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New NIH NCCAM Director Wanted: No Experience or Interest in Field Required PDF Print E-mail
Written by John Weeks   

New NIH NCCAM Director Wanted: No Experience or Interest in Field Required

Summary:  The NIH National Center for Complementary and Alternative Medicine quietly posted its want ad for the new director of the $122-million center. The job description does not require or even note a preference for a candidate with clinical or research experience - or even interest - in complementary, alternative or integrative medicine. Wayne Jonas, MD, urges the CAM community to put forward its best candidates. Adi Haramati, PhD, wonders if the wrong new director may set back positive steps taken in recent years. Others wonder if a fix is already in. What ever, it's time for the CAM and integrative medicine community to say enough is enough: If it's "good medicine" we are heading toward then let's have "good management" to go with it ...

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ImageImagine a job description that read like this:
Position open for individual to direct the NIH National Cancer Institute. No interest in cancer or background in cancer research necessary.
Or how about this:
Applications now being accepted for the most powerful single position in influencing the nation's valuation and use of complementary, alternative and integrative medicine. No interest or experience in complementary, alternative or integrative medicine required. May be a liability.*
Or for a more brief take on a job description.
Top leadership position in new paradigm healthcare research open. Old paradigm thinker preferred.
The first, of course, is unthinkable. There is no way the NCI would ever be run by someone not deeply knowing, schooled, and experienced in cancer research. The second, however, is a matter of fact, with an asterisk - as noted below.

Last week the NIH
National Center for Complementary and Alternative Medicine quietly dropped a little note on the upper right hand column of the NCCAM website:

Director, NCCAM - Job Opening

What qualifications are required? Along with research and management experience such as would be expected, the NCCAM posting reads:
" ... must possess an M.D., D.O., Ph.D., or equivalent doctorate degree in the health sciences field plus senior-level scientific and management experience and outstanding scientific knowledge of research programs in one or more scientific areas that can be applied to advance CAM research."
This is the only mention of CAM in the qualifications for the position. "Integrative medicine" doesn't enter the picture. No expertise, or experience with CAM is required or preferred. Just that. The asterisk is added because many close observers believe that inside the NIH an applicant who has experience and interest may be viewed as damaged goods. Why? A bias against whole systems thinking and whole person therapeutics remains steadfast in the NIH.

So, let's see how this might shake down. Researcher X is a great bio-statistician. That could be applied to CAM. There's a fine candidate! Or how about researcher B who's got a list of publications
of randomized controlled trials (RCTs) of pharmaceutical drugs running up one sleeve and down the other. That experience could be applied to CAM. There's a candidate! Shoot, the great thing is, without requiring any actual experience or interest we've got a field that includes anybody who thinks they know a lot without really know anything. What a huge pool of candidates!

I wish I could fall asleep and wake back up and discover that now, in 2007, 15 years after the NIH began looking at CAM, the NIH would have the self-confidence to know how its own limitations have contributed to the US healthcare mess, and the touch of wonder to allow a director who has a passion for exploring the value the field may have for health care in the United States. Or maybe even someone who has the imagination to realize that whole-person practices, whether of integrative medical doctors, acupuncturists, naturopathic physicians, holistic nurses or other practitioners may need some methodological approaches which are new - and which your average reductive biostatistician or drug researcher just might not grok.

If you know people who would be good candidates,

urge them to apply. Or submit their names directly

to the individual noted on the NCCAM site!

I shared my concern with Wayne Jonas, MD, the former director of the NIH Office of Alternative Medicine and the last NIH director to have any clinical experience in the field. Jonas, now the director of the Samueli Institute - where questions about whole systems are being explored - stated simply: "This is a great opportunity for the CAM community to have input in the process."

Stuart Bondurant, MD - part of team evaluating candidates
What kind of input? Jonas responds: "They should try to identify their most qualified people and get their names into the committee."

Adi Haramati, PhD, a Georgetown based researcher, educator and leader of the Consortium of Academic Health Centers for Integrative Medicine underscores that the selection process should not be prejudged. He does express some concern about the possible outcome. He points to the quality of funded proposals from some CAM schools: "Some of the best proposals have come from these schools. There is an understanding that has been cultivated about building capacity in the CAM schools. New research literacy in CAM clinicians leads to new collaborations and these lead to new opportunities" for exploring more deeply the potential contributions from these fields. Haramati believes this movement might be at risk if the wrong person is selected.

The decision process involves an NCCAM team. Among those on the team are Brian Berman, MD, from the University of Maryland and Stuart Bondurant, MD, who chaired the 2005 report from the Institute of Medicine on CAM in the United States. This team will send a set of names upstream to NIH director who will then make recommendations to the Secretary of Health and Human Services.

Has a Decision Already Been Made?

One source contacted by the Integrator wonders if the posting of the job description may be a cover for a decision already made. The question circles in part around the quiet posting and the tight time frame for applicants. No notice, for instance, was sent out to the thousands who receive the NIH NCCAM newsletter. And potential applicants, once they stumble upon the posting, have only until April 3 to respond. The message, says this source, "is to not bother applying - the decision has been made."

Jonas disagreed. He noted that there is a new NIH-wide rule that allows positions to be posted on websites, rather than advertised, for instance, in Science. The old method was viewed as too slow and expensive. In addition, the process of moving a decision upstream to the point of the HHS Secretary's decision is viewed as so time consuming that they "speed up the front end because the decision takes so long."

Elia Zerhouni, MD, NIH director: will send his recommendation to HHS Secretary
The question arises about who would want the job, given the political-economic cross-hairs in which the director must operate. Taking shots from one side are powerful anti-CAM voices and from the other individuals, for instance, who may wish to see more funding directed toward CAM institutions, or a higher priority on exploration of the potential value of whole-person and whole system practices in chronic diseases. The NIH director, Elias Zerhouni, MD, is also under attack by anti-CAM interests. This favors candidates with a profile like past director Stephen Strauss, MD, a medical doctor and basic science researcher with publicly announced disinterest in ever using CAM. These provide the NIH director with good "cover."

Whether or not there has been a decision made, or a course set, the importance of this selection cannot be overstated. As the application notes, "the incumbent will chart a course for the future of CAM research that will, ultimately, facilitate the integration of proven CAM approaches with conventional health care."

(Additional) Comment: A few years back, in a famous column on CAM,
Marcia Angell, MD, then editor of the New England Journal of Medicine, called for an era when we don't have conventional medicine and alternative medicine but only "good medicine." All would play by the same set of rules.

It is time that the NIH, following this logic, decides to no longer have two sets of rules in leadership selection. Now we have a double standard:

  • Standard institute leadership selection.  A leader is selected based on his or her track record in the field that her or she would lead.
  • NCCAM leadership selection.  In this model, actual knowledge and experience of the field may be viewed as a liability. Leadership is handed to a politically safe candidate who make have skills "that can be applied" to advance CAM research.

It's time for the NIH to support just one "good" leadership selection standard.

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for publication in a future Your Comments article.

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