing a response that opposes the "fight or flight" response. In a small pilot study published in 2004, Dr. Khalsa found significant improvements in most sleep-related outcome measures in participants with chronic insomnia who had practiced a 30- or 45-minute Kundalini yoga treatment once daily for 8 weeks. One of Dr. Khalsa's current studies is a randomized, controlled clinical trial comparing yoga as an insomnia treatment with relaxation exercises and with sleep hygiene (habits that affect a person's quality of sleep).
Three other researchers also presented in the symposium on yoga: Bradly Jacobs, M.D., M.P.H., of the University of California-San Francisco's Osher Center for Integrative Medicine; Kavita Chandwani, M.D., M.P.H., University of Texas-M.D. Anderson Cancer Center; and Jost Langhorst, M.D., Kliniken Essen Mitte, Essen, Germany. - Methodology Content Area. A panel of five IM program directors from three countries presented models of IM programs with research components. They were Shay Pintov, M.D., of Assaf Harofe Hospital, Tzrifin, Israel; Dorit Gamus, M.D., of Sheba Medical Center, Tel-Hashomer, Israel; Gustav Dobos, M.D., of Kliniken Essen Mitte, Essen, Germany; Mary Hardy, M.D.,* of the UCLA Center for Dietary Supplement Research on Botanicals, Los Angeles; and Moshe Frenkel, M.D.,* University of Texas Medical Branch, Galveston. They discussed experiences and challenges in designing and carrying out research projects in IM primary care and hospital settings, working with multidisciplinary teams of both CAM and conventional practitioners, selecting treatments, and related areas.
- Health Services Content Area. Jennifer Hamilton, Ph.D., of the University of Medicine and Dentistry of New Jersey, presented results of a pilot study on the key organizational features of family medicine practices that have integrated CAM. Hamilton and her team observed and conducted interviews at five practices in New Jersey and Pennsylvania. In those practices, they found that a conventional physician trained in multiple therapies most often provided assessment for or treatment with CAM therapies. Overall, the degree to which CAM was integrated into these family medicine practices varied, and local and state laws, insurance issues, patient characteristics, and the style in which a practice was managed often influenced this variability.
- Education Content Area. Keturah Faurot, P.A., M.P.H., of the University of North Carolina at Chapel Hill, presented results of a study of dietary supplement counseling in 34 community pharmacies throughout central North Carolina. The pharmacists in the study considered counseling about dietary supplements to be part of their professional responsibility; 82 percent had discussed supplements with patients in the preceding month. However, they also felt the major barrier to counseling was lack of knowledge about supplements--including a lack of training in pharmacy school, inadequate continuing education, and inadequate evidence about the use of supplements. The researchers concluded that in order to provide supplement counseling, pharmacists need quality training and reliable patient education materials in this area.
- Americans' Use of CAM. Several researchers presented new findings from the 2002 National Health Interview Survey component on Americans' use of CAM.
- Ten student researchers were selected, through masked peer review, for Young Investigator Awards.
Nonpainful stimulation of right-hand finger 3 produced hyperactivation in the left primary sensorimotor cortex in Dr. Napadow's study participants with carpal tunnel syndrome. After acupuncture, this hyperactivity was reduced.
© John Weeks, National Education DialogueExecutive committee members of CAHCIM and the Academic Consortium of Complementary and Alternative Health Care gathered in Edmonton.
Back row: Adam Perlman, Don Warren, Brian Berman, David O'Bryon, Kathleen Healy, David Eisenberg; Middle row: Reed Phillips, Aviad Haramati, Bradly Jacobs, Janet Kahn, Jan Schwartz, Mary Jo Kreitzer, Rita Benn, Victor Sierpina; Front row: Pamela Snider, Susan Folkman, John Pan, Anne Nedow, Liza Goldblatt.
"It Exceeded Our Hopes"
Susan Folkman, Ph.D., is chair of CAHCIM and led the conference's organizing committee. She is also professor of medicine and director of the Osher Center for Integrative Medicine, University of California-San Francisco. She commented, "The number of people who attended exceeded our expectations, even our hopes.... Our keynote speakers' cumulative message was that good research requires great care and skill, imagination, fortitude, and many years of hard work. Many young investigators reported that they were truly inspired by these talks.... I [also] heard many people comment on how much stronger the science was now than it was 4 or 5 years ago."
