Helene Langevin, MD
Helene Langevin, MD, is the director of the National Center for Complementary and Integrative Health (NCCIH). Prior to her installment at the NCCIH, she served as director of the Osher Center for Integrative Medicine, jointly based at Brigham and Women's Hospital and Harvard Medical School, in Boston, MA, and professor-in-residence of medicine at Harvard Medical School since 2012. She also served previously as professor of neurological sciences at the University of Vermont Larner College of Medicine, Burlington, VT.
As the principal investigator of several National Institutes of Health (NIH)–funded studies, Dr. Langevin's research interests have centered around the role of connective tissue in chronic musculoskeletal pain and the mechanisms of acupuncture, manual, and movement-based therapies. Her more-recent work has focused on the effects of stretching on inflammation-resolution mechanisms within connective tissue.
As NCCIH director, Dr. Langevin oversees the federal government's lead agency for scientific research on the diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. With an annual budget of ∼ $142 million, the NCCIH funds and conducts research to help answer important scientific and public health questions about natural products, mind and body practices, and pain management. The center also coordinates and collaborates with other research institutes and federal programs on research into complementary and integrative health.
Bill Reddy, a nationally board-certified licensed acupuncturist, recently interviewed Dr. Langevin, based on the October, 2020 Congressional briefing* where she spoke on a number of topics including the Veterans Administration's Whole Health Initiative and how the NCCIH could refine its research approach from randomized controlled trials (RCTs) to comparative effectiveness research (CER), as well as changing the focus to health promotion and disease prevention.
Bill Reddy, LAc, DiplAc: Please explain which aspects of acupuncture NCCIH is interested in investigating in the future?
Helene Langevin, MD: Many good discussions start with workshops. The workshop we hosted on acupuncture a year ago catalyzed a very substantive discussion on the importance of ontology—of developing a standardized database of acupuncture locations, the acupuncture points, the anatomical locations, the Chinese names, the English names, and the physiologic responses that have been demonstrated in research for these different locations—which would allow researchers to publish an article that could be related to what other researchers were doing and build consistent datasets to inform ongoing work. This is an area that could elevate the entire field and is worth pursuing.
Mr. Reddy: In your current position, what do you know now that you wish you knew when you were a researcher at Harvard?
Dr. Langevin: Before I joined the Center, I knew many fantastic individuals working with the NCCIH, but I did not realize what an incredible team these individuals make when they come together. They are an incredibly dedicated, hard-working, and wonderful team. Together, they foster a dynamic that is geared toward growing and adapting to what we are learning in the research and truly meeting the needs of the community. One cannot truly understand an organization until one becomes part of it, and it has been a delight for me to get to know the NIH better, and especially the NCCIH. It certainly is a wonderful place.
Mr. Reddy: If you were to offer acupuncture researchers advice about acquiring funding, what recommendations would you make to improve their chances of securing such funds?
Dr. Langevin: There is only one way to be funded at the NIH, and that is to write well-organized, good rigorous science. That is the key. The NIH is here to help, and our team is poised to help investigators through that process. If an investigator, or group of investigators, has an idea that they believe has significant merit that warrants funding, the program officers will meet with them to determine whether their specific concept or idea fits with any of our funding opportunities. The officers may recommend other institutes and centers, or perhaps other funding mechanisms, that would be more-appropriate for the idea that they aim to explore. Once they write and submit the grant application and are denied funding, our team will help them understand the reasons, and that understanding may help those researchers improve the application to resubmit it. It is not an easy thing to secure funding, but it is not impossible—and we are here to help.
Mr. Reddy: I know that smaller acupuncture schools that do not have internal review boards or grant writers are at a disadvantage, compared to larger institutions, where researchers have completed quite a few NIH-funded studies, and have the experience and expertise.
Dr. Langevin: We very much encourage people to partner together and form teams. Teamwork is all about finding people who can help complement the expertise that one may or may not have. No single person knows how to do everything, which is an idea that aligns to that larger concept of whole person health. Acupuncturists have important skills and knowledge that can then be leveraged by others who have other types of skills. It is about finding the right partners for research.
Mr. Reddy: You have done incredible research in fascia and chronic pain. Would you talk a little bit about the value of stretching in recovery from chronic pain?
Dr. Langevin: My laboratoy has been working on the topic of stretching for a long time and is very interested in several things. One of them is identifying the mechanical effects of stretching on the body's tissues. We are doing a lot of research—mostly in animal experiments—and we have shown that stretching reduces inflammation. We are trying to understand exactly how it creates that effect.
The other important aspect we are interested in is in terms of fibrosis—when tissues become stuck together and they no longer have mobility. How does stretching help prevent the adhesions from forming?
Another prime aspect is the “dose” of stretching. If one stretches too much, one may rip the tissues and potentially cause an injury. Determining the right amount of stretching will help us to establish the right “dose,” vis-à-vis the effect we want it to have on the body. People stretch because it feels good. Many people do yoga and stretching exercises, but I think we have a long way until we understand exactly why it is good for us and the best way to do it.
Mr. Reddy: In your position at the NIH, and because you can see the overarching picture, particularly in the research world, how do you foresee the field of acupuncture growing in the United States?
Dr. Langevin: We must continue research to deepen our basic and clinical understanding of acupuncture, and when and how it affects people. How does it work? What is it good for? What is it not good for? And how does it get integrated with other treatments, with other approaches to health and self-care? It is with that evidence that acupuncture can be integrated into health care settings and ultimately become a standard part of the care options patients have.
Mr. Reddy: Acupuncture services are offered in the top 10 hospital systems in the Unites States. However, it is typically on an outpatient basis and does not employ large numbers of licensed acupuncturists.
Dr. Langevin: It is a start. Right now, we are funding a study of acupuncture as part of the NIH HEAL (Helping to End Addiction Long-termSM) Initiative that looks at the effect of acupuncture for chronic back pain in older adults. The study is funded in collaboration with the Centers for Medicare & Medicaid Services and the results will inform Medicare reimbursement. Things such as that eventually add up. We know now that nonpharmacologic methods are the first line of treatment for acute and chronic pain, which is what people should try first. That key fact is starting to filter into medical practice. The more we can improve that understanding, the less likely people will receive opioids or other medications with potential side-effects.
Mr. Reddy: One of my colleagues recently received a grant to perform a study on acupuncture in the emergency department, which is very exciting. Are there any parting thoughts you would like to convey to acupuncturists?
Dr. Langevin: Continue doing the good work that you are doing and get involved in research. If you feel like that is something you want to do, do not be afraid to do it. We need clinician scientists—something that is extremely important and we want to support them. The important thing is to read the literature, read the science. Look at the research that the NCCIH has already funded to ensure you are leveraging the best practices in study design that we have helped shape and establish over two decades. This type of research has been building gradually, and we know much more about acupuncture now than we did 20 years ago. It really is quite impressive.
Mr. Reddy: Dr. Langevin, thanks so much for taking time out of your busy schedule to discuss this important topic with me, and with our readers.
Dr. Langevin: Thank you.
See note on first page of this article on Dr. Langevin's role in presenting the “Integrative Health & Wellness Caucus.”