By John Weeks
On January 24, 2008, the NIH appointed, to head the NIH National Center for Complementary and Alternative Medicine, a scientist inexperienced in complementary, alternative and integrative practice. This is the second time that the NIH has chosen to saddle the now $121-million/year exploration with a greenhorn. The NIH is 2 for 2 on this count. Given the virtually life-term of these appointments, the new director could be there until 2020. (1)
Imagine what would happen if cardiology researchers found that the NIH appointed a psychiatrist to run their Institute. I’m guessing that their friends in Congress would be down the NIH’s neck, fast. How is the integrative practice community to respond to this second imposition of a leader with no connection to their field? How do you respond?
I have been all over the map on this. Except to who cares? Or why bother? Because NCCAM will always be powerful in our world, either as a brake or an exceptionally energizing fuel.
Don’t prejudge, many say. We should give the new director time. Maybe it is critically important for this field to have a respected NIH scientist (a.k.a. reductionist disciplinarian) leading the field’s self-awareness campaign. After all, we need to make sure that Dad – the NIH itself – doesn’t toss the upstart out of the house.
These things I have heard from colleagues. My observation is that, while there are outliers, the measure of obsequiousness is a dose-response function related to the percentage of the person’s income that is tied to NIH grants.
Yes, there is a possibility that in the new director’s Complementary. Alternative and Integrative Medicine 101 course, presently underway as a taxpayer-funded initiative, the director will catch a glimpse of integrative practice in a burning bush, suddenly throw off the belief systems and practices etched through a life-time in conventional medical research, and change professional courses. I certainly hope so. And I actively agree that anyone who has the opportunity to be one of the new director’s instructors should speak truth to power. (2) They should bring the very best kindling to fire up the vision of whole system practices. I have shared my suggested curriculum with the new director, online, without being asked. (See my Integrator Open Letter.)
If I am a betting person, however, I’m going to hold onto my wallet.
What I think is going on with this appointment is a pattern well known in power politics, in relationships between oppressors and oppressed, and between colonizers and the colonized.
Let’s play with the metaphor of colonization for a moment. Imagine the intelligence brief on the integrative practice field which would be sent across some ocean of thought to the colonizing agents, who for the purpose of this exercise, I will call the Reductionist Party:
Confidential: The complementary and alternative medicine disciplines and their colleagues in holistic nursing, holistic medicine and integrative medical practice are often a rather unruly lot. They talk of "holism" and "holistic practices" and other un-measurable babble. Most tend to condemn the policies of the Reductionist Party as a part of the problem rather than part of the solution. I’ve infiltrated their conventions. These upstarts are bold enough to suggest that the best way to govern in our current crisis is to powerfully embrace "whole practices," "collaboration" and "team medicine." They claim an evidence base that shows such practices are best for complicated and expensive chronic diseases. It is not my view that they are entirely opposed to all reductionist principles. Rather, it is likely, should they be emboldened, that they will shackle the entire Reductionist cause to their "integrative" and "holistic" ends.
On receiving such a report back in the Fatherland, the key, protective responsibility is to select a governor-director who will keep the colonized in their places. Optimally, the new director will have no known connections with those to be overseen. At the same time, the person’s ability to speak at least some of the native language would be useful. The new director should have a proven record of toeing the party line. Optimally, the new director will have a desire for a future appointment which could be a pay-off for a job well done.
This scenario is not pretty. I have academic research colleagues who tell me my Open Letter was "over the top." They will undoubtedly view this column as a further step.
But where, I challenge them, is this more off base than believing a reductive research lifer will see the promise of integrative health care in a burning bush? I think of the wishful thinking that one still sees among the impoverished and put-upon who kneel at pews throughout the cathedrals of Central America.
Are we not fit enough, or skilled enough, that no one should be imposing a research agenda from outside? How would a self-respecting and powerful "integrative practice movement" have responded to this news of the appointment of the new research over-lord?
It is time that those with deep experience in integrative practice have full academic freedom to prioritize the areas where research of what we offer will have the greatest value to the public we serve.
1. I am not mentioning the name of the new director because this story is, basically, not about individuals but about choices and forces in healthcare.
2. The new director has called for contact and ideas from anyone interested.
Discuss this topic here: