Interview

Integrative Medicine at the University of Maryland Interview with Brian Berman, MD

Daniel Redwood, DC

 

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Topics in Integrative Health Care 2013, Vol. 4(1)   ID: 4.1002



Published on
March 10, 2013
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Brian Berman is a tenured professor of family medicine and director of the Center for Integrative Medicine at the University of Maryland School of Medicine, Dr. Berman trained in family medicine and pain management as well as complementary medical approaches such as Traditional Chinese Medicine. He has dedicated his career to evaluating the efficacy, safety and cost-effectiveness of complementary and integrative medicine. In 1991 he founded the first U.S. academic medical center-based program for integrative medicine.
 
Dr. Berman is one of the most highly funded National Institutes of Health (NIH) researchers in the area of integrative and complementary medicine, receiving over $30 million over the past 14 years. He is currently principal investigator of two NIH specialized center grants for the study of traditional Chinese medicine (TCM) and chronic disease, specifically arthritis and irritable bowel syndrome. These center grants build on 10 years of work from his two previous NIH center grants and a NIH international center planning grant that has built collaborations with leading institutions in Hong Kong, Australia and the U.S.. In 2004, Dr. Berman’s landmark study showing acupuncture to be a safe and effective therapy for osteoarthritis of the knee was published as the lead article in Annals of Internal Medicine. Subsequently, it was the focus of 23 million media stories worldwide. His research publications include 3 books and over 150 articles in leading medical journals focused on integrative medicine approaches for a wide range of chronic health disorders.

For the past 23 years, Dr. Berman has practiced integrative medicine and has introduced this approach into the University of Maryland medical system. He has also introduced core curriculum and elective courses on integrative medicine into the School of Medicine and established both research and clinical fellowships in this field.
 
A pioneer in the field of integrative medicine, Dr. Berman was honored with the Bravewell Leadership Award for Integrative Medicine in 2005. The award “celebrates and supports visionaries who have committed their medical careers to transforming healthcare in America and ushering in a new practice of medicine.” He was chair of the ad hoc advisory committee to the NIH Office of Alternative Medicine when it opened in 1992, as well as the report to the NIH on alternative medicine. Subsequently, he served on their advisory committee for 6 years. Dr. Berman also helped found and now serves as field coordinator for the complementary medicine field of the Cochrane Collaboration, an international organization dedicated to evaluating all medical practices. He was a panel member of the National Academy of Sciences, Institute of Medicine’s report on complementary medicine, published in 2005, and was the first chair of the Consortium of Academic Health Centers for Integrative Medicine, which grew from 7 to 29 North American universities over his tenure. Dr. Berman is the co-founder and president of the Institute for Integrative Health, a not-for-profit organization that engages visionary scholarship and initiates innovative programs that aim to catalyze new paradigms in healthcare.
 
In this interview with Dr. Daniel Redwood, Dr. Berman shares the personal journey that led to his career in integrative healthcare, explains his research at the University of Maryland on acupuncture and osteoarthritis and discusses his current work bringing acupuncture and mind-body healing methods into the university’s world renowned shock trauma center.
 
How did you first become interested in alternatives to conventional medicine?

I did a residency in family practice back in the late 1970s but, once out in practice, realized I didn’t have a lot to offer to patients with musculoskeletal problems. I took some training in Cyriax orthopedic medicine, the diagnosis and treatment of soft tissue problems and that opened my eyes to other possibilities.

I started to meditate back in 1972 when I first started medical school over in Ireland. In a way, I’ve always been interested in more than what the mainstream offers. When I was an undergraduate at Columbia University, I took courses with Margaret Meade in culture and anthropology and actually minored in anthropology while majoring in psychology. I took courses in hypnosis at the Columbia College of Surgeons when I was an undergraduate.

After my medical training, it was very clear to me that I had been taught excellent skills for acute problems but didn’t have enough answers for my patients who suffered from chronic disorders. I had people who I knew weren’t well but all the tests were showing things were fine. I would tell them that there’s nothing that shows up on the tests so maybe we can refer you to the psychiatrist. That didn’t seem like enough so I started to look around and see what else was there. One thing led to another. I was running an emergency room for a couple of years over on the Eastern Shore area of the Chesapeake Bay. I remember going down to a meeting in Virginia Beach, where the owner of the different emergency rooms had their headquarters. So I’m looking at people who are 20 years older than I am who are running these emergency rooms and I’m thinking, I don’t want to be like this in 20 years. [Laughter].

I said to my wife, why don’t we leave the meeting and go for a walk on the beach. And so we did, and walking along I saw this sign for the ARE, the Association for Research and Enlightenment. I remembered that one of my classmates at Columbia was into Edgar Cayce, and I seemed to recall this has something to do with that. We went in there and I picked up a couple of books. One was on drugless therapies, by Harold Reilly.

Yes, the physical therapist. A fine book.


And I said to my wife, that’s what I want to do. That began a journey. We ended up contacting the ARE clinic in Arizona, and Gladys and Bill McGarey were there and they said why don’t you come out, we always like to see young physicians out here. I joined them in 1983. From there, I was really exposed to complementary and alternative medicine.

They were among the founders of the American Holistic Medical Association. Magnificent people.


I used to sit down with Bill twice a week and we would go over cases. I remember the first case I took, I was so proud that I had seen this woman with headaches and I hadn’t given her a prescription for drugs, which is what I would have done based on my medical training. So Bill said, “Okay what did you do?” I said, “Well, no prescription for drugs.” And he said again, “What did you do?” He said I think we should call her back. And he started to teach me about lifestyle behaviors and other alternatives to the usual drug therapy.

When we were out in Arizona, I had the good fortune to meet a German homeopathic doctor who was practicing in Prescott. I went up there once a week. It took me months before I realized that there was something different happening there, which was that people were starting to get better. People that had chronic diseases, from chronic hepatitis to cancer to many other problems. I had never seen that before.

Healing Rather than Disease Management


So you were entering for the first time the realm of actual healing rather than disease management.


Absolutely. He was pretty advanced in what he did. It spurred my interest to study this further. We had the opportunity to go to Great Britain (my wife is British) when we were expecting our first child. We decided to have our child born there. When we were there, I started to look around and saw that there was a whole world of complementary medicine, as they called it back then. I began to look into it in a deeper way.

When I was at the ARE Clinic in Arizona, I had also taken the UCLA acupuncture course with Joe Helms, which he was just beginning to teach at that time. I took that course with about seven other physicians. That was an eye-opener as well. It changed my way of thinking. Acupuncture seemed very natural to me to learn. I took many more courses in acupuncture and Traditional Chinese Medicine, the Eight Principles approach. I found that the energetic approach of homeopathy really complemented that.

We planned to stay in England for a year but ended up staying for almost nine years. I took a lot of training in Europe in mind-body approaches and set up a practice in London that was an integrative practice. We had a psychiatrist who was very eclectic in his approach. I was there as a family physician who used acupuncture and homeopathy and diet. We had an osteopath and a massage therapist. It was very successful and I probably could have stayed there. I saw that I could take care of patients more effectively by incorporating more modalities and an approach [with patients] that was more of a partnership.

How was this received by your more conventional colleagues?


Many of them were looking at me like I had two heads. Basically saying, “Why don’t you come back into the fold?” I eventually approached one of my patients, Sir Maurice Laing, in about 1990. He was a great philanthropist; he did a lot for many types of causes, including holistic medicine. I said I would like to bring this into the mainstream and he asked me to come up with a proposal. We did that and then he said that we needed to find a university to take this on. This was before there was any spotlight on the field.

I approached the University of Maryland, where I had done my internship and residency. I went over in the summer of 1991 with the executive director of the Laing Foundation, Robert Harley, and we met with the head of anesthesiology since we were talking about pain. This was an area where we had a great deal of experience in our clinic. We met with the dean and the president and I remember one meeting with the head of the cancer center, Steve Schimpff, who later became head of the hospital system. He said this is interesting, this journey that you’ve been on, and then he asked me, “Do you think you’ve got all the answers?”

I was taken aback and I said, “No I don’t but I do know that it’s more enjoyable to practice this way. I can treat people more effectively, I have more options, and it’s more of a partnership. But I have no idea of exactly what is working and who it works best for.” He said, “Good, we don’t feel like we have all the answers either.” If you’re willing to travel down this road and study these therapies in a scientifically rigorous way together, I don’t see why not.”

So we walked out of that meeting and the Laing Foundation executive director said, “I don’t think we need more meetings. That’s good enough for us. Why don’t we get started?” And we did. The whole idea was to explore the scientific foundation and the efficacy of complementary medicine to explore the integration of conventional medicine and complementary medicine.

1991: Founding the University of Maryland’s CAM Program


So this was the founding of what’s now called the Center for Integrative Medicine at the University of Maryland School of Medicine.


Right. It started off as a “project” and later on we became a division. They never knew quite where to put us. Later we became a program, which is a whole setting in itself, kind of like a department. Then we became a center, a research center to foster collaboration with other schools and departments and institutes. And now we really have a seat at the round table, we’re very much part of the culture here, we work collaboratively with people in the medical school and the dental school and the schools of pharmacy and nursing. I’ve even done some projects with the law school. People get it now.

What have been your primary areas of research focus and what are you most proud of?


We have focused on the area of pain over the years. Different types of pain—osteoarthritis, musculoskeletal pain. We’ve worked collaboratively with the rheumatology department, with Dr. Marc Hochberg who heads that up. He’s one of the top rheumatologists in the world, particularly for osteoarthritis. So that has been a main focus. Together with Marc, I published one of the first large trials in acupuncture, which showed acupuncture to be both safe and effective for knee osteoarthritis. It was published in the Annals of Internal Medicine at exactly the same time there was the whole furor over the adverse effects of Vioxx.  People with arthritis were desperate, wondering what options they would now have for pain relief.  So our paper generated a huge amount of interest, leading to over 20 million media stories worldwide.

I’m proud of our work with the Cochrane Collaboration. It started in 1993 and we helped start the complementary medicine field within the Cochrane Collaboration in 1995. Do you know about the Cochrane Collaboration?

CAM and the Cochrane Collaboration


I know that it focuses on rigorous systematic reviews of existing research to determine what is effective and what isn’t.


That’s true. They are a worldwide organization started in Oxford, England by Archie Cochrane, who was an epidemiologist. When he founded it, he said that people are unable to make decisions about their healthcare without up-to-date information, that this is true for all of medicine and that it’s a real shame. Ian Chalmers (who is now Sir Ian Chalmers) picked up the ball and moved it forward. The Cochrane Collaboration is now seen by many people as the top evidence-based medicine hierarchy. I think there are now something like 25,000 people that belong to the organization, in over 100 countries. The idea is to gather the best evidence available, and then people in their areas of interest do systematic reviews or meta-analyses of the literature. One might be a review for a particular herb for diabetes, another for acupuncture for lower back pain.

I went over to Oxford. I met with Alex Jadad and he gave me the research database he had developed, which had about 900 clinical trials at the time. We’ve now built it up, with many people all over the world, to where there are over 43,000 randomized controlled trials in the database along with 800 systematic reviews.

Is this for the CAM database or for the whole Cochrane database?


That’s just for CAM. The Cochrane database has over 600,000 randomized controlled trials overall. That’s as of a couple of years ago. I believe they have more RCTs in their database than the National Library of Medicine. This is a great group that doesn’t care if something is CAM or conventional, just whether it’s effective. Through it, we’ve been able to develop collaborations with top-notch people all around the world.

This work is something I’m very proud of because it’s brought in the conventional researchers, scientists, and clinicians to look at the therapies that help, to study them. But more importantly, it has made the evidence more readily available to people, whether you’re a clinician or a researcher or a payer. We’ve looked through all sorts of databases to dig out the information. We’re now going into the Chinese databases, the Indian databases, Japanese and more. It’s a worldwide effort to gather this information that can be used to do these up-to-date reviews.

The Challenge of Applying Cochrane Reviews to Patient Care


As someone who has to some extent explored Cochrane reviews for subjects relevant to my own practice or areas of academic interest, it’s my impression that Cochrane sets the bar very high. And that this makes it quite challenging for health professionals to apply the information in the Cochrane reviews, to translate it into actual practice. I know this is a gross generalization, but it’s almost as if a Cochrane Collaboration review will never conclude that anything (CAM or conventional) is more than just slightly, marginally effective. Can you address that?


That is so. It has a very high bar, for all of medicine. I don’t think it’s a bad thing to have a high bar. What it does is to say okay, here’s what we know, here are the gaps, and here’s what we still need to find out. It helps us in that way. What it doesn’t always help with is to tell the practicing clinician what to tell the patient in front of us. Are we to tell the patient that there are some studies that say such and such, and the methodological quality may not be perfect? Clearly you have to do some interpretation. As you say, a Cochrane review is very rarely going to say that something has overwhelmingly been shown to be effective. In a sense, we can say that Cochrane reviews are building a house of evidence.

You’ve received a substantial amount of funding from the NIH and particularly the National Center for Complementary and Alternative Medicine (NCCAM), with over $30 million in grants over the past 15 years. What are some of the research projects you feel have been the most meaningful and important?

We have received NIH funding for our work in acupuncture and traditional Chinese medicine that I mentioned earlier and also for the Cochrane work.   With that we’ve published many trials and systematic reviews of the literature that have gone into some of the top journals.

That would include the one on acupuncture for knee arthritis?

Yes, we’ve done studies and systematic reviews in arthritis and reviews in areas like back pain; that review was published in the New England Journal of Medicine. I think those are very important along with the one on acupuncture for infertility by Eric Manheimer, who works with me here.

What were the findings on acupuncture for infertility?

It said that acupuncture definitely did make a difference for pregnancy rates. That was clear cut.

I had a couple of female patients who had been unable to conceive, who did so after I treated them with acupuncture. But I never knew whether it was just coincidence. This leads me to think it was the acupuncture.


The research is supportive. We also did a systematic review for osteoarthritis of the knee that was not as clear cut. That gets into the difference between efficacy and effectiveness research.

Real World Research: Efficacy vs. Effectiveness

For readers who may not be familiar with those terms, could you briefly explain the difference?

Efficacy is the extent to which a specific intervention or treatment is beneficial under ideal conditions. In efficacy research, we narrow down the focus of who we allow into the study. So in the case of osteoarthritis and acupuncture, it might only be people between the ages of 40 and 60, and maybe it’s only women or people who are not obese. Then you give the treatment under relatively ideal conditions. With effectiveness, it’s a measure of the extent to which the intervention does what it’s intended to do in routine care. You’re not narrowing it down; you’re using the treatment as it’s practiced in the real world.

That’s a big difference. We see quite often in efficacy studies, for example some of the studies on acupuncture for osteoarthritis and back pain, differences in the effect sizes between acupuncture and sham acupuncture. Andrew Vickers’ recent meta-analysis shows that. But some critics may say, ah, that’s such a small difference [with true acupuncture not showing much more benefit than sham acupuncture] that it’s not even meaningful. But then you look at the effectiveness studies, where it’s comparing real acupuncture to usual care or to a wait list or to drugs, and there we see much larger effect sizes.

So in real world settings, which are what matters most to patients, the beneficial effects are more clearly delineated.

Yes. And a clinician would really say, “That’s what I’m interested in. I want to know whether I should give them that drug or acupuncture, because I’m not going to give them sham acupuncture.” So they’re going to be more interested in the effectiveness studies.

In the classes I teach to chiropractic students, I emphasize that randomized controlled trials were basically developed to compare one little white pill to another little white pill. Whereas, when you look at non-substance based therapies, which is basically all of physical medicine, including not only chiropractic, acupuncture, massage therapy, and physical therapy, but also surgery, these research methods are not as easy or as applicable. And yet we try, because this is considered by many to be the “gold standard” for clinical research. When we compare the measured benefits of true acupuncture or spinal manipulation versus sham acupuncture or sham manipulation, and they don’t look all that different, is it largely because this methodology sets the table in such a way that it’s very difficult to show a robust response?

Right, I think that’s absolutely true. Now, with the whole burgeoning of comparative effectiveness research and real-life care, we have the opportunity to give the therapies the way they’re actually practiced and this can even be in combination with other therapies as they are actually practiced. I mean, most of the time you don’t do acupuncture on its own—you do other things as well. And so the effectiveness with a group of patients, whether you’re comparing it to a drug or whatever, that type of research is going to be extremely important. In addition to that, you also take into account the stakeholders’ own preferences. Put those together and it becomes good evidence-based medicine.

The original definition of evidence-based medicine, by David Sackett, is that it involves using the best available [research] evidence, the clinician’s experience and the patient’s preferences. All three of those things go into the definition of evidence-based medicine. We tend to forget about some of those parts, especially the last two.

NCCAM-Funded Research Showed Benefits from Acupuncture for Arthritis

How do you respond to critics of federal funding for CAM research, when they claim that none of NCCAM’s grants have resulted in any positive demonstration of effectiveness for the use of CAM methods?

First, I think what matters most is that we are showing that you can do rigorous science in complementary medicine. A good example of this research is our work on osteoarthritis of the knee. We did a step-wise approach to that, with NIH funding. It started with a small pilot study of 19 patients with no control group, where we showed that it was safe and effective. We used standard outcome measures [the ones used in non-CAM arthritis studies] and standard acupuncture points. There were arguments even then with the acupuncturists (this was 1992) as to whether we should use standard points [as opposed to individualized choice of points for each patient]. We said let’s just show that it works. And the rheumatologists said the same thing, just show us that it works.

Then, we brought in a comparison group for the next study, which had about 70 patients, with one group getting standard care and the other getting acupuncture plus standard care. When the saw the positive results, the rheumatologists said, “That’s good enough for us.” We had shown them that adding acupuncture to standard care yielded a large effect size showing it was safe and effective. Standard care was not effective on its own, by the way.

The NIH still wanted to see proof of efficacy, to see whether acupuncture works better than a sham control. So we then did a large 570-patient study. But by then, we had already tested the acupuncture points and the sham points. We had already done the shakedown cruise of the boat, so to speak, and we had a pretty good idea what was needed in terms of the number of treatments, the length of the treatments, the points and every aspect of it. So then when we did this larger study, we demonstrated that acupuncture was safe and effective in a large randomized trial.

So this series of studies might be seen as Exhibit A for how NIH funding of research in CAM has actually shown benefits for a CAM method, in this case acupuncture.


Yes, definitely. And certainly the Cochrane reviews [for which the Center for Integrative Medicine has received NCCAM/NIH funding] have shown that there are numbers of such studies. So I have to think that anyone making the claim that there have not been NIH-funded studies on CAM yielding positive results just isn’t that familiar with the scientific literature. Or maybe they don’t look at the literature.

I’ve noticed that stories with those claims often appear in the Washington Post right around the time that NCCAM’s budget is up for renewal.

Getting back to the research itself, what we’ve been able to do, with acupuncture and osteoarthritis for example, is to change the nature of the research. Previously, the research was all over the place. No one was comparing apples to apples. The outcome measures weren’t standardized from trial to trial in the early days. So you couldn’t make good comparisons and couldn’t bring it together into a meta-analysis.

So we started to work with rheumatologists, who said that what they do is to look at the WOMAC [Western Ontario and McMaster Universities Arthritis Index] scores and other standardized methods of measuring the effects of whatever treatment is being used. We standardized the approach. At this point, we continue to look more deeply into the effectiveness and also the mechanism through which it works in the body.

We just put in a grant proposal to NCCAM for a Center of Excellence in Research grant to look at osteoarthritis pain. If we receive the grant, we’ll be looking at osteoarthritis pain, phenotyping people to see if you can predict who will get OA pain, looking at the genomics of OA pain, looking at what happens in the brain with MRI, all of that.

That sounds fascinating.

Then you give acupuncture and see who responds and doesn’t respond, and see if we can predict how and why. For us, the future is in three directions. Certainly it’s to continue the evidence-based Cochrane work, but it’s also to take it more to the effectiveness side of research, and to go deeper using some of these tools like genomics and proteomics. This will be interdisciplinary research.

Integrative Patient Care at the University of Maryland

My understanding is that aside from your research focus at the Center for Integrative Medicine, you also provide patient care there. What kinds of practitioners are included on your team and how do they work together?

We’ve had a clinic since we started in ’91. Initially, we took the pain clinic at the University of Maryland and made it a real multidisciplinary pain center. Eventually we left there to set up our own clinic, which is still part of the university but not part of the pain center. But pain is still a key part of our focus.

Pain is a key focus for CAM and integrative healthcare everywhere.

So we have physicians who are practicing integrative primary care, we have a nurse who practices holistic nursing and we have several doctors of Traditional Chinese Medicine who practice herbal prescribing and acupuncture. We have taiji and qigong classes and mind-body classes with a health psychologist. We have a homeopath, massage therapist and Reiki practitioner. As to how they work, I don’t think we’ve completely gotten that down. It’s not a complete interdisciplinary working together. People refer back and forth as they get to know each other and feel more confident to refer cases out. Usually it’s the physician referring to the different practitioners. It’s still a work in progress.

“Something Truly Exciting”: Acupuncture and Mind-Body Methods at the University’s Shock-Trauma Center

Something truly exciting is what we’re doing with the shock-trauma center here at the University of Maryland. This is one of the top such centers in the world. What they’re best known for is their work on how the first hour [after major trauma] is the “golden hour,” the time where you will either stabilize the patient or they won’t make it. People come from all over the world to train in this shock-trauma center. The man who heads it up, Tom Scalia, approached me at one of the dean’s meetings and said, “We’ve got a problem. We have a group of patients in this kind of acute pain who get into a hyper-inflammatory state. What do you have that could help them? Because if our methods don’t work to bring the inflammation down, they’re usually the ones who go into septic shock and die.”

I said to him that we do a lot with chronic pain and with wellness and prevention. I said I wasn’t sure what we could do. But we started to work with them …

Acupuncture?

Acupuncture first. They started to see some results and that opened up the doors and we started to bring in some mind-body approaches. We began a training program for the nurses to bring in different visualizations, to create a healing space. This included Tibetan bowls as well as Reiki healing. The results have been phenomenal for the patients, for the nurses, and for the doctors. So much so that they want more and more of it.

We’ve trained 75 nurses now in the in-patient and shock-trauma units. We’ve just put forward a big proposal to the university, instigated by both Dr. Scalia and myself, saying that this has been successful and we want to systemize what we’re doing here, bringing in the teaching as well as the education for patients. And that we want to do it as an integrative medicine in-patient consult service. This would be in the shock-trauma center.

It’s amazing. They’ve been so open. This is the center that did a total facial transplant that was all over the news about six weeks ago, the first ever. And the surgeons have asked for our people to be involved during the 72 hours of the surgeries, as well as the pre-op and post-op care. The fellow who had the transplant said, after he had had Reiki and acupressure for a while, “This is the first time I’m getting relief from my pain.”

That is going to start to break down more doors because now the shock-trauma center says they want to do this is a larger, systematic way. And then many of their patients get discharged to the rehab hospital, Kernan Hospital, part of the University of Maryland. The head of the hospital is saying that they want to do the same thing, so that when they’re discharged they have continuity of care that is the integrative approach we’re doing in shock-trauma. If you talk about good continuity of patient care, along with the opportunity to research this from the acute phase all the way through, it’s tremendous.

Being here for 21 years, you kind of build up the trust and the relationships where we can have these discussions. Where he can say, “What do you have?” and I can say, “I don’t know, let’s try and see,” and over several years this can all develop. They must be seeing 20 people a day in the shock-trauma center now. The nurses are leading the way and we’re going to take it further.

Shock-trauma sounds like a branch of medicine, of the healing arts, that is intensely pragmatic.


Yes.

I mean, obviously all of the healing arts should be, and to some extent are pragmatic in terms of wanting to use what’s most effective, but in shock-trauma the patient dies or the patient lives and that’s a very dramatic and measurable outcome.

Absolutely. And you look at the tremendous need. One of the ways that we are looking at it, kind of reframing it, is that trauma can induce growth. Or it can induce fear, where we just get stopped. There are so many types of trauma. Some of the methods we have in complementary and integrative medicine offer the potential not just for the patient to react but to take a step, a pause, and to look at things in a more positive way.

Institute for Integrative Health: Thinking Big

With your wife Sue Berman, you founded the Institute for Integrative Health several years ago. Tell us about it.
 
In 2005 I was given the Bravewell Collaborative leadership award for integrative medicine. There was a cash prize of $100,000 with it and what we decided to do was to take the money and set up an institute outside the university, with Sue as the executive director, to complement activities that are going on in the different centers.
 
In 1991 when we started the Center for Integrative Health, there weren’t any other centers. Now there are many centers. But the same time, people don’t have time to think. Everybody’s so busy making things happen and surviving, that they don’t really have a chance to, look at things from the 30,000 foot perspective, and think about where we are going. So the idea for the Institute was to be able to reframe the important questions in healthcare, to take a step back, to say where are we going and where we want to go. To bring people together from different disciplines to look at areas that are stuck or ripe for innovation in healthcare and to shift the dial from disease management towards health and well-being. Because even in our wonderful integrative medicine centers, we tend to focus on disease management. This is certainly valuable and important, but if we don’t shift our attention and our paradigm toward health and well-being, we’re just not going to get to where we want to go.
 
The institute is set up to be a catalyst for innovation in healthcare that takes into account mind-body-spirit. We have three areas. We have a scholarship area, with Institute Scholars, kind of modeled on Howard Hughes Scholars (not with that kind of money but you never know, maybe someday). We have about eight scholars now, people who have been successful in their careers. We’re saying okay, what would you want to do now to really make a difference? What would make your heart sing? Not taking the next incremental step or working on the next incremental grant, but if you had the time, what could really make a difference? And it has to be in the area of health and well-being. One of the scholars is a NASA scientist at the University of Texas who works with particles and weather, algorithms. He’s working with the Walter Reed Hospital, helping them look at big data, artificial intelligence. Another scholar, David Jones, works with functional medicine, changing the paradigms of what they’re teaching in schools. Another one, Bud Brainard, works with light. He said, “I’ve been running my lab for 25 years and I’d almost forgotten why I’d gotten into this.”
 
This helps them remember.
 
It’s a chance to get back to why I went into this, to reconnect to that and then have some new experiments grow out of that. Ellen Hughes is working with healthy aging. Claudia Witt in Berlin is working with comparative effectiveness research. It’s a wide group there. We have forums in different areas. There was one on comparative effectiveness research in integrative medicine. Another was the Affordable Care Act conference at Georgetown, where you and I met. And we just had one a couple of weeks ago at the Bosch Foundation, where we brought people together from the world of business, in mergers and acquisitions, on what makes a merger successful or not successful, and what can integrative medicine learn from this. Integrative medicine is also a merger of a kind, of different cultures coming together. We’re also starting a fellowship program for young people who are at a stage in their careers where they can benefit from good mentors.
 
The last thing I’ll mention is the practical, on the ground question, “How do we create healthy communities?” There we’re doing things that are beyond the clinic, that take into account the environment, along with good food and stress management. We’re working with some of the tough high schools in Baltimore. We’re working with Health Corps and adding some of our own pieces to that.
 
Daniel Redwood, DC, the interviewer, is a Professor at Cleveland Chiropractic College–Kansas City. He is the Editor-in-Chief of Health Insights Today, Associate Editor of Topics in Integrative Healthcare and serves on the editorial board of the Journal of the American Chiropractic Association. Dr. Redwood’s website and health policy blog are at www.redwoodhealthspeak.com.

A previous version of this article was published in Health Insights Today, a publication of Cleveland Chiropractic College -- Kansas City, and is reprinted with permission.

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References

1.   

Berman BM, Langevin HM, Witt CM, Dubner R. Acupuncture for chronic low back pain. N Engl J Med. Jul 29 2010;363(5):454-461.



2.   

Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. Dec 21 2004;141(12):901-910.



3.   

Berman BM. Integrative approaches to pain management: how to get the best of both worlds. BMJ. Jun 14 2003;326(7402):1320-1321.



4.   

Berman BM, Bausell RB, Lee WL. Use and referral patterns for 22 complementary and alternative medical therapies by members of the American College of Rheumatology: results of a national survey. Arch Intern Med. Apr 8 2002;162(7):766-770.



5.   

Berman BM. Complementary medicine and medical education. BMJ. Jan 20 2001;322(7279):121-122.



6.   

Berman BM. Clinical applications of acupuncture: an overview of the evidence. J Altern Complement Med. 2001;7 Suppl 1:S111-118.



7.   

Berman BM. Seminal studies in acupuncture research. J Altern Complement Med. 2001;7 Suppl 1:S129-137.



8.   

Berman BM, Swyers JP, Hartnoll SM, Singh BB, Bausell B. The public debate over alternative medicine: the importance of finding a middle ground. Altern Ther Health Med. Jan 2000;6(1):98-101.



9.   

Berman BM, Swyers JP, Ezzo J. The evidence for acupuncture as a treatment for rheumatologic conditions. Rheum Dis Clin North Am. Feb 2000;26(1):103-115, ix-x.



10.   

Berman BM, Hartnoll S, Bausell B. CAM evaluation comes into the mainstream: NIH specialized Centers of research and the University of Maryland Center for Alternative Medicine Research in Arthritis. Complement Ther Med. Jun 2000;8(2):119-122.



11.   

Berman BM, Bausell RB. The use of non-pharmacological therapies by pain specialists. Pain. Apr 2000;85(3):313-315.



12.   

Berman BM, Swyers JP, Kaczmarczyk J. Complementary and alternative medicine: herbal therapies for diabetes. Journal of the Association for Academic Minority Physicians : the official publication of the Association for Academic Minority Physicians. 1999;10(1):10-14.



13.   

Berman BM, Swyers JP. Complementary medicine treatments for fibromyalgia syndrome. Bailliere's best practice & research. Clinical rheumatology. Sep 1999;13(3):487-492.



14.   

Berman BM, Singh BB, Lao L, et al. A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Rheumatology (Oxford). Apr 1999;38(4):346-354.



15.   

Berman BM, Ezzo J, Hadhazy V, Swyers JP. Is acupuncture effective in the treatment of fibromyalgia? J Fam Pract. Mar 1999;48(3):213-218.



16.   

Berman BM, Singh BB, Hartnoll SM, Singh BK, Reilly D. Primary care physicians and complementary-alternative medicine: training, attitudes, and practice patterns. J Am Board Fam Pract. Jul-Aug 1998;11(4):272-281.



17.   

Berman BM, Jonas W, Swyers JP. Issues in the use of complementary/alternative medical therapies for low back pain. Phys Med Rehabil Clin N Am. May 1998;9(2):497-513, x.



18.   

Berman BM, Swyers JP. Establishing a research agenda for investigating alternative medical interventions for chronic pain. Prim Care. Dec 1997;24(4):743-758.



19.   

Berman BM. The Cochrane Collaboration and evidence-based complementary medicine. J Altern Complement Med. Summer 1997;3(2):191-194.



20.   

Berman BM, Singh BK, Lao L, Singh BB, Ferentz KS, Hartnoll SM. Physicians' attitudes toward complementary or alternative medicine: a regional survey. J Am Board Fam Pract. Sep-Oct 1995;8(5):361-366.



21.   

Berman BM, Lao L, Greene M, et al. Efficacy of traditional Chinese acupuncture in the treatment of symptomatic knee osteoarthritis: a pilot study. Osteoarthritis Cartilage. Jun 1995;3(2):139-142.