Office of International Health Research
Expanding Global Horizons of Health Care
5-Year Strategic Plan (June 2002)
On this page:
- Introduction
- The Global Challenge
- NCCAM Strategic Plan for International Health Research
- OIHR Goals
- Evaluating OIHR Plans and Programs
- Appendix I: NCCAM Strategic Areas
Introduction
The establishment of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health in 1998 may prove to be a watershed in medical history in America. Not only was the founding of the Center an acknowledgment that Americans are increasingly receptive to forms of health care outside Western medicine, it was an acknowledgment that rigorous research on these forms could enrich Western medicine. The resulting "integrative medicine" could pay off in greater options for improving the health and well being of the American public. NCCAM has underscored this philosophy of inclusion in its description of CAM practices as "those not presently considered an integral part of conventional medicine."
In 2001, NCCAM, with the advice of many individuals and groups within and outside government, developed a 5-year strategic plan, Expanding Horizons of Health Care, expressing the following mission and vision:
Our Mission
We are dedicated to exploring complementary and alternative healing practices in the context of rigorous science, educating and training CAM researchers, and disseminating authoritative information to the public and professionals.
Our Vision
We will advance research to yield insights and tools derived from complementary and alternative medicine to benefit the health and well being of the public, while enabling an informed public to reject ineffective or unsafe practices.
The Global Challenge
The NCCAM Strategic Plan identified four strategic areas for implementation: Investing in Research, Training CAM Investigators, Expanding Outreach, and Facilitating Integration, each with a set of goals and objectives (summarized in Appendix I). Within each of the four areas are goals that envision the need for CAM activities to be international in scope—primarily because so many CAM practices originate or are traditional in other countries. There they constitute the routine system of health care for the majority of citizens. Study of these systems should, therefore, where appropriate, take place on their native grounds, with the cooperation and collaboration of native peoples and practitioners. At the same time, many racial and ethnic minority populations in America will have brought these healing traditions to their new homeland where, over time, the practices may have been modified in the American environment. Thus, global studies of these CAM systems can serve a dual purpose: (1) They can establish which CAM interventions—as practiced in their countries of origin or as assimilated in this country—can benefit the health and well being of all Americans, but may be particularly useful and accepted in selected racial and ethnic minorities; and (2) They can facilitate integrating these practices into conventional health care in the United States, especially into programs specifically designed to address the health needs of minority populations. For the sad truth is that in many areas the health of America's racial and ethnic minorities is poorer than that of the white majority. Indeed, the data documenting these demographic facts of life have led the Department of Health and Human Services and the National Institutes of Health (NIH) to implement research plans to reduce and eventually help to eliminate racial and ethnic health disparities.
Accordingly, NCCAM has created two new and interrelated offices to address these issues. The Office of Special Populations is the focus for NCCAM activities to eliminate racial and ethnic health disparities. The Office of International Health Research is the focus for the Center's international activities. Each Office has been charged to develop its own strategic plan, building on the goals and objectives in the Center's 5-year plan. What follows is NCCAM's Strategic Plan for International Health Research.
Expanding Global Horizons of Health Care
NCCAM Strategic Plan for International Health Research
NCCAM created the Office of International Health Research (OIHR) in February 2001 to provide global leadership in CAM research (called for in the NCCAM Strategic Plan, Strategic Area 1, Goal 4). OIHR activities toward this end are expressed in the following mission and vision statements:
The OIHR Mission
OIHR will identify promising international CAM practices, encourage their rigorous scientific assessment, and promote the development of effective CAM applications by facilitating international scientific collaborations. Also, OIHR will educate and train CAM researchers and disseminate authoritative information to the public and professionals.
OIHR Vision
OIHR will advance international collaborative research on complementary and alternative healing practices leading to improvements in domestic and international health while fostering integration of safe and effective practices.
In pursuing these aims, OIHR is mindful of the need to partner NCCAM resources and of the utility of leveraging existing international research and research training plans and programs. As well, the Office recognizes the importance of ensuring mutual cultural sensitivity among participants in international research ventures. The Office is committed, therefore, to the following guiding principles:
- OIHR will conduct research on traditional and indigenous health practices at sites where the most promising opportunities for CAM research can be identified, working in coordination with international organizations and respecting the heritage and practices of indigenous peoples.
- OIHR will align international programs with existing NIH-funded and other international research programs to ensure the immediate availability in the field of research expertise and the necessary infrastructure.
OIHR Goals
The OIHR strategic plan has formulated goals and initiatives in each of the four strategic areas in the NCCAM Strategic Plan. Specific projects that operationalize OIHR goals are developed annually in a separate implementation plan that reflects research opportunities and resources available.
For NCCAM Strategic Area 1, Investing in Research, OIHR proposes:
Goal 1: To Foster International Research
"International research" includes grant applications submitted by applicants in other countries as well as those originating in domestic institutions with significant foreign involvement. Foreign research applications to NCCAM often come from practitioners who are not familiar with the NIH peer-review system and who may not have had prior research training. They may also lack institutional support and research resources. Not surprisingly, applications of this type have not fared well in the NIH review process. OIHR proposes to assist international colleagues in overcoming these problems with novel approaches and funding mechanisms designed to:
- Facilitate the acquisition of research skills by foreign investigators through formal training and/or collaboration with experienced, NIH-funded investigators;
- Train members of the prospective international research community in grant writing and grant management;
- Assist international institutional leadership in its role in promoting CAM research;
- Improve the existing international CAM research infrastructure and resources; and
- Provide opportunities for and promote scientific exchange, technology transfer, and discussion/resolution of issues related to intellectual property rights.
To maximize support and opportunities for international CAM research, OIHR will partner with other public or private funding agencies. We will also co-fund meritorious proposals submitted to other NIH Institutes and Centers, and build on existing research programs in promising international sites.
Objectives
- Encourage the development of international sites of CAM research excellence by fostering U.S. and foreign research partnerships for the conduct of collaborative CAM research projects at promising foreign venues.
- Sponsor and partner with other agencies the support of CAM-related research in areas of the world that possess unique CAM resources (such as medicinal plants or animal products).
- Promote studies of whole systems of CAM in their countries of origin, working with relevant government agencies, native teachers, practitioners, and patients.
- Facilitate productive working relationships between international research partners through programs focused on bioethics concerns and intellectual property rights.
For NCCAM Strategic Area 2, Training CAM Investigators, OIHR proposes:
Goal 2: To Promote International Research Training
OIHR will vigorously support diverse models of international research training, including traditional classroom courses, workshops, and other modalities as appropriate. Training will also be used as a strategy in programs to promote international research collaborations. CAM international research training needs to focus on basic and clinical research methodology, grant writing skills, grant management skills, and the ethical conduct of research. Not only is such training essential to the conduct of rigorous research, it is also essential in the learning process leading to successful NCCAM grant applications.
Objectives
- Sponsor workshops dedicated to training on research methodology and grant writing at international sites.
- Support NIH-wide efforts to improve the quality of international ethics training, and support advanced training of professionals who could assume leadership in ethics review of research studies.
- Partner with the World Health Organization (WHO) in CAM research training programs to support extramural research training in the United States for international scientists with doctoral degrees.
- Continue to develop new and exploit existing NIH research training award programs and supplements tailored to international CAM students, teachers, researchers, and practitioners.
For NCCAM Strategic Area 3, Expanding Outreach, OIHR proposes:
Goal 3: To Expand Outreach and Dissemination of International Research Information
The establishment of OIHR in itself is concrete evidence of NCCAM's recognition of the importance of reaching out to the international and domestic community for the exchange of ideas, personnel, and resources to facilitate CAM international research. The Office will use multimedia as well as personal representation at international and domestic venues to communicate information on OIHR policies, plans, and projects to a global network of interested parties and agencies as well as to the public at large.
Objectives
- Represent OIHR and NCCAM at international meetings to exhibit and/or exchange information and provide details on NCCAM programs.
- Develop and distribute culturally sensitive informational materials to promote understanding and participation in OIHR/NCCAM programs.
- Develop a user-friendly OIHR homepage for incorporation into the NCCAM Web site.
- Collaborate with other NIH components, WHO, and relevant private and public agencies in communication and outreach concerning CAM international research and research training efforts and joint ventures.
For NCCAM Strategic Area 4, Facilitating Integration, OIHR proposes:
Goal 4: To Facilitate Integration Using Global Models
OIHR participation in international meetings is a means of learning about different CAM models in use around the world and their level of success in achieving integrative medicine. Many such activities are not published in English and/or mainstream journals. OIHR uses these occasions to disseminate reliable research information to participants and network with other attendees. Visits to local research institutions and funding agencies also allow a better understanding of local research priorities and available resources. The knowledge gained from these activities contributes to more effective program planning at OIHR and, insofar as many models are presented and discussed, can suggest new ways of health care research and delivery that may be acceptable and sustainable to the poor and to racial/ethnic minorities in the United States.
Objectives
- Encourage integration of CAM teaching in domestic medical schools through the exchange of international faculty in U.S. institutions. As an example, OIHR is facilitating contacts between the Government of India and U.S. medical schools to discuss the feasibility of a small elective course on "Principles and Applications of Ayurvedic Medicine."
- Promote international meetings and workshops where conventional practitioners can learn about validated CAM therapies from native experts.
- Identify and try to overcome barriers to the integration of safe and effective CAM practices.
Evaluating OIHR Plans and Programs
OIHR will develop a process for the periodic evaluation of both short- and long-term outcomes of OIHR initiatives. Intermediate indicators and endpoints will be defined qualitatively and quantitatively. For example, an intermediate indicator for the NCCAM/WHO Fellowship in Complementary and Alternative Medicine will be the number and type of publications/presentations accomplished during the fellowship. The final endpoint will be the number and success rate of awardees competing for R21 grants. Other endpoints could include, but are not limited to, awardee-initiated CAM activities at the home institution (e.g., seminar series, journal club, visiting speakers), creation of units dedicated to CAM research, and endowment of programs or lecturers.
These data will allow timely evaluation of OIHR programs and their success in accomplishing OIHR goals. Using the above-mentioned example, failure to publish, or publication in non-peer review journals will alert OIHR staff to look at the quality and or quantity of research being conducted, and seek explanation(s) for the situation.
Appendix I
NCCAM Strategic Areas
To achieve our vision, we have identified four strategic areas:
- Investing in Research
- Training CAM Investigators
- Expanding Outreach
- Facilitating Integration
Each of these strategic areas has evolved and will mature through an ongoing process of planning and evaluation, with substantial input from the National Advisory Council on Complementary and Alternative Medicine and our stakeholders.
Strategic Area 1: Investing in Research
NCCAM will advance research by encouraging and supporting CAM research projects according to the philosophies and priorities outlined in Part II of the NCCAM Strategic Plan. The Center's highest priority is clinical research, both with respect to individual therapies and entire systems of medicine. While NCCAM will pursue investigations at all levels of the hierarchy of evidence, our largest investment will be in Phase III clinical trials, with proportionately smaller investments in areas for which less evidence is available. NCCAM will also support basic science research, not only through studies whose primary aim is to elucidate basic mechanisms, but also by exploiting opportunities afforded by clinical trials.
The Center is also committed to building research capacity and infrastructure, both intramurally and extramurally, in the United States and abroad. Throughout these endeavors, the Center will pursue the many advantages afforded by collaborations nationally and internationally, as well as with fellow NIH Institutes and Centers, other government agencies, and industry.
Goal 1: Stimulate submission of high-quality applications in CAM priority areas by both CAM and conventional investigators.
Goal 2: Expand the scope of the NCCAM extramural research portfolio and participation by research subjects.
Goal 3: Create an NCCAM intramural research program.
Goal 4: Establish a global NCCAM research enterprise.
Strategic Area 2: Training CAM Investigators
NCCAM will develop a cadre of investigators in CAM research by providing appropriate career development opportunities; by increasing the knowledge, experience, and capacity of CAM practitioners to conduct rigorous research; and by enhancing conventional practitioners' and researchers' knowledge and experience in specific CAM areas.
Goal 1: Increase the number, quality, and diversity of CAM investigators.
Strategic Area 3: Expanding Outreach
NCCAM will strive to create a public image that conveys our dedication to exploring complementary and alternative healing practices and pursuing rigorous science, providing extensive, accurate information to consumers with sensitivity and compassion, and involving our broad range of stakeholders in shaping the Center's agenda. To this end, NCCAM will use a variety of methods, media, and technologies to provide a timely source of evidence-based CAM information and actively seek input from its stakeholders.
Goal 1: Enhance NCCAM's capacity to provide information to consumers, practitioners, and investigators.
Goal 2: Establish an effective dialogue with CAM stakeholders.
Strategic Area 4: Facilitating Integration
NCCAM will work to facilitate a more integrated practice of medicine. Within this paradigm, CAM and conventional health care professionals would function as interdisciplinary teams to deliver an expanded repertoire of safe and effective treatments that include a focus on the whole person. This goal is consistent with the increasing interdisciplinary nature of health-related research and the renewed focus on integrative biology. Only by holding CAM therapies to the highest standards of evidence will we best accomplish this broad aim.
Goal 1: Facilitate development of health education curricula that respect and incorporate insights and opportunities afforded by safe and effective CAM and conventional practices.
Goal 2: Facilitate coupling of effective CAM and conventional practices within a coordinated, interdisciplinary health care delivery system.
