NCCIH director shares vision of whole person health

Photo Cred: Ridwan Meah/Unsplash

By Bill Reddy, LAc, DiplAc

Helene Langevin, MD, director of the National Center for Complementary and Integrative Health (NCCIH), has a very specific vision of whole person health. Sworn in on November 26, 2018, Langevin oversees the lead federal government agency for scientific research on the diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional medicine. The NCCIH funds and conducts research to help answer scientific and public health questions about natural products, mind and body practices, and pain management. The center also coordinates and collaborates with other research institutes and federal programs on research into complementary and integrative health.

Integrative Practitioner sat down with Langevin to discuss her whole person approaches to health, as well as integrative healthcare research efforts and the future of precision medicine.

Integrative Practitioner: What is your vision of “whole health?” 

Langevin: We talk about whole person health at [the] NCCIH and it has two components—the whole person component and the health component, and they’re related. I [often] illustrate this with two perpendicular axes. It’s a vertical integration of the whole person, across all the different domains, biological and psychosocial, and then within the biological you have the different organ systems. Then, the horizontal axis is the health continuum between health and disease. There’s a back and forth because people can move towards disease but can also move back towards health, so it’s the intersection of the two. That’s what we think about whole person health.

The more you think about health, the more you have to think about the whole person, because health is about the whole person, whereas disease can be about specific organs or systems. That sort of whole person integrative health concept brings those two elements together. 

Integrative Practitioner: How would you try to shift the paradigm in the research community to look at bio-psychosocial aspects? 

Langevin: Analysis and synthesis are both important. It’s kind of reductionistic. Looking at component parts is really important because we have to understand the cells and molecules and all. But we don’t want to do that and not synthesize and go back towards the whole person. They’re both important and it’s the balance between the two. The art is in trying to balance a research portfolio to represent both of those important components. 

Integrative Practitioner: How would implementation science play a role in blending integrative health approaches with conventional care? 

Langevin: Implementation is very important. Implementation science is really about understanding, doing research on how you implement, what things have to tweak or improve, or how you measure. For example, for the things that we know are effective, how do we better understand how they could truly be implemented into the healthcare ecosystem?

Before you can study something’s implementation, you have to first show that it’s effective. Not everything is ready for implementation research. There’s a pipeline of research that goes from basic, translational, clinical, and, eventually, to implementation and dissemination. There are some areas of research that are still not developed enough, and we have to move them along. When they get mature, they can go to implementation research.

Integrative Practitioner: The National Institute on Aging (NIA) has been studying complementary practices like yoga and Tai Chi. Does the NCCIH see potential in promoting integrative health research in these institutions?

Langevin: Absolutely. We already collaborate with the NIA extensively. In fact, the NCCIH and the NIA are co-leads on the Health Care Systems Research Collaboratory. This has been going on for 10 years now and it came out of the National Institutes of Health (NIH) Common Fund, which is a source of funding. Its aim is to [conduct] pragmatic clinical trials in real world clinical settings. We’ve been working with them for a long time, and we’re going to continue to do that.

One of the things that we do a lot at NCCIH is collaborate with other institutes and centers throughout the NIH. We are a small center, so we are very much dependent on inter-institutes and we collaborate beyond them. We even collaborated with the [U.S. Department of Veterans Affairs] (VA) and the Department of Defense (DOD) on the NIH/DOD Collaboratory for pain research. We’re very much interested in extending the reach of whole person health integrated research throughout NIH. 

Integrative Practitioner: Do you know if there are some upcoming studies that investigate structural bodywork or myofascial techniques? 

Langevin: We recently had a workshop last year on the neural-circuitry of force-based manipulation. This was a very interesting workshop looking at the mechanisms by which the mechanical forces applied to the body during palpations, for example, or manual therapies or a movement of the body, can have effects on the nervous system, and the mechanisms of that. We also recently had a workshop on myofascial pain syndrome, which is a very important point of departure for what we hope is going to be starting to understand the syndrome that we call the myofascial unit, which includes both the muscle, the associated fascia, the sensory nerves, and the blood vessels that are associated with these structures.

We need to pay attention to this problem because myofascial pain is very likely relevant to things like low back pain, which we know affects… a big percentage of the population, who don’t necessarily understand what causes it. We’re very interested in this area, and we’re actively pursuing some follow up to these workshops to see what kind of research is needed. 

Integrative Practitioner: What would you say are newly emerging exciting areas of research into non-pharmacologic approaches to pain?  

Langevin: The VA has a wonderful program called Whole Health. It’s looking at the approach to patient care, which is quite revolutionary in terms of starting with looking at what matters to the patients and what is important to the patient. It’s developing a treatment plan that starts from that, as opposed to starting from “what’s wrong with you?” We’re very much aligned with that philosophy. It’s important to put in the biological, psychological, and social components of health together.

Integrative Practitioner: In terms of personalized and precision medicines as the future of healthcare, is there any approach where you may find that, genetically speaking, there’s certain people who respond better to integrative approaches? 

Langevin: We’re starting to look at that. When the concept of personalized medicine and precision medicine came about, precision medicine typically talked about identifying specific markers, genetic and metabolic, to tweak and really decide what treatment is best for this specific patient. The word “personalized,” though, sometimes gets used as a synonym for that. But at the beginning, it was really meant to talk about the whole person.

We like to use “whole person” instead of “personalized” because it’s less ambiguous. Precision medicine is still very important. Understanding, for example, that there are specific genetic markers that may predict somebody’s response to electro-acupuncture, high frequency or low frequency. While I’m talking about mode of stimulation, there’s recently been some interesting studies that have shown that different phenotypes or specific characteristics of patients may correlate with a response to either real or sham acupuncture. We can look at the patient’s phenotype in a very precise way and see whether a person is more or less likely to respond. This is a very interesting and important area of research. 

Editor’s note: This interview has been edited and condensed.