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On this page
- Call to Order and Meeting Procedures
- Introduction of Members
- Review of Confidentiality and Conflict of Interest
- Future Meeting Dates
- Introductory Remarks - Dr. William Harlan, Acting Director, NCCAM
- Introductory Remarks - Dr. Jeffrey White, Director, Office of Cancer Complementary and Alternative Medicine, NCI
- Introductory Remarks - Dr. Ernst L. Wynder, Chairperson, CAPCAM
- Introduction to Best Case Series - Dr. Jeffery White
- Best Case Series Presentation: Homeopathic Treatment of Cancer - Drs. Pransata and Pratip Banerji, BPHRF
- Phase I/II Study of Stage III and IV Non-Small Cell Lung Cancer Patients Taking a Specific Dietary Supplement - Dr. Alexander Sun, Medical Director, Connecticut Institute of Aging and Cancer
- Discussion
- Concept Review of Best Case Series Presentation: Homeopathic Treatment of Cancer
- Review of the CAPCAM Process
- Public Comment - Ann E. Fonfa, The Annie Appleseed Project
- Adjournment
CAPCAM Members Present
- Michael Hawkins, M.D., Co-Chair
- Thomas Brown, M.D.
- Edward Chapman, M.D.
- Peter L. Choyke, M.D.
- Ian D. Coulter, M.D.
- Susan S. Ellenberg, Ph.D.
- William R. Fair, M.D.
- James S. Gordon, M.D.
- Mitchell R. Hammer, Ph.D.
- David J. Hufford, Ph.D.
- Frances A. Jacobs, R.N.
- Konrad Kail, M.D.
- Sheila Moriber Katz, M.D.
- Douglas L. Weed, M.D., Ph.D.
- Lauren V. Wood, M.D.
- Jeffrey D. White, M.D., Director, Office of Cancer Complementary and Alternative
Medicine (OCCAM), NCI - CAPCAM Ex Officio Member
NCCAM Staff Present
- William Harlan, M.D., Acting Director, NCCAM, NIH
- Doug Hussey, NCCAM, NIH
- Richard Nahin, M.P.H., Ph.D., NCCAM, NIH
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Others Present
- Dr. Pratip Banerji, PBHRF
- Dr. Prasanta, PBHRF
- Dr. Alexander Sun, Ph.D., Medical Director, Connecticut Institute of Aging
and Cancer
- Mr. Ted Cron, Cron Communications
- Dr. T.M. Fasy, Mount Sinai School of Medicine
- Mr. Norman Fu, China Times
- Mr. Tom Garvey, Esq., FDA
- Ms. Liz Genski, Capitol Associates for NNFA
- Ms. Freddie Ann Hoffman, FDA
- Ms. Susan Holloran, National Center for Complementary and Alternative
Medicine Advisory
- Mr. Amir Jahangir, American Cancer Society
- Dr. Wayne Jonas, USUHS
- Ms. Joann Miron, FDA
- Mr. Leo Moody, HRSA, BPHC
- Mr. Michael Odone, Myelin Project
- Mr. James O'Leary, FDA
- Mr. George Persinas, Washington Insight
- Dr. M.A. Richardson, University of Texas
- Ms. Rebecca Spieler, The Blue Sheet
- Ms. Deb Stein, Capitol Associates
- Mr. Le-Hai Wang, Mount Sinai School of Medicine
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I. Call to Order and Meeting Procedures
The meeting was called to order at 8:30 a..m. by Dr. Richard Nahin, following
a video presentation designed to familiarize CAPCAM members with their
responsibilities as designated Federal officials serving on this committee.
Dr. Nahin pointed out specific procedures the committee must abide by
now that the CAPCAM is an officially chartered Federal committee. First,
the committee must comply with Freedom of Information Act (FOIA) rules
that govern disclosure of CAPCAM work to the public and set guidelines
for which meetings should be open to the public, and CAPCAM must advertise
public meetings as appropriate. Second, committee members are designated
Federal officials and must abide by Federal ethics rules. Finally, CAPCAM
is charged with providing concept clearance for any initiative-based research
resulting from presentations to CAPCAM. Dr. Nahin said that while panel
members are expected to develop consensus statements regarding how to
proceed with specific research proposals, minority opinions will be taken
into consideration as well. The task of CAPCAM panel members is to listen
carefully to the presentations and then to make one of the following determinations:
Enough data has been presented to warrant further research.
The data presented indicates that no further research is warranted.
The data is insufficient to make a determination. In this case, the panel
members should, if possible, indicate desirable steps or actions to take
so that the investigators can present their cases again.
Once preliminary data indicate that further research is warranted, the
role of the CAPCAM panel is to determine (1) scientific significance of
the proposed concept; (2) the feasibility of conducting the research (i.e.,
sufficient patient population and adequate resources exist); (3) the final
outcomes for evaluation (e.g., survival, quality of life); and (4) concept
relevance to the NCCAM or NCI portfolios. Dr. Nahin explained that the
best case series portion of today's session is closed to the public to
protect patient confidentiality, but that a discussion on that portion
would be conducted in open session tomorrow. He told CAPCAM members that
Dr. Jeffrey White would discuss how the two research presentations came
to the attention of OCCAM. He also said that CAPCAM members are expected
to function as the "eyes and ears" for what is happening on
the cutting edge of CAM research. Future presenters are likely to come
from: (1) current or past NIH grantees; (2) current Centers for Disease
Control (CDC) assessments; (3) the Agency for Health Care Policy and Research
(AHCPR); and (4) collaboration with NIH-sponsored clinical trials already
being done in conventional medicine (if appropriate, an arm incorporating
a CAM component could be added to an existing study).
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II. Introduction of Members
The participants introduced themselves, explained what they do, and told
the panel what specific areas of expertise they lend to CAPCAM.
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III. Review of Confidentiality and Conflict
of Interest
Dr. Nahin told CAPCAM members that a conflict of interest may occur when
any of the following exist: (1) the member has a designated role in the
research as the principal researcher or a subject of the research; (2)
the member has a self-interest-professional or financial-in the research
results; (3) there is even an appearance of conflict stemming from participation
of a family member or someone the CAPCAM member knows. If any of these
conditions is present, Dr. Nahin said, the CAPCAM member must withdraw
from the discussion to prevent the proceedings from having an appearance
of bias. Dr. Nahin instructed members to refrain from discussing meeting
topics outside the forum of CAPCAM meetings. Private discussions about
CAPCAM topics should be conducted only between a committee member and
a member of the NIH staff, not with a researcher or anyone else, he said.
Furthermore, committee members must not keep any materials distributed
in a closed session. These materials must be left with Dr. White since
they contain confidential information. Industry representatives should
be referred directly to Dr. Nahin or Dr. White. A breach of confidentiality
could preclude a CAPCAM member from future participation, and each CAPCAM
member must sign a confidentiality agreement. Previously, most research
investigations of CAM were invisible to NIH; that is, CAM research was
not being brought forward and seriously considered. CAPCAM acts as a forum
where CAM practitioners and investigators can be heard. It is one possible
entry point into NIH. As such, CAPCAM serves as a forum in which ideas
can be generated and explored.
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IV. Future Meeting Dates
Dr. Nahin said the next CAPCAM meeting is tentatively scheduled for Monday,
December 13, 1999.
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V. Introductory Remarks - Dr. William
Harlan, Acting Director, NCCAM
Dr. William Harlan clarified "concept clearance." He said it
is a way for an NIH committee, such as CAPCAM, to look at research before
it becomes an initiative. However, CAPCAM does not review grant applications.
The concept is generated within one of the advisory committees. These
must address the following questions: (1) is concept a reasonable approach;
and (2) if yes, should an initiative be developed that would lead to further
investigation? Committees must determine whether there is sufficient basis
to initiate a clinical trial or whether there is insufficient information.
Dr. Harlan said the community of CAM practitioners requires a liaison
such as CAPCAM to help bring their work forward, and several committee
members concurred.
Dr. Harlan said that Dr.White plays a critical role in identifying data
and has done a superlative job, making it likely that Dr. White's office
will see more and more cases as people realize that it is a good access
point. The critical role of CAPCAM will be to determine what should be
studied and what should not. A challenge, one member said, will be to
ensure the same objectives are consistently applied by all review groups.
The committee also discussed the role of Institutional Review Boards (IRBs)
in assuring the protection of human subjects in CAM therapies research.
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VI. Introductory Remarks - Dr. Jeffrey
White, Director, Office of Cancer Complementary and Alternative Medicine,
NCI
Dr. White presented an overview of OCCAM, a small coordinating office
with a staff of three people. OCCAM serves the following functions: (1)
it serves as the NCI's liaison to NCCAM; (2) it develops NCI's CAM agenda;
and (3) interfaces with the public, the CAM community, and the oncology
community regarding CAM cancer research. As part of its mission, the office
will have a web site by the fall 99. In response to a question from Dr.
Michael Hawkins, Dr. White said his office anticipated being able to present
about two to three best case series per CAPCAM meeting (or 6 to 9 per
year). Dr. White asked committee members for feedback on ongoing CAM cancer
studies, including: (1) a Phase III clinical trial of oral shark cartilage
in patients with cancer; (2) an evaluation of intensive pancreatic proteolytic
enzyme therapy with ancillary nutritional support in the treatment of
inoperable pancreatic adenocarcinoma; (3) work being conducted at the
University of Texas Center for Alternative Medicine; and (4) an NIH RFA
for the Center for Complementary and Alternative Medicine Research. He
reported that a meeting had recently been held in Crystal City, Virginia,
on the subject of integrating CAM therapies into comprehensive cancer
care, and that he would like to see CAPCAM involved in that meeting next
year. Applications in response to an initiative for centers for mind-body
interaction, is under review now. It would provide $1.5 million for studies
at six centers. In closing, Dr. White asked CAPCAM members to urge others
in the field to bring their best case series before the group.
The committee reviewed and approved the minutes of the November 16, 1998,
meeting.
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VII. Introductory Remarks - Dr. Ernst
L. Wynder, Chairperson, CAPCAM
(Dr. Wynder, was unable to attend the meeting, but his written remarks
were read by Dr. Nahin) - Dr. Michael Hawkins, Co-Chairperson, CAPCAM)
Dr. Ernst Wynder said it is time for CAM practitioners to establish what
should to be expected for complementary and alternative medicine. He proposed
five areas for action:
Evaluate data using the scientific method; however, it would be easiest
to study CAM modalities as an adjunct, because a clinical trial presents
many problems.
Consider quality of life when testing CAM treatments in cancers with
high mortality. The three hard end points of therapy are tumor response,
disease-free survival, and survival itself, but quality of life can be
improved as well.
Establish an information network for CAM for which all potential sources
of study results are pursued and through which appropriate information
is routinely disseminated to the medical and lay public.
Consider laboratory research an essential part of establishing CAM's
merit. The total agent as well as its specific components must be tested.
The question, of course, is always whether the identification of a single
factor can be expected to make appropriate use of the whole compound.
Consider epidemiological techniques to give support, or lack of it, to
an agent.
Dr. Wynder charged the committee with producing a document against which
CAM's can be evaluated and urged the committee members to move forward
with this work.
Dr. Michael Hawkins praised Dr. Wynder for having "a great feel
for why we are here and what kind of focus we should have." He praised
Dr. White for his work. Having complete data at the time of review is
the best use of the committee's time, he said, and Dr. White's work has
been so thorough that the committee can trust it as it is, without spending
further time on inquiries.
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VIII. Introduction to Best Case Series
- Dr. Jeffery White
Before introducing the best case series, Dr. White told the committee
that his office has produced a small brochure with a form on the back
that asks practitioners to detail what they are doing in CAM and how their
projects are being funded. The same information will be on his office's
web site in the fall. Dr. White detailed the steps a practitioner should
follow to bring a best case series forward. The steps in operation since
1991 at NCI are changing with CAPCAM's participation. Steps include: (1)
a practitioner contacts NCCAM or NCI; (2) OCCAM coordinates the process
of obtaining materials for review; (3) OCCAM conducts an internal review
and writes a summary; (4) OCCAM distributes a summary to CAPCAM committee
members prior to each scheduled CAP meeting; (5) the practitioner presents
materials and answers questions from the panel; and (6) the panel returns
to the practitioner its assessment of the significance of the results
of the best case series and a statement of its recommendation for further
research, if any.
Dr. White detailed the elements of a case report form and the best case
series process. Following a best case series presentation, potential next
research steps include: (1) prospective observational studies; (2) early
phase-I and II-clinical trials; (3) prospective clinical trials; and (4)
basic research on the potential mechanism of action. Phase II trials,
Dr. White explained, generally use an established dose and establish a
response rate. Phase III trials are generally randomized studies that
compare a new agent with an established agent. The most common problems
with patient information submitted for best case series are: (1) no documented
diagnosis; (2) subjective endpoints (rather than documented shrinkage
of a tumor); (3) short follow-up; (4) concurrent and/or previous standard
cancer therapy; and (5) missing data.
The committee then discussed the difficulties of conducting conventional
clinical trials to determine the efficacy of CAM treatments. Dr. White
emphasized that the problem with concurrent conventional therapies is
significant, and that the scientific community prefers to see no confounding
factors like chemotherapy. Dr. Konrad Kail said there are almost no cases
where conventional therapy is not used; he stressed that it is almost
unethical not to use both approaches simultaneously. Another panelist
said this may not be as true in India and other countries. It was later
explained that if a researcher can address an issue as a unique population
or unique research, NIH can fund projects overseas. Dr. Hawkins said this
is often a problem with best case series documentation. He suggested that
practitioners may want to do a relatively small randomized trial. In that
case, he said, the data collection is not particularly onerous for the
practitioner. If a practitioner believes a particular agent is effective
in the treatment of cancer, conducting a prospective data collection on
the next group of patients would qualify as an individual trial. He said
that this task may have seemed onerous to many CAM practitioners in 1991,
so the best case series was introduced then to avoid intimidating them.
But perhaps this approach is not as necessary as it once was, he said.
The paradigm for conventional research is a pilot study of 30 or 50 patients,
with a report on the response rates and toxicity, and if the CAM community
can get to this point, a best case series becomes unnecessary.
Dr. Edward Chapman pointed out that some alternative therapies, such
as homeopathy, do not look at a single agent. Homeopathists individualize
treatment specifically for each patient. Dr. Douglas Weed suggested that
best case series results ought to be replicated by another practitioner
to get a sense of universality. Drs. Kail and Chapman raised the issue
of informed consent, which varies from state to state because it is legislated
at the state level. Dr. Lauren Wood asked whether there is basic benchmark
data on alternative medicines already in use; after some discussion, Dr.
Sheila Katz asked that the committee members receive background information
on other groups that have addressed these topics.
Dr. Weed raised the issue of numerators and denominators in clinical
trials. The denominator issue is of paramount importance, he pointed out,
showing whether an agent worked in 10 out of 10 patients or 10 out of
1 million. But, he said, the numerator is important as well: in either
case, the agent worked in 10 patients, regardless of whether 10 were in
the study or 1 million. If the numerator isn't there, the results are
not significant, he said. Dr. David Hufford said that some CAM therapies
may prove to be very effective on a small subset of the population. In
the case of CAM, it's important to look at the numerators. Dr. Kail touched
on another point that sets CAM therapies apart from conventional medicine:
Conventional treatment addresses only tumor shrinkage, but alternative
medicine focuses on other factors such as better liver function and the
growth of certain cell populations. Members of the group expressed an
interest in seeing research that addresses quality-of-life and "soft
data." Dr. Wood asked if there is a general sense about CAM practitioners'
willingness to embrace research for legitimacy and recognition. Or, she
wondered, is there a general reluctance on the part of CAM practitioners
to come under scientific scrutiny? Dr. Kail told her that there is a little
bit of both. Offices with small staffs can't even look at the prospective
data in their own offices and are likely to wish to avoid coming under
too-close scrutiny. Individuals with a specific therapy that seems to
work-a small group, he stressed -will come forward, but most funding will
be sought by institutions. Dr. White asked panel members to identify publications
that CAM practitioners with promising modalities might read or other ways
to reach this group through advertising. Dr. Weed suggested that a pre-meeting
workshop at a national meeting might give some CAM practitioners the information
they need to move forward into presenting a best case series or getting
into a clinical trial.
The committee adjourned for lunch and convened again in closed session
at 1:15 p.m.
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IX. Best Case Series Presentation: Homeopathic
Treatment of Cancer - Drs. Pransata and Pratip Banerji, BPHRF
This session was closed to the public for reasons of patient confidentiality.
The committee reconvened Friday, July 9, at 8:30 a.m.
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X. Phase I/II Study of Stage III and
IV Non-Small Cell Lung Cancer Patients Taking a Specific Dietary Supplement
- Dr. Alexander Sun, Medical Director, Connecticut Institute of Aging
and Cancer
Dr. Alexander Sun first used a combination of Chinese herbs and vegetables
to treat the cancer of his mother, who was diagnosed in 1984 with non-small
cell lung cancer. Despite chemotherapy and radiotherapy, the cancer grew
and metastasized until it was graded as a Stage IV cancer and conventional
medicine could not fight the disease. Dr. Sun, a native of Taiwan who
is fluent in Chinese, found a copy of a Chinese traditional medical textbook,
Chinese Medicinal Herbs, and studied it thoroughly. He learned where and
how each herb grows, how to prepare it, what its properties are, whether
it is toxic, and how it is used to treat disease. The book listed the
right ways to use each herb, and Dr. Sun carefully analyzed all this information
to prepare an herbal vegetable soup to boost his mother's immune system
and shrink her tumor. When the tumor was removed surgically in December
1985, the surgeon was impressed that although it was large, it was very
well encapsulated, and that there was no cancer in the margins or lymph
nodes. The surgeon told Dr. Sun he had never seen this kind of encapsulation
in 30 years, and said there must be something about the Chinese herbal
treatment that had led to this result. Dr. Sun reported that his mother
is still free of cancer 14 years later.
Dr. Sun then gave the same soup to a family friend who had three brain
lesions, which subsequently shrank and then disappeared. Further research
followed. The team, which grew to include a number of researchers from
Mount Sinai Medical Center, tested the soup in laboratory mice and determined
that it had both immune-enhancing and tumor-reducing properties. They
next were invited to the Czech Republic where a study on the use of Dr.
Sun's SV soup in treatment of lung cancer patients again showed favorable
results. Later, many family friends were referred to the team. Their medical
records were obtained, and the team viewed their pathological slides and
radiological reports. Of 18 such patients, many were unable to drink the
soup for two months; already they were too sick, and they died. But two
Stage IV cancer patients who took the soup were in complete remission
15 months later. Seven of the patients are still alive after 60 months
or longer. In many, but not all, of this group, the SV soup was used as
an adjunct to surgery or other conventional modality. The primary and/or
metastatic tumors of 10 of the patients were surgically removed, and eight
of those patients remain cancer-free, leading Dr. Sun to believe that
the SV soup and surgical removal of a tumor may be the best approach in
many cases. Radiotherapy also seems helpful when used with the SV soup,
he said. Dr. Sun concluded that the apparent success of his SV soup leaves
many questions. Dr. Richard Fasy, a member of Dr. Sun's team, proposed
a paradigm for a future 24-month clinical trial on 60 Stage IV NSCLC patients,
using a randomized and double-blind design, with 30 patients receiving
the active SV soup and 30 patients receiving a placebo. (Dr. Sun detailed
several difficulties, however, in preparing a placebo that looks and tastes
like a Chinese herbal preparation but has no active medicinal components.)
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XI. Discussion
The research team asked the panel's help in determining what its next
step should be. From the discussion that followed, it became clear that
Dr. Sun and his colleagues have talked with Massachusetts General Hospital,
which has expressed interest in funding and conducting a 60-patient Phase
III clinical trial. Further discussion led the panel to caution Dr. Sun
about carefully assessing the optimum dose (small patients seem to have
done better than larger patients in the earlier studies, leading Dr. Sun
to wonder whether a different dose should be recommended for larger patients)
and developing a true placebo. Furthermore, the panel believed that if
dietary recommendations were made as well, these should be formalized
as part of the Phase III study.
Dr. Fair suggested that SV soup might provide an ideal formula for use
in a neoadjuvant setting. Prostate and colon cancer patients are often
told to wait two months following biopsy before having surgery. He suggested
conducting a study using these patients, in which the soup could be given
to one group of patients and the placebo to another. Histologic changes
in tissue between the biopsy and the surgery could be studied. The consensus
of the committee was that Dr. Sun's work should be moved along to a Phase
III clinical trial. The committee debated whether to suggest that Dr.
Sun follow established channels used to test conventional treatments,
or whether a different course should be charted. Complicating the debate
is Dr. Sun's status as holder of a patent for the SV soup. Since he has
a financial stake in the outcome of the Phase III trial, there was much
debate about the extent to which he should be involved. Many committee
members said they believed his involvement was crucial. The committee
agreed that the program staff will examine several mechanisms for moving
the research forward and prepare a report for the committee to consider
at its December 1999 meeting.
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XII. Concept Review of Best Case Series
Presentation: Homeopathic Treatment of Cancer
Dr. Hawkins explained that the closed session on July 8 had been a best
case series presentation by Drs. Prasanta and Pratip Banerji. It was a
retrospective examination of 12 cases involving patients with various
malignancies, including seven patients with lung cancer, first seen at
Prasanta Dr. Banerji's very busy clinic in India between 1990 and 1998.
Dr. Banerji presented data showing four documented cases of tumor regression
and told the panel that he did not think that these tumor regressions
were unusual for his clinic. The committee was generally enthusiastic
about the best case series presentation. After reviewing the data at the
July 8 session, panel members believed the tumor regressions in the four
patients were "very striking and unusual," as stated by Dr.
Katz. Members indicated a strong willingness to lend support to further
study of Dr. Banerji's methods. Questions and concerns focused on the
following areas:
Can the results be replicated? Can these outcomes be translated to Western
culture?
How can a workable protocol be developed to study the use of homeopathic
agents?
How can the Banerji team be enlisted as active collaborators without
negatively affecting the patients at their clinic?
Dr. Peter Choyke observed problems in four areas that must be resolved
if further study is to take place: (1) the quality of pathology seemed
variable; (2) some variability existed in the quality of imaging; (3)
patient follow-up seemed inconsistent because of travel problems, and
support-including financial help-would be needed to rectify this situation;
and (4) a formal computerized data management system should be put in
place. Several committee members agreed that significant financial support
would be needed because of the extreme poverty in the area where the clinic
operates. Dr. Hawkins addressed the need for a humanitarian approach with
an overlay of scientific support. The committee strongly recommended sending
a representative to India to observe Dr. Banerji's clinic and determine
the feasibility of further study, with assurances of no negative consequences
for the work Dr. Banerji and his staff are doing in their very busy practice.
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XIII. Review of the CAPCAM Process
Dr. Harlan read Dr. Wynder's faxed/written comments. Again, Dr. Wynder
stressed the need to formulate guidelines so that CAM can be regarded
as cost-effective. He set a four-month deadline for completing subcommittee
assignments. Dr. Harlan told the committee that by the next meeting in
December, the committee should receive follow-up on questions from this
meeting, including "perhaps" a report on a visit to the Banerji
clinic in India as well as a report on further conversations with Dr.
Sun. He asked the committee members to provide feedback on the information
they received so far and for information on how to improve the CAPCAM
process.
Dr. Hawkins said the committee needs to have much of the information
in advance of the scheduled meetings. For best case series, he said, it
would be better for the review to take place outside of the committee
so that the committee can focus on discussion. To that end, he said, he
would like to see a summary of research from Dr. White in advance of each
meeting and a carefully prepared, concise half-hour presentation from
the researcher at the meeting. Dr. Hufford asked that each presenter distribute
a one- or two-page backgrounder that addresses the research approach taken
so that the committee can have a clearer picture of the consequences of
its recommendation. Dr. Gordon stressed the need to send a clear message
to the conventional medicine and CAM communities about the openness of
the CAPCAM committee, and Dr. White asked for specific help from all CAPCAM
members on how to go about this. Dr. Katz told the group she believed
that the committee had developed part of a road map, but said a decision
tree should be drafted by the next meeting to simplify the process of
taking a next step.
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XIV. Public Comment - Ann E. Fonfa,
The Annie Appleseed Project
The remarks of Ms. Fonfa, who has been living with breast cancer since
1993, were read by her representative. Ms. Fonfa stressed the need for
research in areas other than conventional medicine and specifically asked
the committee to consider factors such as whole products and combination
ingredients, not just active ingredients or single agents. She recommended
exercising caution, however, in conducting studies using combination agents
on small test groups. The success of a treatment should be measured against
an existing or other experimental agent, she said, and she suggested adding
an alternative medicine arm to all conventional trials conducted by FDA.
Finally, she urged the Federal government to spend more money on the study
of alternative medicine in cancer and to provide wider and more timely
publicity to public meetings like the CAPCAM meeting.
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XV. Adjournment
The meeting was adjourned at 1:15 p.m.
Certification: We hereby certify that, to the best of our knowledge,
the foregoing minutes are accurate and complete.
| Richard L. Nahin, M.P.H., Ph.D. |
Michael Hawkins, M.D. |
| Executive Secretary and Deputy Director, |
Chair, |
| National Center for Complementary
and Alternative Medicine, National Institutes of Health |
Cancer Advisory Panel for Complementary
and Alternative Medicine National Institues of Health |
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|
