Your Comments: 12 Voices on NIH Appointing, to Direct NCCAM, a Scientist Inexperienced in CAM
Written by John Weeks
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.
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One colleague in a conventional research institution and another NIH-funded CAM researcher told me, off the record, that they thought I'd gone too far. "A little over the top" were the precise words from one. The other agreed. Most who wrote, however, were in full alignment with my own dismay. Here are their responses.
These are followed by a brief report, from Integrator reader, Taylor Walsh, on Briggs' first public appearance as NCCAM director, at the NCCAM advisory council meeting on February 1, 2008. There is much in Walsh's excellent report that is cause for hope that some of the recent positive moves in NCCAM will be advanced by Briggs. I have also independently heard that Briggs has reached out to leaders of at least one CAM profession to come, meet, and participate in their upcoming conference. This is more good news.
Still, to make sure that these voices of Integrator readers - totaling over 150 years in the field - have a chance to be part of the education of Dr. Briggs, I will send this Your Comments Forum to her.
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"
"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"
Integrator adviser Michael Levin's career path has included
positions in Big Pharma, in large hospital supply firms, and in the
natural products industry. He provides some insight on what such an appointment can do to a work force.
"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."
9. CAM business owner: "the letter made a sterling contribution ..."
An individual with decades of business and policy experience in and out of Washington, D.C. and the CAM universe wrote with nio plans to see it published. He refers to my family's sabbatical in Central America.
"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."
10. Rhonda Bonfield: "I happened upon your letter ..."
Rhonda Bonfield is a writer and marketing person who works on local
food and sustainability issues who happened upon the Open Letter qwhile surfing the web on other topics. Her
story, unencumbered with any history in complementary and integrative medicine, speaks eloquently of the common sense what? provoked by this move. I imagine she speaks for the average person to whom Tom Paine was writing 200+ years ago.
"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: "Fantastic letter to NCCAM! Can I reprint it on my blog (www.camlawblog.com) with yet another
link-back to you?" I said yes, and am reciprocating with his fascinating take on the learning that Dr. Briggs needs to do to fulfill on her work effectively. With a title of "Advice for the National Center of Complementary and Alternative Medicine," Cohen begins:
"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 Religionfor 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.
Cohen follows with a little humor then prints the Integrator Open Letter. Cohen then concludes with:
"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
12. Taylor Walsh reports on Dr. Briggs self-presentation at NCCAM February 1, 2008
Taylor Walsh, a Washington, DC based entrepreneur in the complementary and alternative healthcare realm, notified me that he planned to attend the regular NCCAM advisory council meeting on February 1, 2008, in Bethesda, Maryland. Here is his fine report.
"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. Given that the interim director Ruth Kirschstein, MD, held that position in her 80s, Briggs could be at NCCAM for 20 or more years - for better and for worse.
I find good news in Walsh's report, and Briggs' reported outreach to at least one CAM discipline. I earnestly hope, as Sheila Quinn stated, that Briggs will "really get lift off" in her new position by experiencing with her whole self what she'll later be charged to evaluate with her mind. I hope she will remain committed to exploring these practices in her own health, just as are most of the practitioners and consumers of these services. It would indeed be worse than "sad," as Bill Manahan, put it, if, to paraphrase Manahan, NCCAM under Briggs fails to "get it."
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