Feature

One of the country's foremost health psychologists, Margaret A. Chesney, PhD, was appointed the first deputy director of the National Center for Complementary and Alternative Medicine (NCCAM) in February. NCCAM, one of 27 institutes and centers that make up the National Institutes of Health (NIH), is charged with rigorously studying complementary and alternative medicine (CAM) practices such as meditation and other forms of relaxation and acupuncture, and disseminating its findings to health-care professionals and the public.

Chesney says NCCAM presents her with a "challenge and an opportunity" to bring solid science to bear on an enormously popular but vast and sometimes unregulated area as well as to integrate proven CAM practices into mainstream health care. In 1997 alone, Americans spent an estimated $27 billion out-of-pocket on CAM-related expenses, yet many patients do not tell their doctors about their use of these treatments and usually do not receive insurance reimbursement, studies show.

"NCCAM's mission, and my approach as well, is to use the best scientific research to build an evidence base that shows what works and what doesn't work for whom and when," says Chesney, who has 30 years of experience in the research, treatment and direction of programs on behavioral aspects of cardiovascular disease and HIV/AIDS. "My goal is to work with the NCCAM team to push the frontiers of medical science, clinical practice and training to investigate and integrate effective, novel strategies for sustaining and enhancing health."

Chesney's strong scientific and clinical credentials--she has served as co-director of the Center for AIDS Prevention Studies at the University of California, San Francisco (UCSF) and senior visiting scientist at the NIH Office of Women's Health--as well as her pioneering work in behavioral health and enthusiastic, visionary and diplomatic personality make her ideally suited to meet this agenda, colleagues say.

"Margaret is one of the most intelligent, energetic, creative and multitalented psychologists in the world," says APA Chief Executive Officer Norman B. Anderson, PhD. "She will bring the perspective of an extremely rigorous scientist and the eye of a psychologist to help NCCAM recognize some of the complex behavioral issues associated with many complementary and alternative approaches."

The range of the job

In her position, Chesney will partner with NCCAM Director Stephen E. Straus, MD, to plan, direct and manage the center's programs and resources. She also will help to develop and manage all NCCAM-funded extramural centers, investigator-initiated research, research contracts, fellowships and training and career awards, which totaled more than $86 million in fiscal year 2002.

Chesney's psychological and biobehavioral expertise equip her to enhance NCCAM's scientific effectiveness and address mind-body interventions, notes Straus. Mind-body interventions are one of five main research domains at NCCAM. The others include alternative medical systems, biologically based therapies, manipulative and body-based methods and energy therapies.

"Dr. Chesney brings to this position an extraordinary record of scientific achievement and leadership in studies of the complex behaviors that lead to cardiovascular disease and AIDS, and of rigorous trials of novel interventions to prevent them," says Straus. "Her influence will be felt most immediately on the center's portfolio of studies of mind-body approaches to healing and related behavioral and social-science investigations."

Integrating care

Chesney says her broad research experience prepares her for both the complex and novel requirements of the job. "Throughout my career, I have been drawn to study the behavioral aspects of complex health conditions that take a toll on different groups in our society," she says.

Her long-term work with AIDS patients is a case in point. Chesney has been the behavioral scientist on multidisciplinary teams that studied medical treatments for AIDS, and she has served as principal investigator on trials that look at behavioral interventions to help prevent and treat the syndrome.

Her AIDS work demonstrates why rigorous study of CAM treatments is so important, she adds. On their own, many patients undergoing treatment at UCSF were supplementing their HIV/AIDS medications with CAM treatments like acupuncture and herbs. While many patients reported the alternatives were truly helpful, some took botanical supplements that actually undermined treatment. Many, for example, took St. John's wort for depression, not realizing the herb interferes with the action of antiretroviral medications, Chesney says.

"At UCSF, I observed practitioners who worked with AIDS patients, providing a model of successful integrative care--helping the patients develop treatment plans that successfully combined traditional and complementary approaches," Chesney says. "The patients felt respected, and the practitioners could guide patients to treatments that would not interact adversely with their antiretroviral regimens."

On a much broader scale, Chesney believes NCCAM is poised to help develop sound and reliable integrated medicine for all Americans over the next decade.

Tori DeAngelis is a freelance writer in Syracuse, N.Y.

Further Reading

For more information on NCCAM, visit the center's Web site at www.nccam.nih.gov.