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| ||Honoring the Samueli Institute at 10 Years: Where Integrative Medicine Was in 2001 and Success Measures for 2021||
Summary: The Samueli Institute hosts an open reception on October 4, 2011 to mark the close of a productive first decade. The Institute, funded by Susan and Henry Samueli and led by Wayne Jonas, is the integrative medicine leader in 3 significant areas. From time-to-time I have had a chance to serve the Institute as an unpaid outside adviser. Here is a reflection, especially on the tension between exploring mechanistic science and moving real world practice. Originally named the Samueli Institute for Information Biology, the Institute played a key role on Obama's top wellness initiative. Included are the Institute's 20 Success Measures for 2021. What do you think of these measures?
I have had the pleasure of serving the Samueli
Institute as an unpaid adviser on multiple occasions. Each has been a rich learning experience. A staff member asked if I might
consider writing something to mark the Institute's entrance into its 2nd decade.
The query held a particular intrigue. I had just written a portrait of the Susan Samueli Center for Integrative Medicine, a separate integrative medicine investment by philanthropists Susan and Henry Samueli. A theme emerged regarding the tension between basic science and real world practice. The tension is also present in the Institute's priorities.
This article explores this dynamic. The Institute's trajectory amidst this shifting balance reflects patterns in our broader cultural approach to integrative and healing practices. Will the Institute's measures of success for 2021 also prove to be aligned with where we are heading?
Some quick kudos
Integrator readers will know that for me, honoring the Samueli Institute's accomplishments is an easy task. The Institute is arguably the integrative health leader
in 3 areas: total fitness in the military, optimal healing environments
in hospitals, and whole system planning in national prevention and
The Institute, directed by Wayne Jonas, MD, made the 2007 Integrator Top 10
for leaping into the messy decision processes health system leaders face in engaging integrative practices and practitioners. Jonas and his team were seeking to create, then promulgate, a financial model to support dominant delivery institutions that wish to integrate healing practices.
Henry and Susan Samueli
A year later the 2008 Integrator Top 10 gave #1 billing to the Samuelis and the Institute for their Wellness Initiative for the Nation
(WIN). That ballsy, visionary project aimed at nothing less than operationalizing health system
transformation. WIN provided the intellectual infrastructure for a
whole systems engagement in nationwide health creation. The National Prevention, Health Promotion and Public Health Council rolled out by the Obama administration as part of the Affordable Care Act was significantly influenced by WIN.
The Institute's work with the US military, led by Joan Walter, PA, JD, is at the forefront of examining integrative approaches for
both healing war wounds and for enhancing military preparedness. They call it Total Force Fitness. Multiple Congressional appropriations funded the Samueli Institute's work. The Samueli team has been remarkably successful in translating research into the practice of military medicine. In time these will migrate into civilian care.
The rivers of science and practice
The accomplishments are many. The more interesting story, however, is how an entity that was originally called the Samueli Institute for Information Biology came to focus on these very practical initiatives. More precisely, why did the Institute's founders, experienced integrative healers, choose to first focus on mechanism research? And where are they going next?
Hints may be found in the Institute's origins. The story goes that when Susan Samueli met Jonas, the former NIH Office of Alternative Medicine (OAM) director, the conversation took a different turn than either had anticipated.
Jonas was considering leaving the rough-and-tumble of the nation's Beltway. Leadership of the NIH's Congressionally-forced entry into exploring alternative therapies and providers had proved, for all its fascinations, a continuous gauntlet. Advocates of whole person, holistic and energetic approaches complained that Jonas kowtowed to the reductive NIH. Antagonists argued that anything other than a reductive, basic science and controlled trial agenda was an affront to the NIH mother ship. Jonas brought his rigorous training in basic research at the Walter Reed Army Institute of Research to his job. He also allowed his leadership to be shaped by his experienced view that there was value in the subject matter he was to research. The politically-charged research climate of 1998 couldn't admit the potential use to human health of "alternative medicine." He became a hot potato, and left.
Wayne Jonas, MD
Not long after Jonas' departure from the NIH, the Samuelis invested $5.7-million to found the Susan Samueli Center for Integrative Medicine
at the UC Irvine medical school. This was the hey-day for stand-alone integrative centers. The Samuelis were interested in Jonas to direct the center. Jonas ventured west to explore an academic integrative medicine position in Orange County, California.
More than one river of curiosity informed Susan Samueli's philanthropic interests. She had a hard science mind as a UC
mathematician who had worked in the emerging high tech industry. She was
also a former lay practitioner of natural health care. Her modalities included homeopathy, nutrition and mind-body practices. While raising her children in the early 1990s, Susan Samueli's practice supplemented the family income of her UCLA engineering professor
husband. This was before his firm, Broadcom, hit big.
Jonas, meantime, also had those two rivers of science and healing practice coursing through him. He was an
integrative clinician as well as a scientist. A former military doctor, Jonas discovered homeopathy and acupuncture while posted to Germany in the 1980s. His views about complementary and alternative medicine were not formed principally through reading the literature. Jonas knew from experience as an individual and practitioner that there was value in healing health care.
Information biology, mechanism and a Trojan horse
The two found themselves in an expansive dialogue. Acupuncture. Health system change. Tough questions surrounding healing agents that purportedly act beyond Avogadro's number.
The two ultimately decided that the UC Irvine post was not highest and best use for Jonas. They cooked up
something new. In July 2001, they launched the Samueli Institute
for Information Biology (SIIB). The tag line: Exploring the Science of Healing.
The name is odd. Search "information biology" and the only direct hit is Samueli Institute. Ask Jonas to describe "information biology" and he will engage a lengthy, complex explanation that has to do with how information as words or medicines or attitudes or context can influence biology. He has been asked to explain the handle more times than he cares to remember. One problem with the name, said Jonas in an interview for this article, was that it "took a diatribe like I just gave you to explain it."
To me, the name seemed to be an artifact of the deep medical conservatism toward complementary and alternative medicine in the 1999-2001. A problem many at the NIH had with Jonas was that he actually knew something about the touch and feel and practice of alternative approaches. They weren't about to make that mistake again. Stephen Straus, MD, Jonas' successor, fit the bill. The first director of the National Center for Complementary and Alternative Medicine was informed by no personal use of, or clinical interest in, the field. Despite Congress' clear mandate to NCCAM that it focus on helping us understand practical questions relative to expanding use, Straus's administration was utterly non-compliant. He promoted a scientist-centered reductive research agenda rather than the patient-centered outcomes research Congress mandated. Straus actively suppressed real-world interests. An internal NCCAM analysis reported in 2007 found that less than 1% of NCCAM funds studied outcomes. No one protested NCCAM's administrative abuse of Congressional intent.
In this context, the use of "information biology" in the Institute's title seems a ploy to grab the curiosity of researchers before they had a chance to realize
they were dealing with alternative or even complementary or integrative issues. The Institute's name provided a protective cover for healing research. While Jonas ardently disagrees, I like to think of the name as a kind of Trojan Horse. Fact was, to announce the Institute's interests more directly in 2001 was yet repulsive to much of the scientific community.
Yet oddly enough, the Institute initially targeted mechanism. Jonas reflects that SIIB's first years "focused on theoretical concepts, on mechanism, on placebo and framing our components of research." He adds: "We have come to realize that care is not the mechanism. The term 'information' is too limited on how healing works. We argue now that we need to do away with the term placebo and talk instead about meaning and context. Placebo puts a negative spin on the art of medicine. We need to talk about how the delivery-effect facilitates healing."
The shift away from looking at subtle mechanism led to the dropping of "information biology" from the Institute's home page and name. Jonas says that the Institute has not abandoned basic research or "information biology." He believes "it was just too early, it's time will come." Jonas is writing a book about it.
Bottom line, the thrust of the work
shifted from a research-centric approach to real world-centered challenges already noted.
Return to the real world
Jonas calls this 'translation': "Our last 5-year strategic plan was called 'Building the
Science of Healing.' The current will probably be about
translating the science of healing' to the military, to the hospitals, to work sites and to policy. 'Translation' will probably be in the title."
This framing of the Institute's shifting priorities fits the NIH's own prioritization of translation. Yet this assumes that mechanisms are sufficiently understood, and trials completed, so that we can now worry the implementation in people's lives.
This is over-tidy. Rather, I view this "translation" as move away from the "information biology" effort to convince reductive skeptics. The move is a return home for healer-practitioners Susan Samueli and Wayne Jonas to the patient-centered planning that each knew before the founding of the Institute.
The timing is right for the Institute to secure the central place for user-stakeholders in their strategic plan. We see a common denominator in the June 2011 Atlantic
series from David Freedman, the July 2011 Consumer Reports survey on
complementary medicine use, the August 2011 survey showing healthcare workers use integrative practitioners at rates higher than the rest of the population. Use rises and acceptance grows despite continuing scientific questions. Patients are well ahead of researchers in translating experimentation in integrative practices and providers into their health regimes. They like the outcomes.
Meantime, another Affordable Care Act initiative, the Patient Centered Outcomes Research Institute, is presently posing the novel question: What is patient-centered outcomes research? Even the 2011-2015 NCCAM Strategic Plan nods to the real world. For the first time, NCCAM acknowledges in its plan that patients use complementary and alternative medicines to enhance health.
I asked Jonas what the Institute will have accomplished by 2021 if he is to consider the next decade of work successful. He laughed: "I can send you a laundry list of healing oriented practices and environments we have identified." He did. The Samueli Institute's Measures for Success in 2021 are attached immediately below.
The formulator of the WIN acronym (Wellness Initiative for the Nation) quickly points out that his word choice (healing oriented practices and environments) was premeditated. The acronym is HOPE. Jonas describes a success measure in clinical practice and cultural assessment: "Never a SOAP note without a HOPE note."
The Samueli Institute will serve us in the coming decade by locking ever more tightly to a patient-centered view. I suspect that Susan Samueli and Wayne Jonas, as experienced clinician healers, know that the chief direction needed is not to translate that experience for skeptical scientists. Let others worry that if they want. Our broken system and the gathering storm of obesity and chronic disease make clear the most important challenges. The Samueli Institute is uniquely positioned to lead is to translate known health-promoting and healing practices and practitioners into use by an ever broader population. Meantime Jonas, the basic researcher, can be an ever more important bridge between the real world-challenged NIH.
We have come a long way since 2001 in this effort to open the culture to integration of health-promoting and healing approaches. I am excited to see where the Samueli Institute's work will land us in 2021.
SUCCESS BY 2021 AT THE SAMUELI INSTITUTE
Note: I asked Wayne Jonas, MD, the Institute's executive director to imagine it is 2021. What would the Institute have accomplished? He had no need to shoot from the hip. The Institute had already developed these success measures, which he then sent.
In 2021 the Institute's goal is that wellness and healing
have become a formative concept in society. The
following are the major success indicators of the Institute's work.
These are the Institute's "Big Hairy Audacious Goals" for the next decade.
of Defense and Veterans Health Administration have established 10 major
initiatives or centers of excellence to deliver wellness and healing to service
members and their families. These Centers are improving wellness, healing,
human resilience and performance in the military. The Total Force Fitness
paradigm is an established doctrine and being used at over half the major
installations in the country.
Ten percent of
all health care systems are striving to become "optimal healing environments" (OHE)
and using Systems Wellness Action Training (SWAT) teams to train in healing and
integrative health care services as part of their routine care.
Five to seven
government and non-government organizations are using the Institute's SEaRCH
program for vetting claims of healing, evaluating their evidence basis, and
connecting this evidence to decisions on policies and appropriateness of
has developed a Systematic Review and Integrative Medicine Research Training
programs that is being used by multiple organizations and individuals
One fifth of the
Fortune 500 companies are moving into health promotion and integrative health
care or are investing in development of a wellness capacity for their own
Seven to ten major
new "Service Value" initiatives have been started by companies and they are
developing new business opportunities to build the foundations of a wellness
implementing incentive policies that encourage development of a wellness
industry and healthier communities, including programs for families and
National Prevention Strategy has created a new set of action items based on a
vision facilitated by the Institute's work on Whole Community Wellness and
are supporting innovative projects that seek to achieve maximum increase in
human health and flourishing in local communities, especially for the
underserved, women and children, and the military.
trials are being conducted by the Institute and its partners on nutritional,
dietary supplement or herbal interventions for national or international health
The Institute is
conducting a major four step program on sustainable health care for children in
underserved communities and the developing countries.
has been the primary researcher on high nutrition, and high omega-3 foods for
non-government agencies are funding research on mind-body practices and
consciousness. Four grants on the physics and neuroscience of consciousness
have been funded by the National Science Foundation or similar organization.
A program on
clinical hormesis (low-dose protection and treatment) has been established and
is funded by both private and public funding. Within this research program are
projects on the rapid induction of protective tolerance (RIPT) as a new
paradigm for managing pandemics and environmental toxin exposure.
The media is
increasingly advertising and reporting on integrative health care and health
promotion practices investigated by the Institute and its partners in a
positive light. Channels like OWN, HBO and Discovery and influential medical
communication programs like TED and the Dr. Oz Show are regularly discussing
integrative health care and optimal healing environments.
There are eleven
community leader training projects implementing whole community wellness and
resilience assessments using Institute developed tools. These communities have
provided instrumental input into the National Prevention Strategy.
The Institute is
the "go-to" organization for vetting claims on healing and providing scientific
advice to government and non-government organizations establishing policies and
guidelines on wellness and healing practices.
The public wants
to have "well-being" and they are willing to seek out and participate in
healthy behaviors and purchase wellness and healing products for improving
health - physically, psychologically, socially and spiritually.
Institute's invitation, national and international cultural change leaders are
gathering both inside and outside their official duties to support social
behavioral change toward wellness and healing.
standard measures and benchmarks for tracking health, healing and well-being in
a whole systems manner with the Institute's major stakeholders.
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