Open Letter to Dr. Josephine Briggs

Imagine you’re put in charge of a major U.S. government research center and told,
“Go figure out which alternative treatments actually work.” You walk into a world
full of herbs, energy fields, detox cleanses, and people insisting that coffee
belongs in places coffee was never meant to go. That, in a nutshell, was the job
handed to Dr. Josephine Briggs when she became director of the National Center
for Complementary and Alternative Medicine (NCCAM), later renamed the National
Center for Complementary and Integrative Health (NCCIH).

Science-Based Medicine (SBM), a group blog run by physicians and researchers
who are deeply committed to skeptical, evidence-first thinking, watched this
experiment with intense interest. When Dr. Briggs agreed to speak at a major
naturopathic conference, SBM’s Kimball Atwood wrote an
“open letter” – a public, carefully argued plea asking her to reconsider lending
scientific prestige to a profession that often promotes unproven or even
disproven treatments. The letter was never just about one talk; it was about the
larger question of whether science-based medicine and pseudoscience can – or
should – be integrated.

Who Is Dr. Josephine Briggs, and Why Does She Matter?

Dr. Josephine P. Briggs is not a fringe figure dabbling in crystals between
astrology sessions. She’s a highly respected nephrologist (kidney specialist)
with a medical degree from Harvard, years of research experience at the
National Institutes of Health (NIH), and a long track record of serious
biomedical work. She joined NIH leadership in the 1990s, eventually taking
over NCCAM in 2008, and served as director through the center’s rebranding
as NCCIH in 2014. Later, she worked in senior roles at the
Patient-Centered Outcomes Research Institute (PCORI), helping guide large-scale,
practical clinical research.

In other words, Dr. Briggs is very much a mainstream scientist asked to take
on a very non-mainstream portfolio: complementary and alternative medicine
(CAM). That tension sits at the heart of the open letter. Could someone so
rooted in rigorous medicine maintain a scientific line while also overseeing
research on acupuncture, homeopathy, naturopathy, energy healing, and a long
list of “integrative” therapies?

Science-Based Medicine vs. Complementary and Alternative Medicine

To understand why the letter was written, it helps to unpack two different
worldviews:

Science-Based Medicine

Science-based medicine starts with basic science and plausibility. It asks,
“Does this treatment fit with what we know about biology, chemistry,
and physics?” If a claim violates well-established laws – for example,
homeopathy’s idea that extreme dilutions of a substance become more
powerful as the substance itself disappears – then the bar for evidence
is extremely high. Randomized controlled trials are important, but they’re
interpreted through the lens of prior probability.

Evidence-based medicine, as commonly practiced, focuses heavily on clinical
trial data but can sometimes treat all hypotheses as if they’re equally
plausible starting points. Science-based medicine insists that how
plausible something is matters. A sugar pill that claims to cure cancer
should not get the same benefit of the doubt as a new chemotherapy drug
built on decades of molecular research.

Complementary, Alternative, and “Integrative” Medicine

Complementary and alternative medicine is a gigantic umbrella. It includes
everything from relatively ordinary practices – massage, meditation,
yoga, nutrition counseling – to highly speculative or outright implausible
ones like energy healing, detox foot baths, or homeopathy. NCCIH’s own
mission statement emphasizes “rigorous scientific investigation” into the
usefulness and safety of these approaches and how they might fit into
whole-person health care.

In theory, that’s a reasonable goal. Patients are already spending billions
of dollars every year on CAM; it makes sense to ask, “What actually works,
what doesn’t, and what’s dangerous?” In practice, however, NCCAM/NCCIH has
long been criticized for pouring money into treatments that start off
scientifically implausible and remain unsupported even after large,
well-funded studies.

How We Got to the Open Letter

When Science-Based Medicine published its open letter, it was responding
to a specific decision: Dr. Briggs’s plan to appear at a major convention
of the American Association of Naturopathic Physicians (AANP). For SBM’s
authors, this wasn’t a harmless public-relations stop; it looked like a
government stamp of legitimacy on a profession that frequently rejects
vaccination, promotes unproven cancer “treatments,” and mixes a handful
of sensible lifestyle advice with a great deal of pseudoscience.

Naturopathy presents itself as holistic, natural, and patient-centered.
In reality, naturopathic training and practice, as documented by medical
skeptics and public health researchers, often includes iridology
(diagnosing disease by looking at the iris), homeopathy, unproven
hormone regimens, chelation therapy for heart disease, and other
interventions that lack solid scientific support. When the director
of NCCAM stands on their stage, it is hard not to read that as an
endorsement, even if her message is cautious.

The open letter to Dr. Briggs essentially asked: Is this really the
company a federal science agency should keep?

The Evidence Gap: What the Research Actually Shows

By the time the letter appeared, NCCAM and other NIH institutes had already
funded hundreds of millions of dollars in CAM research. The results were
not exactly a parade of breakthroughs. Large, carefully designed trials
repeatedly failed to show benefit for many popular alternative therapies.
Critical reviews in major medical journals and science magazines pointed
out that study after study had confirmed what basic science already
suggested: magnets don’t treat arthritis, coffee enemas don’t cure
cancer, distant prayer doesn’t change the course of AIDS, and chelation
therapy is not a miracle cure for coronary artery disease.

All of this raised an uncomfortable question. If:

• Basic science says a treatment is extremely unlikely to work, and
• Clinical trials confirm that it doesn’t work any better than placebo,

then why is a federally funded center continuing to spend money on it –
or on closely related ideas – instead of redirecting those resources to
more promising lines of research? For critics like the SBM authors,
NCCAM’s portfolio risked turning into an expensive monument to negative
trials and lost opportunities.

Why Naturopathy Became a Flash Point

Naturopathy landed at the center of the debate because it functions as a
“greatest hits” package of alternative practices. Many naturopaths offer:

• Homeopathic remedies (chemically indistinguishable from the carrier)
• Unproven herbal mixtures for serious diseases
• Anti-vaccine or vaccine-hesitant counseling
• Chelation and detox protocols for vague “toxins”
• Chiropractic-style spinal manipulation and various energy techniques

Some naturopaths do incorporate standard, science-based care and can
provide generally useful lifestyle coaching – diet, exercise, stress
management. But critics argue that the profession’s core identity still
rests on unscientific ideas, and that its institutions often promote
them without adequate warning or internal criticism.

For SBM, this was not an abstract policy dispute. Physicians have seen
patients delay chemotherapy in favor of naturopathic “immune boosters,”
skip vaccines based on misinformation, or spend huge amounts of money on
supplements instead of proven medications. These are not harmless choices.
When a federal research center’s director appears alongside naturopathic
leaders, skeptics worry that it sends a message: “We’re all on the same
scientific team,” when in fact the underlying standards of evidence may
be very different.

What the Open Letter Asked For

Draw a Bright Line Around Pseudoscience

The open letter urged Dr. Briggs to clearly distance NCCAM/NCCIH from
organizations that promote pseudoscience. It’s one thing to say,
“We will rigorously test whether a particular herbal remedy lowers blood
pressure.” It’s another to share a podium with groups that reject vaccines
or offer homeopathic “alternatives” to antibiotics and chemotherapy.
The former reflects legitimate curiosity; the latter looks like an
endorsement of anti-scientific practices.

From the SBM perspective, a government agency devoted to complementary
and integrative health has an even greater-than-usual obligation to be
precise about what is and isn’t supported by science. It can’t simply
chase popularity and call it “integration.”

Fund the Science That Actually Helps Patients

The letter also urged NCCAM to prioritize research areas with at least
a reasonable basis in physiology and prior evidence. There is genuine
scientific interest, for example, in:

• How meditation and mindfulness-based therapies affect chronic pain and stress
• The role of exercise, sleep, and nutrition in long-term disease risk
• Integrative approaches that combine standard care with carefully chosen, low-risk adjuncts

These topics might fall under the “integrative health” banner, but they
are grounded in plausible mechanisms. In contrast, funding yet another
large trial of a biologically impossible therapy looks less like open-minded
science and more like political appeasement.

Has Anything Changed Since Then?

Since the time of the open letter, NCCAM has rebranded as NCCIH, updated
its strategic plans, and emphasized topics like chronic pain, mind–body
interventions, and whole-person health. Some of this evolution aligns
with what skeptics had hoped for: less focus on outright implausible
modalities, more attention to realistic questions about lifestyle,
self-management, and non-drug strategies for long-term conditions.

Yet criticism persists. Some researchers and physicians still argue that
NCCIH has occasionally lent credibility to “integrative” programs that
smuggle in unproven treatments under a more respectable label. Others
worry that the language of “integration” can blur important distinctions
between practices supported by solid evidence and those that survive
mostly on branding, anecdotes, and wishful thinking.

In that sense, the open letter to Dr. Briggs remains relevant, even years
after her tenure. It speaks to a permanent tension: How can we honestly
test popular but dubious ideas without making them look more legitimate
than the data warrants?

Why This Still Matters for Patients

For most of us, this debate is not about turf wars between scientific
tribes. It’s about what happens when you, or someone you love, is sick,
scared, and scrolling through health information at 2 a.m. You’ll see
everything from NIH summaries of clinical trials to glowing testimonials
for miracle cures that conveniently come in subscription boxes.

A science-based approach gives you a way to navigate that flood:

• Ask about plausibility. Does this treatment make sense given basic biology?
• Look for quality evidence. Are there randomized controlled trials, systematic reviews, or just personal stories?
• Consider risks and opportunity costs. Could this delay or replace something we know works?
• Watch the language. Phrases like “boosts immunity,” “detoxifies,” or “balances your energy” often signal vague, untestable claims.

That mindset – skeptical, curious, but not cynical – is the heart of
Science-Based Medicine. The open letter to Dr. Josephine Briggs is one
public example of experts trying to keep powerful institutions honest
about those standards.

Experiences from the Front Lines of Science-Based Medicine

To appreciate why the tone of that letter was so urgent, it helps to look
at real-world experiences – not just statistics and mission statements.
Consider a primary care physician in a mid-sized American city. She spends
her days treating hypertension, diabetes, anxiety, and the entire bingo
card of modern chronic disease. Increasingly, she finds that her patients
arrive with neatly printed naturopathic “protocols” or long supplement
lists recommended by an integrative clinic across town. Some of the advice
is harmless or even helpful – eat more vegetables, walk every day, sleep
more. But woven through the handouts are recommendations to skip vaccines,
replace prescribed medications with unproven herbs, or undergo month-long
“detox” regimens that leave patients broke, exhausted, and no healthier.

One afternoon, a patient in his 40s comes in with advanced colon cancer.
He had symptoms a year earlier but delayed a colonoscopy after a
naturopath reassured him that his problem was “gut toxicity” and offered
an expensive package of supplements instead. The physician cannot prove
that an earlier diagnosis would have saved his life, but she knows the
odds. When she later hears that the same naturopathic group is hosting a
federal official from NCCIH at its conference, it’s hard not to feel a
jolt of anger. From her perspective, the lines between “research,”
“integration,” and real-world harm have become dangerously blurred.

On the research side, a young scientist at an academic medical center is
trying to design a rigorous trial of acupuncture for chronic back pain.
She’s keenly aware of mixed evidence: some studies suggest modest benefit,
others find little difference compared with sham procedures. She knows
that patient expectations, practitioner enthusiasm, and cultural beliefs
can all influence pain outcomes. Her goal isn’t to “prove” acupuncture
right or wrong; it’s to understand what, if anything, is happening beyond
placebo, and under what conditions it might genuinely help people who
don’t respond well to standard therapies.

Funding from NCCIH could make that work possible. But she also sees the
critiques in Science and JAMA, and the concerns from SBM. She recognizes
that the credibility of her research depends on asking hard questions,
not stacking the deck. For her, the open letter to Dr. Briggs reads as a
challenge: if NCCIH is going to support integrative health research, it
must do so with the same intellectual honesty and skepticism expected
anywhere else in biomedical science.

Finally, picture a patient who stumbles across both NCCIH’s plain-language
fact sheets and Science-Based Medicine’s sharp, sometimes sarcastic blog
posts while researching a new diagnosis. At first, the patient is confused:
one source uses careful, neutral language about “mixed evidence,” while
the other bluntly calls certain practices “quackery.” Over time, the
patient learns to read between the lines: when a federal site quietly notes
that a therapy shows “no clear benefit” in high-quality studies, that’s
bureaucratic for “this probably doesn’t work.” When SBM digs into the same
data and points out why, it can feel bracing or even harsh – but also oddly
empowering. The open letter becomes part of that education: a reminder that
even within the scientific establishment, there are people willing to say,
out loud, that not all “integrative” ideas deserve equal respect.

These intertwined experiences – the clinician dealing with delayed care,
the researcher navigating a controversial field, the patient trying to
decode mixed messages – are the human side of the open letter to
Dr. Josephine Briggs. They explain why the stakes feel so high. The letter
isn’t about scoring points in a skeptical blog war; it’s about who gets
hurt when institutions blur the line between science and wishful thinking.

Conclusion: An Open Letter That’s Really About All of Us

On its face, “Open Letter to Dr. Josephine Briggs” is a public note to a
single agency director. Underneath, it’s a broader demand: that powerful
institutions treat words like “science,” “evidence,” and “integrative
health” with the seriousness they deserve. It asks NCCIH – and by
extension, the entire medical research ecosystem – not to confuse
popularity with validity, or to grant political cover to treatments that
fail both basic science and clinical testing.

Science-based medicine is not anti-curiosity and it’s not anti-compassion.
It is, however, unapologetically pro-reality. When patients are vulnerable,
the least we can do is insist that public agencies, professional groups,
and alternative practitioners play by the same evidentiary rules. The open
letter to Dr. Briggs is one version of that insistence. Whether you agree
with every line or not, it remains a useful lens for asking better
questions about complementary and integrative medicine – and for making
safer, smarter choices about your own care.