Wayne Jonas, MD, is the president and chief executive officer of the Samueli Institute, Alexandria, Virginia, as well as a professor of family medicine at Georgetown University Medical Center, Washington, DC. He is also an associate professor of family medicine with the Uniformed Services University of the Health Sciences, Bethesda, Maryland. A family physician and scientist, Jonas formerly served as the director of the Office of Alternative Medicine at the National Institutes of Health, as the director of the Medical Research Fellowship at the Walter Reed Army Institute of Research, as director of a World Health Organization Collaborating Center for Traditional Medicine, and as a member of the White House Commission on Complementary and Alternative Medicine Policy. He is the author of more than 150 publications including 5 books. He received his medical degree from Wake Forest University School of Medicine, North Carolina.
Q. What have been some of the challenges associated with the research that the Samueli Institute has undertaken over the past few years?
A. One of the big challenges is that we are forging new areas of research and trying to facilitate innovators. At the same time, we are making sure the methods we use are scientifically rigorous. That sets up an inherent challenge because innovation means you’re looking at new things; you’re trying to develop new methods, metrics, and approaches; and at the same time, the work must be high-quality and valid. So the balance between rigor and relevance is one of the main challenges. This arises largely out of the topical focus we’re interested in—healing and how healing occurs.
Q. How do you define healing?
A. We define healing as the process of recovery, repair, reintegration, and the return to wholeness, also called salutogenesis; it’s the reverse of pathogenesis. Pathogenesis is how things break down and become diseased. Salutogenesis is how they get built up, how they recover, how they come back into balance. The methods and the metrics are parallel in terms of developing a science, but healing itself is complex because it is an emergent property of whole systems. So we have to focus on developing approaches that can capture and assess whole systems. To research this, we have to be well versed in a variety of research methods. That means we need to have experts from each of those methods involved in putting research teams together. We go all the way from the bench in the laboratory to the bedside, clinical research up to the boardroom, and look at policy and health systems. We use both qualitative and quantitative methods to help create a fuller picture of what’s going on in the process of healing and how the information we discover can be properly used. That requires experts both at the institute and through our partnerships who can work together as a team and perform interdisciplinary research.
Q. Because you are forging new territory, have you met with resistance among conventional researchers?
A. Not too much. Occasionally, there are naysayers who disregard the whole area no matter what you do, but the scientist that understands what we do and how we do it recognizes that we are building the science of healing. We use solid scientific methods, we have respected partners, and our organization has a history of quality of credibility. Those in the mainstream who look at who we are and what we are doing say, “This is good science; this is an interesting area,” and become intrigued by it. Good science will never get rid of the naysayers because they’re not interested in the science. However, the mainstream is intrigued because they know we need new approaches to healthcare. There are many of us who are looking for fresh and innovative ways to bring new healthcare approaches to the table in a way that’s evidence-based.
Q. Your list of partners is impressive. How significant are your partnerships and are there plans to expand those partnerships even further?
A. Absolutely. Our partnerships are key to being able to accomplish the goals of the Institute. We’re no longer in the age of the isolated creative genius working away in his laboratory coming to a “Eureka” discovery, although certainly that happens. Today research is multidisciplinary, interdisciplinary, and requires teams. We try to focus on developing teams that can work together to answer the relevant and important questions around healing. Because of this, we’re continually looking for strategic relationships in which individuals who have an interest in these areas and have certain skills and capacities can work with us to answer the core questions that our healthcare system is faced with today. One of the advantages of being a nonprofit institute is that we can work with anybody. We’re not restricted to a particular silo that we have to build up because of the nature of the organization that we work in. We are able to build partnerships with government or the private sector, with universities, research organizations, and all types of practitioners. One of the things that I was very pleased to see in Minnesota at the North American conference was the premeeting that brought together the academic consortium with the consortium of the natural health practitioners. It was gratifying to me to see them dialoging now, explicitly and efficiently. I’ve roamed all those circles for quite a long time, and it was wonderful to see them getting together and looking for common goals and possible collaborations. The Samueli Institute wants to foster that type of dialogue and collaboration and in doing joint research.
Q. How does work at the Samueli Institute help the practicing physician either in the short term or long term?
A. Well, I am a practicing physician. I still see patients every week in my family practice. I am constantly trying to integrate the best approaches and make those available to my patients. I guess the catch phrase now is translational research. We are trying to make sure the information we’re collecting has relevance and that we can translate that research into practice. Our primary goal is to build the evidence base for healing and the infrastructure for healing research because we need that in order to create wellness in a rational manner. We try to make that easier to understand. One of the things we’re hoping to develop in order to make this information more useful to physicians in the future is a knowledge center. We are looking for ways in which the research we’ve done for the past several years can be translated into practice settings more readily.
Q. What are some of the other things that the Samueli Institute will be working on in the future?
A. In order to facilitate translating knowledge into clinical practice, we will make the information from our Optimal Healing Environments (OHEs) program more readily available. OHEs looks at all the components that deliver healing—from the inner environment to the interpersonal environment to the behavioral and external environment. How do you integrate and complement our treatment-based system to facilitate recovery and repair? The OHEs program has been doing research looking at exemplars of OHEs around the country. In the future, we hope to take that information and provide a service to healthcare settings that are interested in creating models of optimal healing. We can work with them to assess what they already have in their system and what they need, and we can put them in touch with programs that can help them develop the gap areas that may exist. We will create a template that can more efficiently be duplicated on a broad scale. There will be a component they can use for self-assessment, and there will be the opportunity to bring in a more professional assessment as they move towards becoming an OHE. In addition to the OHEs program, we are very grateful for our work with the military, and we expect that to expand in the future.
Q. You personally have a strong connection to the military don’t you?
A. I was in the military for 24 years as a US Army doctor. In fact, when I ran the Office of Alternative Medicine at NIH, I was still on active duty. I don’t think people realize that the military has been an innovator in the area of health and wellness. The Samueli Institute does considerable work with the Defense Department. There are tremendous needs for effective approaches to stress, pain, cognitive dysfunction, and recovery. For example, we did a series of acupuncture studies that have led to establishing training programs on acupuncture within the Air Force. We’ve also evaluated dietary supplements within the military and developed a center for integrative medicine in the military, the first of its kind. This has all been very gratifying.
Q. What do you feel the future holds for our healthcare system and how does that relate to systems wellness system approach?
A. One of the challenges medicine faces is in prevention and treatment of chronic diseases. It can be difficult to determine which behaviors are having an impact on personalized care. We know that lifestyle components, diet, exercise, stress management, social integration, and other components play a major role in chronic diseases. They have a role in both their prevention and management. Yet it can be difficult to know how to individualize such a program for each patient. There is an emerging area within conventional biomedicine called “systems biology,” and it is putting forth the vision of using genetic, proteomic, and other types of cellular metrics as a guide in those areas. But most of systems biology is focused on deciding on when and how to apply drugs, surgery, and other conventional treatments. Not a lot of it is applied to lifestyle change and the other elements that we know contribute to wellness and help prevent disease. The idea of a systems wellness system is that we take valid and proven metrics of health and wellness and track them in real time. We need a system whereby you can follow an individual to see how well are they doing. Are they going along the pathogenesis path, or are they going along the salutogenesis path? This system should allow for real-time feedback in order to adjust behavior, diet, dietary supplements, and other wellness components. The hope is to provide practitioners with practical tools so they can personalize their medical practice and people in ways to personalize their health behaviors.
Q. And your contention is that our healthcare system, in order to be successful in making the changes that are required, needs to embrace this systems wellness system?
A. Yes. We know the system as it currently operates is not producing health, and it’s costing us too much. We’re not really getting our value for the money. That’s widely acknowledged. Integrating a systems wellness system is a step in the right direction toward more health at less cost.