Notably, no one was heard arguing much in favor of holding on to the terms “complementary and alternative medicine” or CAM.

Take the CAM out of NCCAM?

The stakes went up following a suggestion from Senator Harkin. Harkin proposed changing the name of the NIH National Center for Complementary and Alternative Medicine to the National Center for Integrative Medicine. Some urged him to amend this: How about the National Center for Integrative Health?

Suddenly, a fiscal note of NCCAM’s $120-million annual budget was attached to our armchair discussion of semantic choices. Is it time to erase “CAM” from its only prominent recognition in a significant government agency? What implications might this have? What’s in a name?

Again, there is an evidence base for concern among the licensed CAM disciplines. When NCCAM was created in 1998, Congress required that at least 50% of the members of the National Advisory Council on Complementary and Alternative Medicine be licensed members of the disciplines NCCAM is charged to explore. In the first years, this was interpreted to mean members of the distinctly licensed CAM disciplines. Ten years later, NCCAM, in their efforts to meet this statutory requirement, is choosing to include as “licensed CAM” political leaders of osteopathy and medical doctors who may use some CAM therapies. Many in the licensed CAM fields do not agree, some vehemently.(3) They see this as an erosion of their position in the integrative research dialogue. The percent of members from licensed CAM disciplines is down to 18% from the 50% many in the CAM fields believe is required.

Should members of these professions be comfortable if we take the CAM out of NCCAM?

 Need for affirmative action?

Needless to say, Gaboury’s survey hit a receptive audience when I sent it to ACCAHC list. It wasn’t one-sided. I knew from informal comments and a small e-mail thread that the licensed CAM  leaders who responded – and some 40 did - would be all over the map with their thinking.

Some of the most politically savvy were saying whoa, let’s not give up the CAM term. Here is a comment from one of them in an email which I can only use without attribution:  “I’m concerned at the talk of phasing out the term CAM, especially as it is usually in the context of replacing it with Integrative Medicine (IM) or Integrative Health (IH), e.g. there were some not too subtle hints of this at the IOM conference.  I feel strongly that switching to IM or IH will further marginalize our CAM professions and will place the conventional medicine folks in a stronger position to decide what gets ‘integrated.’ Call me paranoid, but in my view we need ‘affirmative action’ for CAM for a while longer, even as NCCAM moves to more narrowly define rather than to broaden what it considers under the CAM umbrella.” 

The argument is that there is value in this continued clustering of professions as CAM and the shared identity of the CAM disciplines as fields that need some special, focused attention, given their historic ostracizing by mainstream medicine. The successful appeal from this set of professions, via ACCAHC, to the IOM for a representative on the Summit’s planning committee is an example of where the CAM grouping was instrumental in insuring inclusion in an otherwise exclusionary integrative medicine discussion.

Developing an “exit strategy”

Bill Meeker, DC, MPH, a leading NCCAM-funded chiropractic researcher and now president of Palmer College-West, spoke to the point via email:”I think that right now we need to keep some ‘affirmative action’ going so that policy makers can’t make it easy to dismiss us. But in the long term we need an appropriate exit strategy. This is a topic that should be addressed but rarely is. I don’t have any particular insights, however. Exits are going to be slow evolutionary affairs, I suspect.”