The development of the CAM commission was outlined in the FY 1999 Omnibus Appropriations Bill and brought to life July 13, 2000 when President Clinton announced by executive order his first appointments to the commission. (See "Clinton Appoints 13-Member White House Commission on CAM Policy: Tally: 8 MDs - 4 Lay/Business Persons - 1 PhD - 0 DCs," in the Aug. 18, 2000 issue or at http://www.ChiroWeb.com/archives/18/18/02.html.)
The commission, led by James Gordon,MD, has the broad task to make legislative and administrative recommendations on research, training, certification of CAM practitioners, insurance coverage, among other alternative medicine issues.
Dr. Meeker's testimony focused on the need for federal funding of chiropractic research and research in other CAM professions commensurate with federal funding for other health care professions. He presented an overview of chiropractic's place in health care, the profession's role in developing its own research capacity, the rationale for federal funding of chiropractic research, and what specific steps the federal government can take to support chiropractic research and training institutions in the broadest sense.
"The fact that chiropractic institutions were invited to testify in front of this prestigious and unprecedented White House commission is of tremendous significance," Dr. Meeker said. "It is a recognition from the highest level of the U.S. government that chiropractic is a major force in the CAM (complementary and alternative medicine) area, and that research is necessary to increase scientific and eventually public understanding of chiropractic."
The White House Commission on Complementary and Alternative Medicine Policy was established by an executive order on March 7, 2000, to develop a set of legislative and administrative policy recommendations that will maximize the benefits of CAM practices and products for the general public. The commission has been charged to submit a report to the president and Congress by March 2002.
The president's executive order outlined four broad topic areas for consideration by the commission:
- coordinated research to increase knowledge about CAM practices and products;
- reliable and useful information about CAM that can be made readily accessible and understandable for the general public;
- guidance for appropriate access to (and delivery of) CAM; and
- education and training of health care practitioners in CAM.
Dr. Meeker's presentation focused on two major points. "First, the professions that value it the most will accomplish the best CAM research, because it is their professional duty," he told the commission. "It is the obligation of chiropractic, for example, to develop its research capacity and conduct research in its training institutions, just like all the other health professions."
"Second," Dr. Meeker continued, "the federal government has the duty and obligation as an agent of the public to assist the development of the research capacity of the CAM professions, particularly chiropractic, just as it has for the other health professions."
He pointed out that chiropractic already has a major role in health delivery in the U.S., with more than 60,000 professionals and growing; that it is the third largest doctorate health profession in the United States; and that 11-15 percent of the U.S. population visits a chiropractor every year, for a total of nearly 200 million annual patient visits, compared to not quite 400 million visits to primary care medical doctors.
"A well-known CAM researcher at a famous medical school once told me that if we consider CAM to be a room, then chiropractic is the elephant standing in the middle," Dr. Meeker said. "It simply cannot be ignored any longer."
Taking the opportunity to clarify distinctions of great importance to the chiropractic profession, Dr. Meeker told the commission that research on a health profession such as chiropractic must be broader and should include at least the disciplines of sociology, economics, health services, anthropology, law and education.
In listing the specific ways the federal government can assist chiropractic research, Dr. Meeker urged broad support of chiropractic training institutions. "Support chiropractic training institutions in the broadest sense, like all other health professions, to eliminate the dependence on tuition and to provide the resources to develop a more effective and consistent research culture."
Dr. Meeker's other suggestions:
- Train CAM scientists.
- Ecourage interdisciplinary, multi-disciplinary and inter-professional collaboration between CAM institutions and tax-supported universities.
- Apply the entire panoply of research project and program funding mechanisms to initiate, encourage and support chiropractic and CAM research, including "bricks and mortar."
- Apply the entire panoply of research project and program-funding mechanisms to initiate, encourage and support chiropractic and CAM research, including "bricks and mortar."
- Establish and fund academic clinical research centers at chiropractic and CAM professional training institutions.
- Call for interdisciplinary conferences to explore scientific states-of-the-art on CAM topics and establish rigorous research agendas; support the agendas with targeted research funding program announcements.
- Encourage the National Library of Medicine to include CAM topics and references in its indexing systems.
- Ensure that chiropractors and other CAM professionals are routinely appointed and otherwise included in research policymaking efforts (to include hiring chiropractors at the same level as other doctors in the Department of Health and Human Services as administrators and investigators).
- Consider that CAM professions and their institutions might benefit from special attention to jump-start their research efforts; perhaps something similar to the "Centers of Excellence" in HRSA's Bureau of Health Professions.
Editor's note: Because Dr. Rosner was out of the country while this article was going to press, we were unable to obtain the particulars of Dr. Rosner's testimony before the White House Commission on CAM Policy. We will print that information in our next issue.