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This report summarizes the recommendations of the working group meeting on March 25, 2008. The working group, which included individuals who spanned a range of CAM and conventional backgrounds, was convened by the NCCAM Director on NACCAM’s recommendation, with the goal of assessing NCCAM’s current approach to supporting the development of CAM research capacity at CAM institutions. NACCAM felt that a reassessment of the goals and structure of the program as currently constituted was justified based on concerns expressed during the most recent peer review meeting. Following discussion the working group made recommendations regarding shortand long-term goals for research capacity development at CAM institutions, as well as approaches to achieving those goals, approaches to assessing progress towards them, and time frames for achieving them.

Recommendations of the working group

The working group agreed that NCCAM should continue to support efforts to build robust programs of rigorous research at CAM institutions. The members also agreed that the long-term goal is for CAM institutions to be able to participate as full partners in CAM research and CAM research teams. Ideally this would be evidenced by independent acquisition of NIH (or other) awards. It was recognized, however, that CAM institutions as a whole have historically been focused on practice and on training practitioners, endeavors critical to the financial prosperity of these institutions in the absence of the substantial philanthropy that cushions many research-intensive institutions. Achieving the goal of having sustainable and independent research programs at CAM institutions therefore, in many cases, requires long-term commitment on the part of the institution (including, but not limited to, the institution’s leadership, faculty and alumni), the relevant CAM community, and the NIH. Substantial time is required to achieve this ideal goal and solidify a new research discipline, and there are clear differences among CAM institutions in their progress towards building a sustainable research effort. NCCAM’s efforts to support and to evaluate research capacity development at CAM institutions must recognize that such development occurs over periods of a decade or more, and must take into account the variability in CAM institutions’ histories of research experience and specific goals for involvement in research. The working group also agreed that in no case should funding of CAM research in the setting of capacitybuilding efforts be associated with any lessening of scientific rigor.

The working group recommended that future initiatives to support the development of CAM research capacity at CAM institutions:

• Adopt a flexible, long-term approach to accommodate differences among institutions in research experience and in aspirations regarding the eventual breadth, focus and independence of the institution’s research capacity
• Recognize and value the critical importance of mentoring by researchexperienced partners by strengthening the emphasis on and support for mentoring through such partnerships
• Recognize and value the necessity for participating CAM institutions’ strong commitment to support of research
• Maintain substantial NCCAM staff involvement

Because building research capacity in a new discipline is a long-term, multistage process, the working group recommended that review of applications responding to CAM research capacity-building initiatives, as well as assessment of NCCAM’s CAM research capacity-building program as a whole, place greater emphasis on the development and achievement of milestones agreed upon with the participating institutions prior to funding. Such milestones may include, for example:

• Increases in the participation of CAM institution staff, fellows, students and alumni in research, research coursework and research training
• Participation by CAM institution faculty, fellows students or alumni in new collaborations with researchers at research-intensive institutions
• Growth of the CAM institution’s ability to participate fully in peer-reviewed CAM research through development or further development of institutional research capacity such as IRBs, pre- and post- award financial administration expertise, biostatistical expertise, hiring of researchexperienced staff, implementation of IT or other systems that support research
• Submission of applications to NIH or other research funders for support of research, research training, or related activities, such as research conferences

Such explicit capacity-building milestones should not replace the milestone of research publications in high impact biomedical or clinical journals. However, the working group recommended that greater recognition, value, and support be given to the long-term effort needed to reach that goal than has been the case to date.

List of background materials provided to the working group

• Other components of NCCAM’s CAM research capacity-building efforts
• Curriculum development (R25) program
• 2002 Expert Panel Review of NCCAM’s Centers Program
• Developmental Centers for Research on CAM (DCRC):
• summary of initiatives and funding history
• DCRC participants: applications submitted, awards and scores
• DCRC investigator publications
• 2007 DCRC application Summary Statement executive summaries

Questions addressed by the working group

Goals for developing CAM research capacity at CAM institutions

• What should the goals be for developing research capacity at CAM institutions?
• ability to compete independently for NIH R01 funding?
• ability to be a strong partner in CAM research collaborations?
• how broad is the range of institutions that should be addressed?
• For CAM institutions with different levels of research experience, what time frames should be considered?

Structure to achieve the goals

• What approaches are likely to provide the strongest support for achieving the above goals for CAM research capacity-building at CAM institutions?
• Centers comprising multiple research projects?
• Centers focused on building research capacity at CAM institutions?
• Centers requiring collaboration between CAM and conventional, biomedical research-intensive institutions? If so, is support for mentoring an important consideration?
• Is there a range of research training approaches, and of allocations of focus between research and training that should be considered?
• NCCAM staff involvement (as with cooperative agreements)?
• What about levels of funding and funding periods?

Criteria for evaluation

• in terms of absolute measures?
• in terms of progress over time and beyond baseline attainment?
• What criteria should be used for evaluation of progress?
• standard criteria such as number of research publications and awards funded?
• additional criteria, e.g., changes in culture and priorities (e.g., number of students at the CAM institution(s) enrolling in optional research courses, or voluntarily participating in research)?
• How should progress in developing research capacity at CAM institutions be evaluated?

Working Group Participants

Extramural:

Susan Folkman, PhD, UCSF Osher Institute, working group chair
Timothy C. Birdsall, ND, Cancer Treatment Centers of America
Helene Langevin, MDCM, LAc, U. of Vermont
Reed B. Phillips, DC, PhD, FCER

NCCAM:

Josephine P. Briggs, MD, NCCAM Director
John Y. Killen, MD, NCCAM Acting Deputy Director
Partap Khalsa, DC, PhD, Program Officer
Martina Schmidt, PhD, Review Officer
Barbara C. Sorkin, PhD, Program Officer