John Weeks Interview

As many of you know, The Integrator Blog News & Reports is featured monthly in the Qi-Unity Report. John Weeks, research advocate and networking maven, has lent his voice and organizing skills to the cause of integration since 1983. He was been actively involved in promoting research strategies in natural health care when he was a vice president at Bastyr University, helping create Bastyr’s first research department in the mid-1980s. Weeks’ publication serves as a hub of reference among the individuals and institutions that connect to the larger discourse on the role of complementary, alternative and integrative care – including AOM – on how health care takes shape in the U.S. An ongoing focus of the Integrator is clarifying the research agenda which will be of greatest value to advancing AOM and other whole-person fields. In this interview Weeks, discusses some of the dynamics that inform AOM research in the current environment.

QUR: Why is research important?

JW: Showing positive clinical and economic outcomes are critical in opening doors, whether to employers or hospitals or government agencies or community clinics or media or to more consumers. I also think there is something like “human need” at work here; I want to know more about what we do.

QUR: Holistic medicine addresses homeostatic balance in the body. Does the pan-systemic, interlocking puzzle of interconnected factors make conventional research models less appropriate for AOM?

JW: One instinctively responds “yes.” We have been schooled by pharmaceutical medicine to deify the single-agent, randomized controlled trial as the conventional research model. It is certainly a lousy if not impossible fit for whole person care that is individualized, and it might include, for instance, herbs, nutritional advice, some tui na, a quality and supportive clinician-patient relationship, and needles. However there are many methods in conventional research which can be very useful and which might better fit what we do. Google “Wayne Jonas evidence house” for a better view.

QUR: Can you give an example of a contemporary research model that you think is working?

JW: If our interest is in exploring what we do out in communities, with our patients – and on advancing our abilities to access patients – our primary focus needs to be on clinical outcomes of what the typical AAAOM member or other integrative practitioner does in his or her clinical practice. That’s kind of obvious, but it is frequently lost on the research community. We need to be embracing strategies which look at whole practices or, as some call it, whole systems. The “whole systems” concept is listed in the 5 year plan of the NIH National Center for Complementary and Alternative Medicine. To date – while we have seen a few related initiatives – we haven’t seen much action.

QUR: Do you anticipate this part of the agenda will be elevated in the future?

JW: We need a concerted re-focusing of energies. I would call your readers’ attention to terrific work led by the Canadian Interdisciplinary Network for Complementary and Alternative Medicine Research. Check out www.outcomesdatabase.org. The site just went public this spring with a compendium of instruments which capture practical outcomes. I would bet that any AOM member skimming through the scores of patient survey instruments in that database would find themselves more aligned with the idea of research than they ever thought they could be. These are practical research tools which are closer to what clinicians typically care about.

QUR: You have written about a research strategy of working with employers - about the potential value of AOM and integrative strategies to what some employers call “the global costs associated with health.”

JW: I wrote a column recently in which I suggested that Dow Chemical may be integrative medicine’s best friend. The reason is that Dow is among a group of large employers who are deeply and economically interested in the health of their employers. They have realized that the cost of medical care is a small fraction of the global costs of an employee’s bad health. Medical costs are typically 25% or less. Other costs include those related to, for instance, absenteeism and disability. But the most significant cost associated with poor employee health – accounting for roughly 50% of the global cost of poor health to an employer – is productivity loss. The employers are calling this “presenteeism.”

QUR: I see. So how does “presenteeism” and the global costs framework fit into the AOM research agenda?

JW: Right now this framework is virtually unknown and under-utilized by AOM and integrative practice researchers, and it is a huge missed opportunity. An exception is Patricia Herman, ND, MS, PhD (cand.) who is heading up the fascinating AOM pilot at Good Samaritan Hospital in Los Angeles. Google “presenteeism” to learn more about it. Take a look at the validated presenteeism instrument developed by Debra Lerner and a group out of Tufts called the “Work Limitations Questionnaire.” What is exciting here is that many of the factors that contribute to lower productivity – to work limitations - are very familiar to AOM and other integrative practitioners. These are things like low energy, depression, headache, pain, adverse effects of conventional Pharma, allergies, asthma, and the management problems concerning an employee’s child. Most AOM clinicians I have met are pretty confident with their abilities to be effective in these areas. And betterment accounts for 50% of the costs of poor health to an employer. We should be all over this.

QUR: Will whole practices or whole systems be a more significant part of what NCCAM funds in the future?

JW: Good question. There are positive signs. I met with the new director of NCCAM, Josephine Briggs, MD, and she expressed interest. But what we face in elevating this agenda is a research infrastructure which has been built around a reductive model. Most researchers, grant reviewers, peer reviewers, and editors of journals have been schooled into that single-agent, pharmaceutical set of priorities. Many of our new CAM researchers who can speak eloquently about whole practices have learned to follow the dollar and are limiting their proposals to questions which they think are more likely to get funding. The nasty joke line is that many reductive researchers would rather know perfectly well something that is absolutely meaningless than to explore some suggestive but yet uncertain directions about things that might be powerfully meaningful. Changing that mind-set will require advocacy. I think if we advocate powerfully, NCCAM will be responsive.

QUR: What kinds of advocacy are you talking about?

JW: First, we need to frame our questions around their most significant value to our culture. Let me explain. Funding whole systems and whole practice research is not an AOM or integrative medicine issue. The present prioritization of the single agent placebo controlled trial, rather than clinical and global economic outcomes, harms our ability to understand and respond to chronic diseases. Chronic conditions are typically of multiple origins and suggest multiple, whole practice, whole system, and team approaches. Our research challenge in AOM is medicine’s challenge at this point in time. This is a natural area of leadership and partnership for all of the integrative disciplines.

QUR: What kind of partnership do you imagine?

JW: AOM’s voice, by itself, is going to be small. To make headway, all of our fields need to establish these approaches as a shared priority. As I said, I think NCCAM will be responsive if we have this conscious intention across disciplines. Many of our integrative MD colleagues are interested in this agenda as well. If for some reason NCCAM doesn’t move, then AAAOM and its newfound allies need to go to U.S. Senator Harkin and other key congressional leaders and make the case that the highest and best use of NCCAM dollars is to look at the role that AOM and other whole person approaches can have for reforming medicine by helping create health and taking people out of the sick care system. Our schools need to begin teaching the value of whole practice research outcomes in the context of the global costs associated with health. It’s a good fit with core philosophy. The paradigm is health-oriented, it’s a systems model. And the sensitivity to the interests of large employers also creates the possibility of developing alliances with powerful, large stakeholders. We need them. I like to think of the AAAOM and its integrative practice allies entering the policy arena with its case being argued by a set of large employers. That would help us move!

QUR: Quite an agenda.

JW: Well, leaders of the AOM and other integrative practice fields – naturopathic medicine, integrative MDs, holistic doctors and nurses, broad scope chiropractors - have been talking for decades about transforming health care and moving out of the disease paradigm. How many times have we heard some conference speakers urging that what healthcare needs is more of what AOM has to offer? I think this is our put-up-or-shut-up research agenda. I’d love to heard from any of your readers who agree or disagree! johnweeks@theintegratorblog.com