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The Integrator Blog. News, Reports and Networking for the Business, Education, Policy and Practice of Integrative Medicine, CAM and Integrated Health Care. - Your Comments: Perspectives on the Appointment of NCCAM's Inexperienced Director Josephine Briggs
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Your Comments: Perspectives on the Appointment of NCCAM's Inexperienced Director Josephine Briggs PDF Print E-mail
Written by John Weeks   

Your Comments Forum: Additional Perspectives on the Appointment of NCCAM's Inexperienced Director Josephine Briggs, MD

Summary: The Integrator exchange on the appointment of a new overseer of the National Center for Complementary and Alternative Medicine who has neither professional experience nor known personal passion for the field she will direct continues to generate response. Here are comments from policy leader Marc Micozzi, MD, past AHNA president Sonja Simpson, RN,  MS, King County Natural Health Clinic organizer Merrily Manthey, National Center for Homeopathy president Nancy Gahles, DC, CCH, RSHom(NA), natural products attorney Debra Bass and acupuncturist Jesse Woodson, LAc.
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The announcement by Elias Zerhouni, MD, the director of the National Institutes of Health, that Josephine "Josie" Briggs, MD, would be the new director of the National Center for Complementary and Alternative Medicine, continues to generate significant commentary. The cause: the NIH's repetition of its past practice of appointing to direct the Center an individual who has neither professional experience nor known passion for the field they are to oversee. This diverse group of commentators follow 12 earlier voices.

integrative medicine pioneer, policy
Marc Micozzi, MD, PhD
1.    Micozzi: "surprising that the CAM community is disappointed"

Marc Micozzi, MD, PhD is a medical anthropologist who has made numerous significant contributions to the evolution of the complementary and alternative medicine (CAM) and integrative medicine dialogue. These have included publishing,
convening the first significant gathering of educators, working closely on these topics with former Surgeon General Everett Koop, MD, running an academic integrative medicine program, and stimulating various policy initiatives. Micozzi brings us a seasoned Beltway perspective.
"I am surprised that the CAM community continues to be disappointed by NIH/NCCAM. As Bill Clinton used to say here in Washington, DC,  'Fool me once, shame on you. Fool me twice, shame on me.'

"Even though NIH is located mere blocks from my Bethesda office, I stopped paying attention long ago. We should have given up when Wayne Jonas left (the Office of Alternative Medicine) over ten years ago. Fortunately, in the local Washington community, there are great things happening with CAM education at Georgetown U and with CAM services at George Washington U and Suburban Hospital. At the federal level, importantly, the CAM community should focus on more broad-based government involvement in CAM.

"NIH is only of several important divisions of the Department of Health and Human Services (DHHS), and DHHS is only one federal agency with proper public interests in the broad scope of CAM. We have been able to make more progress with Center for Disease Control and Prevention, Health Resources and Services Administration, Agency for Healthcare Research and Quality, Department of Defense and other agencies on projects and programs related to the public health and health services significance of CAM. 

"A few years ago, Sen. Tom  Harkin (D-Iowa) told me he was ready to look beyond NIH for federal leadership in CAM. However, he needs an organized and sophisticated CAM public policy effort with which to work. Also, years ago, Sen. Arlen Specter (R-Pennsylvania) relayed to me NIH's comment that they 'don't believe in bioenergy.' My suggestion was to ask the US Department of Energy to mount an effort on bioenergy research (much as they have in other health fields). At least DoE can't say they don't believe in energy.

"Let's read the writing on the wall and stop looking to NIH for CAM leadership - or miracles - after all, they don't believe in miracles either."

Marc Miccozzi, MD, PhD
Bethesda, Maryland
Comment: Micozzi's point has much merit. I tend to disagree on giving up on NCCAM because, first, that's where the most dedicated money is, and second, it can very well be that the reform of health care will necessarily include a reformulation of the appropriate focus of the nation's core research initiative. More specifically: What is the contribution to the nation's deplorable health care outcomes of the NIH's present, reductive, pharma-driven agenda? Can we reform healthcare without refocusing the NIH? Must this not, reasonably, be part of the agenda of a so-called "movement" which seeks to transform US healthcare? Meantime, Micozzi's suggestions may be more practical, especially for those with the clout to create earmarks ...

Sonja Simpson, RN, MSN, AHN-BC
2.    Holistic nursing leader Simpson: "err on the side of give (Briggs) time ..."

Sonja Simpson, RN,
MSN, AHN-BC is a past president of the American Holistic Nurses Association. She  takes a view that underscores the potential value of the NIH's brand.
"I am always impressed with the candor of your blog newsletter and I am empathetic to the comments that were published in terms of concern about the appointment of a person to an essential and important post in terms of integrative medicine and it’s future..that is not experienced in the field of integrative care.

"I would err on the side of giving the person the 'listening time' (however that is defined!!) to see if her credentials in research will advance in any way the use of and understanding of the importance of integrative medicine in the world of healing.

"It appears as though research will 'sell the validity and prove the efficacy of integrative care' and that would be a great goal to achieve…the greater goal would be how much the current healthcare system embraces that validity in terms of understanding and using it!"

Sonja Simpson, RN, MSN, AHN-BC
Former President, American Holistic Nurses Association

Nancy Gahles, DC, CCH, RSHom (NA)
3.  NCH President Gahles: "homeopathy blatantly absent" from proposed study plan for Briggs

Nancy Gahles,
DC, CCH, RSHom (NA), is the current president of the National Center for Homeopathy. She offers an addition to the proposed experiential study plan which I provided for Briggs in my Open Letter.
"I loved your letter to Dr. Briggs. Really put her into a new mode of thinking.

"However, it was a glaring oversight that among all the CAM modalities you asked her to explore, homeopathy was blatantly absent. We DO have a headquarters in Alexandria, VA and we do have a list of Certified Classical Practitioners to choose from if you visit our incredible website.  When thinking CAM, think HOMEOPATHY!  We are alive and well and healing whole persons all the time.  I also invite you to listen to the webcast on our site of a debate on homeopathy that I think you may enjoy.

"Blessings on your work,"

Nancy Gahles, DC, CCH, RSHom (NA)
President, National Center for Homeopathy

Director, Health and Harmony Wellness Education
Comment: Amidst what can seem to an outsider (like Dr. Briggs) an amazing, chaotic mix "CAM" therapies, I typically focus on the licensed disciplines which have undergone the stringent and challenging self-regulatory and regulatory processes which lead to seeking federal-recognition for an accrediting agency. Homeopathy, while it is nominally licensed in 3 states (I say nominally in that the most visible of the 3, Arizona, actually has a sort of "integrative medicine" license masquerading as homeopathy). The field hasn't an agreed-upon credential. Witness the useful "important note about credentials" which the NCH puts on their website:
"NCH has formatted the practitioner listings so that readers can see at a glance whose homeopathic skills have been reviewed by an independent certifying organization. If the practitioner has acquired any of these thirteen homeopathic certifications or licenses they will appear immediately after their names: CCH, CVH, BHMS, DHANP, DHMS, DHt, DNBHE, FSHom, RSHom, RSHom(NA), HMD, MD(H), and VetMFHom. On the following line are all other credentials (if any) a practitioner holds. The homeopaths listed in this directory come from a wide variety of backgrounds, and may have other areas of education and practice that are not listed. NCH recommends that consumers seek additional information about the practitioner's education and experience in homeopathy as well as any other fields that affect their practice."
King County Natural Medicine clinic, AAFP
Merrily Manthee
4.    Natural Health Clinic Visionary Manthee: "let's suggest a set of Town Hall meetings ..."

Merrily Manthee will be known to many with long-ish memories in integrative healthcare as the individual who stimulated the dialogue in Seattle-King County in 1994-1995 which led to the establishment of the nation's first publicly-funded, integrated natural medicine clinic. That  partnership between Bastyr University and Community Health Centers of King County continues to hear fruit today in a network iof integrated CHCKC facilities. Among Manthee's current involvements is service as Washington State director for the American Association for Health Freedom.
"Given your role vis a vis the Integrator, the first 'response' by Dr. Briggs to your excellent open letter already suggests a path. Let's suggest a set of 'Town Hall' meetings for Dr. Briggs with the public, Training Sessions for Dr. Briggs, and a Weekly Exchange with her (not staff) as part of the 'intense listening.'"

Merrily Manthee
Kent, Washington
5.   Natrual Products Attorney Bass: "Why not a stakeholders meeting?"

Debra Bass is an attorney with a long association with the natural products industry. Her suggestion parallels Manthee's.
"I think it would be great to help Dr. Briggs set her priorities for NCCAM by reaching  out to the community. After all, we are the stakeholders, along with consumers.

"Why not hold a stakeholder's meeting? My first suggestion is that she focus on outcomes and the cost of care. As we are all well aware, the cost of health care is out of control and breaking the bank. Integration of low tech, CAM therapies, can help lower the cost by preventing chronic illness, improving quality of life and reducing need for pharmaceutical solutions.

"In addition, there is a dire need to incentivize integration through research support. Moreover, one comment she made, identified via Taylor's comments on the NCCAM meeting is physician /patient communication. So why doesn't NCCAM look at reimbursement issues related to spending time educating patients about lifestyle,etc. so that CAM practitioners are not endlessly caught in the miscoding scenario?

"Perhaps this is too much, or perhaps only a beginning."

Debra Bass, JD, LLM
Rockville, Maryland
Jessee Woodson, lower right
6.    Acupuncturist Woodson: '"Reinventing the wheel that wasn't broke ..."

My original letter to Dr. Briggs began with "Oops, they did it again," a Brittany Spears lyric which invaded my mind the moment I realized that the NIH had once again appointed a greenhorn. Jesse Woodson, LAc, picks up from there.
"In the parlance of the 'new school generation,' you go boy!' I just read (belatedly) your 'opps...' letter & was thrilled!

"Then, as a former County Mental Health Admin, I said, 'there they go again, re-inventing the wheel that wasn't broke, just out of fashion.' By that I mean, I too have been following the development of NCCAM since its inception in the '90's, & lately only praying for it, as I realize it's turned into another bloated bureaucracy with constipation in various body systems, & so I go silent to protect my blood pressure

"For example, the Community Mental Health Centers, the State Mental Hospitals, the Public Health Centers, County Hospitals, the neighborhood pharmacies, the apothecaries, & 'elders' have all virtually died out as the safety net of the populace. And oh yeah, let's not even talk about how diseases that were 'trounced' in the 50's & '60's are back again with a vengeance! Let's not go there about encouraging inclusion of new & master/traditional generations (dying & taking their secrets with them by the way).

"Another example is being a U Penn grad who couldn't even get a reply back when asking how to involve a culturally rich & diverse healing area like Philly into the 'funded research.' As the kids also say, 'Who's zooming who?'
"Yet, us, who come from generations of healers called Nurses, Orderlies, Herbalists/Root Doctors, Bone-Setters, Candy Strippers, Private Duty Companions, Undertakers, are not surprised that the 'same ole same ole" is happening again. Now that so many have been bumped up into the mainstream medical gravy train, its' like Parliament sang so long ago 'give the people what they want when they want & they want it all the time.' In other words, the new Dr. looks safe & inoffensive, so yeah, lets' give her time to spend more $$$, & see if she can colonize the fringes...'
"My biggest disappointment is not that there is scant diversity apparent in this appointment (after all, she is a Woman  but that there is no platform given other than maintaining the 'bloat' that infests the system.
"I propose that before the 'wheel gets re-invented,' look at the Public Health System, & do a WOTS Analysis - that used to mean to explore the Weaknesses-Opportunities-Threats-Strategies that could uplift as well as reveal what is working in both rural & urban areas. There are so many stories of devotion to the ER's of teaching hospitals, the Public Health Centers, the County Hospitals that take you when no one else will, the Granny/GrandPa that saved your baby &/or your dog, cow, crop, self...
"The partnership between Traditional Healers and the people is a very rich & sacred source of needful information, but there is no mechanism that honors the keepers of the secrets, and allows them to leave those secrets to the living. There is no vehicle that entices/assists involvement in the process for the common good. This too is disturbing because since marketing is so expert at 'educating,' healing is made harder because more mis & dis information flows to 'give the people what they want,' & therefore by the time Alternatives are sought, the condition is too critical, too late stage, or has been abandoned because CAM was inaccurately attempted in the 1st place.
"No joke, just food for thought that's been simmering for a long time...see why I left Public Health & went into acupuncture & Oriental medicine? I can point to the billions who using this medicine for thousands of years, went right on while Best Practices & Evidence-Based Medical Concepts are just being concretized.
"Just wanted to give 1.5 cents from the front line. Thanks again for being on point!"
Jessy Woodson, LAc
Comment: Woodson's comments may seem to make the argument for hiring a ruler-whapping rigor of NIH process to the wild mind of natural healthcare. Dr. Briggs does have her significant challenges - among them deciding what sort of homeopaths to use, should she take NCCAM there, and whether it is more useful to the public health to investigate examining a fractionated botanical or the possible value of Woodson's herbalists in community health. All the more reason that she invest, deeply, in getting her feet on the ground.

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