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Bradly Jacobs, MD, MPH: Changing the Face of Integrative Medicine Research

Bradly Jacobs, MD, MPH: Changing the Face of Integrative Medicine Research

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Bradly Jacobs, MD, MPH, is cofounder, senior vice president of clinical affairs, and senior medical director of Mytrus, Inc, San Francisco, California, a clinical research organization dedicated to providing technology and services for remotely conducted direct-to participant clinical trials. Dr Jacobs has a private practice at Cavallo Point Lodge in Sausalito, California. Dr Jacobs is focused on developing innovative clinical models and research methods to help people live healthier, happier, and more productive lives in an environmentally sustainable way. To this end, he spends his time conducting research and building technology platforms and decision-support tools at Mytrus, Inc, and caring for patients in his integrative primary care clinical practice. Dr Jacobs is trained in internal medicine and has studied acupuncture, nutrition, herbal medicine, stress management, yoga, and martial arts. He is the senior author of The ACP Evidence-Based Guide to Complementary and Alternative Medicine (American College of Physicians; Philadelphia, PA; 2009). (Adv Mind Body Med. 2012;26(1):22-29.)
Editor’s note: This interview is an excerpt of an interview first published in the March/April 2011 issue of Alternative Therapies in Health and Medicine (Altern Ther Health Med. 2011;17(2):61-70.)
Bradly Jacobs, MD, MPH, is cofounder, senior vice president of clinical affairs, and senior medical director of Mytrus, Inc, San Francisco, California, a clinical research organization dedicated to providing technology and services for remotely conducted direct-to participant clinical trials. Dr Jacobs has a private practice at Cavallo Point Lodge in Sausalito, California. Dr Jacobs is focused on developing innovative clinical models and research methods to help people live healthier, happier, and more productive lives in an environmentally sustainable way. To this end, he spends his time conducting research and building technology platforms and decision-support tools at Mytrus, Inc, and caring for patients in his integrative primary care clinical practice. Dr Jacobs is trained in internal medicine and has studied acupuncture, nutrition, herbal medicine, stress management, yoga, and martial arts. He is the senior author of The ACP Evidence-Based Guide to Complementary and Alternative Medicine (American College of Physicians; Philadelphia, PA; 2009). (Adv Mind Body Med. 2012;26(1):22-29.)
Editor’s note: This interview is an excerpt of an interview first published in the March/April 2011 issue of Alternative Therapies in Health and Medicine (Altern Ther Health Med. 2011;17(2):61-70.)

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Spring 2012.22 ADVANCES. NO. MD. MPH . 26. VOL. 1 X An Interview With Bradly Jacobs.

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Bradly Jacobs, MD, MPH: Changing the Face of Integrative Medicine Research
Interview by Craig Gustafson and Suzanne Snyder • Photography by Kevin Meynell Photography

Bradly Jacobs, MD, MPH, is cofounder, senior vice president of clinical affairs, and senior medical director of Mytrus, Inc, San Francisco, California, a clinical research organization dedicated to providing technology and services for remotely conducted direct-to participant clinical trials. Dr Jacobs has a private practice at Cavallo Point Lodge in Sausalito, California. Dr Jacobs is focused on developing innovative clinical models and research methods to help people live healthier, happier, and more productive lives in an environmentally sustainable way. To this end, he spends his time conducting research and building technology platforms and decision-support tools at Mytrus, Inc, and caring for patients in his integrative primary care clinical practice. Dr Jacobs is trained in internal medicine and has studied acupuncture, nutrition, herbal medicine, stress management, yoga, and martial arts. He is the senior author of The ACP Evidence-Based Guide to Complementary and Alternative Medicine (American College of Physicians; Philadelphia, PA; 2009). (Adv Mind Body Med. 2012;26(1):22-29.)

of Mount Everest at around 14 000 feet. While I was there, I was providing care to both tourists and the locals. Coincidentally, I ran into Bernard Osher, whom I had heard of and knew had an interest in integrative medicine—or at least in progressive approaches to the delivery of health care. I struck up a conversation with him, not really knowing who he was, up in the middle of nowhere at about 12 000 feet in a village called Tengboche. He said, “When you get back to the United States, you might hear my name.” Upon returning from my trip to Nepal, I came back to find that Mr and Mrs Osher had been kind enough to— through his foundation, the Osher Foundation—give a $10 million grant to the University of California San Francisco to create what is now called the Osher Center for Integrative Medicine. Ellen Hughes had been appointed interim executive director of the center while UCSF looked for a permanent executive director. She asked if I would come on as the founding medical director for the clinical programs at the Osher Center. ATHM: Did you know from a young age that you wanted to pursue medicine? Dr Jacobs: What influenced and informed my interest in a broad perspective toward health is that I started practicing martial arts at the age of 8, and that has profoundly influenced my interest and perspective toward life in general but specifically around health. I continue to practice martial arts. The second influence was my grandmother, who took up yoga at the age of 65 and practiced for 22 years before passing. Those were the two most profound influences that set the stage for me to be interested in a more broad approach toward health. I practiced martial arts at the Chuck Norris Studios, in a style called tang soo do, a Korean style of martial arts. The friend who got me excited about it dropped out, but I continued to really enjoy it, so I continued on that path. It taught me the concepts of qi, or an energetic body. At that time, I didn’t have an intellectual understanding of it but rather simply cultivated an embodied sense, and as I got older, the experience and insight that came as a consequence was an integral part of my normal human existence; I was aware of my own internal energetic body and also aware of how you can use the mind to direct your intention and to inform your decision making. No one in my family was in the health-care field except for a second cousin, who is a dentist. Actually, my father, who is now deceased, found doctors to be quite arrogant
ADVANCES, Spring 2012, VOL. 26, NO. 1 23

Editor’s note: This interview is an excerpt of an interview first published in the March/April 2011 issue of Alternative Therapies in Health and Medicine (Altern Ther Health Med. 2011;17(2):61-70.)

Alternative Therapies in Health and Medicine (ATHM): Please tell us about your background and education. Dr Jacobs: I was born and raised in the United States and completed medical school at Stanford University. From there, I went on to do a residency and a research fellowship at the University of California San Francisco. During that time, I did acupuncture training in medical acupuncture through the Helms Institute and five-element acupuncture through the San Francisco School of Acupuncture. After completing my training and the fellowship, I went overseas and worked in a high-altitude clinic in Nepal through the Himalayan Research Association. The highaltitude clinic is in the Khumbu Valley, which is at the base
Opposite: Shown here at Cavallo Point Healing Arts Center & Spa, Dr Jacobs believes that one of the few blessings of the current health care crisis is that because of increasing health care costs, people will be more motivated to engage in self-care.
X An Interview With Bradly Jacobs, MD, MPH

as he would say. In martial arts. now I have the time to pursue learning more about Chinese medicine more formally. Spring 2012. and I went to medical school at Stanford University. in college I became interested in malnutrition in developing nations and decided to live in Africa for a year after college. it would be my martial arts teachers and my grandmother. the best chance one has to transform a system is by assimilating within the system so that you become “one of them. If you look at some of the classic teachings and you start to learn about Chinese philosophy. you don’t have anything. Those were the two paths I was considering. It stresses how important your intention is and how important your thoughts are. “When did you decide you were going to practice alternative medicine?” If I had to attribute it to individuals. a discussion of how intent creates actions.” That’s when I decided that I would go into medicine. Those interventions have a massive salubrious impact on populations. After I did my training. I didn’t even know about naturopathy schools at that time. where naturopathy wasn’t recognized as a health profession. Also. ATHM: How did your foray into acupuncture come about? Dr Jacobs: It was a fairly natural extension of practicing martial arts. People often ask. and that then feeds back and creates your character. and David Eisenberg. so I decided that I wanted to pursue that. I had been considering a career as an acupuncturist vs medical doctor. Once I had decided this was the path I wanted to pursue. the late Barry Rosen. that is what would make me happy. I pursued a public health degree at the University of California at Berkeley and studied epidemiology and biostatistics. Dr Jacobs: Yes. I was trying to decide whether I should study Chinese medicine and become a licensed acupuncturist or go to medical school and become a medical doctor. I and the other medical students organized a student-run international health and alternative medicine group. As I grew. Once I decided to go into the field of health. MPH . I became more and more interested in public health and malnutrition and the living conditions of developing countries. a natural extension of those philosophies is Chinese medicine. After college. 1 X An Interview With Bradly Jacobs. 24 ADVANCES. “When did you decide you wanted to become a doctor?” And. But he supported me in my decision to pursue this career path if. It was a conscious decision. But I decided to take that path so that I could be within the hub of the power center of how health care is delivered in the United States and try to change the system from within. John Weeks. vs going to study Chinese medicine and coming out with a licensed acupuncture degree and not having quite the same leverage. After my public health school studies. Dean Ornish. there’s a range of dialogue that would occur at the character level. MD.and pompous. We would bring lecturers in and learn quite a bit about the prejudice.” ATHM: How did knowing that you wanted to help effect change in the health-care system influence your experience at medical school? Dr Jacobs: Despite its overall conservative political attributes. 26.” and she focused on the importance of being proactive and preventive in your own personal health. Brian Berman. It was through that experience that I realized how public health has dramatically elevated health globally through campaigns focused on concepts we take for granted here in the United States and Europe. I was fortunate enough to meet and seek guidance from some of the major national leaders who are around today. Stanford allowed its students to pursue a range of interests. vaccinations programs. they attribute it to a specific mentor or someone they met along the way who encouraged that. “If you don’t have your health. such as sanitation and hygiene. I had been treated by Chinese medicine practitioners and knew that it was powerful and indeed had beneficial effects. I engaged more and more with people like Andrew Weil. “Okay. When I decided to go into medicine after public health. VOL. But it seems that your journey was more internally driven. I realized the best way to change the current healthcare delivery system was from within—that is. ATHM: Often when people start out with more conventional medical training and then get into integrative medicine. being in California. My grandmother would say. I decided to go to medical school knowing full well that I was about to walk into a profound socialization process and recognizing that it might change my character in the process. I said. NO.

and we created the clinical practice. director of education. 10 000-plus-square-foot facilities weren’t making it. or medical school. and a lot of the social workers and the people who don’t usually attend lectures came as well. there was an opportunity for me to at least raise the issue of qi. paying them a minimum salary that covered their time to attend our weekly case conferences and cross discipline training sessions. ATHM: Between your residency and joining the Osher Center. and that wasn’t happening. Unlike many of our predecessors who hired a large practitioner staff on full-time salary. I found many of these centers were financially struggling and others were closing. did you have opportunities to work toward advancing the acceptance of integrative medicine? Dr Jacobs: Everyone does a thesis where I trained. It’s like that story where you’ve lost your key. and power struggles between health disciplines. chiropractics. and he says. That sort of set the stage: once the Osher Center was created.politics. I had drafted a business plan and circulated it through both the internal and external groups. about 2500 square feet. and it is reflective of many education institutions. NO. 26. we didn’t take insurance. where they give a final presentation to the division. All of the nurses attended it. PhD. The thought was. MD. MPH ADVANCES. ATHM: What was your experience at the Osher Center like? Dr Jacobs: I was at the Osher Center from 2000 to 2006. Very few of them wanted to engage in a dialogue at all. it was fee for service. the first long-term goal I pursued as medical director for the clinical programs was to X An Interview With Bradly Jacobs. I came to realize that large. so this is where I’m looking. As their practices grew. and we created a scholarship fund for people who couldn’t afford care to allow people across the economic spectrum to come. That was one of the main indications that things were shifting. we could provide salary and benefits. I remember in one class. “Well. I did mine on acupuncture. and then I did some demonstrations of acupuncture for the hundred or so people who attended.” The key is really across the street. it was a natural fit for me to be helping lead that center.” We wanted to start with a very small impact and let it grow over a decade. I spent the next several months writing a business plan and developing financial projections to ensure we had the best chance of achieving sustainability within 5 years. which included touring both private and community-based integrative medicine programs across the country. That was the experience I had at Stanford. lots of money went into these large. beautiful facilities. Ellen Hughes. Spring 2012. they will come. whether they be schools of acupuncture and traditional Chinese medicine. The hope was that if you build it. sitting in a dark corner. and that’s what we did. As part of my lifetime mission to change the healthcare delivery system from within. 1 25 . Susan Folkman. MD. That was a moment when I realized how narrow-minded— or focused in a very different direction. Initially. and I can remember raising my hand and posing the question. These practitioners would then share a percentage of the revenue generated from their clinical activity. shall we say— Western medicine is. I had gone through all the literature and presented all the research behind it. We started the initiative in 2000. I found very few centers that were fiscally sound. PhD. and I were the only clinical faculty. to try to figure out which ones were working and which ones weren’t and to understand why. That was quite an interesting experience. We intentionally made it quite small. as well as academic-based programs. We asked them to grow their practices within the center itself. and they just didn’t have the volume to support them. naturopathy. and this is an example of that. “Small is beautiful. but he feels much more comfortable looking where the light is. Good things take a while to mature. which allowed Ellen Hughes to accept the position she had always been passionate about. We wanted to start very slight and let it grow over time. VOL. I had a crowd—a larger crowd than was typical. Over the past couple of decades. We had a slow start. I spent about a year and a half doing background research. A few years later. We then started to ask our medical school instructors questions about alternative medicine. Initially. “Does qi exist? Is there any science that supports it?” The instructor and many of the class members laughed at me. people who were very mature in their practices. accepted a position as executive director. The faculty had to recognize that this was an area of importance. and hired folks in an intentional manner. we opened the clinical practice with only one and a half fulltime salary equivalents (across three faculty) and hired the remaining six practitioners. everyone thought I was making a joke. and you see someone looking under the street lamp. this is where the light is.

But despite those scious decision to go the path of having them be recognized effects.series of meetings. that we would come in as an They felt that it gave substance S HEALTH CARE integrative medicine group and credibility to what they providing care for inpatients. 26. We showed that in addifiliated health programs where tion to that treatment. The other issue is that know if these therapies—acupuncture. The second was the relationships that we created with the spine center. as well. improve weren’t credentialed as health mood. PEOPLE having proven that there was cess for that and created scopes some benefit to what we were of practice so that these practiWILL BE PUSHED TO offering. within the university. and sure enough.” We had a to offer it.” We said. such as as. in this case. Many of those gram in light of those results. 1 X An Interview With Bradly Jacobs. tory and inpatient settings in the hospitals and clinics. I’ve seen that time and time again. most part. for the would start sending their patients to us. VOL. city level. There were already signifiAnother major aspect of our work at the Osher Cencant groups within the university that were quite upset about ter is that we developed and then offered an inpatient prothe existence of an Osher Cengram within the university so ter for Integrative Medicine. and they quite progressive. the medical faculty at those centers would Dr Jacobs: It’s very interesting.ATHM: It’s surprising that there was resistance to the protility center. It will be interesting to see over the next several sistant professor. So we had provided care to post surgical to navigate this minefield quite BECOMES MORE patients in the cancer hospiadeptly. PhD. That is the model for our future naners we were going to approach them about first and which tionally. yoga therapists. That was one inpatient services and will budget accordingly to allow them of the most important accomplishments during my tenure to continue. there is resistance. The early con. Even though California is naturally feel more comfortable and trusting of us. Then we decided called a licensed acupuncturto convert it to a clinical reist— and a yoga therapist and AND MORE ON THE search trial so that we could a massage therapist. associate professor. we don’t really sorts of initiatives. “Listen. if a service isn’t a source of revenue or isn’t one that the instiso I’m only willing to have this conversation in the context tution would be reimbursed for. (the new executive director) have remained commitIt took a lot longer. and I brought one of our senior acupunctitioners. Just like there is with race and religion. all of a sudden the divide dissolves. initially. at the Osher Center. tioners could be recognized as We ran a clinical trial health professionals within the TAKE CREATER CON. we ended up creatEXPENSIVE AND THE port from the Mount Zion ing for the first time ever at the Health Fund. they’re much more reluctant of doing clinical research together. After that.venous opiates if they needed volunteers or through the afthem.turists to them. NO. MD. that was indicative of the whole issue: because hundreds of hours working with the executive medical group of fear and ignorance. depending on their discipline. and Margaret Chesney.similar throughout the nation. conversations. And traditionally trained physicians are fairly A classic example was the fertility center. We received grant supmeetings. the cancer center. PhD. and full professor.tive medicine. for example—work. I spent To me. Both Susan Folkman. were about doing research collaboratively.where we provided people university. Every university. ones we would have to wait on. Spring 2012. A 26 ADVANCES. we were DEN. We made a conisfaction. MPH . After literally dozens of tal. it’s the mining which practitioners would be allowed to practice same within health care. thought was a field that didn’t SHIFTS A N D Specifically.hospitals. we deserve any of that.and community patient had an inpatient pain based hospitals chose a differIN ORDER TO DECREASE service consultation. with therapy or they were Most if not all of the other TROL OF THEIR HEALTH wait-list controlled. after maybe four or five tialed health professionals who could practice in the ambula. the hospital was unwilling to support the inpatient for all that they should be recognized for at the state level or service. the academic institutions aren’t. the fer. That years whether the hospital recognizes the benefits of these was another reason why we took the first step. improve patient satprofessionals.have the medical center recognize Chinese medicine prac. and we ran this university a health professional BURDEN IS PUT MORE program. We went get long-term support after through the credentialing proINDIVIDUAL. They chose to let these received epidural and intrapractitioners come in either as THEIR FINANCIAL BUR. they started sending us patients. “Fine. and massage therapists as creden. and the women’s health center.and there’s collaboration. but the natural subsequent route was ted to gaining acceptance of this program at the university going to be to allow them to have academic titles. there is a prejudice against alternafor the hospital. People ent path.meetings. We were very strategic in determining which practitio. so when it comes to these versations were along the lines of. And through exposure. they weren’t recognized as and able to decrease pain. it was an interesting process of them deter.

There are other places that do this sort of thing but we’re different in that we are not located within an academic medical center. yet I felt as though we were moving much too slowly in affecting how health care was delivered across the medical center. I had applied for a career development grant at the National Institutes of Health and was fortunate enough to win that award. 1 27 . nutrition services. It’s in a gorgeous area next to the Discovery Museum for Children and the Coast Guard. Dr Jacobs: I’m in private practice at Cavallo Point Lodge in Sausalito. Fort Baker. was thriving. DC. hypnotherapy. She did a tremendous job teaching consumers and the medical students. as she had committed her career to medical education and is a gifted and passionate educator. the timing was right to set up a practice there. We provide an opportunity for people to get a thorough and in-depth overview of their health and then plan for themselves in a comprehensive manner. 26. Finally. and more. we weren’t allowed to prescribe herbs. close to a metropolitan city and to an academic medical center at UCSF with which we have an affiliation. I am providing primary care. so we are able to manage tertiary care. Additionally. which was on the north side of the Golden Gate Bridge in Sausalito. similar to other universities. and cooking school. By the time I decided to leave. herbal medicine. It was moving too slowly for the amount of change that I wanted to see happen. and faculty. refreshing opportunity for me. We are in a spectacular national park. underneath the northern pillar of the Golden Gate Bridge. But when we try to offer something new that’s considered “alternative medicine” or an “integrative medicine” approach. The Healing Arts Center has massage therapists and body workers and offers acupuncture. so I went off to Revolution Health. we do 3.What’s interesting is that hospitals offer plenty of different services that have never undergone a randomized clinical trial. We had made a fair amount of progress at the university over a fair amount of time. The lodge would not open for 1 to 2 years. MD. Naturopaths weren’t on our staff at that time. ADVANCES. it was slower than I wanted to move. it falls under the rubric of “the effectiveness needs to be demonstrated through clinical research. We were fortunate to have Ellen Hughes as our director. Passport Resorts in partnership with Equity Community Builders was awarded the opportunity to create the lodge. but show me the randomized trial at that specific setting that has demonstrated changes in important outcomes. NO. converting the military barracks there. show me the clinical trials that show that the pain services reduce duration of hospitalization or reduce costs. People can go there for a comprehensive assessment and then participate in fitness activities. Spring 2012. which I’ve since done. In addition. the third pillar at the Osher Center. I had to make some decisions. The property has a demonstration kitchen where cooking classes are held. a third of our patients were referred from providers within UCSF. As I said. which is a wonderful. there was a lot of openness toward getting research grants and doing interesting research. This is not unusual for academic medical university hospitals. we provide a monthly lecture series that’s free to the public. We had no chiropractors on our staff. education. There are dozens of hiking trails in the Marin Headlands.” Meanwhile. so visitors get the best of both worlds. including nature hikes and walks. and we also have a gym there. I have a relationship with UCSF. A different standard is put forth for this new paradigm in health than for the conventional paradigm. Her work will affect generations of health-care providers in the future. One was with a lodge called Cavallo X An Interview With Bradly Jacobs.and 5-day health retreats on the property. where they can learn to cook more healthful foods and to cook and eat in a more mindful manner. and there was limited support in the administration for what we were trying to do in the clinical practice. In 2006. ATHM: Where did you go after leaving the Osher Center? Dr Jacobs: I had started two conversations before leaving for Washington. the clinic was growing rapidly. and when I came back. On the other hand. The owners had asked if I was interested in coming to the lodge to provide integrative health services in a retreat center there. We know they can generate huge amounts of financial reimbursement for the hospital. People also come for consultations. VOL. MPH Point Lodge. ATHM: Please tell us about your current practice. residents. as well as a weekly yoga/martial arts class that’s about learning to be embodied within your being and how to awaken one’s mind and body to one’s intentions. people can see cardiologists or other specialists and get whatever imaging they may need to have done during their stay. On the other hand. In addition.

if research had shown it was not effective therapy. people will be pushed to take greater control of their health in order to decrease their financial burden. MPH . and how do you design the intervention in a manner that feels like “real” massage yet doesn’t have the potential health benefits of the real intervention? These are challenging issues to overcome. ATHM: There have been many challenges in demonstrating the efficacy of integrative medicine through traditional clinical trials. you probably have seen quite an increase in its popularity. allowing them to tweak the intervention to improve its effectiveness. They think. How do you design. The intent of that book was to provide a resource for the conventional medical doctors so that when their patients ask them a question about alternatives to medications or surgery. Unfortunately. MD. they can discover that if they engage in basic activities of self-care. and conclusion. thereby making it appear that Chinese medicine doesn’t work when actually the research study pulled out a small component and manipulated that component in a manner that does not reflect clinical practice. This proves quite challenging. 26. In a book that I coedited. At least 10% of the population is practicing yoga. intervention. methods. when looking at the research. and being socially engaged. Spring 2012. One can argue we are intentionally limiting the effectiveness of the intervention and in so doing reducing the likelihood that we will find the therapy effective. That’s one of the few blessings in the current health-care crisis: people will be much more moved to engage in self-care. 1 X An Interview With Bradly Jacobs. seeing a yoga mat at a Walmart was unheard of. You need to be mindful of what you’re doing. Though this is widely recognized as an effective treatment. We did a survey in 1997 that showed that about 50% of practitioners were using alternative therapies at UCSF and 50% of the practicing doctors were using it. cultivating resilience. acupuncture needles. One needs to be clear about the design of one’s hypothesis. look up the question. As health care shifts and becomes more expensive and the burden is put more and more on the individual. With some coaxing from health-care professionals. comparison groups. I think that money—rather than the theoretical concepts like telling people that they’ll feel better—will be the primary driver in people improving their health. It needs to be modified based on what the different treatments are that you’re studying. we devote a section to this issue. for example. you will find most studies limited the therapy to a single acupuncture point: pericardium point number 6 (PC-6). clinical researchers encourage their colleagues to restrict the intervention to smaller parts in order to be able to discern better why the intervention is working or perhaps not working. Dr Jacobs: Absolutely. What’s really interesting is to see large retail stores like Walmart selling yoga mats. and bodywork and provide nutrition and dietary guidance when rendering treatment in his clinical practice. the American College of Physicians Evidence-Based Guide to Complementary and Alternative Medicine. a fundamental concept of the treatment or desired outcome is difficult to measure. adequate placebo controls. and have an answer in less than 5 minutes. but what does that mean. In the early 1990s. NO. Acupuncture provides a great example of the mechanism of action not being fully understand from a scientific perspective and. as with all research regardless of the intervention. you can rest assured that practitioners of sound mind would take issue with the fact that the studies were not designed in a manner that represents clinical practice. including proper concealment of treatment assignment. such as exercise and eating more fruits and vegetables. I think there will be an even more dramatic shift in the next 5 or 10 years. The bottom line is. they can dramatically reduce their health-care costs. being more mindful. Now we see DVDs and CDs of relaxation practices and yoga mats in a Walmart in Kansas. We have seen a dramatic increase since then among both practitioners and consumers. and you must account for the specific intervention in both your hypothesis and in your conclusion. consider fixed acupuncture for the treatment of nausea and vomiting. chosen outcomes. the challenge of creating standardized interventions makes it difficult to replicate clinical practice and clinical trial protocols. that you can do research on complementary and alternative therapies. they can grab the book. Furthermore. but people are so conceptually removed from that experience that they can’t imagine the difference. Acupuncture is an example of an intervention that is typically composed of multiple treatments. There is some great research by Pomerantz and Stutz 28 ADVANCES. VOL. While the research shows this is an effective therapy. One of the sections is devoted to just this question: how do we evaluate complementary and alternative medicine in the context of research? Some say the results don’t mean anything because there’s too much of a placebo effect and you can’t really tease out the placebo effect from the effect of the therapy itself. Frequently. practitioners typically use multiple points (including PC-6) and frequently will alter the points used depending on the presentation of the patient at each visit. a Chinese medicine practitioner will use herbal medicine. or manipulate. a proposed mechanism of action does not cor- relate with currently accepted principles of science. the intervention is typically comprised of multiple treatments. the treatment will be individualized across patients and within a single individual over time.” they’ll be more motivated to make changes. an adequate placebo control trial for massage? One can use “sham” massage. “What does it mean to feel more vibrant? What does it mean to have a better quality of life?” But when you say. Typically. Though this makes it easy for scientists to replicate the study. of course. are particularly difficulty to design. it is important to have sufficient number of people participate in the study to ensure you are able to detect differences between the two groups and therefore be able to say the therapy works or does not work. It’s true. Can you comment on that? Dr Jacobs: This is a very important topic. For example. define. Is where the needles are located what matters or not? That is a complex question. “It’s going to affect your pocketbook. There are six main categories to consider when discussing challenges to studying CAM: a proposed treatment was developed before current concepts of scientific analysis could influence its evolution.ATHM: In the time that you have been practicing integrative medicine.

Publications by Dr Jacobs include the following: • Mehling W.33(3):258-266. Altern Ther Health Med. PA: The ACP Press. 2004. et al. Tice JA. Iaquinto G. NO. Bent S. J Pain Symptom Manage. • Rambaldi A. That is. this effect is more like 50% or 60%. If you know that. 1 29 . Only when you combine them in systematic reviews or meta-analyses. 2009. anywhere on the body results in decreased pain experience. That can take many different forms in the academic world. This is called a type 2 error and relates to having what is called an underpowered study. scientists frequently had limited funding to run large studies and therefore would conduct research only to realize later that their studies had insufficient power to detect a difference between groups. Blackwell T. Jacobs BP. et al. Acree M.B a s ed Guide to Complementary and Alternative Medicine. 26. Gundling K. • Jacobs BP. Lawrence V. Milk thistle for alcoholic and/or hepatitis B or C liver diseases—a systematic cochrane hepato-biliary group review with metaanalyses of randomized clinical trials. MPH ADVANCES. Symptom management with massage and acupuncture in post-operative cancer patients: a randomized controlled trial. based on studies they did in the ’70s and ’80s in Canada: they showed putting a noxious stimuli. the study did not have sufficient power to detect a difference between two groups when indeed the difference was present. Dennehy C. Providing students—in their formative years—with exposure to a broader perspective of health is critical and will improve health care because it will shift the practice of these future generations of practitioners. the effect is more like 70% to 80%. Am J Med. I think it’s important for practitioners to encourage acupuncture students. in the respective schools. ATHM: What are your thoughts on the future of integrative medicine? Dr Jacobs: One of the things I focused on when I was at the Osher Center was to create collaboration between medical students and the students of an acupuncture college—in this case. you find that the therapy actually did work. When you bring them together in aggregate. Suzanne Snyder was managing editor of Alternative Therapies in Health and Medicine. MD. If there’s a placebo effect at 30% to 40%. But when you do specific point location. Philadelphia. VOL. Cummings SR.84(4):197-207. Spring 2012. The American College of Traditional Chinese Medicine. and I have seen the importance of this sort of exposure. Often. massage therapy students. X An Interview With Bradly Jacobs. Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. • Jacobs BP. 2007. Avins A. 2002. Gluud C. eds. Mehling W.113(6):506515. a needle. • Jacobs BP.10(2):80-83. 2005. Am J Gastroenterol. you see that there is a difference. 2005. Jacobs BP. and medical students to come into their practices so that they can see that there is a different world from what they’re learning. Ramirez G. Medicine (Baltimore). there is a more narrow view of health care and of how it should be provided. In the ’70s and ’80s. Feasibility of conducting a clinical trial on Hatha yoga for chronic low back pain: methodological lessons. Those types of scientific requirements are important to think through when you’re designing a study. you need to have enough people in the study to be able to detect a smaller difference. Craig Gustafson is editorial director at InnoVision Professional Media. An internet-based randomized. • Jacobs BP. The American College of Phy sic ian s ( AC P ) Ev ide nce . naturopathic students. Ellen Hughes and I spent a significant amount of time trying to create an exchange program between the medical students and the acupuncture students. One of the most important things that we as health-care educators and practicing health-care providers can do is provide exposure. I have sat on the board of The American College of Traditional Chinese Medicine for the past several years. placebo-controlled trial of kava and valerian for anxiety and insomnia.100(11):2583-91.

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