COVID-19: NCCIH Director Helene Langevin on the NIH Integrative Center’s Response

NIH Integrative Center’s Response

The push for evidence to assist in formulating more effective clinical response to the COVID-19 pandemic is awakening scores of research projects and multipliers more of recommended directions. In the integrative sphere, a team led by Lise Alschuler, ND from the University of Arizona Andrew Weil Center for Integrative Medicine published a paper on “considerations” for natural practices and agents. The Chinese government claims the use of traditional Chinese medicine is in part responsible for its apparently relatively rapid turn-around there. TCM researcher John Chen, PhD, PharmD, OMD, LAc and others have brought that work to the United States. Ryan Bradley, ND, MPH at Helfgott Research Institute led a global team to create a Traditional, Complementary and Integrative Health and Medicine COVID-19 Support Registry. I helped promote it with this JACM editorial. Yet the US government has been quiet, when not frankly antagonistic to supportive COVID-19 strategies. I connected with the NIH National Center for Complementary and Integrative Health (NCCIH) to see what they are up to related to COVI-19. This column reports the exchange with Helene Langevin, MD, NCCIH’s director.

The question to the NCCIH is especially important given the agency’s decision, when the pandemic broke loose in the United States, to steer people away from natural agents. The bulletin, essentially a public service announcement, included this:

The media has reported that some people are seeking “alternative” remedies to prevent infection with COVID-19 or to treat the virus. Some of these purported remedies include herbal therapies and teas. There is no scientific evidence that any of these alternative remedies can prevent or cure the illness caused by COVID-19. In fact, some of them may not be safe to consume. [The bolding is from the NCCIH announcement.]

The message is not unique to NCCIH. The Weil Center for Integrative Medicine team, for instance, both began and ended its paper with a similar statement. Yet to have this as the one and only message from NCCIH on XCOVID-19 seemed a vast disrespect for the field and failure of responsibility given public and practitioner interest in potential natural health contributions. Here are some responses from Langevin:

Topic: Generally, what is NCCIH doing relative to COVID-19?

Langevin: Thank you so much for bringing timely information to our shared stakeholders during this rapidly evolving situation. First, we want to address what we are doing for our existing grantees and research projects that have been severely impacted by the COVID-19 pandemic. While it is vital to focus efforts on developing therapeutics and coping strategies surrounding COVID-19, we cannot forget that we have a robust number of grants and grantees who need our guidance and support during this time. In cooperation with our colleagues across NIH, we are developing a suite of diverse mechanisms and approaches that we hope will address our grantees’ unique research challenges. Some of these approaches have already been announced, while others are still in development. Please check that page often for updates.

Side-note for non-researchers: I spoke yesterday with a researcher involved with a large trial and got some insider perspective. Think of the hardship and heart break of being mid-trial with hands-on treatment with assessment at, say, 4 weeks, 8 weeks and 6 months. The whole project is likely entirely disrupted. As COVID-19 hardship and heartbreak go, this is minor, but huge for the researchers and granting agencies.

Topic: Any new COVID-19 research initiatives at NCCIH?

Langevin: Second, we are working at a rapid pace with our NIH colleagues to develop research mechanisms to directly address treatment, prevention, and coping strategies regarding COVID-19. One such NCCIH-led initiative that was just announced is a Notice of Special Interest (NOSI) for research on stress management in relation to COVID-19. Topics of specific interest for this NOSI include research on stress management strategies, including mind and body approaches, that individuals may engage in remotely to address stressors related to social distancing, as well as to address recovery and recurrence of symptoms during and after COVID-19 infections. We also have other NCCIH initiatives under consideration.

Topic: Investigator initiated proposals?

Langevin: Finally, as always, NCCIH accepts investigator-initiated research applications which would include projects related to COVID-19. It is important for your readers to know that if they have an idea for a COVID-19 research project that they should reach out to our program staff to discuss options for submission.

Topic: Additional comments?

Langevin: Finally, as always, NCCIH accepts investigator-initiated research applications which would include projects related to COVID-19. It is important for your readers to know that if they have an idea for a COVID-19 research project that they should reach out to our program staff to discuss options for submission.

Topic: Additional comments?

Langevin: I would also like to say how grateful and proud I am to be working at NIH during this time. My colleagues across NIH and within NCCIH have risen to the challenges brought forth by this pandemic. And they have swiftly altered course to meet the changing needs of our grantees, employees, and most importantly, the public.

Topics: On receipt of these responses from Langevin, I sent her a follow-up note with questions in 3 areas that have caught the attention of multiple practitioners and researchers in the integrative health and medicine communities relative to COVID-19:

  1. Many people and organizations in the field including the University of Arizona AWCIM and the naturopathic doctors have focused on the potential value of individual natural agents. Did you consider a call that focused on natural products?
  2. The Chinese government puts a great deal of stock in its use of TCM – and has released some loose, suggestive data. The NCCIH would seem to be the place in the US to test whether there is any “there-there” rather than the current rather summary dismissal of the claim despite the fact that China seems to have fared better than the US is. Have you considered specific work in this area?
  3. Specifically, injected Vitamin C has had a lot of visibility as potentially useful. This would seem to be in NCCIH’s zone. Any focus on that?

Langevin: In terms of funding research on COVID-19, NCCIH will take into consideration anything under our purview that may hold promise. And, of course, NIH as a whole is also exploring many potential avenues. However, we cannot discuss the specifics surrounding the development of funding opportunities in advance of posting for the public. We’re happy to reach back out to you when we have more to share.

Follow-up on NCCIH rules on what can be shared presently: Sometimes bureaucratic rules can come off as non-transparency – yet such requirements for non-discussion as Langevin notes here are set up to keep their granting on an even keel. I shared with Langevin and her team my frustration – that I imagined will be shared by many – that more was not being done presently that NCCIH can share. Langevin re-stated the importance of the rule.

Langevin: Talking about any funding opportunity ahead of time is simply not allowed.  I understand people might wish otherwise, but there is nothing I can do about that.  We are all working as hard and fast as we can to deal with this crisis, and will release information about new funding opportunities as soon as it becomes available.  We very much appreciate your help in disseminating this important message.

Concluding comments: I took up the theme of the divergent views of different governments in the Call to Action on the Traditional, Complementary and Integrative Health and Medicine COVID-19 Support Registry that I published as an editorial in JACM. I began by juxtaposing the governmental dismissal of natural agents in North America and Europe compared to the governmental views in China and India:

The variability in guidance by national governments on potential value relative to COVID-19 through traditional, complementary, and integrative products, practices, and practitioners is nothing short of astounding. The Chinese government credits its swift turnaround to an ‘‘integrative’’ method through which patients received Traditional Chinese Medicine plus biomedicine. (1,2) The Indian government issued a memorandum that was a composite of practices viewed as potentially useful by the various branches of its AYUSH ministry (Ayurveda, yoga, Unani, Siddha, homeopathy, and naturopathy). (3) On the contrary, North American and European governments are typically silent on these practices, (4) unless to warn of possible harm and overselling. (5)

The NCCIH staff are clearly under the gun. They are not exactly first responders but are certainly massively impacted. It is good to see that the NCCIH has chosen to address at least one area of special interest that is well-focused and timely in the social distancing era. Yet with very broad interest of citizens of the United States in the potential value of so much more, I continue to hope that the present limits on announced interest will soon open into new areas. As the famous charge has it: If not the NCCIH, who? If not now, when?

John Weeks
In May 2016, he accepted an invitation to serve as the editor-in-chief of the Journal of Alternative and Complementary Medicine. Since mid-2015, John has re-focused his work on presenting, teaching and mentoring. He has keynoted, led plenary sessions, breakouts and offered guest lectures for dozens of organizations. These range from the Association of American Medical Colleges and Harvard University to Bastyr University and American College of Traditional Chinese Medicine; the UCLA School of Medicine to the Institute for Health and Productivity Management and Palmer College of Chiropractic; from the International Congress for Research on Integrative Medicine and Health to the American Hospital Association and the Midwives Alliance of North America. He has consulted with insurers, employers, professional organizations, universities, and government agencies at all levels. As an organizer, Weeks convened the Integrative Medicine Industry Leadership Summits (2000-2002), directed the National Education Dialogue to Advance Integrated Care (2004-2006), fund-raised the start-up and was on the founding steering committee of the Integrated Healthcare Policy Consortium (2002-). He co-founded the Academic Collaborative for Integrative Health, which he directed 2007-2015, and was on the founding board of the Academy of Integrative Health and Medicine. In 2014, three consortia and others combined to grant him a Lifetime Achievement Living Tribute Award. Four academic institutions have granted Weeks honorary doctorates for his work. Seattle-based, he considers himself a particularly lucky soul to have worked remotely while living with his spouse Jeana Kimball, ND, MPH, and their children in Costa Rica, Nicaragua and Puerto Rico for 6 of the last 15 years. For more with John Weeks, follow his Integrator Blog.