Testimony on AHCPR and Alternative Medicine Research

Douglas B. Kamerow, M.D., M.P.H., Assistant Surgeon General and Director, Center for Practice and Technology Assessment, AHCPR

Before the House Committee on Government Reform and Oversight

February 24, 1999

AHCPR's Mission

The Department of Health and Human Services has a variety of roles related to alternative medicine. The National Institutes of Health (NIH) facilitate research into new therapies that may someday be future options for the treatment of illnesses. The Food and Drug Administration (FDA) is responsible for approving new medical devices or drugs that are safe and effective in the treatment of diseases and other maladies.

The mission of the Agency for Health Care Policy and Research (AHCPR), where I work, is to support and conduct research that improves the quality, outcomes and appropriate use of health care services. Our research provides the scientific foundation that is necessary for informed health care decisions. We want the decisions that are made by patients and clinicians, purchasers, health care system leaders, and policymakers to be based on solid evidence about what works, when, and for whom.

I serve as Director of AHCPR's Center for Practice and Technology Assessment, where we sponsor and conduct evaluations that provide the evidence of the impact of health care services. This evidence is then translated into the information that makes us all more informed health care decision-makers.

The study of complementary and alternative medicine falls solidly under AHCPR's mission. This is an area where the scientific foundation is inadequate at best. While we have a wealth of data documenting the growth in the popularity of alternative care, we don't have details on whom these patients are and what services they are using. We don't know which alternative treatments work, which don't work, and which can cause harm to the patients who use them. This research is particularly critical as the availability of complementary and alternative therapies increases and their popularity grows.

AHCPR has been supporting research on complementary and alternative medicine since it was created in 1989. Our early research in this area has focused on the effectiveness and cost-effectiveness of alternative therapies, including chiropractic, acupuncture, and manual therapy, for the treatment of low back pain. It also evaluated patients' satisfaction with their care as compared with patients treated more conventionally.

Current AHCPR Research

We also are working closely with the National Center for Complementary and Alternative Medicine at NIH to improve the methodology for studying alternative therapies. This partnership has greatly enhanced our ability to support health services research on alternative medicine as well as supporting conventional clinical trials through the NIH institutes. Currently, we are cosponsoring two studies on acupuncture. The first will evaluate its effectiveness to treat back pain; the second, its effectiveness in treating depression during pregnancy.

These studies will give us valuable information on the clinical situations in which acupuncture works. But they will also help us in another way. One of the contributions AHCPR can make is to advance the methods that researchers can use to evaluate the effectiveness of health care. Our collaborations in the evaluation of alternative and complementary medicine are designed not only to answer today's questions about effectiveness, but also to develop better and more reliable approaches for evaluating complementary and alternative medicine for years to come.

For example, AHCPR is cosponsoring a conference with NIH in late 1999 to develop strategies that address common challenges faced by researchers as they study the effectiveness of complementary and alternative therapies. This is our second joint conference. In 1996, a meeting we cosponsored on how insurers make coverage decisions for complementary and alternative medicine made it very clear that decisionmakers have few data sources to guide their decisions.

Building Research Capacity

Let me be more specific with examples of how we are building the capacity to study alternative medicine. AHCPR has undertaken a two-part effort to build new sources of data.

First, we are using our Medical Expenditure Panel Survey (MEPS) to collect information on persons who consulted with a complementary and alternative medicine provider during 1996.

This survey represents 21,500 individuals and 9,500 households. It will provide the largest national sample of persons who have used alternative care, and will provide the most accurate estimates yet of the use of complementary and alternative care providers.

The second part of our investment in data is support for a national alternative medicine ambulatory care survey conducted by the Group Health Cooperative of Puget Sound. The primary goal of this survey is to provide a comprehensive description of alternative providers' practices. Providers being surveyed are acupuncturists, chiropractors, massage therapists and naturopaths. This survey, modeled on a current survey of ambulatory medical care, will provide unprecedented information on the content of care for some of the most common alternative and complementary providers.

We also are helping establish the scientific, clinical evidence for complementary and alternative treatments. In 1997, we established 12 Evidence-based Practice Centers (EPCs) to develop evidence reports and technology assessments on clinical topics that are common, expensive, and/or are significant for the Medicare and Medicaid populations. Under this initiative, we are currently evaluating the use of garlic and silybum marianum in the treatment of certain diseases and conditions. We also are reviewing a number of complementary and alternative medicine topics for future reports, and we are discussing further collaborations with NIH's Center for Complementary and Alternative Medicine.

Research Needs

AHCPR is a small agency, and therefore our investment in this area only scratches the surface of what is needed to create the scientific foundation for complementary and alternative medicine. We need to develop better, more reliable methods for studying and evaluating these therapies, and much research is needed on their effectiveness and outcomes. We need to increase the available data on their use, and we need to know how patients feel about the care they receive and why. The best evaluation of medical care is one that measures its impact on the outcomes that patients care about the most.

These efforts will allow us to identify complementary and alternative therapies that improve health and health care and enhance patients' quality of life. We also may learn lessons that will help us in our work to improve the delivery of conventional health care services.

Current as of March 1999