Clinical trials of the sort sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) and other NIH divisions are essential for the further development of holistic health care, but they are not enough to guide policy decisions, according to Marc Micozzi, MD, PhD, director of the newly formed Policy Institute for Integrative Medicine. Dr. Micozzi’s new institute, affiliated with Thomas Jefferson University, is dedicated to translating the findings from clinical trials into practical public health policy that creates infrastructures to support integrative medicine.
For most of the last decade, congressional advocates of integrative medicine like Sen. Tom Harkin, have counted on NIH’s burgeoning NCCAM programs to set the pace of policy development. While Dr. Micozzi applauded NCCAM’s efforts and the financial funding they’ve received, he believe it is time to look beyond NIH. “We need to broaden the effort, not just deepen it.” It is time to involve the Public Health Service, Centers for Disease Control, Department of Agriculture, and a host of other agencies in the effort of integration.
Controlled clinical trials, NIH’s stock-in-trade, are important for establishing a core evidence base. But policy development requires applied research, utilization and cost-effectiveness analysis, explained Dr. Micozzi, who also edits the new journal, Seminars in Integrative Medicine (Elsevier). The number of controlled clinical trials of CAM modalities has been increasing in recent years. But the field still lacks reliable utilization reviews, cost analyses, and implementation studies.
The Policy Institute for Integrative Medicine, founded on a grant from the Ira and Myrna Brind Foundation, has as its over-riding mission the gathering, analysis and presentation of information on best practices that can help policymakers, health professionals, and consumers re-shape the system.
The institute’s debut project is on establishing best practices for management of low-back pain. “We have lots of cost effectiveness, efficacy, and quality of care data. The question is how to pull it all together in guidelines for best practices to treat the number one cause of disability among working Americans?” Dr. Micozzi stressed that PIIM will not undertake any original primary research. “We’re tackling areas where there is already evidence and then trying to develop analyses that will be relevant and useful for policymakers.”
It is not enough simply to know that a particular therapy is effective as proven by a clinical trial. Health care professionals need to be trained to offer that therapy; funding mechanisms need to be established. “We know that spinal manipulative therapy is effective for low back pain. We have the evidence to say that “an alternative modality” actually is effective and cost-effective. What happens as we discover more things that are effective and cost-effective? How do we train the manpower to provide these treatments to millions of people who could benefit?”
Dr. Micozzi has spent much of his career at the interface of science, medicine and public policy. At NIH, he studied diet and cancer prevention, and was a member of the research team that first discovered lycopene and lutein as key antioxidants. Later, he worked with former Surgeon General C. Everett Koop on a series of consumer education programs, and ran the Philadelphia College of Physicians for 7 years.
He believes it is high time for the integrative medicine movement to get involved in health care reform. “When people think about the health care crisis, they ought to be thinking about CAM as part of the solution. Yet it has not been in the thinking or rhetoric on the issue. We need to show, based on evidence, that these therapies can play a big role in alleviating the perceived crisis.”
