Your Comments: 12 Voices on NIH Appointing, to Direct NCCAM, a Scientist Inexperienced in CAM

Summary: My open letter to Josephine Briggs, MD, who was appointed to direct the NIH NCCAM despite having virtually no experience in complementary or integrative medicine, produced a dozen, printable responses. Here are comments from Harvard Associate Professor Michael Cohen, JD, naturopathic medical leader Bruce Milliman, ND, Integrated Healthcare Policy Consortium chair Sheila Quinn, holistic medicine pioneer Bill Manahan, MD, nurse-coach Linda Bark, RN, natural product consultant Michael Levin, publicist Rhonda Benfield, Georgetown law professor Sherman Cohn, JD, Kaiser Permanente physician Lydia Segal, MD, Healing Quest TV producer Judy Brooks and some who preferred to remain anonymous. I conclude with an excellent short report from CAM entrepreneur Taylor on Briggs' comments at her first NCCAM meeting, February 1, 2008. The report and some early Briggs moves are hopeful.

Josephine Briggs, MD

I was stimulated to write on Open Letter to Josephine Briggs, MD, on learning of her appointment to direct the National Institutes of Health National Center for Complementary and Alternative Medicine. My motivation was learning that Briggs, like her predecessor, has virtually no professional background related to complementary and integrative medicine. (See

Sheila Quinn, IHPC chair

1.    Sheila Quinn: " ... you've take a step that may help Dr. Briggs get lift-off in her new position"

Sheila Quinn co-founded what became the nation's first university of natural health sciences, Bastyr University, in 1978. She is the current chair of the Integrated Healthcare Policy Consortium. This, like most of these notes, was not written for publication. I asked her if I could publish it - like the others - as evidence of response from the community.

"My heartfelt thanks for taking the time to craft such a direct, clear, and comprehensive letter to Dr. Briggs. Very likely no one else will be as honest or as informative as you, and so you may have taken a step that will enable Dr. Briggs to really get liftoff in her new position. Knowing you have sent it, and offered such practical advice, I think we can assess her ability to listen and become educated by observing whether she actually does any of the things your recommended (or anything similar). If you get a reply, I would be grateful if you would share it!"

Sheila Quinn
Gig Harbor, Washington

Bill Manahan, MD

2.    Bill Manahan, MD: "It really hurts to continue to be patronized by our colleagues at the NIH"

Bill Manahan, MD is an Integrator adviser and a long-time leader in holistic medicine,

"Wow, it really hurts to continue to be so patronized by our colleagues at NIH.  You have a method of writing, John, of articulating so well just how foolish it is to appoint an NCCAM Director who by her resume seems to know nothing about CAM.

"Many of us are not by nature patient people.  Yet I believe most of us gave Stephen Straus [former NCCAM director] the benefit of the doubt.  But for NIH to do this type of thing a second time is truly making a mockery of our integrative medicine patients and of those of us practitioners immersed in this movement for the past 30 years.  I guess all I can say is Ouch!

"It is very sad to me how even after all these years our NIH colleagues just do not get it."

Bill Manahan, MD
Minnesota

Bruce Milliman, ND

3.    Bruce Milliman, ND: "actual integration awaits a more enlightened time ..."

Bruce Milliman, ND, a leader in perhaps the largest integrative practice in the nation, Seattle Healing Arts, and a past Physician of the Year for the American Association of Naturopathic Physicians, brings an unusual past to his work in natural health care. His father founded Milliman, Inc. the international healthcare consulting and actuarial firm. Milliman - with 30 of his own in naturopathic medicine -  sent me a note that was not intended for publication, but he authorized my doing so.

"Wow!  As they say, 'if I saw you in a fight with a bear, I think I'd help the bear!'  Your open letter to Dr. Brigg's, regarding her recent appointment as Director of NCCAM gave no quarter, and left nothing out...nothing, as it were, to the imagination.  It is a great piece of journalism. It reads as from one who is speaking on the behalf of all of us, we who are so disheartened by the seemingly never-ending struggle to not just be not ignored, but to be seen.

"Acceptance and understanding, and yes, actual integration I believe most recognize must be deferred to a more enlightened time in our country's emergence.

"Thank you."

Bruce Milliman, ND
Seattle Healing Arts
Seattle, Washington

Michael Levin

4.    Michael Levin: Possible "insidious effect of de-motivating her subordinates"

"As I read your powerful letter to Dr. Briggs, it occurred to me that her appointment might have the more insidious impact of de-motivating her subordinates, further undermining NCCAM's progress. In the business world, I've seen, time and again, talented staff de-motivated by hiring a boss unfamiliar with a company's products or services. The longer the learning curve, the tougher it often is for staff to remain positive, engaged and productive.

"What unfortunate timing! Do please share with us any response you may receive from NIH."

Michael Levin
Health Business Strategies

Linda Bark, RN

5-8.    A nurse coach, a Kaiser MD, a Gerogetown law professor, a producer

• Linda Bark, RN, a health coach and founder of AsOne Coaching Institute wrote simply: "Thanks for sending that letter to Dr. Briggs...amen...amen...amen..."

• Sherman Cohn, JD, a former Watergate lawyer, professor at the Georgetown University Law Center and chair of the board for Tai Sophia Institute writes: "Great letter to Dr. Briggs.  I hope she reads it and takes it seriously. Could you imagine NIH appointing to head [Briggs'] former office a renown dermatologist, much less an acupuncturist? At least some of us believed that Stephen Strauss grew in the job.  So, wearing my usual happy face, I am willing to be hopeful until proven wrong."
  

• Lydia Segal, MD, integrative medicine leader with Kaiser Permanente, Mid-Atlantic: "I wondered the same, about the NIH CAM new director. Glad I was not the only one thinking that. I do understand the value of a researcher and an insider to NIH. Still."

• Judy Brooks is executive producer and co-host with Healing Quest, a natural health-oriented television program featuring Deepak Chopra, MD, and singer and cancer survivor Olivia Newton John, and others. Brooks wrote, echoing Quinn, after a note on another topic: "I forgot to say I loved your letter to Dr. Briggs, you certainly gave her a lot to think about.  Can't wait to see if you get a response."

"Inclusion as a posting on your blog I seek not. Just wanted to tell you that, if you spend the rest of 2008 sipping Pina Coladas on a Central American beach, through your letter you will already have made a sterling contribution to the integrated health care movement in the United States this year. I expect you back at your duty station January 1, 2009, however.

"With good fortune, we may then have a new national political dynamic."

"I happened upon your blog via the Alternative Medicine Foundation’s site, and had just been reading about the appointment of Dr. Briggs to NIH’s NCCAM. First, I never knew the NCCAM existed (and was skeptical but impressed with NIH’s efforts to accommodate alternative medicine -- a science that is being adopted in millions of homes!). 

	"While reading Dr. Brigg’s CV, I thought, 'interesting, I really don’t see anything about alternative or complementary medicine in her works.'” - Rhonda Benfield

"Second, while reading Dr. Brigg’s CV, I thought, 'interesting, I really don’t see anything about alternative/complementary medicine in her works.'  And then, third, upon being led to NIH’s Clinical and Translational Research awards page, I browsed over the 24 medical institutions that have been awarded since 2006, but, although this program would be a perfect forum/resource for alternative treatment studies, did not see anything about alternative or complementary medicine studied by these institutions, although I’m not an expert in reading scientific reporting.  So I guess the NIH is paying lip service at this point.

"And then I visited your blog and saw the letter you wrote to Dr. Briggs last week.

"I have no particular bone to pick with the medical community — I try to choose my battles.  Although I’m glad someone picks. In short, I’m just a freelance marketer, writer, graphic designer and I try to focus my talents and interests on the food-system, with a special passion for the buy-local movement.

"Gaia Herbs’ farm is in my state (North Carolina) and so I peruse their site occasionally (as a GREAT example of successful branding).  That’s where I got off track in my internet surfing and found your blog.

"Really, the only reason I’m writing is to complement you in your efforts to confront Dr. Briggs and to make constructive suggestions. I’m glad you do the work you do.  It takes chutzpa!  I’m also wondering whether or not you’ve received any response.

"Nevertheless, keep writing and have a great day!

Rhonda Bonfield
Winston-Salem, North Carolina
www.rhondabonfield.com

Michael Cohen, Esq.

11.    Michael Cohen/CAMlawblog.com: "Fantastic letter ..."

Michael Cohen, an adjunct faculty member at Harvard School of Public Health has always combined his knowledge of the law with his practice and teaching of yoga and his background in the fine arts. He wrote me immediately:

"The Integrator Blog, a site dedicated to business news and trends in integrative medicine and complementary medicine, gives advice to the new Director of the National Center for Complementary and Alternative Medicine. The Integrator Blog has its own style, but also its advice lays down a challenge that makes sense to me: if you really want to understand complementary, alternative, and integrative medicine, understand it experientially. Even if you have the finest research credentials and clinical experience on the globe, you cannot understand something like, for example, meditation, merely as a fly on the wall (a scientist-fly, that is).

"There is an old story about the ladle trying to taste the pudding.

"Even if you have the finest research credentials and clinical experience on the globe, you cannot understand something like, for example, meditation, merely as a fly on the wall." - Michael Cohen

"It is much more difficult to be dismissive if one has their own experience. Of course, we need to question our experience, just as Descartes questioned his. (Of course, Descartes was the one who separated mind and body, questioning whether he really had either, and setting up centuries of mind-body dualism. Kids, don't try this at home.)

"But in many ways, 'complementary, alternative, and integrative medicine' is a quadruple misnomer: it isn't necessarily complementary, alternative, or integrative -- though these words, for now, help anchor various philosophical platforms; and it isn't necessarily even 'medicine' (at least not in the 20th-century, legal and technological sense; though it may be if one thinks in the metaphor and archetype of the Medicine Buddha).

Rene Descartes - thoroughly imbedded in the debate over NCCAM's value

"That would make a great statement for a final exam, followed by: 'discuss.' For now, suffice it to say that 'healing' is a much broader idea than 'biomedicine' (see A Fixed Star in Health Care Reform: The Emerging Paradigm of Holistic Healing) and that the notion of 'medical pluralism' encompasses a much larger path than certain technological approaches to health care that we sometimes denote through various labels such as 'reductionistic,' 'Western' and so on (see Healing at the Borderland of Medicine and Religion for a longer discussion). So The Integrator wisely suggests seeing some of these therapies 'up close and in person' before rendering judgment. All of which is to say to add other forms of empirical evidence to the usual 'literature search.' After all, the evidence base of being human is quite broad.

"One more 'thought:' I like the writer who said that the history of Western intellectual thought -- and possibly of medicine -- would have been completely different if Descartes had simply written, 'I love, therefore I am.' How do I know that I am? Because I love, not because I think.

	"[The Integrator letter] engages NCCAM in the kind of dialogue a 'CAM' or integrative medicine practitioner might have had with Descartes." - Michael Cohen

"Last night I heard a lecture by someone who holds a PhD in psychology and a degree in naturopathic medicine. He practices psychology in one room and naturopathic medicine in another. Why? Because, he said, we have to separate mind and body. Legally, he feels, when he treats "the mind" he cannot touch "the body," for fear of a lawsuit. So when he wears one professional hat he leaves the other one in the other room. All of the credentials on the wall of one room say Mind Healer and those in the other room say Body Healer. He feels our current health care system, and the laws that support it, have forced him into repeating the 'original sin' of Cartesian dualism.

"It would have been nice to sit in the armchair opposite Descartes and ask: 'Okay, so I think therefore I am, but what is 'I'? What is 'am'? Sorry, Mr. D, but the 'therefore' is just too easy."

"In the meanwhile, read the Integrator Blog. He doesn't have Descartes in the chair, but engages NCCAM in the kind of dialogue a 'CAM' or integrative medicine practitioner might have had with the French philosopher."

Michael Cohen, Esq.
Cambridge, Massachusetts

"Here is an account of Dr. Briggs' remarks at the NCCAM council meeting Friday. Parse/use at will if anything appears useful. She came across as eager to get into the work and took some pains it seemed to bring whatever CAM-related experience she has had to the fore. Full staff appeared to be in attendance.

Taylor Walsh

"Dr. Josephine Briggs, new director at NCCAM, was introduced to the public at the quarterly meeting of the NCCAM National Advisory Council in Bethesda, MD on Feb. 1, at which six more new members were also introduced.

"In her remarks, Dr. Briggs laid out the background and philosophy she’ll bring to what she called 'a complex and interesting job,' one that she said she 'wanted very much.'  As she described her work and experience she did so with an emphasis on where CAM and mind-body approaches have been part of her work or have influenced her thinking. 
"Dr. Briggs’ experience at NIH was in the Division of Kidney, Urologic and Hematologic Diseases, where she was director (1997-2006).  After an 18-month stint at Howard Hughes Medical Center, a couple of miles from NIH where she was senior scientific officer, she returns to NIH to assume the director’s role at NCCAM.

"As a kidney specialist, Dr. Briggs said she was 'always aware of how people felt lost and depersonalized in the machinery'of dialysis.  Thus, she said, 'an emphasis on the whole person is very much needed.'  Equally important is learning the cultural background of the patient and family, which is especially true for populations burdened by kidney disease, notably Native Americans and African Americans.

'"Kidney disease is very hard to live with,' she said.  'The ability to cope depends on support.'  That support, from the practitioner side, she said, has been sorely deficient.  'The core problem,' she said, 'is a loss of communication' between providers and the patient and the family.

Briggs with her predecessor, Stephen Strauss, MD, at the conference on placebo they co-chaired

"In 1999 along with NCCAM’s then-director Dr. Stephen Straus, she co-directed the NIH conference "Science of the Placebo: Toward an Interdisciplinary Research Agenda,"  (There is a picture of Briggs and Straus at that conference on this page. See picture.)

"She said that the collaborative event between NCCAM and the National Institute of Diabetes and Digestive and Kidney Diseases (also including 17 other NIH units) was her 'first exposure to mind-body medicine.'

"But Dr. Briggs also described observing applications of CAM in some of her earliest experiences.  In the years (1979-1985) she worked as a research scientist at the Physiology Institute of the University of Munich in Germany, she noticed that physicians occasionally prescribed herbal remedies as a first course of treatment, and often recommended that patients get out into the fresh air and otherwise reduce stress before returning to normal routines.

"Dr. Briggs says that some of this collaborative and observational experience has influenced her approach to research and medicine that will inform her directorship at NCCAM. As a scientist she said that while she is devoted to the rigor of evidence-based science, 'I am a bit of a skeptic when I see dogmatic thinking, including from the establishment.'  Specifically she cited the path that acupuncture has taken through those skeptical tides.  It is important, she said, to understand 'interventions with a long history of people turning to them for comfort.'

"'Breakthroughs,' she said, 'come from outside the mainstream.' Noting the work being done on the central nervous system and acupuncture, she said she is “excited about the potential in modern science to reshape CAM research…(there are) real revolutions to come in clinical research.”

"Agenda for the first year:Dr. Briggs described her objectives for the next 12 months: 

• In the first six months: listening to staff and to members of the council and to focus on priorities: “those areas with most scientific promise and which are important to stakeholders"

• by September she hopes to have top priorities identified
• by the spring of 2009 she hopes to have two or three primary areas of focus.

"She noted that the current strategic plan of 2005 'won’t be replaced right now,' and that time will be taken before revisiting that plan. She said that she will be seeking partnerships with other parts of NIH, noting that 'interest in CAM is shared by the public; people care. Other (NIH) institutes agree with this.'"

Comment: Thank you Taylor, for your report. Thank you all for taking the time to weigh in on this very important matter. My sentiments were my own when I wrote.  I will send these of so many of you, off to Dr. Briggs, just as I sent my own letter. Together, to my estimation, we represent over 150 years in these fields.

The odd thing is, in this nominal Democracy, NIH director-level positions tend to be like Supreme Court appointments: the person selected can hold the position for life.