Recently named by President Clinton to chair the White House Commission on Complementary and Alternative Medicine Policy, James Gordon, M.D., is Clinical Professor of Psychiatry and Family Medicine at Georgetown University School of Medicine, Director of the Center for Mind-Body Medicine, and was the first Chairman of the Advisory Council of the National Institutes of Health (NIH) Office of Alternative Medicine (OAM). He is a member of the NIH Cancer Advisory Panel and was the Director of a Special Study of Alternative Services for the President's Commission on Mental Health. A graduate of Harvard College and Harvard Medical School, Dr. Gordon serves on the editorial boards of Alternative Therapies in Health and Medicine, The Journal of Alternative and Complementary Medicine, and Alternative and Complementary Therapies.
Gordon has written several books on holistic medicine, including the landmark Manifesto for a New Medicine (Addison Wesley, 1996), and developed at Georgetown one of the first medical school curricula on complementary and alternative medicine. He is, in short, a pioneer in the field.
Since 1998, Gordon's Center for Mind-Body Medicine has sponsored annual Comprehensive Cancer Care (CCC) conferences, bringing together the world's leading alternative and conventional cancer researchers and practitioners, policy makers, and patients in an unprecedented meeting of the minds, to explore the full range of cancer treatments and midwife the creation of a truly integrative approach to this most challenging illness. Now co-sponsored by the National Cancer Institute and the NIH's National Center for Complementary and Alternative Medicine (NCCAM), CCC is among the foremost models for breaking down barriers between conventional and alternative therapies. (Transcripts and summaries of the CCC conferences can be accessed at www.cmbm.org). Gordon's most recent book, Comprehensive Cancer Care (Perseus, 2000), co-authored with Sharon Curtin, draws on the presentations at CCC I and II as well as Gordon's work with cancer patients in his practice.
In this wide-ranging interview with Dr. Daniel Redwood, Dr. Gordon describes the goals of the White House Commission, the key areas it will address, and the commission's desire to elicit the broadest possible input from both the alternative health and conventional health communities. He also discusses the current status of CAM research for cancer and recent steps toward greater integration of CAM in medical education.
The Commission will release an interim report in July 2001 and a final report in March 2002. As part of their information gathering process, members of the Commission will hold a series of regional town hall meetings around the country. The first two are scheduled for San Francisco on September 8, 2000 and Seattle on October 30, 2000. Dr. Gordon expects one of the town meetings to be held in Washington, DC.
For further information:
White House Commission on Complementary and Alternative Medicine Policy
6701 Rockledge Drive
Bethesda, MD 20817
Center for Mind-Body Medicine
5225 Connecticut Avenue, N.W.
Washington, DC 20015
DANIEL REDWOOD: According to the law passed by Congress calling for the appointment of a White House Commission on Complementary and Alternative Medicine Policy, what is the commission's job?
JAMES GORDON: The commission's job is to take a look at a variety of different aspects of CAM [complementary and alternative medicine] and to try to understand the overall significance of CAM, and in particular, how we should enlarge or rethink four different areas: research, public information, training of health professionals, and delivery of services. The commission will make recommendations to the President through the Secretary of Health and Human Services, and also to Congress, about what kind of legislation is needed to make sure that whatever kinds of perspectives, practices, and approaches we think are important are included in health care for everybody.
REDWOOD: Over the years, there have been blue-ribbon government commissions on many topics whose recommendations were never implemented. Are you hopeful that your commission? recommendations will result in actual policy changes?
GORDON: I'm very hopeful. I see the work of the commission as sharpening our national perspective, not only on specific CAM therapies but on how health care and health education as a whole, and health care research, can be enriched and transformed by the perspective in CAM, by a holistic perspective, by an emphasis on healing partnerships between patients and health care practitioners, and by a focus on education and not just on treating.
I see this as an opportunity to present a worldview about health care, and then also to present very concrete proposals. The reason I'm very hopeful about it is because there is tremendous bipartisan support. Many commissions come up with recommendations, and I think the reason they get stalled is because there is a great deal of division about specific issues. On the issue of integrating CAM therapies, there is tremendous bipartisan support for the idea that those therapies that are useful, those approaches that make sense, should be part of health care. So I'm very optimistic about much of what we recommend coming into legislation, and at least a significant part of that legislation being passed.
There may be more difficulty, of course, about who is going to pay for whatever is being recommended. But my hope is that what we can do is not only show that some of these approaches are effective, but to encourage major experiments in integrating some of these approaches into health care so that we can see if, on a large scale, they're not only effective but also save money.
REDWOOD: What's a good example of work like this that's already been done?
GORDON: A good example of something that's already been done is Dean Ornish's work using an integrative approach to treat serious heart disease. [Ornish's program combines a very low-fat vegetarian diet, yoga, meditation, and sharing groups]. There's been a kind of progression of initially looking at this as a totally outrageous approach to heart disease, to the point at which, after having done some fairly large scale experiments using this approach [published in Journal of the American Medical Association and Lancet], it's now become a part of health care in many hospitals and is covered by many insurance companies. I'm hoping we can make recommendations that will move the whole field forward in that way. To say, here are some approaches that look very interesting, here are some data that suggest that they may be useful, so now let's see about doing a significant experiment or pilot program to see if this can make a difference to large numbers of people.
I would also expect the commission to recommend that certain kinds of education be included in the training of all health professionals. I obviously don't know at this point what the commission's recommendations are going to be, but I think it's reasonable to recommend that whatever we come up with should be mandated as part of the education of health professionals. I think that can have a significant effect.
For us, the final challenge is going to be to put all that into simple, direct language that can be part of legislation. I think we'll be able to come up with some very significant things. Just the fact that the National Center for Complementary and Alternative Medicine (NCCAM) has begun to put out requests for applications for education on integrative medicine has stimulated major medical institutions to apply for those grants and to be more willing to integrate CAM approaches into their curriculum. For example, if we have legislation that says part of the work of a particular government agency is to foster education in these approaches and here is an appropriation of x number of dollars to do that, then I think that's going to happen. The time is right. What's needed is guidance and financing.
REDWOOD: Does the commission's membership reflect the diversity of CAM practice in the United States? Aside from holistic MDs like yourself, Dean Ornish, and Wayne Jonas [Wayne Jonas, MD, is the former head of the NIH Office of Alternative Medicine], are there non-MD alternative providers represented?
GORDON: Yes. Some have been named already, and more members going to be appointed. There are a number of MDs who are integrative care practitioners, that's true, but there are several more members who are alternative practitioners. There will be a chiropractor and there are two people who practice Chinese medicine. The fact that there are physicians who are holistic practitioners along with various alternative practitioners is a wonderful bonus for the commission. Many commissions are asked to address a certain area, and may only have one or two, if any, practitioners in that area. Also, the role of the commission is not just to rely on our own expertise. Our work is to go and find those people in the alternative community who will come in and tell us what they think.
REDWOOD: How will you do that?
GORDON: There will be plenty of time, both in the regular commission meetings and in town hall meetings around the country where we will be soliciting input. We're having a town hall meeting in Seattle on October 30, and our major partner in that meeting is the naturopathic community. So whether or not there is a naturopath on the commission, there is going to be major input from the naturopaths. I think we'll see the same pattern all over the country. In some areas there will be input from curanderos and Native American healers. The effort is to make sure that all voices in the alternative community are heard.
REDWOOD: Are you also reaching out to the medical establishment?
GORDON: Absolutely. We've just been planning our first research meeting for October 5th and 6th. This will be the first of two meetings on research issues. As part of this, we're asking major medical centers what they are doing in this area and why they are doing it. And if they're not doing research on CAM therapies, why not? We're also going to be asking major government agencies. Our role is to bring in everybody who is already interested in this area, or who we think could or should be interested, and find out what they're doing. And if they're not doing much, or doing anything, to ask why not. Also, to ask them what would make it easier for them to do work in this area. These are the kinds of questions we would be asking the dean of a medical school which has not done anything in CAM, or the head of a hospital system which was not particularly interested in CAM therapies. So our goal is to find out what's going on and what's in the way of moving ahead.
REDWOOD: Why do you think you were chosen to chair the commission?
GORDON: I think it's partly because I was the first chair of the Advisory Council for the Office of Alternative Medicine (OAM) and, more generally, because a lot of my work has been bringing together people from different worlds and helping them have a dialogue about what kinds of approaches to health care we should be taking. Also, I suppose, because I am a physician who has used complementary and alternative therapies for over 30 years. I integrate a variety of different systems, both in my work with patients and in my public work?irst, when I was a researcher at the National Institute of Mental Health (NIMH), then working with the OAM, and creating other programs. One of these is our nonprofit, the Center for Mind-Body Medicine, that embodies what I hope is the best of the modern western scientific method and the most exciting, hopeful, and promising of the complementary and alternative therapies.
That's what our annual cancer conference is about as well, bringing those groups together. That may have influenced the White House. Also, I know Mrs. Clinton read my book, Manifesto for a New Medicine and the President at least looked at it. So I assume they have a sense of what I'm about, who I am, and what my perspective is. I also think?nd this is partly based on a conversation with Mrs. Clinton?hat it's the fact that I am concerned with making sure that people of all income levels and all ethnic groups are involved in this process and have full access to everything that rich folks have access to. That perspective was probably an important one to them as well. A lot of the work I've done for the past 35 years has been with people who don't have money and don't ordinarily have access to these approaches.
REDWOOD: What are some of the ways you've brought together people from different worlds?
GORDON: I think that the most recent and ongoing example is the Comprehensive Cancer Care conferences. [See our book review section for a review of Dr. Gordon's new book, Comprehensive Cancer Care]. We just finished our third annual conference. What happens at the conference is that we're able to bring in the people who are doing the most exciting work, work that has not yet even been looked at by the traditional oncology community, people who a few years ago were persona non grata among oncologists. We're able to bring those people together with leaders of the cancer establishment. The leadership of the National Cancer Institute, and researchers and clinicians from some of the major cancer centers in the country?nd get them to talk together and think together about how to best study some of these approaches and how to integrate them into cancer care for everyone. So that's a significant example.
Another is that I've worked in D.C. since 1971, first with runaway and homeless kids and then with kids from the Latino and African-American communities, using a holistic approach to help these kids and their families deal with stress and trauma. I've worked with a variety of mind-body therapies, with yoga, meditation, Tai Chi and martial arts, nutrition, and exercise, teaching these kids, and their families and teachers in many instances, how to help themselves.
Then there's the other work that we've been doing in Kosovo and Bosnia for the past three years, bringing this holistic approach to people who are either in the middle of a war or in a post-war situation, to help them deal with stress and trauma. We've shared what we know, not only with doctors and nurses but also with teachers and leaders in the women's community in Kosovo, helping them to then help the mass of the population. These are just three examples of the way that I've tried to bring different worlds together and to offer these approaches to people who would not ordinarily have access to them.
REDWOOD: One of the critiques of alternative medicine has been that it is largely a middle and upper middle class phenomenon. You're talking here about models for branching out far beyond that.
GORDON: It has to happen. I think the receptivity is just as strong among people who don't have much money, and it's certainly there among people who are not white because in many instances they're much closer to this kind of healing and this kind of medicine than white upper middle class people. Their mothers or grandmothers were practicing some of these approaches. I've also worked over the past 10 years with about 5000 HIV-positive addicts in New York City, teaching a mind-body and holistic approach in a program that a friend of mine started. The receptivity is very, very high. Our work is to serve people, not just to serve people with money.
REDWOOD: Based on the scientific evidence now available, what complementary methods can cancer patients use with confidence?
GORDON: There are several areas in which there is enough evidence for me to recommend that every cancer patient use these approaches. The most important thing, I would say, which goes beyond any of the specific approaches, is to tell cancer patients that you can make a difference in your own health care, that you are not totally dependent on the oncologist. So the first thing is to help people see that they can help themselves. The second is mind-body approaches. There is clear evidence that, at the very least, such mind-body approaches as meditation, biofeedback, and guided imagery, can significantly reduce stress, enhance immune function, and help deal with pain a'd the nausea and vomiting of chemotherapy. That should be included in everybody's cancer care. Third is the use of nutritional therapies, including a basic program of supplementation that can improve people's chances for good health and for preventing recurrences, and that also can probably be used to help prevent cancer altogether. ***
There was a recent study in the New England Journal of Medicine, which showed that 70 percent of all cancer is related to environmental factors of one kind or another. Only 30 to 40 percent tops is genetics. Environment is pollution, environment is what you eat, it's how you think, what your life is like. The evidence is becoming clearer and clearer. So a basic program of nutrition is very important here.
Next would be a program of physical exercise. It's also clear that exercise enhances mood and can enhance immunity. We're going beyond the old myth, which was that cancer patients shouldn't do very much. Of course, the old myth also said that cancer patients should eat whatever they want to eat, which is also not a terribly good idea.
REDWOOD: Can Chinese medicine be helpful?
GORDON: Yes, and this is true of both Chinese herbs and acupuncture, in the hands of someone who is knowledgeable. With Chinese herbs, it's not a matter of saying this herb enhances immunity so let's grab it off the shelf. If you have cancer, you really need to find someone who knows about Chinese herbs, and ideally someone who knows about Chinese herbs in the treatment of cancer. It can make a big difference, and there are a number of studies indicating this.
REDWOOD: Are there many such practitioners spread widely throughout the country?
GORDON: There are increasing numbers of them. One of the things the commission has to do, which relates to our work on the cancer conference, is to find out who they are. There are people who are licensed as acupuncturists who don't know that much about herbs. In most states, you don't have to be an herbalist to receive an acupuncture license. But there are people who are becoming expert in both. There are a few in this area, the Washington, D.C. area. I know there are some in New York, some in Boston, and other major metropolitan areas. For those people who don't have access, there are some more general Chinese herbal therapies for which there is pretty good evidence.
Some of this work was presented at the Comprehensive Cancer Conference. Sophie Chen's work on prostate cancer, using a formula PC-SPES, looks very promising, as does Alexander Sun's work on non-small cell lung cancer. He's got a pretty good series of cases and is doing some more research. Both of them are developing formulas for other kinds of cancer as well.
Ideally, you find someone who can individualize the herbal treatment to your particular situation. That's the best way to do it. But if you can't, then there will be more general formulas. Debu Tripathy, an oncologist at the University of California at San Francisco, is now doing some excellent work in this area. So, I think increasingly for those people who don't have access, or don't know who the best trained Chinese herbalists are in their neighborhood, there will be formulas available that will have been tested in clinical trials.
And then, finally, there is group support. The evidence for group support being helpful not only in quality of life but in prolonging life for people with cancer, is as good as the evidence for a number of chemotherapies. I think group support should be available and recommended for every cancer patient. Not just a group that comes together occasionally, but a small group in which people are really helped to understand themselves and to help themselves.
REDWOOD: Are you talking about group support facilitated by a professional?
GORDON: Yes. I'm not saying other groups can't be helpful. I'm saying that the specific research, and certainly my experience here at the Center for Mind-Body Medicine, is working with small groups of 8, 9, or 10 people at most. We meet together over a period of weeks and the people with cancer have an opportunity to talk about their concerns and issues. At the same time, they're taught a variety of mind-body approaches and ways to help themselves.
The several approaches I've mentioned can be included in everybody's cancer care. Beyond that, there are techniques and other approaches that may be extremely helpful for some people but where we don't know enough about them to recommend them to everybody and in every situation. Many of those are presented in Comprehensive Cancer Care. Mistletoe, for example, is a very strong immune stimulant that is being used in Germany and other European countries quite a bit, and may have a major role to play in cancer care. Or some of the therapies like Burzynski's therapy or Gonzalez's therapy, which also may have important roles to play.
REDWOOD: Is it true at this point that no CAM methods have been shown to cure cancer?
GORDON: I'd say that's generally true. But on the other hand, there is data accumulating to show that some of the approaches are significantly prolonging life. We don't have follow-ups for long enough periods to know if it cures them, but that may just be a matter of time. If Nick Gonzalez [Nicholas Gonzalez, M.D., practices in New York City] has patients with pancreatic cancer who are alive four or five or eight or nine years later, do we count five-year survival as a cure? For five-year survival, yes, there are some [CAM therapies] that are showing that now. But cure means that you live as long as you would if you didn't have cancer, and we just don't have the statistics for that yet. But there are there are definitely therapies that are significantly prolonging survival of people with cancer, including Chinese herbal therapies used in combination with radiation and chemo. In that instance, it's a complementary therapy, but it's making a real difference in how long people live.
REDWOOD: How would you characterize the current degree of integration of alternative medicine in medical education?
REDWOOD: What else needs to happen?
GORDON: The first thing that needs to happen is that the people who are teaching in medical schools need to have both a personal experience and an intellectual experience of the efficacy of some of these therapies. Once that begins to happen on a wider basis, then I think they will begin to integrate these therapies more into the curriculum. At least in Western allopathic medical schools, it's extremely hard to change the basic curriculum. Even if you want to change a single lecture in biochemistry from one lecture to another, you may need months of curriculum meetings to do it. So to bring in a whole different worldview and a whole variety of other healing approaches is a major effort.
The state of the art is that in probably three-quarters of medical schools there is at least some kind of elective on alternative approaches to health care. It's there because large numbers of students and small numbers of committed faculty want to have it there. What I think is going to happen, in significant part because of the NIH push in this direction, is that a number of medical schools are going to come up with more comprehensive plans to integrate these therapies into all aspects of their curriculum.
I've worked on the Georgetown Medical School application for the NIH grant. Because the grant was available, some interested faculty (including some very prominent basic science faculty) thought, "This is a great idea, let's do this." So I worked with them on the grant, and we were able to get support from the dean's office and from a number of different departments. We have a plan, a way to integrate this approach into all years of the medical school curriculum. Until now at Georgetown, I've been teaching a lecture here, a seminar there, or an elective course. Our plan is to have required education in CAM therapies in all of the major parts of medical education. So I think in the next few years we're going to be taking a big step ahead.
REDWOOD: So the increased funding available through NCCAM and other federal sources is really helping to catalyze the expansion.
GORDON: Exactly. It's money and it's also the support and the imprimatur of the NIH. I mean, money always talks, but it talks much more coherently when it's the NIH that's giving it out. Because of this, many academics have felt much more comfortable expressing their own interest and being willing to take on a project in this area. I've seen this at Georgetown, where there are people who are very interested in this area, but they were previously interested on their own or in isolated research projects. Once the money and the opportunity became available, they were really ready to step up and be extremely helpful.
REDWOOD: You were the first Chair of the Advisory Committee for the Office of Alternative Medicine. Looking back ten years or so to the time before OAM existed, did you have any idea that by the year 2000 things would have progressed to the point they have?
GORDON: Let me think.
REDWOOD: I'm asking because it's been my sense that virtually no one-and you may be an exception-really saw in advance the leaps and bounds that would occur in the 1990s.
GORDON: I know that this approach makes sense and I know that there are a number of techniques that are helpful. It always seemed so obvious, and therefore it seemed to me that other people would come around to it as well. On one level, I couldn't imagine why it wouldn't happen. People-ordinary, non-physician type people-are often much more sensible than all of the medical establishment. If something makes sense to them and it works, then eventually it's going to happen, no matter what interests are arrayed against it.
I guess I'm optimistic by nature. I just kept seeing the increase in interest at every step along the way. Thirty years ago, when I was at NIMH and beginning to talk about this, there were certainly a lot of people who thought I was probably a nice fellow, working with runaway and homeless kids and all, but rather strange. They wondered, what were these alternative therapies all about? I said, "Well, I've come to it out of my experience of the limitations of other therapies." At this point, I think what's happened is that we've had such a long run, so much research, so many hundreds of billions of dollars being spent on conventional pharmacotherapy and surgery, that we've all seen its limitations. Just as I felt these limitations on my own body and in my own life, other people have as well, including lots of physicians. In a sense, it feels like this is just a redressing of an imbalance and an enlarging of our perspective.
I understood why people resisted these approaches because I had some of that resistance myself when I first heard about them. When I first heard about Chinese medicine in the 1960s, I thought, "What is this stuff? This is weird, this is different. Could this possibly work, energy circulating in the body?" It sounded like a nice idea. But once I began to experience it and look at it more deeply, it just became clear. I figure that people with open minds and people in need are going to discover the same kinds of things that I've been discovering.
So on one level I could say I'm surprised. Did I know when OAM started with $2 million that it would grow to $100 million? No, I can't say I specifically expected that. But did I think in some deep way that this approach was going to make a major difference in health care in this country? I think so. Again, it's a combination of a sense that "of course it's going to happen," and yet at the same time incredible surprise at seeing Andy Weil and Dean Ornish on the cover of news magazines, and seeing this interest in all these medical schools, and all these orthodox physicians who are coming around. It's a combination of pleasure and surprise, and at the same time, "Yeah, of course, why not? It should be happening!"
REDWOOD: If there were a single key message you'd like to impart to all healing arts professionals and students, what would it be?
GORDON: I'd say that the most crucial thing for physicians and students in all the health care professions is not their specific technique-whether it's allopathic medicine, or chiropractic, or acupuncture-but rather a worldview that has to emphasize first of all that being a physician is a privilege. That being a healer and a helper is a privilege, and that we're there to serve other people. This is not just about having a trade, or a profession, or a way of making money. The primary work that we do?his is the message of all medical traditions, but unfortunately it's often been lost?s to serve other people.
One of the fascinating things at this year's cancer conference was the clear message from patients that our role is not to promote our particular brand of healing, our particular technique. We had a wonderful panel of patients, ranging in age from 8 to 60. They said that one of the most crucial things to them in an oncologist, or any other physician, was that that person not only be willing to talk about what he or she was doing but also willing to help them consider all forms of healing. So it seems to me crucial that anybody who's in the health care professions be open to helping people find what's best for them, whether or not it's something that they themselves offer, and whether or not it's something that they're paid for.
The other thing is that people have a far greater capacity to help themselves than most of us ordinarily realize. The only way we as physicians are going to realize that other people can help themselves is by helping ourselves, by doing what we can to take care of ourselves, to become more self-aware, to learn more, and to deepen ourselves as human beings. If we can do that, then we can help other people do the same. For me, what's crucial, whether it's in our training programs for professionals, or in programs in medical schools, or with the commission, is really to come back to helping people help themselves, helping people to help one another, and making self-knowledge and self-care integral to all health education and all treatment of all people for all conditions.
Our work is not ultimately about relieving symptoms. That's part of our work. Our work is about helping human beings to live fulfilled lives. That's what the ultimate healing is about, and all our techniques are ultimately in the service of that. I think that's a really important message to get across, and especially to get across to physicians.
Every year we have our training program at the Center for Mind-Body
Medicine, which we now limit to 120 people. And every year, we have about six people, usually MDs, who come and say, "I didn't know I was going to have to work on myself. I didn't know I was going to have to use this guided imagery and meditation and knowledge about these therapies to help myself. I thought I was just going to learn to use this on my patients." No matter how many times we say in our brochure that healing others begins with self-healing, some people don't see it.
The wonderful thing, of course, is that after they've been in the training program for a few days, they get it. They say, "I'm glad I didn't see it. I wouldn't have come if I'd seen it. But now that I'm here, I realize how much help I need, and how important it is for me to learn how to take care of myself so I can then take care of other people."
REDWOOD: So it all leads back to the point of realizing that we're all in it together.
GORDON: That's right.
Daniel Redwood practices chiropractic and acupuncture in Virginia Beach, Virginia. He is the author of A Time to Heal: How to Reap the Benefits of Holistic Health and Contemporary Chiropractic. A collection of his writing is available at www.drredwood.com. He can be reached by e-mail at firstname.lastname@example.org