I WANT TO NOW CALL TO ORDER THE
OPEN SESSION OF THE 80TH MEETING
OF THE NATIONAL ADVISORY COUNCIL
FOR COMPLEMENTARY AND
INTEGRATIVE HEALTH.
I NOTE FOR THE RECORD THAT THIS
MEETING IS BEING HELD VIRTUALLY
FOR ALL COUNCILMEMBERS, MOST NIH
STAFF, AND THE PUBLIC.
MY NAME IS PARTAP KHALSA AND I
SERVE AS THE EXECUTIVE SECRETARY
FOR THIS COUNCIL AND AS PER
FEDERAL REGULATIONS, I'M THE
DESIGNATED FEDERAL OFFICIAL FOR
THIS MEETING OF THIS NATIONAL
ADVISORY COUNCIL.
THIS COUNCIL MEETING IS CONVENED
AS REQUIRED BY TITLE 42 OF THE
U.S. CODE OF LAWS THAT GOVERN
NIH IN GENERAL AND NCCIH
SPECIFICALLY, AND IN ACCORDANCE
WITH THE FEDERAL ADVISORY
COMMITTEE ACT THAT IS CODIFIED
IN TITLE 5 OF THE U.S. CODE OF
LAWS.
I NOTE THAT THE CLOSED SESSION
OF THIS COUNCIL WAS HELD EARLIER
THIS MORNING AND WAS CLOSED TO
THE PUBLIC IN ACCORDANCE WITH
THE GOVERNMENT IN THE SUNSHINE
ACT, AND AS CODIFIED IN TITLE
5 OF U.S. CODE, DEALING WITH
ADMINISTRATIVE PROCEDURES FOR
FEDERAL AGENCIES.
WE WILL ENDEAVOR TO FINISH THE
OPEN SESSION THIS AFTERNOON BY
4:30 P.M. EASTERN TIME.
THE OPEN SESSION OF COUNCIL IS
OPEN TO THE GENERAL PUBLIC TO
ATTEND BY A LIVE NIH VIDEOCAST
AND THIS CAN AND MAY BE VIEWED
BY INDIVIDUALS ACROSS THE
COUNTRY AND INDEED AROUND THE
WORLD.
THE OPEN SESSION WILL INCLUDE
REMARKS AND A REVIEW -- EXCUSE
ME, THESE REMARKS, AND THEY WILL
BE FOLLOWED BY THE NCCIH
DIRECTOR'S REPORT TO COUNCIL.
WE WILL THEN BREAK FOR LUNCH,
AND FOLLOWING LUNCH, WE WILL
RECONVENE AT 1:20 P.M. EASTERN
TIME AND THERE WILL BE A
PRESENTATION BY DR. DSOUZA ON
RESEARCH PRIORITIES FOR
TEMPOROMANDIBULAR DISORDERS AND
SHARED INTERESTS WITH NCCIH.
FOLLOWING THAT, THERE WILL BE A
MINI SYMPOSIUM ON CLINICAL
TRIALS TO ADDRESS STRESS IN
DIFFERENT CONTEXTS AND WHAT
MAKES TRIALS IMPACTFUL.
FINALLY, WE WILL HAVE THREE
CONCEPT CLEARANCES WHICH WILL BE
ON, FIRST, VALIDATION STUDIES OF
ANALYTICAL METHODS FOR DIETARY
SUPPLEMENT CONSTITUENTS.
THE SECOND CONCEPT WILL BE ON
RESEARCH NETWORKS TO PROMOTE
INNOVATIVE MECHANISTIC AND
TRANSLATIONAL STUDIES OF SICKLE
CELL DISEASE PAIN, AND THE THIRD
WILL BE ON BUILDING
CROSS-CUTTING RESEARCH NETWORKS
TO PROMOTE MULTIDISCIPLINARY
MECHANISTIC STUDIES OF MUSIC AND
HEALTH.
COUNCILMEMBERS HAVE ALREADY
RECEIVED A COPY OF THE
JANUARY 2022 MEETING MINUTES IN
THE ELECTRONIC COUNCIL BOOK, AND
AT THIS TIME, I WOULD LIKE TO
FINALIZE THE MINUTES,
SPECIFICALLY ARE THERE ANY
CORRECTIONS TO THE COUNCIL
MEETING MINUTES?
I'M GOING TO ASK COUNCILMEMBERS
IF THEY HAVE ANY COMMENTS TO GO
AHEAD AND RAISE THEIR DIGITAL
HANDS ON THE ZOOM OR WAVE AT ME
VIA THEIR VIDEO FEED.
SEEING NONE, I WILL ASK FOR A
MOTION FOR APPROVAL OF THE
MEETING MINUTES.
I NEED TO HEAR THAT AUDITOR ILY
BY ONE COUNCILMEMBER.
>> I MOVE.
>> AND A SECOND?
>> SECOND.
>> AND IS THERE ANY FURTHER
DISCUSSION BEFORE WE VOTE IN AND
SO WHAT I'D LIKE TO HAVE IS
THAT, AGAIN, THERE WILL BE A
POLL QUESTION APPEARING ON YOUR
SCREEN.
YOU'RE VOTING TO APPROVE THE
JANUARY 2022 COUNCIL MEETINGS, A
VOTE OF YES MEANS YOU'RE
APPROVING, A VOTE OF NO MEANS
YOU'RE NOT, AND YOU CAN ABSTAIN.
I SEE THE THING BUT I DON'T SEE
THE NUMBER OF COUNCIL VOTES.
CAN YOU TELL ME IF WE'VE GOT ALL
THE VOTES?
>> YES.
>> SO IT'S UNANIMOUS?
ALL RIGHT.
SO THE COUNCIL MINUTES ARE
APPROVED UNANIMOUSLY.
THANK YOU.
THERE WE GO.
LATE TO THE PARTY.
FUTURE COUNCIL MEETING DATES ARE
NOTED ON THE AGENDA WHICH
COUNCILMEMBERS HAVE ALREADY
RECEIVED.
OUR NEXT MEETING WILL BE ON
AUGUST 12TH, 2022, AS CLOSED
SESSION ONLY.
AND THAT WILL THEN BE FOLLOWED
BY A REGULAR MEETING OF COUNCIL
MEETING, BOTH CLOSED AND OPEN
SESSIONS, ON FRIDAY,
SEPTEMBER 9TH OF THIS YEAR.
IF THERE'S ANY CHANGE TO THESE
DATES FOR ANY REASON, IT WILL BE
ANNOUNCED IN ADVANCE.
PLEASE BE SURE TO LET US KNOW AS
SOON AS YOU KNOW IF YOU WILL NOT
BE ABLE TO ATTEND ANY GIVEN
MEETING.
THE LAST AGENDA ITEM FOR THE
OPEN SESSION LATER THIS
AFTERNOON IS A PUBLIC COMMENT
SESSION.
BECAUSE THIS COUNCIL MEETING IS
BEING HELD VIRTUALLY RATHER THAN
IN PERSON FOR ALMOST EVERYBODY,
THEN IT'S NOT POSSIBLE FOR
MEMBERS OF THE PUBLIC TO MAKE
IN-PERSON COMMENTS.
AS SUCH, ANY MEMBER OF THE
PUBLIC WHO WISHES TO MAKE A
PUBLIC COMMENT MAY DO SO BY
SENDING ME YOUR WRITTEN COMMENTS
WITHIN 15 DAYS OF THE CON CONCLN
OF THIS MEETING.
THIS CAN BE DONE EITHER BY EMAIL
OR HARD COPY LETTER.
YOUR WRITTEN COMMENTS SHOULD BE
LESS THAN 700 WORDS IN LENGTH,
WHICH IS CONSISTENT WITH A
FIVE-MINUTE ORAL PRESENTATION.
YOUR WRITTEN COMMENT WILL BE
ADDED TO THE MINUTES -- OR
SHARED TO COUNCIL VIA THE
ELECTRONIC COUNCIL BOOK.
DR. LANGEVIN, PLEASE PROCEED.
>> THANK YOU SO MUCH,
DR. KHALSA.
IT'S NOW MY DISTINCT PLEASURE TO
SHARE MY DIRECTOR'S REPORT TO
COUNCIL.
ALL RIGHT.
WE'RE GOING TO START WITH SOME
GENERAL NIH NEWS.
WE HAVE HAD RECENTLY THE
ANNOUNCED IMPENDING DEPARTURE OF
DR. NED SHARPLESS, WHO HAS
STEPPED DOWN AS THE DIRECTOR OF
THE NATIONAL CANCER INSTITUTE.
DR. SHARPLESS HAS BEEN DIRECTOR
OF THE NCI SINCE 2017.
AND HE ALSO, DURING THAT TIME,
WAS ASKED TO FILL IN AND ACT AS
THE ACTING COMMISSIONER FOR FOOD
AND DRUG AT THE U.S. FOOD AND
DRUG ADMINISTRATION, FDA, FOR
SEVEN MONTHS, IN 2019.
AND THEN HE CAME BACK TO NCI,
AND NOW, AFTER HIS DEPARTURE,
PRINCIPAL DEPUTY DIRECTOR
DOUGLAS LOWY IS SERVING AS NCI'S
ACTING DIRECTOR.
ANOTHER -- WE ALSO WANT TO
WELCOME DR. JULIE GERBEDING,
PREVIOUSLY SERVED AS DIRECTOR OF
THE CDC AS WELL AS THE CHIEF
PATIENT OFFICER AND EXECUTIVE
VICE PRESIDENT OF MERCK.
SO WE ARE VERY PLEASED THAT
SHE'S NOW GOING TO BE LEADING
FNIH.
NOW FOR SOME STAFF UPDATES AT
NCCIH.
WE WOULD LIKE TO ALL PLEASE JOIN
ME IN WELCOMING SEVERAL NULL
PROGRAM NEW
PROGRAM OFFICERS.
A NEW PROGRAM DIRECTOR IN THE
CLINICAL RESEARCH BRANCH AT
NCCIH, DR. CHIDEYA, WHERE HER
PORTFOLIO INCLUDES HEALTH
DISPARITIES, POPULATION HEALTH
AND DISEASE MANAGEMENT, MHEALTH
INTERVENTIONS AND PRODUCTS
RESEARCH.
SHE IS ESPECIALLY INTERESTED IN
FINDING -- EXPLORING THE UTILITY
OF NATURAL PRODUCTS FOR MENTAL
HEALTH AND ISSUES RELATED TO
PALLIATIVE CARE.
PRIOR TO JOINING NCCIH,
DR. CHIDEYA WORKED FOR APPLE,
WHERE SHE STRENGTHENED
POPULATION HEALTH INITIATIVES
AND SPEARHEADED A MULTI-PLATFORM
INTERVENTION FOR GENERALIZED
ANXIETY DISORDER.
SHE'S A TRAINED MEDICAL
EPIDEMIOLOGIST, AND WE ARE VERY,
VERY PLEASED TO HAVE DR. CHIDEYA
JOIN US AT NCCIH.
NEXT IS A PROGRAM DIRECTOR IN
THE CLINICAL RESEARCH BRANCH IN
THE DIVISION OF EXTRAMURAL
RESEARCH, OVERSEEING A PORTFOLIO
OF CLINICAL RESEARCH INCLUDING
HEALTH DISPARITIES, PEDIATRIC
RESEARCH ON MENTAL AND EMOTIONAL
WELL-BEING, MATERNAL MORBIDITY
AND MORTALITY AND PRAGMATIC
CLINICAL TRIALS.
ADDITIONALLY SHE CONTRIBUTES TO
THE MENTAL EMOTIONAL AND
BEHAVIORAL OR MEB FLISHTIVES, AS
WELL AS THE PRAGMATIC TRIALS
COLLABORATORY.
BEFORE JOINING NCCIH,
DR. JEAN-FRANCOIS SERVED AS
ADMINISTRATOR AT THE NATIONAL
INSTITUTE OF MINORITY HEALTH AND
HEALTH DISPARITIES, WHERE SHE
CO-LED THE DATA COORDINATING
CENTER FOR THE RADX INITIATIVE.
WELCOME, DR. JEAN-FRANCOIS.
NEXT I WOULD LIKE TO WELCOME DRM
DIRECTOR IN THE BASIC AND
MECHANISTIC RESEARCH BRANCH.
DR. TUTTLE CURRENTLY LEADS
SEVERAL TRANS-NIH INITIATIVES,
INCLUDING THE HEAL MYOFASCIAL
PAIN BIOMARKERS PROGRAM AND THE
FORCE BASED MANIPULATION
RESEARCH NETWORKS PROGRAM.
HIS ADDITIONAL PROGRAMMATIC
EFFORTS WILL INCLUDE DEVELOPING
RESEARCH INITIATIVES INVOLVING
MULTIORGAN SYSTEMS AND
MULTICOMPONENT INTERVENTIONS
CENTERING AROUND THE
MUSCULOSKELETAL SYSTEM.
PRIOR TO JOINING NCCIH,
DR. TUTTLE SERVED AS ACTING
CHIEF OF STAFF FOR THE NATIONAL
INSTITUTES OF NEUROLOGICAL
DISORDERS AND STROKE, OR NINDS.
HE ALSO SERVED AS A LEAD PROGRAM
ANALYST FOR THE HEAL ANALYST
THINK TANK.
SO WELCOME TO ALL OF THESE
WONDERFUL NEW PROGRAM STAFF.
I AM ALSO HAPPY TO WELCOME
DR. BACKONJA AS ACTING CLINICAL
DIRECTOR.
OF COURSE WE ALSO WANT TO THANK
DR. MARILYN POWELL, WHO HAS BEEN
SERVING AS THE ACTING CLINICAL
DIRECTOR AT NCCIH SINCE 2020.
FLAD TO HER WORK AT NCCIH,
DR. PAO HAS ALSO BEEN SERVING AT
THE NATIONAL INSTITUTES OF
MENTAL HEALTH.
INTRAMURAL RESEARCH PROGRAM.
WE TRULY APPRECIATE VERY, VERY
GRATEFUL FOR DR. PAO FOR
EVERYTHING SHE HAS DONE FOR US
AT NCCIH, AND WE REALLY LOOK
FORWARD TO CONTINUING TO WORK
WITH HER IN THE FUTURE.
WE ALSO NOW HAVE A NUMBER OF NEW
ARRIVALS AND DEPARTURES.
ONE DEPARTURE, RETIRING FROM THE
OFFICE OF POLICY PLANNING AND
EVALUATION, SHE'S BEEN AT NCCIH
FOR MANY YEARS, AND OUR NEW
ARRIVALS IN THE OFFICE OF
COMMUNICATIONS AND EXTRAMURAL
RESEARCH, EXTRAMURAL ACTIVITIES
AND INTRAMURAL RESEARCH AS WELL.
NOW OUR BUDGET.
SO JUST TO KIND OF GUIDE YOU
THROUGH A LITTLE BIT THIS
MECHANISM TABLE THAT WE SHOWED
TO SHOW TO
YOU EVERY TIME, OBVIOUSLY THE
NUMBERS THAT ARE HERE ARE ALWAYS
A LITTLE BIT LAGGING, BUT WHAT I
DO WANT TO POINT OUT IS THAT IN
FY 22, WE RECEIVED A 3.4%
INCREASE, SO OUR BUDGET WEN FROM
$153,000,616 YOU SEE AT THE
BOTTOM TO $159,000,365.
NOW, THIS ALSO KIND OF RESULTED
IN A GRADUAL SORT OF INCREASE IN
THE AMOUNT OF MONEY THAT WE HAVE
BEEN ABLE TO PUT TOWARDS
RESEARCH PROJECTS.
AT PREVIOUS COUNCILS WE HAD
TALKED ABOUT THE POSSIBILITY IN
THE FY 22 PRESIDENT'S BUDGET,
THERE HAD BEEN A SUBSTANTIAL
INCREASE TO NCCIH SPECIFICALLY
FOR PAIN RESEARCH.
THIS DID NOT COME TO FRUIT.
WE DID NOT GET THIS INCREASE.
HOWEVER, AS YOU CAN SEE IN THE
FY 23 BUDGET, THE INCREASE IS,
AGAIN, BACK IN THE PRESIDENT'S
BUDGET.
SO YOU CAN SEE THAT THE TOTAL AT
THE BOTTOM WOULD GO UP TO
$183 MILLION.
$183,000,368.
HOWEVER, AS WAS DEMONSTRATED
LAST YEAR, THE PRESIDENT'S
BUDGET DOES NOT OBVIOUSLY
GUARANTEE ANYTHING.
BUT THIS IS WHERE WE STAND RIGHT
NOW.
WE HAVE -- SO THERE IS A
PROPOSED $183 MILLION, SO AN
INCREASE OF $29 MILLION,
SPECIFICALLY $26 MILLION OF THIS
WOULD BE ALLOCATED TO EXPANDING
NCCIH'S RESEARCH INTO PAIN AND
PAIN MANAGEMENT.
THIS REALLY IS, YOU KNOW, A
REFLECTION OF THE VERY IMPORTANT
RESEARCH, LEADERSHIP AND
CONTRIBUTION THAT NCCIH HAS MADE
IN THE AREA OF PAIN IN THE PAST,
SO WE'LL JUST SEE WHAT HAPPENS
WITH THIS.
FOR SOME PROGRAM NEWS, AT BOTH
NIH AND NCCIH, I WANT TO JUST
GIVE A VERY QUICK UPDATE ON THE
BRIDGE2AI PROJECT INITIATIVE
THAT WE WERE HOPING TO HAVE SOME
AWARDS ANNOUNCED AT THIS COUNCIL
ROUND, BUT IT'S NOT GOING TO BE
UNTIL MAY OR EARLY JUNE, SO
WE'LL GIVE YOU AN UPDATE ON THIS
IN SEPTEMBER.
BUT HOWEVER, I AM DELIGHTED TO
ANNOUNCE OUR AWARDEES FOR THE
NEUROMECHANISMS OF FOR SPACE
MANIPULATION, JOINED BY NCCIH
AND THE NATIONAL INSTITUTES OF
NEUROLOGICAL DISORDERS AND
STROKE.
THIS PROGRAM IS FOCUSING ON
DEVELOPING INNOVATIVE AND
IMPACTFUL RESOURCES TO ADVANCE
OUR UNDERSTANDING OF BOTH NEURAL
MECHANISMS AND BIOMECHANICS
UNDERLYING FORCE-BASED
MANIPULATION.
SO YOU CAN SEE THE THREE AWARDS,
SO THESE ARE THREE SEPARATE
NETWORKS THAT WILL BE REALLY
KIND OF ESTABLISHING GROUPS OF
INVESTIGATORS TO REALLY GET THIS
WHOLE FIELD KIND OF LAUNCHED.
AND SOME GREAT NEWS FROM THE
ALL-OF-US RESEARCH PROGRAM.
THE NIH IS AWARDING $170 MILLION
OVER FIVE YEARS PENDING THE
AVAILABILITY OF FUNDS, OF
COURSE, TO CLINICS AND CENTERS
ACROSS THE COUNTRY FOR A NEW
PRECISION NUTRITION STUDY THAT
WILL DEVELOP ALGORITHMS TO
PREDICT INDIVIDUAL RESPONSES TO
FOODS AND ALSO DIETARY ROUTINES
OR BEHAVIORS.
SO THIS NUTRITION FOR PRECISION
HEALTH IS THE FIRST EMBEDDED
CLINICAL TRIAL IN THE ALL-OF-US
RESEARCH PROGRAM.
SO WE'VE OPINION BEEN EXPECW
WITH QUITE TREPIDATION BECAUSE
THE WHOLE POINT OF THE ALL-OF-US
PROGRAM IS TO ENROLL LARGE
NUMBERS OF HUMAN PARTICIPANTS,
BUT ALSO -- AND COLLECT DATA TO
ESTABLISH THIS VERY EXTENSIVE
DATABASE, BUT ALSO TO ENABLE
WHAT WE CALL ANCILLARY STUDIES
TO THIS ENORMOUS DATABASE THAT
WILL BE FUNDED SEPARATELY.
AND THIS IS THE FIRST ONE OF
THESE.
WE ANTICIPATE A NUMBER OF U54,
U24 AND UG1 PROJECTS FUNDED
THROUGH THE NUTRITION FOR
PRECISION HEALTH PROGRAM.
NOW PRECISION NUTRITION, OF
COURSE, ALIGNS VERY CLOSELY WITH
NCCIH'S INTERESTS AND OUR VERY
OWN CRAIG HOPP IS THE PROJECT
SCIENTIST ON THE METABOLOMICS
AND CLINICAL ASSAY CENTER.
NOW ALSO, NEARLY 100,000 HIGHLY
DIVERSE WHOLE GENOME SEQUENCES
ALONG WITH A WEALTH OF
ASSOCIATED PHENOTYPIC DATA FROM
ELECTRONIC HEALTH RECORDS,
WEARABLES, SURVEY DATA ARE
AVAILABLE THROUGH THE ALL-OF-US
RESEARCH PROGRAM.
THIS IS OPEN TO ANYONE WHO WANTS
TO ACCESS IT.
50% OF THESE DATA IS FROM -- I
MEAN INVESTIGATORS -- FROM
INDIVIDUALS -- 50% OF THE DATA
IS FROM INDIVIDUALS WHO IDENTIFY
WITH RACIAL OR ETHNIC GROUPS
THAT HAVE HISTORICALLY BEEN
UNDERREPRESENTED IN RESEARCH.
SO YOU CAN SEE HERE THE LARGE
NUMBERS OF GENOME SEQUENCES THAT
WILL BE ASSOCIATED WITH EACH OF
THE VARIOUS DIFFERENT TYPES OF
DATA.
WE ARE VERY MUCH LOOKING FORWARD
TO SOME ANTICIPATED FUNDING OF
OPPORTUNITY ANNOUNCEMENTS
REGARDING ADDITIONAL ANCILLARY
STUDIES.
ANOTHER VERY, VERY IMPORTANT
AREA THAT'S REALLY GETTING A LOT
OF ATTENTION NIH-WIDE IS
MATERNAL MORTALITY.
WE KNOW ESPECIALLY THAT THERE IS
TWO TO THREE TIMES MORE
LIKELY -- MORTALITY IS 23 TIMES
MORE LIKELY IN AMERICAN INDIAN,
ALASKA NATIVE AND BLACK WOMEN,
THE MORTALITY RATE FROM A
PREGNANCY-RELATED CAUSE, THAN IN
WHITE WOMEN.
SO THIS IS A HUGE PRIORITY AT
NIH AND MULTIPLE ICS HAVE
INVESTED IN RESEARCH TO PREVENT
MORBIDITY AND MORTALITY AND
OVERALL HEALTH OF PREGNANT
WOMEN.
SO AT NCCIH, WE'RE WATCHING THIS
SPACE VERY CLOSELY, AND WE'RE
KEEPING OUR FINGER ON THE PULSE
OF THESE NIH-WIDE PROJECTS AND
WE'LL LET YOU KNOW WHEN FUNDING
OPPORTUNITY ANNOUNCEMENTS ARE
AVAILABLE FOR IMPLEMENTATION
RESEARCH IN THIS VERY IMPORTANT
AREA.
WE'RE PARTICULARLY INTERESTED IN
COMPLEMENTARY HEALTH APPROACHES
FOR MANAGING THE VARIOUS
DIFFERENT ASPECTS OF PREGNANCY
THAT COULD LEAD TO IMPROVED
HEALTH OUTCOMES FOR PREGNANT
WOMEN.
NOW AS I'VE PRETTY MUCH BEEN
DOING FOR THE LAST TWO YEARS,
GIVING YOU A LITTLE BIT OF
UPDATES ON WHAT'S HAPPENING IN
THE AREA OF COVID.
ONE VERY IMPORTANT INITIATIVE IS
THE ROSALIND TRACKER.
THIS IS VERY IMPORTANT BECAUSE
IT'S A REALTIME TRACKER TO
SUPPORT THE RAPID GENOTYPING FOR
SARS-COV-2.
THE CURRENT SITUATION RIGHT NOW
IS MOST OF THE PRIMARY METHOD
FOR DETECTING VARIANTS IS NEXT
GEN SEQUENCING.
THE PROBLEM WITH THIS FIRST OF
ALL IS IT'S EXPENSIVE AND IT CAN
TAKE MANY WEEKS BEFORE
SEQUENCING DATA IS AVAILABLE IN
PUBLIC DATA REPOSITORIES.
THE ROSALIND TRACKER IS VERY
NOVEL AND IMPORTANT BECAUSE IT
USES A PCR-BASED GENOTYPING
APPROACH THAT REALLY IS VERY,
VERY QUICK.
IT CAN BE IMPLEMENTED IN ANY
TESTING LAB THAT PERFORMS PCR,
AND IT'S SIGNIFICANTLY LESS
EXPENSIVE.
SO YOU CAN SEE HERE FROM THE BAR
GRAPH THAT OVER THE LAST 60
DAYS, THE BA2, BA3 VARIANT HAS
BECOME DOMINANT OVER THE OTHER
OMICRON VARIANTS, BUT HOWEVER,
THERE'S SOME VARIATION BY STATE.
SO IT'S REALLY IMPORTANT THAT WE
HAVE METHODS THAT ARE ABLE TO
REALLY DETECT THIS IN REALTIME
AS THESE VARIANTS ARE SORT OF,
YOU KNOW, POPPING UP AND
SPREADING.
SO THIS RESEARCH IS SUPPORTED
WITH FUNDING FROM NIBIB AS PART
OF THE RAPID ACCELERATION OF
DIAGNOSTICS OR RADX INITIATIVE.
NOW, IN MARCH, THE FDA
AUTHORIZED A FOURTH DOSE OR THE
SECOND BOOSTER OF PFIZER AND
OTHER -- AND MODERNA VACCINES
AND OTHER VACCINES FOR OLDER AND
CERTAIN IMMUNOCOMPROMISED
POPULATIONS.
AND THE NEW ENGLAND JOURNAL OF
MEDICINE STUDY THAT WAS
PUBLISHED RECENTLY FROM A
RESEARCH GROUP IN ISRAEL, VERY
CONVINCINGLY SHOWED THAT A
SECOND BOOSTER SIGNIFICANTLY
DECREASES THE LIKELIHOOD OF
HOSPITALIZATION, SEVERE
INFECTION AND DEATH.
YOU CAN SEE THESE CURVES, THE
DIFFERENCE BETWEEN THE RED AND
THE BLUE LINES ARE VERY
CONVINCING.
SO IF THERE WAS EVER ANY DOUBT
THAT THESE BOOSTERS ARE DOING
SOMETHING, REALLY THIS IS IT.
NOW, A NEW NATIONWIDE TEST TO
TREAT INITIATIVE, THIS IS VERY
IMPORTANT, WAS ALSO LAUNCHED IN
MARCH BY THE BIDEN-HARRIS
ADMINISTRATION TO ALLOW
INDIVIDUALS TO QUICKLY ACCESS
FREE LIFE SAVING TREATMENTS FOR
COVID-19.
SO THIS TEST TO TREAT PROGRAM
MEANS THAT IF YOU GO TO A
CERTAIN AREA, PLACE TO BE
TESTED, FOR EXAMPLE, AT CERTAIN
PHARMACIES OR HEALTH RESOURCES
SERVICE ADMINISTRATION SUPPORTED
FEDERALLY QUALIFIED HEALTH
CENTERS, THEN YOU CAN -- IF YOU
TEST POSITIVE AND TREATMENTS ARE
APPROPRIATE, YOU CAN RECEIVE A
PRESCRIPTION FROM A HEALTHCARE
PROVIDER RIGHT THERE ON THE SPOT
AND HAVE PRESCRIPTIONS FILLED AT
THAT LOCATION.
THESE ARE AT PHARMACY-BASED
CLINICS THAT HAVE THESE KINDS OF
FACILITIES.
BUT THIS IS GOING TO BE VERY
IMPORTANT GOING FORWARD TO MAKE
SURE THAT WE TAKE FULL ADVANTAGE
OF THE KIND OF LIFE SAVING
MEDICATIONS THAT WE NOW HAVE.
NOW ANOTHER VERY IMPORTANT
COURSE OF THIS PANDEMIC IS POST
COVID, OR WHAT WE CALL PAS, POST
COVID SEQUELAE OR LONG COVID.
WE KNOW THAT RECOVERY FROM
SARS-COV-2 INFECTION IS
EXTREMELY VARIABLE.
MANY PATIENTS RECOVER VERY
QUICKLY AND HAVE MINIMAL
SYMPTOMS, BUT OTHERS REALLY HAVE
PROMINENT SYMPTOMS THAT CAN
CONTINUE ON FOR QUITE A WHILE,
INVOLVING MULTIPLE ORGAN SYSTEMS
AND REALLY CAN SIGNIFICANTLY
AFFECT QUALITY OF LIFE.
SO THE MAGNITUDE OF THE PUBLIC
HEALTH IMPACT OF THESE SEQUELAE
IS POTENTIALLY VERY LARGE, GIVEN
THE NUMBER OF INDIVIDUALS ACROSS
ALL THE AGE SPECTRUMS THAT HAVE
ALREADY BEEN AFFECTED AND WILL
CONTINUE PROBABLY TO BE INFECTED
WITH SARS-COV-2.
SO THIS REQUEST FOR APPLICATIONS
IS TO SOLICIT APPLICATIONS
PROPOSING CLINICAL TRIAL
PROTOCOLS TO BE FINALIZED AND
EXECUTED RAPIDLY FOR THE
IDENTIFICATION OF SAFE AND
EFFECTIVE TREATMENTS AND
PREVENTIVE STRATEGIES VERY
IMPORTANTLY FOR PASC IN THOSE
OVER 18 YEARS OF AGE.
WE ANTICIPATE FURTHER
OPPORTUNITIES FOR TRIALS
INVOLVING CHILDREN.
SO WE'RE REALLY INTERESTED OF
COURSE IN THIS AREA FROM POINT
OF VIEW OF CHRONIC STRESS AND
STRESS MANAGEMENT AND BEHAVIORAL
INTERVENTIONS THAT CAN HELP TO
SORT OF STRENGTHEN OVERALL
HEALTH, BECAUSE WE THINK THIS IS
VERY IMPORTANT.
OUR OVERALL HEALTH AND THE
FUNCTION OF OUR IMMUNE SYSTEMS
IS NOT JUST AN ISOLATED EVENT.
IT REALLY FENDS ON A LOT OF
FACTORS THAT ARE INFLUENCED BY
SELF-CARE AND ATTENTION TO
NUTRITIONAL, PSYCHOLOGICAL,
PHYSICAL, ET CETERA, KIND OF
ASPECTS OF HEALTH.
SO WE THINK THIS IS GOING TO BE
VERY, VERY IMPORTANT.
I ALSO WANT TO HIGHLIGHT SOME
RESEARCH, SOME RECENT
PUBLICATIONS INCLUDING SEVERAL
PAPERS FROM OUR CURRENT AND PAST
INTRAMURAL RESEARCHERS,
ESPECIALLY RICHARD -- AS WELL AS
LAURA CASE WHO WAS PREVIOUSLY A
POSTDOCTORAL FELLOW, NOW
ASSISTANT PROFESSOR AT U.C.
SAN DIEGO.
AND SO IF YOU HAVE A CHANCE TO
CHECK THESE OUT, THESE ARE ALL
IN YOUR PACKET.
AND I ALSO WANT TO POINT OUT
THIS STUDY FROM UNIVERSITY OF
WASHINGTON IN SEATTLE, WHERE
RESEARCHERS LOOKED AT WHETHER OR
NOT RESIDENTIAL GREEN SPACES ARE
ASSOCIATED WITH A RISK OF
DEMENTIA AMONG OLDER ADULTS.
THIS WAS A STUDY, AN ANCILLARY
STUDY FROM THE GINKGO EVALUATION
OF MEMORY STUDY, THE GEM STUDY,
WHERE 3,000 PARTICIPANTS 75 OR
OLDER WERE ENROLLED BETWEEN 2000
AND 2008.
AND THEY WERE ABLE TO GO BACK
AND LOOK AT ASSOCIATIONS BETWEEN
THE GREEN AREAS, GREENSPACE
SURROUNDING WHERE PEOPLE LIVE
AND WERE ABLE TO CONTROL FOR
MULTIPLE FACTORS, INCLUDING
SOCIAL -- NEIGHBORHOOD
SOCIOECONOMIC STATUS.
WHAT THEY FOUND IS THAT EVIDENCE
FOR ASSOCIATION BETWEEN THE
GREENSPACES AND ALL CAUSE
DEMENTIA SUGGESTING THAT
GREENSPACES MAY ACTUALLY BE
PROTECTIVE.
SO IT WILL BE INTERESTING TO
FOLLOW HOW THIS KIND OF RESEARCH
EVOLVES.
THIS IS YOU A 'NOTHER ANG
STUDY WHERE RESEARCHERS SHOW
THAT GUT MICROBIOME, DIVERSITY
AND ABUNDANCE CORRELATES WITH
GREY MATTER VOLUME IN THE
HIPPOCAMPUS AND NUCLEUS
ACCUMBENS IN OLDER ADULTS WITH
DEPRESSION.
SO LOOKING ACROSS THE DIFFERENT
SYSTEMS OF THE BODY, THIS TIME
THE GUT AND THE BRAIN, AND
ALTHOUGH THIS WAS AL SMALL
STUDY, THE DATA SUGGESTS THAT
THE GUT MICROBIOME MAY REFLECT
AND INFLUENCE BRAIN HEALTH IN
GERIATRIC DEPRESSION.
THE STUDY WAS PARTIALLY FUNDED
BY NCCIH AND WITH A K24 AWARD TO
HELY LEF
HELEN LAVRETSKY.
INCREASING CONSUMPTION OF ORAL
SUPPLEMENTS MADE FROM KRATOM
LEAVES IS VERY MUCH ON THE RISE
IN TERMS OF PEOPLE USING THESE
HERBS AND HERBAL DERIVATIVES TO
MANAGE OPIOID WITHDRAWAL
SYMPTOMS IN THE EAST, FOR
EXAMPLE, INDONESIA, VERY MUCH
EVERYBODY WHO HAS A BACKYARD HAS
A KRATOM TREE.
AND PEOPLE PICK THE LEAVES AND
DRINK IT AS TEA.
IT'S VERY, VERY COMMON.
AND THIS HAS BEEN USED IN THIS
COUNTRY FOR WITHDRAWAL SYMPTOMS
AND PAIN, BUT UNFORTUNATELY,
THIS IS LEADING TO INCREASED
KRATOM-LINKED OVERDOSES AND
DEATH.
SO WE NEED TO UNDERSTAND WHAT'S
GOING ON.
IN THIS STUDY FROM MARY PAINE'S
GROUP, UNIVERSITY OF SEATTLE IN
WASHINGTON, THE TEAM PERFORMED A
COMPREHENSIVE PHARMACOKINETIC
CHARACTERIZATION OF KRATOM
ALKALOIDS IN SIX HEALTHY ADULTS
WHO WERE ADMINISTERED A SINGLE
LOW DOSE WELL CHARACTERIZED
KRATOM PRODUCT AS A TEA, WHICH
IS THE MOST COMMON ROUTE OF
CONSUMPTION WORLDWIDE.
THIS IS A REALLY IMPORTANT
RESULT TO OPEN THE DOOR TO FUEL
TOUR STUDIES THAT WILL ENABLE
REGULATORY AGENCIES TO MAKE
INFORMED DECISIONS ABOUT THE
SAFE USE OF THIS INCREASINGLY
POPULAR BOTANICAL PRODUCT AND
ADDRESSING IMPORTANT PUBLIC
HEALTH CONCERNS.
THIS WAS FUNDED BY NCCIH AND
ODS.
I WOULD ALSO LIKE TO MENTION A
VERY EXCITING STUDY FROM
DR. ERIC GARLAND'S GROUP,
SUCCESSFUL TREATMENT OF OPIOID
MISUSE AMONG PEOPLE WITH CHRONIC
PAIN WHICH IS, AS WE KNOW, VERY
CHALLENGING.
THIS IS A NIDA-FUNDED RANDOMIZED
CONTROLLED TRIAL WHERE
DR. GARLAND'S GROUP SHOWED THAT
THE MINDFULNESS ORIENTED
RECOVERY ENHANCEMENT OR MORE
INTERVENTION LED TO SUSTAINED --
SO VERY IMPORTANT RESULTS.
JUST WANT TO GO THROUGH SOME
NCCIH FUNDING OPPORTUNITIES.
I'M GOING TO START WITH A --
ACTUALLY IT'S NOT FUNDING BUT
THIS IS A REQUEST FOR
INFORMATION, OR RFI, TO IDENTIFY
A SET OF DETERMINANTS FOR WHOLE
PERSON HEALTH.
NOW WE'RE VERY INTERESTED IN
THIS, VERY EXCITED ABOUT THIS
RFI, BECAUSE THIS IS REALLY A
FOLLOW-UP FROM A LOT OF THE
INFORMATIONS
CONVERSATIONS WE'VE BEEN HAVING
AT NCCIH THROUGHOUT OUR WHOLE
PERSON BOTH INTERNAL AND
EXTERNAL WORKING GROUPS AS WELL
AS COUNCIL, INPUT THAT WE HAVE
GOTTEN FROM ALL OF YOU IN TERMS
OF THE IMPORTANCE OF
UNDERSTANDING THE FACTORS THAT
INFLUENCE WHOLE PERSON HEALTH.
THIS IS NOT A SIMPLE THING.
YOU CAN IMAGINE, WHAT WE'RE
GOING TO BE ASKING FOR IN THIS
RFI, AND I HOPE THAT ALL OF YOU
EITHER HAVE BEEN OR WILL
HOPEFULLY RECEIVE EMAILS ABOUT
THIS.
WE'VE ALSO REALLY KIND OF BEEN
BLASTING THIS FOR ALL OF OUR
COMMUNICATION CHANNELS.
WHAT WE'RE ASKING PEOPLE IS TO
GIVE A LIST OF 20 FACTORS THAT
INFLUENCE WHOLE PERSON HEALTH,
INCLUDING ALL OF THE DIFFERENT
DOMAINS.
BIOLOGICAL, BEHAVIORAL, SOCIAL
AND ENVIRONMENTAL.
WE PICKED THE NUMBER 20
ARBITRARILY, BASICALLY BECAUSE O
MUCH, AND SO WE KIND OF SHOT
SOMEWHERE IN THE MIDDLE, AND
IT'S NOT GOING TO BE THE FINAL
NUMBER OBVIOUSLY, WE'RE GOING TO
SEE WHAT INPUT WE GET.
BUT WE REALLY WANT TO TRY TO
DEFINE, WHAT ARE THE MAIN
FACTORS IF YOU HAD TO NAME 20
FACTORS THAT ARE REALLY MOST
IMPORTANT, WHAT WOULD THEY BE?
SO THIS IS AN EXPERIMENT.
WE WANT TO HEAR WHAT WE GET FROM
THE COMMUNITY, FROM ALL OF YOU,
SO PLEASE SPREAD THE WORD ABOUT
THIS.
WE REALLY HOPE TO GET -- AND THE
RFI IS OPEN RIGHT NOW ON OUR
WEBSITE FOR RESPONSE.
I WANT TO ALSO POINT OUT A NOSI
AIMED AT PROMOTING CHILDREN'S
MENTAL, EMOTIONAL AND BEHAVIORAL
HEALTH IN SCHOOL SETTINGS.
WITH A PARTICULAR FOCUS ON
SCHOOLS THAT SERVE HEALTH
DISPARITY POPULATIONS AND OTHER
VULNERABLE POPULATIONS LIKELY TO
BE UNDERRESOURCED.
WE KNOW THAT MENTAL HEALTH IN
SCHOOLS RIGHT NOW IS REALLY
BECOMING AND ACUTE PROBLEM,
REALLY AN EMERGENCY, SO WE THINK
THIS NOSI IS VERY TIMELY.
ACTUALLY I'M JUST GOING TO
QUICKLY GO BACK TO THE RFI FOR
ONE SECOND.
I FORGOT TO MENTION THAT OUR
ULTIMATE GOAL OF THIS RFI IS NOT
SIMPLY TO IDENTIFY FACTORS, BUT
TO IDENTIFY MEASURES.
SO ONCE WE GET THE INPUT FROM
THE FACTORS, WHAT WE'RE GOING TO
DO IS WE'RE GOING TO BE TAKING
EACH OF THESE FACTORS ONCE WE'VE
DETERMINED THE LIST AND
ASSOCIATE THESE FACTORS WITH A
LIST OF DATA ELEMENTS,
MEASURABLE.
AND THESE COULD BE FROM
QUESTIONNAIRES, FROM WEARABLE
SENSORS, GEOSPATIAL DATA, HEALTH
RECORDS, TO DEFINE EACH OF THESE
FACTORS, AND THEN TO DEVELOP A
SET OF COMMON DATA ELEMENTS THAT
PEOPLE CAN USE TO REALLY IMPROVE
THE RIGOR AND REPRODUCIBILITY
AND GENERALIZABILITY OF THE
STUDIES THAT PEOPLE DO ON WHOLE
PERSON HEALTH.
I WANT TO NOW ALSO POINT OUT
ANOTHER NOSI, NOTICE OF SPECIAL
INTEREST, THAT ENCOURAGES
APPLICATIONS FOR ADMINISTRATIVE
SUPPLEMENTS TO NCCIH SUPPORTED
AWARDS TO SUPPORT COMPLEMENTARY
HEALTH PRACTITIONERS IN AN
INTENSIVE, SUPERVISED RESEARCH
EXPERIENCE THAT WILL LEAD TO A
BETTER UNDERSTANDING OF AND
PRACTICAL EXPERIENCE IN
COMPLEMENTARY AND INTEGRATIVE
HEALTH RESEARCH.
NOW THIS RESEARCH OPPORTUNITY
SUPPORTED UNDER THIS NOSI IS
INTENDED TO PROVIDE A VEHICLE
FOR COMPLEMENTARY HEALTH
PRACTITIONERS TO OBTAIN RESEARCH
SKILLS THAT WILL BENEFIT THE
COMPLEMENTARY HEALTH RESEARCH
COMMUNITY, AS THESE INDIVIDUALS
BRING VERY IMPORTANT IN DEPTH
KNOWLEDGE OF THE DME MEN COY
HEALTH RESEARCH TO THE
ENTERPRISE.
NOW WE ALREADY HAVE RECEIVED A
NUMBER OF APPLICATIONS TO THIS
VERY IMPORTANT RFA ON THE
HEALTHCARE RESEARCH
COLLABORATORY PRAGMATIC AND
IMPLEMENTATION TRIALS OF
EMBEDDED INTERVENTIONS.
BUT I JUST WANT TO POINT OUT
THAT THERE'S ANOTHER RECEIPT
DATE ON JUNE 18TH, SO THERE'S
STILL TIME TO SUBMIT APPLICATION
IS FOR THIS RFA.
NEXT, THIS IS AN OPPORTUNITY FOR
EXISTING T32 TRAINING PROGRAMS
TO APPLY FOR ADMINISTRATIVE
SUPPLEMENT TO SUPPORT ADDITIONAL
TRAINING SLOTS FOR PRE-DOCTORAL
AND POST-DOCTORAL CANDIDATES
FROM DIVERSE BACKGROUNDS,
INCLUDING THOSE FROM GROUPS THAT
ARE UNDERREPRESENTED IN THE
BIOMEDICAL, CLINICAL, BEHAVIORAL
AND SOCIAL SCIENCES.
AND THE NEXT RECEIPT DATE FOR
THIS IS JULY 2ND.
ALSO HERE'S AN OPPORTUNITY FOR
ADDITIONAL T32 -- I JUST SAID
THAT.
DID I DUPLICATE THIS SLIDE?
YEAH.
SORRY.
NOW I WILL MENTION A FEW UPDATES
REGARDING THE HEAL INITIATIVE,
OR HEALTH ADDICTION -- TO END
ADDICTION LONG TERM.
NOW, AS I MENTIONED IN PREVIOUS
REPORTS, WE HAVE OUR SICKLE CELL
DISEASE AND PAIN INITIATIVE THAT
IS PART OF THE HEAL INITIATIVE,
THIS IS FUNDED BY THE HEAL
INITIATIVE.
WE HAD A FANTASTIC TURNOUT AT
OUR WORKSHOP LAST JULY WHICH
RESULTED IN A REQUEST FOR
APPLICATIONS, AND WE HAVE
RECEIVED APPLICATIONS, THE
RECEIPT DATES ARE NOW CLOSED AND
THESE APPLICATIONS ARE UNDER
REVIEW AND WE LOOK FORWARD TO
GIVE YOU AN UPDATE ON THIS
LATER, AT A LATER DATE.
I ALSO WANT TO MENTION THE
MYOFASCIAL PAIN INITIATIVE, ALSO
FUNDED BY THE HEAL INITIATIVE TO
DEVELOP QUANTITATIVE IMAGING
BIOMARKERS OF BIOFACIAL TISSUES,
PREDICT OUTCOMES FOR A VARIETY
OF PAIN MANAGEMENT.
APPLICATIONS AGAIN ARE UNDER
REVIEW AND WE WILL GIVE YOU SOME
UPDATES ON THESE.
I WANT TO ALSO MENTION THAT WE
CONTINUE TO BE INTERESTED FOR
BOTH THE MYOFASCIAL PAIN AND THE
SICKLE CELL PAIN.
WE CONTINUE TO BE INTERESTED IN
THESE TOPICS SO WATCH OUT FOR
POSSIBLE ADDITIONAL RECEIPT
DATES ON THESE INITIATIVES.
HERE IS ANOTHER INITIATIVE
CURRENTLY UNDER REVIEW,
RESTORING JOINT FUNCTION THAT
REFLECTS A VERY IMPORTANT
COLLABORATION BETWEEN THE
NATIONAL INSTITUTES OF ARTHRITIS
AND MUSCULOSKELETAL DISEASES AND
SKIN DISEASES, NCCIH, NINDS,
NEUROLOGICAL DISEASE AND STROKE,
NIDCR, DENTAL AND CRANIOFACIAL
RESEARCH, NIBIB, BIOMEDICAL
ENGINEERING BIOIMAGING, AND
NATIONAL INSTITUTE ON AGING.
AND THE GOAL IS TO DEFINE -- OF
THIS PARTICULAR INITIATIVE IS TO
DEFINE THE INNERVATION OF THE
DIFFERENT ARTICULAR AND
PERIARTICULAR TISSUES THAT
COLLECTIVELY FORM THE JOINT,
INCLUDING BONE, CARTILAGE,
SYNOVIUM, JOINT CAPSULES,
LIGAMENTS, TENDONS, FASCIA,
MUSCLE, ET CETERA.
THESE COMPONENTS, AS WE TALKED
ABOUT THIS AT A PREVIOUS COUNCIL
DISCUSSIONS, VERY IMPORTANT TO
THINK ABOUT A WHOLE JOINT
APPROACH, AND WE WILL BE REALLY
LOOKING AT USING THESE AS A
PLATFORM FOR LOOKING AT
PREVENTIVE STRATEGIES TO PREVENT
THE DEVELOPMENT OF JOINT PAIN
AND DYSFUNCTION.
SO AGAIN, WE HAD A NUMBER OF
APPLICATIONS FOR THESE AND
THEY'RE CURRENTLY BEING
REVIEWED.
PAST ACTIVITIES AS ACTIV.
ARE THEY CONVENED THE THIRD
ANNUAL MEETING, FEDERAL
OFFICIALS AND OTHER STAKEHOLDERS
ACROSS THE COUNTRY TO IDENTIFY
OPPORTUNITIES TO ADVANCE THE
GOALS OF THE INITIATIVE.
AND A RECORDING OF THIS EVENT
CAN BE FOUND ON THE NIH
VIDEOCAST WEBSITE.
NOW, THIS IS ANOTHER IMPORTANT
PAST EVENT, INTERNATIONALLY
INTERDISCIPLINARY WORKSHOP
FOCUSED ON THE THEME OF CREATIVE
MOVEMENT AND THE BRAIN.
IT WAS A WONDERFUL SUCCESS.
THIS IN-PERSON WORKSHOP TOOK
PLACE AT THE WOLF TRAP NATIONAL
PARK FOR THE PERFORMING ARTS AND
THE PLANNING COMMITTEE INVITED
AN EXCEPTIONALLY WIDE RANGE OF
SCIENTIST, ENGINEERS, CLINICIANS
TO EXCHANGE IDEAS AND TO
INTEGRATE KNOWLEDGE AND
EXPERIENCE AMONG CREATIVE
MOVEMENT PROFESSIONALS AND OTHER
PERFORMING ARTISTS.
AND THE PRIMARY GOAL OF THE
EVENT -- GOALS WERE TO ENCOURAGE
ALL PARTICIPANTS TO REACH BEYOND
THE CONFINES OF THEIR EXPERTISE
TO EXPLORE THE SCIENCE OF
LEARNING TO MOVE.
HOW THE CREATIVE PROCESS HAD
MANIFESTED IN THE BRAIN AND HOW
IT CAN BE HARNESSED TO ENHANCE
HEALTH AND QUALITY OF LIFE.
SO VERY, VERY EXCITING.
THE NCCIH HOT TOPICS WEBINAR
RECENTLY FEATURED A CONVERSATION
BETWEEN DR. EMILY EDWARDS,
MYSELF AND TWO OUTSTANDING
RESEARCHERS FROM THE UNIVERSITY
OF MINNESOTA.
WE HAD A VERY INFORMATIVE
DISCUSSION ON THE INTERSECTION
OF RESEARCH ON STRUCTURAL RACISM
AND DISCRIMINATION AND WHOLE
PERSON HEALTH.
THIS WAS VERY WELL ATTENDED.
WE HAD 549 ATTENDEES AND A
RECORDING CAN BE FOUND ON THE
NIH VIDEOCAST SITE.
NOW WE ALSO HAD A TWO-DAY
STEERING COMMITTEE MEETING THAT
CELEBRATED THE 10 YEARS OF THE
COLLABORATORY HEALTHCARE --
PRAGMATIC TRIALS COLLABORATORY
WHICH HAS RECENTLY BEEN
REBRANDED.
THIS IS THE PREVIOUS HEALTHCARE
SYSTEMS RESEARCH COLLABORATORY
WHICH NOW HAS A NEW NAME.
AND THE DISCUSSIONS OF THE
EVOLUTION AND CURRENT LANDSCAPE
OF EMBEDDED PRAGMATIC CLINICAL
TRIALS SHARED THOUGHTS ON
PRIORITIES FOR THE FUTURES OF
THESE CLINICAL TRIALS INCLUDING
HOW TO BETTER SERVE DIVERSE
POPULATIONS, AND HEAR UPDATES ON
PROGRESS AND TRANSITION PLANS
FROM THE UG3 DEMONSTRATION
PROJECTS.
IT ALSO FOCUSES ON CHALLENGES
AND LE SOBS LESSONS LEARNEDE
DEMONSTRATION PRACTICE AS WELL
AS THE LATEST BIOETHICS
ACTIVITIES OF THE NIH
COLLABORATORY.
DR. CHRISTOPHER MCCURDY SLIVERED
AN EXCELLENT PRESENTATION ABOUT
THE CONTROVERSIAL KRATOM ONCE
AGAIN IN THE CONTEXT OF THE
OPIOID CRISIS EVENT.
HAD A GREAT TURNOUT WITH
864 TOTAL VIEWS, BOTH LIVE AND
ON DEMAND.
AND ANOTHER SUCCESSFUL PAST
EVENT, THE PRECISIONS PROBIOTICS
WORKSHOP THAT IDENTIFIES
KNOWLEDGE GAPS FROM CURRENT
METHOD OLS AND CHALLENGES IN
PROBIOTIC RESEARCH, AS WELL AS
ROAD MAPPING FUTURE DIRECTIONS
OF THE PRECISION PROBIOTIC
THERAPIES.
THERE WERE 11 PARTICIPATING
INSTITUTES AND CENTERS.
NCATS, NCCIH, NCI, NHLBI, NIA,
NIAAA, NIAID, NICHG, ODS AND
ONR, SO YOU CAN SEE IT WAS A
VERY, VERY BROAD AND TRANS-NIH
INTEREST IN THIS.
OUTSTANDING VIEWERSHIP.
2,118 LIVE VIEWERS ON DAY ONE
AND 1500 ON DAY TWO.
NOW SOME UPCOMING ACTIVITIES AND
EVENTS.
PLEASE SAVE THE DATE FOR MAY
18TH.
DR. MICHELLE MARTINS IMLS TALK,
INTEGRATIVE MEDICINE LECTURE
SERIES ENTITLED "WELL-BEING AND
ECONOMIC BURDEN OF DISEASE."
WHAT ARE WE LEARNING FROM CANCER
SURVIVORS?
AND ONCE AGAIN, NCCIH WILL HAVE
A SUBSTANTIAL PRESENCE AT THE
ANNUAL INTEGRATIVE --
INTERNATIONAL CONSORTIUM FOR
INTEGRATIVE MEDICINE AND HEALTH
MEETING IN PHOENIX, ARIZONA.
IN JUST 10 DAYS.
LEADING A VARIETY OF WORKSHOPS
AND SYMPOSIA.
AND I'VE OUTLINED SOME OF THESE
AT OUR LAST COUNCIL MEETING, AND
I WILL HAVE THE PLEASURE OF
HAVING A CONVERSATION WITH
DR. SUZANNE SIMMARD, PROFESSOR
OF FOREST ECOLOGY AT THE
UNIVERSITY OF BRITISH COLUMBIA
AND THE AUTHOR OF "FINDING THE
MOTHER TREE" BOOK.
WONDERFUL BOOK.
SHE'S A PIONEER IN PLANT
COMMUNICATION AND KNOWN FOR HER
RESEARCH ON HOW TREES INTERACT.
SO REALLY LOOKING FORWARD TO
THIS CONVERSATION WITH HER.
AND MARINE JOYCE US FOR OUR 17TH
ANNUAL PAIN CONSORTIUM SYMPOSIUM
FEATURING NIH SUPPORTED
RESEARCHERS WHOSE WORK HAS MADE
AN IMPORTANT CONTRIBUTION TO
PAIN RESEARCH.
AND I'M PLEASED TO SAY THAT THIS
YEAR'S THEME IS PAIN MANAGEMENT
THROUGH THE LENS OF WHOLE PERSON
HEALTH.
AND KEYNOTE SPEAKERS ARE GOING
TO BE DR. TRACY GAUDET AND
DR. RUTH WOLEVER.
AND IN ADDITION TO SPEAKERS AND
PANEL SESSIONS, THERE IS A
POSTER SESSION FEATURING EARLY
CAREER INVESTIGATORS.
AND RESEARCHERS WITH THE BEST
ABSTRACTS ARE SELECTED TO GIVE
ORAL PRESENTATIONS, AND THERE
WILL BE THE AWARD FOR BEST
POSTER AWARDED.
AND ALSO PLEASE SAVE THE DATE
FOR JUNE 23RD FOR A TALK
ENTITLED ADVANCING RESEARCH ON
EMOTIONAL WELL-BEING AND
REGULATION OF EATING BY
DR. ELISSA EPEL.
FINALLY ON SEPTEMBER 29TH, WE
WILL BE HOLDING THE INAUGURAL
ANNUAL INVESTIGATOR MEETING OF
THE NIH BLUEPRINT FOR
NEUROSCIENCE RESEARCH ON
INTEROCEPTION THAT WILL FOCUS ON
FUNCTIONING NEURAL CIRCUITS.
SO IF YOU RECALL, THIS WAS AN
INITIATIVE THAT WAS FUNDED
THROUGH THE NEUROSCIENCE
BLUEPRINT, AND IT WILL BE VERY,
VERY FASCINATING TO SEEK UPDATES
FROM THESE INVESTIGATORS ON HOW
THINGS ARE GOING.
AND I FINALLY WANT TO POINT OUT
OUR NEXT MEETING, SEPTEMBER 9TH
OF OUR ADVISORY COUNCIL.
AND I WANT TO ALSO JUST MENTION
THAT WE ARE DOING A LITTLE BIT
OF AN EXPERIMENT TODAY FOR THIS
COUNCIL BECAUSE WE ARE DOING A
HYBRID -- A LITTLE MINI HYBRID
MEETING, AS YOU CAN SEE, SOME OF
US, THE NCCIH STAFF IS IN THE
ROOM.
MOST OF THEM -- MOST OF THE
STAFF IS VIRTUAL, AND SO ARE THE
COUNCILMEMBERS.
BUT WHAT WE WANT TO KNOW AND WE
WOULD LIKE TO HEAR FROM OUR
COUNCILMEMBERS IS HOW WOULD YOU
ALL FEEL ABOUT EXPANDING THIS IN
SEPTEMBER AS LONG AS, YOU KNOW,
COVID STATISTICS PERMIT, WE
WOULD KIND OF OPEN THIS UP AND
REALLY EXTEND THIS TO BE A MORE
FULLY HYBRID MEETING WHERE
COUNCILMEMBERS WOULD BE INVITED
TO COME AND PARTICIPATE IN
PERSON AND HOPEFULLY WE CAN ALSO
HAVE A SOCIAL EVENT AT THIS
MEETING, WHICH WE HAVEN'T HAD
NOW FOR TWO YEARS.
AND I WOULD BE CURIOUS TO
HEAR -- I SEE SOMEBODY CHIMING
IN IN THE CHAT.
BUT WE'D LOVE TO HEAR WHAT ARE
YOUR THOUGHTS ON THIS.
SO AS WELL AS ANY OTHER
MATERIALS THAT I PRESENTED.
SO I'M GOING TO STOP SHARING.
YOU CAN REMOVE THE SLIDES AND
WE'D LOVE TO HEAR COMMENTS FROM
COUNCIL ON ANY OF THESE TOPICS.
>> SO AGAIN FOR COUNCILMEMBERS,
IF YOU'LL RAISE YOUR DIGITAL
HAND OR WAVE AT US VIA VIDEO,
WE'LL CALL ON YOU IN ORDER THAT
YOU SO INDICATE.
AND AS YOU GATHER YOUR
THOUGHTS --
>> YEAH, AS YOU GATHER YOUR
THOUGHTS, I'M JUST GETTING A
PING FROM OUR DIRECTOR OF OFFICE
AND POLICY PLANNING EVALUATION.
I WANT TO JUST MENTION ALSO THAT
I RECENTLY HAD A CONGRESS FLAL
HEARING, BRIEFING, WITH TWO
CONGRESS MEMBERS, CONGRESSWOMAN
JACKIE WILORSKY AND
CONGRESSWOMAN JUDY CHU, WHO ARE
BOTH CO-CHAIRS OF THE
INTEGRATIVE HEALTH CAUCUS.
AND SO IT WAS VERY WELL
RECEIVED.
WE TALKED ABOUT WHOLE PERSON
HEALTH AS WELL AS THE IMPORTANCE
OF CHRONIC STRESS.
AND HOW CHRONIC STRESS IS REALLY
REACHING ALARMING PROPORTIONS,
ESPECIALLY INCREASINGLY IN THE
U.S., THERE ARE SOME SURVEYS
THAT ARE -- QUITE CONCLUSIVELY
SHOW PEOPLE IN THE UNITED STATES
HAVE LEVELS OF STRESS THAT ARE
AMONG THE HIGHEST IN THE WORLD.
AND WE ALSO HAVE SOME DISTURBING
HEALTH STATISTICS, THAT OUR LIFE
EXPECTANCY IS DECREASING, WE
HAVE A LOT OF PROBLEMS WITH
DIFFERENT AREAS OF HEALTH THAT
CAN BE INFLAWNSED BY STRESS,
INCLUDING OPIOID USAGE, DEATH,
ADDICTION, PAIN, AND AS WELL AS
MENTAL HEALTH, BUT ALSO VERY
IMPORTANTLY, PHYSICAL HEALTH.
WE HAVE RISING RATES OF
CARDIOVASCULAR DISEASE, CHRONIC
OBESITY AND METABOLIC DIABETES,
TYPE 2 DIABETES THAT CAN -- THAT
ARE WORSENED, AND HYPERTENSION
WORSENED BY STRESS.
AND, OF COURSE, COVID.
AND WE NE OUR IMMUNE RESPONSES
ARE INFLUENCED BY STRESS.
SO THIS IS AN AREA WE FEEL WE
REALLY WANT TO RAISE AWARENESS
OF THE IMPORTANCE OF STRESS
MANAGEMENT, NOT ONLY FOR
PSYCHOLOGICAL REASONS THEY'RE
EXTREMELY IMPORTANT BUT FOR
PHYSIOLOGICAL REASONS AS WELL.
AND SO WE DISCUSSED THIS AND
THERE WAS A LOT OF INTEREST IN
THIS TOPIC.
SO THANK YOU, MARY BETH, FOR
REMINDING ME TO MENTION IT.
>> QUESTIONS, COMMENTS FROM
COUNCIL?
>> DR. CECH?
>> I JUST WANTED TO SAY THANK
YOU, THAT WAS A REALLY
INTERESTING AND DIVERSE OVERVIEW
OF SOME REALLY EXCITING
INITIATIVES.
I'M JUST OBSERVING THAT THERE'S
SUCH A THEME HERE OF
INTERCONNECTIVITY THAT NCCIH HAS
REALLY BEEN MAKING AN EFFORT TO
CONNECT WITH OTHER INSTITUTES
AND OTHER PROJECTS ACROSS NIH
REALLY IN A FORWARD-THINKING WAY
EVEN BEFORE WE WERE MOVING INTO
THIS SITUATION THAT WE'RE IN
CURRENTLY WITH SUCH A
REALIZATION OF HOW ALL THE
DIFFERENT TYPES OF STRESSORS
THAT WE'RE HAVING ON OUR LIVES
ARE REALLY IMPACTING HEALTH IN
WAYS THAT CANNOT BE ISOLATED TO
A SINGLE DISEASE.
AND NCCIH HAS REALLY BEEN A
LEADER IN THINKING ABOUT WHOLE
BODY HEALTH AND
INTERCONNECTIVITY FOR A VERY
LONG TIME, BUT IT'S EXCITING TO
SEE SOME OF THIS COMING TO
FRUITION AND SEE SOME OF THE
INTEGRATED EFFORTS ACROSS NIH
AND ALSO THE EFFORTS TO REACH
OUT TO COMMUNITIES THAT HAVEN'T
PARTICIPATED IN SOME OF THESE IN
THE PAST AND REACHING OUT TO
PEOPLE TO GET THEIR OPINIONS
ABOUT WHAT ARE THE MOST
IMPORTANT VARIABLES WE SHOULD BE
LOOKING AT IN RESEARCH.
I JUST THINK IT'S REALLY VERY
CUTTING EDGE AND I JUST WANT TO
ACKNOWLEDGE ALL OF THE EFFORT OF
ALL THE PEOPLE WHO'VE
CONTRIBUTED TO THAT.
IT'S REALLY EXCITING TO SEE.
>> WELL, THANK YOU FOR THIS
COMMENT.
I REALLY APPRECIATE IT.
WE ALL DO.
IT'S VERY INTERESTING AS YOU
SAID THAT THE INTERCONNECTIVITY
IS SO IMPORTANT AND SO VITAL TO
HOW WE THINK, BUT ALSO REACHING
OUT TO OTHER GROUPS, BY
NECESSITY, RIGHT, AT NCCIH
BECAUSE WE HAVE SUCH A SMALL
BUDGET, WE NEED TO REACH OUT AND
WE'VE BEEN ACTUALLY VERY
SUCCESSFUL IN GETTING CO-FUNDING
PARTICIPATION IN THESE TRANS-NIH
INITIATIVES WHICH ALLOWS US TO
AUGMENT THE FUNDS THAT WE HAVE.
SO, SO FAR, SO GOOD I THINK,
YES.
BEN AND THEN JUSTIN AND THEN --
>> THANKS, DR. LANGEVIN.
I JUST HAVE A QUESTION, I GUESS,
WHICH IS, AS YOU DO THAT
REACHING OUT ACROSS TO OTHER
INSTITUTES, HOW DO YOU FIND THE
RECEPTION TO THIS CONCEPT OF
WHOLE PERSON HEALTH?
DO YOU FIND A LOT OF OPENNESS
AND WILLINGNESS TO GET ON BOARD
WITH THE INITIATIVES? DO YOU
FIND STILL A FAIR AMOUNT OF
SKEPTICISM FROM THE OTHER
INSTITUTES?
I'M JUST CURIOUS, YOUR GENERAL
IMPRESSION ON THAT.
>> A LOT OF INTEREST.
AND IN FACT, THE PROOF OF THAT
WAS THE FANTASTIC COLLABORATIONS
THAT WE IN OUR WHOLE PERSON
RESEARCH WORKSHOP.
THIS WORKSHOP WAS ORGANIZED IN
COLLABORATION WITH A NUMBER OF
DIFFERENT INSTITUTES, AND WE HAD
PROGRAM OFFICERS FROM ALL THESE
INSTITUTES COME AND HELP US
SHAPE THE PROGRAM AND
CONTRIBUTED THEIR INVESTIGATORS
TO THIS VERY AMAZING WORKSHOP
THAT OCCURRED.
SO WE ON PURPOSE WANTED THAT,
BECAUSE WE WANTED TO HEAR FROM
OTHER FIELDS THAT ARE ALREADY
THINKING IN AN INTEGRATIVE
DIRECTION, WHO ARE ALREADY
THINKING ACROSS SYSTEMS AND
ACROSS DOMAINS.
OF COURSE THE INSTITUTES THAT
ARE MORE -- ALREADY HAVE, FOR
EXAMPLE, ENVIRONMENTAL HEALTH,
NURSING, MINORITY HEALTH, AGING,
THESE ARE THE INSTITUTES THAT
ARE WHAT WE CALL
NON-CATEGORICAL, THOSE ALREADY
THINK THIS WAY.
BUT WE ALSO HAD -- WE HAVE A LOT
OF INTEREST NOW FOR VERY
IMPORTANTLY THE MUSCULOSKELETAL,
YOU'RE GOING TO HEAR THIS
AFTERNOON FROM DR. RENA DSOUZA,
THEY ARE ALSO REALLY THINKING IN
AN INTEGRATIVE WAY.
SHE'S GOING TO BE TALKING ABOUT
THIS TOO.
SO THE WORD IS DEFINITELY
SPREADING.
IT'S GONE REALLY WELL.
DR. SONNENBURG, JUSTIN?
>> HELENE, THANKS FOR THE REALLY
WONDERFUL OVERVIEW.
FAST MOVING, THERE'S A TON GOING
ON.
I THINK JUST TO KIND OF ECHO
SOME OF THOSE SENTIMENTS, JUST
OVER THE PAST FOUR YEARS OF
BEING ON COUNCIL, SEEING THIS
DIFFERENT WAY OF THINKING ABOUT
DOING MEDICINE AND THINKING
ABOUT HEALTH, TRANSITIONING FROM
BEING SOMETHING THAT IS, YOU
KNOW -- I THINK FELT VERY
FOREIGN, IT FELT LIKE TO A LOT
OF NIH TO NOW BEING REALLY
CENTRAL AND BEING AT THE LEADING
EDGE, I THINK THAT'S SUPER
EXCITING TO SEE THE INTEGRATION
WITH ALL THE OTHER INSTITUTES
AND CENTERS, ALL THE JOINT
INITIATIVES AND JUST TO
HIGHLIGHT ONE POINT THAT YOU
TOUCHED ON, THAT TRANS-NIH
WORKSHOP ON PROBIOTIC THERAPIES
THAT I WAS PART OF, I THINK THAT
WAS JUST A SUPER INSPIRING TWO
DAYS.
INCREDIBLE LINEUP OF SPEAKERS,
INCREDIBLE DISCUSSION.
THAT FIELD IS CLEARLY GOING IN A
LOT OF INTERESTING DISCUSSIONS,
INCORPORATING PROBIOTICS 2.0,
MICROBES FROM THE GUT AS
PROBIOTICS AND EVEN ENGINEERED
MICROBES FROM THE GUT.
SO I THINK THERE'S JUST SO MANY
EXCITING THINGS GOING ON THERE.
AND THEN JUST A FINAL THANK YOU
TO THE NCCIH STAFF THAT WERE
INVOLVED IN PULLING THAT OFF.
IT WAS REALLY JUST A REALLY
EXCELLENT WORKSHOP AND
DISCUSSION.
>> THANK YOU FOR THIS COMMENT.
I WANT TO SAY ALSO A VERY
INTERESTING THING.
A COUPLE YEARS AGO, WE DID A
PORTFOLIO ANALYSIS AND WE LOOKED
AT THE KIND OF RESEARCH THAT WE
WERE ALREADY FUNDING, LIKE IN
PREVIOUS YEARS, THAT WENT ACROSS
SYSTEMS.
AND THE NATURAL PRODUCTS
PORTFOLIO AND PROBIOTICS AND
MICROBIOME WAS SOME OF THE MOST
INTEGRATIVE RESEARCH THAT WE
WERE ALREADY FUNDING.
SO IT'S VERY INTERESTING THAT
THIS FIELD HAS BEEN REALLY
LEADING THE WAY IN UNDERSTANDING
HOW THE BODY IS CONNECTED, SO
IT'S VERY INTERESTING TO SEE
THAT.
SO EMILY?
>> THANK YOU, HELENE.
IT'S FUNNY, AS WE DO THIS ON A
DAY-TO-DAY BASIS WITHOUT
REALIZING HOW MANY ACTIVITIES,
EXCITING ACTIVITIES THAT WE'RE
INVOLVED IN.
SO THANK YOU FOR THIS WONDERFUL
SUMMARY.
BUT I WANTED TO JUST HIGHLIGHT
THE TWO INTEGRATIVE MEDICINE
SERIES YOU MENTIONED, DR. MARTIN
AND DR. EPEL, THEY'RE FROM THE
RESEARCH NETWORKS THAT WERE
FUNDED IN 2020, AND THAT
GROUP -- THOSE NETWORKS ARE
FULLY FUNCTIONING AND REALLY
MOVING FORWARD, SO I'M REALLY
HAPPY THAT WE'RE ABOUT TO
FEATURE THE WORK OF SOME OF THE
THOSE NETWORKS IN THE NEXT
COUPLE OF MONTHS.
THANKS.
>> THANK YOU, EMMELINE, YES,
THANK YOU, VERY IMPORTANT.
THANK YOU FOR MENTIONING THAT.
KAREN?
>> I FIND THIS VERY, VERY
EXCITING.
ONE OF THE CHALLENGES, THOUGH,
AS I THINK ABOUT WHAT YOU'VE
SAID ABOUT STRESS, HAVING REALLY
RISEN RELATIVELY RAPIDLY DURING
THE COVID PERIOD, AND JUST
LOOKING AT WORLD EVENTS, IT
DOESN'T LOOK LIKE IT'S GOING TO
COME DOWN ANY TIME SOON, BUT OUR
TYPICAL, YOU KNOW, IT TAKES
THREE TO FIVE YEARS TO GET
RESULTS AND GET THEM OUT AND
STUFF IS A LITTLE CONCERN, AND
I'M JUST WONDERING IF THERE'S A
WAY TO PUT TOGETHER SOMETHING
FROM ALL OF US WITH MAYBE SOME
ONLINE INTERVENTIONS AND SOME
REALLY NOVEL, QUICK, RAPID WAYS
OF GETTING THINGS OUT AND
TESTING THEM, MAYBE TESTING
MULTIPLE THINGS AT ONCE OR
WHATEVER, TO REALLY OFFER THINGS
TO PEOPLE SOON.
>> RIGHT.
WELL, PART OF THAT IS TO LOOK AT
INTERVENTIONS THAT WE ALREADY
KNOW ARE EFFECTIVE, AND THEN TO
SORT OF REALLY PUSH THE
IMPLEMENTATION RESEARCH.
AND THIS IS AN AREA WHERE WE'RE
STARTING TO REALLY KIND OF
LEARN -- WE'RE DEVELOPING A PLAY
BOOK AS TO HOW TO MOVE THIS KIND
OF RESEARCH ALONG, SO YEAH,
YOU'RE RIGHT, WE DON'T WANT TO
SIT ON THIS.
I MEAN, THIS IS A CRISIS.
AND JUST -- OBVIOUSLY WE'VE
RECOGNIZED THE OPIOID CRISIS,
THE PAIN CRISIS, BUT I THINK WE
HAVE A STRESS CRISIS RIGHT NOW.
IT'S MANIFESTING ITSELF ACROSS A
LOT OF DIFFERENT AREAS.
SO YEAH, WE'RE DEFINITELY GOING
TO TRY TO SEE AND LOOK FOR
CREATIVE WAYS TO PUSH THIS
QUICKLY.
HELEN?
WE CAN'T ACTUALLY SEE YOUR
VIDEO.
THERE WE GO.
>> SO JUST TO COMMENT ON THE
PREVIOUS COMMENT, YOU KNOW, THIS
IS A VERY IMPORTANT AREA,
ESPECIALLY WITH LONG COVID, AND
THE NEED IS ACCELERATED BY THE
PANDEMIC, AND WHAT WE DO,
ESPECIALLY MIND/BODY
INTERVENTIONS, IS PROVIDING
TOOLS FOR SELF-REGULATION.
THE AMOUNT OF PEOPLE NOW UNDER
STRESS, IT'S JUST IMPOSSIBLE TO
FIND PROVIDERS FOR EACH OF THEM,
SO IT HAS TO BE A PUBLIC
EDUCATIONAL CAMPAIGN ABOUT
SELF-REGULATION, STRESS
REDUCTION, AND I DON'T KNOW
WHETHER NCCIH HAS A MISSION LIKE
THIS.
>> OH, YES, ABSOLUTELY.
WELL, YOU KNOW, THE WHOLE --
WHAT YOU'RE CALLING
SELF-REGULATION IS VERY, VERY
IMPORTANT, AND WE WANT TO
UNDERSTAND BETTER FROM A BASIC
SCIENCE POINT OF VIEW, WE
UNDERSTAND THE AUTONOMIC NERVOUS
SYSTEM IS VERY IMPORTANT HERE,
THE ENDOCRINE SYSTEM IS RELATED
TO OUR IMMUNE RESPONSES.
IT'S RELATED TO A LOT OF -- THE
FIELD OF INTEROCEPTION THAT WE
ARE REALLY KIND OF TRYING TO
UNDERSTAND BETTER.
WHAT ARE THE SENSORY QUEUES THAT
YOU GET FROM YOUR BODY TO EVEN
KNOW THAT YOU'RE STRESSED?
YOU KNOW, DIFFERENT PEOPLE FEEL
DIFFERENT WAYS, RIGHT?
AND SO THAT'S IMPORTANT.
THAT'S AN IMPORTANT PIECE OF IT.
AND THEN WHAT ARE SOME OF THE
PRACTICES THAT WE ALREADY KNOW
CAN BE REALLY IMPLEMENTED THAT
ARE EASY TO DO, DON'T REQUIRE
EXTENSIVE TRAINING.
BREATHING, FOR EXAMPLE, DEEP
BREATHING, SIMPLE HEAD TO TOE
RELAXATION, SIMPLE MINDFULNESS
EXERCISES THAT CAN BE KIND OF
SCALED DOWN SO THAT THEY'RE
ACCESSIBLE TO PEOPLE.
WE REALLY WANT TO TRY TO REALLY
EXPLORE WHAT IS THE BEST WAY
THAT THIS CAN BE PUT INTO THE
HANDS OF PEOPLE SO THAT THEY CAN
APPLY THIS TO THEIR DAILY LIVES.
AND REALLY HELP -- WE HAVE THIS
KIND OF NEW LITTLE -- WHAT DO
YOU CALL IT, PRESS RESET ON
STRESS.
HOW DO YOU HELP PEOPLE TO PRESS
RESET SEVERAL TIMES DURING THE
DAY SO THAT THEIR LEVELS OF
STRESS DON'T ACCUMULATE AND SORT
OF REALLY SORT OF BUILD UP OVER
THE COURSE OF A STRESSFUL DAY,
WHICH WE ALL HAVE TO DEAL WITH.
SO RIGHT, I THINK THIS ELEMENT
OF SELF REGULATION IS SO
IMPORTANT, WHAT YOU'RE TALKING
ABOUT, WE NEED TO UNDERSTAND
BETTER HOW TO GIVE PEOPLE TOOLS
SO THAT THEY CAN DO THIS EASILY,
OR AT LEAST, YOU KNOW --
>> WELL, YOU KNOW, SO YOU HAVE
ALL THIS INFORMATION AVAILABLE
ON YOUR WEBSITE FOR THE PUBLIC,
FOR THE GENERAL PUBLIC ABOUT
SUPPLEMENTS, BUT CAN YOU DEVELOP
A SIMILAR KIND OF TOOLBOX ABOUT
SELF-REGULATION TOOLS THAT WE
KNOW ABOUT?
>> THAT'S A GREAT IDEA.
IN FACT, WE ARE WORKING WITH OUR
COMMUNICATIONS TEAM ABOUT REALLY
SORT OF REIMAGINING OUR STRESS
INFORMATION PACKET, AND I
THINK -- WE'LL TAKE YOUR
RECOMMENDATION.
I THINK THAT'S A FANTASTIC IDEA.
THANK YOU.
I THINK, RICK, YOU HAD A HAND
UP?
>> HE DID HAVE HIS HAND UP.
>> JUST TO PIGGY BACK REAL
SHORTLY, I THINK ONE REALLY
OPPORTUNITY FOR THIS SELF-CARE
MASS IMPLEMENTATION AND MAYBE
QUICKER CLINICAL TRIALS PROBABLY
WILL INVOLVE INTERNET
APPROACHES, MAYBE APP APPROACHES
FOR THINGS THAT ARE ALREADY
OBVIOUSLY WORKING FOR US, LIKE
MEDITATION IS A VERY OPTIMAL
ONE, AS WOULD BE LIKE
ACUPRESSURE, THAT CAN ALL BE
TAUGHT VIA AN APP.
AND THAT'S REALLY KIND OF THE
ONLY WAY I CAN SEE MANY SITES
WORKING TOGETHER TO POOL DATA
QUICKLY, WOULD HAVE TO HAVE
INTERVENTION THAT WOULD BE
ADMINISTERED FROM LIKE A LOCAL
HUB THAT WOULD BE SENT OUT VIA
SMARTPHONES OR WHAT HAVE YOU.
MAYBE LIKE A FUNDING OPPORTUNITY
THAT WOULD STIMULATE THAT KIND
OF A NETWORK WHERE THESE
EFFICACIOUS THINGS THAT WE
ALREADY KNOW WORK CAN BE
IMPLEMENTED REALLY QUICKLY.
SO ANYWAY, JUST KIND OF OBVIOUS
THINGS.
>> THIS IS DEFINITELY VERY GOOD
THOUGHTS.
>> JUST WANT TO BE MINDFUL OF
TIME.
WE'VE GOT LIKE 4 MINUTES LEFT
AND WE'VE GOT DR. SONNENBURG AND
DR. KNUTSON AND I THINK THAT
WILL PROBABLY TAKE US TO THE
LUNCH BREAK.
>> I'LL MAKE MINE REALLY QUICK.
JUST TO COMMENT ON DR. SHERMAN'S
COMMENT ABOUT THE RAPIDITY RANGE
OF MOTION THAT'S NEEDED, I THINK
THIS IS A REALLY KEY POINT.
ONE OF THE THINGS THAT I THINK
ABOUT WHEN I THINK ABOUT RAPID
TRIALS IS SAFETY AS WELL AS
EFFICACY, AND I THINK DIET IS
ONE OF THESE THINGS THAT WE
HAVEN'T PAID ENOUGH ATTENTION
TO.
I KNOW WE TALK ABOUT IT A LOT AT
NCCIH, AND THE PRECISION
NUTRITION COMPONENT OF ALL-OF-US
IS COMING, BUT I WORRY THAT THAT
MAY NOT EXPLORE ENOUGH DIETARY
DIVERSITY AND THAT IT MAY NOT BE
RAPID ENOUGH TURNAROUND.
SO JUST THINKING ABOUT WAYS
TO -- WE'RE DELIVERING MASSIVE
DOSES OF DRUG-LIKE COMPOUNDS TO
OUR BODIES THREE TIMES A DAY,
SOMETIMES MORE TIMES A DAY.
THAT'S MANIPULATING OUR
MICROBIOME AND THEN CHANGING ALL
OF OUR BIOLOGY, AND WHAT AN
OPPORTUNITY TO HAVE A HUGE
HEALTH IMPACT IF WE COULD
UNDERSTAND THAT AND LEVERAGE IT.
>> EXCELLENT POINT.
THANK YOU.
LORI, YOU HAVE THE LAST WORD.
>> ALL RIGHT.
I'LL BE QUICK.
IT'S REALLY RESTATING MANY OF --
MUCH OF WHAT'S BEEN SAID, BUT
THE NCCIH WEBSITE HAS THE HEALTH
INFORMATION COMPONENT WHICH I
THINK IS FOR THE GENERAL PUBLIC,
AND THERE'S GREAT INFORMATION ON
THERE ABOUT STRESS, BUT I THINK
THAT HOW DO WE PACKAGE THIS FOR
THE GENERAL PUBLIC, AND I WOULD
ALSO SAY EMPLOYERS WHO HAVE A
GREAT INTEREST IN WHAT'S GOING
ON HERE.
HOW DO WE PACKAGE THIS AND MAKE
IT PROACTIVE VERSUS PASSIVE
WHERE PEOPLE HAVE TO FIND THE
SITE AND SO TO GET THROUGH THE
MATERIALS.
SO JUST A COMMENT ABOUT MORE
BROAD COMMUNICATION ABOUT THE
FINDINGS AROUND STRESS.
>> THAT'S GRACE.
ONE OF THE GREAT.
ONE OF THE AREAS I'VE PERSONALLY
BEEN INTERESTED IN GETTING MORE
INPUT FROM YOU ALL
COUNCILMEMBERS IS, HOW EASY IS
TO GET THE INFORMATION FROM OUR
WEBSITE?
YOU KNOW, REGARDING A LOT OF
THINGS.
THIS IS FOR PUBLIC BUT ALSO
WE'RE VERY INTERESTED ABOUT HOW
USER-FRIENDLY SOME OF OUR
INFORMATION REGARDING FUNDING
OPPORTUNITIES, REGARDING --
WE'VE PAID A LOT OF ATTENTION TO
THAT OVER THE LAST COUPLE YEARS
AND TRIED TO IMPROVE THE
USABILITY AND MAKE IT EASIER FOR
PEOPLE TO SEARCH TO FUNDING
OPPORTUNITIES, TO SEARCH FOR
DIFFERENT EVENTS.
SO IF YOU HAVE ANY FEEDBACK ON
THAT, WE WOULD REALLY WELCOME
THAT.
>> JUST A VERY QUICK ONE.
I WOULD ADVOCATE FOR A BIGGER
TWITTER PRESENCE.
I DON'T SEE A LOT FROM YOU GUYS.
BUT THAT'S THE WAY FORWARD.
>> THANK YOU.
WELL, I KNOW.
>> THANK YOU, DR. HANEY.
>> WE NEED TO DO MORE.
>> SO THAT'S GOING TO BE THE
LAST COMMENT BEFORE WE BREAK FOR
LUNCH BUT I'M GOING TO USE THIS
TO SEGUE FOR A PLUG ACTUAL
LITTLE FOR THIS AFTERNOON'S MINI
SYMPOSIUM, WHICH IS GOING TO BE
ON CLINICAL TRIALS AND HOW THEY
ADDRESS STRESS IN DIFFERENT
CONTEXTS, AND PARTICULARLY HOW
THOSE TRIALS CAN BE HIGHLY
IMPACTFUL.
WE HAVE THREE GREAT PRESENTERS
WHO WILL BE COMING IN,
INVESTIGATORS TALKING ABOUT THIS
FROM DIFFERENT PERSPECTIVES, AND
WE WILL THEN HAVE ALSO A LOT OF
TIME OR AT LEAST SOME TIME FOR
COUNCIL TO INTERACT WITH THE
PRESENTATIONS AND WEIGH IN ON
THE DISCUSSIONS AND MAKING
SUGGESTIONS ON THIS VERY
IMPORTANT TOPIC.
SO HAVE A GOOD LUNCH.
WE'LL MEET BACK HERE AGAIN
PROMPTLY AT 1:20 P.M. EASTERN
TIME TO START OFF, AND THAT WILL
BE THE SESSION LED BY DR. D'
SOUZA, AND THAT WILL BE FOLLOWED
BY THE MINI SYMPOSIUM ON STRESS.
SO HAVE A GREAT LUNCH.
WELCOME BACK FROM LUNCH.
WE ARE GOING TO BE STARTING NOW,
RECONVENING THE OPEN SESSION OF
THE 80 MEETING OF THE NATIONAL
ADVISORY COUNCIL FOR
COMPLEMENTARY AND INTEGRATIVE
HEALTH.
AND DR. LANGEVIN, TAKE IT AWAY.
>> THANK YOU SO MUCH, DR.
DR. KHALSA.
IT'S MY PLEASURE TO INTRODUCE
DR. RENA D'SOUZA, DIRECTOR OF
THE NATIONAL INSTITUTE OF DENTAL
AND CRANIOFACIAL RESEARCH AT
NIH.
SHE OVERSEES NIDCR'S ANNUAL
BUDGET OF MORE THAN
$475 MILLION, WHICH SUPPORTS
BASIC, TRANSLATIONAL AND
CLINICAL RESEARCH IN AREAS OF
ORAL CANCER, OROFACIAL PAIN,
TOOTH DECAY, PERIODONTAL
DISEASE, SALIVARY GLAND
DYSFUNCTION AND ORAL
COMPLICATIONS OF SYSTEMIC
DISEASES.
DR. D'SOUZA HAS BEEN AT NIH NOW
FOR A COUPLE OF YEARS NOW.
SHE WAS ONE OF THE INSTITUTE
DIRECTORS THAT WAS RECRUITED AND
STARTED I BELIEVE RIGHT AT THE
BEGINNING OF THE PANDEMIC, IF
I'M CORRECT.
AND IT'S BEEN WONDERFUL TO HAVE
DR. D'SOUZA JOIN OUR NIH FAMILY,
AND WE'VE HAD MANY CONVERSATIONS
WHERE IT'S VERY CLEAR THAT HER
INTERESTS REALLY INCLUDE THE
RELATIONSHIP OF ORAL HEALTH TO
WHOLE PERSON HEALTH AS WELL AS
PREVENTION, AND WE ALSO SHARE A
LOT OF INTERESTS IN THE AREAS OF
PAIN.
DR. D'SOUZA HAS BEEN
INSTRUMENTAL IN REALLY FOSTERING
A LOT OF COLLABORATIONS THAT
WE'VE HAD ACROSS MANY
INSTITUTES, INCLUDING MYOFASCIAL
PAIN INITIATIVE, INCLUDING THE
REJOIN INITIATIVE, AND SO WE'RE
SO EXCITED TO HAVE HER COME IN
AND SPEAK TO OUR COUNCIL TO TELL
US ABOUT THE PRIORITIES OF NIDCR
AND ALSO MANY DIFFERENT AREAS
WHERE WE CAN COLLABORATE.
ON A PERSONAL LEVEL, MY OWN LAB
AT NIDCR IN THE INTRAMURAL
RESEARCH DIVISION AT NIDCR, AND
IT'S WONDERFUL THAT THERE ARE
SUCH A DIVERSE ARRAY OF
INVESTIGATORS AND INTRAMURAL
RESEARCHERS THAT REALLY SPAN
ACROSS SO VARIED AREAS OF
HEALTH.
SO DR. D'SOUZA'S OWN RESEARCH
INTERESTS FOCUS ON CRANIOFACIAL
DEVELOPMENT, GENETICS, TOOTH
DEVELOPMENT, AND REGENERATIVE
DENTAL MEDICINE.
SHE AND HER TEAM HAVE MADE
IMPORTANT ADVANCES IN THE FIELD
OF TISSUE ENGINEERING IN THE
CONTEXT OF DENTAL CARE.
PRIOR TO JOINING NIH,
DR. D'SOUZA WAS THE ASSISTANT
VICE PRESIDENT FOR ACADEMIC
AFFAIRS AND EDUCATION FOR HEALTH
SCIENCES AT THE UNIVERSITY OF
UTAH IN SALT LAKE CITY, WHERE
SHE ALSO SERVED AS PROFESSOR OF
DENTISTRY AND THE CHAIR OF THE
SCHOOL OF DENTISTRY AND
PROFESSOR OF NEUROBIOLOGY AND
ANATOMY AND PATHOLOGY AND
SURGERY IN THE SCHOOL OF
MEDICINE AND THE DEPARTMENT OF
BIOMEDICAL ENGINEERING.
IF THAT WASN'T ENOUGH, IN 2002,
SHE WAS SELECTED TO BE INAUGURAL
DEAN AT THE UNIVERSITY OF UTAH
SCHOOL OF DENTISTRY.
IN ADDITION TO BEING A HIGHLY
PRODUCTIVE RESEARCHER AND
LEADER, DR. D'SOUZA IS ALSO A
DEVOTED MENTOR AND CHAMPION OF
DIVERSITY IN THE BIOMEDICAL
RESEARCH WORKFORCE.
SHE HAS SERVED AS A VOLUNTEER
DENTIST FOR WOMEN IN NEED AND
PEOPLE STRUGGLING WITH
HOMELESSNESS IN SALT LAKE CITY,
DALLAS AND HOUSTON SINCE 1985.
DR. D'SOUZA RECEIVED HER
BACHELOR'S DEGREE IN DENTAL
SURGERY FROM THE UNIVERSITY OF
BOMBAY, INDIA AND EARNED A DDS
AS WELL AS PH.D. IN PATHOLOGY,
BIOMEDICAL SCIENCES FROM THE
UNIVERSITY OF TEXAS HEALTH
SCIENCE CENTER IN HOUSTON.
SO WELCOME, DR. D'SOUZA.
THANK YOU SO MUCH FOR COMING AND
SPEAKING TO OUR COUNCIL.
>> THANK YOU.
THANK YOU, HELENE.
I WOULD SAY AS A NEW DIRECTOR, I
WAS ACTUALLY SWORN IN OCTOBER OF
2020 VIRTUALLY.
IT BEEN VIRTUAL REALITY SINCE.
BUT THAT REALITY HAS BEEN MADE A
WHOLE LOT MORE PLEASANT BECAUSE
OF FELLOW COLLEAGUES LIKE HELENE
LANGEVIN, IT'S BEEN SUCH A
PLEASURE KNOWING YOU AND SEEING
YOU AS A REAL ADVOCATE AND
SHARING THE VALUES THAT WE AT
NIDCR UPHOLD VERY DEARLY.
SO I WANT TO BRING TO ALL OF YOU
MANY DPREETINGS FROM GRR
INSTITUTE.
WE HAVE A VERY IMPORTANT
PARTNERSHIP WITH NCCIH AND WE
INTEND TO ACTUALLY STRENGTHEN
THAT IN THE MONTHS AND YEARS TO
COME.
AND I WANT TO SAY THAT -- LET ME
GO INTO THE SLIDE HERE.
SO THE TITLE IS FAIRLY
EXPLANATORY.
I WANT TO STRESS THAT THROUGHOUT
THE PRESENTATION, AS I DESCRIBE
WHAT'S IN OUR PORTFOLIO, I'M
HOPING THAT YOU ALLOW YOURSELF
THE FREEDOM TO MAKE THE
CONNECTIONS BECAUSE THAT'S HOW
IDEAS ARE BORN.
SO EVEN THOUGH I'M NOT GOING TO
SPECIFY WHICH ONES UNTIL THE
VERY END, I DO HOPE THAT WE CAN
GAIN FROM THIS CONNECTIONS FROM
THIS TALK.
AND THERE'S NO OTHER TIME
ACTUALLY TO KNOW AND LEARN AND
FEEL THAT IMPORTANCE OF HUMAN
CONNECTIONS AS THE PANDEMIC HAS
TAUGHT US THESE LESSONS.
I LOVE THAT "TIME" MAGAZINE
COVER BECAUSE IT ACTUALLY TELLS
US THAT LIFE HAS CHANGED AND
WILL NEVER BE THE SAME, AND HOW
WE REDEFINE THE FUTURE IS REALLY
UP TO US.
WE LEARNED THAT NIMBLENESS AND
BEING FLEXIBLE WAS SO KEY, AND
THAT PARTNERSHIPS AND TEAM WORK
WERE ACTUALLY CRITICAL FOR
HEALTH-RELATED MATTERS.
I SWITCHED THE IIIs THAT WE IN
SCIENCE WOULD LABEL AS
IMMUNOLOGY, INFECTION AND
IMMUNITY.
INTEGRATION DOESN'T MEAN WE LOSE
OUR IDENTITY OR OUR ECOSYSTEM
NATURES.
IT MEANS WE CONNECT THE DOTS SO
THAT WE IMPROVE HEALTH FOR THE
INDIVIDUAL IN A HOLISTIC MANNER.
BUT SHARK TANK APPROACHES WORK,
THAT, IN FACT, WE LEARNED THAT
THERE WERE MANY DEFICIENCIES IN
OUR HEALTHCARE SYSTEM AND THEY
CONTINUE TO PERSIST.
IT WAS PRETTY OBVIOUS, AND THAT
INDIVIDUALS MOST DISADVANTAGED
ARE ACTUALLY THE ONES THAT
SUCCUMBED TO THE PANDEMIC EARLY
ON, AND THAT THE SOCIAL
DETERMINANTS REMAIN I THINK A
DETERRENT TO US ACHIEVING IDEAL
OPTIMUM HEALTH FOR INDIVIDUALS.
IN THE FIELD OF ORAL HEALTH,
TELEDENTISTRY ACTUALLY DID
IMPROVE ACCESS TO CARE, SO THAT
WAS WONDERFUL LESSONS LEARNED
THAT WE COULD ACTUALLY USE THESE
NEW TECHNOLOGIES AND TOOLS TO TO
GET THE HELP THEY NEEDED.
AND OF COURSE IT WAS SO OBVIOUS
THAT SCIENCE AND TECHNOLOGY
COUNTS AND THAT LEADERSHIP
MATTERS.
SO I'M VERY GRATEFUL THAT HELENE
IS AT THE HELM OF LEADING THE
CENTER OF INTEGRATIVE HEALTH AND
COMPLEMENTARY MEDICINE, REALLY,
WITH COLLABORATIONS IN MIND.
SO TO INTRODUCE TO YOU THE HUMAN
FACE, EACH ONE OF YOU ON THIS
PANEL HAS THIS UNIQUE IDENTITY,
THE SENSE OF SELF WORTH AND
WELL-BEING, AND IT COMES FROM
THAT UNIQUE FACE, RIGHT, THAT WE
SOMETIMES TAKE FOLKS FOR
GRANTED.
YOU JUST HAVE TO TALK TO A
HOMELESS INDIVIDUAL THAT'S
MISSING FRONT TEETH AND YOU PUT
THEM BACK ON AND LIFE CHANGES
FOR THAT INDIVIDUAL.
AND THERE'S SO MANY EXAMPLES
THAT I'LL COME TO THROUGHOUT THE
TALK.
NOW WHAT WE ARE VERY, VERY PROUD
TO OWN ARE THE BIOLOGICAL
SYSTEMS THAT, IN FACT, ARE
PARADIGMS FOR BIOLOGY, REALLY,
AND MEDICINE.
WE HAVE ENAMEL WHICH IS
IRREPLACEABLE, THE HARDEST
TISSUE IN MAMMALIAN SYSTEMS, WE
HAVE THE DISTINCT PATTERNING OF
THE CRANIOFACIAL COMPLEX WHICH
MEANS THAT SUTURES AND TEETH AND
THEIR ERUPTION AND SHEDDING ARE
VERY STRICTLY TIMED, WHICH MEANS
STRICT GENETIC CONTROL.
WE HAVE THE UNIQUE TONGUE AND
TASTE BUDS, SALIVA, WE HAVE
MICROBIOME UNIQUE FOR THE ORAL
CAVITY.
SO WE OWN THESE SYSTEMS THAT
WE'RE VERY PROUD OF BUT WITH
THEM COME A HOST OF CHALLENGES
BECAUSE THEY ALL IMPACT SMALL
SPACES THAT WE WORK IN AND SMALL
TISSUES, RIGHT?
SO FOR ALL OF THESE AMAZING
SYSTEMS, WE HAVE A SET OF
CHALLENGES THAT WE HAVE TO STEP
UP TO MEET.
THE ORAL CAVITY, MORE THAN
ANYTHING ELSE, IS THE PORT OF
ENTRY FOR THE COMMON RISK
FACTORS THAT IN FACT PREDISPOSE
IF NOT CONTRIBUTE TO
CARDIOVASCULAR DISEASE AND
METABOLIC SYNDROME.
WE CAN SEE CERTAIN SYSTEMIC
DISEASES MANIFESTED VERY EARLY
IN THE MOUTH AND SARS-COV-2 WAS
NO EXCEPTION.
THE FIRST THING TO GO TYPICALLY
IS THE LOSS OF TASTE.
AND THEN YOU LAND UP WITH DRY
MOUTH AND OTHER SCE SEQUELAE F
COVID-19.
WE ALSO CAN MONITOR HEALING AND
COMPLIANCE BY LOOKING AT THE
ORAL CAVITY, WE CAN LOOK AT A
PATIENT AND KNOW ABOUT AS LONG
AS LONG TERM
DRUG USE, MENTAL ILLNESS, CAN BE
CONTROLLED WITH COMPLIANCE AS
WELL AS SIMPLY MONITORING THE
PROGRESS TREATMENT THROUGH ORAL
TISSUES, SO THERE'S A LOT THERE
WE NEED TO KNOW.
NOW WHEN I READ THROUGH YOUR
WEBSITE AND WENT THROUGH YOUR
STRATEGIC PLAN AND I LOOKED AT
YOUR PRINCIPLE CORE MISSIONS,
THERE WAS SUCH AN OVERLAP WITH
WHAT WE AT NIDCR ACTUALLY CARE
ABOUT.
SO I HOPE THIS IS JUST THE
BEGINNING OF CONTINUING THE
JOURNEY SET UP BETWEEN MARTHA
SOMERMAN AND HELENE YEARS AGO.
SO JUST AN OVERVIEW, WHAT MAKES
US TICK, SO TO SPEAK, WHAT OUR
CHARGES ARE, WHAT WE ACTUALLY
TAKE ON BEYOND THE SCIENCE, WHAT
IS ACTUALLY HAPPENING TO ORAL
HEALTH AND THE STATUS IN THIS
COUNTRY?
VERY IMPORTANT TO KNOW WHAT THAT
IS.
IT POINTS TO SO MANY CHALLENGES,
LESSONS AND OPPORTUNITIES FOR
THE FUTURE, HOW WE ORGANIZE AND
OF COURSE OUR RESEARCH
HIGHLIGHTS JUST TO PICK A FEW.
ALL OF THESE ARE LEAD TO OUR
COLLABORATIONS RIGHT NOW ACROSS
CAMPUS, ACROSS INSTITUTES AND OF
COURSE OUR EXTRAMURAL
INVESTMENTS, SO THAT WE CAN MAKE
MORE CONNECTIONS WITH NCCIH.
SO WE'RE ONE OF 20 INSTITUTES.
WE'RE I THINK ON THE SMALLER
END, OUR BUDGET ACTUALLY,
HELENE, MOVED UP TO 500 MILLION
AND 200 ODD THOUSAND DOLLARS SO
WE MOVED BEYOND THE 500 MARK,
WHICH IS WONDERFUL, BUT WHAT
MAKES US DISTINCT IN MANY WAYS
WAS OUR ACTUAL HISTORY.
WE WERE CREATED 48 YEARS AGO.
SO WE CELEBRATED CELEBRATT
YEAR ALONG WITH NEI AND GARY
GIBBONS, NHLBI.
WE WERE CREATED WITH A PUBLIC
HEALTH MISSION.
HARRY TRUMAN WAS CONCERNED WITH
THOSE BEING ENLISTED IN THE WAR
COULDN'T BECAUSE THEY HAD VERY
BAD ORAL HEALTH.
A LOT OF DECAY AT THAT TIE.
PRIOR TO THE INTRODUCTION OF
FLUORIDE IN COMMUNITY WATER
SYSTEMS.
SO WE CHANGED OUR NAME TO NIDCR
TO INCLUDE THE CRANIOFACIAL
COMPLEX FOR THE REASONS I
MENTIONED JUST EARLIER.
AND WE STAY TRUE TO THAT MISSION
TODAY, WHICH IS TO REALLY
ADVANCE HEALTH THROUGH
KNOWLEDGE, THROUGH DISCOVERIES,
THROUGH PARTNERSHIPS.
BECAUSE WE CAN'T TO TO DO IT R
OWN.
WHEN I CAME ON BOARD, LITTLE DID
I KNOW THAT WE WOULD HAVE TO
TAKE ON THE RESPONSIBILITY OF
STEERING THIS REPORT WHICH WAS
ON THE ORAL HEALTH STATUS OF THE
COUNTRY, THE PREVIOUS SURGEON
GENERAL, JEROME ADAMS, WAS
REALLY STRUCK BY THE DEMANDS OF
COVID AND WAS UNABLE TO SHEPPARD
THE TRUTH FURTHER, AND THE NEW
SURGEON GENERAL HAD THE BORDER
CRISIS, MENTAL HEALTH AND OTHER
RESPONSIBILITIES SO WE KIND OF
FELL IN THE CRACK THERE.
AND NIH STEPPED UP WITH NIDCR TO
GUIDE IT THROUGH.
IT'S A 790-PAGE DOCUMENT.
THE EXECUTIVE SUMMARY IS ONLY 25
PAGES SO I URGE YOU TO READ
THAT.
I'VE PLACED THE LINK HERE AND I
WILL LEAVE THE POWERPOINT WITH
YOU.
THE WAY WE PROCEEDED WAS TO
ORGANIZE ACROSS THE LIFESPAN
LOOKING AT DISEASES AND
DISORDERS THAT REALLY
CHARACTERIZE EACH AGE GROUP AND
ALSO PICKED ON WHAT I CONSIDERED
THE CROSS-CUTTING THEMES OF PAIN
IMAGINAGEMENT, OPIOID, SUBSTANCE
USE DISORDERS, ADDICTIONS OF
DIFFERENT KINDS.
SO WE'RE HOPING THAT IT WILL
STAY AS A LIVING DOCUMENT AND
HELP US GUIDE OUR THINKING AND
OUR STRATEGIES FOR THE FUTURE.
AND IT WAS GOOD WITH THE HELP OF
LARRY TABAK, WE WERE ABLE TO
STRIKE UP A COLLABORATION WITH
DR. VIVEK MURTHY, WHO'S THE
CURRENT SURGEON GENERAL, AND WE
WROTE THIS SHORT PERSPECTIVE
ARTICLE PUBLISHED IN THE NEW
ENGLAND JOURNAL, AND THIS IS A
QUOTE FROM THERE THAT BASICALLY
STRIKES AT THE VERY CORE OF WHAT
WE ACTUALLY REPORTED ON.
AND IT WAS IN MANY WAYS AN
UPLIFTING EXPERIENCE BECAUSE WE
ACKNOWLEDGED ALL THE GOOD
SCIENCE AND DISCOVERIES THAT
CAME ABOUT IN THE LAST 20 YEARS,
SO THE FIRST SURGEON GENERAL
REPORT WAS PUBLISHED IN 2000.
AND THAT WAS A REPORT THAT
STRESSED THE CONNECTION BETWEEN
THE ORAL SYSTEMS AND SYSTEMIC --
GENERAL SYSTEMS.
BUT DESPITE ALL OF THE PROGRESS
WE'VE MADE, WE STILL HAVE THIS
HUGE PROBLEM WHERE INDIVIDUALS
AND POPULATIONS IN THIS COUNTRY
EXPERIENCE ORAL HEALTH
DIFFERENTLY.
AND THAT WE CANNOT LOOK AT
HEALTH AND WELL-BEING WITHOUT
CONSIDERING ORAL HEALTHCARE AS
BEING ABSOLUTELY INEXTRICABLY
LINKED TO GENERAL HEALTH.
SO OVER THE LAST 20 YEARS WE ALL
KNOW THE DEMOGRAPHICS HAVE
CHANGED SIGNIFICANTLY.
WE'VE MOVED ESPECIALLY IN ORAL
HEALTH TO A VERY DIGITAL ERA.
WE'RE LOOKING NOW AT DATA
SCIENCE AND BIG DATA, THE
DELIVERY OF SYSTEMS AND OUR
DELIVERABLES HAVE CHANGED, WHAT
PATIENTS EXPECT THE KINDS AND
SCOPES OF PRACTICES HAVE
CHANGED, OUR DISEASE TRENDS HAVE
CHANGED TO WHERE HBV POSITIVE
OROPHARYNGEAL CANCERS ARE NOW
MORE DOMINANT THAN CERVICAL
CANCERS OF HBV ORIGIN.
OUR DISCOVERIES HAVE BEEN
FANTASTIC BUT WE HAVE THE
DIVIDES AND BARRIERS AND
DETERMINANTS OF HEALTH THAT HOLD
US BACK, ALONG WITH UNEXPECTED
PANDEMICS THAT WE'RE NOT QUITE
PREPARED FOR.
AND THIS IS WHAT THE REPORT
SAYS.
THAT THE BURDEN OF ORAL DISEASE
IS HUGE AND IT'S FELT GLOBALLY.
CRANIOFACIAL DEFECTS OUT OF ALL
THE INHERITED DISORDERS, 50% OF
THEM INVOLVE THE CRANIOFACIAL
COMPLEX.
I BRING THAT UP, I KNOW I HAVE
IN THE PAST TO HELENE THAT
THAT'S AN AREA THAT IS HARDLY
UNDERSTOOD.
LITTLE BABIES HAVE TO ENDURE
LONG HOURS OF SURGERY AND THEN
LIFELONG MANAGEMENT INVOLVING A
LOT OF FACIAL TISSUES AND A LOT
OF MUSCULATURE AND THEY FALL
INTO THIS KIND OF CRACK OF NOT
BEING ATTENDED TO FULLY WELL.
DENTAL DECAY OR CARE EAST, WHICH
IS REALLY THE MOST PREVALENT OF
ALL CHILDHOOD DISEASE, THE
COMMON REASON WHY CHILDREN MISS
SCHOOL AND ARE TAKEN TO THE E.R.
YOU'RE SUPPOSED TO ACCESS A
DENTIST WHERE OFTENTIMES YOU
CAN'T.
SEVERE PERIODONTITIS REMAINS AN
ADULT DISEASE, VERY COMMON, ONE
OF THE MOST COMMON OF ALL
INFECTIOUS DISEASES.
AND THEN, OF COURSE, WE HAVE THE
CANCERS, VERY HARD TO DETECT,
ALWAYS DETECTED TOO LATE,
TREATMENT IS SURGICAL RESECTION
WHERE HALF THE TONGUE IS REMOVED
AND THEN YOU HAVE THIS VERY
PAINFUL RECOVERY PROCESS FOR
WHICH THERE ISN'T ANY -- REALLY
NO MEDICATIONS THAT CAN
ALLEVIATE SOME OF THIS PAIN AND
DISCOMFORT.
AND OF COURSE HPV RISING TO
CERVICAL CANCER, HIGHER THAN
THAT.
THIS IS JUST AN EXAMPLE WHAT
CHILDHOOD CARE EAST CAN DO TO
INDIVIDUALS.
YOU START A CHILD WITH THAT -- A
MOUTHFUL OF DECAY, THAT CHILD IS
SET FOR LIFE FROM THEN ON.
TYPICALLY THEY GO INTO SURGERY,
EITHER HAVING TO HAVE LOTS OF
EXTRACTIONS OR STAINLESS STEEL
CROWNS, AND IT'S VERY PREVALENT
IN THIS COUNTRY.
AND YOU CAN SEE TO THE VERY FAR
RIGHT, ONE WHO WAS NEGLECTED, IT
SPREAD TO HIS BRAIN,
UNFORTUNATELY HE DIED BECAUSE
THERE WAS NO CARE.
HE WASN'T GIVEN THE CARE HE
NEEDED.
SO I KNOW I'M EMPHASIZING PUBLIC
HEALTH HERE BUT IT'S ALL GUIDED
BY OUR SCIENCE OR OUR NEED TO
LOOK AT A DIFFERENT WAY TO
HANDLE OUR DISEASES AND
PROBLEMS.
RISING AND ALSO VERY NE NEGLED
ARE THE TRIBAL NATIONS, WHERE A
COMBINATION OF ACCESS TO ONLY
WELL WATER THAT HAS A LOT OF
ENVIRONMENTAL STRESSES AND
TOXINS WITH PHENOLS AND FAIL S
CONTRIBUTE TO ORAL HEALTH, DECAY
IS SO HIGH AMONGST THESE
POPULATIONS AS IT IS AMONGST
HISPANICS AND AFRICAN AMERICANS
WHO HAVE NO ACCESS TO CARE, AND
THAT'S EXACTLY WHAT A TYPICAL
MOUTH LOOKS LIKE.
AND I'VE BEEN THERE AND TREATED
THESE PATIENTS.
SO WE'VE REALIZED THROUGH SOUL
SEARCHING, WHICH WASN'T WHAT WE
WERE THINKING 20 YEARS AGO AND
IS SO CENTRAL TO NCCIH IS THAT
WE LOOK AT A PATIENT AS A WHOLE.
AND AS WE TREAT INDIVIDUAL
CONDITIONS, THAT WE PUT THAT
PATIENT IN THE CONTEXT OF THEIR
FAMILY SETTINGS AND THEIR
COMMUNITY LEVEL INFLUENCES AND
YOU LOOK AT BEST WAYS TO
MITIGATE THESE NEGATIVE UPSTREAM
DETERMINANTS THAT REALLY IN THE
END PUSH SOMEONE INTO THE
DISEASE PATH.
THAT HAS BECOME AN ISSUE FOR
GLOBAL HEALTH CONCERN ABSOLUTELY
SO AND STRESSED BY WHO ACTUALLY
PASSING A RESOLUTION THAT ORAL
HEALTHCARE SHOULD BE PART OF
UNIVERSAL HEALTH COVERAGE, SO
SAYING IT IS ABSOLUTELY
ESSENTIAL FOR OVERALL HEALTH AND
WELL-BEING.
IT IS SO NICE WHEN THE OLDEST OF
WORLD CLASS JOURNALS PUT AN
EMPHASIS ON ORAL HEALTH BY
PUBLISHING A SPECIAL SERIES IN
2019 THAT EMPHASIZED THE
IMPORTANCE OF EVIDENCE OF
ADDRESSING THE DETERMINANTS,
TACKLING INEQUALITIES AND
ACTUALLY CHANGING THE WAY WE
DELIVER CARE.
AND SO IT WAS GOOD AND THEY ARE
ACTUALLY NOW IN THE PROCESS OF
DELIVERING A COMMISSION AND OUR
OWN REPORT THAT NIH ACTUALLY IS
GOING TO BE PART OF THE REPORT
ON GLOBAL ORAL HEALTH STATUS.
BUT WHAT'S VERY CHALLENGING FOR
NIDCR IS WE ALSO ARE STEWARDS OF
THE PROFESSION OF DENTISTRY.
BECAUSE OUR STAKEHOLDER GROUPS,
OUR DENTIST SCIENTIST, OUR
CLINICIAN SCIENTISTS, OUR PHTs
M COULD FROM THAT
PH.D.s COME FROM THAT
EDUCATION POOL SO WE FEEL OUR
MISSIONS ARE VERY INTERTWINED
WITH CLINICAL PRACTICE OF
DENTISTRY AND A ADA'S OWN POLIY
AND OF COURSE SUCH THAT EVERY
MISSION, IF SUCCEEDING,
STRENGTHENS THE OTHER MISSIONS.
THAT'S A UNIQUE CHARGE THAT OUR
INSTITUTE FACES.
MAYBE NURSING HAS THE SAME
RESPONSIBILITIES.
SO WE STRUGGLE AGAINST BIASES,
WE STRUGGLE THAT IN FACT ORAL
HEALTH IS NOT SEEN AS A CRITICAL
DETERMINE NAPT OF HEALTH.
DETERMINANT OF HEALTH AND THAT
EVEN PERSISTS WITHIN NIH.
WE HAVE PROFESSIONAL
ORGANIZATION AND EDUCATION UNITS
WHO DO NOT PRIORITIZE THE
IMPORTANCE OF RESEARCH BECAUSE
DEPTH INDUSTRY IS A VERY -- IT'S
A VERY LIKELIHOOD DRIVEN
PROFESSION AND THERE'S A LOT OF
EMPHASIS ON FEE FOR SERVICE AND
PROVIDER CODES, ET CETERA.
THE EVIDENCE BASE, THE ANECDOTAL
REVERENCES THAT WE WORRY ABOUT.
SOL WE HAVE TO ACTUALLY THINK OF
ENGAGING ALL THESE CONSTITUENTS
AT THE SAME TIME.
NOW WE ALSO HAVE OVER US A VERY
BIG CHALLENGE BECAUSE THE FIELD
OF ORAL HEALTHCARE HAS VERY,
VERY FEW MINORITY
REPRESENTATIVES SUCH THAT IT'S
NOT EVEN CLOSE TO REPRESENT THE
DEMOGRAPHICS OF THIS NATION.
AS YOU CAN SEE ON THE LEFT, IT'S
CHANGING.
WE HAVE THE DISEASE BURDEN THAT
SEEMS TO -- NOT SEEMS BUT DOES
AFFECT DISADVANTAGED
POPULATIONS, BUT WE DON'T HAVE
THE WORKFORCE TO ACTUALLY CARE.
SO WE'RE TAKING THAT VERY
SERIOUSLY AS NIH BUILDS ITS OWN
CAMPUS-WIDE INITIATIVE, UNITE,
ALONG WITH ALL OUR OTHER
PROGRAMS.
AND NIDCR'S OWN PORTFOLIO
REFLECTS THAT DEFICIENCY.
AND YOU CAN SEE THAT FOR EACH
ONE OF OUR GRANT MECHANISMS.
WE HAVE VERY FEW AFRICAN
AMERICANS, VERY FEW HISPANICS,
AND VERY, VERY FEW NATIVE
AMERICANS.
SO IN THINKING OF IT, KNOWING WE
COULDN'T DO THIS ON OUR OWN,
KNOWING THAT WE COULDN'T JUST
RELY ON UNITE TO MAKE THE
DIFFERENCE, WE ARE FORGING A
PUBLIC/PRIVATE PARTNERSHIP WITH
KEY ORGANIZATIONS AND REALLY
EVERY STAKEHOLDER GROUP TO THE
TABLE SO WE CAN ADDRESS MISSION
CRITERIA, PIPELINE DEVELOPMENT,
RETENTION AND NURTURING
INDIVIDUALS FOR THE FIELD WITH
SUPPORT FROM INDUSTRY WHO
WOULDN'T SUPPORT US DIRECTLY BUT
WOULD HELP IN FINANCING SCO
SCHOLARSHIPS.
DEP DENTAL EDUCATION, BY THE WS
VERY EXPENSIVE.
GRADUATING AFTER FOUR YEARS WITH
A DDS AND HAVING DEBTS BETWEEN
400 AND $500,000, DEPENDING ON
WHICH PART OF THE NORTHEAST
YOU'RE IN, SO THAT'S
SIGNIFICANT.
SO WE WERE THINKING OF ALL OF
THIS INDEPENDENTLY CAME THE
CHARGE OR THE RESPONSIBILITY FOR
ME TO CONTINUE DEVELOPING OUR
STRATEGIC PLAN THAT MARTHA
SOMERMAN HAD INITIATED.
AND IT WAS HARD TO DO THAT BY
JUST CONDITIONING ON THAT PATH
JUST CONTINUING ON THAT PATH,
THE PANDEMIC CHANGED OUR WORLD.
WE HAD TO THINK OF TRANSLATION,
WE HAD TO THINK OF DIVERSIFYING
AND USING METRICS TO MEASURE THE
OUTCOMES.
SO I WAS VERY DISEASE-AGNOSTIC,
EVEN THOUGH I HAVE MY INTEREST
AREA, I DECIDED NOT TO BE
FOCUSED ON ONE DISEASE OR THE
OTHER, BUT TO THINK OF THE
OVERARCHING THEMES OF
TRANSLATION DIVERSE FIGHTING D
OUTCOME ASSESSMENTS.
WE THIS HAD THESE FIVE VERY C
GOALS, STRESSING TRANSLATION
RESEARCH INVOLVES ALL OF THESE
DOMAINS OF RESEARCH, THERE'S NOT
ONE THAT STANDS OUT AND IS MORE
IMPORTANT THAN THE OTHER.
BECAUSE ENGAGING WITH THE
COMMUNITY NORMALLY GIVES RISE TO
A FINDING OR OBSERVATION THAT
CAN BE TESTED IN A
HYPOTHESIS-DRIVEN WAY.
SO IN THE PAST WE WOULD THINK
BASIC ON ONE END, CLINICAL ON
THE OTHER AND TRANSLATION IN THE
MIDDLE, VERY LINEAR, BUT IT
REALLY IS A CIRCULAR CONTINUUM
AND I WANTED TO EMPHASIZE THAT
OBVIOUS LIP FOR THIS GROUP.
OBVIOUSLY FOR THIS GROUP.
THE FIRST PRIORITY IS TO REALLY
PUT MEAT ON THE BONES, TO
ACTUALLY FIND THE UNDERPINNINGS
OF WHAT THAT MEANS.
UNIQUENESS AND SHARED PROPERTIES
OR QUALITIES OF PROGRESS OF THE
DISEASE.
THEN TAKE THAT INFORMATION AND
DRAW FROM ALL OF US AND THESE
AMAZING PROGRAMS THAT EXIST TO
COME UP WITH INDIVIDUALIZED
APPROACHES FOR PERSONALIZED
DENTAL MEDICINE, TRANSLATING IN
IMPLEMENTATION SCIENCES IS SO
IMPORTANT FOR OUR COMMUNITY AS
IS NURTURING THE DIVERSE NEW
GENERATION AND EXPANDING OUR
PARTNERSHIPS, INCLUDING THOSE
WITH OTHER INSTITUTES.
SO IF YOU LOOKED AT THE
EXTRAMURAL PROGRAM AND MOST OF
OUR FUNDING GOES OVER
$350 MILLION OF OUR BUDGET IS
SPENT ON THE EXTRAMURAL
COMMUNITY.
WE FUND PRACTICALLY EVERY AREA
OF SCIENCE.
THE ONES ON THE FAR RIGHT ARE
ONES WE'RE PUTTING EXTRA
EMPHASIS ON, BUT REALLY THERE'S
SOMETHING HERE FOR EVERYONE.
YOU CAN GO THROUGH THE LIST AND
THERE ARE CERTAINLY
OPPORTUNITIES FOR COLLABORATION
IN EACH OF THESE DOMAINS,
WHETHER IT'S DISEASE OR
DISCIPLINE.
LILLIAN SHUM IS REALLY AN EXPERT
DIRECTOR OF OUR PROGRAM.
WE HAVE BUILT UP OUR TRAINING
PROGRAM SO WE ADDRESS ALL THE
LEAKS IN THE PIPELINE, WHICH AS
I'VE MENTIONED BEFORE IS NARROW
AND NOT YIELDING OF THE CRITICAL
MASS THAT WE NEED AS AN
INSTITUTE AND AS A PROFESSION TO
FORGE SCIENCE FORWARD.
BUT WE'RE TRYING VERY HARD, AND
WHAT YOU SEE IN THE PINK OR RED
BOXES IS WHAT THE INTRAMURAL
PROGRAM OFFERS, AND EXTRAMURAL
PROGRAMS HAVE THESE AND ALL OF
THESE TERMS ARE VERY FAMILIAR TO
YOU.
WE'VE REALLY ADDED ON A HUGE
MOUNT OF DIVERSITY SUPPLEMENTS
AND MECHANISMS TO ENCOURAGE AS
EARLY AS POSSIBLE A PIPELINE
DEVELOPMENT THROUGH CEPA, WHICH
IS N IGMS'S PROGRAM, SO WE'VE
DOVETAILED TO ACTUALLY MOVE THE
NEEDLE IN THIS AREA.
YOU KNOW, WHEN I CAME ON BOARD,
THE PUBLIC HEALTH RESIDENCY
PROGRAM THAT HAD EXISTED FOR
YEARS WAS ACTUALLY SLATED FOR
CLOSURE.
IT WAS, IN FACT, SHUT DOWN.
BUT THE PANDEMIC SHOWED US THAT
THERE WAS A NEED FOR THIS IN OUR
PROFESSION AS IT WOULD BE FOR
THE GENERAL FIELD, RIGHT, PUBLIC
HEALTH WAS ALWAYS SEEN AS A
SIDELINE THING, BUT NOW I THINK
EVERYONE GETS IT, THAT IT IS
ACTUALLY IMPORTANT FOR US TO
HAVE A MOBILIZABLE UNIT OF --
UNITS ALL OVER THE COUNTRY THAT
CAN ACTUALLY ENGAGE AND MITIGATE
PANDEMIC OR ANYTHING LIKE THAT.
SO WE ARE NOW LAUNCHING A
THREE-YEAR PROGRAM A LITTLE
DIFFERENT, IT USED TO BE JUST
ONE YEAR, WE'RE ADDING ON A
TWO-YEAR POSTDOC EXPERIENCE, SO
THAT OUR FELLOWS IN TRAINING WHO
ARE TYPICALLY DDAs WITH MPHs
CAN AUTOIMMUNE TACH TO T
HAS INTEREST IN ORAL CANCERS.
SO THAT WOULD BE A GREAT CANCER.
PROJECT.
WE HAVE NATIONAL INSTITUTE OF
AGING, COGNITIVE DECLINE, SO
WITH AT LEAST TWO OR THREE
TRAINEES A YEAR, WE CAN MAKE A
LITTLE BIT OF A DENT IN
PRODUCING A PUBLIC HEALTH --
PUBLIC HEALTH DENTISTS WHO ARE
WELL INFORMED, WHO ARE KNOWLEDGE
CREATE TORES, NOT
KREE CREATORS.
WE OFFER A TWO YEAR RESEARCH IF
FELLOWSHIP WHERE THEY ACTUALLY
LOOK AT WHERE AN UNDIAGNOSED
CONDITION, I'LL GIVE YOU
EXAMPLES OF THE SEARCH GOING ON
THERE, VERY NICE PROGRAM THAT
HAS GROWN IN ITS NATIONAL
STATURE LED BY JANICE LI, WHO
YOU SEE HERE ON THE RIGHT.
YOU KNOW, I THINK IF I LOOKED AT
THE BLESSINGS THAT WE HAVE
ACCUMULATED OVER THESE 75 YEARS,
OUR INTRAMURAL PROGRAM STANDS
OUT BECAUSE WE HAVE THE MOST
OUTSTANDING GROUP OF
INVESTIGATORS WHO ARE CUTTING
EDGE SCIENTISTS, VERY SERIOUS
ABOUT WHAT THEY DO, AND WE'RE
GROWING TO WHERE 7 OUT OF THE
26 -- SORRY -- ACTUALLY ARE
CLINICIAN SCIENTISTS, AND THEY
WORK IN BUILDING 10 PRIMARILY,
AND SOME OF THEM ARE SCATTERED
ACROSS CAMPUS.
AND THE FOCUS IS IN THESE AREAS.
THERE'S A HUGE SECTION ON
SKELETAL MATRIX AND
MECHANO-BIOLOGY.
THESE ARE THE PIs HERE.
IT'S GREAT BECAUSE THEY ACTUALLY
SEE PATIENTS AND THEY'RE TESTING
VARIOUS INTERVENTIONS AND
PHARMACOLOGICAL INTERVENTIONS
ACTUALLY FOR VERY RARE AND
UNDIAGNOSED CONDITIONS.
YOU CAN SEE THAT RIGHT HERE IN
THE CENTER OF OUR CAMPUS.
WE HAVE A SJOGREN'S CENTER THAT
ACTUALLY DIAGNOSES AND TREATS
PATIENTS LED BY BLAKE WARNER AND
HIS TEAM.
SO THAT'S A BLESSING TO HAVE
THAT AVAILABLE, AND WE DO HAVE
REFERRALS FROM ALL OVER THE
WORLD ACTUALLY AND HAVE A
PATIENT REPOSITORY.
ABOUT 4,000 CASES OF SJOGREN'S,
WHERE WE'VE COLLECTED SAMPLES
AND HAVE KIND OF A LARGE
BIOREPOSITORY TO MOVE FORWARD.
I BROUGHT THIS UP AS JACKIE'S
PROJECT LOOKING AT
GRAFT-VERSUS-HOST DISEASE
BECAUSE THERE ARE LOTS OF ORAL
MANIFESTATIONS AND JACKIE IS
ACTUALLY LOOKING AT AN
INTERVENTION THAT'S PROVEN TO BE
QUITE SUCCESSFUL.
AS YOU CAN SEE THE SEVERE
REACTIONS IN GRAFT-VERSUS-HOST
DISEASE AFFECTS SO MANY TISSUES
IN THE ORAL CAVITY, SCLEROSIS,
HYPERKERATOSIS AND LOTS OF OTHER
LESIONS THAT AFFECT SALIVARY
GLAND FUNCTION AND OTHER BODY
FUNCTIONS.
INTERESTING FOR MY INTRAMURAL
WORLD AND FIBROSIS IS THIS FAC
INHIBITOR THAT'S ACTUALLY BEING
USED TO PREVENT SCAR TISSUE
FORMATION.
JUST THOUGHT I WOULD BRING THAT
UP AS AN OPPORTUNITY FOR NCCIH
AND US TO COLLABORATE ON SPINOFF
STUDIES THAT WOULD COME FROM
WOUND HEALING, AND BEING ABLE TO
CONTROL EXCESSIVE FIBROBLAST
FUNCTION REALLY.
IF THERE'S NOT ENOUGH
REMODELING, THAT'S WHAT IT IS.
SO LIKE EVERY OTHER INSTITUTE,
WE ON A SMALLER SCALE INVEST IN
LARGER INITIATIVES ACROSS THE
COUNTRY.
THESE COST A LITTLE BIT MORE.
AND WE HAVE THREE OF THEM THAT
HAVE BEEN RUNNING FOR YEARS NOW
INTO THEIR SECOND AND THIRD
CYCLES, AND I'M GOING TO
DESCRIBE THEM VERY BRIEFLY.
THE NATIONAL PRACTICE-BASED
NETWORK, THE REGENERATIVE
MEDICINE ONE THAT MARTHA WAS
VERY INSTRUMENTAL IN SETTING UP,
FACEBASE, WHICH IS A REPOSITORY
OF GENOMIC INFORMATION AND
PHENOTYPE INFORMATION ON
CRANIOFACIAL DISORDERS, AND THEN
WHAT'S COMING UP VERY SOON IS
THE TEMPOROMANDIBULAR JOINT OR
DYSFUNCTION CENTER.
SO IN THIS PARTICULAR EFFORT OF
CREATING A NETWORK ACROSS THE
COUNTRY OF PRACTITIONERS WHO ARE
CALIBRATED AND TRAINED TO
ACTUALLY ANSWER QUESTIONS THAT
ARE COMMON CLINICAL QUESTIONS,
EVERYDAY PROBLEMS THAT DENTISTS
AND ORAL HEALTH PROFESSIONALS,
AND THEY'VE GOT A GOOD BASE OF
7,000 PRACTITIONERS, AND THEY'RE
GOING TO BE MORPHED BECAUSE THE
PANDEMIC TAUGHT US THEY OUGHT TO
BE CONNECTING THIS AND BE READY
TO ACTIVATE THIS GROUP TO LOOK
AT OPERATORY CONDITIONS AND
THINGS THREATENING TO THE
PRACTICE OF DENTISTRY.
SO THIS IS IN THE PROCESS OF
ACTUALLY SHAPING UP TO BE MUCH
MORE DIVERSE AND INCLUSIVE.
BUT WHAT'S INTERESTING IS, WE'RE
GOING TO START UP A PRACTICE
BASED RESEARCH -- WITHIN DENTAL
SCHOOLS BECAUSE SCHOOLS ARE
SAFETY NET PROVIDERS AND SEE THE
ENTIRE SPECTRUM OF PATIENTS FROM
VERY SIMPLE TO VERY COMPLEX TO
THE MEDICALLY COMPROMISED AND
SPECIAL NEEDS PATIENTS.
THAT REQUIRE VERY SPECIAL CARE
AS YOU KNOW.
SOMEONE WITH SPINA BIFIDA OR
MULTIPLE SCLEROSIS, THEY DON'T
HAVE A DENTIST THAT HAVE THE
OPERATORIES AND EVEN ARE TRAINED
FOR SPECIAL NEEDS PATIENTS, AND
SO WE'RE GOING TO SET THIS UP
WITHIN SCHOOLS TO ENGAGE
CLINICIANS AND FACULTY,
ADMINISTRATORS AS WELL AS
PATIENTS AND CREATING THIS SENSE
OF CURIOSITY AND DRIVE TO
ACTUALLY CREATING KNOWLEDGE
CHAIRSIDE THAT THEY CAN TAKE
THEN INTO THEIR PRACTICE
EXPERIENCES OR WHEN THEY COME
BACK AS FACULTY.
THE REGENERATIVE MEDICINE
CONSORTIUM WHICH IS BASED IN
CALIFORNIA, WE HAVE TWO GROUPS
AND THE MICHIGAN HARVARD
PITTSBURGH ONE, NORTHEAST, SO TO
SPEAK, IS DOING VERY WELL.
THERE'S MANY FDA PRODUCTS RIGHT
NOW THAT ARE IN THE PROCESS OF
BEING APPROVED, AND THEY DEAL
WITH VARIOUS ASPECTS OF
PERIODONTAL DISEASE AND FRACTURE
HEALING AND DIFFERENT KINDS OF
REGENERATIVE -- SO THAT'S
ACTUALLY BEEN A HIGHLY
SUCCESSFUL INFRASTRUCTURE AND
CAPACITY BUILDING CONSORTIUM.
VERY PLEASED WITH IT.
FINALLY THE FACEBASE, A PROGRAM
THAT I TALKED ABOUT, HAS
GATHERED QUITE A REPOSITORY OF
GENOMIC INFORMATION AND -- IN
THIS DATABASE THAT IS ACCESSIBLE
TO ALL, AND THEY'RE HOPING THAT
THE DATA SCIENCE INITIATIVE, NIH
IS ACTUALLY INVESTING IN IT NOW,
THAT WE CAN ACTUALLY MAKE ALL OF
THIS TRANSFERABLE AND
INTERRELATABLE, BECAUSE THAT IS
THE CHALLENGE.
YOU CAN SEE THAT IT'S ACROSS
EVOLUTION WITH DIFFERENT MODEL
SYSTEMS AND MAKING A DIFFERENCE
TO PATIENTS.
AND THIS IS WHAT I MEAN BY
CRANIOFACIAL DISORDERS.
SO HERE IS A CHILD THAT HAS
CLEFT, CORRECTED SURGICALLY,
CHILD IS ABOUT 6 MONTHS OLD,
COMES BACK IN FOR SECOND
INTERVENTION.
THE MID FACE IS GROWING AT THAT
TIME SO THERE'S ALWAYS A MID
FACE KIND OF DEPRESSION BECAUSE
YOU'RE BRINGING ABOUT CLOSURE
BEFORE THAT ACTUALLY HAPPENS.
IN AN UNNATURAL WAY.
AND THAT CHILD UNDERGOES A
SERIES OF CARE --
MULTIDISCIPLINARY CARE
THROUGHOUT LIFE.
WHEN YOU LOOK AT HIM, GOD BLESS
HIM, HE ACTUALLY PASSED HIM AWAY
BUT I TREATED HIM WHEN HE WAS IN
AFRICA, HE HAD SURGERY THAT
INVOLVED REPLACING HIS -- REALLY
RESHAPING HIS SKULL AND HIS
BRAIN.
LOOK AT THE EFFECTS ON HIS
ORBITS AND ALL THE SEQUELAE OF
THAT SURGERY THAT HE HAD TO DEAL
WITH AND THE SAME WITH PUZANS.
SO WE HAVE A NEED TO BE LOOKING
AT THAT GROUP OF PATIENTS AND
THEN TAKING ADVANTAGE OF THIS
DATABASE TO SEE HOW BEST WE CAN
TRANSFER THIS TO MAKE IT REALLY
USER-FRIENDLY FOR CLINICIANS WHO
HAVE A HARD TIME DIFFERENTIATING
BECAUSE THESE SYMPTOMS --
SYNDROMIC CONDITIONS ARE VERY
SUBTLE SOMETIMES AND CAN BE
MISSED.
VERY OFTEN THE DENTAL PHENOTYPE
IS NOT TAKEN AS SERIOUSLY.
SO AS I LOOKED AT THE MOVING
FRONTS AND HPV RISING EVEN WITH
THE VACCINES THAT ARE EFFECTIVE,
THAT IT'S RISING TO WHERE MALES
ARE GETTING FAR MORE AFFECTED
THAN FEMALES.
INITIALLY THE VACCINE WAS
AVAILABLE FOR TEENAGE GIRLS, IF
YOU REMEMBER.
WELL, NOW IT'S SEEMING TO BE
THAT YOUNG MALES ARE AFFECTED
FIVE OR SIX FOLD TIMES MORE.
SO WE BROUGHT TOGETHER A THINK
TANK, NED SHARPLESS WAS ON BOARD
TO LOOK AT HOW WE CAN ADVANCE
EARLY DIAGNOSIS, AND YOU KNOW
THAT WITH NCCIH, THAT THE
EMPHASIS ON BEHAVIORAL
CONDITIONING OF MAKING SURE THAT
HABITS THAT BECOME HABITS ARE
NICKED EARLY IN THE BUD ARE
VERY, VERY IMPORTANT FOR THIS
KIND OF CANCER, SO AS FOR ORAL
CANCERS IN GENERAL.
I WAS VERY PLEASED SO SEE FROM
OUR VERY INNOVATIVE PARTNERSHIP
INITIATIVE THAT FRANCIS COLLINS
WAS RESPONSIBLE FOR SETTING UP
SEVEN YEARS AGO, BRINGING TO THE
TABLE INDUSTRY PARTNERS,
GOVERNMENT, ACADEMIA AND NIH, TO
REALLY SOLVING THE MOST
DIFFICULT ISSUES, THE MOST
COMPOUND DISEASES LOOKED AT
SERIOUSLY: DIABETES,
PARKINSON'S, ALZHEIMER'S.
SO THEY'VE MADE GOOD PROGRESS IN
AUTOIMMUNE DISORDERS, ON
SYSTEMIC LUPUS AND RHEUMATOID
ARTHRITIS, TO WHERE FRANCIS FELT
THAT SHOW GRINS SJOGREN'SF
THIS, AND WE JUMPED AT THE
OPPORTUNITY.
WE NOW HAVE A GRANT THAT
INVOLVES ACADEMIC PARTNERS AT
OKLAHOMA AND JOHNS HOPKINS WITH
OTHER INSTITUTES HERE INVOLVED,
ALONG WITH OUR INTRAMURAL
PROGRAM THAT HAS A VERY RICH
HISTORY IN SALIVARY GLAND
BIOLOGY AND RECONSTRUCTION.
TO LOOK AT THIS DISEASE FROM
START OH TO FINISH, WELL
CHARACTERIZED, WE'VE ALREADY GOT
A LARGE COLLECTION OF
BIOSPECIMENS AND TAKE IT UP FROM
THE DEACON STRUCKTIVE MODE F
SINGLE CELL ANALYSIS, PUTTING T
BACK TOGETHER AND COMING UP WITH
THERAPEUTIC PRODUCTS THAT WOULD
HALT THE PROGRESS OF THIS QUITE
DEVASTATING DISEASE.
HELENE AND I WOULD BOTH AGREE
THAT THE TRANS-NIH ACTIVITIES
ARE TRULY EXCITING, AND WE HAVE
TO BE AT THE TABLE TO INTEGRATE
AS BEST AS WE CAN.
I THINK WE SHARE SOME OF THE
STRUGGLES AND SOME OF THE GREAT
SUCCESS STORIES HERE IN THIS
EFFORT, AND YOU CAN SEE THAT
RANGE FROM THE CANCER MOONSHOT
TO BRAIN IMAGING TECHNOLOGIES,
THAT THERE IS AN APPLICATION FOR
US IN ORAL HEALTH AS IT MUST BE
HERE.
SO I JUST ACTUALLY HAVE DONE AN
IN DEPTH INTERVIEW WITH REBECCA
BAKER WHO ACTUALLY RUNS IT SO
EFFICIENTLY.
IT'S DIVIDED INTO PAIN
MANAGEMENT AND SUBSTANCE USE
DISORDERS.
DENTISTS AND ORAL HEALTH -- ARE
VERY INVOLVED INITIALLY FOR
OVERPRESCRIBING.
THAT TREND HAS ACTUALLY DECLINED
OVER THE YEARS.
SO WE HAVE TWO MAJOR
INITIATIVES.
THE FIRST ONE WAS INITIATED BY
NCCIH ON MYOFASCIAL TISSUES AND
CLINICAL PAIN MANAGEMENT.
AND VERY RECENTLY DRIVEN REALLY
BY THE LEADERSHIP OF HELENE, WE
HAVE THIS MULTI-INSTITUTE
PARTNERSHIP ON RE-JOIN, WHICH IS
FOCUSED ON UNDERSTANDING THE
NEURAL PATHWAYS IN JOIN, SUCH AS
THE KNEE JOINT AND
TEMPOROMANDIBULAR JOINT.
THEY HAVE DIFFERENT CHALLENGES
AND I'LL SHOW YOU WHY.
BECAUSE HERE YOU HAVE THE JOINT.
LET ME SEE IF I CAN POSSIBLY --
THE HEAD OF THE CONDYLE
ARTICULATES IN THIS LITTLE FOSSA
AND THERE'S THIS FIBER CARTILAGE
HERE, NOT THE SAME AS YOU SEE IN
THE KNEE JOINT.
FIBER CARTILAGE DEGENERATES FAST
AND CANNOT GENERATE EASILY.
IT'S AVASCULAR, IT'S NOT
INNERVATED EITHER.
SO IT'S VERY PRONE TO
DESTRUCTION AND CAN'T REPAIR
ITSELF EASILY.
SO WE START OFF THERE,
PERIARTICULAR TISSUES AROUND THE
JOINT ARE REALLY WHAT SETS THE
JOINT UP FOR A DISEASE PROCESS.
BECAUSE IT'S A VERY FINALLY
CONNECTED NEUROMUSCULAR TISSUE
WHERE FASCIA PLAYS A HUGE ROLE,
SO IF YOU LOOK AT THE
DYSFUNCTION ITSELF, THEY NO
LONGER CALL IT TEMPOROMANDIBULAR
JOINT.
IT'S TEMPOROMANDIBULAR
DYSFUNCTION BECAUSE IT'S NOT
JUST THE JOINT ITSELF.
IT INVOLVES THE JOINT
PRINCIPALLY BUT ALSO THE MUSCLES
AND THE FASCIA AND EVERYTHING
THAT GOES WITH IT.
THE ATTACHMENTS, THE TENDONS,
THE LIGAMENTS.
AND VERY OFTEN THE SYMPTOMS ARE
ALSO VERY, VERY COMPLEX AND
INDICATIVE AT THE START OF THE
DISEASE.
SO THIS IS MY ASK FOR YOU, IS
THAT WE REALLY WANT YOU AT THE
TABLE AS A PARTNER, BECAUSE WE
CANNOT DO THIS IN A
UNIDIRECTIONAL MANNER.
IT HAS TO BE A PARTNERSHIP WITH
NCCIH AND SOME OTHER INSTITUTES.
SO FAR, I LOOKED UP EVERYTHING
THAT WE WERE INVOLVED WITH, WITH
NCCIH, AND THESE ARE THE
INITIATIVES THAT WE HAVE A
COMMON INTEREST IN AND WE HAVE
PARTNERSHIP ON.
YOU CAN SEE IT VARIES FROM
LOOKING AT OMEGA 6 DIETS, PAPER
MANAGEMENT AND SO PN
MANAGEMENT AND CONTROL OF PAIN,
MUSIC.
IT'S A PORTFOLIO THAT LENDS
ITSELF TO EXPANSION IN EVERY
AREA.
NOW WHERE I SEE OURSELVES
MOVING, IF I CAN PROJECT A BIT
FOR THE FUTURE, IT WOULD BE IN
THE AREA OF PAIN FOR SURE.
WE STRUGGLE AND WITH VERY
DISTINCT OROFACIAL PAIN
PHENOMENA THAT ARE HARD TO
CALIBRATE SOMETIMES AND EVEN
STRATIFY.
WE NEED DO THAT, WITH A BETTER
THESAURUS.
WE NEED HEALTH APPROACHES AND
INTEGRATIVE TREATMENTS FOR EVERY
ONE OF OUR DISEASES AND
DISORDERS.
WE HAVE TO, I THINK, INSTITUTE
MUCH MORE OF A PREVENTIVE AIF
PROACH TO EVERYTHING WE DO, AND
TO PROBE INTERCEPTOR PROCESS IN
THE CONTEXT OF ORAL DISEASE,
BECAUSE IT IS, IN FACT,
AFFECTING GENERAL HEALTH AND
WELL-BEING.
SO THIS IS WHERE I WOULD END,
WHICH IS I'VE SPECIFIED THE
PROBLEMS, I'VE ENVISIONED A PLAN
THAT I'M HOPING THE INSTITUTE
WILL MOVE ALONG IN A VERY, VERY
INTENTIONAL WAY, AND I'M HOPING
THAT THE RESULTS WILL ACTUALLY
BE ORAL HEALTH FOR ALL.
THROUGH INTEGRATION, THROUGH
INNOVATION AND BY INSPIRING
THOSE THAT WE MENTOR.
I WANT TO THANK MY STAFF WHO ARE
EXTREMELY SUPPORTIVE AND
TALENTED, DEDICATED GROUP.
IT'S REALLY A PRIVILEGE AND AN
HONOR TO BE HERE EVEN IF IT'S
VIRTUAL.
THANK YOU.
ANY QUESTIONS AND COMMENTS?
I'M HAPPY TO TAKE THAT.
>> THANK YOU SO MUCH.
RENA, THIS WAS SO OUTSTANDING.
IT'S SO IMPRESSIVE TO SEE IN THE
SHORT AMOUNT OF TIME THAT YOU'VE
BEEN AT NIH AND THE LEADERSHIP
THAT YOU'RE SHOWING AND THIS
WONDERFUL SPIRIT OF
COLLABORATION.
I REALLY -- I'M JUST SO
IMPRESSED AND IT'S WONDERFUL TO
HAVE YOU AS A COLLEAGUE.
WE HAVE A FEW MINUTES FOR
QUESTIONS.
I HAVE A QUESTION BUT I'LL LET
OTHERS JUMP IN FIRST.
RICK AND THEN NADJA.
>> THANK YOU VERY MUCH FOR THAT
WONDERFUL TALK.
I REALLY, REALLY ENJOYED
LISTENING TO IT.
I WAS WONDERING IF THERE MIGHT
BE SOME OVERLAPS BETWEEN YOUR
INSTITUTE AND NCCIH,
PARTICULARLILY WITH THE TURNG.
TONGUE.
IN TRADITIONAL CHINESE MEDICINE,
THERE'S DIFFERENT THEORIES ABOUT
WHAT THE TONGUE LOOKS LIKE,
COLOR, EVERYTHING ABOUT THE
TONGUE CAN BE IMPORTANT IN
DIAGNOSES, AND I WAS WONDERING
IF THERE'S ANY OVERLAB THERE.
>> HUGE AMOUNT, RICK.
HUGE.
EVEN WITH COVID AND THE TASTE
BEING SO AFFECTED AND SO EARLY
ON, WE HAVE A POCKET OF
RESEARCHERS LOOKING AT THE
PHYSIOLOGY OF TASTE AND
SENSATIONS, LOOKING AT THE TURNG
IN ITS NEUROMUSCULAR CAPACITY,
AS AN INDICATOR OF VITAMIN
DEFICIENCY, IS IT OFTENTIMES
EVALUATED IN THE CLINICAL EXAM?
>> IN TRADITIONAL CLIE NIECE MED
SIGN, MANY TIMES THE TONGUE IS
LOOKED AT AS AN INDICATOR OF
WHAT THE INTERNAL ORGANS MIGHT
BE DOING AND HOW THE HOMEOSTASIS
OF THE INTERNAL BODY SYSTEM IS,
SO IT'S KIND OF A WINDOW TO THE
INSIDE THAT'S MANY TIMES USED IN
INITIAL DIAGNOSIS.
THE COLOR, SHAPE, COATING, LOTS
OF THINGS YOU CAN JUST TELL BY
LOOKING.
>> YES.
AND WE HAVE A HOST OF DISEASES
ALL OF WHICH AFFECT THE TONGUE,
THOSE ARE ACTUAL PATHOLOGIES BUT
YOU CAN ALSO GET A FIRM
INDICATION OF OVERALL HEALTH BY
LOOKING AT THE TONGUE.
NADJA?
>> THANK YOU SO MUCH.
YOU JUST REALLY JUST REAR
PRESENTATION AND I'M REALLY
INSPIRED BY THE WORK THAT YOU'VE
DONE TRANSITIONING FROM BEING ON
THE GROUND AND SEEING PATIENTS
AND THEN MOVING TOWARDS BEING
MORE INVOLVED IN POLICY AND
HAVING THAT REALLY INFORMED BY
YOUR ON THE GROUND EXPERIENCE.
IN THAT REGARD, I JUST WONDERED,
I KNOW SOME OF THE POPULATIONS
THAT YOU'VE WORKED WITH IN THE
PAST WHEN YOU WERE IN PRACTICE,
ARE SOME OF THE SAME POPULATIONS
THAT DO USE ALTERNATIVE
THERAPIES, COMPLEMENTARY
APPROACHES A GREAT DEAL, WHETHER
THAT'S APPROACHES FOR PAIN
MANAGEMENT OR ORAL HYGIENE OR
THINGS LIKE THIS BASED ON BOW
TAN YAL KALES OR THINGS LIKE
THAT AND I WONDERED IF YOU HAD
ANY PERSONAL EXPERIENCE WITH
THAT OR ANY PERSONAL INTEREST IN
THAT CONNECTION BETWEEN IT SEEMS
LIKE THERE'S A NEED FOR OFTEN
SURGICAL INTERVENTION BUT THEN
SOME OF THESE SRP APPROACHES
MIGHT BE USED FOR PAIN
MANAGEMENT, RECOVERY, OVERALL
PAIN MANAGEMENT, THAT HAS
HAPPENED.
I JUST WONDERED IF YOU HAD ANY
PERSONAL THOUGHTS ABOUT THAT.
>> SUMP A GREAT POINT.
>> RELATED TO, SAY, THE
EFFECTIVE ENVIRONMENTAL STRESSES
ON TOOTH DEVELOPMENT.
BECAUSE TEETH DEVELOP IN UTERO,
THEY LAND UP AS BEING VERY
IMPORTANT BIOLOGIC HARDWARE FOR
RECORDING THE INSULTS THAT
ACTUALLY HAPPEN DURING
PREGNANCY.
I KNOW PEOPLE DON'T REALIZE
THAT, BUT YOU GET THESE LITTLE
ENAMEL DEFECTS THEY CALL
HYPERMINERALIZATION DEFECTS ON
BABY TEETH AS WELL AS PERMANENT
FIRST MOLARS THAT REFLECT THAT
THE MOTHER WAS EXPOSED TO SOME
VIECIALT TALL VERY
ENVIRONMENTAL STRESSOR, IT'S
RECORDED IN YOUR TEETH.
ALTERNATIVE APPROACHES,
DENTISTRY AND ORAL HEALTH
PRACTICE IN THE U.S. IS VERY,
VERY TRADITIONAL.
VERY CONSERVATIVE, VERY
PROCEDURE-DEPENDENT,
INTERVENTION-DEPENDENT RATHER
THAN PREVENTION, AND THAT MOST
OF THE PRACTICES THAT INVOLVE
HOMEOPATHY, AYURVEDICS ARE
OCCURRING OUTSIDE THE COUNTRY IN
DIFFERENT PARTS OF WORLD.
IN CHINESE MEDICINE IN INDIA,
FOR SURE ALL OF THAT IS
HAPPENING, AND EXCEPT FOR THE
TEMPOROMANDIBULAR JOINT WHERE
IT'S GONE INTO THE GREY AREA
OF -- I WOULDN'T CALL IT VOODOO
DENTISTRY BUT IT'S IN THE
PSYCHOSOMATIC RANGE ONLY BECAUSE
YOU WALK INTO AN OFFICE WITH
FLASHY LIGHTS AND THINGS THAT
YOU JUST CAN'T PUT YOUR FINGER
ON BECAUSE PEOPLE DON'T
UNDERSTAND THE DISEASE.
SO I THINK IN THAT AREA, THERE
ARE ALTERNATIVE APPROACHES BUT
NOT THE KIND THAT YOU'RE
THINKING.
BUT NOT IN GENERAL, NO, I
WOULDN'T SAY UNLESS I'M NOT
KEEPING ON TOP OF WHAT'S
HAPPENING IN THE FIELD.
I WILL TAKE A LOOK AT THAT AND
SEE IF THERE ARE ANY -- YOU CAN
PUT ON A TOOTH THAT'S THROBING
WITH PAIN.
TYPICALLY IT'S ZINC OXIDE
EUGENOL, WHICH IS CLOVE OIL.
WE STILL USE THAT.
AND THAT IN A SENSE IS A
BIOLOGICAL DERIVATIVE.
IT'S A GOOD THING, BECAUSE WE
CERTAINLY NEED THE BEHAVIORAL
CONDITIONING ASPECTS OF MUCH
MORE REINFORCED IN OUR PRACTICE
AND OUR PRINCIPLES OF PRACTICE.
SO THANK YOU FOR THAT.
>> THANK YOU.
>> SO I HAVE ONE QUESTION IF
THERE'S NO OTHER QUESTIONS OR
COMMENTS, BECAUSE I WANTED TO
FOLLOW UP ON RICK'S QUESTION
ABOUT TRADITIONAL CHINESE
MEDICINE.
ONE OF THE REASONS IS THAT IN
OUR STRATEGIC PLAN, ONE OF THE
THINGS THAT WE'VE PUT IN ONE OF
OUR FIRST STRATEGIC AIM IS TO
LOOK AT WHAT WE CALL DIAGNOSTIC
SYSTEMS AND THERAPEUTIC SYSTEMS,
BUT PRIMARILY DIAGNOSTIC, THAT
ARE DIFFERENT FROM THOSE OF
CONVENTIONAL MEDICINE.
SO AIR VAI DA, YOU MENTIONED
COULD BE ONE OF THEM,
TRADITIONAL CHINESE MEDICINE
WHERE THE PRACTITIONER
INTERPRETS THE PERSON'S SIGNS AN
SYMPTOMS IN A WAY THAT IS A
DIFFERENT FRAMEWORK, SIGNS AND
SYMPTOMS ARE LOOKED AT
DIFFERENTLY IN ORDER TO COME TO
A DIAGNOSIS.
A LOT OF THESE DIAGNOSES ARE
VERY, VERY -- THEY DON'T OVERLAP
REALLY WITH OUR DIAGNOSES.
SO ONE OF THE THINGS WE WANT TO
DO IS TO HAVE SOME INITIATIVES
TO VALIDATE ESSENTIALLY THESE
DIAGNOSES AND DO INTERRATER
RELIABILITY, FOR EXAMPLE.
ONE OF THE THINGS THAT RICK WAS
MENTIONING, SAY TAKE 10
DIFFERENT PRACTITIONERS OF
TRADITIONAL CHINESE MEDICINE AND
SHOW THEM 10 DIFFERENT TONGUES
AND SEE WHETHER THEY, FIRST OF
ALL, AGREEL ON WHAT THE SIGNS
AND SYMPTOMS ARE, AND HOW DO
THEY INTERPRET IT, WHAT DO THEY
DIAGNOSE BASED ON THAT.
THIS MIGHT BE A REALLY
INTERESTING -- AND THEN USE THE
PRACTITIONERS WHO ARE TRAINED,
YOU KNOW, IN THIS PARTICULAR
METHOD, DIAGNOSTIC METHOD TO
INFORM THE RESEARCH QUESTION.
SO I THOUGHT THIS MIGHT BE AN
AREA WHERE WE COULD COLLABORATE.
IT WOULD BE VERY INTERESTING,
WOULDN'T IT?
>> YES.
ESPECIALLY NOW IN THE AGE OF
DIGITAL IMAGING WHERE INTRAORAL
PHOTOGRAPHY IS SO WELL DEFINE
AND WELL REFINED SO WE CAN HAVE
AI AND MACHINE LEARNING TOOLS
THAT WOULD ACTUALLY BE
PREDICTIVE AND DIAGNOSTIC.
I THINK THAT WOULD BE ONE AREA
WE COULD INTEGRATE DATA SCIENCE,
ABSOLUTELY.
>> I TOTALLY AGREE.
SO LET'S PUT THAT DOWN.
>> AND THERE'S LOTS TO TALK
ABOUT, HELENE, AS YOU KNOW.
>> GOSH.
IT HAS BEEN LOVELY TO HAVE YOU,
RENA.
WE'RE ACTUALLY OUT OF TIME SO
WE'RE GOING TO MOVE ON IN OUR
PROGRAM, BUT WE CANNOT THANK YOU
ENOUGH FOR TAKING THE TIME TO
COME AND SPEAK WITH OUR COUNCIL
AND LOOKING FORWARD TO FOLLOWING
UP ON ALL THESE IDEAS THAT WE'RE
DISCUSSING.
>> THANK YOU.
AND THANK YOU, DR. KHALSA, FOR
MAKING ALL OF US WORK ON TIME.
THANK YOU.
BYE-BYE.
>> THANK YOU.
BYE-BYE.
>> OKAY.
WE ARE NOW GOING TO MOVE TO THE
MINI SYMPOSIUM THAT WE HAVE
TALKED ABOUT EARLIER, AND I'M
GOING TO TURN THE MICROPHONE
OVER TO DR. EDWARDS, WHO WILL
INTRODUCE DR. WEBER, WHO WILL
INTRODUCE THE SPEAKERS.
>> THANKS, PARTAP.
SO I THINK AS WE CONCEPTUALIZE
THIS LITTLE MINI SYMPOSIUM, WE
ACTUALLY DREW BACK FROM OUR
STRATEGIC PLAN WHERE AT THE END
OF THE PLAN, YOU CAN FIND OUR
TOP 10 SCIENTIFIC PRIORITIES.
ONE OF THEM IS ACTUALLY
SUPPORTING IMPACTFUL CLINICAL
TRIALS.
SO AS WE DISCUSS PUTTING THIS
SYMPOSIUM TOGETHER, WE ACTUALLY
COMBINE TWO AREAS OF INTEREST AS
YOU HEARD EARLIER, WE'RE VERY
MUCH INTERESTED IN DEVELOPING
NEW PROGRAM FOR REDUCTION OF
STRESS, SO WE THOUGHT WE'D PUT
THE DISCUSSION OF IMPACTFUL
TRIAL IN THE CONTEXT OF STRESS
RESEARCH, BUT WE ARE GOING TO
HAVE WENDY ACTUALLY SET THE
STAGE, AND WE ALSO INVITED THREE
OF OUR INVESTIGATORS THAT ARE
GOING TO ILLUSTRATE THE VARIOUS
ASPECTS OF WHAT WE CONSIDER AS
IMPACTFUL TRIAL FROM THE
PERSPECTIVE OF THE SCIENCE
THAT'S BEING TARGETED, THE
APPROACH, THE POPULATIONS THAT
ARE BEING TARGETED AND ALSO THE
PROCESS THAT WE FOLLOW.
SO WITHOUT FURTHER ADO, I'M
GOING TO TURN IT OVER TO WENDY,
WHO'S GOING TO SET THE STAGE FOR
THE REST OF THE PRESENTATION.
WENDY?
>> GREAT.
THANK YOU SO MUCH, EMMELINE.
LET ME JUST MAKE SURE THAT
EVERYONE CAN SEE MY SLIDES OKAY.
AND LET'S SEE IF I CAN GET THEM
TO GO TO THE CORRECT MODE.
CAN EVERYBODY SEE THAT?
GREAT.
SO IT'S MY PLEASURE TO TALK WITH
YOU ALL THIS AFTERNOON AND TALK
TO YOU ABOUT THIS IDEA OF
CLINICAL TRIALS TO ADDRESS
STRESS IN DIFFERENT CONTEXTS AND
WHAT REALLY MAKES TRIALS
IMPACTFUL.
SO LET ME START OFF WITH JUST
DOING A FEW INTRODUCTIONS AND
OVERVIEW OF WHAT WE'RE GOING TO
TALK ABOUT THIS AFTERNOON.
SO I'M GOING TO GIVE A LITTLE
BIT OF AN INTRODUCTION AND TALK
A LITTLE BIT ABOUT OUR FRAMEWORK
FOR CLINICAL TRIAL RESEARCH AND
WHAT WE THINK SUCCESS WOULD LOOK
LIKE FOR IMPACTFUL CLINICAL
TRIALS AND THEN I'M GOING TO
TURN THINGS OVER TO OUR
DIFFERENT SPEAKERS.
DR. MICHAEL CHRISTOPHER IS GOING
TO TALK ABOUT ADAPTATION AND
FEASIBILITY OF INTERVENTIONS IN
A WORKPLACE SETTING, AND
DR. CHRISTOPHER IS A PROFESSOR
AT PACIFIC UNIVERSITY AND THE
DIRECTOR OF MINDFUL HEALTH AND
RESILIENCE LABORATORY.
HIS PRIMARY RESEARCH IS FOCUSED
ON THE IMPACT OF MINDFULNESS AND
ITS RELATED CONTEMPLATED
PRACTICES ENHANCING RESILIENCE
AND IMPROVING STRESS REACTIVITY
IN HIGH RISK AND DIVERSE GROUPS.
HE'S DEVELOPED THE MINDFULNESS
AND RESILIENCE TRAINING DESIGNED
TO PREVENT STRESS REACTIVITY AND
HEALTH OUTCOMES AMONG HIGH
STRESS COHORTS.
THEN WE'RE GOING TO TURN THINGS
OVER TO DR. ZEV ZEV
SCHUMAN-OLIVIER WHO'S GOING TO
TELL US ABOUT POPULATION-BASED
SCREENINGS HE'S DOING IN A
HEALTHCARE SETTING AND SOME
RESEARCH HE'S DOING IN THAT
SPACE.
CAMBRIDGE HEALTH ALLIANCE AS
WELL AS AN ASSISTANT PROFESSOR
IN THE DEPARTMENT OF PSYCHIATRY
AT HARVARD MEDICAL SCHOOL.
HE'S THE FOUNDING DIRECTOR OF -H
SUBSTANCE USE, MENTAL HEALTH
DISORDERS AND CHRONIC PAIN IN
BOTH MENTAL HEALTH AND PRIMARY
CARE SETTINGS.
OUR FINAL SPEAKER WILL BE
DR. JUDITH MOSKOWITZ.
DR. MOSKOWITZ IS A PROFESSOR OF
MEDICAL SOCIAL SCIENCES AT
NORTHWESTERN UNIVERSITY FEINBERG
SCHOOL OF MEDICINE.
SHE'S THE DIRECT DIRECTOR OH
AT THE CENTER FOR INTEGRATIVE
HEALTH AND HER CURRENT RESEARCH
IS FOCUSED ON UNIQUE ADAPTIVE
ROLE OF POSITIVE EMOTION IN THE
PROCESS OF COPING WITH VARIOUS
TYPES OF HEALTH RELATED AND
OTHER LIFE STRESSORS.
SO WE'VE GOT A STAR STUDDED
PANEL FOR YOU TODAY.
SO I WANT TO JUST GIVE A VERY
BRIEF CONTEXT, THINK WE'VE
TALKED THIS MORNING A LITTLE BIT
ABOUT STRESS AND HOW CHALLENGING
THE SITUATION IS GETTING AROUND
THE WORLD AND HOW MANY STRESSORS
WE'RE DEALING WITH BUT JUGS TO
PUT THIS IN CONTEXT, EVEN BEFORE
THE PANDEMIC THIS IS SOMETHING
WE WERE TALKING ABOUT.
OUR STEVEN STRAUSS DISTINGUISHED
LECTURE FOR COMPLEMENTARY
THERAPIES WE DO ANNUALLY, ABOUT
A NATION UNDER PRESSURE AND THE
PUBLIC HEALTH CONSEQUENCES OF
STRESS IN AMERICA.
AND AS WE ARE ALL WELL AWARE,
THIS HAS JUST GOTTEN WORSE WITH
THE PANDEMIC, SO MUCH SO THAT
DR. MURTHY AS SURGEON GENERAL
HAS JUST ISSUED IN THE LAST FEW
MONTHS AN ADVISORY ON THE YOUTH
MENTAL HEALTH CRISIS THAT WE
HAVE, WHICH HAS BEEN FURTHER
EXPOSED BY THE COVID-19
PANDEMIC.
SO THIS IS JUST A MAJOR ISSUE
FOR ALL OF US, BUT PARTICULARLY
THE CHILDREN IN OUR -- IN THE
U.S. AS WELL AS INTERNATIONALLY.
MANY OF YOU ARE PROBABLY
FAMILIAR WITH THESE STATISTICS.
EARLY ON IN THE PANDEMIC,
SURVEYS REPORTED THAT 70% OF
AMERICANS SURVEYED FELT THAT THE
COVID PANDEMIC WAS AN EXTREME OR
SEVERE CRISIS AND NEARLY TWO
THIRDS SAID THEY HAD REPORTED
INCREASED STRESS, ANXIETY OR
DEPRESSION, AND THAT
COVID-RELATED STRESSORS WERE
INTERFERING MODERATELY, SEVERELY
OR OVERWHELMINGLY IN THEIR
LIVES.
TWO YEARS LATER, WE HAVEN'T
GOTTEN MUCH BETTER.
IN MARCH OF 2022, THE AMERICAN
PSYCHOLOGICAL ASSOCIATION
RELEASED A SERIES OF DATA AND
STATISTICS LOOKING AT STRESS IN
AMERICA, MONEY, INFLATION AND
THE WAR THAT'S GOING ON IN THE
UKRAINE PILE ON TO A NATION
THAT'S STUCK IN SORT OF THIS
CONTINUED SURVIVAL MODE.
A FEW GRAPHICS FROM THEIR
INFORMATION THAT THE DIFFERENT
SOURCES OF STRESS, 87% OF
AMERICANS SAY THAT THE RISING
COST OF INFLATION IS A MAJOR
STRESSOR.
GLOBAL UNCERTAINTY, THE WAR IN
RUSSIA AND POTENTIAL RETALIATION
ARE ALL MAJOR STRESSORS WITH
MORE THAN 80% OF INDIVIDUALS
REPORTING THESE AS STRESSORS.
OVER TWO THIRDS HERE AGAIN
REPORT THAT THEIR LIVES HAVE
BEEN FOREVER CHANGED BY THE
PANDEMIC.
AND THAT THEY CONSTANTLY FEAR
THE NEXT VARIANT THAT MAY BE
COMING.
AND WHEN YOU LOOK AT THE
DIFFERENT ECONOMIC STRESSORS BY
RAISE AND ETHNICITY, YOU SEE
THAT THEY DO VARY SOMEWHAT.
I THINK WHAT'S VERY INTERESTING
HERE IS HOUSING IN PARTICULAR,
AND HOW MUCH HOUSING AS A
STRESSOR AND WHERE YOU'RE GOING
TO LIVE DIFFERS BY SOMEONE'S
BACKGROUND IN TERMS OF THEIR
RACE AND ETHNICITY WITH ONLY 45%
OF WHITE ADULTS REPORTING THIS
AS A STRESSOR VERSUS 57 TO 62%
OF BLACK AND LATINO ADULTS.
SO THIS CONTINUES TO BE A MAJOR
ISSUE AND SO THE QUESTION IS,
WHAT DO WE DO ABOUT IT AND HOW
DO WE ADDRESS THIS?
SO THIS IS WHERE SORT OF OUR
FRAMEWORK IN THINKING ABOUT HOW
DO WE FUND RESEARCH IN CLINICAL
RESEARCH TO BE ABLE TO ADDRESS
SOME OF THESE STRESSORS.
AND WHAT I'M GOING TO SHARE WITH
YOU IS OUR FRAMEWORK IN HOW WE
THINK ABOUT THIS, BUT THIS IS
BEING ADDRESSED IN A NUMBER OF
DIFFERENT WAYS.
FOR EXAMPLE, THE CDC EVEN
RELEASED ON THE LEFT HERE A
GENERAL WAY OF HOW TO CARE FOR
YOURSELF DURING THE PANDEMIC.
THINGS TO DO TO KEEP SOCIALLY
CONNECTED AND KEEP YOURSELF
HEALTHY.
AND THEN IF YOU GO ON THEIR
WEBSITE, THEY HAVE ONE
SPECIFICALLY FOR OLDER ADULTS,
SPECIFICALLY FOR FIRST LINE
WORKERS AND FOR STUDENTS AND FOR
YOUNG PEOPLE, WHERE THEY'VE
TARGETED THESE MESSAGES TO TRY
TO REALLY HELP PEOPLE THINK
ABOUT HOWL DO YOU TAKE CARE OF
YOURSELF DURING THESE TIMES.
AND OUR ROLE HERE AT NCCIH IS,
HOW DO WE FUND THE RESEARCH TO
GIVE YOU THE EVIDENCE THAT DOING
THESE THINGS WILL ACTUALLY
REDUCE YOUR STRESS?
AND THAT'S WHERE SORT OF OUR
FRAMEWORK COMES INTO MIND.
NOT ONLY MECHANISTICALLY HOW DO
THESE INTERVENTIONS IMPACT
STRESS IN OUR LIFETIME, BUT AS
WE THINK ABOUT DEVELOPING THESE
INTERVENTIONS, HOW DO WE REFINE
THEM, HOW DO WE OPTIMIZE THEM,
LOW DO WE TEST WHETHER THEY
WORK, HOW DO WE THEN GET THEM
OUT INTO CLINICAL PRACTICE, INTO
EITHER HEALTHCARE SETTINGS,
COMMUNITY-BASED SETTINGS, OR
EVEN EMPLOYER-BASED SETTINGS.
I THINK WE'VE SHARED WITH
COUNCIL AT PREVIOUS MEETINGS
THAT WE DO HAVE FUNDING
OPPORTUNITIES FOR THIS WHOLE
RANGE OF RESEARCH QUESTIONS FROM
THE VERY EARLY FEASIBILITY WORK
TO THE EFFICACY STUDIES AND
EVENTUALLY INTO THOSE
DISSEMINATION AND IMPLEMENTATION
SCIENCE FRAMEWORKS, BOTH FOR THE
INTERVENTIONS THAT HAVE
PSYCHOLOGICAL, BEHAVIORAL AND
PHYSICAL UNDER PINNINGS TO THEM
WITH MIND AND BODY INTERVENTIONS
BUT ALSO FOR OUR NATURAL
PRODUCTS, WE HAVE FUNDING
MECHANISMS ACROSS THE SPECTRUM,
AND CERTAINLY WE'RE WELL AWARE
OF DIFFERENT NATURAL PRODUCTS
USED IN DIFFERENT COMMUNITIES TO
HELP MANAGE STRESS, SO THERE ARE
OPPORTUNITIES FOR THESE AS WELL,
LOOKING AT THE IMPACT IN BUY
BIOLOGICAL SIGNATURES AND
EVENTUALLY MOVING INTO EFFICACY
STUDIES.
AS WE'VE GONE ALONG OVER TIME IN
DEVELOPING OUR FUNDING
OPPORTUNITIES, WE'VE TRIED TO
STREAMLINE THESE SO THAT WE CAN
GET TO THOSE EFFICACY AND
EFFECTIVENESS STUDIES AS QUICKLY
AS POSSIBLE, BUT WE UNDERSTAND
SOMETIMES THE PRELIMINARY DATA
MAY NOT BE THERE YET TO ACTUALLY
JUSTIFY DOING THAT FULL SCALE
TRIAL.
THAT'S WHY WE PROVIDE A VARIETY
OF LITTLE ENTRY POINTS INTO THAT
FRAMEWORK FOR DOING THESE TYPES
OF CLINICAL TRIALS.
WE WANT TO MOVE PAST THE
FEASIBILITY WORK AND WE'VE
ADDRESSED THE PRELIMINARY DATA
REQUIREMENTS AND ENCOURAGING OUR
INVESTIGATORS TO LEVERAGE THE
PUBLISHED LITERATURE AND MOVE ON
TO THE NEXT STAGE OF RESEARCH.
AND I'M GOING TO SHOW YOU IN
JUST A MINUTE HOW WE HAVE
FUNDING OPPORTUNITIES ACROSS THE
ENTIRE FRAMEWORK FOR YOU TO
CONSIDER.
AND HERE'S AN EXAMPLE OF THAT.
WHERE WE'VE PLUGGED IN ALL OF
THE VARIOUS FUNDING
OPPORTUNITIES, AND YOU CAN FIND
THESE ON OUR WEBSITE IF YOU JUST
SEARCH ON OUR WEBSITE FOR
CLINICAL RESEARCH FUNDING
OPPORTUNITIES, THERE'S A LIST OF
ALL OF THESE VARIOUS FUNDING
OPPORTUNITIES AND SORT OF WHERE
THEY FIT IN AND WHAT STAGE OF
RESEARCH THEY'RE APPROPRIATE
FOR.
I DO WANT TO MENTION ONE THING
THAT WAS PRESENTED IN A PREVIOUS
CONFERENCE WE HAD BACK IN
SEPTEMBER BY DR. LINDA COLLINS,
WHO'S AT NYU.
SHE'S DONE A LOT OF WORK IN
THINKING ABOUT HOW DO WE
OPTIMIZE INTERVENTIONS AND USING
SOME ADAPTIVE DESIGNS TO DO
THAT, AND SHE JUST RECENTLY HAS
SORT OF STARTED TALKING ABOUT A
NEW ACRONYM THAT SHE'S USING
CALLED EASE, WHICH IS, AS WE
THINK ABOUT DESIGNING AND
EVENTUALLY TESTING
INTERVENTIONS, IT'S A BALANCING
ACT BETWEEN HOW EFFECTIVE ARE
THOSE INTERVENTIONS, WHICH IS
WHAT WE ALWAYS TRY TO MAXIMIZE,
BUT THAT WE ALSO -- I OFTEN
THINK OF THE SCALABILITY ELEMENT
IN BEING -- CAN IT BE USED IN
DIFFERENT PLACES, CAN YOU SHIFT
IT OR CHANGE IT OR HAVE SOME
FLEXIBILITY IN IT SO THAT IT CAN
BE CUSTOMIZED OR TAILORED TO
SPECIFIC POPULATIONS OR MAYBE
LESS RESOURCE INTENSIVE
ENVIRONMENTS, OR MAYBE THEY
DON'T HAVE THE SAME
INFRASTRUCTURE.
SO THINKING ABOUT THAT UP FRONT
AS WE DESIGN AND OPTIMIZE AND
REFINE OUR INTERVENTIONS IS
REALLY IMPORTANT SO THAT AS WE
TEST INTERVENTIONS AND KNOW
WHETHER THEY WORK, THAT THEY
ACTUALLY CAN BE SCALED UP AND
SCALED OUT.
SO AS WE THINK HERE AT NCCIH
ABOUT IMPACTFUL CLINICAL TRIALS,
THERE'S A FEW THINGS THAT WE
THINK ABOUT.
AS WE MOVE TOWARDS EFFICACY AND
DOING EFFICACY STUDIES ON
NATURAL PRODUCTS, WE WANT TO
KNOW THAT WE HAVE AN ACTIVE
BIOLOGICAL SIGNATURE THAT THE
NATURAL PRODUCT CAN REPRODUCIBLY
AFFECT A POTENTIAL MECHANISM AND
THAT HELPS US KNOW THAT WE'VE
GOT AN ACTIVE COMPOUND AND WE'RE
READY TO MOVE INTO EFFICACY
STUDIES.
SIMILARLY ON THE MIND AND BODY
SIDE OF THINGS AND OUR
INTERVENTIONS ON THAT SIDE, WE
WANT TO MAKE SURE WE HAVE
INTERVENTIONS THAT ARE FEASIBLE,
PEOPLE CAN DO THEM, AND THAT
THEY CAN BE DELIVERED WITH
FIDELITY ACROSS SITES SO THAT
WHEN WE GO TO THAT MULTISITE
TRIAL, WE KNOW THAT EVERYBODY IS
GETTING THE SAME OR VERY CLOSE
TO THE SAME INTERVENTION, WE
KNOW WHAT ARE THE CORE
COMPONENTS AND WHAT CAN MAYBE BE
ALTERED BY SITE.
AND THEN WE'RE READY TO MOVE
INTO THOSE EFFICACY IN
EFFECTIVENESS STUDIES.
AND ONCE WE KNOW WHETHER
INTERVENTIONS WORK OR NOT,
WHETHER THEY HAVE EFFICACY OR
EFFECTIVENESS, THEN WE'RE READY
TO DO THOSE PRAGMATIC TRIALS.
HOW DO WE GET THEM INTO THE
HEALTHCARE SETTING OR
COMMUNITY-BASED APPROACHES,
COMMUNITY SETTINGS, THE
WORKPLACE SETTINGS OR OTHER
PLACES LIKE THAT.
AND SO IN REALITY, TRIALS ALL
ALONG THIS CONTINUUM CAN BE
IMPACTFUL BECAUSE KNOWING
WHETHER WE HAVE A REPRODUCIBLE,
BIOLOGICAL SIGNATURE TELLS US
WHEN WE'RE READY TO MOVE TO THAT
NEXT STUDY, SO THAT'S A REALLY
IMPORTANT STEP.
DETERMINING THE FEASIBILITY AND
THE FIDELITY OF THESE
INTERVENTIONS CAN BE REALLY
IMPACTFUL, BECAUSE IT CAN SHIFT
AND CHANGE HOW THE INTERVENTION
IS DELIVERED AND HOW IT'S
DESIGNED SO IT HAS THE
OPPORTUNITY TO BE TESTED AS WELL
AS SCALED UP EVENTUALLY.
SO WHAT WILL SUCCESS LOOK LIKE
FOR US?
THAT WE'LL HAVE A RANGE OF
TRIALS ACROSS THE FRAMEWORK IN
ALL OF THESE DIFFERENT
APPROACHES.
THAT THINGS MOVE ALONG THAT
FRAMEWORK SUCH THAT WHEN WE KNOW
THAT THEY'RE FEASIBLE, THAT WE
KNOW THAT THEY'RE EFFECTIVE,
THEY MOVE INTO CLINICAL PRACTICE
OR INTO COMMUNITY OR WORKPLACE
SETTINGS.
AND THAT EVENTUALLY, THE TRIALS
THAT WE'RE SUPPORTING ARE
ACTUALLY INCORPORATED INTO
GUIDELINES THAT THEY SET
HEALTHCARE POLICY DECISIONS,
THEY INFORM PAYORS ABOUT WHAT
INTERVENTIONS SHOULD BE COVERED
AND MADE AVAILABLE TO THE
BROADER COMMUNITY.
SO I THINK THAT IS MY LAST
SLIDE, AND I THINK WHAT I'M
GOING TO DO NOW IS TURN THINGS
OVER TO DR. MICHAEL CHRISTOPHER
TO TELL US A LITTLE BIT ABOUT
SOME OF THE EXCITING WORK THAT
HE IS DOING UP AT PACIFIC
UNIVERSITY.
>> THANK YOU, VERY MUCH,
DR. WEBER.
THANK YOU VERY MUCH TO THE
COUNCIL FOR HAVING ME HERE
TODAY.
IT AN HONOR FOR ME TO .
SO I'M GOING TO START OFF WITH A
QUICK STORY, I PROMISE I'LL KEEP
IT VERY QUICK.
THIS IS A DETECTIVE FROM THE
HILLSBOROUGH POLICE DEPARTMENT.
BEFORE HE WAS SHINY, HAPPY
SMILING ON THE COVER OF "LIFE"
MAGAZINE, HE WAS IN
HILLSBOROUGH, OREGON, AND --
BURNED OUT AND STRESSED, I DON'T
WANT TO BE A POLICE OFFICER
ANYMORE, I'M DEPRESSED AND MY
COLLEAGUES ARE JUST LIKE ME,
WE'RE ALL BURNED OUT, WE'RE
STRESSED, WE JUST CAN'T DO THIS
WORK ANYMORE.
HE HAD READ A LITTLE BIT OF MY
WORK WE WERE DOING IN
MINDFULNESS.
HE SAID I TRIED MEDITATION MAYBE
LIKE 20 YEARS AGO.
I DON'T KNOW IF THIS MINDFULNESS
STUFF IS SORT OF THAT SAME
THING, BUT I NEED SOMETHING.
I JUST NEED -- SOMETHING HAS TO
CHANGE.
SO WE ENROLLED HIM IN OUR 8-WEEK
PROGRAM AND TO USE RICH'S
LANGUAGE, HE DRANK THE KOOL-AID.
HE CALLED IT LIFE CHANGING.
RICH IS A VERY DYNAMIC GUY, SO
FOR HIM, IT WAS NOT ONLY LIFE
CHANGING FOR HIM.
IN HIS PERSPECTIVE, LIKE EVERY
POLICE OFFICER IN THE WORLD
NEEDED TO DO MINDFULNESS.
THEY NEEDED TO GET INVOLVED IN A
MINDFULNESS TRAINING.
SO THAT'S A QUICK BACK STORY OF
HOW THIS PROGRAM AND RESEARCH
GOT STARTED, WITH RICH'S
PARTNERSHIP.
SO THIS IS RICH AND I SITTING
DOWN, KIND OF FIGURING OUT FROM
THE BEGINNING, WHAT DO WE REALLY
WANT TO ACCOMPLISH HERE?
SO AGAIN FOR RICH, IT WAS THAT
THIS IS REALLY IMPROVING MENTAL
HEALTH, PHYSICAL HEALTH, THE
THINGS THAT HE EXPERIENCED.
WE KNEW A GOOD DEAL OF RESEARCH
ON THAT.
I KIND OF CAME TO THIS AS NOT A
LAW ENFORCEMENT OFFICER BUT A
SCIENTIST IN A BACKGROUND OF C
VPR AND COMMUNITY METHODS, ALSO
REALLY INTERESTED IN THE IMPACT
THIS CAN HAVE ON OUR COMMUNITIES
AND COMMUNITY POLICING.
IT WAS AROUND THIS TIME THAT
UNFORTUNATELY MICHAEL BROWN OF
FERGUSON WAS KILLED BY POLICE
THERE, AND WE THOUGHT MAYBE THIS
WAS ALSO NOT ONLY A WAY TO
IMPROVE POLICING IN GENERAL BUT
TO LOOK AT SOME OF THOSE VIOLENT
OUTCOMES THAT ARE OFTEN THE
RESULT OF STRESS BASED OR
OFFICERS BEING OVERLY STRESS AND
MAKING POOR DECISIONS.
SO WE ENGAGED BOTH OF US IN THIS
CULTURAL IMMERSION.
FOR ME AND MY LAB IT WAS DOING
THINGS LIKE RIDE-ALONGS, GOING
TO BRIEFINGS, GETTING A BETTER
SENSE OF THAT CULTURE, AND FOR
RICH AND SOME OF THESE
COLLEAGUES IN THE PROGRAM AND
THIS RESEARCH, THEY JOINED OUR
LAB ESSENTIALLY AS EQUAL
CO-PARTNERS IN THE LAB,
CONTRIBUTING TO PAPERS, THINGS
LIKE THAT.
SO ONCE WE HAD THE BACKGROUND
AND THIS THEORY, WHAT WE WANTED
TO DO, WE DECIDED TO GO FOR IT
AND DO A GROUP FOR LAW
ENFORCEMENT OFFICERS.
WE GOT A SMALL PILOT GRANT.
THERE'S ONE OF MY
CO-FACILITATORS LEADING FOLKS
THROUGH AN EXERCISE.
WE HAD SOME PRETTY GOOD DATA, WE
FOUND SOME SIGNAL CHANGE ON
THINGS LIKE STRESS, RESILIENCE,
BURNOUT, THINGS LIKE THAT.
THROUGH SOME FOCUS GROUPS AND
THEN LEARNING AS WE WERE GOING,
WE LEARNED THAT MB -- IT NEEDED
CHANGES, IT NEEDED ADAPTATION.
A SIMPLE EXAMPLE IS A LOT OF
OFFICERS WERE RELUCK AT THAT
PARTICULAR TIME TO DO THE
TRADITIONAL BODY SCAN OF LYING
DOWN ON THE BACK.
SORT OF TALKING WITH THEM ABOUT
THAT, WHAT'S THE PROBLEM THAT
WAS GOING ON, IT WAS THAT YOU
HAD A ROOM FULL OF POLICE
OFFICERS, LYING DOWN ON THEIR
BACK WITHOUT THEIR WEAPONS AND
THEY FELT VERY VULNERABLE.
AT ANY POINT SOMEONE COULD COME
IN WITH A GUN, FOR EXAMPLE, SO
WE HAD THIS AGREEMENT THAT THE
DOOR STAYS LOCKED.
SO THE DOOR WAS LOCKED SO NO ONE
ELSE COULD COME IN THAT WASN'T
SUPPOSED TO BE THERE.
SO LITTLE THINGS LIKE THAT, ONE
OF THE THINGS WE REALLY FOCUSED
ON IN DISCUSSING THIS AND GOING
BACK TO THE LITERATURE WAS
RESILIENCE ENHANCEMENT.
THIS IS SOMETHING THAT THE
LITERATURE WAS TAKING OFF AT
THIS TIME AND WE FELT THAT WAS
SUCH AN IMPORTANT SKILLSET FOR
LAW ENFORCEMENT, IS IT'S
INEVITABLY A STRESSFUL JOB,
THERE ARE GOING TO BE TRAUMAS,
AND WE THOUGHT IS THERE A WAY WE
CAN CULTIVATE USING MINDFULNESS
FOR LAW ENFORCEMENT.
SO WE DEVELOPED MINDFULNESS
BASED RESILIENCE TRAINING.
SO WE GOT SOME FUNDING FROM
NCCIH FOR AT THE TIME WAS -- IT
WAS MORE OF A HIGH RISK HIGH
REWARD AS YOU ALL KNOW BUT WE
SORT OF SHAPED THIS WORK TO A
FEASIBILITY TRIAL.
SO FOR STARTERS, THIS WAS A
SINGLE -- A RELATIVELY SMALL
TRIAL HERE IN PORTLAND, OREGON.
AND WE ALSO WERE JUST LOOKING
AGAIN FOR SOME PRELIMINARY
SINGLE CHANGE.
IT WAS A SINGLE ARM -- AN RCT SO
WE WERE LOOKING AT STRESSOR
ACTIVITY, WANTED TO LOOK AT
BIOMARKER, WE LOOKED AT CORTISOL
AWAKENING RESPONSE.
WAS REAL INTERESTED TO SEE,
COULD WE MAKE A CHANGE IN
IMPLICIT RACE BIAS ACTIVATION BY
TRAINING IN MINDFULNESS, AND
LASTLY PSYCHOLOGICAL HEALTH AND
RISK.
SO IN TERMS OF OUR FEASIBILITY
MARKER, WE SET SOME BENCHMARKS.
SO JUST COULD WE RECRUIT, COULD
WE GET 60 OFFICERS IN THE
PORTLAND METRO AREA WILLING TO
DO THIS, WITH 90% OF THEM ACCEPT
BEING EITHER RANDOMIZED MBRP OR
THE RANDOMIZED CONTROL GROUP.
WOULD ABOUT THREE QUARTERS
ATTEND THE CLASSES AND MAKE ALL
THE CLASSES, AND COULD WE DO
THIS WITH 20% ATTRITION.
AND LUCKILY WE MET ALL THOSE
BENCHMARKS.
SO WE HAD THE PARTICIPANTS,
PEOPLE STUCK AROUND AND THEY
ACCEPTED THE RANDOMIZATION.
SIMILARLY FOR OUR ACCEPTABILITY
GOAL, WE JUST USED A FAIRLY
STRAIGHTFORWARD THREE-ITEM
MEASURE OF ACCEPTABILITY.
WE WERE JUST LOOKING FOR
RESPONSES IN A LIKELY OR
REASONABLE RANGE.
AND WHAT WE FOUND AGAIN, PRETTY
SIMILARLY, IS THAT MOST OFFICERS
WOULD RECOMMEND THIS TO A
FRIEND.
THEY'D DO IT AGAIN IF IT WERE
OFFERED AGAIN BUT THEY DID FIND
THE WHOLE PRACTICE A LITTLE
UNREASONABLE.
THAT WAS AGAIN PART OF OUR
ADAPTATION PROCESS.
MAYBE 45 MINUTE A DAY OF
MEDITATION HOMEWORK JUST MIGHT
NOT BE FEASIBLE FOR THIS
POPULATION.
IN TERMS OF OUR OUTCOMES, AGAIN
WE WERE REALLY MORE INTERESTED
IN JUST LOOKING AT WERE THEY
FEASIBLE.
SO WE FOUND WITH CORTISOL
AWAKENING RESPONSES, AGAIN, WE
HAD OFFICERS DOING THIS THREE
DAYS PREINTERVENTION AND THREE
DAYS POST, SO THOSE WHO HAVE
ACTUALLY DONE THIS, IT'S QUITE A
CHALLENGE FIRST THING IN THE
MORNING TO COLLECT SALIVA THREE
TIMES, DO NOT EAT, DRINK, DO
ANYTHING ELSE, SO WE WE ARE WERY
PLEASANTLY SUR PLIED WE HAD
ABOUT A 95% COMPLETION RATE.
THIS IS CALLED THE SHOOTER BIAS
TASK.
WHAT IT DOES VERY BRIEFLY IS
LOOK AT IMPLICIT BIAS IN
DECISION SHOOT OR NO SHOOT.
WE WERE CONCERNED THAT POLICE
OFFICERS WOULD REFUSE AT HIGH
NUMBERS TO DO THIS BECAUSE,
AGAIN, WE WERE COLLECTING THIS
DATA AND ALTHOUGH, AGAIN,
OBVIOUSLY IT WAS CONFIDENTIAL
AND NOMINALIZED, AFTER WE HAD A
CERTIFICATE OF CONFIDENTIALITY,
WE THOUGHT WE WOULD HAVE SOME
OFFICERS WHO WOULD FLAT OUT
REFUSE DO THIS.
SO AGAIN YOU'RE PROVIDED WITH
IMAGES OF EITHER A WHITE OR
BLACK MALE HOLDING SOMETHING
LIKE EITHER A CELL PHONE OR A
GUN, AND YOU HAVE TO MAKE THAT
QUICK WITHIN A FEW MILLISECONDS
DECISION OF WHETHER TO SAY THAT
THEY'RE HOLDING A WEAPON OR
THEY'RE HOLDING SOMETHING LIKE A
CELL PHONE.
SO WE HAD 100% COMPLIANCE HERE,
WE DIDN'T HAVE A SINGLE OFFICER
REFUSE TO DO IT.
AND THEN OUR LAST TWO SORT OF
OUTCOMES, AGAIN, WE HAD SOME
SELF-REPORT MEASURES, 100%
COMPLETION RATE, AND WE'VE
BEEN -- WE OBVIOUSLY WERE
PLEASANTLY SURPRISE HEERD AS
WELL, ABOUT 322 MINUTES OF HOME
PRACTICE.
IT WASN'T EXACTLY THAT 45
MINUTES A DAY THAT WE HAD HOPED
BUT WE LEARNED PRETTY QUICKLY
THAT'S JUST NOT REALISTIC, AS
IT'S NOT IN MOST SAMPLES.
SO FELT PRETTY GOOD ABOUT THAT.
I JUST WANT TO READ A COUPLE
QUOTES HERE.
I KNOW I'M SORT OF RUNNING SHORT
ON TIME BUT WE ALSO DID SOME
INTERVIEWS AND GOT SOME REALLY
NICE QUOTES FROM OFFICERS.
I USED TO FLY OFF THE HANDLE, I
DON'T SO MUCH ANYMORE, WHICH IS
REALLY NICE.
RM "PUN TIME MY WIFE TOLD ME, I
CAN ACTUALLY SEE THE CLASS KICK
IN WHILE WE WERE TALKING.
AND SHE'S JUST LIKE -- HELPED ME
NOT ESCALATE.
SO IT WAS REALLY NICE AGAIN TO
HEAR FROM THE OFFICERS, SORT OF
THEIR LIVED EXPERIENCE WITH THIS
COURSE.
SO LESSONS LEARNED SORT OF
QUICKLY IS, AS WITH ANY
COLLABORATIVE RESEARCH PROJECT,
IT WAS REALLY IMPORTANT FOR US
TO ENGAGE POLICE LEADERSHIP
EARLY ON THROUGHOUT THE PROJECT.
ALTHOUGH WE HAD A LOW DROPOUT
RATE T OCCURRED MOSTLY AFTER
THAT FIRST GROUP.
SO WE LOST THREE OR FOUR
PARTICIPANTS AFTER JUST OUR
NORMAL TWO-HOUR SESSIONS, SO WE
THOUGHT MAYBE WE NEED TO DO
SOMETHING TO GET BETTER BUY-IN
AT THE BEGINNING.
THE POLICE OFFICER DILEMMA,
WHICH WE SHOWED YOU, ALTHOUGH WE
HAD 100% OF OFFICERS DO IT, THEY
DID REALLY WELL ON IT, ALMOST
TOO WELL.
AND WE KNEELED -- REALLY NEEDED
A MORE SOPHISTICATED DESIGN FOR
A PAPILLATION THAT'S VERY WELL
TRAINED IN POPULATION THAD
AT -- -- THAT WAS REALLY
DISHEARTEN, WE NEEDED TO DO MORE
TO KEEP THEM -- ALTHOUGH IT IS
PRIMARILY A MALE PROFESSION, WE
HAD 90% MALE AND 80% WHITE
SAMPLE SO WE WANT TO DO BETTER
IN OUR NEXT ROUND.
SO BASED OFF OF THE R21, WE
APPLIED AND RECEIVED A U01 FOR A
MULTISITE FEASIBILITY TRIAL.
SO HERE WE WERE TAKING WHAT WE
LEARNED FROM THIS TRIAL AND NOW
WE WERE EXPANDING THAT OUT TO
DISTANT SITES, SO HERE AGAIN IN
PORTLAND, COLLEAGUES, AGAIN THE
GOAL HERE WAS A MULTISITE
FEASIBILITY TRIAL.
CAN WE REPLICATE WHAT WE'VE DONE
AND CAN WE DO THAT IN
PREPARATION FOR A FULL SCALE
EFFICACY TRIAL.
SO NEXT STEPS JUST REAL QUICKLY
HERE, SOME OF YOU MIGHT
RECOGNIZE THESE FACES.
WE RECRUITED SARAH TO COME JOIN
US AT PACIFIC A FEW YEARS AGO.
HER BACKGROUND IS REALLY MORE IN
MBRP AND ADICKS.
BUT AFTER A LOT OF A CAJOLING D
PUSHING WE GOT HER EXCITE TODAY
JOIN ME ON THIS PROJECT.
MANY OF YOU PROBABLY KNOW, THESE
TWO ARE REALLY SORT OF THE CORE
DEVELOPERS ALONG WITH ALLAN, OF
COURSE, OF -- PREVENTION.
AND THEIR INFLUENCE WAS SORT OF
WHERE WE WENT THE NEXT DIRECTION
OF MBRT WAS REALLY IMPORTANT.
WE SORT OF SHIFTED AWAY A LITTLE
BIT FROM MBSR ALTHOUGH IT WAS A
QUICK COUSIN -- ONE OF THE
IMPORTANT DISTINCTIONS WE'VE
MADE HERE IS THAT REACTIVITY IS
REALLY ONE OF THE CORE TARGETS
WITHIN MBRP, SORT OF LOOKING AT
AGAIN PREDICTIONS BUT IT REALLY
FIT WITH WHAT WE WERE KIND OF
THINKING WAS OUR PRIMARY
MECHANISM, BOTH FROM THE
PRELIMINARY DATA WE HAD BUT JUST
ANECDOTALLY SO SOME OF THE
QUOTES THAT WE CAPTURED EARLIER,
DECREASING THAT REACTIVITY
DURING TIMES OF STRESS LEADING
TO BAD OUTCOMES ESSENTIALLY IN
POLICING.
OBVIOUSLY A HIGH TRAUMA
POPULATION, SO WE INTEGRATED
THAT MORE INTO THIS NEXT PHASE
OF MBRT.
WE ALSO BASED ON THE PILOT WORK
WE HAD DONE REALIZED THAT --
WERE GETTING LOTS OF MOVEMENT,
LOTS OF SIGNAL CHANGE, LOTS OF
BODY WORK WITH THE OFFICERS
RESPONDED WELL TO.
SO WE DECIDED TO MOVE TO A
SIX-HOUR IMMERSION IN WEEK ONE
TO GET MORE BUY-IN, AND THEN ON
THE END, ADD BOOSTER SESSIONS TO
HOPEFULLY FOSTER MORE PRACTICE.
AND THEN LASTLY, WE SHIFTED MORE
TO AN ACUTE STRESS CHALLENGE.
WE WANTED TO SEE HOW OFFICERS
RESPONDED TO A STRESS PATH IN
THE LAB, MEASURING THESE
PARAMETERS AND LOOKING AT THAT
AGAIN AFTER AND SEEING IF WE
WOULD HAVE NOT AT HIGH AS A PEAK
BUT ALSO A QUICKER RETURN BACK
TO BASELINE.
AND THIS NEXT STEP TOO, WE
INCLUDED AN ACTIVE CONTROL
CONDITION, STRESS MANAGEMENT
EDUCATION.
AND LASTLY, BECAUSE IT WAS MORE
OF A FEASIBILITY TRIAL, WE
REALLY WANTED TO MOVE FROM -- IT
WAS STILL INCLUDING SORT OF
SELF-REPORT AND OTHER MEASURES
OF AGGRESSION AND USE OF FORCE
TO ACTUALLY COLLECTING
BEHAVIORAL DATA, ACTUALLY USE
SOME FORCE.
TO SEE IF A IT WAS FEASIBLE TO
COLLECT AND B IF WE COULD DETECT
ANY SLOT CHANGES.
MOVING TO MORE OF THAT ACUTE
PHYSIOLOGICAL ACTIVITY.
SO WE PARTNERED WITH OUR THREE
AGENCIES IN THE THREE CITIES,
AND OUR STUDY STARTED WITH AN
ENTIRELY IN-PERSON PROTOCOL.
OFFICERS WERE COMING TO THE LAB,
WE WERE STRESSING THEM OUT, AND
GROUPS ENTEARLY IN PERSON.
WE STARTED OFF IN ALBUQUERQUE,
FIRST PARTICIPANT JANUARY 5TH,
2020, WE HAD 24 AND WE COMPLETED
OUR FIRST GROUP, WE WERE SO
EXCITED, ON MARCH 11, 2020.
AND THE NEXT DAY, COVID
ESSENTIALLY HIT AND SHUT US
DOWN.
SO IT WAS 3/12, OUR SITES WENT
INTO LOCKDOWN.
WE WERE SORT OF IN A HOLDING
PATTERN, NOT SURE WHAT TO DO FOR
A WHILE AND AS YOU ALL KNOW, TWO
MONTHS AFTER THAT, GEORGE FLOYD
WAS MURDERED IN MINNEAPOLIS, AND
IT WAS REALLY A TOUGH TIME
FRANKLY.
BETWEEN COVID AND NOT SURE WHAT
TO DO, BUT GEORGE FLOYD'S MURDER
AND THEN THE SOCIAL PROTESTS FOR
SOCIAL JUSTICE AFTER THAT, AS A
TEAM, WE REALLY SPENT A LOT OF
TIME TO SORT OF FIGURE OUT THIS
WAS THE RESEARCH WE WANTED TO
KEEP DOING, DO YOU WANT TO
SHIFT, DO YOU WANT TO DO
SOMETHING DIFFERENT.
SO WE TOOK A SIX MONTH PAUSE AND
I WANT TO MENTION HOW HELPFUL --
WAS DURING THIS TIME, KEEPING US
ON TRACK, COMING BACK TOGETHER,
AND AT THE END, CONSULTING WITH
COMMUNITY MEMBERS AND OTHER
PEOPLE, OKAY, WE REALLY NEED TO
GET BACK TO WORK HERE, TO MOVE
FORWARD WITH THIS.
SO WE SHIFTED GEARS, TAKE TWO
HERE, AND SWITCHED FROM ENTIRELY
IN PERSON TO AN ENTIRELY
VIRTUALLY PROTOCOL, WHICH AS YOU
CAN IMAGINE WAS QUITE AN
UNDERTAKING.
WE WERE THEN SHIFTED OVER TO
INFLAMMATORY MARKER, WHICH WAS
AGAIN MORE OF A CHRONIC MEASURE
BUT WE THOUGHT AT LEAST IT KEEPS
SOME BIOMARKERS WE COULD LOOK
FOR THAT CHANGE AND AGAIN, ALL
DATA THAT THAT WERE NOW COLL,
DELIVERED VIA ZOOM.
SO WE ENROLLED OUR FIRST
PARTICIPANT IN MID DECEMBER OF
2020.
AND THE -- AGAIN VIRTUALLY AND
STRESS -- AP DAP TAITION IN OUR
THREE SITES.
VERY RECENTLY WE JUST FINISHED
OR SIX MONTH FOLLOW-UP DATA
COLLECTION.
WE MANAGED TO DO IT ALL
VIRTUALLY.
THIS WAS ABOUT A COUPLE, TWO
MONTHS AGO THAT WE FINISHED DATA
COLLECTION.
SO I'LL JUST QUICKLY GO THROUGH
SORT OF OUR BENCHMARKS THAT WE
FOUND AND LUCKILY WE FOUND THAT
MULTISITE TRIAL, DESPITE SOME OF
THE ISSUES THAT WE DEALT WITH,
THAT WE HIT OUR ENROLLMENT
TARGETS.
WE WERE VERY HAPPY TO SEE THAT
WE REALLY MADE A STRONG EFFORT
TO RECRUIT A DIVERSE SAMPLE IN
ALL THREE OF OUR SITES, AND WE
ACTUALLY EXCEEDED OUR DIVERSITY
TARGETS.
WE HAD ALMOST WERE FEMALE.
LARGELY ACCEPTED RANDOMIZATION.
WE WERE REALLY HAPPY WITH OUR
RETENTION EFFORTS THAT, WE KEPT
86% OF OUR OFFICERS AT SIX
MONTHS OUT.
REALLY HIGH RATES OF COMPLETION
WITH DATA.
THOUGH ONE THAT WE DIDN'T MEET
WAS OUR DRY BLOODSPOTS.
SO WE WERE MAILING THEM OUT TO
PARTICIPANTS HAVING TO DO IT AT
HOME WHILE WE WERE WALKING
THROUGH IT ON ZOOM.
FEDEX UNFORTUNATELY LOST A BATCH
OF THEM SO I WON'T CLAIM FULL
RESPONSIBILITY UNFORTUNATELY FOR
NOT MEETING THIS BENCHMARK.
AND WE HAD OUR T GROUP, WHICH
WAS GREAT, THE VAST MAJORITY DID
ATTEND, R. AT LEAST FIVE E
SESSIONS.
AND THEN LASTLY, OUR
PARTICIPANTS FOUND IT
ACCEPTABLE.
AND THEN TO SUMMARIZE, THIS IS
REALLY THE PART WE'RE WORKING ON
AS WE SPEAK.
SO WIRE LOOKING WE'RE LOY
AGAIN, FIDELITY ACROSS SITES, SO
WE'RE LOOKING VERY CAREFULLY TO
SEE HOW WELL OUR
INTERVENTIONISTS -- IN EACH OF
THE THREE SITES.
AGAIN OUR ANALYSIS HERE, WE'RE
NOT LOOKING AT GROUP DIFFERENTS.
WE'RE REALLY LOOKING AT MORE
EFFICIENCY OF MEASURES AND
SENSITIVITY TO CHANGE.
BUT LUCKILY -- NON-REACTIVITY,
INTERNAL
INTERROW ACCEPTIVE AWARENESS ARE
EFFICIENT AND SENSITIVE TO
CHANGE.
EXCESSIVE USE OF FORCE DATA,
THIS IS CALLED BLUE TEAM, SO WE
HAVE REAMS OF DATA OF USE OF
FORCE.
WE WERE UNABLE TO GET THIS IN
ALBUQUERQUE, BUT AT LEAST WE
HAVE ONE THERE, THEAND WE'RE
WORKING ON OUR INFLAMMATION
BIOMARKER TATA NOW.
DATA NOW.
WE'VE GOT 47 INTERVIEW, SO LOTS
OF RICH THEMES COMING OUT OF
THIS ACROSS ALL PHASES OF THE
STUDY.
NOT JUST THE -- AND ALL THE
DIFFERENT ASPECTS.
LASTLY AGAIN, PRETTY -- WE DON'T
HAVE MINUTES -- AT LEAST 95% DID
IT.
SO VERY QUICKLY, SOME NEXT
STEPS, AGAIN WE'RE GOING TO
ANALYZE THIS DATA AND THEN OUR
FINAL STEP HOPEFULLY IF ALL GOES
WELL ONCE WE PUBLISH SOME OF THE
PAPERS FROM THIS IS TO SUBMIT
APPLICATIONS IN OCTOBER SO WE'VE
MET MOST OF OUR BENCHMARKS AND
WE'LL FIND OUT AGAIN HOW WE DO
ON THE OTHER MEASURES.
JUST LASTLY, WE'RE OPENING AGAIN
TO MOVE IN THIS LAST STUDY BACK
TO INCLUDE RACE BASED BIAS IN
SHOOTING.
WE'VE BEEN WORKING WITH A LAB IN
UNIVERSITY OF WASHINGTON WHO'S
DOING THIS WITH MUCH MORE HIGH
SOPHISTICATED EQUIPMENT AND -- K
THINGS TO LIKE A COMMUNITY
ADVISORY BOARD.
VERY LASTLY HUGE THANKS TO ALL
THE OFFICERS WHO PARTICIPATED IN
THIS, AND AGAIN TO ALL THE
PEOPLE, I'M JUST A SPOKESPERSON
REALLY FOR ALL THE WONDERFUL
PEOPLE WHO DID THIS WORK.
SO THANK YOU AGAIN.
I'LL TURN THIS BACK OVER.
>> THANK YOU SO MUCH, MIKE.
THAT WAS WONDERFUL.
I THINK WHAT WE'RE GOING TO DO
IS HOLD QUESTIONS UNTIL THE END,
JUST SO WE CAN GET THROUGH ALL
THE PRESENTATIONS.
SO PLEASE, ANYONE, ON THE CHAT
OR VIDEOCAST, PLEASE GO AHEAD
AND SUBMIT QUESTIONS IF YOU HAVE
THEM, ON ZOOM YOU CAN DO THAT
THROUGH CHAT AND I BELIEVE WE
HAVE A Q & A BOX OR AN EMAIL
UNDER THE VIDEOCAST WHERE YOU
CAN SUBMIT QUESTIONS.
BUT THANK YOU SO MUCH, MIKE, AND
I AM GOING TO TURN THINGS OVER
NOW TO OUR NEXT SPEAKER, WHO IS
ZEV SCHUMAN-OLIVIER.
SO ZEV, YOU'RE UP NEXT AND JUST
TELL ME "NEXT SLIDE" AND I'LL GO
AHEAD AND CLICK THROUGH FOR YOU.
>> GREAT.
THANK YOU.
AND MICHAEL, WHAT AN EXCITING
STUDY TO GET TO HEAR ABOUT.
I FEEL LUCKY TO BE ABLE TO HEAR
ABOUT IT SO EARLY HERE.
I'M ZEV SCHUMAN-OLIVIER, CENTER
FOR MINDFULNESS AND COMPASSION.
I'M GOING TO TELL YOU ABOUT A
PROJECT THAT REALLY IS MUCH
BIGGER THAN ME AND EVEN OUR
CENTER AND OUR ENTIRE HEALTHCARE
SYSTEM.
I WANT TO JUST THANK, BEFORE WE
GET STARTED, MANY OF OUR TEAM
MEMBERS WHO HELPED TO PUT
TOGETHER SOME OF THESE SLIDES
AND FIGURES FOR US AND I WANT TO
POINT OUT THAT IT REALLY HAS
TAKEN AN ENTIRE TEAM.
THIS IS OUR CURRENT TEAM RIGHT
HERE, AND CARL FULYILER IS WITH
ME ON THIS PROJECT, AND REALLY
WANT TO THANK THE OTHERS FOR
HELPING TO PUT TOGETHER.
SO LET'S KEEP GOING.
SO THIS PROJECT STARTED RIGHT AT
THE VERY BEGINNING OF COVID,
COVID-19, IN MARCH 2020.
AND WHAT WE PREDICTED MIGHT
HAPPEN IS WHAT HAPPENED, AND
THAT IS THAT THE PANDEMIC HAS
REALLY CAUSED A TSUNAMI OF
MENTAL HEALTH NEEDS.
SO STRESS, ANXIETY, DEPRESSION,
TRAUMA, GRIEF IS ABUNDANT, AND
NOT EVEN JUST FROM THE -- FROM
COVID ITSELF BUT ALL THE CHANGES
THAT RELATED TO IT, THE JOB
CHANGES, HOUSING CHANGES THAT
WENDY TALKED ABOUT BEFORE,
SOCIAL ISOLATION, CONTRACTING
COVID AND THE IMPACT OF THAT,
THE DELAY IN ROUTINE MEDICAL
PROCEDURES, THE IMPACT OF
PEOPLE'S HEALTH PROBLEMS, DEATH
OF LOVED ONES, THE RACIAL STRESS
AS MICHAEL POINTED OUT AND THEN
THE LOSS OF IDENTITY.
PEOPLE LEAVING JOBS TO CARE FOR
CHILDREN AT HOME, PEOPLE WORKING
FROM HOME, PEOPLE HAVING TO
RETURN HOME FROM SCHOOL AND FROM
AN ENVIRONMENT THEY WERE
COMFORTABLE IN TO NEEDING TO
HIDE THEIR IDENTITIES.
PEOPLE LAID OFF FROM WORK OR
HAVING TO TRANSITION.
A LOT OF STRESS ALL AROUND.
SO WE STARTED A PROJECT CALLED
CHA MINDWELL.
I JUST WANT TO SAY I'M REALLY
APPRECIATIVE TO THE CAMBRIDGE
HEALTH ALLIANCE EXECUTIVE TEAM
AND OUR PARTNER PSYCHIATRY
LEADERSHIP FOR REALLY KIND OF
GREEN LIGHTING SOMETHING IN THE
MIDST OF THE ACTIVE CHAOS AS THE
ENTIRE HOSPITAL WAS GOING INTO
EMERGENCY MODE TO BE ABLE TO
ALSO HAVE SOME FORESIGHT TO HAVE
SOMETHING TO BE ABLE TO WORK ON
THE MENTAL HEALTH CONSEQUENCES.
SO WE STARTED A FREE MENTAL
HEALTH WELLNESS PROGRAM TO
CONNECT THEM WITH SERVICES AND
AN ONLINE COMMUNITY.
BASICALLY PEOPLE GO ONLINE AND
THEY WERE USING COMPUTERIZED
ADAPTIVE TESTING FOR MENTAL
HEALTH AND COMPUTERIZED ADAPTIVE
TESTING FOR SOCIAL DETERMINANT
OF HEALTH.
AND WITH USING SEVEN DIFFERENT
MODULES, ASSESSING THEIR MENTAL
HEALTH, ANXIETY, DEPRESSION,
PTSD, ADHD, MANIA/HYPOMANIA,
JUST AS AN EXAMPLE OF SOME OF
THE MODULES.
WE DO THAT AT BASELINE WHEN THEY
REGISTER AT ENROLLMENT, WE DO IT
AT ONE MONTH, TWO MONTHS, THREE
MONTHS, FOUR MONTHS, SIX AND
NINE MONTHS AND 12 MONTHS.
WE'RE AND WHEN PEOPLE'S DATA ,
WE THEN HAVE A PROCESS AND
ALGORITHM FOR TIERING PEOPLE.
SO TIER ONE, PEOPLE WITH NO OR
MINIMAL SYMPTOMS, TIER TWO WITH
MILD OR MODERATE SYMPTOMS, AND
THEN TIER THREE WAS SEVERE
SYMPTOMS.
SO IF YOU THINK ABOUT IT THIS
WAY, BASED ON WHAT PEOPLE'S TIER
WAS WE COULD GIVE THEM
PERSONALIZED RECOMMENDATIONS FOR
WHAT THEY NEED NEEDED.
SO EVERYONE HAD ACCESS TO A
MONTHLY NEWSLETTER ON MENTAL
HEALTH TOPICS.
WE GAVE MENTAL ILLNESS
PROGRAMMING WITH A COORDINATOR,
GIVE THEM ADVICE ON SELF-HELP
MOBILE APPS, ESPECIALLY FOR THE
TIER 1 FOLKS THAT WERE IN TIER
1.
THEN PEOPLE WOULD ALSO GET EMAIL
OR PHONE COACHING AROUND
ACTIVATING AND USING THE
RESOURCES THAT WERE IN THE
PROGRAM.
WE TRAINED ALL OF OUR STAFF IN
MOTIVATIONAL INTERVIEWING BY A
CERTIFIED MOTIVATIONAL
TRAININGER SO ALL
TRAININGER SO OUR COORDINATORS
KNEW HOW TO TALK TO PEOPLE ABOUT
ACTIVATING AND MAKING BEHAVIOR
CHANGE IN ENGAGING WITH THE SELF
HELP APPS, LIVE ONLINE,
MINDFULNESS PROGRAMS, AND WE
MADE IT AVAILABLE FOR ANYONE IN
THE PROGRAM TO JOIN A FREE
MINDFULNESS COURSE THAT WAS
AVAILABLE.
WE HAD THINGS LIKE MBSR, STRESS
REDUCTION, COGNITIVE THERAPY FOR
RESILIENCE, MINDFULNESS TRAINING
FOR LIVING WELL, AND FOR SELF
COMPASSION GROUPS.
FOR THOSE WHO WERE IN TIER IT OR
TIER 3, THERE WAS AN OPPORTUNITY
TO MEET AND DO A PHONE OR VIDEO
CHECK-IN WITH A MENTAL WELLNESS
SPECIALIST WHO WAS A CLINICIAN,
CLINICALLY TRAINED CLINICIAN WHO
COULD DO A BRIEF TRIAGE AND
ASSESSMENT AND EVALUATE WHETHER
OR NOT PEOPLE NEEDED A HIGHER
LEVEL OF CARE OR NOT.
AND SO THEY WERE ABLE TO THEN
MAKE REFERRALS TO ADDITIONAL
CLINICAL CARE AS NEEDED.
IT IMPORTANT TO SAY THAT DURING
THIS TIME OVER COVID, OUR WAIT
LIST OUTPATIENT CARE WAS IN THE
THOUSANDS.
AS FAR AS PEOPLE SEEKING MENTAL
HEALTHCARE.
SO THE IDEA THAT PEOPLE COULD BE
ABLE TO ASSESS RAPIDLY IN THIS
AUTOMATED WAY AND BE ABLE TO GET
TRIAGE TO PEOPLE THAT REALLY
NEED SUPPORT RIGHT AWAY WAS
REALLY A GREAT PART OF THIS
PROGRAM.
SO NEXT SLIDE, PLEASE.
THIS BASELINE STARTED IN APRIL,
SO ABOUT THREE WEEKS AFTER THE
COVID LOCK DOWNS STARTED HERE IN
BOSTON.
WE MOVED QUICKLY, IN ABOUT 10
DAYS, AND STARTED A QUALITY
IMPROVEMENT PROJECT WHERE WE
STARTED MINDWELL WITH CAT-MH AND
WE GOT ANXIETY AND DEPRESSION
SCORES FOR EIGHT WEEKS IN A ROW
AND EVERYBODY IN THIS CASE WAS
ENROLLED OR OFFERED TO ENROLL IN
THE MINDFULNESS BASED COGNITIVE
THERAPY PROGRAM.
AND YOU CAN SEE HERE THAT EVEN
IN THAT VERY FIRST ITERATION, WE
SAW A 41% REDUCTION IN ANXIE%Y
AND 34% REDUCTION IN DEPRESSIVE
SYMPTOMS DURING THIS HEART OF
THE COVID LOCKDOWN.
WHICH SUGGESTED THAT WE WERE ON
TO SOMETHING AND WE REALLY
SHOULD PURSUE THIS FURTHER.
WHAT WE BUILT, WE HAD THIS IDEA
IN ORDER FOR TO BE REALLY
IMPACTFUL FOR US AND OTHER
HEALTHCARE SYSTEMS EVENTUALLY,
WE WANTED TO BE ABLE TO
INTEGRATE THIS TESTING DEVELOPED
BY ADAPTIVE TESTING TECHNOLOGIES
THROUGH AN FBR GRANT WITH NIMH.
WE WANTED TO BE ABLE TO
INTEGRATE THIS INTO RED CAP.
THERE WAS BEGINNING TO BE CODE
AROUND AN EXTERNAL MODULE THAT
WAS DEVELOPED AT VANDERBILT IN A
PROGRAM WITH CARL REID, SO WE
STARTED WORKING WITH CARL TO
GIVE US HIGH LEVELS OF
PROCESSING TO BE ABLE TO GET
PEOPLE'S SEVERITY, RESPONSES TO
BE ABLE TO SEE WHAT CATEGORY
THEY'RE IN AND THEN BE ABLE TO
TIER THEM AND THEN SCHEDULE THEM
FOR APPOINTMENTS IF NEEDED OR
MOVE THEM ALONG.
YOU CAN SEE HERE THIS IS JUST AN
EXAMPLE TEST HOW FOR EACH
DIFFERENT TYPE OF ASPECT OF
MENTAL WELLNESS, DEPRESSION,
ANXIETY, MANIA, SUBSTANCE USE,
PSYCHOSIS, ADD AND SOCIAL
DETERMINANTS OF HEALTH, WE WERE
ABLE TO GET A HIGH PRECISION
SCORE AND ASSESS THEIR TIER
LEVEL.
THIS EXTERNAL MODULE ACTUALLY IS
AVAILABLE ON GITHUB IF YOU WANT
TO BRING THIS INTO YOUR OWN RED
CAP DATABASE.
SO WE GOT READY, WE DID FOCUS
GROUPS WITH THE NEW SYSTEM THAT
WAS MORE AUTOMATED USING RED CAP
IN THE SUMMER AND FALL OF 2020 ,
AND THEN WE SUBMITTED NIH
SUPPLEMENT TO ANOTHER R33 GRANT,
AND WE WERE WAITING FOR THAT AND
I WANT TO EXPRESS MY GRATITUDE
TOLY
TO LENNAE, ROBYN AND WEN DEEP
THROUGH CHAOTIC TIMES TO HELPING
MOVE THIS PROJECT ALONG.
SO FINALLY IT WAS APPROVED
FOR -- IN EARLY FALL.
UNFORTUNATELY -- WE WANTED TO
PUT AN RTC TO LOOK AT THE
DIFFERENCES OF HOW RANDOMIZED
PEOPLE TO DIFFERENT ARMS AND
INTERVENTIONS WOULD WORK AND
THERE WERE SUBSTANTIAL COVID
DELAYS.
THE MINDWELL-READ CAP STARTED IN
2020, AND IN DECEMBER AND I HAVE
TO SAY IT WAS AN INCREDIBLY
DIFFICULT TIME WITH THESE
BUILDING LEVELS, RACIAL STRESS,
POLITICAL POLARIZATION.
SO IN EARLY JANUARY, WE ACTUALLY
HAD TO STOP OUR IMPLEMENTATION
FOCUS ON MAINTAINING STAFF AND
THE STAFF'S MENTAL WELLNESS
DURING THE COLLECTIVE
DIFFICULTIES THAT ARE HAPPENING
IN EARLY JANUARY, AND THROUGH
MID MARCH AND FINALLY WE'RE ABLE
TO GET IRB APPROVALS AND CHANGE
IN STAFF ON THE IRB SO WE MOVE
FORWARD.
I THINK OF THIS AS REALLY
PUTTING OUR MASKS ON FIRST TO
DEAL WITH ALL THE INTERNAL
IMPACTS, EVERYTHING THAT WAS
GOING ON AND STABILIZE THEIR
SYSTEM.
SO EVEN TAKING THAT TIME TO
STABILIZE OURSELVES DIDN'T
REALLY PREPARE US FOR WHAT
WASSING WHAT WHAT WAS
ABOUT TO COME.
WHEN WE FINALLY REALLY OPENED
THE GATES WIDE TO BE ABLE TO
ALLOW PEOPLE TO START ENROLLING
FOR CHAMINDWELL, WE GOT 200
ENROLLMENTS LITERALLY IN 24
HOURS.
AND OUR SYSTEM WAS DESIGNED TO
HAVE 20 TO 30 A WEEK.
SO WE NEED LE HAD TO SHUT DOWN T
DOWN THE PROGRAM AGAIN AND SHUT
THE DOOR BECAUSE THE NEEDS WERE
SO INTENSE.
AFTER A MONTH OR TWO OF
REORGANIZING, WE OPENED AGAIN
AND YOU CAN SEE AGAIN JUNE
THROUGH SEPTEMBER, VERY QUICKLY
THE POPULATION STRESS EVEN AFTER
THE COVID WAVE HAD PASSED IN
JANUARY AND FEBRUARY WAS STILL
VERY MUCH THERE FOR THE SUMMER.
AND WE ACTUALLY HAD TO CLOSE AND
LIMIT ENROLLMENT AGAIN BECAUSE
OF THE INTENSITY.
WE OPENED UP AGAIN IN OCTOBER
AND WE'VE BEEN ABLE TO MAINTAIN
A PRETTY STEADY FLOW SINCE THEN.
SO WE WERE FUNDED TO RUN A RCT
WITHIN THE CONTEXT OF THE
CHAMINDWELL IMPLEMENTATION
PROJECT.
AND IT WAS COMPARATIVE
EFFECTIVENESS RCT COMPARING
COGNITIVE BASED THERAPY PLUS THE
MINDWELL MONITORING AND COACHING
VERSUS INTERNET CBT WHERE WE
USED THE SIX WEEK ASYNCHRONOUS
MOOD GYM CURRICULUM AS OUR
ACTIVE CONTROL GROUP, AND THEN
WE ALSO HAD AS ANOTHER CONTROL
ARM JUST CHAMINDWELL ALONE.
SPECIFICALLY WE WERE LOOKING AT
THE PRIMARY OUTCOMES, LEVELS OF
DEPRESSIVE SYMPTOMS, AT 24
WEEKS, SUBSTANCE USE, AND
UTILIZATION OF TELEVISITS DURING
THIS TIME.
THIS WAS THE STUDY FORMAT,
RANDOMIZING TO THREE DIFFERENT
ARMS.
WE CONTINUE TO DO CAT-MH EVERY
FOUR WEEKS THROUGHOUT THE STUDY.
WE ALSO HAD A SALIVARY SUBSTUDY
WHERE WE WANTED TO LOOK AT THE
RELATIONSHIP BETWEEN DAILY
STRESS AND AFFECT AS RECORDED ON
AFFECT DIARIES THAT WERE
DEVELOPED AT PENN STATE
UNIVERSITY.
AND WE WERE LOOKING AT DIFFERENT
TYPES OF STRESS INCLUDING STRESS
RELATED TO COVID-19.
AND THEN TO LOOK AT THE
RELATIONSHIP BETWEEN STRESS AND
POSITIVE AND NEGATIVE AFFECT
DAYS WITH ESPECIALLY IL-6,
INTERLEUKIN-6, WHICH HAS BEEN
DEMONSTRATED TO BE LINKED -- OR
ASSOCIATED WITH DEPRESSION AND
THERE'S SOME PRELIMINARY DATA
SUGGESTING THAT IT MAY BE
NEGATIVELY ASSOCIATED WITH
POSITIVE AFFECT.
SO WE'RE PLANNING TO GATHER
THAT'S DATA BEFORE AND AFTER THE
INTERVENTION PERIOD OF THE FIRST
EIGHT WEEKS.
UNFORTUNATELY SALIVA BECAME
CLASSIFIED AS A CATEGORY B
SUBSTANCE DUE TO COVID-19 AS WE
WERE GETTING READY TO LAUNCH THE
STUDY, SO WE ACTUALLY HAD TO GO
THROUGH MULTIPLE LAYERS OF
SAFETY REVIEW SO WE WEREN'T ABLE
TO IMPLEMENT THE SALIVARY STUDY
UNTIL HALFWAY THROUGH THE STUDY.
SO IT'S ONGOING NOW BUT THAT WAS
A LIMITATION OF WORKING IN THIS
CON
CONTEXT.
SO I WANT TO SHARE SOME OF OUR
DATA FROM THE MINDWELL PROJECT
WHICH IS THIS POPULATION MENTAL
WELLNESS PROJECT.
WE REALLY ARE FIGHTING AGAINST
THE TIDE HERE.
IF YOU LOOK AT THOSE YELLOW
LINES ON THE LEFT, THOSE ARE THE
LEVELS IN 2019 OF ANXIETY
DISORDER, DEPRESSIVE DISORDER OR
ANXIETY AND DEPRESSION, AND YOU
CAN SEE THAT ALTHOUGH THE
BIGGEST INCREASE IN ANXIETY AND
DEPRESSION HAPPENED BETWEEN JUNE
AND DECEMBER 2020, THAT IT HAS
NOT GONE BACK TO BASELINE AND,
IN FACT, WE STILL ARE ABOUT
THREE TIMES THE LEVEL OF
ANXIETY/DEPRESSION THAT WE WERE
SEEING PRE-PANDEMIC.
SO I JUST WANT TO KEEP THAT IN
MIND.
OUR GOAL WAS JUST TO HOPE THAT
WE WERE KEEPING PEOPLE THAT WERE
ENROLLED IN OUR POPULATION
WELLNESS PROGRAM WITHOUT CHANGE,
WITHOUT THIS MASSIVE INCREASE,
BUT THE REST OF THE COUNTRY IS
EXPERIENCING.
THIS IS DATA FROM OUR FIRST
921 R
921 PATIENTS THAT ENROLLED IN
THE PROGRAM.
ONE OF THE GOALS WAS THAT WE
WOULD HAVE PEOPLE ENROLL IN A
WAY THAT WOULD NOT CREATE ANY
EQUITY ISSUES OR DISPARITIES.
THAT WAS A REALLY IMPORTANT PART
OF TESTING OUT THE FEASIBILITY
APPROACH GIVEN THAT IT IS
INTEGRATING WITH TECHNOLOGY AND
WHEN WE STARTED IN THE FIRST
YEAR, WE WERE PRIMARILY USING
ENGLISH BASED PROGRAMS, ALTHOUGH
WE ARE GETTING READY TO LAUNCH A
SPANISH BASED PROGRAM AS WELL.
AS YOU CAN SEE, THE RACIAL AND
ETHNIC BREAKDOWN OF OUR SERVICE
AREA IS BASICALLY REFLECTED IN
THE PEOPLE WHO COMPLETED
MINDWELL.
SO THERE WAS NO DISPARITY IN
ENROLLMENT AND WHEN WE DO HIGH
SCORE ANALYSIS, THERE WAS NO
STATISTICALLY SIGNIFICANT
DIFFERENCE IN THOSE WHO ALSO
COMPLETED.
>> ZEV, WE'VE PROBABLY GOT ABOUT
TWO OR THREE MINUTES.
>> I'LL GO THROUGH THESE LAST
ONES PRETTY FAST.
IT WAS PRIMARILY MORE FEMALE
ENROLLING IN THIS PROGRAM.
YOU CAN SEE ANXIETY ON RIGHT ARE
PEOPLE WHO HAD TIER TWO OR TIER
THREE LEVEL SCORES, AND YOU CAN
SEE THAT WE DID HAVE SIGNIFICANT
REDUCTION IN ANXIETY SCORES AT
BASELINE COMPARED TO THE
FOLLOW-UP TIME POINT.
IN ANXIETY.
IF YOU LOOK AT THE RIGHT AS
WELL, YOU CAN SEE FOR ALL PTSD
SCORES ESPECIALLY THOSE THAT
REACHED A TIER 2 OR TIER
3 LEVEL, WE HAD SIGNIFICANT
REDUCTIONS IN PTSD SCORES OVER
TIME AND SYMPTOMS, AND -- I'M
SORRY, THIS IS DEPRESSION.
WE SEE THE SAME THING WITH
DEPRESSION.
SO SAME PATTERN ACROSS ALL OF
THOSE.
AND FINALLY WE HAVE -- WE ALSO
ARE LOOKING AT MANIA/HYPOMANIA
SCORES AND YOU CAN SEE
REDUCTIONS ON THE RIGHT AS WELL
OVER TIME IN THOSE SCORES.
IN ALL FOUR OF THE CATEGORIES
THAT WE WERE LOOKING AT, WE TEAD
OF THE INCREASES YOU WERE SEEING
IN THE REST OF THE POPULATION WE
ACTUALLY SAW SIGNIFICANT
DEYEASTS, AND
DECREASES AND PEOPLE HAD
BASICALLY HALF THE ODDS OF STILL
BEING IN TIER TWO OR THREE AFTER
A THREE TO SIX-MONTH FOLLOW-UP.
SO WE DID SEE A LOT OF PEOPLE
COMING DOWN IN TIER BECAUSE OF
THE INTERVENTION.
NEXT SLIDE.
I JUST WANT TO SHOW THAT AS I
SAID, WE HAD A REAL BACKUP IN
OUR INDIVIDUAL THERAPY AND
INDIVIDUAL TREATMENT IN OUR
SYSTEM, AND SO ONE OF THE
THINGS WE LOOKED AT IS WHERE ARE
THE REFERRALS GOING TO OUR
PROGRAM, AND WE ACTUALLY FOUND
THAT MORE THAN MORE THAN HALF
WENT TO GROUP-BASED PROGRAMS,
WHICH WAS A REALLY GOOD FINDING
FOR US FROM A FEASIBILITY
STANDPOINT AND BEING ABLE TO
DEAL WITH THE MASSIVE MENTAL
HEALTH NEEDS OF OUR SYSTEM AND
ACTUALLY ONLY 8% OF THE
95 PEOPLE ACTUALLY NEEDED THAT
THERAPY, SO THIS PROGRAM IS
REALLY HELPING US TO BE ABLE TO
GET SOME TREATMENT AND
OPPORTUNITIES TO PEOPLE TO TAKE
CARE OF THEMSELVES.
AND NOT OVERBURDENING THE MENTAL
HEALTH SYSTEM.
THIS IS OUR CURRENT RESILIENCE
STUDY.
WE ARE ALMOST AT OUR GOAL OF 120
PEEP 120
PEOPLE ENROLLED.
WE HAVE 104 RIGHT NOW AND WE
HOPE TO FINISH WITHIN SEVERAL
MONTHS OF ENROLLMENT.
I THINK JUST GIVEN TIME, I'M
GOING TO KEEP GOING BUT WE HAVE
ONE TO TWO MORE COHORTS OR
GROUPS.
I WANT TO SAY THANK YOU, IT
REALLY DID TAKE AN ENTIRE TEAM
TO BE ABLE TO DO A PROJECT LIKE
THIS AT THE POPULATION LEVEL,
AND TO BE ABLE TO WORK WITH NOW
MORE THAN 100,000 PATIENTS
INVOLVED IN THE POPULATION
MENTAL WELLNESS PROGRAM.
SO I WANT TO THANK EVERYBODY FOR
THEIR EFFORTS, AND I WANT TO
THANK YOU ALL FOR INVITING ME TO
SHARE OUR WORK WITH YOU.
>> GREAT.
THROUGH SO MUCH, ZEV.
THAT'S JUST AN INCREDIBLE AMOUNT
OF WORK.
AND LIKE YOU SAID, TO LAUNCH
THAT IN SEVEN DAYS AND GET THAT
UP AND MOVING FOR SUPPORT IS
JUST AN AMAZING -- I'M ALREADY
STARTING TO SEE QUESTIONS COME
THROUGH IN THE CHAT.
I ENCOURAGE THAT TO KEEP GOING.
I'LL TURN IT OVER TO OUR LAST
SPEAKER AND THEN WE'LL OPEN IT
UP FOR DISCUSSION.
SO OUR NEXT SPEAKER IS DR. JUDY
MOSKOWITZ AND SHE'S GOING TO
TELL US ABOUT THE FOREST STUDY.
>> GREAT.
THANK YOU.
YES, SO THANK YOU FOR HAVING ME.
I'M HAPPY DOING HERE TO TALK
ABOUT FOREST, WHICH IS NOT ABOUT
NATURE BATHING OR PLANT
COMMUNICATION.
IT'S A FUNCTION OF -- WE NAME
MOST OF OUR STUDIES USING SORT
OF BOTANICAL OR PLANT OR FLOWER
ACRONYMS.
SO FOREST ACTUALLY STANDS FOR
FOSTERING OPTIMAL REGULATION OF
EMOTION TO PREVENT SECONDARY
TRAUMA.
SO OUR PROGRAM OF RESEARCH HAS
REALLY CENTERED ON THIS
MULTICOMPONENT INTERVENTION THAT
TEACHES PEOPLE HOW TO HAVE MORE
POSITIVE EMOTION ON A DAILY
BASIS TO COPE WITH WHATEVER TYPE
OF STRESS THEY'RE COPING WITH.
SO WE'VE DONE A NUMBER OF TRIALS
IN MOSTLY PEOPLE COPING WITH
HEALTH-RELATED STRESS, HIGH
SCHOOL STUDENTS, SO -- SORT OF
RUN THE GAMUT IN SEEING WHETHER
WE CAN -- WHEN WE TEACH PEOPLE
THESE SKILLS, IF THEY HAVE
IMPROVEMENTS AND TR THEIR
PSYCHOLOGICAL WELL-BEING AS A
RESULT.
SO AROUND THE END OF 2019, I
GUESS IT WAS SUMMER OF 2019, WE
COULD HAVE CONTINUED WITH
RANDOMIZED TRIAL AFTER
RANDOMIZED TRIAL, EFFICACY
TRIAL, EFFECTIVENESS TRIAL.
BUT WE WERE REALLY STARTING TO
THINK HOW COULD WE -- WE'VE GOT
GOOD EVIDENCE THAT THIS WORKS.
FOR THE PEOPLE WHO DO IT.
SO HOW CAN WE HAVE MORE OF AN
IMPACT WITH THIS WORK?
AND IN AUGUST OF 2019, I WAS AT
THE AMERICAN PSYCHOLOGICAL
ASSOCIATION CONFERENCE IN
CHICAGO, AND WATCHING ONE OF
THEIR MAIN STAGE EVENTS.
IT WAS ON GUN VIOLENCE.
AND ONE OF THE SPEAKERS WAS
EDDIE BOCANEGRA, WHO AT THE TIME
WAS THE SENIOR DIRECTOR FOR A
PROGRAM CALLED READY CHICAGO.
WHICH IS A GUN VIOLENCE
PREVENTION AND INTERVENTION
PROGRAM WHERE THEY REACH OUT TO
MEN AT HIGHEST RISK OF BEING
INVOLVED IN GUN VIOLENCE AND
BRING THEM IN FOR A 12-MONTH
PROGRAM OF COGNITIVE BEHAVIORAL
SKILLS, JOB TRAINING,
TRANSITIONAL SKILLS, OTHER SORT
OF WRAP-AROUND SERVICES.
SO I SAW EDDIE SPEAK AND HAD THE
OPPORTUNITY TO MEET HIM BACK
STAGE, AND I WAS -- YOU KNOW,
THAT POINT I WASN'T THINKING
ABOUT OUR PROGRAM.
I WAS JUST -- I'M A
PSYCHOLOGIST, I REALLY THINK
WHAT YOU'RE DOING IS AMAZING,
HOW CAN I HELP?
I'M HERE IN CHICAGO.
AND HIS FIRST THOUGHT WAS, WELL,
WE'RE DOING THESE COGNITIVE
BEHAVIORAL SKILLS, WE COULD USE
A PSYCHOLOGIST TO HELP US WITH
FIDELITY TO THOSE SKILLS.
I WAS LIKE, OH, I'M NOT THAT
KIND OF PSYCHOLOGIST.
BECAUSE I'M A SOCIAL
PSYCHOLOGIST.
SO I WAS LIKE, BUT I KNOW
PEOPLE, I COULD PROBABLY FIND
SOMEONE TO HELP YOU WITH THIS.
AND THEN HE SAID WHAT DO YOU DO?
AND I WAS LIKE, WELL, I DO THIS
POSITIVE EMOTION THING TO HELP
PEOPLE COPE WITH STRESS.
AND I PROBABLY SAID IT JUST LIKE
THAT TOO, BECAUSE I'M ALWAYS
VERY WARY OF COMING OFF AS, UR
KNOW, JUST BE HAPPY AND IT WILL
FIX EVERYTHING NO MATTER HOW
SEVERE YOUR STRESS IS.
BUT AS SOON AS I DESCRIBED TO
HIM A LITTLE BIT, HE IMMEDIATELY
SAID, CAN YOU HELP OUR STAFF?
THIS IS REALLY CHALLENGING WORK,
THERE'S HIGH RATES OF BURNOUT,
SECONDARY TRAUMA, REALLY HIGH
TURNOVER.
COULD THIS PROGRAM POSSIBLY HELP
OUR STAFF COPE BETTER WITH THE
STRESS OF BEING A FRONT LINE GUN
VIOLENCE PREVENTION WORKER?
SO WITH MY COLLEAGUES, WE
STARTED TALKING WITH -- AT THE
DIFFERENT SITES OF READY.
READY HAS THREE SITES LOCATED IN
SORT OF THE SOUTH AND WEST SIDE
OF CHICAGO.
SO WE WENT TO SOME OF THEIR
MEETINGS, WE PRESENTED SORT OF
AN OVERVIEW OF THE PROGRAM, HAD
THEM PRACTICE SOME OF THE
SKILLS, JUST IN SORT OF A GROUP
FORMAT, AND ASKED PEOPLE WHO WAS
INTERESTED IN LEARNING MORE
ABOUT THIS PROGRAM.
SO WE WERE ABLE TO GET SOME -- A
SMALL POT OF MONEY TO RUN A
PILOT TEST OF THE PROGRAM WHERE
WE DO SORT OF A TRAIN THE
TRAINERS.
BECAUSE THAT WAS OUR FIRST
THOUGHT OF A WAY FOR US TO BE
ABLE TO IMPLEMENT THIS PROGRAM
ACROSS THE REA DI SITES.
SO WE CALLED IT PEAs, WHICH IS
SORT OF A PLANT, FOR POSITIVE
EMOTION AMBASSADORS.
WE WORKED WITH ABOUT 15 STAFF
MEMBERS FROM ACROSS THE THREE
READI SITES AND WENT THROUGH THE
PROGRAM WEEK BY WEEK.
SO WE GROUPED THE SKILLS INTO
FIVE WEEKS OF CONTENT AND A
SIXTH WEEK WE RAN SORT OF AS A
FOCUS GROUP TO GET FEEDBACK.
AND EACH SESSION, WE WOULD TEACH
A SKILL OR TWO AND THEN WE
WOULD -- THEN THEY WOULD
PRACTICE IT DURING THE WEEK, AND
WE WOULD ALSO TALK ABOUT ALONG
THE WAY HOW MIGHT THIS BE
IMPLEMENTED AT READI.
BECAUSE IT WAS PRETTY CLEAR TO
US WE WEREN'T JUST GOING TO GO
IN THERE, DO A PRESENTATION AND
SAY GO AHEAD, NOW YOU DO IT.
SO WE WALKED THEM THROUGH THE
SKILLS.
THIS WAS IN THE FALL OF 2020 SO
IT WAS ALL ON ZOOM.
A LOT OF THINGS GOING ON IN THE
WORLD AS WE'VE ALREADY DISCUSSED
DURING THE SIX WEEKS WE WERE
RUNNING THIS WITH THEM, THE
TRIAL FOR THE POLICE WHO SHOT
BREONNA TAYLOR, THE VERDICT CAME
DOWN FOR THAT.
SO WE HAD A LOT OF SORT OF
PROCESSING OF THAT AS PART OF
THE CLASS BECAUSE YOU CAN'T JUST
TALK ABOUT POSITIVE EMOTION, WE
HAVE TO TALK ABOUT THE STRESS
AND THE NEGATIVE EMOTIONS THAT
ARE GOING ON AS WELL.
SO WE GOT SOME REALLY GREAT
FEEDBACK TO THAT PROGRAM AND TO
THE SKILLS, AND HERE ARE TWO OF
MY FAVORITES.
THE FIRST ONE, I THINK FOR STAFF
IT'S ABSOLUTELY NECESSARY AND
IMPORTANT BECAUSE YOU CAN HAVE
BURNOUT.
YOU'RE DEALING WITH NOT JUST THE
EMOTIONS OF YOURSELF, BUT OF AN
ENTIRE GROUP OF OTHER PEOPLE
THAT HAVE A LOT OF THINGS GOING
ON WITH THEM.
AND YOU HAVE TO TACKLE THAT ON A
CONSISTENT BASIS.
PEAs, AGAIN IS FLES SAIR .
THE QUOTE ON THE RIGHT, WE LIKED
IT SO MUCH, WE PUT IT ON THE
BACK OF THE JOURNALS WE GAVE
THEM AS A THANK YOU FOR
PARTICIPATING IN THE GROUP.
ONE OF THE PARTICIPANTS SAID,
THE USE OF POSITIVE EMOTIONS, IT
FEELS ALMOST LIKE GOING OUTSIDE
WITH A RAINCOAT.
IF YOU GO OUT WITH A SWEATER,
YOU GET RAINED ON AND YOUR SHIRT
GETS HEAVY, YOU HAVE TO CARRY
THAT BURDEN.
THE RAINCOAT ALLOWS THAT STUFF
TO WASH OFF OF YOU.
OFTENTIMES AT READI, WE'RE
STANDING IN THE RAIN ALL THE
TIME.
I FEEL LIKE WE'RE OFTEN THE
PEOPLE WHO NEED TO REMEMBER WHY
WE'RE HERE AND REMINDING US AND
GIVING US TOOLS TO NOT LET THOSE
THINGS WEIGH US DOWN.
SO WE WERE JUST WRAPPING UP THIS
GETTING FEEDBACK AND DOING SOME
FOLLOW-UP INTERVIEWS WITH THE
POSITIVE EMOTION AMBASSADORS
WHEN THIS CALL CAME OUT, THIS
R21 R33 FOR FIREARM INJURY AND
MORTALITY PREVENTION RESEARCH.
WORKING WITH READI CHICAGO, IS
NOT SOMETHING I WOULD HAVE EVEN
NOTICED BUT IT WAS REALLY CLEAR
TO US THAT THIS WAS A GREAT FIT
FOR THE WORK THAT WE WERE DOING
AND THAT WE WANTED TO CONTINUE
TO DO.
SO OUR GOAL FORM THIS WAS WE AIM
TO ADAPT, IMPLEMENT AND
MANUALIZE THE FOREST PROGRAM AND
BUILD CAPACITY FOR READI CHICAGO
TO SUSTAINABLY ENHANCE
RESILIENCE, PREVENT BURNOUT AND
REDUCE TURNOVER AMONG FRONT-LINE
STAFF WORKING TO PREVENT FIREARM
INJURY AND MORTALITY.
SO THIS IS A PHASED AWARD.
WE ARE ABOUT 8 MONTHS INTO THE
R21 PHASE, 8 MONTHS OF THE TWO
YEARS.
WHERE OUR GOALS ARE TO ADAPT AND
FINALIZE THE CONTENT OF THE
INTERVENTION.
SO WE DON'T REALLY ANTICIPATE
THAT THE CORE SKILLS ARE GOING
TO CHANGE A LOT.
WE DID HAVE FEEDBACK THAT THEY
WANTED TO BE MORE
TRAUMA-INFORMED AND WE ARE
INCORPORATING THAT PERSPECTIVE.
SOME OTHER SORT OF CULTURAL
TAILORING AND SOME OTHER NEEDED
ADAPTATIONS, AND WE'RE GOING TO
BE GETTING FEEDBACK THROUGH THIS
FIRST TWO YEARS ON WAYS WE CAN
IMPROVE THE CONTENT.
AND THEN WE'RE ALSO LOOKING TO
INFORM STRATEGIES TO IMPLEMENT
FOREST AT THE THREE READI SITES
BASED OP SYSTEM, ORGANIZATION
AND STAFF FACTORS.
SO OUR PLAN WAS TO DO SURVEYS,
REALLY IMPLEMENTATION SCIENCE
KIND OF SURVEYS LOOKING AT THESE
CONTEXTUAL FACTORS.
WITH THE STAFF, WITH LEADERSHIP
AND OTHER KEY STAKEHOLDERS, AND
THEN FOLLOWING THAT WE'RE GOING
TO DESIGN THE STUDY WE WANT TO
DO IN THE THREE-YEAR FOLLOW-UP
PHASE IF WE NEED OUR BENCHMARKS.
FOR THE FIRST TWO, INCLUDING HOW
ARE WE GOING TO EVALUATE IT.
AS A PSYCHOLOGIST, WE WANT TO
LOOK AT THE WELL-BEING OF THE
FRONT LINE WORKERS, WE WANT TO
LOOK AT THEIR LEVELS OF BURNOUT.
THE LEADERSHIP AT READI IS GOING
TO HAVE OTHER THINGS THAT THEY
MIGHT BE INTERESTED IN, IN
ADDITION TO JUST INDIVIDUAL
WELL-BEING.
SO WE'RE GOING TO DO SOME
INTERVIEWS WITH THOSE KEY
STAKEHOLDERS TO FIND OUT WHAT
THEY WOULD LIKE TO SEE OUT OF
THIS PROGRAM AND HOW WE CAN BEST
EVALUATE IT.
AND THEN IN THE R33 PHASE, IF
WE'RE -- IF WE DO A GOOD JOB IN
THE FIRST PART AND WE GET THIS
SECOND PHASE, WE WILL DO A
LONGITUDINAL STUDY WHERE WE
IMPLEMENT THE PROGRAM AT READI,
AND THEN WE WANT TO TRY TO
FIGURE OUT HOW WE CAN MAKE IT
SUSTAINABLE, HOW WE CAN BUILD
READI CAPACITY SO THEY CAN
CONTINUE WITH IT ONCE THE
RESEARCHERS PULL OUT.
AND THEN POSSIBLY TO DISSEMINATE
TO OTHER GUN VIOLENCE PREVENTION
PROGRAMS IN CHICAGO AND OTHER
LARGE CITIES.
SO WHEN WE RECEIVED OUR FUNDING,
THE NORTHWESTERN COMMUNICATIONS
OFFICE GOT A CALL FROM SENATOR
DICK DURBIN, FROM HIS TEAM, AND
THEY WANTED TO -- AND SENATOR
DURBIN WAS VERY EXCITED ABOUT
THIS, BECAUSE HE'S BEEN A LONG
TIME ADVOCATE FOR INCREASING
FUNDING FOR GUN VIOLENCE
RESEARCH.
SO HE WAS VERY EXCITED THAT
NORTHWESTERN AND ACTUALLY THE
UNIVERSITY OF CHICAGO BOTH
RECEIVED A GRANT AT THE SAME
TIME TO WORK WITH READI CHICAGO
IN DIFFERENT CAPACITIES.
SO HERE WE ARE IN OUR PRESS
CONFERENCE WITH SENATOR DURBIN.
SO IT WAS KIND OF EXCITING.
SO THIS IS A TRUE PARTNERSHIP
BETWEEN THE RESEARCHERS AT
NORTHWESTERN AND THE READI
CHICAGO TEAM.
WE MEET WEEKLY TO TALK THROUGH
VARIOUS ASPECTS OF THE PROGRAM
AND TO UNDERSTAND WHAT WE'RE
SEEING IN THE DATA.
SO I'LL JUST GIVE YOU A LITTLE
INSIGHT, WE'RE EIGHT MONTHS IN
SO WE'VE JUST COMPLETED THIS
FIRST ROUND OF FOCUS GROUPS.
INITIALLY WE PLANNED ON DOING
SURVEYS, BUT IT WAS REALLY CLEAR
TO US AS WE LOOKED AT SOME OF
THE IMPLEMENTATION SCIENCE
SURVEYS THAT WE NEEDED TO OPEN
IT UP MORE AND REALLY LOOK MORE
BROADLY AND DO THESE FOCUS
GROUPS TO REALLY LOOK AT SORT OF
THINGS LIKE WHAT WORKS IN NEW
PROGRAMS THAT ARE ROLLED OUT,
WHAT DOESN'T WORK, WHAT SHOULD
WE AVOID DOING, WHAT WE MIGHT
WANT TO DO, AND TO GET VIEWS OF
WELLNESS AND HOW READI COULD
SUPPORT WELLNESS THROUGH THIS
PROGRAM.
SO WE DID FIVE FOCUS GROUPS.
TWO WITH OUTREACH WORKERS, ONE
WITH CREW CHIEFS, ONE WITH
COACHES AND MANAGERS SO TO GET A
RANGE OF ROLES AND GET THEIR
INPUT, AND THE GROUPS WERE VERY
DIFFERENT IN THE KINDS OF THINGS
THAT THEY WERE TELLING US.
SO WE'RE GOING TO AN OPEN CODING
PROCESS, THIS IS REALLY MESSY.
SO BE GENTLE ON ME.
WE'RE NOT THERE YET FIGURING
EVERYTHING WE HAVE, BUT I WANTED
TO GIVE YOU SOME INSIGHT INTO
WHAT WE'RE SEEING.
SO GENERALLY, FACILITATORS,
BARRIERS, SOME CONTEXTUAL
THINGS, AND THEN WE'RE ALSO
COLLECTING SUGGESTIONS FOR
IMPLEMENTATION.
SO IN TERMS OF FACILITATORS,
THERE ARE A LOT OF THINGS ABOUT
THE CULTURE OF READI THAT REALLY
MAKES IT READY TO HAVE A PROGRAM
LIKE THIS.
SO THEY REALLY HAVE AN
ACCEPTANCE OF NEGATIVE EMOTIONS
AND THE STRESS OF THE PROGRAM,
SO THEY ARE VERY MUCH IN LINE
WITH OUR POINT ABOUT OUR PROGRAM
IS NOT ABOUT IGNORING THE STRESS
OR PRETENDING LIKE NEGATIVE
EMOTIONS DON'T EXIST.
SO THEY ARE VERY GOOD AT BEING
AWARE OF NEGATIVE EMOTIONS.
AND THEIR CULTURE REALLY
SUPPORTS WELLNESS AND SELF-CARE.
I'LL GIVE YOU AN EXAMPLE.
SO AS AN EXAMPLE, THE CULTURE
SUPPORT, READI WANTS YOU TO BE
AT YOUR BEST IN ORDER TO GIVE
YOUR BEST.
SO SELF-CARE, IN ESSENCE, IS
PUSHED TO SAY, HEY, WE'RE
SERVING BUT WE DON'T WANT TO
SERVE FROM AN EMPTY PLACE.
THEN IN TERMS OF BARRIERS, WE
GOT A LOT MORE ABOUT BARRIERS
BECAUSE WE WERE REALLY ASKING
WHEN A PROGRAM DOESN'T WORK, WHY
DOESN'T IT WORK?
SO WE GOT A LOT OF INFORMATION
ON THIS.
FACTORS RELATED TO CULTURE,
208 IS THE ADDRESS OF THE
LEADERSHIP.
SO WE HEARD A LOT ABOUT 208 AND
A DISCONNECT BETWEEN 208 AND
WHAT'S REALLY GOING ON AT THE
SITE, AND THEN BARRIERS
ASSOCIATED WITH THE NATURE OF
THE WORK.
AN EXAMPLE OF THE DISCONNECT
BETWEEN THE LEADERSHIP AND THE
STAFF.
SO WE NEED TO BE AT THE TABLE
WHEN PROGRAMMATIC CHANGES ARE
BEING MADE SO OUR VOICES CAN BE
HEARD.
AS OPPOSED TO 208 MAKING THOSE
DESIXES AND ROLLING IT DOWN TO
US, AT THAT POINT IT'S NOT A
SUGGESTION, IT'S SOMETHING
THEY'RE GOING TO DO.
AND THEN AN EXAMPLE OF SORT OF
THE NATURE OF THE WORK AND THE
BARRIERS HERE.
AND THIS IS ABOUT PERSONAL
EXPERIENCES WITH TRAUMA AND HOW
THAT PLAYS OUT WHEN YOU'RE DOING
THIS KIND OF WORK.
SO EVERY DAY WE'RE DEALING WITH
TRAUMA, IT'S DIFFERENT FROM YOU
GOING TO A CORPORATE JOB AND
YOU'RE JUST GOING TO FOCUS ON
THAT JOB BUT IF YOU'RE DEALING
WITH TRAUMA AT HOME AND THEN YOU
HAVE TO COME IN AND TEACH OTHERS
HOWL OTHERS
HOW TO DEAL WITH TRAUMA, IT CAN
WEIGH HEAVILY, AND BLEED INTO
WHAT YOU'RE TRYING TO DO.
THEN IN TERMS OF CONTEXT, WE
CODED EVERY TIME WE SAW
SOMETHING ABOUT COVID, THE
NATURE OF STRESS AT READI AND
THE MEANING AND PURPOSE IN THEIR
WORK.
I KNOW THIS YEAR ALONE, I THINK
WE MAY HAVE LOST TWO OR THREE
PARTICIPANTS.
WHEN I SAY LOST, I MEAN DIED.
OF COURSE IT'S TRAUMATIC AND YOU
ATTEND THE FUNERAL BUT BY THE
SECOND OR THIRD TIME, IT'S HARD
TO HAVE THE STOMACH TO ATTEND
SOME OF THOSE FUNERALS ANYMORE.
YOUR SPIRIT IS KIND OF A BURNOUT
AND PEOPLE START TO DRAW
BOUNDARIES, THAT'S START REALLY
GETTING TO YOU, YOU CAN SEE
THEY'RE DRAWING MORE AND MORE
BOUNDARIES TO SOME OF THE THINGS
THEY'RE EXPERIENCING THROUGH THE
JOB OR EXPERIENCING VICARIOUSLY.
AND THEN WE HEARD A LOT ABOUT
THE SENSE OF MEANING AND PURPOSE
BEHIND THIS WORK.
I HAVE ONE JOB AT READI AND
THAT'S TO KEEP THESE GUYS ALIVE.
THAT'S THE ONLY JOB I HAVE.
EVERYTHING ELSE IS WORK.
YOU STAND WHAT I THERE IT
READI THAT I'VE COME ACROSS THAT
IS NOT THERE TO KEEP THESE YOUNG
BROTHERS ALIVE.
IT'S EXTREMELY DIFFICULT.
SO WE'RE IN THE PROCESS OF
REFINING AND FINALIZING THESE
CODES AND REVISING THE CONTENT
OF THE INTERVENTION.
WE'RE GOING TO FOLLOW UP WITH
MORE IN DEPTH INTERVIEWS ABOUT
THE INTERVIEWS AND POSSIBLE
IMPLEMENTATION AND WE'RE ALSO
GOING TO BE IDENTIFYING AND
TRAINING PERSONNEL IF WE'RE
GOING TO GO THIS TRAIN THE
TRAINERS ROUTE.
AND I THINK THAT'S IT.
>> YES.
WONDERFUL.
WELL, THANK YOU ALL SO MUCH.
I'M GOING TO STOP SHARING AND
BRING US BACK TO OUR SQUARES
WHERE WE CAN SEE EVERYBODY.
I'M SEEING SOME CLAPS AND SOME
APPLAUSE.
THE WORK THAT YOU ARE ALL DOING
IS JUST REALLY AMAZING, AND SO
I'LL OPEN IT UP IF PEOPLE WANT
TO ASK QUESTIONS.
I DID SEE A COUPLE OF THINGS IN
THE CHAT.
BUT I DON'T KNOW IF DR. LANGEVIN
OR IF YOU WANT TO START OFF, IF
YOU'VE GOT QUESTIONS AS WE'RE
WAITING FOR OTHERS TO USE
THEIR -- RAISE THEIR HAND
FUNCTION TO START THE
CONVERSATION.
>> THANK YOU, WENDY.
WOW, THIS WAS REALLY GREAT.
I HAD A QUESTION I ASKED IN THE
CHAT AND IT GOT ANSWERED, BUT
MAYBE I CAN JUST RAISE IT MORE
GENERALLY.
I'M REALLY CURIOUS ABOUT THIS
THING ABOUT HOW -- IS LESS MORE.
YOU KNOW, IF YOU SET THE
EXPECTATION THAT SOMEBODY IS
GOING TO DO A CERTAIN AMOUNT OF
PRACTICE EACH DAY OR THEY'RE
GOING TO HAVE A CERTAIN -- A
GOAL TO SET IN TERMS OF THEIR
PRACTICE, IS SETTING A SHORTER,
SMALLER, MORE PERHAPS ACHIEVABLE
GOAL BOTH MORE REALISTIC BUT
ALSO MAYBE EVEN BETTER IN TERMS
OF EMPOWERING THE INDIVIDUAL TO
DO SOMETHING, IF YOU SET THE
GOAL TOO HIGH OR LIKE SAY
PRACTICING FOR 30 OR 45 MINUTES
A DAY, IS THAT
COUNTERPRODUCTIVE?
I'M JUST WONDERING, I THINK THIS
IS A VERY INTERESTING QUESTION
AND I WAS JUST WONDERING IF ANY
OF YOU HAVE SORT OF EXAMINED
THAT SPECIFICALLY.
>> I DON'T KNOW, MICHAEL OR ZEV
OR JUDY IF YOU GUYS HAVE
THOUGHTS ON THAT?
MIKE, WHY DON'T YOU START.
>> I'LL KEEP MINE SHORT.
AS I MENTIONED IN THE CHAT, I
THINK THAT'S EXACTLY RIGHT.
I THINK THAT'S SORT OF WHAT WE
FOUND IN OUR STUDY.
WE NICHE INITIALLY BASED THI-
INITIAL 30, 45 MINUTES A DAY OF
PRACTICE AND I THINK YOU HIT IT
RIGHT ON THE HEAD, A LOT OF
FOLKS SAID I CAN'T DO THAT SO I
JUST WON'T DO ANYTHING.
WE HAVE SOME OF THAT IN OUR DATA
WHERE WE HAVE THEM SAY YOU'RE
ASKING US TO DO TOO MUCH.
SO WE DID DECREASE THAT REQUEST
AND WE REVIEWED IT A LITTLE MORE
CAREFULLY AT THE BEGINNING OF
EACH GROUP.
WE HAD THEM SET THEIR OWN
PERSONAL GOALS SO INSTEAD OF US
TELLING THEM YOU HAVE TO DO THIS
AMOUNT, LIKE WHAT'S RIGHT FOR
YOU, AND WE ADAPTED THAT
THROUGHOUT TREATMENT.
AND AGAIN, WE'RE JUST STARTING
TO LOOK AT THE DATA.
BUT SO FAR WE SUGGESTED WE HAD A
MUCH BETTER CONTINUE TO PRACTICE
AT SIX MONTHS OUT.
>> FUNNY BECAUSE WE USUALLY
THINK OF A DOSING EFFECT AS
BEING LINEAR, THE MORE YOU DO,
THE BETTER IT IS.
THIS MAY APPLY TO MORE THAN
MINDFULNESS.
>> IF I COULD SAY, THERE IS A
DOSING EFFECT, AND THE MORE YOU
PRACTICE, OFTEN WE SEE CHANGES
IN SYMPTOMS AND EVEN IN BRAIN
MECHANISMS.
BUT, IF IT'S TOO MUCH WHEN
YOU'RE STARTING AND YOU'RE
OVERWHELMED AND THAT LEADS YOU
TO FEEL LIKE YOU'RE SOMEONE WHO
CAN'T DO IT, OR TO FEEL BAD
ABOUT YOURSELF LIKE SOMETHING IS
WRONG WITH YOU, THEN THAT'S TOO
MUCH AND THERE WILL BE NO
PRACTICE.
SO SOME IS GOING TO BE BETTER
THAN NONE IN THAT CASE.
IN OUR PRIMARY CARE MINDFULNESS
STUDY, WE -- WE FOUND THAT
WITHIN EIGHT WEEKS, THE
EIGHT-WEEK PROGRAM HAD
SUBSTANTIAL REDUCTIONS IN
ANXIETY, DEPRESSION AND STRESS,
BUT BY 24 WEEKS, THE PEOPLE THAT
HAD ONE HOUR AND THEN REFERRAL
TO COMMUNITY PROGRAMS CAUGHT UP
AT LEAST WITHIN THE CONTEXT OF
STRESS.
WHAT WE DIDN'T SEE WAS THAT THE
PEOPLE THAT WENT TO THE 8-WEEK
GROUP WERE 2 1/2, 4 TIMES AS
LIKELY TO INITIATE A BEHAVIOR
CHANGE WITHIN TWO WEEKS, WHICH
WASN'T A PRIMARY OUT COME OF THE
STUDY.
2 1/2 TO 4 TIMES AS LIKELY AS
THE GROUP THAT ONLY GOT AN HOUR
OF MINDFULNESS.
AND THE CHANGES IN MECHANISMS
LIKE EMOTION REGULATION,
INTERCEPTIVE AWARENESS AND SELF
COMPASSION WERE MUCH LARGER
EFFECTS IN THE EIGHT-WEEK GROUP
COMPARED TO THE ONE HOUR GROUP.
SO I THINK THAT THERE IS A DOSE
EFFECT AND IF YOU DON'T TEACH IT
IN A MOTIVATIONALLY SALIENT WAY
AND YOU DON'T PAY ATTENTION TO
WHERE PEOPLE ARE AT, THEN YOU
WILL TURN A LOT OF PEOPLE OFF.
AND THE WORK WE'VE BEEN DOING
WITH ADICKS, WITH OPIATE USE
DISORDER, ADDIF
MINDFULNESS AND USE WHAT WE CALL
AN ASCENDING PRACTICE DOSE
LADDER SO WHEN PEOPLE
CONSOLIDATE IN THAT 10 MINUTES,
THEN THEY CAN GO TO 15 AND THEN
WHEN THEY GET TO 15 THEY CAN GO
TO 20.
BECAUSE THE RISKS IN OPIATE USE
DISORDER OF SOMEONE FEELING LIKE
THIS WON'T WORK FOR THEM OR I'M
NOT GOING TO BE GOOD ENOUGH, AND
THEN DROPPING OUT OF TREATMENT,
ARE REALLY HIGH.
SO WE WANT TO START SLOW AND
KIND OF GO WITH THEM.
BUT THAT COULD BE SAID FOR
NEARLY ANY POPULATION WHERE
MINDFULNESS IS NOT SOMETHING
THAT THEY'RE ACTIVELY COMING TO
AND WHERE MAYBE THERE WAS
IMPULSIVITY OR INTENTIONAL
CHALLENGES OR JUST REALLY
INTENSE STRESS FOR TRAUMA, THAT
PEOPLE NEED TO BE ABLE TO GET
COACHING AROUND HOW TO BE WITH
AND HOW TO BE KIND TO THEMSELVES
AROUND, BEFORE THEY ACTUALLY CAN
MOVE ON AND DO THE PRACTICE.
THIS IS WHY WE'VE BEEN WORKING A
LOT AROUND THIS IDEA OF WARM
MINDFULNESS OR INTEGRATING SELF
COMPASSION AND MINDFULNESS MORE
EXPLICITLY BECAUSE ESPECIALLY IN
THE U.S., I THINK PEOPLE NEED
TO -- NEED TO KNOW HOW TO BE
KIND TO THEMSELVES IN ORDER TO
THEN BE ABLE TO TOLERATE THAT
MAYBE THEY CAN'T DO 30 MINUTES
RIGHT AWAY.
MAYBE THIS IS HARD.
MAYBE I CAN BE OKAY WITH THAT.
MAIBL I'M OKAY HOW I AM AND I
CAN BE KIND TO MYSELF AND THAT
ACTUALLY CAN ALLOW PEOPLE TO
THEN STICK WITH THE PRACTICE IN
THE LONG TERM.
I WON'T SAY ANY MORE.
THOSE ARE MY THOUGHTS ON IT.
>> WONDERFUL.
SO I SEE WE'VE GOT A SEER EAVES
HANDS UP.
SERIES OF
HANDS UP.
RICK, I'LL START WITH YOU.
>> I'LL JUST CHIME IN.
I LOVE THAT QUESTION THAT
DR. LANGEVIN POSED ABOUT THE
DOSE.
WE'VE DONE A CLASS HERE AT THE
UNIVERSITY OF MICHIGAN WHERE WE
TEACH GRADUATE STUDENTS
MINDFULNESS-BASED MEDITATION AS
A COURSE FOR JUST ONE SEMESTER,
AND WE HAVE THEM MEDITATE FOR
JUST FIVE MINUTES A DAY, AND
THEN TO DO A SHORT JOURNALING
DAILY.
THAT'S THE ONLY THING THAT WE
REALLY REQUIRE OF THEM, OF THE
CLASS.
WE HAD THEM THROW AWAY THEIR
READING, DON'T THINK ABOUT
MAKING A PRESENTATION.
WE JUST WANT YOU TO WORK WITH
YOUR MIND DURING THE COURSE.
AND WE HAD -- WE'VE DONE THIS
NOW FOR FOUR SEMESTERS, AND WE
HAVE 35 TO 40% REDUCTION IN
ANXIETY AND DEPRESSION IN THESE
GRADUATE STUDENTS THAT'S
CLINICALLY AS WELL AS
STATISTICALLY REALLY
SIGNIFICANT.
SO I DO AGREE THAT A SHORTER
DOSE OR LIKE A SHORTER TIME OF
MEDITATION CAN REALLY BE
EFFECTIVE, ESPECIALLY WHEN
YOU'RE LEARNING THE TECHNIQUE &
GETTING IT GOING.
SO I DO THINK A SMALL DOSE CAN
BE HELPFUL.
>> KAREN?
>> THE ISSUE I WANTED TO RAISE
IS SORT OF THE NEXT STEP AFTER
THAT.
AFTER YOU HAVE ENOUGH OF
EXPERIENCE WITH, SAY,
MINDFULNESS, THAT YOU RECOGNIZE
YOU'RE NOT GOING TO FALL APART,
THAT YOUR THOUGHTS DON'T OWN YOU
AND ALL THAT SORT OF STUFF, THEN
THE QUESTION BECOMES HOW TO TAKE
THAT FROM YOUR FIVE MINUTE OR
YOUR 10 MINUTE OR YOUR 30 MINUTE
EXPERIENCE EVERY MORNING OR
WHENEVER YOU DO TO THROUGHOUT
THE DAY.
IN MY PERSONAL EXPERIENCE AS
WELL AS AS A RESEARCHER, THAT
PIECE HAS BEEN MUCH HARDER TO
FIGURE OUT.
I FINALLY JUST STARTED
PROGRAMMING MY CELL PHONE TO GO
OFF EVERY SO OFTEN AND BEEP AT
ME AND IT'S, OH, YES, I PRESENCE
MYSELF.
BUT I HAVEN'T REALLY READ MUCH
ABOUT THAT IN SORT OF A SPECIFIC
PROBLEM-SOLVING WAY IN THE
RESEARCH LITERATURE, AND I THINK
IT WOULD BE FUN TO HEAR YOU GUYS
ALL COMMENT ON THAT.
>> I CAN SPEAK TO MY THOUGHTS ON
THAT.
WHEN I WAS DOING SOME WORK WITH
THE DEFAULT NETWORK AND THINKING
ABOUT INTENTIONAL PATHWAYS AND
IT SEEMED TO ME THAT WE TEND TO
MIND WANDER WITHIN 6 TO
8 SECONDS OF ANY MOMENT THAT WE
ARE ACTUALLY PAYING ATTENTION TO
SOMETHING.
AND SO I DID A BACK OF THE
ENVELOPE KIND OF CALCULATION AT
SOME POINT WHERE I THOUGHT ABOUT
THAT AND THOUGHT ABOUT HOW MANY
MINUTES OF SITTING AND LETTING
YOUR MIND WANDER AND COMING BACK
AGAIN WOULD TAKE TO BE ABLE
TO -- UNTIL THIS KIND OF BECOMES
MORE AUTOMATED, AND IN THESE
EIGHT-WEEK PROGRAMS, THAT 30
MINUTES A DAY, YOU WOULD DO THAT
ABOUT 10,000 TIMES AROUND WEEK
SIX.
THAT'S A BACK OF THE ENVELOPE
KIND OF DISCUSSION, NOT
SCIENTIFIC, SO I WANT TO
ACKNOWLEDGE THAT AND I'M
BRINGING THAT EVEN HERE INTO
THAT ADVISORY COUNCIL, BUT I DO
THINK THAT THERE IS THIS WHAT'S
CALLED CULTIVATION OF
MINDFULNESS SO THAT IT'S NOT
JUST EFFORTFUL TO TRY TO PAY
ATTENTION IN THE MOMENT, WHERE
YOU'RE CONSTANTLY REMINDING
YOURSELF, BUT WHERE ACTUALLY, I
HEAR THIS ALL THE TIME FROM
PEOPLE I'VE WORKED WITH, I'M
WALKING ACROSS THE STREET AND
SLOWLY -- MY BREATH.
SOMEWHERE AROUND FOUR, FIVE, SIX
WEEKS, THAT'S WHERE I THINK A
LOT OF THE EASE STARTS COMING,
WHEN PEOPLE ACTUALLY START TO
PAY ATTENTION TO THE PRESENT
MOMENT, TO THEIR BODY, AND
SOMETIMES IT TAKES EVEN LONGER
THAN THAT.
THAT MAY DEPEND ON MANY
DIFFERENT THINGS, BUT THAT'S HOW
HE
I SEE THESE, WHERE IT CAN START
TO COME ON AUTOMATICALLY AND
THEN YOU CAN CULTIVATE AND KEEP
THAT GOING.
BUT IT MAY HAPPEN MORE EASILY,
QUICKER, FOR OTHER PEOPLE WITH
OTHER TRAINING PATHWAYS.
>> JUDY OR MIKE?
>> I'D LIKE TO ADD TO THAT.
>> I'LL BRIEFLY ADD THAT WE'VE
BEEN VERY INTERESTED IN THE
DISTINCTION, I GUESS WHAT WE
CALL FORMAL VERSUS INFORMAL.
WE TEACH THAT IN OUR COURSE OF
THE FOUNDATION FIRST AND
BUILDING THROUGHOUT THE DAY.
I DIDN'T MENTION IN THE TALK, WE
HAVE SOME DATA WE LOOKED AT AS
WELL OF -- WE -- TO GET A SENSE
OF WHEN THEY WERE ENGAGING AND
HOW OFTEN IN INFORMAL PRACTICE.
SO WE PLAN TO LOOK AT THAT
ACTUALLY AS ONE OF OUR GOALS, TO
LOOK AT SECONDARY ANALYSIS, WHAT
ACCOUNTED FOR MORE POTENTIAL AND
MORE LINKS WITH THEIR OUTCOMES,
WAS IT FORMAL, INFORMAL OR BOTH.
WE'VE DONE THIS IN PREVIOUS
STUDIES.
IT'S BEEN ABOUT EQUAL, SO THAT
INFORMAL PRACTICE, KAREN, BACK
TO YOUR QUESTION IS CERTAINLY --
IS SOMETHING BUILDING ON THE FOR
MALPRACTICE, WE'VE DONE SOME OF
THIS WORK WITH ER PHYSICIANS TO
SUGGEST THAT THOSE INFORMAL
MOMENTS OF MEDITATION ARE AS
IMPORTANT AS GETTING ON THE
CUSHION.
BUT IT SEEMS LIKE THAT NEEDS TO
PRECEDE SORT OF THEN DOING THAT.
>> GREAT.
THANKS.
RONI?
>> I JUST WANT TO THANK THE
PRESENTERS FOR THESE GREAT
PRESENTATIONS AND PROVOKING SO
MUCH INTEREST.
IT'S EXCITING TO HEAR YOUR WORK.
I COMMEND YOU FOR GETTING
THROUGH THOSE HARD TIMES AT THE
BEGINNING OF THE PAN PANDEMIC.
TRYING TO DO THE SAME THINGS IN
MINNEAPOLIS, AT THE TIME OF
GEORGE FLOOD'S MURDER AS ,
IT'S JUST INCREDIBLE WHAT YOU
WERE ABLE TO ACCOMPLISH.
AS WE MOVE FORWARD, A LOT OF
PEOPLE CAN FORGET THAT.
SO JUST CONGRATULATIONS.
I THINK THESE CONVERSATIONS
ABOUT DOSE AND HOW IT RELATE TO
ADHERENCE AND ENGAGEMENT ARE SO
IMPORTANT.
I'D LOVE TO SEE ANOTHER SERIES
OF PRESENTATIONS ON THAT AT
MAYBE THE NEXT COUNCIL MEETING,
BECAUSE I THINK IT'S SO
CRITICAL.
AND I GUESS I HAVE A QUESTION TO
THE PRESENTERS.
BACK TO THIS DEALING WITH THE
TIME OF COVID, FOR THOSE OF YOU
THAT WERE CAUGHT MIDSTREAM, HOW
DO YOU DEAL WITH THIS IN THE
ANALYSIS AND HOW DO YOU -- WHAT
DO WE HAVE TO LOOK FORWARD TO IN
OUR STATISTICAL ANALYSIS?
BECAUSE WE'RE NOT DONE YET.
NOT ONLY DID COVID JUST APPEAR,
BUT THIS INCREASING STRESS THAT
WE'RE SEEING, HOW IS THAT GOING
TO AFFECT THINGS?
SO I JUST WONDER IF YOU GUYS ARE
THINKING ABOUT THAT LOOKING
FORWARD, BECAUSE THAT'S
SOMETHING THAT'S ON MY MIND A
LOT.
>> I CAN SPEAK TO THAT A LITTLE
BIT WITH OUR OTHER TRIALS.
I GUESS THE BLESSING IS THAT
WE'RE ALL GOING THROUGH THIS.
SO YOUR CONTROL GROUP AND YOUR
INTERVENTION ARE GOING THROUGH
THIS SAME STRESS AT LEAST WRIT
LARGE, AND THEN THERE WILL BE
THE NORMAL INDIVIDUAL DIFFERENCE
VARIATION AROUND THEIR REACTIONS
TO IT.
THAT SHOULD WASH OUT ACROSS THE
GROUPS.
LIKE I SHOWED YOU IN OUR FOCUS
GROUPS, WE'RE CODING THE COVID
PIECE BECAUSE LIKELY THAT'S
STILL GOING TO BE THERE GOING
FORWARD AND WE NEED TO KEEP THAT
IN MIND IF THEY'RE GOING BACK
AND FORTH BETWEEN BEING IN
PERSON AND BEING VIRTUAL AND
TRYING TO DO THEIR PROGRAM
VIRTUALLY AND THE DIFFERENT
SITES ARE DOING IT DIFFERENTLY,
WHICH IS WHAT WE WERE HEARING,
WE NEED TO TAKE THAT INTO
ACCOUNT AND AS WE'RE TRYING TO
DESIGN A PROGRAM THAT IS GOING
TO BE ROLLED OUT DURING COVID,
THERE'S JUST NO -- YOU NE OH.
UNLESS WE WAIT A DECADE, IT'S
STILL GOING TO BE AN ISSUE.
>> I THINK, JUDY, YOU BRING UP A
REALLY GOOD POINT.
I KNOW THIS IS SOMETHING,
EARLIER TODAY WE'VE BEEN TALKING
ABOUT SOME OF OUR PRAGMATIC
TRIALS WE'RE DOING, SOME OF THE
COLLABORATORY PROGRAMS, AND BOTH
IN THE NIH DOD PAIN MANAGEMENT
COLLABORATORY AND IN THE
PRAGMATIC TRIALS COLLABORATORY,
THEY'RE WORKING WITH A LOT OF
THOSE TRIALS TO TRY TO FIND SOME
LESSONS AND LOOK AT HOW THEY'RE
GOING TO MANAGE THAT
STATISTICALLY, SO I DO
ANTICIPATE SOME PUBLICATIONS
COMING FORWARD AND I'LL LOOK AND
SEE IF THERE'S ANYTHING I'LL PUT
IN THE CHAT FOR OTHER
PUBLICATIONS ABOUT HOW TO HANDLE
THIS, AND THE TRIALS THAT WERE
MOST DISRUPTED HONESTLY WERE THE
STEPPED WEDGE DESIGNS, THOSE
RANDOMIZING THE ORDER OF ROLLOUT
BECAUSE THE BASE WAS DIFFERENT
FOR EVERYBODY.
BUT IF YOU HAVE A PARALLEL GROUP
DESIGN, YOU SORT OF HAVE A PRE
AND A POST OR A PRE AND MID AND
POST, DEPENDING ON HOW THINGS
WENT, AND SO I THINK A LOT OF
OUR BIOSTATISTICIANS ARE LOOKING
AT THESE ISSUES AND MAKING SOME
RECOMMENDATIONS ACROSS THE
TRIAL, SO HOPEFULLY WE'LL GET
SOME MORE INFORMATION OUT TO THE
BROADER COMMUNITY ABOUT HOW SOME
OF THE STUDIES ARE APPROACHING
IT.
I DON'T KNOW THAT WE HAVE THE
ANSWERS, BUT HOW DIFFERENT
GROUPS ARE LOOKING AT IT.
GREAT QUESTION, RONI.
HELEN.
>> YES.
SO I HAD A COUPLE OF COMMENTS ON
THE GRAVITY OF THE
INTERVENTIONS.
IT'S BEEN STUDIED AND BRIEF
INTERVENTIONS DO -- MY STUDY
SHOWED THE 11 MINUTE MEDITATION
RESULTED IN PROFOUND BIOLOGICAL
CHANGES.
SO WHAT I'M STRUGGLING WITH IS
PATIENT PREFERENCES, AND THOSE
ARE RARELY INCLUDED IN THE
DESIGNS, AND WE KNOW IF PATIENTS
DON'T LIKE AN INTERVENTION, THEY
WILL NOT DO IT.
SO ADD SHEERNS ENTIRELY DEPENDS
ON PATIENT PREFERENCES.
AND I THINK THAT'S SOMETHING
THAT NEEDS TO BE INTEGRATED INTO
THE FUTURE TRIALS.
>> I WANT TO SPEAK TO THAT.
ONE OF THE THINGS WE'RE TRYING
TO DO IS WHEN MINDFULNESS IS ONE
OF THE INTERVENTIONS, WE DON'T
MENTION IT ANYWHERE IN THE
CONSENT OR IN THE MARKETING.
WE TRY TO CALL THEM STRESS
REDUCTION PROGRAMS OR BEHAVIORAL
TRAINING PROGRAMS.
WHAT WE'VE FOUND IS THAT IF WE
SPECIFICALLY RECRUIT FOR A STUDY
SAYING MINDFULNESS IS ONE OF THE
THINGS THAT'S BEING TRAINED, IT
HAS THE POTENTIAL OF BIASING THE
STUDY BECAUSE AS HELEN SAID,
PEOPLE ARE COMING AND THEY MAY
WANT THAT.
SO THAT PRIMARY CARE STUDY THAT
I WAS TELLING YOU ABOUT, WHERE
THERE WAS A DIFFERENCE BETWEEN
ONE HOUR AND 8 WEEKS, THAT WAS A
STUDY WHERE PEOPLE KNEW THAT
MINDFULNESS WAS WHAT WAS BEING
OFFERED.
SO IN THAT CONTEXT, WE SAW A
CERTAIN AMOUNT OF DROPOUT AND
DYSPHORIA AMONG THE FOLKS THAT
DIDN'T GET THE 8 WEEK PROGRAM
AND ONLY GOT AN HOUR.
IN OTHER PROGRAMS THAT WE'RE
RUNNING WHERE WE ARE KEEPING
IT -- WHERE IT'S A STRESS
PROGRAM OR RESILIENCE PROGRAM, I
THINK OFTEN PEOPLE SEEM -- WHEN
THEY GET RANDOMIZED TO A
MINDFULNESS CONDITION OF EIGHT
WEEKS AND TWO HOURS A WEEK, SOME
PEOPLE KIND OF FEEL OVERWHELMED,
I THINK, BY THE IDEA OF IT.
AND DIDN'T FEEL LIKE THEY WANTED
TO BE DOING THAT KIND OF
INTENSIVE TURN TOWARDS
THEMSELVES AND THEIR EXPERIENCE.
SO JUST SPEAKING TO WHAT HELEN
SAID, DIFFERENT PEOPLE WANT
DIFFERENT THINGS, AND A SHORT
INTERVENTION COULD BE VERY
APPROPRIATE IF THAT'S WHAT
SOMEBODY WANTS, AND FOR
DIFFERENT POPULATIONS, AN
INFORMAL PRACTICE, THERE ARE
SEVERAL STUDIES SHOWING THAT --
ESPECIALLY WITH ADDICTION,
WHERE -- THAT THE INFORMAL
PRACTICE SEEMS TO BE CORRELATING
WITH OUTCOMES, WHEREAS OTHER
POPULATIONS, THE LONGER -- THE
LARGER DOSE OF FOR MALPRACTICE
MIGHT BE WHAT CORRELATES.
SO THAT MAY BE ALSO DIFFERENT
PEOPLE AND DIFFERENT POPULATIONS
MAY NEED DIFFERENT APPROACHES.
>> ABSOLUTELY.
WELL, I JUST WANT TO THANK ALL
THE SPEAKERS AND HOPEFULLY WE'VE
GIVEN YOU AS COUNCIL AN IDEA OF
SORT OF DIFFERENT KINDS OF
STUDIES CAN BE IMPACTFUL FOR
DIFFERENT REASONS.
THE REALLY IMPORTANT THINGS
THAT, MIKE, YOU LEARNED IN THE
FEASIBILITY WORK OF HOW DO WE DO
THIS, AND WE NEED TO SHIFT THIS
INTERVENTION AROUND AND TAILOR
IT, WE NEED TO LOCK THAT DOOR SO
PEOPLE FEEL SAFE, YOU KNOW, IS
COMPLETELY DIFFERENT THAN A
DIFFERENT POPULATION THAT SAYS
NEVER LOCK THE DOOR, I NEED TO
BE ABLE TO GET OUT.
AND SORT OF CUSTOMIZING THAT IS
SO IMPORTANT AND HOW WHAT YOU'RE
LEARNING HAS INFORMED AND WILL
HELP YOU DESIGN THAT FUTURE
TRIAL, AND THEN THE IMPORTANCE
OF DOING THOSE EFFICACY TESTS
YOU'RE DOING, ZEV, AND ACTUALLY
UNDERSTANDING WHAT'S THE IMPACT
AND THE DIFFERENTIAL IMPACT OF
DIFFERENT KINDS OF PROGRAMS,
ABSOLUTELY WILL SET US IN, HELP
TO INFORM POLICY DECISIONS AND
WHAT KINDS OF PROGRAMS DIFFERENT
PAYORS WILL MAKE AVAILABLE, IS A
COMPLETELY ASYNCHRONOUS CBT
PROGRAM, SOMETHING THAT WORKS
JUST AS WELL AS AN IN-PERSON
DELIVERED SORT OF MBSR TYPE OF
PROGRAM THAT'S DONE VIRTUALLY.
THOSE QUESTIONS ARE REALLY
IMPORTANT TO PAYORS, AND WHO
NEEDS WHAT INTERVENTION, I THINK
ARE SOME REALLY INTERESTING
FUTURE QUESTIONS THAT WE CAN
LOOK AT.
AND I THINK, JUDY, YOU'RE DOING
ALL THIS PREIMPLEMENTATION WORK
TO FIGURE OUT HOW DO WE MAKE
SURE THAT THIS PROGRAM WE KNOW
WORKS IN ONE SETTING, WILL IT
WORK FOR THIS PARTICULAR
POPULATION, AND MAKE IT
SUSTAINABLE, MAKE IT SOMETHING
THAT COULD BE SCALED TO
DIFFERENT PLACES AND SO IT'S NOT
JUST THE EFFICACY STUDY THAT CAN
HAVE IMPACT.
IT'S ALL OF THESE DIFFERENT
STUDIES THAT CAN BE IMPACTFUL
AND I THINK THOUGHTFUL DESIGN IN
THESE STUDIES AND THINKING
THROUGH HOW WAS IT -- WHAT WILL
I LEARN FROM THE STUDY AND WHERE
WILL IT TAKE ME NEXT AND WHAT
WILL BE THE NEXT STEP AFTER
THAT, THAT'S OFTEN THE ADVICE
I'M GIVEN TO ALL OF YOU AS
APPLICANTS, IS THINKING THROUGH,
YOU KNOW, DESCRIBING YOUR STUDY
FOR THE REVIEWERS IS NOT ONLY
WHAT AM I GOING TO DO BUT WHAT
WILL I LEARN AND HOW WILL IT
INFORM WHAT I WOULD DO NEXT.
AND THAT IS REALLY, REALLY
HELPFUL IN PUTTING TOGETHER
COMPELLING APPLICATIONS AND FOR
US AS FUNDERS, COMPELLING
APPLICATIONS WHERE WE CAN SEE
WHERE THE SCIENCE IS GOING TO
LEAD.
SO EMILY, I DON'T KNOW IF, R
HELENE, IF YOU HAVE ANY CLOSING
COMMENTS AS WE WRAP UP.
>> I WOULD JUST SAY THE SESSION
REALLY MET OUR OBJECTIVE MORE
THAN WE EXPECTED.
THANK YOU SO MUCH FOR THE
WONDERFUL DISCUSSION, AND I'M
SURE WE WILL FOLLOW UP WITH ALL
OF YOU.
THANK YOU.
>> OKAY.
WE'RE GOING TO MOVE ON TO THE
LAST FORMAL PART OF THE OPEN
SESSION OF COUNCIL, WHICH IS
THREE CONCEPT CLEARANCES THAT
WE'RE GOING TO PRESENT.
I JUST WANT TO REMIND COUNCIL
THAT CONCEPT CLEARANCES ARE
SOMETHING THAT PRECEDES THE
POSSIBILITY OF DEVELOPING
FUNDING OPPORTUNITY
ANNOUNCEMENTS, ONE OR MORE, FROM
A GIVEN CONCEPT CLEARANCE.
SO WE PRESENT THESE QUITE
BROADLY, WITHOUT A LOT OF
SPECIFICS, BUT IT IS REALLY
ABOUT THE CONCEPT ITSELF, AS
YOU'LL SEE.
SO UP FIRST IS DR. ADAM KUSZAK
FROM THE OFFICE OF DIETARY
SUPPLEMENTS, AND ADAM, ARE YOU
READY TO GO?
>> YES, I AM.
CAN YOU HEAR ME?
>> YES, WE CAN HEAR YOU, AND
KELLY IS GETTING YOUR SLIDES
READY.
>> OKAY.
SO YOU'RE GOING TO ADVANCE THEM,
KELLY?
SO ADAM, WHEN YOU'RE READY FOR
THE NEXT SLIDE, JUST SAY NEXT
SLIDE, PLEASE.
>> PERFECT.
GOOD AFTERNOON, EVERYBODY.
AS INTRODUCED, EYE ADAM KUSZAK
FROM THE OFFICE OF DIETARY SUM.
I WANT TO THANK MY COLLEAGUES AT
NCCIH FOR THE OPPORTUNITY TO
SPEAK WITH YOU TODAY.
AND WITH THIS PRESENTATION, THE
OFFICE OF DIETARY SUPPLEMENTS IS
REQUESTING CONCEPT CLEARANCE FOR
REISSUE ANS OF AN ADMINISTRATIVE
SUPPLEMENT FUNDING OPPORTUNITY
ANNOUNCEMENTS.
AND THIS ADMINISTRATIVE
SUPPLEMENT FUNDING OPPORTUNITY
IS FOR FORMAL VALIDATION STUDIES
OF ANALYTICAL METHODS THAT
CHARACTERIZE DIETARY SUPPLEMENTS
AND NATURAL PRODUCTS.
SORE THE OFFICE OF DIETARY
SUPPLEMENT AT NIH COORDINATES
SEVERAL PROGRAMS AND ACTIVITIES
TO FULFILL ITS MISSION TO
SUPPORT SCIENTIFIC RESEARCH TO
STRENGTHEN OUR UNDERSTANDING OF
THE HEALTH EFFECTS OF DIETARY
SUPPLEMENTS.
THIS FOA IS A COMPONENT OF THE
ANALYTICAL METHODS AND REFERENCE
MATERIALS PROGRAM WHICH PROMOTES
RESOURCE DEVELOPMENT FOR
CHEMICAL ANALYSES FOR NATURAL
PRODUCTS.
AS SUCH, THIS FOA TIES TOGETHER
WITH SHARED STRATEGIC GOALS OF
NCCIH AND ODS TO ADVANCE
RESEARCH RIGOR AND FACILITATE
RELIABLE ANALYTICAL METHODS FOR
NATURAL PRODUCT RESEARCH.
NEXT SLIDE, PLEASE.
I'M SORRY.
THANK YOU.
SO FOR A LITTLE BACKGROUND TO
THE FOA, REPLICABLE
CHARACTERIZATION OF KEY
EXPERIMENTAL RESOURCES AND
INTERVENTIONS IS AN IMPORTANT
COMPONENT OF EXPERIMENTAL RIGOR
AND REPRODUCIBLE RESEARCH.
AND ONE OF O DS'S RESPONSES TO
THIS NEED IS AN INITIATIVE THAT
SUPPORTS VALIDATION STUDIES ON
METHODS THAT CHARACTERIZE THE
COMPLEX CHEMICAL COMPOSITION OF
SUPPLEMENTS AND NATURAL
PRODUCTS.
THESE FORMAL VALIDATION STUDIES,
WHAT THEY DO IS THOROUGHLY
DETERMINE AN ANALYTICAL METHODS
MEASUREMENT PARAMETERS, SUCH AS
ITS ACCURACY, PREVISION,
APPLICABILITY, REPEATABILITY,
THOSE TYPES OF THINGS.
AND THAT CAN BE CRITICAL TO
ASSESS METHODS PERFORMANCE
PARAMETERS WHEN USING IT TO
QUANTIFY THE CHEMICAL
CONSTITUENTS, METABOLITES, OR
CONTAMINANTS THAT MIGHT BE FOUND
IN SUPPLEMENTS OR NATURAL
PRODUCT RESEARCH, INTERVENTIONS
OR CLINICAL SPECIMENS.
SO THE FOA'S CORE PURPOSE IS,
THEREFORE, THE PROMOTION OF
EXPERIMENTAL REPLICABILITY AND
COMPARABILITY, THE ADVANCEMENT
OF TOOLS THAT ENABLE NATURAL
PRODUCT REAGENT STANDARDIZATION,
AND ULTIMATELY INCREASED
RESEARCH REPRODUCIBILITY THAT
SUPPORTS RESEARCH'S TRANSLATION
TO CLINICAL TRIAL
INVESTIGATIONS.
I'LL BRIEFLY SUMMARIZE HERE SOME
OF THE HISTORY AND OUTCOMES OF
THE FOA TO DATE, THE PRIOR
ISSUANCES.
NCCIH HAS BEEN A STRONG PARTNER
THROUGHOUT THE HISTORY.
IMPORTANTLY, ODS IS NOT
REQUESTING FUNDING CONTRIBUTIONS
FROM NCCIH OR OUR OTHER IC
PARTNERS.
FLEURN THE METHOD VALIDATION IS
COMPARATIVELY A NICHE AREA FOR
RESEARCHERS, AND THIS IS A
SMALLER SCALE FUNDING
INITIATIVE.
BUT 12 OF THE 17 TOTAL AWARDS
HAVE BEEN TO NCCIH-FUNDED
INVESTIGATORS.
THREE OF THE METHODS THAT WERE
UNDERGOING VALIDATION, ACTUALLY
THAT VALIDATION WAS DONE IN
DIRECT SUPPORT OF A CLINICAL
TRIAL, AND THERE HAVE BEEN EIGHT
FORMAL VALIDATION STUDIES
PUBLISHED.
I THINK TWO CLICKS OF THE NEXT,
ONE MORE, PLEASE.
THANK YOU.
AS I SAID, THE MAJORITY OF
ADMINISTRATIVE SUPPLEMENT AWARDS
HAVE BEEN TO NCCIH INVESTIGATORS
FOR A TOTAL OF JUST OVER A
MILLION IN FUNDING SO FAR, AND
THE METHODS THAT WERE SUBJECT TO
VALIDATION REALLY THEY'VE BEEN
APPLICABLE TO A MIXTURE OF
MECHANISTIC AND CLINICAL FOCUSED
RESEARCH STUDIES.
ALSO NOTABLE IS THAT A MAJORITY
OF THE METHODS WERE FOR
QUANTIFICATION OF NATURAL
PRODUCT METABOLITES IN
BIOLOGICAL SAMPLES.
SHOWN HERE ARE SOME OF THE
SPECIFIC PUBLICATIONS THAT
ILLUSTRATE REALLY HOW THIS
ADMINISTRATIVE SUPPLEMENT
FUNDING HAS HELPED INVESTIGATORS
DEMONSTRATE THE PERFORMANCE OF
THEIR STATE OF THE ART METHODS.
SO FOR EXAMPLE, THERE'S BIGGER
CHROMATOGRAPHY MASS SPEC
QUANTIFICATION UNDER
INVESTIGATION FOR INTERACTION
WITH CYTOCHROME 450s, THERE'S
GAS CHROMATOGRAPHY MASS SPEC
CHARACTERIZATION OF A COMPLEX
MIXTURE OF GRAPE SEED FLAVENOLS
STUDIES IN MODELS OF STRESS
RESILIENCE.
THERE ARE OTHER EXAMPLES BUT THE
POINT I WANT TO MAKE IS THAT THE
FORMAL METHOD VALIDATION STUDIES
HERE, THEY HELPED ADD CONFIDENCE
TO THE BIOMEDICAL RESEARCH ON
THE LINKS BETWEEN THE DIETARY
INGREDIENTS, THEIR METABOLITES,
MECHANISMS OF ACTION, AND
ULTIMATELY HEALTH OUTCOMES.
THE LATEST FOA ISSUANCE, THAT
ACTUALLY ENDED UP BEING TIME
WISE CONCURRENT WITH THAT PERIOD
WHERE THE PANDEMIC HAD THE MOST
SIGNIFICANT NEGATIVE EFFECTS ON
RESEARCH AT THE LAB BENCH, SO
WITH CLOSURES AND LIMITED
OCCUPANCY.
BUT WE HAVE SEEN INTEREST FROM
PIs START TO PICK UP AGAIN
THIS YEAR.
SO THEREFORE, ODS REMAINS
COMMITTED TO SUPPORTING THIS
APPROACH TO ENHANCING RESEARCH
RIGOR AND ADDRESSING STRATEGIC
GOALS THAT OVERLAP WITH NCCIH
AND OTHER PARTNER ICs AND
WE'RE REQUESTING CONCEPT
CLEARANCE FOR A REISSUANCE.
THE REISSUED FOA IS INTENDED TO
CONTINUE ITS FOCUS AND PURPOSE,
ALSO LOOKING TO MORE CLEARLY
DELINEATE CONSIDERATION OF
METABOLOMICS METHODS AND
QUALITATIVE APPROACHES FOR
IDENTIFICATION AND
AUTHENTICATION OF COMPLEX
NATURAL PRODUCT PREPARATIONS.
AGAIN, THERE CONTINUES TO BE NO
BUDGET REQUEST TO NCCIH OR OTHER
IC PARTNERS.
ODS IS COMMITTED TO FUND THE
TOTAL COST OF THESE
ADMINISTRATIVE SUPPLEMENTS.
AND WITH THAT, I WANT TO SAY
THANK YOU TO THE COUNCIL FOR
YOUR CONSIDERATION, AND I'M
HAPPY TO TAKE ANY QUESTIONS.
>> THANK YOU, DR. KUSZAK.
ANY QUESTIONS FROM COUNCIL?
>> THIS WAS GREAT TO SEE.
AS YOU KNOW, I'VE BENEFITED FROM
THIS PROGRAM AT THE PAST AND
REALLY APPRECIATE ALL YOU'RE
DOING ON THE STANDARDIZATION
WORK MAKING SURE PEOPLE ARE
DOING EFFECTIVE STANDARDIZATION.
I WONDERED IF YOU HAVE ANY
PARTICULAR FOCUSES MOVING
FORWARD ON SPECIFIC BOTANICALS
THAT HAVEN'T BEEN LOOKED AT AS
MUCH BUT SEEM TO BE IMPORTANT OR
IF YOU'RE LEAVING THAT ENTIRELY
UP TO THE INVESTIGATORS TO
CHOOSE WHAT'S RELEVANT TO THEIR
STUDIES?
>> YEAH, THANKS, NADJA, FOR THE
QUESTION.
AND THANK YOU, WE'RE MUCH
APPRECIATIVE OF ALL YOUR WORK IN
THE AREA.
THERE IS NOT A FOCUS ON A
PARTICULAR BOTANICAL WITH THE
PROGRAM.
WE WANT TO HAVE THAT BE OPEN TO
THE INVESTIGATOR INITIATED FOCUS
AREAS, SO THERE HAVE BEEN, IN
THE PAST, EXAMPLES OF THINGS
THAT ARE VERY PROMINENT IN TERMS
OF USAGE AND THINGS THAT ARE
MUCH LOWER IN USE.
SO WE WANT TO KEEP THAT OPEN FOR
LETTING THE INVESTIGATOR DRIVE
THE FOCUS.
>> MAKES SENSE.
>> ANY OTHER QUESTIONS OR
COMMENTS FROM COUNCIL?
SEEING AND HEARING NONE, WE'LL
GO AHEAD AND VOTE ON THE CONCEPT
CLEARANCE.
YOU'LL SEE IT ON YOUR SCREEN
MOMENTARILY.
A POLL QUESTION ASKING YOU TO
VOTE.
IF YOU VOTE YES, YOU'RE IN
CONCURRENCE WITH THE CONCEPT
CLEARANCE.
IF NO, THEN UROPOSING IT AND YOU
CAN ABSTAIN.
COUNSELING MEMBERS WHO ARE
ELIGIBLE TO VOTE WILL DO SO NOW.
AND WE HAVE UNANIMOUS VOTE FOR
IN FAVOR OF THIS CONCEPT
CLEARANCE.
THANK YOU VERY MUCH.
DR. KUSZAK.
THANK YOU VERY MUCH.
FOR YOUR
PRESENTATION.
>> THANK YOU.
THANK YOU, EVERYONE.
HAVE A GOOD DAY.
>> THANK YOU.
WE'LL NOW MOVE TO THE SECOND
CONCEPT CLEARANCE, WHICH IS
GOING TO BE PRESENTED BY
DR. INNA BELFER ON RESEARCH
NETWORKS TO PROMOTE INNOVATIVE
MECHANISTIC AND TRANSLATIONAL
STUDIES OF SICKLE CELL DISEASE
PAIN.
DR. BELFER?
>> THANK YOU, PARTAP.
GOOD AFTERNOON, EVERYONE.
TODAY I'M VERY EXCITED TO TELL
YOU ABOUT THIS NEW INITIATIVE ON
INNOVATIVE NETWORKS TO PROMOTE
BASIC AND TRANSLATIONAL RESEARCH
FOR SICKLE CELL DISEASE.
SO WHAT IS THE SICKLE CELL
DISEASE PAIN?
JUST TO REMIND THAT SICKLE CELL
DISEASE IS AN UNDERSTUDIED
LIFELONG DISEASE -- MINORITY
POPULATIONS IN THE UNITED
STATES.
THERE IS ABOUT 100,000 OF
AFRICAN AMERICANS AND HISPANICS
AFFECTED BY SICKLE CELL DISEASE.
PAIN IS THE MOST COMMON CLINICAL
COMPLICATION OF SICKLE CELL
DISEASE.
IT IS CHARACTERIZED BY SEVERE
ACUTE PAIN EPISODES, ALSO --
PAIN, CHRONIC -- PAIN, IT SPANS
FROM CHILDHOOD TO ADULTHOOD AND
EVEN AFTER -- FOR SICKLE CELL
DISEASE.
SEVERE CHRONIC PAIN CONTINUES IN
ABOUT 40% OF INDIVIDUALS.
IT HAS -- IN INDIVIDUALS WITH
SICKLE CELL DISEASE, HIGH RATE
OF HOSPITALIZATIONS AND MISSED
SCHOOL AND WORK DAYS AND POOR
FUNCTIONAL AND PSYCHOSOCIAL
OUTCOMES, AS WELL AS INCREASED
RATE OF MORTALITY.
THE MANAGEMENT OF SICKLE CELL
DISEASE PAIN IS COMPLEX AND
OFTEN DOESN'T ADDRESS MULTIPLE
COMORBIDITIES SUCH AS ANXIETY,
STRESS -- AND ORGAN DAMAGE, AND
ADDED COMPLICATIONS OF THE
SICKLE CELL DISEASE.
TO BETTER UNDERSTAND CURRENT
STATUS AND POTENTIAL FUTURE
DIRECTION OF SICKLE CELL DISEASE
PAIN RESEARCH AND PAIN
MANAGEMENT, NCCIH IN
COLLABORATION WITH HEART LUNG
AND BLOOD INSTITUTE, CO-LED --
VIRTUAL WORKSHOP LAST YEAR.
-- SUBJECTS INCLUDING EXPLORING
CRITICAL GAPS, RESEARCH
CHALLENGES AND BRAINSTORMING OF
POTENTIAL SOLUTIONS FOR THIS
IMROASLY UNDER DID
GROSSLY UNDERSTUDIED CONDITION
IN A HIGHLY UNDERSERVED
POPULATION.
WE KNOW MUCH ABOUT SICKLE CELL
DISEASE AS A GENETIC DISEASE
WITH WELL-KNOWN GENETIC MUTATION
S BOTH IN VARIOUS LEVELS OF RED
BLOOD CELL AND CELL SICKLING,
ESTABLISH UNDERSTANDING OF
UNDERLYING -- HOWEVER, WE DON'T
HAVE THIS EXTENT OF KNOWLEDGE
ABOUT SICKLE CELL DISEASE
CLEANING MECHANISM OF WHICH IT
IS STILL POORLY UNDERSTOOD.
PATIENTS WITH SICKLE CELL
DISEASE DESCRIBE PAIN OFTEN AS
DEEP, STABBING, ELECTRICAL,
THROBBING, BEATING, SPREADING,
OR LIKE BROKEN GLASS IN THEIR
VEINS.
THERE IS ENORMOUS HETEROGENEITY
IN SICKLE CELL DISEASE PAIN
POPULATIONS, AS WELL AS WITHIN
INDIVIDUAL VARIABILITY.
IN ADDITION PAIN TRAJECTORY IN
SICKLE CELL DISEASE IS UNIQUE
AND COMPLICATED.
IT ALWAYS STARTS WITH ACUTE PAIN
EPISODES AND THE TYPE OF PAIN
MAY CHANGE ACROSS LIFESPAN.
IT'S CHARACTERIZE BID
MULTIPLE -- PAIN CRISES.
MOST PATIENTS DEVELOP CHRONIC
PAIN WITH SUDDEN ACUTE PAIN
EPISODES AND -- CRISIS ON TOP OF
CHRONIC PERSIST AT THE PRESENT
TIME PAIN.
ON CLINICAL LEVELS, BOTH ACUTE
AND CHRONIC IT IS A MULTIORGAN
PROBLEM.
DUE TO OR DPAN DAMAGE CAUSED BY
SICKLE CELL DISEASE, MANY
PATIENTS REPORT ACUTE PAIN IN
THEIR LIVER, SPLEEN, KIDNEY,
INTESTINE, CHEST, -- AND GENERAL
TELLS.
ALSO THEY HAVE SEVERE HEADACHES
AND -- PAIN DUE TO THE STROKE,
ACUTE PAIN EPISODES --
VASOOCCLUSIVE CRIES I, BONY
INFARCTION AND MULTIORGAN
FAILURE.
AVASCULAR NECROSIS AND BONY
INFARCTION.
RECENTLY, SEVERAL STUDIES
POINTED MUSCULOSKELETAL PAIN IN
PATIENTS WITH SICKLE CELL
DISEASE.
THIS PAIN IS BELIEVED TO REFLECT
ACUTE AND CHRONIC INJURIES TO --
AND BONES.
ONE OF THE BIGGEST PROBLEMS
DISCUSSED AT THE WORKSHOP IS
THAT CLINICAL STATUS OF ORGAN
DAMAGE IN SICKLE CELL DISEASE DO
NOT -- AND MOST ANIMAL IS IT DUS
OF SICKLE CELL PAIN FOCUS ON
SKIN, NOT ORGAN IMPACTED IN
SICKLE CELL DISEASE PATIENTS.
SO FOR EXAMPLE -- ON MUSCLE
ACTIVATION CAUSES SICKLE CELL
DISEASE PAIN -- THAT IS FOCUSING
ON SENSITIZATION OF -- IN SKIN
OF -- INTERVENTION STUDY OF THE
SICKLE CELL MICE -- WERE ALSO
DONE IN SKIN.
-- INCLUDE LIMITED
OPPORTUNITIES TO INTEGRATE
RESEARCH ACROSS MULTIPLE
DISCIPLINES, OPPORTUNITIES TO
CONNECT SICKLE CELL DISEASE
PAIN -- ACCESS FROM OTHER PAIN
FIELDS.
-- DISSEMINATION OF KNOWLEDGE
ON SICKLE CELL DISEASE RESOURCES
AND BETWEEN -- CLINICIANS AND
PATIENTS, DIVERSION IT AND
INCLUSION OF
UNDERREPRESENTED --.
TO OVERCOME THESE FAILURES --
DEVELOPMENT OF THREE SUCH
NETWORKS WITH THE FOLLOWING
OBJECTIVES.
ONE OBJECTIVE IS TO DEVELOP
FRAMEWORK TO ENABLE
TRANSLATIONAL AND -- STUDIES.
ALSO TO SUPPORT NOVEL TECHNOLOGY
SUCH AS HUMANIZE ANIMAL MODELS,
NOVEL MUSCLE BONE JOINT -- PAIN
MODEL, MECHANISM-BASED PAIN
PHENOTYPING, ACCESS TO -- SUCH
AS DRGs, LARGE OR MIXED
MICROBIOME AND IMAGING STUDY
WITH LONGITUDINAL DESIGN TO
STUDY DEVELOPMENT AND
PROGRESSION OF PAIN.
THESE NETWORKS WILL ALSO SUPPORT
THE DEVELOPMENT OF INTERVENTIONS
SUCH AS NON-ADDICTIVE
PHARMACOLOGICAL THERAPIES,
COMPLEMENTARY INTERVENTIONS
AND -- BECAUSE SICKLE CELL
DISEASE IS DEFINITELY A --
FUNCTION PROBLEM.
ALSO THESE NETWORKS WILL BRING
TOGETHER PEOPLE OF DIFFERENT
EXPERTISE SUCH AS HEMATOLOGISTS,
ORGAN BIOLOGISTS, PAIN EXPERTS,
NEUROSCIENTISTS, PSYCHOLOGISTS,
GENETICISTS, MICRO BIOLOGISTS,
BEHAVIORAL SCIENTISTS AND
CLINICIANS.
SPECIFICALLY, THE INITIATIVE
WILL ENCOURAGE THOSE GROUPS TO
GET TOGETHER FROM VARIOUS
DISPLIPS AND
DISCIPLINES AND THEY WILL
DEVELOP THE PAIN RESEARCH
NETWORKS.
THIS WILL INVOLVE TRAINING SUCH
AS INTENSIVE WORKSHOPS AND
SUMMER INSTITUTES OR VISITING
SCHOLAR PROGRAMS.
MEETING AND CONFERENCES, ALSO
SMALL SCALE RESEARCH THAT WOULD
SUPPORT, ENABLE AND LAY THE
GROUND WORK FOR POTENTIAL
TARGETED PROJECTS TO ADDRESS THE
PRIORITY AREAS SUCH AS POTENTIAL
THERAPEUTIC TARGETS, REVERSE
TRANSLATION, BIOMARKERS,
MULTIMODAL INTERVENTIONS, AND
WHOLE PERSON HEALTH.
THIS INITIATIVE IS THE SAME
APPROACH THAT WAS SUCCESSFUL
WITH OTHER -- PROGRAMS SUCH AS
EMOTIONAL WELL-BEING AND FORCE
BASE MANIPULATION.
THIS APPROACH WOULD AIM TO BRING
TOGETHER SCIENTISTS AND
SPECIALISTS THAT CURRENTLY DO
NOT COLLABORATE AND THE TOPIC OF
THE -- JOIN FORCES.
AS WITH OTHER SIMILAR
INITIATIVES, WE'D HOPE THAT THIS
PROGRAM WILL BE SUPPORTED BY OUR
NIH PARTNERS, INCLUDING HEART
AND LUNG AND BLOOD INSTITUTE,
CHILD HEALTH AND DISEASE
INSTITUTE, NIDA, NATIONAL
INSTITUTE OF MINORITY HEALTH AND
HEALTH DISPARITIES AND OTHERS.
WITH THIS, I THANK YOU FOR YOUR
ATTENTION AND SEEK YOUR APPROVAL
AND SUPPORT OF THIS NEW
INITIATIVE.
AND HAPPY TO ANSWER ANY
QUESTIONS.
>> THANK YOU, DR. BELFER.
QUESTIONS FROM COUNCIL?
IF YOU COULD GO BACK TO THE
"HOLLYWOOD SQUARES" HERE.
THANK YOU.
QUESTIONS FROM COUNCIL.
OKAY.
>> I THINK MAYBE MORE OF A
COMMENT RATHER THAN A QUESTION.
I THINK SICKLE CELL IS SOMETHING
THAT IS WOEFULLY UNDERSTOOD AND
WOEFULLY UNDERRESEARCHED.
AND I THINK GETTING LARGE GROUPS
OF PEOPLE TOGETHER TO
COLLABORATE ACROSS MULTIPLE
DISCIPLINES IS REALLY, REALLY
GREAT.
SO I THINK THIS IS A REALLY
EXCITING PROPOSAL.
>> THANK YOU, DR. COGHILL.
OTHER COMMENTS OR QUESTIONS?
DR. HARRIS?
>> I WOULD SECOND THAT COMMENT
FROM DR. COGHILL.
I'M ALSO WONDERING IF THERE'S A
WAY TO FACILITATE RECRUITMENT OF
PATIENTS INTO THESE NETWORKS
BECAUSE IT'S VERY DIFFICULT FOR
A SINGLE SITE TO BE ABLE TO
RECRUIT ENOUGH SICKLE CELL
PATIENTS TO WARRANT STUDY, SO A
KEY FACTOR IS GOING TO BE
RECRUITMENT ACROSS MULTIPLE
SITES AND I'M WONDERING HOW MUCH
OF THIS INITIATIVE IS GOING TO
BE GOING TOWARDS THAT
SPECIFICALLY.
>> THE PATIENT ENGAGEMENT WILL
BE A BIG ASPECT OF THE NETWORKS,
AND DEFINITELY NEEDS TO BE
ADDRESSED BY THE GROUPS THAT
WILL PARTICIPATE IN THIS
INITIATIVE.
PATIENT ENGAGEMENT AND THE
EXPERIENCE WITH WORKING OF THE
PATIENTS DEVELOP -- THIS IS
DEFINITELY THE EXPERTISE WE'RE
LOOKING FOR IN THESE NETWORKS.
>> DR. COGHILL, DID YOU HAVE
ANOTHER QUESTION?
>> YEAH, I'LL JUST SECOND RICK'S
THOUGHTS ON THAT IS, I THINK
RESEARCH OPPORTUNITIES FOR
UNDERREPRESENTED MINORITIES ARE,
AGAIN, IT IS CHALLENGING TO
REACH OUT, IT'S CHALLENGING TO
CONNECT WITH THEM IN AN
APPROPRIATE WAY AND THEN HAVING
THAT BAKED INTO THE SYSTEM, I
THINK IS A REALLY POWERFUL
FEATURE, SO I'M REALLY GLAD THAT
THAT'S THERE AS WELL.
>> THANK YOU, DR. COGHILL.
DR. SHERMAN?
>> SO I JUST WANT TO OFFER TWO
COMMENTS.
FIRST, I LOVE THE IDEA OF
BUILDING A NETWORK LIKE THIS FOR
SUCH A COMPLEX CONDITION AND
TRYING TO BRING PEOPLE TOGETHER.
I THINK THAT'S FANTASTIC.
I ALSO WONDER IF YOU CAN USE
THIS AS A MODEL FOR OTHER KINDS
OF CONDITIONS THAT MIGHT REQUIRE
BRINGING DIFFERENT PEOPLE
TOGETHER THAT ARE COMPLICATED
LIKE THIS SO THAT WE CAN REALLY
FIGURE OUT HOW, AS EFFICIENTLY
AS POSSIBLE, TO BUILD THE
NETWORKS FOR THESE KINDS OF
THINGS, SO I THINK THAT JUST
MIGHT BE A POTENTIAL ANCILLARY
CONSEQUENCE IF WE'RE PAYING
ATTENTION.
>> THANK YOU, DR. SHERMAN.
DR. EDWARDS, DID YOU WANT TO
COMMENT ON DR. SHERMAN'S POINT?
>> DID YOU CALL ON ME FOR THAT?
>> YES, I JUST WONDERING IF YOU
WANTED TO COMMENT ON WHAT
DR. SHERMAN WAS SAYING.
>> SURE, I'LL JUST SAY, KAREN,
WE'VE BEEN REALLY EXPERIMENTING
WITH THIS MODEL.
THIS IS GOING TO BE -- IF YOU
CONCUR, THIS WOULD BE THE THIRD
SET OF NETWORKS THAT NCCIH WOULD
BE SPONSORING.
AS YOU RECALL, WE STARTED OUT
WITH EMOTIONAL WELL-BEING
NETWORKS, AND BRINGING TOGETHER
INVESTIGATORS FROM VARIOUS
DISCIPLINES TRYING TO UNDERSTAND
THE MECHANISM OF WELL-BEING.
AND THEN WE MOVE TO THE FORCE
BASE MANIPULATION, WHERE WE'RE
BRINGING TOGETHER
NEUROSCIENTISTS TO WORK WITH
INVESTIGATORS THAT WERE IN THE
MANUAL THERAPY FIELD.
AND SO WE SEE THIS AS ACTUALLY A
FAIRLY ECONOMICAL WAY TO JUMP
START THE FIELD.
AND THIS PROGRAM THAT RENA IS
PRESENTED TO YOU IS CONTINUING
THAT PRACTICE.
AND I THINK WE'LL HAVE ONE MORE
LATER ON THIS AFTERNOON AS WELL.
SO WE ARE REALLY SATISFIED AND
PLEASED WITH THE PROGRESS THAT
THE CURRENT NETWORKS ARE DOING,
AND VERY HOPEFUL THAT THIS IS A
GOOD MODEL FOR US TO --
>> SURE.
THIS IS A LITTLE BIT DIFFERENT
BECAUSE IT FOCUSES ON SORT OF
MORE OF A DISEASE CONDITION
THAT'S ACTUALLY VERY
COMPLICATED, SO I THINK THAT WAS
THE ANGLE I WAS PICKING THIS UP
FROM, BUT YOUR POINT, OF COURSE,
IS VERY WELL TAKEN.
>> THANKS.
>> DR. MEHLING, I SAW YOU POSTED
A COMMENT IN THE CHAS.
DID YOU WANT CHAT.
DID YOU WANT TO FOLLOW UP ON
THAT?
>> I JUST REVIEWED RECENTLY A
GRANT WHERE I LEARNED THERE IS
SUPPOSEDLY SOMETHING LIKE A
CLINICAL RESEARCH NETWORK
ALREADY FOR SICKLE CELL DISEASE.
-- INCLUDE NEUROSCIENTISTS BUT
I THINK THERE IS A NETWORK OF
CLINICS ALREADY NATIONWIDE.
>> THANK YOU.
>> SICKLE CELL DISEASE FOCUSED
NETWORKS.
HOWEVER, THEY'RE FOCUSED ON THE
DIFFERENT ASPECTS.
THE NETWORKS THAT THIS
INITIATIVE WOULD SUPPORT WOULD
HAVE MULTICOMPONENT WHICH WILL
HAVE A CENTER THAT WOULD
COORDINATE DIFFERENT CRITICAL --
AND DIFFERENT RESEARCH PROCESS
AND DIFFERENT TRAINING PROGRAMS.
THESE WOULD BE THE UNIQUE
COMPONENTS THAT OTHER SICKLE
CELL DISEASE PROGRAMS THAT ARE
MORE FOCUSED ON PARTICULAR
THERAPIES, AND THEY WOULD BE
MISSING THIS COMPONENT OF CROSS
DISCIPLINE -- THAT IS ONE OF
THE -- OF THIS INITIATIVE.
PRIORITIES OF THIS INITIATIVE.
>> ANY NICHE QUESTIONS OR
COMMENTS, ANYTHING TO ADD BEFORE
WE VOTE?
OKAY.
SEEING NO HANDS UP OR HEARING
ANYTHING, I'D LIKE TO GO AHEAD
AND LET'S CALL THE VOTE ON THIS.
YOU'LL SEE ON YOUR SCREENS THE
USUAL THING, IF YOU'RE VOTING
YES, YOU'RE FOR APPROVING THE
CONCEPT CLEARANCE, NO WOULD BE
FOR NOT, OR YOU MAY ABSTAIN.
13 IN FAVOR, ONE ABSTENTION.
THANK YOU VERY MUCH, DR. BELFER.
FOR THE THIRD CONCEPT FOR TODAY,
THIRD AND LAST GOING TO BE
PRESENTED BY DR. WEN CHEN,
BUILDING CROSS-CUTTING RESEARCH
NETWORKS TO PROMOTE
MULTIDISCIPLINARY MECHANISTIC
STUDIES OF MUSIC AND HEALTH.
AND IN THIS CASE, WEN, YOU'RE
GOING TO BE SHARING YOUR SCREEN
AND PRESENTING YOUR OWN SLIDES.
>> ARE YOU LOOKING AT THE RIGHT
SLIDE, I HOPE?
>> WE GOT THE RIGHT SLIDE BUT
YOU'VE GOT YOUR -- YOU'RE NOT IN
PRESENTATION MODE.
>> OKAY.
LET ME TRY TO SWAP THE DISPLAY.
IS THIS CORRECT NOW?
>> YES, THAT'S PERFECT.
>> EXCELLENT.
THANK YOU.
WELL, GOOD AFTERNOON, EVERYONE.
AS A FINAL ACT TODAY, I AM THE
CHIEF OF MECHANISTIC RESEARCH
BRANCH WITHIN THE DIVISION OF
EXTRA RESEARCH AT NCCIH.
TODAY I AM PRESENTING A NOVEL
CONCEPT RELATED TO BUILDING
CROSS-CUTTING RESEARCH NETWORKS
TO PROMOTE MULTIDISCIPLINARY
MECHANISTIC STUDIES OF MUSIC AND
HEALTH.
SO TO BEGIN THIS PRESENTATION,
I'D LIKE TO HAVE A QUICK
REFRESHER ON HISTORY OF THIS
TRANS-NIH THANK MUSIC AND HEH
INITIATIVES.
IT STARTED WITH TWO MUSIC
LOVERS, THE FAMOUS U.S. SOPRANO
MRS. RENE -- AND OUR BELOVED NIH
DIRECTOR FRANCIS COLLINS MANY
YEARS AGO IN A SOCIAL EVENT THAT
EXPLORED THE IDEA OF MUSIC AND
MEDICINE TOGETHER.
THE INITIAL CONVERSATION
EVENTUALLY LED TO THE FIRST EVER
NIH WORKSHOP ON MUSIC AND THE
BRAIN, RESEARCH ACROSS THE
LIFESPAN, IN JANUARY OF 2017,
SLIGHTLY OVER FIVE YEARS AGO.
THE KENNEDY CENTER FOR
PERFORMING ARTS, NATIONAL
ENDOWMENT FOR THE ARTS WHICH IS
PART OF THE DEPARTMENT OF
EDUCATION AND MUSIC THERAPY
PROFESSIONAL AND ADVOCACY GROUPS
TO THE NIH TO DISCUSS BASIC
MECHANISTIC WAYS THAT MUSIC CAN
AFFECT THE BRAIN AS WELL AS
MUSIC AND HEALING.
THAT WORKSHOP ALSO RESULTED IN A
LANDMARK REVIEW ARTICLE
PUBLISHED IN NEURON IN 2018 ON
MUSIC AND THE BRAIN.
MOST IMPORTANTLY THIS NEURON
PAPER SUMMARIZES RESEARCH MUSIC
IN THE BRAIN SPECIFICALLY IN
AREAS OF BASIC MECHANISTIC
RESEARCH, TRANSLATIONAL AND
CLINICAL RESEARCH METHODS AND
OUTCOME AS WELL AS CAPACITY
BUILDING AND INFRASTRUCTURE.
TO TACKLE THOSE RECOMMENDATIONS,
NIH IMMEDIATELY FORMED A
TRANS-NIH WORKING GROUP ON MUSIC
AND HEALTH.
THE GROUP FIRST FOCUSED ON THE
TOP TWO TOPICS FROM THE WORKSHOP
RECOMMENDATIONS, SUPPORTING
BASIC MECHANISTIC RESEARCH AS
WELL AS TRANSLATIONAL AND
CLINICAL RESEARCH THROUGH A SET
OF THREE RFAs UTILIZING THE
R61R33, R21 AND R01 FUNDING
MECHANISMS.
A TOTAL OF 15 AWARDS WERE MADE
PHYSICALLY IN 2019 WITH OVER
5 MILLION PER YEAR IN AWARDS.
FOR SOME OF YOU WHO WERE AT
COUNCIL AT THAT TIME, YOU MAY
HAVE ACTUALLY REVIEWED THOSE
CONCEPTS AS WELL AS THE FUNDING
PLAN FOR THOSE INITIATIVES.
AND IN FISCAL YEAR 2020, WE
FOLLOWED UP THE INITIAL RFAs
WITH ACTUALLY MULTIPLE PROGRAM
ANNOUNCEMENTS TO CONTINUE OUR
SUPPORT FOR MUSIC AND HEALTH
RESEARCH.
IN 2021, THE WORKING GROUP LED
BY NCCIH -- ORGANIZED THREE HALF
DAY WORKSHOPS TO TACKLE THE
RECOMMENDATIONS ON METHODS AND
OUTCOMES.
THE FIRST WORKSHOP LAID THE
FOUNDATION BY DEFINING THE
BUILDING BLOCKS OF THE
MUSIC-BASED INTERVENTIONS.
THE SECOND WORKSHOP FOCUSED ON
ASSESSING AND MEASURING TARGET
ENGAGEMENT, SPECIFICALLY ON
MECHANISTIC AND -- OUT COME
MEASURES FOR BRAIN DISORDERS OF
AGING, AND THE THIRD WORKSHOP
WORKED ON RELATING TARGET
ENGAGEMENT TO CLINICAL BENEFITS.
THE SERIES OF EFFORTS IS
SUMMARIZED IN THE MANUSCRIPT
CURRENTLY UNDER CONSIDERATION
ENTITLED NIH MUSIC-BASED
INTERVENTIONS TOOLKIT.
THE ONLY CATEGORY OF THE 2017
WORKSHOP RECOMMENDATIONS YET TO
BE ADDRESSED IS THE CAPACITY
BUILDING AND INFRASTRUCTURE.
MORE SPECIFICALLY THROUGH
NETWORKS AND COLLABORATIVE
STUDIES INVOLVING
NEUROSCIENTISTS, MUSIC
THERAPISTS, MUSICIANS,
BIOMEDICAL, BEHAVIORAL OR SOCIAL
SIGH TISES
SCIENTISTS AND -- EVIDENCE-BASED
BEST PRACTICE.
AS YOU HEARD FROM DR. BELFER'S
PRESENTATION AS WELL AS
DISCUSSION ON A NUMBER OF PRIOR
MODELS OF RESEARCH NETWORKS, WE
FELT THAT A COLLECTION OF
RESEARCH NETWORKS FOCUS ON MUSIC
AND HEALTH MAY BE THE BEST
APPROACH TO ADDRESS THE SPECIFIC
RECOMMENDATION ALIGNED IN THAT
NEURON PAPER.
CONCEPTUALLY, WE CAN HAVE EACH
NETWORK MAY FOCUS ON A SPECIFIC
CONDITION SUCH AS PAIN OR
ALZHEIMER'S DISEASE OR STROKE OR
PARKINSON'S DISEASE OR COULD BE
EVEN MENTAL HEALTH DISORDERS,
AND TOGETHER THEY WILL ADDRESS
SOME COMMON TOPICS RELATED TO
MUSIC-BASED INTERVENTIONS AS
WELL, ESPECIALLY REGARDING
TERMINOLOGIES AND TAXONOMY, FOR
EXAMPLE.
THIS RESEARCH NETWORKS CAN
ACCOMPLISH OBJECTIVES THROUGH
MEETINGS, WORKSHOPS, CONFERENCES
BOTH VIRTUAL AND IN PERSON, AS
WELL AS COLLABORATIVE
DISCUSSIONS IN EXCHANGE FOR
VISITING SCIENTIST ARRANGEMENTS
AS WELL AS TRAINING
OPPORTUNITIES, FOR EXA FOR .
THE NETWORKS MAY ALSO FUND PILOT
RESEARCH PROJECTS THAT WILL FILL
UNIQUE GAPS IDENTIFIED TO
PREPARE FOR THE NECESSARY
PRELIMINARY DATA THAT WILL BE
HELPFUL TO THE INVESTIGATORS TO
PREPARE COMPETITIVE NIH
APPLICATIONS THROUGH THE
EXISTING MUSIC AND HEALTH PUBLIC
HEALTH ANNOUNCEMENTS AND OTHER
FUNDING OPPORTUNITIES.
ALSO THE NETWORKS MAY SUSTAIN
THE SCIENTIFIC IMPACTS THROUGH
PUBLICATIONS OF RESEARCH
FRAMEWORK, COMMON TERMINOLOGIES,
REVIEWS, AND OTHER BEST
PRACTICE, AS WELL AS THE OTHER
DISSEMINATION AND OUTREACH
STRATEGIES.
BUT NETWORK ACTIVITIES AND PILOT
PROJECTS TO BE SUPPORTED, WE
HOPE, HIGH PRIORITY TOPICS IN
THREE GENERAL AREAS, INCLUDING
MUSIC INTERVENTION, MECHANISMS
AND BIOMARKERS, TECHNOLOGY TOOLS
AND MODELS.
FOR MUSIC INTERVENTION, WE WILL
ENCOURAGE THE RESEARCH NETWORKS
TO HELP DEFINE DIFFERENTIATE
DIFFERENT TYPES OF MUSIC-BASED
INTERVENTIONS, PASSIVE LISTENING
OR ACTIVE ENGAGEMENT, TO DEFINE
VARIOUS COMPONENTS OF MUSIC AND
MUSIC-BASED INTERVENTIONS.
THAT'S JUST SOME EXAMPLES.
AND FOR THE MECHANISMS AND
BIOMARKERS CATEGORY, WE HOPE THE
RESEARCH NETWORKS WILL HELP TO
SUPPORT EXPLORATION OF INOH HE
VAITIVE NEUROMECHANISTIC
INSIGHTS RELEVANT TO MUSIC AND
THE SPECIFIC HEALTH CONDITION.
THAT MAY HELP TO -- AND NOVEL
MEASURES TO MUSIC-BASED
INTERVENTION AND THE SPECIFIC
HEALTH CONDITION OR HELP TO
DISCOVERY SPONS OF PREDICTIVE
BIOMARKERS, SIGNATURES, PROFILES
FOR THIS TYPE OF INTERVENTIONS.
AND FOR TECHNOLOGY TOOLS AND
MODELS, WE HOPE THEY WILL HELP
TO SUPPORT THE DEVELOPMENT OF
NOVEL TECHNOLOGIES TO MEASURE
MUSIC-BASED INTERVENTIONS OR
MONITOR DISEASE-BASED RESPONSES
TO MUSIC-BASED INTERVENTIONS
THAT MAY HELP TO DEVELOP OR TEST
INNOVATIVE ANIMAL MODELS TO
STUDY MECHANISMS AND BIOMARKERS
OF THOSE TYPE OF INTERVENTIONS
OR HELP TO DEVELOP NOVEL
COMPUTATIONAL MODELS TO STUDY
THE MECHANISMS OF MUSIC OR MUSIC
INTERVENTIONS ON SPECIFIC HEALTH
CONDITIONS.
SO WE HOPE THAT THE RESEARCH
NETWORK INITIATIVE WILL BE ABLE
TO COMPLETE THE FINAL
RECOMMENDATION FROM THAT 2018
NEURON PAPER, IN PARTICULAR, TO
OVERCOME IDENTIFIED RESEARCH
BARRIERS TO BUILD THE NETWORK
AND INFRASTRUCTURE TO ADVANCE
THIS VERY IMPORTANT AREA OF
SCIENCE.
I'M GOING TO PAUSE HERE AND
THANK YOU FOR YOUR ATTENTION AND
I CERTAINLY HOPE THAT YOU FIND
THIS CONCEPT COMPELLING AND
WE'RE LOOKING FOR YOUR COMMENTS
AND HOPEFULLY YOUR SUPPORT FOR
THIS CONCEPT PROPOSAL.
THANK YOU, I'M GOING TO PAUSE
RIGHT HERE AND MOVE ON TO THE
NEXT SLIDE ABOUT QUESTIONS.
>> THANK YOU, DR. CHEN.
COMMENTS OR QUESTIONS FROM
COUNCIL?
THERE WE GO.
DR. LEF RETS LEF LAVRETS.
>> THIS
>> THAT'S A VERY GOOD QUESTION,
DR. LAVRETSKY.
THIS IS SORT OF A RESEARCH
NETWORK BUILDING THAT WILL BRING
DIFFERENT -- INVESTIGATORS FROM
DIFFERENT DISCIPLINES TOGETHER,
AND BUILD -- THREE PROJECTS SO
THEY CAN GENERATE THE
PRELIMINARY DATA THAT WILL HELP
THEM TO BE COMPETITIVE FOR
R21s, R01s OR EVEN R -- 33.
SO WE HAVE THE PREVIOUS
INITIATIVE EFFORTS, WE STILL
REALIZE THAT THAT'S A VERY
CHALLENGING GAP THAT HAS NOT YET
TO BE OVERCOME AND THIS SL SORT
OF THE FINAL PIECE OF THE PUZZLE
WE'RE HOPING TO ADVANCE THE
FIELD, SO REALLY SEEDING THOSE
PILOT PROJECTS.
IT'S NOT QUITE -- WE DON'T
REALLY -- NIH OTHERWISE DON'T
REALLY QUITE HAVE FUNDING
MECHANISMS EXCEPT TO R03, WHICH
IS ALSO A SOMEWHAT PROBLEMATIC
ON ITS OWN.
SO WE FELT THIS WAY, WE CAN
REALLY -- THIS KIND OF RESEARCH
NETWORKS, WE CAN HELP TO BUILD
THAT KIND OF COLLABORATION
RESEARCH NETWORKS FOR THE
INVESTIGATORS.
>> SO WOULDN'T IT BE CRITERIA
FOR INVESTIGATORS JOINING THIS
NETWORK?
IF THEY'RE NOT PROPOSING
RESEARCH PROJECTS INITIALLY, HOW
WOULD YOU SELECT THEM?
>> I HAVE TO BE CAREFUL OF WHAT
I'M SAYING HERE.
SO LET ME THINK ABOUT HOW TO
ANSWER THAT QUESTION.
THE PILOT PROJECT COMPONENTS IN
THE RESEARCH NETWORKS WHERE I
THINK IF THEY CAN DEFINE IN MY
LAST SLIDE, THE PRIORITY TOPICS,
FOR EXAMPLE, AND THEN REALLY
TYPICAL WOULD DO PRETTY BROAD
CALL TO -- BEYOND THE ACTUAL
INSTITUTIONS THAT'S RECEIVING
SUPPORT, SO REALLY PUBLIC CALL
FOR COMPETITION TO SUBMIT IDEAS.
SO THOSE IDEAS CAN BE FUNDED
THROUGH THE RESEARCH NETWORK TO
DO THOSE PILOT PROJECTS.
DOES THAT ANSWER YOUR QUESTION,
I HOPE?
>> MORE OR LESS, YES.
THANK YOU.
>> WEN, LET ME JUST ADD, WHEN WE
PULL OUT THOSE CALLS FOR -- YOU
KNOW, THOSE MULTIDISCIPLINARY
NETWORK, WE ALWAYS HAVE THE SET
OF HIGH PRIORITY TOPIC, AND
REALLY THE INVESTIGATORS THAT
ACTUALLY ARE SUCCESSFUL ARE
GROUPS THAT CAN FULLY
DEMONSTRATE THE EXPERTISE THAT
THEY'RE BRINGING TOGETHER WOULD
BE ABLE TO ADDRESS ONE TO THREE
OF THOSE HIGH PRIORITY TOPICS.
SO IT'S NOT ONLY THROUGH THE
PILOT PROJECT, IT'S REALLY
THROUGH BRINGING THOSE
PARTICIPANTS TOGETHER TO BE ABLE
TO CONCEPTUALIZE MORE SCIENTIFIC
PROJECT THAT WOULD MOVE THE
FIELD FORWARD.
AND THAT'S ONE OF THE CRITERIA
THAT WE HAVE TO EVALUATE,
SUCCESSFUL APPLICATIONS AND
SUCH, THE PROPOSAL.
>> DR. MEHLING?
>> JUST A BRIEF CURIOSITY
QUESTION.
LIKE MUSIC FOR PARKINSONISM, A
MOVEMENT DISEASE, SO MY QUESTION
WOULD BE, IS DANCE INCLUDED OR
IS IT EXCLUDED FROM THIS KIND OF
TOPIC?
>> IT DEPENDS.
IF DANCE -- WE DO DANCE TO MUSIC
SO YES, IT WOULD BE CONSIDERED A
MUSIC-BASED INTERVENTION.
UNLESS THERE'S NO -- I DON'T
KNOW -- THAT WOULDN'T BE CALLED
DANCE, I GUESS.
>> YOU COULD USE A MET TROA
NOME.
>> ACTUALLY THAT'S STILL RHYTHM.
>> TRUE.
THAT'S TRUE.
>> IS DRUMMING MUSIC?
>> YEAH.
>> YES?
>> RHYTHM IS A COMPONENT OF
MUSIC, AND THAT'S HOW WE HAVE
ACTUALLY -- THUS FAR WE WOULD
INCLUDE THOSE AS PART OF
MUSIC-BASED INTERVENTIONS.
>> OKAY.
UNLESS THERE ARE ANY OTHER
CRITICAL QUESTIONS TO POSE, THEN
LET'S GO AHEAD AND VOTE ON THIS
CONCEPT CLEARANCE.
ON YOUR SCREEN YOU'LL SEE A
POLL.
VOTING FOR YES MEANS YOU'RE
VOTING IN FAVOR OF THE CONCEPT,
NO MEANS YOU'RE IN OPPOSITION,
AND YOU MAY ABSTAIN.
SO IT IS UNANIMOUS VOTE IN FAVOR
OF THIS CONCEPT.
SO IT CARRIES.
THANKS VERY MUCH.
THANKS, DR. CHEN.
>> THANK YOU.
>> SO THE LAST THING ON THE
AGENDA IS JUST A REMINDER FOR
THE PUBLIC, IF YOU WISH TO MAKE
A PUBLIC COMMENT AGAIN, BECAUSE
WE'RE DOING THIS VIRTUALLY,
PLEASE YOU MAY SUBMIT THOSE
COMMENTS IN WRITING, EITHER BY
EMAIL OR A HARD COPY WHICH COULD
BE MAILED.
AGAIN, IT NEEDS TO BE RECEIVED
WITHIN 15 DAYS OF THIS MEETING.
AND THEN THESE WILL BE SHARED
WITH COUNCIL BY OUR ELECTRONIC
COUNCIL BOOK.
DR. LA VETS KEY, LAVRETS?
>> I WAS TRYING TO SUBMIT RFI
FOR WHOLE HEALTH AND THE WEBSITE
REJECTED MY SUBMISSION.
CAN YOU PLEASE CHECK THAT IT'S
WORKING?
>> WE WILL CHECK THAT.
THANK YOU VERY MUCH FOR LETTING
US KNOW.
YOU'RE IN THE .
IN THE ROOM IS DIRECTOR OF THAT
WEBSITE SO IT WILL BE TAKEN CARE
OF VERY PROMPTLY.
THANK YOU VERY MUCH.
LET ME JUST ASK IF THERE ARE ANY
FINAL COMMENTS BY DRS. EDWARD,
SHIRTLIVE OR DR. LANGEVIN?
EMMELINE, ANY FINAL COMMENTS FOR
COUNCIL?
>> I WANT TO THANK EVERYBODY FOR
A VERY, VERY EXCITING DAY, AND
WE HEARD SOME REALLY GREAT
DISCUSSION AND WE'RE VERY
GRATEFUL THAT THE HYBRID MEETING
ACTUALLY WORKED PRETTY WELL.
SO THAT WAS GOOD.
THANK YOU.
>> THANK YOU, DR. EDWARDS.
>> AND I'LL JUST ADD, THANK YOU
TO COUNCIL FOR ALL YOUR
ENTHUSIASM AND CONSTRUCTIVE
FEEDBACK.
REALLY I THINK FOR US,
VALIDATING WHAT WE'RE DOING AS A
CENTER IS REALLY GRATIFYING, SO
WITH MUCH GRATITUDE WITH YOU,
COUNCILMEMBERS, FOR YOUR ADVICE.
I JUST WANT TO PUT A SHOUT OUT
TO ALL OUR STAFF WHO REALLY MAKE
ALL THIS HAPPEN.
IT'S VERY EXCITING TO BE PART OF
THIS GROUP AND WORKING WITH BOTH
COUNCIL AND WITH OUR STAFF AND
WITH THE EXTRAMURAL COMMUNITY,
SO THANK YOU SO MUCH.
>> THANK YOU.
DR. LANGEVIN.
>> SO I REALLY LIKED THE COMMENT
THAT LORI JUST PUT IN THE CHAT
ABOUT WITNESSING THE WHOLE
THREAD OF WHOLE PERSON RESEARCH
THROUGHOUT THE DAY.
YOU KNOW, THE THING THAT AMAZES
ME AT EVERY ONE OF THESE COUNCIL
SESSIONS IS REALLY A
CROSS-SECTIONAL SNAPSHOT AT ONE
POINT IN TIME.
WHAT YOU'RE SEEING IS THIS
ENTIRE ARC WHICH IABLE ONLY NOW
BEGINNING TO EXPERIENCE AFTER
DURING MY TIME AS NCCIH
DIRECTOR.
BETWEEN FORMULATING A CONCEPT --
IDENTIFYING THE GAP FIRST OF
ALL,, THEN FORMULATING THE
CONCEPT AS YOU SAW SOME OF
TODAY, AND ISSUING THE FUNDING
OPPORTUNITY, WHICH -- THAT'S A
LOT OF WORK TOO, THEN RECEIVING
AND REVIEWING THE APPLICATION,
AND THEN EVENTUALLY ISSUING THE
AWARDS.
THIS IS A CYCLE THAT LASTS WAY
MORE THAN A YEAR ACTUALLY.
AND SO IT TAKES A LONG TIME
BEFORE YOU CAN THIS CYCLE MANY
TIMES.
THAT'S WHY WE TRY TO EMBRICATE
LOTS OF DIFFERENT THINGS THAT
ARE GOING TO FEED ON EACH OTHER
SO YOU DON'T HAVE TO WAIT UNTIL
ONE CYCLE IS COMPLETELY OVER
BEFORE YOU START THE NEXT ONE.
SO THIS IS REALLY COMPLICATED
AND IT REQUIRES -- I CANNOT SAY
ENOUGH ABOUT A FABULOUS TEAM WE
HAVE, SO, SO IMPRESSIVE.
WHAT YOU WITNESS AS
COUNCILMEMBERS, MOSTLY PEOPLE
WHO TALK HERE ARE MOSTLY
REPRESENTING A PROGRAM, BUT
THERE'S ALSO BEHIND ALL OF THAT
OBVIOUSLY REVIEW, THERE'S ALL
EXTRAMURAL ACTIVITY, THERE'S
GRANTS MANAGEMENT, THERE'S
OFFICE OF ADMINISTRATIVE
OPERATIONS, THERE'S
COMMUNICATION, I.T., POLICY,
PLANNING EVALUATION.
ALL OF THESE PEOPLE ARE REALLY
KIND OF WORKING TOGETHER TO MAKE
THIS A SMOOTH RUNNING MACHINE.
I CAN'T TELL YOU, YOU KNOW, HOW
GRATEFUL I AM FOR ALL OF THE
HARD WORK THAT EVERYBODY AT
NCCIH PUTS TO MAKE ALL OF THIS
HAPPEN.
AND ESPECIALLY TO OUR IT TEAM
TODAY THAT REALLY WENT THROUGH
MANY DIFFERENT REHEARSALS TO
MAKE SURE THAT -- AND DID PUT A
LOT OF THOUGHT AND EFFORT INTO
MAKING THIS HYBRID MEETING.
AS FAR AS I CAN TELL, WE WOULD
LOVE TO HEAR YOUR FEEDBACK FROM
WHAT IT WAS LIKE FROM THE ZOOM
END OF THINGS.
I CAN SAY THAT FROM THE ROOM
SIDE, I REALLY FELT DIFFERENT,
AND ACTUALLY REALLY NICE
COMPARED TO BEING ON -- FOR ME
PERSONALLY, I REALLY -- SO I'M
REALLY HOPING THAT IF WE DO HAVE
AN OPPORTUNITY TO GET TOGETHER
IN THE FALL, THAT MANY OF YOU
WILL TAKE THE OPPORTUNITY TO DO
SO.
I REALLY, REALLY WOULD LOVE TO
MEET IN PERSON THOSE
COUNCILMEMBERS WHO HAVE JOINED
US WHILE WE WERE VIRTUAL, AND OF
COURSE ALL OUR OLD FRIENDS WE
HAD FROM BEFORE.
I LOVED BEN'S COMMENTS, ONE OF
THE BEST RUN HYBRID MEETINGS.
I HAVE TO SAY, I AGREE.
I'VE ATTENDED SOME NOT SO GOOD
HYBRID MEETINGS RECENTLY, AND I
THINK THIS ONE ACTUALLY WENT
PRETTY WELL.
SO GRATEFUL TO ALL OF YOU, AND
YOU'LL BE HEARING, OF COURSE,
UPDATES FROM US AS TO WHAT WE'RE
GOING TO DO WITH FUTURE
MEETINGS.
BUT WE WOULD LOVE YOUR INPUT
ABOUT HOW YOU FEEL ABOUT THIS,
WHETHER YOU WOULD BE EXCITED IN
COMING BACK IN PERSON AND WE'LL
TRY TO MAKE IT FUN.
SO GREAT.
ANYWAY, THANK YOU VERY MUCH,
EVERYONE.
AND I GUESS THAT'S IT.
>> SO I'D ALSO JUST LIKE TO
EXTEND MY PERSONAL THANKS TO ALL
OUR STAFF WHO HAVE MADE THIS
MEETING HAPPEN.
IT'S AN HONOR TO WORK WITH THEM.
AND WE WILL -- IN TERMS OF THE
SEPTEMBER MEETING, AGAIN, THE
AUGUST MEETING AT COUNCIL, THE
CLOSED SESSION ONLY MEETING,
THAT WILL BE HELD VIRTUALLY.
IT'S THE SEPTEMBER MEETING WHICH
WE'RE CONSIDERING HOLDING AS A
HYBRID MEETING IN WHICH
COUNCILMEMBERS COULD ALSO COME
OPTIONALLY.
IT WAS NOT A REQUIREMENT THAT
COUNCIL WOULD HAVE TO HAVE COME
IN PERSON TO THE CONTRARY, BUT
IT WOULD BE AB OPTION.
NOW THIS OF COURSE IS GOING TO
BE CONTINGENT UPON WHETHER IT'S
SAFE TO TRAVEL AND ALL THOSE
THINGS AND ALL THE THINGS WE
KNOW TOO WELL AT THIS POINT
AFTER TWO YEARS PLUS OF LIVING
WITH COVID.
BUT WE WILL COMMUNICATE WITH YOU
THIS SUMMER ABOUT OUR BEST 'FESS
AS TO WHETHER WE WILL BE ABLE TO
HOLD THIS TO IN-PERSON OPTION
FOR COUNCILMEMBERS AND IF SO,
WE'LL ACTIVATE THE USUAL
MACHINERY THAT THOSE OF YOU WHO
HAVE BEEN AROUND FOR A FEW YEARS
ANYWAY KNOW ABOUT HOW WE MAKE
PLANE RESERVATIONS AND HOTEL
RESERVATIONS AND GET YOU FED AND
FROM THE HOTEL TO HERE AND ALL
THOSE KINDS OF THINGS.
SO STAY TUNED, AND WE'RE VERY
EXCITED ABOUT THE POSSIBILITY AS
WELL.
AND WITH THAT, THEN I'LL GO
AHEAD, WE'LL CONCLUDE THIS
MEETING, THE 80TH MEETING OF THE
NATIONAL ADVISORY COUNCIL FOR
COMPLEMENTARY AND INTEGRATIVE
HEALTH.
THANK YOU VERY MUCH.
IT'S BEEN GREAT BEING WITH YOU
ALL DAY, AND I HOPE YOU ALL HAVE
A GREAT WEEKEND AS WELL.