DISCUSSION Thursday, May 25, 2:00-4:30
Methodological Challenges in Whole Systems Research
Speakers: Cheryl Ritenbaugh, PhD, MPH, Charles Elder,
MD, MPH, Vinjar Fønnebø, MD, Marja Verhoef, PhD, Mikel
Aickin, PhD, Richard Hammerschlag, PhD, Iris Bell, MD, PhD, George Lewith,
DM
While most CAM research has focused on single
modal interventions, CAM practitioners commonly prescribe holistic,
multimodality therapies, operating from paradigms that may assume non-linear,
non-local approaches to health/illness. NCCAM's 2005-2009 Strategic
Plan emphasizes the importance of conducting Whole Systems Research
(WSR). Specifically, NCCAM seeks to acquire a richer understanding of
CAM whole medical systems and how they operate, document the benefits
of some CAM whole medical system treatments for selected health conditions,
and elucidate mechanisms underlying successful multimodal treatments
used in CAM whole medical systems. Achievement of these goals within
a WSR paradigm presents multiple challenges to current methodological
approaches.
This session will provide an opportunity for
dialogue about these challenges and exploration of diverse perspectives
about methodologies appropriate for WSR. The first half of the session
will highlight general themes salient to whole system studies. Panelists
will review key differences between allopathic and CAM care, emphasizing
the nature, and importance, of nonspecific treatment effects. Methodologic
issues specific to WSR will be detailed from both quantitative and qualitative
vantage points with a focus on model validity. WSR must consider unique
dynamics such as the patient practitioner interaction and individually
tailored treatments, and quantitative strategies for coping with these
challenges will be elucidated, along with novel approaches to study
design. Qualitative approaches to capturing patient centered outcomes
will likewise be reviewed, emphasizing the role of patient expectations
and beliefs in influencing outcomes, and strategies for capturing and
describing that dynamic. Finally, the central role of the practitioner's
perspective will be examined, as it may impact both conventional outcomes
and nonspecific effects.
The second part of the session will review applications
of these issues within specific CAM whole systems of care, emphasizing
issues of special relevance to each system. Panelists will discuss WSR
as applied to homeopathy, with a special focus on issues related to
practitioner perspective. Application of WSR within Traditional Chinese
Medicine will likewise be detailed, including approaches to managing
the dynamic of dual CAM/allopathic diagnoses. Finally, a panelist will
consider issues related to integrated medicine practitioners, e.g. what
special considerations are introduced where the practitioner may have
competence in both allopathic care and a CAM system?
Woven throughout the discussion will be unique
and often divergent perspectives brought to these issues by both panelists
and attendees of various national and professional backgrounds. This
discussion will encourage progress and insight toward designing and
conducting rigorous scientific WSR in keeping with the goals presented
by NCCAM.