Reviewing and Assessing the Role of the Natural Health Products Directorate in Research: An Invitational Roundtable

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Table of Contents

• Executive Summary
• Introduction
• Agenda
• Participants
• NHPD: Role in Research
  • Background
  • Defining NHPD Research
  • Establishing Priorities
  • Developing a Strategy
  • Next Steps
• Consultation on Current Issues
  • General Advice to the NHPD
  • Wellness Models and Prevention
  • Promote the Canadian Context
  • Promote Access to Funding for Research
  • Specific Funding Requested from the NHPD
  • Focus on Research Methodology and Capacity Building
  • Information Technology and Knowledge Transfer
  • Possible Infrastructure to Advance the NHPD Research Mandate
  • Goals for the NHPD for the end of March 2002
• Directions for the Future

Executive Summary

A diverse cross-section of stakeholders met to discuss what has been accomplished thus far by the Natural Health Products Directorate (NHPD) in the area of research, and to provide feedback and suggestions for future directions. More particularly, the group recommended specific objectives that the NHPD might accomplish by the end of its current fiscal year - i.e., by March 31, 2002 - and goals that would provide direction for the subsequent three to five years. The stakeholders at this roundtable included representatives from consumer groups, academia, research, industry, and patient care. While some participants had attended previous meetings hosted by the NHPD, others were new to these discussions. Accordingly, the advice that emerged reflected the breadth of experience of the participants. Some of the advice reinforced the direction and work that the NHPD has already chosen, while some proposed the next steps in the evolution of the NHPD as it continues to develop an infrastructure to meet its mandate.

Short-Term Recommendations

The following suggestions were emphasized during discussions:

• continue to ensure community and practitioner input at all levels
• avoid holding meetings that might repeat the work that has already been done; direct funds and energies to support the recommendations that were made at prior conferences and roundtables and that were reinforced during these discussions
• facilitate a process whereby leaders in complementary and alternative health care (CAHC) research and natural health product (NHP) research meet, discuss and choose worthwhile research projects that might be funded in part by the NHPD
  • when these projects are properly completed, they can serve as templates for future projects
• continue to forge partnerships and collaborations that
  • maximize the research dollars of the NHPD through leverage with other partners (such as the Canadian Institutes of Health Research - CIHR)
  • encourage funders to become more receptive of CAHC and NHP research
• fund workshops that lead to the sharing of perspectives between conventional and CAHC/NHP researchers/practitioners, particularly in the area of research methodology
• fund workshops on research methodology in CAHC to develop a new paradigm for research
  • because of the methodological challenges currently facing CAHC and NHP research
  • because the funds available for NHP research are not, and will not be, at all comparable with the funds that have been spent on pharmaceutical research
• establish an effective network for information exchange and knowledge transfer so that efforts to increase the training capacity of CAHC researchers can be shared
  • the network will enable the dissemination of information and training materials across the country to those who cannot attend the workshops and minimize duplication while maximizing limited human and financial resources
  • fund the salary of a coordinator for the network, a software knowledge transfer consultant, and meetings to organize the network and train personnel
  • the network should be web-interfaced
  • the network will encourage cross-disciplinary dialogue and collaboration
  • the network will publish case studies and case series so that researchers do not feel limited to conducting only randomized control trials
• product related matters such as quality control and standardization remain a priority
• the work of the NHPD should include focus on wellness models
  • prevention and wellness models should receive more attention in contrast to the traditional emphasis on sickness models
  • consumers are using NHPs to stay well, not just to treat disease
  • determine if the use of NHPs helps consumers to move toward optimal health
  • there is a need to insert the holistic perspective into research
  • to date this has not been sufficiently emphasized in research recommendations and strategies
• form a central advisory committee or working group of perhaps 10 people with a variety of NHP/CAHC expertise/experience, and form sub-committees of interest groups or nodes feeding into this central working group
  • the focus of the individual nodes might include basic biomedical science; applied/clinical research and health systems; industry; quality control; research capacity and methodology; and information technology and knowledge transfer
  • while each node must have a majority of its participants selected from one specific field of expertise (e.g., a basic science research node would contain a majority of basic scientists), overall membership would be invitational and would include practitioners, consumers, industry, researchers and academics
  • linkages and feedback can exist among the nodes, the central advisory committee and consensus conferences that could be held as needed
  • linkages might also be fostered with CIHR, SSHRC, NSERC, etc.
• investigate the unique contribution that Canada can make to the international community; e.g.:
  • aboriginal and multicultural use of complementary and alternative therapies
  • indigenous botanicals and therapies

The priorities that are realized during the remainder of the fiscal year will not be done in isolation. They will be part of a general network of information sharing that will be established, and part of a general strategy to implement recommendations from previous conferences and roundtables.

Long-Term Recommendations

After March 2002 and beyond, the NHPD will:

• continue to build research capacity and to increase receptivity within funding agencies
• seed-fund the research priorities that emerge from the first group of interest group nodes
• fund workshops that cut across a number of nodes, and/or fund an annual conference that brings together a number of the nodes
• undertake a systematic review of the issues in CAHC and NHP research
• promote the unique contribution that Canada can make in the area of NHP/CAHC research at international dialogues. The unique contributions include:
  • aboriginal and multicultural contributions to health care
  • indigenous botanicals and therapies
  • the emerging blend of marketplace factors, publicly funded health care, diverse practitioners, and consumer needs
• support the establishment of database(s) of informed information that can be easily accessed by researchers, practitioners and consumers
  • objective, third party, evidence-based medicine research monographs

Introduction

As the Natural Health Products Directorate (NHPD) continues with its mandate "to ensure that all Canadians have ready access to natural health products that are safe, effective, and of high quality, while respecting freedom of choice and philosophical and cultural diversity," it periodically brings together various stakeholders in the Complementary and Alternative Health Care (CAHC) community to review the current work of the NHPD and to seek constructive input.

On October 4-5, 2001, a diverse cross section of stakeholders gathered in Ottawa to review and assess the role of the NHPD in research. The participants were asked to examine what had been accomplished thus far by the NHPD in the area of research, and to provide feedback and suggestions for future directions. More specifically, they were asked to provide specific objectives that the NHPD might accomplish by the end of its current fiscal year - i.e., by March 31, 2002 - and goals that would provide direction for the subsequent three to five years.

This roundtable on research brought together representatives from consumer groups, academia, research, industry and patient care. Some participants had been part of previous discussions hosted or funded by the NHPD, while others were participating for the first time. The diversity of the participants is reflected in the diversity of advice that was offered during the roundtable discussions. Some of the advice reinforces the direction that has been taken by the NHPD and the work that has been done, while other advice proposes a natural evolution of efforts to date. Finally, some advice proposes new directions as the NHPD continues to develop the infrastructure to meet its mandate. The breadth of these views and the advice proposed are presented in this report

During the formative months of the NHPD, discussions concerning research emphasized the need to set goals and to establish research priorities, as well as to identify needs and gaps and to speculate on ways to bridge them. Now there was a shift to develop the infrastructure to put these ideas into action.

The intention of this invitational roundtable was to build upon past dialogue and consultations, most notably the Priority-Setting Conference held by the NHPD in Halifax in 1999.

Agenda

Thursday, October 4, 2001

6:00 p.m.

Buffet Dinner

7:30 p.m.

Welcome and opening remarks - Philip Waddington

Introduction of NHPD staff and facilitator

7:45 p.m.

Introductions by participants - Dennis O'Hara

8:00 p.m.

"Proposed Research Agenda for the Natural Health Products Directorate-2001-2002" - Michael Smith

Friday, October 5, 2001

8:00 a.m.

Continental breakfast

9:00 a.m.

Consultation on Current Issues

Overview of the issues - Michael Smith

9:20 a.m.

Small groups will:

1. consider each of the issues identified

2. propose a plan of action for the NHPD

3. identify other issues that need to be dealt with, including a proposed plan of action

10:30 a.m.

Break

10:45 a.m.

Small groups report back

11:30 a.m.

Consensus building on consultation

12:00 p.m.

Lunch

1:00 p.m.

Directions for the Future

Overview of current NHPD research priorities and strategies - Dennis O'Hara

1:20 p.m.

Small groups will:

1. consider each of the strategies

2. propose a specific plan of action for the NHPD, including an identification of the players and roles

3. identify other directions that the NHPD could consider as part of a 2, 3, and 5 year plan, including a specific plan of action

2:30 p.m.

Break

2:45 p.m.

Small groups report back

3:15 p.m.

Clarification and Consensus building concerning strategies

3:45 p.m.

Forging a common vision for the NHPD and NHP research

4:30 p.m.

Adjournment

Participants

Professor John Thor Arnaston

University of Ottawa
Ottawa, Ontario

Dr. Claire Bombardier

University of Toronto
Toronto, Ontario

Dr. Heather Boon

University of Toronto
Toronto, Ontario M5S 2S2
Member, Scientific Advisory Board, Institute of Health Services and Policy, CIHR

Paula Brown

Herbal Evaluation and Analysis Laboratory
Dept. of Chemistry and Forensic Science
Burnaby, British Columbia

Donna Herringer

Canadian Health Food Association
Markham, Ontario

Dr. Timothy Johns

McGill University
St. Anne-de-Bellevue, Quebec

Dr. Timothy Lee

Dalhousie University
Halifax, Nova Scotia

David Moher

Children's Hospital of Eastern Ontario Research Institute
Ottawa, Ontario

Dr. Leelamma Nielsen

Nielsen's Homeopathic Clinic
Dr. Nielsen's Homeopathic Medical Education and Research Centre Inc.
Winnipeg, Manitoba

Dr. Silvano Mior

Canadian Memorial Chiropractic College
Toronto, Ontario

Dr. Ron Reichert

Tzu Chi Institute for Complementary and Alternative Medicine
Vancouver, British Columbia

Ron Rosenes

Canadian Treatment Action Council Aids Committee of Toronto
Toronto, Ontario

Scott Sawler

Non-Prescription Drug Manufacturers Association of Canada
Ottawa, Ontario

Michael J. Smith

Health Canada
Ottawa, Ontario

Dr. Marja Verhoef

University of Calgary
Calgary, Alberta

Michael Vertolli

Canadian Coalition of Herbal Associations
Maple, Ontario

Philip Waddington

Health Canada
Ottawa, Ontario

Facilitator

Dr. Dennis Patrick O'Hara
Toronto, Ontario

NHPD: Role in Research

On the evening of Thursday, October 4, 2001, Michael Smith, Senior Advisor for Natural Health Products and Complementary and Alternative Health Care, Health Canada, provided an overview of Canadian efforts to develop a research capacity to study natural health products (NHPs).¹ In particular, he reviewed the consultations that the NHPD has already held with various stakeholders to establish priorities for NHP research, and the preliminary steps taken toward realizing these goals. He described some of the recent and future conferences and roundtables that continue to advance these priorities. Finally, he reviewed the types of research endeavours that the NHPD is able to fund and how its limited ability can be leveraged with other partners. A summary of his presentation follows.

Background

NHP research priorities established at the Halifax Conference, November 6 - 8, 1999:

• creation of a database
• risk/benefit research
• quality control and standardization
• health economics
• development of new assessment methodologies

Recommendations from the Halifax Conference:

• Health Canada should work with active researchers in the field to develop a strategy for achieving a Canadian Institutes of Health Research (CIHR) for NHP research
• the research supported by Health Canada should be of a seed nature, giving priority to cross-cutting research across disciplines that is relevant to industry and health care practitioners
• the first research to be supported should relate to the creation of a credible database and to the safety, efficacy and standardization of existing NHPs

Defining NHPD Research

NHP research is defined as any form of research involving NHPs related to the four key themes identified by CIHR:

• biomedical research
• clinical research
• research respecting health systems and health services
• research on societal, cultural and environmental influences on health and the health of populations

Establishing Priorities

In addition to the Transition Team report, information has been gathered from:

• Natural Products Research-Priority Setting Conference, Halifax 1999

• conclusions reached by Canadian NGOs

  • Towards Integrative Care: National Strategic Planning Meeting on Complementary Therapies and HIV/AIDS (Research)

• priorities determined by international initiatives

  • Expanding Horizons of Healthcare (5 year strategic plan), National Center of Complementary and Alternative Medicine, US

  • Select Committee on Science and Technology 6^th Report, House of Lords, UK, 2000

Developing a Strategy

From the existing information, four strategic initiatives were identified:

1. supporting clinical trials and research projects
2. building research capacity
3. fostering collaboration and partnership building
4. information retrieval and knowledge transfer

The NHPD can disperse funds for use in four primary ways, namely:

1. operational funding
2. contract funding
3. vote 5 - contributions
4. vote 5 - grants

1. Supporting Clinical Trials and Research Projects

• CIHR is likely to be the major partner in the future although initiatives have also been started with other funding agencies as part of a strategy to leverage NHPD funds
• CIHR is comprised of 13 theme institutes, and CAHC therapies are considered to be a cross-institute theme; therefore, there is not a separate institute for CAHC research
• three Institutes - Cancer, Aboriginal Health, and Health Services and Policy - have identified CAHC therapies within their theme
• NHPs are considered within the CAHC mandate of CIHR

2. Building Research Capacity

• personnel training awards
  • as part of an existing CIHR/NHPD partnership, two training awards were granted this year - five went to biomedical researchers and one to a clinical researcher
• CIHR training centre competition
  • to fund centres or partnerships that will develop research training programs to address specific gaps in the current CAHC research education
• opportunity to expand with community partners
• opportunity to expand with other areas of Health Canada: e.g., Health Human Resource Strategy Division (HHRSD)
• recommendations from the roundtable for Assessing Research Literacy in Complementary and Alternative Health Care Products and Practice (Aug. 2001)
  • do a needs assessment
  • support research network development
  • develop research training modules
  • support research training programs for faculty

3. Fostering Collaboration and Partnership Building

• Interdepartmental Projects
  • partnership with HHRSD
  • series of 3 invitational roundtables
    • Research Capacity (July 2001)
    • Informed Choice (November 2001)
    • Health Law and Ethics (December 2001)
  • other partners: Population and Public Health Branch (PPHB), CIHR
    • potential partners: Women's Health Bureau, Bureau of Infectious Diseases
• Consensus building conferences
  • Planning Stage:
    • drug interactions with NHPs
    • role of NHPs/CAHC in children and adolescents
    • use of NHPs/CAHC in HIV/AIDS
  • Negotiation Stage:
    • development of new research methodology
    • methods of knowledge transfer
    • national prioritizing workshop: CAHC and NHPs
  • Potential Stage:
    • role of industry in NHP research
    • basic science and emerging technologies
    • population groups (e.g., women, First Nations, Inuit)
    • disease groups/clinical areas (e.g., cancer, musculoskeletal conditions)

4. Knowledge Transfer and Communication

• working with partners in area
  • Canadian Health Network, CAMLINE, HHRSD roundtable
• participation in national consultation process
• monograph development
• integral to all projects to date

Next Steps

During the next three to five years, the NHPD could support the following initiatives:

• via grants - support investigator-driven projects, most likely with CIHR
• via contributions - direct support or collaborations to support
  • research capacity building
  • infrastructure development
• via operational funds - support for workshops, consultations, research personnel awards

What priorities do you think the NHPD should adopt for the remainder of this fiscal year (i.e., to March 31, 2002) and for the next three to five years? Keep in mind:

• the need to maximize collaboration and partnerships
• the need to achieve goals within budget of $1 million per year
• the relationship between NHP research and CAHC
• the relationship of research to the regulatory process

Consultation on Current Issues

The roundtable participants were asked to provide feedback on the current work of the NHPD as it relates to research. They were asked to offer advice on the fiscal priorities that the NHPD might set for the remainder of its budget year - i.e., until March 31, 2002.

General Advice to the NHPD

• continue to ensure community and practitioner input at all levels
• fill the gaps between what we know and where we want to be
• avoid holding meetings that might repeat the work that has already been done; direct funds and energies to the support of the recommendations that were made at prior conferences and roundtables, including:
  • seek a new peer-review committee at CIHR
  • leverage research funds with other funders
  • fund specific research projects/studies that can also serve as templates for future research
  • train CAHC/NHP researchers via workshops and materials
  • fund workshops that lead to the sharing of perspectives between traditional and CAHC researchers/practitioners, particularly in the area of research methodology
  • establish a network for information exchange and knowledge transfer
    • particularly as efforts are made to increase research capacity through the training of researchers, the information presented in these types of workshops needs to be distributed across the country so that efforts are not duplicated and information is shared across the network
• promote research on what is being treated and what has been effective
• there is a need to determine when or if the focus of the NHPD will simply be products and efficacy, or larger questions of population based benefits and a community determined research agenda, or both
• facilitate community and practitioner input into the following priorities:
  • quality control - develop a pilot project or partner with one already under way
  • training and research capacity remains a priority - develop a pilot project that can serve as a template for future endeavours
  • fund a research methods conference
  • develop a research network
• Product related issues such as quality control and standardization remain a priority
• examine and identify the role of the directorate
  • what is needed now?
  • what will be needed in the future?
  • who is out there and what do they want to do?
  • how does research help the NHPD to fulfill its mandate?
  • establish goal, then work backwards to identify the next steps

Wellness Models and Prevention

• the work of the NHPD should include focus on wellness models
  • prevention and wellness models should receive more attention in contrast to the traditional emphasis on sickness models
    • consumers are using NHPs to stay well, not just to treat disease
    • it needs to be determined if the use of NHPs helps consumers to move toward optimal health
• need to insert the holistic perspective into research since this is a different approach to treatment and some feel that to date this has not been sufficiently emphasized in research recommendations and strategies
• while it was recognized that CIHR indirectly includes an interest in preventive care in its work - e.g., through certain research in diabetes, cancer and heart disease - it was also felt that more research specifically focusing on the prevention of disease through the use of CAHC therapies is needed.

Promote the Canadian Context

• need to interact with other CAHC and NHP groups around the world and with CAHC groups that have a world-wide membership or focus
• need to understand the unique contribution that Canada can make; e.g.:
  • aboriginal and multicultural use of alternative therapies
  • indigenous botanicals and therapies

Promote Access to Funding for Research

• since CIHR, the Natural Science and Engineering Research Council (NSERC) and the Social Science and Health Research Council (SSHRC) - all of which are larger funders of research - do not have committees or institutes specifically established to review requests for funding for CAHC/NHP research, it can be difficult for CAHC/NHP researchers to win awards from these groups
• the NHPD should continue to forge partnerships and collaborations that
  • maximize the research dollars of the NHPD through leverage with other partners (such as the CIHR), and
  • encourage funders to become more receptive of CAHC/NHP research
    • the NHPD could continue to encourage the CIHR to form an institute that specifically focuses on NHPs
• the NHPD could provide funds for a specific research focus, leveraging money with other partners in government or industry
  • the success of this approach could become a template for further research funding and leveraging
• since most money that is allocated at CIHR goes to investigator-initiated research (rather than through the institutes) perhaps it would be possible for the NHPD to assist CAHC/NHP researchers to apply for funding of investigator initiated research
  • this might take the form of a grant writing workshop
• the NHPD could allocate some research funding via competitions
  • for conferences, graduate students, grant writing, small projects

Specific Funding Requested from the NHPD

• make funds available to
  • provide travel grants to NHP conferences when researchers/academics are involved in presenting papers, but only provide funds to support quality work
  • research the practice and cost effectiveness of holistic medicine
  • fund conferences that bring practitioners and researchers together
  • examine integrative care
  • develop research methodology that can be used to evaluate the efficacy of integrated care
  • develop research capacity, research assistants and graduate students
  • develop grant writing skills
  • undertake small research projects
  • promote studies on product safety, not just the use of products

Focus on Research Methodology and Capacity Building

Health care research on people essentially asks three questions:

1. Who will be included in the study?
2. What intervention(s) will be studied?
3. How will the impact of the intervention(s) be measured?

Biomedical research has traditionally grouped people by disease, while in CAHC, patients are not grouped by disease, but more often by constitution. Thus, CAHC and non-CAHC research tend to deal differently with the first question. Interventions have traditionally been a single treatment for a single ailment. In CAHC, however, the person - not the disease - is treated, so it is unlikely that only one therapy would be utilized. This makes control, measurements and comparisons difficult. With respect to the third question, biomedical researchers have traditionally looked for specific objective changes in blood levels, etc., while CAHC treatments tend to deal with a 'whole-patient' perspective that is more subjective and multivariant.

• the NHPD should continue its work to bring both medial researchers and CAHC researchers/practitioners together in order to find new ways to address the three questions above
• there remains a pressing need to fund workshops on research methodology in CAHC in order to develop a new paradigm for research
  • because of the methodological challenges detailed above
  • because the funds available for NHP/CAHC research are not and will not be at all comparable with the funds that have been spent in pharmaceutical research
• the NHPD should provide money for training in research skills to build research capacity but should do so in a way that this training can be shared via a network so that information and training are not duplicated at additional cost
• need to get practitioners involved in research so that CAHC practices can become a source of data
  • e.g., 'tombstone' data collection done in individual practices
• the NHPD could facilitate presentations from practitioners, stimulate seed projects, and manage and fund a research network to establish working groups who can develop expertise and projects that these practitioners would link into
• the NHPD could facilitate a process whereby leaders in CAHC research meet, discuss and choose worthwhile projects
  • when these projects are properly completed, they can serve as templates for future projects

Information Technology and Knowledge Transfer

The NHPD has provided forums for dialogue among various stakeholders and has actively solicited input from consumers, researchers, academics and industry. It has encouraged the publication and dissemination of information relating to the regulation and use of NHPs.

Suggestions for furthering its work include:

• develop a 'consumers' report' on NHPs
• develop partnerships in electronic technology
• establish an effective network so that the work to increase the training capacity of CAHC researchers can be shared, communicating the information across the country to those who cannot attend the training workshops and thereby avoiding duplication and maximizing limited human and financial resources
  • fund the salary of a coordinator for the network, a software knowledge transfer consultant, and meetings to organize the network and train personnel
  • the network should be web-interfaced
  • the network will encourage cross-disciplinary dialogue and collaboration
  • the network will be linked with existing networks
• develop a forum/network for sharing case studies and case series so that people do not feel constrained to doing only randomized control trials

Possible Infrastructure to Advance the NHPD Research Mandate

• form a central advisory committee or working group of perhaps 10 people who have a variety of NHP/CAHC expertise/experience, and form sub-committees of interest groups feeding into this central advisory committee/working group
  • identify the interest groups and the directors of these interest groups; then facilitate meetings of these groups so that membership can be determined and the task of research in the various areas of interest can begin
  • the directors of each interest group would be on the central advisory committee
  • links can be forged between sub-committees of interest groups (or nodes), further enhancing information sharing and networking
  • this will increase networking and continue the goal of bringing together stakeholders who did not previously have much contact
  • linkages and feedback can exist among the nodes, the central advisory committee, and consensus conferences that could be held as needed
  • linkages might also be fostered with CIHR, SSHRC, NSERC, etc.
  • identify the funding needs for the various sub-committees of interest groups or nodes before the start of fund allocation
  • focus on the easy nodes or focus areas first (perhaps basic science, research capacity, etc.)
  • the Directorate remains key

Possible Nodes of Research Focus:

1. Basic Biomedical Science
2. Applied/Clinical/Health Systems (a compilation of three interest groups that could also be separate nodes rather than an Applied/Clinical collective; both alternatives were considered as possible approaches)
   1. Clinical Research
   2. Health Services and Systems
   3. Population Health
3. Industry
4. Developing Research Capacity, and re-thinking Research Methodology
5. Information Technology and Knowledge Transfer
6. Conceptual
7. Product issues such as quality control and standardization
   1. alternatively, each node could consider questions or set goals pertaining to methodology, training and knowledge transfer, and these would not have to be separate nodes
   2. Quality control as well as information technology and knowledge transfer could also be considered within any of the nodes, and might not simply be seen as independent nodes
   3. various nodes could pool money for a common project
   4. practitioners and consumer involvement is required with each node so that there is a diversity of views and input
   5. fund the meetings of the various nodes and workshops or themes that cut across the nodes (e.g., could choose a theme like information transfer that brings the nodes together)
   6. the priorities of developing CAHC research methodology, increasing research CAHC capacity, and establishing a research network and knowledge transfer could now be incorporated into the functioning of the working group as well as the various focus nodes

Goals for the NHPD for the end of March 2002

In the best of all possible worlds, these are the goals that the roundtable participants hope that the NHPD will have realized by the end of March, 2002. The NHPD will have:

• wisely allocated all of the research budget
• moved forward on the recommendations made at earlier conferences and roundtables it has hosted
• set the goals for NHPD research and developed a plan to get there
• determined a definition of NHP research based on discussions that include industry and consumers
• determined the needs of clinical research in CAHC and use of NHPs
• established a communication and knowledge transfer website and completed a survey to evaluate how effective the website is
• established an NHP/CAHC research network
• established the central advisory committee/working group, and have organized at least three of the sub-committees of interest groups/focus nodes
  • priority should be given to establishing nodes for basic science, health systems and clinical, and quality control and product standards
  • other nodes might have general strategies written
• assisted the organization and funding of a research methodology workshop; the workshop will have completed its work with a summary published on the communication and knowledge transfer website
• assisted the organization and funding of various training modules that will have been completed

The priorities that are realized during the remainder of the fiscal year will not be done in isolation. They will be part of a general network of information sharing that will be established, and they will be part of a general strategy to implement the recommendations of earlier conferences and roundtables.

Directions for the Future

In the next fiscal year - i.e., after March 31, 2002 - and into the next three to five years, the NHPD will:

• continue to build research capacity

• seed-fund the research priorities that emerge from the first group of interest group nodes that get up and running

• help the other nodes to get up and running

• fund workshops that cut across a number of nodes, and/or an annual conference that brings together a number of the nodes

• establish a peer review committee

• increase receptivity within funding agencies

  • influence the climate

  • influence the receptivity of peer review committees

• clarify terms and concepts

  • e.g., 'natural health products' and 'complementary and alternative medicine'

• become a home for NHP and CAHC research

• undertake a systematic review of the issues in NHP and CAHC research

• understand and promote at international dialogues the unique contribution that Canada can make in the area of NHP/CAHC research

  • aboriginal and multicultural contributions to health care

  • indigenous botanicals and therapies

  • the emerging blend of marketplace factors, publicly funded health care, diverse practitioners and consumer needs

• support the establishment of database(s) of informed information that can be easily accessed by researchers, practitioners and consumers

  • objective, third party, evidence based medicine research

  • monographs

¹ Throughout this report, natural health products (NHPs) and complementary and alternative health care (CAHC) are often linked. This is not surprising since NHPs are used by CAHC practitioners in the care of their patients, and research pertaining to NHPs often focuses on diseases treated by CAHC practitioners. Accordingly, research in NHPs can raise and address issues that are also the concern of CAHC research. The boundaries between NHP and CAHC research are not always clear and some participants expressed a desire to bring greater clarity to the distinctions.