White House Commission on Complementary and Alternative Medicine Policy
Statement of the American Chiropractic Association before the White House Commission on Complementary and Alternative Medicine Policy
October 6, 2000
Washington, DC
Good Afternoon, my name is Ingrida Lusis, I am the Director of Government Relations for the American Chiropractic Association. This afternoon I will focus my comments on two questions posed in the Federal Register: 1) What can be done to expand the current research environment so that practices and interventions that lie outside conventional science are adequately and appropriately addressed; and 2) How can we effectively integrate the CAM and conventional research communities to stimulate an coordinate research.
As the public demand for complementary and alternative care increases, research must continue to ensure that safe and effective CAM services are made available to the public. Therefore, the Commission, in its formal recommendations must encourage Congress to continue funding of the National Institute of Health's Center for Complementary and Alternative Medicine. The Commission must also recommend that the National Institute of Health's National Center for Complimentary and Alternative Medicine Information Clearinghouse become the repository of all outcomes on complementary and alternative health care research.
While investigating the best approach to expand, integrate and coordinate research, the Commission should review the practices of successful research programs being conducted throughout the United States. The Commission should query these programs as to what works and what type of incentives are needed to facilitate additional research into alternative and complementary health care. A prime example of an integrated approach that includes chiropractic research is the Texas Health Research Institute (THRI), a nonprofit medical research organization founded in 1985 by the Texas Back Institute. Within the THRI, there is staff dedicated to work on studies supported by the Texas Back Institute Research Foundation which is dedicated to performing academically oriented research primarily in the areas of spinal diagnostics and treatments.
The ACA continues to urge the Commission to not reinvent the wheel. Research is currently being conducted to evaluate the benefits and efficacy of many complementary and alternative procedures. In gaining insight into the types of research currently being conducted, the Commission should establish contacts with professional organizations representing complementary and alternative providers. These organizations should be able to provide the Commission with research organizations, such as the Texas Back Institute, who are actively engaged in this area.
The Commission may wish to review the organization and success of several other chiropractic research organizations including the Consortial Center for Chiropractic Research and the Foundation for Chiropractic Education and Research (FCER), both located in Iowa. The Consortial Center has brought together research representatives from the government, chiropractic colleges, and faculty from medical colleges. The Center's primary purpose is to annually bring together an interdisciplinary leadership group to establish a chiropractic research agenda and to attract public and private funding for these projects. The Bureau of Health Professions, Health Resources and Services Administration of the U.S. Department of Health and Human Services fund these annual workshops.
It should be noted that historically, the chiropractic profession has relied on FCER, which was established in 1944, to support chiropractic as well as collaborative research. The foundation continues to be the largest chiropractic-based research-funding agency worldwide. Since 1980 alone, it has funded over 167 grants resulting in 250 publications in peer review journals as well as 135 post-chiropractic fellowships and residencies.
In addition, there are two main forums for the presentation of chiropractic research; the biannual scientific symposium of the World Federation of Chiropractic; and the International Conference on Spinal Manipulation which is sponsored by FCER.
In encouraging research, the Commission should also make formal recommendations to Congress to change regulatory guidelines that restrict and deny reimbursement for complementary and alternative health care in all federally funded programs. For example, the Health Care Financing Administration (HCFA) has currently announced a proposed national coverage decision regarding Medicare coverage of clinical trials and the coverage of routine costs. HCFA defines routine costs of a clinical trial to include all items and services that are otherwise generally available to Medicare beneficiaries (i.e. there exists a benefit category, it is not statutorily excluded, and there is not a national coverage decision) except for, among other things the investigational item or service itself. The Commission should encourage Congress to instruct HCFA to also provide reimbursement for effective complementary and alternative practices in these clinical trials. In providing for clinical trials of CAM procedures, HCFA as well as other researchers should recognize the need for balance between clinical trials, collaborative efforts and case studies. The acceptable double-blind approach to research, although appropriate for traditional allopathic research, may not be appropriate for CAM procedures.
The ACA is encouraged by the aggressive meeting agenda put forth by this Commission as you gather information on which to base formal policy recommendations. The ACA reaffirms its commitment to working with the commission as you develop your formal recommendations to Congress. I would be happy to answer any questions the commission may have.
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