James S. Gordon, M.D.
Two years ago, in March 2000, the President and Congress responded to public demand and public need by creating the White House Commission on Complementary and Alternative Medicine Policy. The Commission's mandate was to develop legislative and administrative recommendations that would help public policy maximize potential benefits, to consumers and American health care, of complementary and alternative medicine (CAM) therapies - chiropractic, acupuncture, massage, herbs, and nutritional and mind-body therapies, as well as a host of other approaches.
Many of the 20 Presidentially appointed Commissioners are conventionally trained health professionals and others are trained purely as CAM practitioners. Several more are conventional health professionals who integrate complementary and alternative approaches into their work. The Commission also includes a number of academic physicians and health and mental health professionals who joined the Commission interested in, but not experts in, CAM approaches. There are, as well, several business executives and patient advocates.
Though the Commissioners came from these diverse backgrounds, all swiftly agreed that our responsibility was to ensure the safety of products and practices that had been, or might be, labeled "CAM", as well as to maximize potential benefits of these approaches for the public.
For 18 months we listened and read, in 14 meetings, the testimony of over 700 individuals and organizations and we read over 1,000 written submissions. Commission members discussed what we had heard in subcommittees and in full Commission meetings. All participated actively in these discussions and learned from one another, as well as from those who testified.
In particular, I want to mention our friend and fellow Commissioner, William Fair, M.D., a world-renowned urologic surgeon, who contributed so much to this Report. Bill, who died two months before this Report was completed, reminded the Commission often about the value of this work and, particularly, about the importance of helping to prevent chronic illness by teaching children and young people the fundamentals of self-care. He taught all of us who knew him even more about how to live courageously and generously with life-threatening illness.
The Report that follows, which has been prepared with the invaluable support of the Commission's Executive Director, Stephen Groft, Pharm.D., and the Commission staff, is a response to the public trust the Commission was given and to the questions we were asked by the President and Congress.
At times there were differences of opinion among us about, for example, the proper balance between freedom of choice and regulation as well as the appropriate roles of the various CAM professions in the health care system. Thanks to the persistence and dedication of the Commissioners, we were able to resolve many aspects of these and other questions. Still others remain to be addressed by the appropriate Federal agencies, and by the task forces and advisory groups whose creation this Report recommends.
We wrestled, as well, with other questions: What is the best way to discuss approaches like self-care and prevention that are very much a part of good conventional medicine as well as CAM? How to address the healing power of prayer and spirituality in the context of CAM when these are of such importance to so many Americans, whether or not they are using CAM, or conventional, approaches to cope with an illness.
I believe the Report reflects our best response to the complexity of the questions raised, as well as the diverse nature of the Commission and of those who testified. This introductory "Chairman's Vision" represents my own reflections on our work.
Over the last 30 years, increasing numbers of Americans, particularly those with chronic and life-threatening illnesses, have begun to look for health care answers in complementary and alternative approaches. They are not turning their back on conventional medicine - it is, in fact, those who have had all the benefits of modern scientific medicine who have led the search - but they are very much aware of its limitations and side effects. They are exploring approaches that would complement this medicine - or in some cases, be alternatives to it. And, most often, they are exploring these approaches without valid scientific information to guide them.
These people are looking for therapies that are both more helpful and less burdened by side effects. Many of them are searching for something else as well. They want more time with the professionals who will provide care for them - a sustained, healing partnership rather than a brief consultation, and an opportunity to participate in their own care as well as to "follow doctor's orders".
Now, at the beginning of the 21st century, this White House Commission's Report addresses the hopes and concerns of the American people and the professionals who serve them. It acknowledges and respects the American people's use of a variety of approaches to health care and emphasizes the need to use the tools of biomedical research to assess the perspectives and findings of a worldwide spectrum of approaches, techniques and systems of healing.
This Report is grounded in the conviction that first-class scientific research on these approaches and well-designed demonstration projects - of the same high quality required for conventional approaches - is crucial to helping all Americans, and those who care for them, make the wisest healthcare decisions.
The Report's vision is holistic. It is shaped by attention to the mind, body, and spirit of each person, and to the social and ecological world in which we all live. This perspective, which has also re-emerged over the last 30 years in Western medicine under the name "biopsychosocial", has long been the shaping principle of traditional systems of healing.
The Commission's Report is also defined by an emphasis on the importance of each person participating in his or her own care, and moderated by the understanding that government has a responsibility to facilitate this process. The Report recommends, as the Institute of Medicine has also done, active participation of the public in all aspects of their care, including the development of new research agendas.
There is a powerful emphasis in the Report on the importance of good information as the basis for health care decision-making. It recognizes the American people's pressing need to know, with as much authority as possible, what works and for whom, in complementary and alternative, as well as conventional medicine. Again and again the Report makes recommendations - for more and more rigorous and relevant research and for the training of researchers - to facilitate this process.
All Americans should have access to qualified and accountable practitioners and safe health care products. In this Report, there is an emphasis on the unique role the Federal government can take in making available and accessible the latest research findings; in ensuring the safety of products; in helping to assess the appropriate levels of training of various CAM practitioners and the evidence base for their practice; in evaluating the different ways that states are regulating CAM practitioners; and in facilitating dialogue among CAM and conventional providers, scientists and the public. The Report addresses as well the important leadership role that states can take in developing models for appropriate regulation of CAM practitioners and of conventional professionals who incorporate CAM approaches in their work.
The Report's approach is pluralistic. The American people want their conventional healthcare practitioners to help them make wise decisions about whether to use complementary and alternative therapies - and which ones to use - and they want their CAM practitioners to be responsive and informed partners with their mainstream medical caregivers. The Report offers guidance for both the integration of complementary and alternative therapies that are safe and effective into conventional medicine, and for respectful collaboration and cooperation between conventional health professionals and those whose practices are shaped by other healing traditions. It looks forward to cross-fertilization among these disciplines in education and research as well as clinical care.
It seems to me that this Report is shaped by the Commission's particular concern for an aging population with an increasing incidence of chronic illness - for precisely those people who are among the most frequent users of CAM products and services. It makes clear that people with chronic illness and those who are dying need to have available approaches that can reduce their stress and suffering, approaches - including CAM therapies - that recognize the spiritual, as well as the physical and emotional dimensions of their lives.
The Report also makes clear that those in the greatest need - including, most particularly, those with limited incomes - must have available the most accurate, up to date information about which techniques and products may help and which may harm, and which practitioners are basing their recommendations on solid research and which are not. These Americans and their families must be offered this information in easily accessible forms - from the Federal government, in the practitioner's office, and in pharmacies and health food stores, as well as on the Internet.
There is an emphasis as well on the singular importance to the long-term health of the American people of approaches that prevent disease and promote health and wellness. Some of these approaches have been presented in government reports like Healthy People 2000 and 2010. Many of the principles and practices of CAM approaches are, like some of these more conventional health care practices, aimed at enhancing health and well-being, and promoting each person's capacity for self-healing. The Report highlights the opportunity that Federal agencies now have to evaluate the ways that safe and effective CAM therapies may be integrated into their ongoing efforts to promote health among all children and adults.
It seems to me, that the intentions of the Commission members were to engage Americans to participate actively in their own care; to stimulate research that will fairly test promising new and ancient approaches; to fully inform all health professionals and the people they serve about what is, and is not, known about CAM therapies; to make sure safe and reliable products are available to all Americans; to expand all Americans' options for safe and effective care; and to promote the study of approaches that may save us all money as well as enhance our health and well being.
My larger concern - and that of the Report - is not, of course, complementary and alternative therapies, but the health and wellness of all Americans. I believe that this Report helps create the foundation for a more comprehensive health care system, a system responsive to the unique needs of each person.
As research determines which approaches are safe and effective and for whom, as that information is widely disseminated, and as health care evolves, I expect that the words "complementary" and "alternative" will become far less important. We will be concerned then only with making what has been determined to be safe and beneficial as widely available as possible and with bringing the same rigorous but open-minded study to a new generation of approaches which we have not yet examined.
I look forward to a health care practice in which engaged and informed patients form healing partnerships with respectful and collaborative practitioners who are offering a wide range of safe and effective approaches, a health care practice in which all of us learn to take better care of ourselves and one another. I hope that this Commission's Report will help to provide a map that will guide Americans in making some next steps toward these goals.