by John Weeks
James Gordon, MD: The White House Commission
Integrative Practitioner adviser James Gordon, MD was the chair of the White House Commission on Complementary and Alternative Medicine Policy. The Commission, which was created in the Clinton administration as part of the 1998 legislation which established the NIH National Center for Complementary and Alternative Medicine, submitted its report to Congress in March 2002. (The final report can be accessed here http://www.whccamp.hhs.gov/.)
The time was heady for the integrative practice field. Complementary medicine was just entering the consciousness of US lawmakers and mainstream medicine. The Commission recommended establishment of a federal office for coordinating and moving the other directions developed through over 1700 separate items of written and oral testimony. Gordon reflects on the Commission’s recommendations and grades the outcomes to date. What impact has the Commission had? Gordon speculates on what it will take for integrative practices to make more significant inroads into national policy in this time when health reform is very much present.
When I first met Gordon in 1990, he had just returned from Brazil where he had explored native spiritual practices. A psychiatrist, a professor at Georgetown Medical School and founder of the Center for Mind Body Medicine, Gordon has continued to have a passion for international work. He has helped bring mind-body practices to war-torn Bosnia, Kosovo and the Middle East, where he has researched their effectiveness. The author’s most recent book is a clinical and self-care book on depression, entitled Unstuck: Your Guide to the Seven-Stage Journey Out of Depression. His interest in transforming U.S. medicine, the subject of this interview, is reflected in an earlier book, Manifesto for a New Medicine.
Greatest hopes for the Commission’s work
Weeks: The report from your two years of work with the White House Commission included wide-ranging recommendations, strategies for inclusion in education, research coverage, you name it. What was your greatest hope for that document?
Gordon: My greatest hope was, first, that people in positions of power in Congress and in various government agencies would take this work and reevaluate the role of complementary and integrative practices in their thinking as they were doing their business. The other was a hope that the people in the field, the practitioners and professional organizations and others working in the field would take it as a kind of manifesto. We hoped that people would insist that policy-makers take account of these recommendations.
Weeks: I recall that, a year or so ago, some of you on the Commission were thinking of reviewing any action areas and issuing a report card on the outcomes. What grade would you give, overall? How would you evaluate the results of the ensuing 6 years?
Grading the work – Have agencies used it?
Gordon: I’d say we get a passing grade for effort and thoroughness as a Commission, but we’re in the B minus range for results. Our efforts and our report have been particularly useful for only a few agencies. We’ve been more helpful to organizations and groups in the field. For example, the Veteran’s Administration has used our work consciously to open up services and the Department of Defense has become much more interested in CAM and integrative approaches. On the other hand, the National Institutes of Health, with the important exception of the National Cancer Institute, has not been nearly as responsive as I would have hoped. Our fundamental recommendation in the area of research, to look at integrated care rather than single agents, to examine a wellness approach – they haven’t moved on this. Nor have they maintained their focus on education – something some of us on the Commission had helped bring about - which was a very good program for moving things forward.
Weeks: Yes, those R-25 grants from [the National Center for Complementary and Alternative Medicine] were powerful in showing directions for shifting health professions education to better reflect the integration and diversity of treatment which the public wants. I seem to recall the Commission also had recommendations which reached into primary school education.
Gordon: We did. I had a very frank talk with an assistant secretary in the Department of Education. He said that promoting wellness under this [Bush] administration is not going to go very far because their exclusive focus is on reading and math scores. What hasn’t happen is a new openness in the government to explore complementary and integrative approaches to the problems that haunt us – cancer, pain, depression, diabetes and cardiovascular disease - and we haven’t seen the far greater popular push we need to create these changes and to make these a standard of care.
Grading the work – Has the integrative practice community used the Report?
Weeks: So let’s talk then about the second area of hope – that practitioners and professions and people in the community would be empowered by the Commission’s recommendations to push for changes in the care they receive and the policies that might back these changes.
Gordon: What the Commission did has clearly been useful to the Bravewell Collaborative of philanthropists for integrative medicine and the Consortium of Academic Health Centers for Integrative Medicine. These were already moving ahead and we gave them a boost. Some of the people you’ve worked with in the National Education Dialogue [to Advance Integrated Health Care: Creating Common Ground] and the other Consortium [Academic Consortium for Complementary and Alternative Health Care] have taken the Commission’s recommendations and used them quiet effectively.
Weeks: Yes, the White House Commission’s recommendations on education were part of our case statement.
Gordon: In general, I do think we advanced a dialogue between the complementary and alternative medicine world and the conventional world. We had 700 give testimony and over 1000 written comments. We had just about everybody formulate positions. This is the first important thing we did that shouldn’t be overlooked. I was very pleased with that. I don’t know long-term what it means, except that groups like the AMA and the American Association of Medical Colleges have integrative medicine and CAM in far more prominent places on their table. We also reinforced people in many major institutions and organizations that benefitted from the imprimatur of a White House Commission in pushing their agencies to act. This helped give the field a kind of stature and legitimacy that it didn’t have before.
Weeks: I know it has been very useful to our work with the National Education Dialogue and today with the Academic Consortium for Complementary and Alternative Health Care to name-drop a White House Commission. Now what didn’t happen following that 2002 report which you anticipated would – and why?
What didn’t happen
Gordon: There are areas in the Commission’s report deserving of a tremendous amount of work and of mobilizing across the disciplines. One I already noted is the need to dedicate a significant portion of research funding to integrative or comprehensive approaches to care. It’s not about St. John’s wort, or exercise therapy or cognitive therapy. What we need to do is put together and study comprehensive programs for treatment and prevention.
Weeks: So – put a number on it: What part of the NIH NCCAM budget do you think should be focusing on whole practices or whole systems of care?
Coming together to promote research on comprehensive care
Gordon: I think 20%-25% of the budget should be devoted to this. NCCAM should be a leader here and NCCAM should be setting the agenda. We need to be looking at comprehensive treatment, not just in “CAM” or “integrative medicine.” NCCAM should also be looking at cost effectiveness and on wellness research. I don’t want to see the tax-payer dollar subsidizing mechanism research so that some pharmaceutical company can make a bundle off of what is learned. They can fund that. This has certainly got to be a principle in NCCAM’s research.
Weeks: Where else do you believe the response to the Commission’s report has fallen down?
Gordon: We had a major emphasis on wellness programs and using self-care. We need to be funding education and service programs, integrating information into programs on health and health education for our kids. This is whole other constituency. We should be funding education at every level. Another area is to shift priorities in some funding for programs that are already out there but don’t have enough visibility or use. Dean Ornish’s program [for reversing heart disease] is an example. It’s included now but it’s regarded as peripheral. It should be central.
Weeks: You mentioned the VA earlier. I know your Center for Mind Body Medicine has been active there, and the Samueli Institute, directed by your fellow commissioner Wayne Jonas, has had a number of interesting contracts with the military.
Gordon: We are seeing a better response in the VA because they know they have problems where there aren’t good answers [from conventional treatment]. There is an openness in the armed forces based on need. They are willing to look at things. We just received a grant from the Department of Defense to study our integrative mind-body approach with war-traumatized veterans returning from Iraq and Afghanistan. The problem in academic medicine is that it is so slow, and so painfully cautious.
A federal Office of Complementary/Integrative Medicine
Weeks: One might think with the so-called “health care crisis” at $2.4 trillion a year – heading toward $4-trillion - one might see a sense of urgency coming into academic medicine and the research community. Oh well. I’d love your comments on what I recall was a central recommendation from the Commission – to establish a federal CAM or integrative medicine office to coordinate information, resources and dialogue around all of the Commission’s recommendations. I know it was backed by the set of leaders who met in 2001 as the National Policy Dialogue to Advance Integrated Health Care.
Gordon: The Office, I believe, would have helped move the Commission’s agenda forward far more effectively. The fact that it’s been hard to get many of the Commission’s recommendations moving indicates that there is a necessity to have an engine within government to keep things going. An example is the Office of Women’s Health. The office would keep the questions out there. Are you bringing wellness in? Are you bringing this new research approach to the NIH?
Are the Presidential candidates on this?
Weeks: Can’t leave without the topical question: What do you know, on the ground there at Georgetown, in the Beltway, about either of the Presidential candidates and integrative medicine? I’ve looked over plans and seen nothing specific on complementary or integrative medicine.
Gordon: Not a lot. I was in touch with one of Obama’s top people when she worked for Hillary. It’s time to go back. Neither candidate has come up with a plan that satisfies me. I don’t see that either has addressed the issues we are concerned about – wellness, integrative care – and for me, single payer.
Weeks: Well, we do know from Code Blue Now’s surveys that 65%-75% of citizens, whether in Iowa or Washington state, whether Ds or Rs, want to see more resources spent on primary prevention and they also support the services of licensed chiropractors, acupuncturists and naturopathic doctors being in basic benefits. I would have thought that one or both of the campaigns, if nothing more than as opportunists, would seize on these topics.
Gordon: The ideas have to be advanced by our communities. All of us need to be heard from. And we need to get behind the legislative initiative supporting wellness and prevention that emerge, like House Concurrent Resolution 406.
Weeks: Thanks for your time. Good luck on your book touring with Unstuck and your new project with returning Vets. Hopefully, with a little concerted action, we can get some of the Commission’s other recommendations “unstuck” before too long.
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