The paradigm-exploring brilliance of the whole-person health focus National Center for Complementary and Integrative Health (NCCIH) director Helene Langevin, MD chose to kick off public comments on the agency’s 2021-2026 Strategic Plan sneaks up on you. In her virtual keynote, Langevin engages her audience with a fireside chat type conversational tone. She shares concepts under consideration since she left the directorship of the Harvard Osher Center for Integrative Medicine for her NIH post 17 months ago. The highly-regarded basic science researcher starts, indeed, with basics. She shares that she and her staff are re-examining what they mean by the key words like “complementary” and “health” in the agency’s name. One slowly realizes that Langevin is quietly opening what may be the most significant exploration that the $33-billion NIH should be engaging in the present era in which even an acute challenge like COVID-19 reminds us is fundamentally damaged by chronic disease.
In the presentation originally intended to keynote the International Congress on Integrative Medicine and Health, Langevin opens questions regarding how beast to research multi-modal and personally-tailored applications of whole systems of medicine. Such whole person strategies notably are the optimal treatment of virtually all major chronic conditions. Langevin breaks medicine’s artificial boundaries between organ systems. She urges research, for instance, on how yogic breathing can influence digestion. She speaks of the need to focus outcomes not just on symptom suppression or attacking external agents but on the “R-words”: restoration, renewal, revitalization, rehabilitation, and resilience.
She asks what are these classically female questions. These R-words ask not for the blunt instrument of single, eradicating agents but instead for the myriad means of supporting people toward health. She urges questions many in the integrative movement have been yearning for years to hear from inside the reductive and attack-oriented male culture of anti-this and anti-that dominating the NIH culture. Langevin’s message, in contra-distinction, empowers the culturally balancing force for which the integrative movement was invented.
In mid-February, Langevin offered a less developed version that I wrote about, also with enthusiasm, here. In the virtual plenary, Langevin deepened and re-worked that talk to hit an extraordinary bar. She spent more time, for instance, exploring whole systems of care delivery. This is the ground of the medical model across the integrative-functional-naturopathic-traditional medicine space and is the elephant that in NCCIH’s 22 years has never been invited into research’s sanctum sanctorum. Langevin focuses in on the whole system with which the former board member of the Society for Acupuncture Research is most familiar: traditional Chinese medicine. She makes clear that these individualized methods are not easy to measure. Yet now at least she has thrust the challenges begged integrative medicine’s defining clinical forms are on NCCIH’s table.
By the end, one wonders if there are others in leadership positions at the NIH who, like Langevin, invite the complex grappling with these big ideas. One realizes one is cozy-ing up to breakthrough concepts like Kuhn’s structure of scientific revolutions, of Capra’s paradigm shifts. Langevin’s tone is conversational, inviting, firm and collaborative. She kindly invites us onto such long-awaited paths. I’ll put a clock on how long I have waited: the first book thrust into my hands in late 1983 when I was considering taking a job at what was then the John Bastyr College of Naturopathic Medicine was Frijof Capra’s clarion call The Turning Point. From work a decade ago on a prior NCCIH strategic plan, we know that research on whole systems – “researching the way we practice” was the term – was the top priority across multiple disciplines. (See here and here.)
If you missed Langevin’s talk, give yourself a treat and go listen.
Get engaged! and protect against a regression to the mean at NCCIH
Which takes us to the action step: the actual invitation behind Langevin’s plenary. Until June 30, 2020, the NCCIH is open to comments on the first draft of what will be published early next year as the 2021-2026 NCCIH Strategic Plan. The plan will drive the meaning, inside the NCCIH, of “whole person health” and how it may be explored.
The importance of integrative health clinical and practice communities participating actively with the NCCIH can’t be overstated. While Langevin is cultivating new ways of thinking, the culture of the NIH, from concepts to review to granting policies, and including professional advancement methods, are rutted in reductive routines. The familiar saying that it is tough to find one’s way out of a mess with the thinking that got one into it applies. Those who have spent 20-40 years excelling through reductive science are not likely to have the brush strokes needed to imagine the route to optimal methods for research that can open onto vistas for a robust, integrative, whole person health future. For NIH veterans, customary ways of problem solving and developing research methods will return. Even the members of the NCCIH community who have excelled in the NIH culture will likely regress to NIH’s reductive mean. The integrative communities with 20 or 40 years of thought and practices formed and refined around providing whole person health will be essential to success.
The timing of this woman-led whole-person health direction is fascinating. It come amidst the remarkable recent announcement of the Whole Health Institute, also woman-led: directed by long-time integrative leader Tracy Gaudet, MD and funded by Alice Walton, the wealthiest woman in the world. Each major initiative marks a dramatic shift toward the R-words, toward health creation, toward the whole of health and away from mere suppression of symptoms and management of disease.
Let there be no mistake: what Langevin introduces, and what Gaudet and team are seeking to implant, are culture shifts of the first order. Institute for Healthcare Improvement co-founder and former CMS administrator Don Berwick, MD proposed a 30 year time-frame for change toward what he interchangeably called “health creation” and “salutogenesis.” In a presentation to leaders of the medical industry on his vision, he remarked:
The pursuit of health, the creation of health, may require something even bolder [than the precepts of value based medicine]. The redesign we need may be even more radical than we have imagined.
Thorough engagement from the integrative, functional, naturopathic, East Asian medicine and other traditional practice communities – not just in shaping the 2021-2026 strategic plan but in seeing it through – may be a necessary countervailing force so that Langevin’s quietly radical vision will have a chance to thrive and spread at NCCIH and through the whole of NIH. Why not a Langevin-led, NIH-wide collaborative on whole person health?
Post note: Last year I had the opportunity to work with an extraordinary team of researchers to produce the JACM Special Issue on Multi-Modal Approaches in Integrative Health: Whole Persons, Whole Practices, Whole Systems. Thanks to a philanthropic partner, the entire issue is in open access. Multiple articles in the issue may be useful to anyone wishing to explore Langevin’s questions further.