by Ava Lorenc, RCCM Trustee
Yasamin Veziari, Saravana Kumar and Matthew J. Leach have just published a new paper on the barriers to CAM research for stakeholders. Although the study was conducted in Australia and New Zealand, many of the issues identified are important worldwide.
- CAM practitioners’ access to resources and infrastructure and capability to translate and implement research findings into clinical practice – via the information hub on our website and training events, RCCM aim to equip CAM practitioners with the skills and resources to overcome these barriers.
- Governance and leadership e.g. CAM professional bodies involvement in research. Through RCCM’s corporate membership scheme we support CAM professional bodies to be able to lead research initiatives in their profession and support CAM practitioners.
- Barriers to collaboration within CAM industries, and a lack of linkages between the CAM industry and other institutions e.g. universities. RCCM aims to foster collaboration via our membership and events and our new members’ discussion space on Linkedin
- Lack of multi-disciplinary research collaborations and professional unity- one of RCCM’s key strengths is bringing together a diverse range of CAM interventions, as illustrated by our corporate membership base
RCCM is passionate about addressing many of these issues, including fostering collaboration and providing unity and leadership. Come join us! rccm.org.uk/join
For our latest blog post we are privledged to have Karen Charlesworth from the Northern College of Acupuncture discussing the issue of ethical approval in CAM. At RCCM we often receive queries asking whether we can provide ethics approval -sadly this is beyond our capabilities, but hopefully here Karen can shed light on some of the alternatives. We would also recommend visiting the excellent NHS Research Ethics Service that has a wealth of information and even dates of REC meetings in the UK: Search Research Ethics Committee Directory – Health Research Authority (hra.nhs.uk). We also have a section in our members’ area on ethics https://www.rccm.org.uk/members/research-guidance/cam-research-ethics/
Ethics for the independent researcher, by Karen Charlesworth
It’s an enduring fact that much research in UK-based complementary and integrative medicine (I’ll call it CIM for convenience) happens outside the traditional academic and/or commercial pathways. Despite this, there are plenty of excellent research ideas out there, often generated by CIM practitioners themselves. In my role as research director at the Northern College of Acupuncture (NCA) I’ve talked with, and supported many, practitioners who come across an interesting aspect of their practice and want to turn it into a piece of research.
But how to move these ideas forward if you aren’t affiliated to a university? Perhaps surprisingly, it’s not too difficult to get an independent research study up and running, especially if the researchers don’t need to apply for funding. A bit of nous about project management, some practice in data analysis, a few ounces of goodwill from practitioners delivering the interventions, and a lot of legwork – for independent CIM researchers the world over, this approach is a time-honoured tradition. For instance, I’ve recently been talking with a group of local yoga teachers who banded together a year ago to provide free Iyengar yoga classes for people suffering from Long Covid, and who now want to publish the rather spectacular outcomes. For researchers taking this kind of quick-and-dirty approach, the results will likely be underpowered and probably won’t be published in a peer-reviewed journal, but – as with the yogis – that’s not usually the intended audience anyway.
But even if all these elements can be brought together, there’s still one major hurdle that indie researchers can’t clear easily: ethics. All research involving participants should include informed consent with approval from a Research Ethics Committee, or REC, along the lines of “This research has received a favourable opinion from the XXX Research Ethics Committee (ref. 3856/LO/B620, dated 11/12/21)”. It’s a guarantee that the research has been approved by an independent body dedicated to ensuring that research meets high standards of trustworthiness and validity.
What is research integrity?
Rather than simply being a single application-and-outcome at the start of a project, ethical principles should be embedded throughout. Increasingly, ethics is being absorbed into the principles and practice of research integrity, which in the last 10 years or so has become a dominant theme across all types of research in all kinds of sectors and industries. At its most basic, research integrity ensures that research is carried out to the highest standards of scientific and ethical practice.
Independent researchers are well-advised to embed the principles of research integrity into their study protocol, design and implementation – not least because attention paid to research integrity at the early stages automatically sets a project on a path towards smoother ethical approval. The UK Research Integrity Office (UKRIO) Checklist for Researchers is an excellent, concise statement of the basic principles of research integrity, downloadable from https://ukrio.org/publications/checklist-for-researchers/.
Ethics for the independent CIM researcher
For independent CIM researchers, few questions are more difficult to answer than the seemingly simple “Where can I find a Research Ethics Committee to review and approve my project?” By their nature, RECs are not generally available for independent applications. The average REC is a big beast peopled by research experts – academics or professionals with specialist ethics training and expertise. Its work is skilled and exacting, the personnel are highly experienced, and outcomes are often achieved via thorough debate and consensus. All of this makes the work time-consuming and expensive, so a REC usually exists for the benefit of its parent organisation, whether that’s a charity, a university or the NHS. So how can independent CIM researchers who aren’t allied to one of these organisations apply for ethical approval?
- Affiliated team member
The most popular route is to assemble a team of researchers, one of whom is affiliated to a university (student or staff member), and who can access the relevant REC within that university. University RECs are used to this kind of approach and will want proof that their affiliate has an ongoing and central responsibility. Some researchers become students themselves, turning their research into an academic project and therefore automatically gaining access to their institution’s REC. Clearly not many researchers will want to turn student simply to access a REC – but if you’re somebody who’s always hankered after that MSc/PhD anyway, now might be the time to go for it!
- NHS ethics approval
A similar approach can also be made to an NHS REC, operating under the aegis of the UK Health Research Authority, assuming that (i) the project is eligible, and (ii) that it can/should be carried out with NHS involvement. Few independent CIM projects will tick these boxes, but if they do, advice should be sought from the local NHS R&D department (usually sited within the local NHS Trust) on how to go forward: NHS ethics review is not for the faint-hearted, and requires persistence, dedication and a lot of guidance.
- UK Research Integrity Office
While it doesn’t offer an ethics review service, the independent charity UKRIO can provide advice on specific issues of ethical practice in research. The service is open to all, including research students and members of the public, and can be accessed via: https://ukrio.org/our-work/advice-services/.
- Useful ethics resources for indie researchers
Helen Kara, whose thought-provoking book Research Ethics in the Real World is highly recommended for all indie researchers in CIM, published a 2020 blog post on research ethics for independent researchers at https://helenkara.com/2020/07/22/research-ethics-for-independent-researchers/. It contains a few different approaches arguably more relevant to Kara’s own social research work with indigenous communities in Australia and NZ than to medical research in the UK, but which nonetheless make for interesting reading. The post also cross-references another Kara blog post containing links to free online resources for research ethics training (https://helenkara.com/2018/01/18/free-online-research-ethics-resources/).
- NCA ethics support
For UK-based independent CIM researchers, the Northern College of Acupuncture (NCA) has an active programme of supporting research into the therapies it teaches: acupuncture, Chinese herbal medicine and nutritional therapy. Researchers with a project in one of these areas are welcome to contact the College by emailing email@example.com. In line with general principles of research integrity, the NCA’s programme includes support from experienced CIM researchers to embed the principles of research integrity and scientific rigour from the initial design stages onwards; it also includes access to ethics review and ongoing ethics compliance, and support for publication. The NCA, which is an educational charity, prioritises its own graduates, but has a principle of giving every project a fair hearing – one of its charitable objectives is to promote high quality research into its disciplines, and it recognises the difficulties caused by lack of access to ethics committees. One example of this is the College’s ongoing work with Acu-Track, the acupuncture/Chinese herbal medicine clinical audit data capture software: NCA is working with the Acu-Track developers to ensure the ethical standing of their informed consent materials for users and patients, data gathering processes, and the journal articles that Acu-Track publishes using its datasets.
When I received the invitation to participate in RCCM seminar on strategy from our Chair I remember accepting immediately. The event was scheduled a few months ahead, and it felt like I’ve been waiting for an opportunity like this for years! When we hear words like ‘strategy’ or ‘research’ usually people think of businesses, business plans, money or the cold scientific world out there. As therapists in complementary therapies these terms are just naturally not the first ones that come to mind. We do what we do primarily because we have established long ago – for many of us since we were very young- that it is our call, our vocation ‘to help others’ in an experiential way. So, to think ‘strategy’ ‘research’ and moreover to acknowledge their value and significance when your inner belief system tells you something else will most probably give birth to cognitive dissonance and this is not easy to live with.
One of the most valuable things that I took away from the seminar was that having a strategy and developing a research strategy within our organisations and practices does not take away that individuality or dilute the way we do things, but on the contrary will give the complementary therapies the opportunity to align their extraordinary contributions to human wellbeing with the bigger body of traditional medicine and finally take its well-deserved place on the national therapeutic stage.
This stage is very large, and it can feel discouraging and daunting having to compete with all the other established therapies backed by decades of solid evidence and a national health system, but the changes we have witnessed in the last couple of years and especially since the pandemic, showed us that it is not about competing with the ‘Other’. We live in times we can easily call ‘emergency times’ yet, inside emergency there is the word ‘emerge’, coming out of danger into opportunity and working alongside each other, enriching our clients’ experience and at the same time disseminating our vision and potency in a clear, convincing and evidenced way.
Why strategy and why research strategy? In simple words because it is the fastest and most reliable way, not only to create change, because change is created with every single person we help through our work, but to affect change at a macrolevel, beyond the influence we can have on our families, friends, peers, and clients. Being influential at a macrolevel means reaching those organisations and policy makers who have the power of translating visions and research into practices accepted and implemented nationally. Why now? There have never been more propitious and conducive to change times as the ones we live in now, because there has never been a greater need for science to hold hands with her sister – complementary therapy – and balance the load of work to be carried together. For this to happen naturally and successfully, applying the principles of a good research strategy also means taking the path that was most travelled before us and that will give us a voice and a seat at the decisions table.
Mia Pal – BAThH
Bowen Therapy Professional Association members Dianne Bradshaw and Jo Wortley have put together a study to look at Bowen therapy for long Covid. The attached paper gives all the details and they have a facebook group www.facebook.com/groups/covidbowenstudy. They are hoping to have some results available soon, which we will update here. long-covid-btpa-article
The British Society for Integrative Oncology (BSIO) worked with professional conference organisers Progressive Communications to initiate the first Integrative Oncology UK conference. The virtual event took place on Saturday 15th May 2021, with more than 380 delegates attending, across a range of disciplines from an impressive 27 countries. The conference was aimed at healthcare professionals interested in evidence-based integrative approach to cancer care. Some of the delegates were new to this clinical field and a quarter of participants were working within the NHS.
During the one-day live event, oncologists, integrative medicine doctors, GPs, researchers, clinical nurse specialists, nutritionists, mind-body experts, and people living with a cancer diagnosis, shared their knowledge on the science and evidence base underpinning lifestyle and complementary approaches in cancer care, to optimise quality of life and clinical outcomes.
The BSIO conference committee brought together medical and non-medical experts in their fields. The event had an impressive line-up of eighteen speakers presenting the evidence for incorporating lifestyle and complementary approaches into pre-treatment phases, during active cancer treatment and in advanced cancer.
BSIO Conference Committee:
Dr Catherine Zollman, conference chair, GP, medical lead of Penny Brohn UK cancer charity, clinical lead for Personalised Care and Support, SWAG NHS Cancer Alliance and fellow in Integrative Medicine from the University of Arizona
Dr Penny Kechagioglou MBBS, MRCP, FRCReq, MPH, MBA, Consultant Clinical Oncologist and Group Clinical Director for Surgery and Emergency Medicine, at the University Hospitals Coventry and Warwickshire
Prof Robert Thomas, MRCP (UK), MD, FRCR, Consultant Oncologist at Addenbrooke’s and Bedford Hospitals, a visiting Professor at Cranfield University and a clinical teacher at Cambridge University
Dr Nina Fuller-Shavel, MB BChir MA Hons DipIM PG Cert IFMCP mBANT, Integrative Medicine doctor, scientist and educator, Vice Chair of BSIO, Director of Synthesis Clinic, Fellow of the College of Medicine, United Kingdom
Dr Carol Granger, Registered nutrition practitioner and microbiologist with a particular interest in the human microbiome. Co-chair and trustee of the Research Council for Complementary Medicine (RCCM)
Dr Caroline Hoffman, Clinical and Research Director, Breast Cancer Haven.
If you missed the live event and you would like to catch up at your leisure, the recordings are available to purchase at: www.IntegrativeOncologyUK.com/recordings
In this month’s blog, pharmacist and RCCM member Seema Bhattessa discusses her research interest in the electromagnetic and energetic field around the human body.
My background is Pharmacy, Energy Medicine and Holistic Health. My research interest is on how prescribed medication influences the human Biofield (Meridian, Chakra and Auric fields) where a collaborative effort would be necessary to make any headway in this research.
Why I think this research is necessary:
There is evidence that the human Biofield exists and instruments available to measure them. The body has a physical, biochemical system and an energetic system. Drug development and clinical trials did not include participants’ energetic profile or considered effects on the human Biofield system. There is anecdotal evidence that prescribed drugs influence the Biofield and my own experience working with clients who were taking prescribed medication. Traditional and holistic forms of health and self-care are centred around the concept of the Bio-energetic system. They have continued to gain more popularity in the Pre-Covid years, mostly supporting existing conventional healthcare and treatment. During the pandemic and Post-Covid era, this trend is expected to boom as it addresses multiple issues-particularly mental and emotional health. However, conventional drugs are here to stay, and a “Hybrid” form of healthcare will always exist with little or no research on how they may interact or influence one another. One of the most important factors in non-compliance of therapeutic agents is adverse drug reactions or side effects. Many require hospitalization, from a single dose or prolonged administration of a drug are often treated with additional medication to
counteract these unwanted effects to “Poly-Pharmacy”. This ongoing cycle creates more health problems for individuals and is an economic burden on the NHS. Energy Medicine may offer non-invasive alternatives to help support the body’s systems and organs when medication is necessary and save money on the NHS. Response to the public interest. For the growing population that participates in holistic and traditional health practices regularly support this research area, and as healthcare professionals, we should respond!
My article “Pharmaceutical Drugs and the Human Energy System (Biofield)” , a call to action for collaboration, was published in the Global Journal of Medical Research.
Seema Bhattessa B.Pharm; firstname.lastname@example.org