Long-timers in the integrative trenches will know the paradoxical feelings of dismay at how messed up health care still is and at the same time satisfaction at just how far “integration” has advanced. Evidence for the latter comes from not one but two recent moves in the career of chiropractor and health services researcher Christine Goertz, DC, PhD. Place yourself in 1988. The chiropractors were just concluding their decade-long, successful Wilk vs. the AMA anti-trust suit. Most of medicine and much of the media – in part because of the AMA’s economically-driven attacks – equated “chiropractor” with “quack”. Now consider where Goertz has arrived via her health services research and policy career that focused on safety, effectiveness and quality issues. She was recently named by the General Accounting Office as Chairperson, Board of Governors, for the Congressionally-funded, quasi-public Patient Centered Outcomes Research Institute (PCORI). And Goertz just began a new role as Professor and the Director of System Development and Coordination for Spine Health at Duke Health in the Department of Orthopaedic Surgery. I reached Goertz to talk with her about her dual ascension.
This is part 2. The first was an interview with Joe Selby, MD, MPH, PCORI’s founding executive director.
None of this was a stroke of luck. Here is the founding executive director of PCORI, Joe Selby, MD, MPH, speaking of Goertz work over the last 8 years as the sole Congressionally-required “state-licensed integrative health care practitioner” on the PCORI board:
Christine has provided leadership on the Board in a range of positions since Day One. I credit the GAO (Government Accountability Office) with having the wisdom to recognize her as an obvious choice to serve as PCORI’s next Board Chair. Don’t forget that she is both a practitioner of integrative medicine – a chiropractor – and a brilliant clinical researcher.
Goertz’ is a career buttressed by one ground-breaking leadership position after another. She was among the first to realize that chiropractors – and the other complementary and integrative medicine fields – needed researchers trained in researching cost and effectiveness. She completed a PhD in health services research and policy from the University of Minnesota. She became the first licensed “CAM” practitioner to serve as a staff member at the National Institutes of Health. As such, she was the first to be a full-time employee of the federal government. Goertz left for the private not-for-profit world in a stint as Deputy Director at the Samueli Institute. Subsequently at Palmer College where Goertz served as Vice Chancellor for Research and Policy, she and her team built a research portfolio that totaled $27-million over her 11 year tenure there. Recognizing the need to demonstrate the quality, consistency and value of conservative for spine care, she founded co-founded and directed the Spine Institute for Quality where she was serving as executive director at the time of her appointment at Duke. The interview was conducted in late September 2019.
Integrator: Let’s start with your new day job.
Goertz: I’m very excited to be joining the Duke faculty on October 1 as a Professor and Director of System Development for Coordination for Spine Health. I’ll be co-located at the Duke Clinical Research Institute and the Department of Orthopedic Surgery in the School of Medicine.
Integrator: Did you bring funding? Were there outside grants that helped make this happen? I know a couple other chiropractors now in important research positions in conventional academic health centers had major leverage from NCMIC.
Goertz: I’m a PI on an NIH funded grant evaluating the dosing of chiropractic services in the VA that will provide salary support and I have applied for a couple of other NIH awards. My position is not funded by NCMIC or other chiropractic organizations.
Integrator: Let’s turn to PCORI where you’ve been on the Board of Governors since the beginning in 2010 as the legislated “CAM” member. I recently interviewed Joe Selby, the outgoing founding director. He had good things to say about your skills and leadership. You’ve had multiple roles there.
Goertz: I am passionate about our mission to conduct patient-centered outcomes research on questions that really matter to patients, clinicians and caregivers, as well as our important focus on implementation and dissemination. As a scientist, I’ve been conducting patient-centered, comparative effectiveness research focused on complementary and integrative health for decades. It is exciting to see this field of research grow in terms of interest and rigor. Subsequently, I’ve been a very engaged member of the PCORI Board of Governors since the beginning, serving in multiple roles. These include spearheading our first pilot projects program, chairing both the Program Development and Selection Committees, serving as Vice Chairperson of the Board and now in my new role as Chairperson.
Integrator: I recall when we had a conversation in your first years there. You remarked on the high levels of intellect, skills and experience of your Board colleagues – commenting as I recall on the differences between being trained within the research culture found in conventional academic medicine versus the under-resourced research cultures found in CIH professions such as chiropractic and acupuncture and naturopathic medicine. I’d have found it intimidating.
Goertz: It was a little intimidating at first. But I soon learned that this very diverse Board of Governors – all highly accomplished and at the top of their fields – were also highly committed to a common vision that patients and the public have information they can use to make decisions that reflect their desired health outcomes.
Integrator: Your term as Chairperson is three years. What do you expect to or plan to accomplish?
Goertz: It’s a pivotal time in PCORI’s evolution. It is looking more and more likely that Congress will have re-authorized our funding by years end and at the same time we will also be saying goodbye to our amazing founding executive director Joe Selby, as he begins his much-deserved retirement. Our search for a new ED is well under way and we are very lucky to have Dr. Josie Briggs, former Director at NCCIH/NIH as our interim director during the search process. We are also beginning to work on a new strategic plan to execute on “PCORI 2.0”.
Integrator: It would be great to see an overview of the PCORI activity to date. And then I think many Integrator readers will be interested in knowing how many grants went for researchers in complementary and integrative topics. From the beginning of the discussion of comparative effectiveness research — a big chunk of the work here at 471 awards – policy makers saw that this was a zone for looking at the comparative value of complementary and integrative interventions. The desire for head to head trials – and assumptions that their care will come out well – has animated a lot of the integrative community. It would be great to see the list of those trials. [Goertz and PCORI subsequently made these two tables of information available.]
Integrator: The interview with Dr. Selby was remarkable for the extent to which putting patients at the center of research has had multiple positive effects on design and the utility of outcomes. Has there been a rub off on the NIH – has it begin to have more interest in patient-centered research and effectiveness?
Goertz: I think that one of PCORI’s signature accomplishments over the past 9 years has been to foster a nationwide conversation about how important it is to bring the patient into the research process at a meaningful level. Many investigators are beginning to involve patients in their research as a matter of course. I have definitely seen the NIH institute/center that I have the most experience with, NCCIH, putting increasing emphasis on supporting the conduct of pragmatic, real-world comparative-effectiveness clinical trials.
Integrator: Place yourself back in 2010. Any surprises in what you have witnessed?
Goertz: I don’t know about surprises, but it has been truly rewarding to have the opportunity to work with such a talented and committed Board and staff over the past nearly 10 years. It is amazing what can be accomplished when so many people work so hard toward a shared goal of conducting high quality comparative effectiveness research focused on questions that really matter to patients and those who care for them. Given how far we have come since 2010, it is really exciting to think about what can be accomplished over the next 10 years.
Integrator: Can you think of one or two trails in particular that you think have been impactful?
Goertz: In the field of integrative medicine, Mike Schneider [DC, PhD)’s study of spinal stenosis and Paula Gardner [MD, MPH]’s work on integrative group services are examples that come to mind.
Integrator: Do you have any specific comments for the complementary and integrative community?
Goertz: I’d love to see more grant applications submitted by CIH investigators. In particular, studies focused on decreasing the use of opioids and learning more about non-pharmacological approaches for pain management have been, and will continue to be, high priority areas for PCORI.
Integrator: So you are not headed for retirement soon …
Goertz: My husband and I spent 3 weeks in Italy this summer thinking about whether or not it was time to wind down a little bit and maybe even buying a second home there. The day before we left, I got a message from Duke. All thoughts about retirement flew out the window and the next day I was instead flying to Durham to learn more this new opportunity. The chance to conduct research with an outstanding group of like-minded scientists and develop and coordinate new ways to think about spine health is truly my dream job. I can’t think of anything else that I would rather be doing right now or any other place where I would rather be doing it.
Integrator: I have to ask – any blow back from the anti-chiropractic MD crowd? It has always struck me how many of our colleagues starting integrative programs in academic centers have been told, essentially, that chiropractors are deal breakers. It seems left over from Wilk and the MD-DC wars.
Goertz: I can tell you that, while that sort of bias still exists, it happens far less than it used to in the past. I’ve had to block a couple of my Twitter followers. However, the overwhelmingly response has been really positive. And in the end, it really doesn’t matter what the “quackbusters” have to say. As long as the chiropractic profession stays focused on the delivery of evidence-based, multi-disciplinary care for spine-related disorders and always puts the best interests of the patient first, the rest will take care of itself.
Integrator: A good note on which to end. Thank you for your time and good luck in both of your ventures