CAMbrella Final Report

Work package 6:

The global perspective

Leading beneficiary: Karolinska Institute (KI)

Objectives:
The aim of WP6 was to map the international position and status of CAM within health care policy so as to view the EU situation in context. This approach was founded on the WHO Global strategy for Traditional Medicine (TM) and/or CAM, and its main objectives were to:

incorporate experiences from countries in which CAM Research and Development (R&D) is integrated and publicly supported (US/Canada), while exploring its use as TM in developing countries (China/India)
understand the pros and cons of CAM R&D internationally addressing issues of patient rights and need, cost, regulation (of practitioner and product), evidence base and research policy/strategy
consider the risks of over harvesting medicinal plants and the protection of traditional inherited knowledge of traditional medicine used within CAM
identify the strategies we need to address from an EU perspective, as well as develop an understanding of how the EU might relate to international developments.

Description of work:
Through a nomination and prioritisation process, fifteen global R&D stakeholders were identified based on their international relevance as indicated by number of publications, funded research projects and financial research allocations:

Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), India - State funded department/institute
Central Council for Research in Ayurveda & Siddha (CCRAS), AYUSH, India - State funded department/institute
China academy of Traditional Chinese Medicine, China - State funded department/institute
The Consortium of Academic Health Centers for Integrative Medicine (here referred to as IM consortium) (CAHCIM), North America - Research association
Federal Ministry of Health/Complementary and Alternative Medicine, Brazil – State funded department/institute
nternational Society for Complementary Medicine Research (ISCMR), International - Research association
Japan Society of Oriental Medicine, Japan - Research organisation
Korean Institute of Oriental Medicine, Korea - State funded department/ institute
National Center for Complementary and Alternative Medicine, National Institutes of Health, USA - State funded department/institute
National Institute of Complementary Medicine (NCIM), Australia - Research organisation (partly state funded)
Natural Health Product Directorate, Health Canada, Canada - State funded department/institute (time limited initiative)
Osher Program for integrative medicine, located centers in USA & Sweden – Research organisation
Research Council for Complementary Medicine, international, UK based – Research association
Samueli Institute, USA - Research organisation
World Health Organization, Traditional Medicine, international - Global health organisation

WP6 developed a protocol for data collection, partly based on structure, process and outcome indicators published by WHO, to facilitate the development of evidence based national policies on medicinal products. The main topics in the protocol included the mission statement, R&D activities, and explicit or implicit R&D strategies.

We collected information from policy documents from the prioritised stakeholders and carried out personal interviews with them, selecting documents on the basis of their relevance in answering the questions in the research protocol, including policy documents and information on websites. Although documents were available for all prioritised stakeholders independent of the interviews, the interviews proved to be very valuable for finding the most relevant, accurate and up to date documents.

An international meeting in Chengdu, China, was arranged so as to benefit from a wider audience of CAM researchers present at the large international research meeting ICCMR85 2011. At this meeting the WP6 results were presented and participants were invited to comment on the findings. In addition, separate interviews were arranged with high level Korean and Chinese experts.

WP6 analysed the interviews with key stakeholders and documentary information collected from all stakeholders using principles of content analysis. Data of descriptive character included the budget, source of funding, number of funded research projects, and focus area (e.g. TM/CAM vs. specific therapies). The explorative analysis included data from both documents and interviews concerning mission statements and R&D strategies. R&D strategies could be categorised as follows:

context, paradigms, philosophical understanding and utilization
safety status
comparative effectiveness
component efficacy
biological mechanisms.

Findings:
The findings indicate that activities of key stakeholders vary greatly in terms of capacity, mission, and source of funding (private/public). R&D activities among selected stakeholders ranged from a mere provision of research funding to a comprehensive R&D and communication agenda.

Key stakeholders on the global arena of CAM R&D vary greatly in terms of capacity, mission, and funding source (private/public). They ranged from only providing research funding to having a comprehensive R&D and communication agenda. A common shift in R&D strategy was noted where ten years ago, research focused mainly on exploring efficacy and mechanisms while the majority of stakeholders today, emphasise the importance of a broad spectrum of research including methodologies exploring context, safety and comparative effectiveness of whole systems of care.

Europe lags well behind other regions such as North America, Asia and Australia in terms of the level of investment in CAM research and the integration of research results into health policy and health regulation. An emerging trend among many of the stakeholders was to prioritise studies focusing on clinical effectiveness of whole systems of care. The choice of method(s) for any particular project or experiment should be based on the specific scientific question and should focus on delivering safe and effective health interventions to EU citizens.

The lessons from this analysis of CAM R&D amongst international stakeholders provided valuable input into the EU CAM research roadmap. In line with our findings (Hök J et al. International Development of Traditional Medicine/Complementary and Alternative Medicine Research – What can Europe learn? Forsch Komplementmed 2012;19(suppl 2):44-50) (86), the CAM research strategy for Europe should be based on the popularity of a specific intervention and related to the national or regional public health needs and disease burden.
The work of WP6 supports a formation of a centralized and academically supported EU CAM research centre.