Former NIH Center leader offers directions for integrative research
January 26, 2017
by John Weeks, Publisher/Editor of The Integrator Blog News and Reports At a recent summit entitled “Future Trends in Healthcare: An Integrative Approach to Health and Wellness” at the University of Colorado Anschutz Medical Campus, the mission was to provide guidance on ways integrative health and medicine might assist that state’s campaign to become the nation’s healthiest. Kicking off the presentations was Margaret Chesney, PhD, who a decade ago served as the deputy director of what is now the National Center for Complementary and Integrative Health. Chesney recommended that amidst the present crisis in the medical industry we need a significant shift of integrative medicine research priorities to include cost effectiveness and other “research that can inform public policy.” In her presentation, available in this video and these slides, Chesney, who was most recently director of the UCSF Osher Center for Integrative Medicine, begins with a frank description of the historical focus that most medical delivery organizations have relative to shifting focus toward health and wellbeing. “We know that before [the Affordable Care Act] basically hospitals focused on getting those high-end surgeries in,” Chesney said. “They specialized in neurosurgery and liver transplant [and other high end procedures] that were important to provide the revenues to kept the whole system going in many ways.” Healthy people require fewer surgeries and generate less revenue. She provided data on the growing interest in integrative health and medicine in academic medical centers and spoke to the challenges for the field. One is clarifying “the best research design questions.” Her core recommendation was to support a very practical end. “If you really want to find out if [an integrative approach] is an optional treatment, [measuring] against usual care is probably the way to go," she said. While there can be value in measuring an effect against placebo, she argues that integrative medicine clinical trials “should always have an arm receiving usual care.” Such information can help decision makers in hospitals, insurance companies and government agencies to come to grips with the likely impacts if they add new integrative therapies or practitioners. Chesney then spoke directly to the research direction needed to help create wellness in Colorado. “I am a real advocate for how we can gather data that can inform policy.” How? She charged researchers to measure cost outcomes, stating, “we need to do things that cost less.” She called for “more health services research and evaluation studies” in addition to randomized trials. These, she noted, can be done relatively rapidly. Chesney’s recommendations were infused with a sense of urgency. She referenced the Institute of Medicine Summit on Integrative Medicine and the Health of the Public in 2009, which highlighted, she said, that “the disease-driven approach to care has resulted in spiraling costs as well as a fragmented health system that is reactive and episodic as well as inefficient and impersonal. We need to get information and answers much more quickly. The public needs more answers.” The former NCCIH deputy director offered specific research ideas. She urged exploration of “dosing”—how many acupuncture, mind-body, chiropractic or massage sessions, for instance, are necessary for an effect. She noted that one issue with many integrative prescriptions is the challenge the patient has in making behavioral changes, or returning to a practitioner for six or a dozen visits. “The issue of adherence could really hurt the field. We need to work on increasing adherence to attending sessions and to home practice of integrative skills. This is a vulnerability.” Chesney concluded by showing the links between the state’s goal of promoting wellbeing and integrative medicine’s philosophic bent. “Integrative medicine wants more than the absence of disease," she said. "We want to reduce vulnerability to daily stress. We want resilience. We want optimal health.” Then, she added a challenge to the integrative field, as to the rest of medical delivery. “If you want to be the healthiest state, you want to move beyond the one to one care in the clinic, to the communities and neighborhoods. We need to expand the idea of personalized medicine from genetic code to zip code. We need to step outside our clinics and labs into communities. We need to go to city council meetings." The one-day conference was hosted through the University of Colorado Health Sciences Library and the Strauss-Wisneski Indigenous and Integrative Medicine Collection and sponsored by the Bard Family Foundation. Comment: Chesney’s talk, like the presentation at the Colorado meeting of one of her predecessors at the NIH, Wayne Jonas, MD, spoke to what I have dubbed “Era 5” in the evolution of the movement for integrative health and medicine: The Convergence in Health Creation. This is what the meeting was exploring. The more rapidly research priorities shift toward the practical and economic, the sooner decision-makers will have the data that can walk them out of their boxes. Chesney offered an honest account of the pervasive challenges to our medical culture, and some smart steps in the right direction. Editor's note: This article was edited after original publication.