Pictures from an Exhibition: Integrative Research Priorities Emerge at ICCMR, Brisbane, May 8-10, 2019

On May 7-10, 2019, I attended the top international integrative health research conference that comes around each year. The 14th International Congress on Complementary Medicine Research drew roughly 400 “delegates” as the Brisbane, Australia hosts welcomed us. We hailed from 34 nations. The turnout to the distant location was about half that when the meeting is hosted in North America or Europe and roughly on par with a 2015 South Korean event. Yet despite or perhaps because of the size and distance new themes emerged and old ones that needed prodding re-emerged. Together these offer an impactful direction for the global integrative research community and for ISCMR, the organization of traditional, complementary and integrative medicine researchers that co-sponsors each of these event.

The themes distinguished the conference from the fealty to biomedical industry’s typical disposition – despite resent shuffling toward value-based priorities and pragmatism – to hold up basic research as the godhead and efficacy trials as chief stock in trade.

The differences in Brisbane flow from the top. The Platinum Sponsor of the event was the Australian Research Center for Complementary and Integrative Medicine (ARCCIM) at the University of Technology in Sydney. ARCCIM presents itself as “the world-leading critical public health and health services research centre focusing on traditional, complementary and integrative health care.” These “public health” and “health services research” priorities distinguish the center from prior hosts. The focus is on the real world. They announce for “translational research” in their logo.

The two ARRCIM leaders who served as ICCMR co-chairs, Jon Adams, PhD and Amie Steel, ND, PhD – Steel was research director at Endeavor College of Natural Health, the host of the meeting and also a significant contributor when they began the journey –  led a team that designed the Congress to include some unusual “firsts”:

  • A plenary session focused on implementation science. Shifting chronic pain treatment, for instance, toward appropriate use of non-pharmacologic, integrative approaches is optimally aided by such research.
  • A public health oriented plenary session from a leader of WHO, Vivian Lin, who has been in the thick of that organization’s efforts, via its traditional, complementary and integrative medicine office, to integrate traditional medicine practices into its mission of primary care for all and universal health care.
  • A presentation by Steel related to her organization’s multiple practice-based research networks (PBRN) on “Integrative medicine clinical research in the real world: practice-based, practice relevant and practice-informed.” This is another room in the evidence house from efficacy trials.
  • Plenary presentations from a lead organizer of the Western hemisphere’s WHO affiliate, PAHO, and another from Brazil and yet a third working with Australia’s aborginal healers on efforts to engage the work of integration. By way of comparison, efforts to include community based licensed acupuncturists, chiropractors, naturopathic doctors and other practitioners in the US don’t receive this level of attention in the North American meetings.
  • A regular session on whole systems research (with which I was involved) that explored, through the lens of a special issue of a journal, possible reasons for re-awakening the mission that forged ISCMR two decades ago: ” …to foster the development and dissemination of new knowledge regarding whole person healing and whole systems healthcare research, including all traditional, holistic, alternative, complementary and integrative forms of medicine (TCAIM).” At ISCMR’s general membership meeting, past board chair Jianping Liu, PhD noted ISCMR’s partnership on the special issue as a highlight of its prior year.

An additional new theme of activism emerged not as part of the conference program but in the ISCMR membership meeting. University of Toronto Researcher Nadine Ijaz, PhD reported that the ISCMR Board of Directors had resolved to take a role in advocating for scientific “rigor” when it is apparent that bias in the dominant school of medicine is acting against integrative health in policy and the media in ways that disrespect integrative science. (Example, for instance, are the bias shown in the United Kingdom against acupuncture for low back pain and osteoarthritis of the knee, and in Australia against naturopathy.) With sufficient resources and when deemed appropriat, ISCMR anticipates weighing in as an international organization of researchers.

Such a turn toward pro-activity by ISCMR is a marked shift for an organization that in recent years has appeared somewhat rudderless. The founders’ initial organizing drive for whole systems research waned. The organization has not since then led significant initiatives that identify it as a necessary player in the advance of the field. As an active member, I’ve learned that ISCMR struggles with an inflexible website and inefficient newsletter. Not surprisingly, while membership grows slightly, the organization’s stature hasn’t reflected the growth of the integrative movement in North America and Europe and, under a powerful 2014-2023 traditional medicine strategy, the WHO’s support for action on traditional, complementary and integrative medicine.

The practical directions the ARCCIM leadership brought to ICCMR 2019 are refreshing, and timely. In December, the NIH National Center for Complementary and Integrative Health will hold a full day exploration of implementation science for integrative health such as it is promotion through the  HEAL program. Multiple integrative medicine leaders and government agencies are being given opportunities as were evident in papers submitted here to implement the science that supports non-pharmacologic approaches. A pain leader who co-chaired the US National Pain Strategy is pointing out that the next steps for quality pain treatment may be in addressing the social determinant called “loneliness.” Most importantly, value-based treatment increasingly respects the diversity of choice and of practice begged by patient-centered and culturally appropriate care.

On the hierarchy of the dominant school of medicine’s funding and prestige, “health services” are, suitably for this column. down under basic research and efficacy trials. Similarly, ARCCIM’s declaration for public health and that field’s engagement with the principal health determinants declare for a poverty stricken cousin to clinical medicine’s specialties particularly the high-rollers like cardiology or oncology.

Yet if it is value one seeks, then an agenda for ISCMR and the integrative research community that looks to the emergent themes highlighted in Brisbane may be an exceptional and inclusive fresh direction.