The way Joe Selby, MD, MPH tells it, the naming of the $3.2-billion Patient Centered Outcomes Research Institute (PCORI) – which from the outset had a charge to explore the comparative effectiveness of complementary and alternative medicine methods – was both serendipitous and brilliant. At the time the quasi-public agency was established as part of the Affordable Care Act, the idea of “comparative effectiveness research (CER)” a hot-potato for the medical industry. Medicine’s waste, morbidity, mortality and cost prompted interest in real-world, decision-oriented research. But powerful medical stakeholders were worried enough about the comparative effectiveness of their part of the status quo that elevating a “CER Institute” was not attractive. The patient centered name was a political compromise. It captured something of the real world. And what politician or stakeholder could oppose a name like that? In this interview at the end of his 9 year stint as PCORI’s founding executive director, Selby shares some of the “undeniable influence” – including at the NIH and the FDA and in discovering influences on cost savings that is growing out of PCORI’s active placement of patients at the table in decision-making.
The headliner for the September 27, 2019 Dr. Rogers Prize Colloquium was Alessio Fasano, MD the Harvard professor and celiac disease researcher making the global rounds as a microbiome expert. Fasano broke ranks with conventional practice when he began to assert the link between dysbiotic and disordered gut bacteria and the shocking rise of autism. He shared the stage at the Vancouver, BC event with two Canadians: fecal transplant researcher Jeremy Burton, BSc, MSc, PhD, and this year’s $250,000 Dr. Rogers Prize winner, the pioneering micro nutrient and mental health researcher Bonnie Kaplan, PhD. Perhaps because of the content, when it came to audience questions the spirit pervading the room was that of the 16-year-old Swedish climate activist Greta Thunberg. That very day outside the meeting place, Thunberg’s activism provoked a student-led march. The micro and macro met in parallel calls for disruptive change. “So the question is,” Kaplan asked, “where is our Greta Thunberg?”
About the first thing one is taught in medical research is that there are hierarchies of evidence and that the “RCT” (randomized controlled trial) sits on the Iron Throne. What the integrative user of multimodal, individually-tailored approaches immediately feels is estrangement and resentment at rules that seem form-fit for pharma. Can integrative even get an audience in such a court? Now the American College of Lifestyle Medicine (ACLM) and the True Health Initiative led by Yale public health, integrative, and lifestyle medicine leader David Katz, MD, MPH have published a model that seeks to take the RCT’s down a notch. It’s a diversity play. They recommend a “systematically weighted approach” involving multiple research models that “(increase) the weight and thereby validity of evidence specially applied to lifestyle interventions.” I reached Katz for an interview in which he spoke to the model’s relationships to integrative whole system research models and of the “tyranny of the RCT”. He shares intriguing political, strategic and tactical dimensions to lifestyle medicine’s Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM).
The blog post to which my attention was called was entitled When Big Brother Went High Tech. The news from energy medicine author Lynn McTaggert jerked attention of the integrative community to a story I’d long anticipated: Google’s censors turned their attention to the still wild political-economical-medical frontier of “alternative medicine”. Osteopath and internet businessman Joseph Mercola reported that 99% of the traffic to his sometimes pugnacious mercola.com “natural health” website was killed. “Integrative medicine” was not spared. Visits to the much more tame Dr. Weil site from that field’s godfather dropped 66%. In an August 2019 e-blast to his list of Minnesota holistic practitioners on Google’s incendiary actions, an integrative leader of 40-years Bill Manahan, MD writes: “”I think you will find it pretty scary for those of us in the integrative, alternative, and functional medicine fields.”