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Invited Voices on the Legacy of Stephen Straus, MD, NIH NCCAM Director, 1947- 2007 PDF Print E-mail
Written by John Weeks   

Invited Voices: The Legacy of NIH NCCAM Director Stephen Straus, MD (1947- 2007)

Summary: If one were to chose the single individual who has had the most significant influence on the evolution of the complementary and integrative medicine dialogue over the past decade, one would be hard pressed to top that of Stephen Straus, MD. Straus, who was selected to direct the NIH National Center for Complementary and Alternative Medicine when it was founded, had a profound impact on how roughly $700-million of NIH funds were spent. Straus died on May 14, 2007 following a multi-year battle with brain cancer. The Integrator invited some who knew Straus to share reflections on the man, and his tenure with NCCAM. Here is a sampling from Brian Berman, MD, Susan Folkman, PhD, Carlo Calabrese, ND, MPH, Adi Haramati, PhD, Ted Kaptchuk, OMD, Kathi Kemper, MD, MPH and, from across the Atlantic, George Lewith, MD, PhD.
Send your comments, anecdotes and reflections on Straus' tenure
to

for inclusion in a future Your Comments article.

Controversy is in the nature of the job of representing complementary and alternative medicine (CAM) inside
the National Institutes of Health. Most leaders of that proud and righteous institution felt that it was a low blow to the NIH's integrity, back in 1991, when Congress mandated that the NIH look at "unconventional medicine." Worse yet, six years later, Congress added injury to that insult when it elevated CAM to become the National Center for Complementary and Alternative Medicine (NCCAM), one of just 27 NIH institutes and centers.

Image
Stephen Straus, MD - 1947-2007
In this context, the individual charged with directing NCCAM would necessarily be controversial. That individual would oversee what is now a $120-million annual budget - a huge sum in an otherwise relatively poverty-stricken corner of the healthcare universe. The NCCAM director would arguably become the most powerful human being in shaping integrated care in the United States.

The individual charged to fill that role in 1999 was an unknown to the integrative medicine world, Stephen Straus, MD. Straus brought a strong NIH resume but no integrative medicine experience to NCCAM when he took its reins. In the ensuing seven years, he fulfilled on one 5-year plan for NCCAM and shaped another before a debilitating battle with a brain cancer led Straus to resign his position in 2006.

On May 14, Straus died, at age 60, leaving a wife and three children. The NIH sent out a release honoring Straus' long research career. I contacted some individuals who knew Straus and had worked with him. I asked them to share an anecdote or comment on the man, and on his legacy for the field into which the spirits of our time thrust him.


1.
    "A man on a mission  to make  it credible to  do research in this field"

Adi Haramati, PhD
, directs the integrative medicine exploration at Georgetown University School of Medicine. He has a background as a basic science researcher but developed an interest in complementary and alternative medicine in the late 1990s. Haramati has played a number of significant roles since. He was the first vice chair of the Consortium of Academic Health Centers for Integrative Medicine and has been a leader in fostering multi-disciplinary dialogue and action through the Integrated Healthcare Policy Consortium which he co-founded. He was a principal investigator for an R 25 grant through NCCAM.
"I had known Dr. Stephen Straus for a short time–7 years - yet our lives were linked in ways that only recently became apparent.  He was named the director of the National Center for Complementary and Alternative Medicine in October 1999, around the time that I began to take an interest in this field. 

"Dr. Straus had come to NCCAM after having built an exceptional scientific career at NIH in basic and clinic research on a variety of topics in virology and infectious disease.
  There were clear challenges that he faced, both from skeptics to CAM on the one hand, and long-time researchers and practitioners in the field on the other. I specifically recall the piece in Science and the interview in The New York Times that highlighted the delicate balancing act he was managing.  It was clear that he was a man on a mission—and the mission was to make it credible to do research in this field.  I attended quite a few of the sessions of NCCAM Council meetings that were open to the public, and saw over several years the degree to which he guided NCCAM masterfully with vision, passion, and politic.

"On a personal level, we first met in early 2001.  I had written my first grant application to do work in this field and he was interested in why a basic scientist would do so.  Actually, I think Steve was more interested in my name.  It turns out that we both attended the same high school—Yeshivah of Flatbush—the largest Jewish school in North America at the time.  Moreover, he delighted in telling me that my father, the chairman of the Bible department, was one of his favorite teachers and had a profound influence on him.  From our first meeting, we always exchanged a few words in Hebrew when we greeted each other, but then Steve would quickly switch to asking me about the progress on the NCCAM-funded project I was leading.  He always ended with a smile, but also a clear directive to 'do a good job!'  I felt this enormous responsibility to get it right and not disappoint Steve. 

"In recent months, as Steve was unable to go to work, he started a class, a discussion group really, at his home on Monday evenings to reflect on topics such as 'Dying with Dignity.' 
I attended two of those sessions, and was privileged to see not only the love that his friends and neighbors had for Steve, but also the incredible devotion and strength of his wife Barbara and their three children.  In the end, Steve was still teaching all of us—about priorities, about relationships and about compassion."

Adi Haramati, PhD
Georgetown University
Image2.   An international perspective

George Lewith, MD, PhD has been one of the United Kingdom's leading researchers on complementary and alternative medicine for many years. He is a co-founder of the
International Society for Complementary Medicine Research (ISCMR). Lewith has recently been active with an informal international group which has been promoting whole systems approaches to research.
"Stephen was a man of great integrity and honesty who had a clear scientific vision about the development of CAM. He was able to establish a well funded institution that has become the world’s leading CAM research organization."

George Lewith, MD, PhD
International Society for Complementary Medicine Research
3.    "Willingness to take a risk on CAM"

Susan Folkman, PhD, the director for integrative medicine at the UCSF Osher Center for Integrative Medicine, is the current president of the Consortium of Academic Health Centers for Integrative Medicine.

"It was January of 2001, and I had just had my first conversation with Dean Haile Debas about the directorship of the UCSF Osher Center for Integrative Medicine.  As I was leaving Dean Debas’ office, he said, 'Susan, you MUST call Dr. Stephen Straus and speak with him.  It is very important that you speak with him.' 

"Within hours I was on the phone with Dr. Straus, and we spoke for 90 minutes. Dr. Straus shared with me his own reasons for taking the directorship of NCCAM. In doing so he revealed his willingness to take risks by moving to the field of complementary and alternative medicine, his commitment to scientific rigor, and his uncanny ability to know what a behavioral scientist such as myself would be wondering about.
 

"But it was what that conversation revealed about Dr. Straus, the person, that is vivid in my memory: he was incredibly bright, focused, courageous, curious, and direct, articulate, and wise.
  He listened to the questions I asked and responded with great honesty and thoughtfulness.  In short order, I felt both trust and respect for this NCCAM director, whom I had never met. 

"I did meet him in person, several months later, a short time after I assumed the Osher Center directorship in May of that year.
  Dr. Straus invited me to his home to share Shabbat dinner with his family. I will not forget that evening – its warmth, the wonderful dinner prepared by Barb Straus, including home baked Challah, and the general sense of optimism and hope that infused the wide ranging discussions of art, science, and diverse other topics.  It was clear that NCCAM was in just the right hands.  I will miss Stephen Straus. 

Susan Folkman, PhD
UCSF Osher Center


4.  "My relationship with him was both cooperative and contentious ..."

Carlo Calabrese, ND, MPH, was the co-principal investigator on one of the NIH's first center grants, awarded to Bastyr University in 1994, prior to Straus' tenure. Calabrese, a current member of NCCAM's national advisory committee, has been a leading NIH adviser on methodology issues. His strong interest in whole practice and whole systems approaches sometimes put him at odds with Straus' conventional views of NCCAM priorities. Calabrese is a senior researcher with the Helfgott Research Institute associated with National College of Natural Medicine and has an appointment with the Oregon Health Sciences University.
"I’m not sure what I might say about him belongs in a memorial. He was a sharply intelligent, energetic and devoted man who wanted to make important contributions. My relationship with him was both cooperative and contentious.  In research, he was more of a reductionist and seemed to want CAM research to be as much like pharmaceutical research as possible.  He wanted the organization of research lead by reductionists like himself; I wanted it more fully inspired by CAM practitioners and patients who had a better idea of where the social and personal benefits lay. Of course, CAM practitioners didn’t have the skills to organize investigations of the potential of their own practices at the scale that became available with the establishment of NCCAM. 

"When political (not scientific or academic) processes made millions available for CAM research, he won the leadership and set off to replicate the NIH approach to drug development. Perhaps that was for the best, earning some respect within NIH for research efforts in CAM.  He was at the center of, and skillful in, the NIH culture and made the presence of CAM research there obvious both internally and to the public. 

"Yet, I wondered why he wanted the position; little in his preparation or experience seemed to call for it.  As his tenure went on, he seemed more and more to realize how CAM and conventional medicine are different socially, historically, and in their research needs.  He came to more actively support educating CAM practitioner-scientists and the development of research infrastructure at CAM (institutions) and gave more attention to mind-body interactions, and encouraged development of the right methodologies including observational studies, early phase trial techniques, and complex systems approaches. 

"He loved his legacy, especially as it was expressed in emerging young scientists.  At a conference once, he enthusiastically gathered a number of young NDs whose training was NCCAM-funded around him for a photograph. He was glowing—more effusive than I’d ever seen him.  Had he lived, his contributions, remarkable as they are, I think would have just been beginning.  He was growing fast right up to the end."

Carla Calabrese, ND, MPH
Helfgott Research Institute
National College of Natural Medicine
Oregon Health Science University
Portland, Oregon
 
5.   Though new to the field, Straus work will have a lasting impact

Brian Berman, MD, has been the darling of NIH CAM researchers, receiving multiple project and center grants through his base at the University of Maryland Center for Integrative Medicine. Berman's program was the first integrative medicine operation to be housed in a conventional academic health center in the United States. Interestingly, Berman is also among the most experienced, clinically, in integrative medicine among the directors of the integrative medicine programs in conventional academic health centers; he may also be the most inquisitive explorer of unusual therapies, approaches and devices. Berman was the founding chair of the Consortium of Academic Health Centers for Integrative Medicine and was given the Bravewell Leadership Award in 2005.

"Steve Strauss asked me to visit him in his office shortly after he took over as Director of the newly formed National Center for Complementary and Alternative Medicine.  A highly respected scientist and clinician in his own field of immunology, he admitted to being new to the field of complementary and alternative medicine but his questions were sharp and his comments insightful. I was greatly impressed at how quickly he grasped the issues surrounding the state of the science in CAM and acted to implement and fund programs that would effectively move the field forward.

"Over his tenure as director, Steve’s leadership brought great credibility and esteem to NCCAM both within the NIH and in the broader medical and CAM communities.  This was no small accomplishment, but his emphasis on rigor and quality, his ability to grasp the complex nature of CAM, and his gift of nurturing collaborations enabled the CAM scientific community to flourish and grow. 

"One particular memory I have is working with Steve on developing international collaborations for the study of indigenous medical systems.  From the start of collaborating with NCCAM and the Hong Kong Bureau of Health on a high level scientific conference (to take place) in Hong Kong aimed at raising the standard of research in traditional Chinese medicine, to the creation of collaborative international research centers, I got to experience how Steve’s vision and great integrity have allowed for meaningful work that will have lasting impact." 

Brian Berman, MD
University of Maryland
6.    Sense of humor helped him navigate his role

Ted Kaptchuk, OMD has introduced scores of thousands of souls - including me - to Chinese medicine through his classic book, The Web That Has No Weaver. He's since introduced many more thousands to the fascinating role of the placebo through his research and writing on that topic. Kaptchuk, a member of the faculty at the Harvard-Osher Center for Integrative Medicine, serves on the advisory council to NCCAM.

"Steve's sense of humor let him navigate one of the toughest positions at the NIH. He was able to get along with hard core scientists and CAM advocates and still lead NCCAM to sharpen its focus and produce scientific knowledge. He'll be missed."

Ted Kaptchuk, OMD
Harvard-Osher Center

6.    A profound impression

Kathi Kemper, MD, MPH is an author, clinician, educator and researcher who heads up the integrative medicine program at Wake Forest University. Her leadership in the field, with a focus on pediatrics, has been acknowledged through her selection as a nominee for the prestigious Bravewell leadership award.
"I did not know Dr. Straus well, but when I met him years ago at the first Pediatric Integrative Medicine meeting in Tucson, I had my son, Daniel with me.  At the time, Daniel was about 2 years old, in a stroller, and I was torn between the meeting and caring for him.
"One day as I walked through the hotel grounds with Daniel, I saw Dr. Straus in the garden. I went to say how much I appreciated his talk and his leadership of NCCAM. He thanked me, and immediately bent down to talk with Daniel.

"He was immediately engaged, and we talked about his own kids and his pride in them and about the balancing act of being a physician-scientist-leader and a parent. He clearly knew which job was tougher and more important.

"I thought then and continue to believe that Dr. Straus was a pediatrician at heart. As I watched his career unfold from a distance, I always remembered that day, and whenever there was a question about a policy decision or something like that, I could easily recall that Dr. Straus' had the highest possible intentions.

"He was a truly compassionate person. I've prayed for him often over the past 2 years, and now I extend those prayers to his family. If he made such a profound impression on me with so little contact, I can hardly imagine what his loss is for them. He was a great gift to the CAM community and to the world."

Kathi Kemper, MD, MPH
Caryl J Guth, MD Chair for Holistic and Integrative Medicine
Wake Forest University Health Sciences

Comment: Integrator readers will know that I have strongly-held views that the leader of the NIH NCCAM should have experience, imagination and passion for the field. Straus, on the other hand, was the consummate political appointment. While a respected NIH researcher, he had no prior interest in, or experience with, integrated care. He publicly affirmed his disinterest in personally exploring the therapies his NIH Center was researching. Our views were polar opposites. He stood on the grounds of the pure "objectivity" of his disinterest while I - and others - hold that subjective experience of the whole-person paradigm of care may be critically important to informing the development of both methodological tactics and overall strategic planning.

Yet associates have shared with me many times how they believed Straus was the right man for the job. I came to begrudgingly credit their practical perspectives, despite my alternate vision. Reason allows us only so much leeway amidst our ongoing denial of reductive research's contributions to the dismal state of health in the United States. NCCAM seems to have needed a leader who could move between the worlds, unencumbered by the taint of passion or personal experience. Yes, Straus may well have been the optimal person to establish the credibility of CAM research. But what of integrated care's contribution to health itself?

I like to imagine Straus' ultimate legacy this way. Yes, he played a large part in developing the credibility of research in the field. Now let's take this foundation and find a new director who will take us further down the road on which Calabrese describes Straus walking.
This new director will increasingly see, as Straus did in Calabrese's portrayal, "how CAM and conventional medicine are different, socially, historically, and in their research needs." This director will further this image of Straus' leadership:
"He came to more actively support educating CAM practitioner-scientists ... and gave more attention to mind-body interactions, and encouraged development of the right methodologies including observational studies, early phase trial techniques, and complex systems approaches."
If this part of the Straus legacy is embraced by his successor, we can be sure that Straus' foundational contributions, remarkable as they are, have just been beginning and will have a chance to express complementary, alternative and integrative medicine's maximum impact on our health.

Send your comments, anecdotes and reflections on Straus' tenure
to
for inclusion in a future Your Comments article.


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