When the news hit the dominant medical industry in January 1993 that 33% of adult Americans used some “unconventional medicine” and spent $13.7-billion annually out of their pockets, most of the medical industry’s stakeholders were startled awake. A huge cultural-medical phenomenon had been obscured by their prejudice. The awakening was all the more effective because the data that grabbed them was from the inner sanctum. The research hailed from Harvard University. The results were published in the top-cited New England Journal of Medicine (NEJM). The Harvard brand was then affixed to high profile conferences that sanctified and kick-started the integrative era. While the first leaders have moved in powerful new directions, 27 years later, the Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women’s Hospital is being led by director Peter Wayne, PhD and a new generation that substantially grew up inside the institution. Returning to Harvard seemed a good way to cap the series of 6 portraits of integrative academic health centers – from the shock waves via peer-reviewed journal to anticipated next-gen directions.
Fruits of the Center’s origins
The Harvard survey didn’t come out of nowhere. Less known about Eisenberg is that in 1979 he became the first National Academy of Medicine sponsored fellow to travel to China to study acupuncture. And long prior to the 1993 publication, Eisenberg had done what then was shocking. In what was akin to a Brahman-Untouchable relationship. he began working closely with a licensed acupuncturist, Ted Kaptchuk, OMD. Kaptchuk, author of the wildly influential introduction to acupuncture and East Asian medicine, The Web That Has No Weaver, is now the director of Harvard’s globally renown Program in Placebo Studies and the Therapeutic Encounter that is associated with Osher Center.
Eisenberg directed the Center from 2001-2012. He has since, through his base at Harvard’s TH Chan School of Public Health, founded the now global Teaching Kitchens Collaborative. In November 2020, his Teaching Kitchens Research Day drew over 2500 registrants from 79 countries. Eisenberg returns to Osher to present the Center’s Grand Rounds on January 12th, 2021. The theme: Teaching Kitchens as Learning Laboratories of the Future.
Next up was Helene Langevin, MD, the medical doctor-acupuncturist-researcher who made a global name for herself via basic science research on connective tissue. Langevin was recruited in 2012 to direct the Center. She led it until 2019, with Wayne as her research director, and left to become just the 3rd director of the NIH National Center for Complementary and Integrative Health (NCCIH). At NCCIH, Langevin is presently cooking on her first strategic plan. She has branded it with the utterly appropriate, and still – for the reductive world view enamored by the NIH – revolutionary interest in “whole person health.”
Wayne: the new Osher Center director
Wayne came to Harvard via his former position as one of the first two research directors at an acupuncture college, the New England School of Acupuncture. Research collaborations drew him across town to Harvard. The Harvard-trained evolutionary biologist/ecologist, Tai chi practitioner, and educator by passion, has been the principal or collaborator on 25 NIH grants. In mid-December, Wayne was honored with the Catherine Kerr Award for Courageous and Compassionate Science. (I can add that Wayne has been both principal scientific backbone and visioning partner for JACM in my time the last 5 years as editor-in-chief.)
As Wayne describes it, his vision for the future of the Harvard Osher program integrates his training in evolutionary biology while also reflecting his years of close work with Langevin: “The emergence of systems thinking, from molecular biology to medicine, creates a rich scaffolding for the Osher Center to further ecological models of health and health care, that emphasize the whole person, including the communities they live within.”
The Osher Center has followed an unusual path since 2012. At the time, it declared itself a Center without walls. The Center has invested in the model in multiple ways. They developed two interactive maps to help connect the integrative community in the greater Boston area, famous for its cluster of medical delivery organization and academic medical centers – and their rivalries. The Research Map and Clinical Map (the latter currently being restructured) each make the basic point of the abundance of activity. Available here, one quickly sees that the connected networks in both areas are significantly more substantial than any one of these researchers, educators, or clinicians, wrapped up in their own work, is likely to have imagined. To date, the center has awarded over $1,000,000 across multiple pilot grants to seed new collaborations across the research network. Every second year, the Center hosts a “Harvard Center Network Forum” to bring together, feed, and develop the communities.
The research map is particularly robust. For years, the Center’s newly appointed director for clinical research, Gloria Yeh, MD, MPH, has directed the Center’s NIH T32 research education grant and the Harvard-wide Research Fellowship in Integrative Medicine. The program has been ongoing for 20 years. Yeh, an internist, was one of its first graduates. “Originally our fellows were primarily physician general internists,” recalls Yeh. “But what’s been an exciting and important evolution is that now we are training a multidisciplinary group of individuals- including neurologists, physiatrists, basic neuroscientists, and clinical psychologists. One of our current fellows is even trained in veterinary medicine, advancing translational research from animal models of stretching to yoga.” The Fellowship typically has 5-6 fellows in a given year, each of whom is part of a 3-year track. Its graduates, beside Yeh, whose mind-body research and clinical trials led to an appointment to the NCCIH National Advisory Council, are some big names in integrative medicine. Former Consortium chair Rob Saper, MD, MPH, group services expert and PCORI grant winner Paula Gardiner are two. Yeh and the Center’s director of education, Darshan Mehta, MD, MPH are also among those who have benefited from the NCCIH-backed program.
New research directions
Wayne and each express excitement with the recent hiring of Kathryn Hall, PhD, who like Yeh and Mehta, is another graduate of the fellowship program. Yeh shares that the research of the center has increasingly embraced a full array of explorations, from cell and mechanism to practical, real-world issues such implementation, cost and effectiveness. (Initial considerations for a 2021-2026 strategic plan in development also underscore a need for the Center to concern itself with equity and access.) Hall has a background that includes10 years in biotech, an MPH from the Chan School of Public Health, and a directorship in “Placebo Genetics” in Kaptchuk’s program. Add to this a 2015 faculty fellow role with the Harvard Catalyst Program for Faculty Development and Diversity Inclusion and the honor of being a 2019 Brigham and Women’s Minority Faculty Career Development Awardee. Hall has begun co-directing research with Yeh at the center, with a title that encompasses basic and translational research. This complement Yeh’s clinical focus. Said Yeh: “Kathryn’s work allows us to both probe deeper into mechaisms and collectively to extend the full translational research spectrum from basic to implementation. I’m excited to bridge our portfolios.”
Regarding the translation of research into clinical models of care, Wayne shared that things are moving in a positive direction. He speaks with excitement of the potential for influence due to new research supporting a multimodal chiropractic model for migraine headaches. He notes that chiropractor and researcher Matt Kowalski, DC has collaborated with Vitaly Napadow, PhD, LAc on “two high-profile recent studies” published here and here. These have led, among other things, to a $750,000 chiropractic research fellowship which is certainly to heighten the potential clinical interest in services from the chiropractic profession. Osher is one of first centers to integrate chiroractic into an academic research hospital. Research has also supported multimodal models of clinical care for chronic low back pain. Among other modalities offered are acupuncture, cranialsacral therapy, tai chi, yoga, mindfulness training, health coaching, and integrative medicine consults.
I asked Wayne if the famous Harvard medical conservatism may be in the way. Wayne leaned into his practice of Tai chi in his response: “The second, in Tai chi, that you no longer see the person you are crossing hands with with as an opponent, and rather as someone you can borrow strength from, you realize the seeds to the solution are embedded in the challenge. The seeds for integrative medicine have been planted, and medicine is already moving in the direction of systems, of biospychosocial thinking. And we are standing on the shoulders of the two visionary directors who preceded me. We are excited to represent the next generation. We see a lot of potential. We are excited to be working together on our new strategic plan.”