From the perspective of research contributions from academic institutions in integrative health, the 7 multidisciplinary universities have been key important contributors. These institutions, with one exception, are products of the last 20 years of advance of complementary, integrative and non-pharmacologic approaches in US health care. Each began as a professional school for chiropractic doctors, naturopathic doctors or acupuncturists then chose to expand its offerings for bird-of-a-feather programs, morphing into universities of integrative, natural health sciences. Part 1 of this series, “The Future of Integrative Health – Interviews with Presidents of 7 Multidisciplinary Universities”, examined the cornucopia of their present offerings. Part 2 offers an examination of the current place of research in these integrative health universities as the nation begins to call on their practices and practitioners in developing a new chronic pain strategy.

Changing Context: Fewer NIH Grants to “CAM” Institutions?

The 1998 Congressional mandate that created what is now the National Center for Complementary and Integrative Health specifically charged the agency, in “Section h – Research Centers” with making grants to institutions that educate the licensed complementary and integrative health professions: “The provision of support for the development and operation of such centers shall include accredited complementary and alternative medicine research and education facilities.”

A team from the Academic Collaborative for Integrative Health led by Martha Menard, LMT, PhD published a 2015 paper that estimated total NCCIH grants to any non-conventional institution. These are found to have declined from 21 of 393 awards to 8 of 330 awards between 2010 and 2014. Total grant dollars shrunk by two-thirds, from $6.3-million to $2-3-million. At the time of the analysis, 4 of these universities institutions had received at least one NIH grant (Bastyr, Northwestern, NUNM, and NUHS).

Decline of NCCIH Funding to All “CAM” Institutions – 2010-2014

From Menard, et al https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4505754/

While grant-getting was small, even this level of funding to these institutions may be passing as the first generation of researchers who received NIH grants are moving on or retiring. At Northwestern Health Sciences University, former research leaders Gert Bronfort, DC, PhD and Roni Evans, DC, PhD, are both now based out the University of Minnesota Medical Center. A former Bastyr University research center that produced a succession of members of the NIH National Advisory Council for Complementary and Integrative Health (Standish, Calabrese, Guiltinan) has been quiet as Leanna Standish, PhD, ND, LAc, Bastyr’s principal rain maker, has cut back.  At University of Western States, a robust effort led by Mitchell Haas, DC, MA has quieted since Haas’ retirement.

Former NIH grant-getters: Evans & Bronfort (moved), Standish (less active) and Haas (retired)

UWS president Joe Brimhall, DC, believes that the landscape has simply changed. “The face of research in the integrative medicine fields has changed drastically. There is a lot of focus now on the opioid crisis, how to get money for related initiatives. We think the direction forward is collaborating with other entities.”  He spoke to the success of his former rainmaker, Haas: “What Mitch did is remarkable, but I don’t think it would work in this environment. You have to collaborate.” He sees an environment of fewer external research resources: “We need to make institutional resources available.”

The Collaborative – of which all 7 universities are members – has lobbied the NIH (see ACCAHC – NCCAM Correspondence 2009-2011) to invest more thoroughly in building research capacity. The trend of any NIH research funding involving members of these professions appears to be toward grants to researcher whose bases are in conventional academic health centers – like Bronfort and Evans, Michael Schneider, DC, PhD at University of Pittsburgh, and Lynne Shinto, ND, MPH at Oregon Health Sciences University.

Data from the Websites

An examination of the websites of the 7 institutions yields a portrait of less than robust activity in the area of research.

• 3 of the 7 (SCU, MUIH, UWS)  don’t have a button for “research” on their home page. This could signal that this part of the classic 3-legged stool of academic medicine (education, clinical, research) is not viewed as core – though presidents of all 3 speak to its importance.
• 3 of the seven (Bastyr, Northwestern, NUNM) have their research operation denoted as a “center” or “institute.” Notably, one of these – Northwestern, where Bronfort and Evans were – however, appears to be relatively inactive, listing no publications since 2015.
• Just 2 of the 7 (NUNM, SCU) appear to currently be operating with NIH grants. Each of the NUNM are training related. SCU has a grant comparing spinal manipulation and drug therapies for long-term care. ( Co-investigator James Whedon, DC, MS is also an investigator on an NIH grant to Dartmouth that is the largest exploration of the relationship between cervical manipulation and cervical artery tears. Three of the other universities have had them in the past (Bastyr, NUHS, Northwestern) but do not appear to presently. None has a coveted investigator-initiated RO1 grant for multi-year funding of a clinical question.

(Mainly) Web-Based Information on Research Action at the 7 Universities of Integrative Health

Some Additional Perspectives of the Presidents

UWS’ Brimhall shared that present focal projects for research at UWS are “everything from teaching methods to nutritional and chiropractic interventions. As our mental health counseling continues to growth, I anticipate we will have more focus there.” But as for any strategic focus of research to drive an agenda for UWS fields: “I don’t see a particular focus now.”

At National University of Health Sciences in Chicago, president Joe Stiefel, MS, EdD, DC strikes a similarly internally-focused tone. Research under way is often of an educational variety: “We have a lot of focus on research on what is going on in the institution – the tremendous weight of providing data for accreditation. It’s similar to liberal arts schools. Our research focus is on internal outcomes.”

A university where research investment follows a strategic plan is Southern California University of Health Sciences. Following significant investment in an interprofessional focus, President John Scaringe, DC, EdD is interested in clarifying the value of models that will lead to more employment. One research project is a partnership with Dartmouth that explores outcomes of a team pain treatment model that includes a lifestyle focus medical doctor, a neuromuscular-oriented chiropractor and a mental or behavioral health provider. Noting that SCU’s research leader is a real world oriented health services researcher, James Whedon, DC, MS, Scaringe adds: “We are looking at big data as leverage” to move the integrative process. The SCU NIH grant noted above is one such project, as is the Dartmouth grant on which Whedon is a co-investigator.

Marc Levin, MBA, MA, CPA, the new president at MUIH, notes that when what was the Tai Sophia Institute became a university in 2013, MUIH “developed a research strategic plan to grow a culture of research where one did not exist.” They added faculty training and mentorship, an annual symposium, and are looking at developing a way to recognize research contributions in formal faculty advancement processes. He shares that “these intentional efforts have grown the number of faculty, students, and disciplines engaged in research and scholarly publications.” Levin anticipates more collaboration with other universities going forward.

David Schleich, PhD, at NUNM, the institution that appears to have the only NIH grants among the 7 universities, also picks up on the theme Brimhall notes and Levin affirms: the importance of inter-institutional collaborations. Schleich views the skills and interests of NUNM’s researchers as attractions: “NUNM is consistently welcomed into the research community.  It’s the skill and knowledge of our people. It’s the content of what we choose to investigate.” Timeliness is a factor: “What was too often eschewed by biomedicine is now top of mind.” Examples, he says, are NUNM research projects related to nutrition, mind-body medicine, lifestyle choice, and social determinants. He notes his institutional commitment: “Research is securely in the base budget.” (NUNM’s current lead NIH grant-getter is Ryan Bradley, ND, MPH, director of NUNM’s Helfgott Research Institute.)

At NWHSU, president Deborah Bushway, PhD framed the institution’s research interest as an effort to serve “all our constituents.” The commitment is to “research and the dissemination of knowledge gained from that research. Too often, research in our professions gets buried, and thus is not effectively used.”  The focus on dissemination extends not just to “impact how we educate” but also “how our graduates practice and how policies – both public and privately held – are developed and implemented.”

Comments

The universities of natural health science have accounted for virtually all of the NIH funding that any schools of integrative health have received (with the notable exception of Palmer College of Chiropractic which, as the federally-recognized center for chiropractic research, has garnered more such grants than any other integrative health institution). As such, one might hope that these multidisciplinary universities would be the intellectual, policy and production engines for setting research priorities that will most advance the ability of their professions to contribute productively to the nation’s challenged medical and health conditions.

In fact, it is tough to establish and sustain a research culture anywhere if federal authorities are not granting funds to support such a culture shift. Presently, the brief golden era for NIH grants – “gold-dust era” may be more appropriate, given the low NIH investment even then – appears to have ended. Perhaps the applications are not being submitted. And perhaps they have dried up because NIH National Center for Complementary and Integrative Health has signaled that the agency doesn’t see value in a kind of compensatory investment structured to help bring the maturing integrative health professions to which these multidisciplinary universities are dedicated more deeply into the evidence-informed arena.

What seems to be clear across the board is what UWS’ Brimhall noted: these institutions must now rely more on internal investment in research. Amidst the pressures – as NWHSU’s president Bushway put it in the first part of this series – of operating “in the cross-hairs of two industries” in turmoil, health care and education, upping such a core commitment may be especially challenging. Yet a next generation of integrative health researchers awaits nurturing from these institutions.

The 2011-2015 Strategic Plan of the NIH NCCIH announced this:

“CAM practitioners are the key holders of knowledge related to the potential application of CAM interventions and disciplines.”

Given the growing interest in non-pharmacologic practices and practitioners in setting a new standard for chronic pain treatment, it is critical that both internal and external investment be upped dramatically.

Part 1 of this series was “The Future of Integrative Health – Interviews with Presidents of 7 Multidisciplinary Universities”