Research can be a problematic area for practitioners of East Asian medicine.  While many acupuncturists are keen to share research with patients that paints acupuncture in a positive light, especially for marketing purposes, there are not many of us that are generating that research. And there is the issue of double-blind studies, which are the gold standard in conventional medical research, but difficult to apply to East Asian medicine, as the practitioner is an integral part of the treatment.

This episode is a conversation with a full on Western style Ph.D. researcher who also is a dedicated practitioner of East Asian medicine. She has some unique views on how to apply research methods to our particular methods.

Students of doctorate programs will find this episode especially helpful, as it will give you tools and perspectives to engage researching your area of interest and contributing to our profession.

Head on over to the show notes page for more information about this episode and for links to the resources discussed in the interview. 

The medicine of east Asia is based on a science that does not hold itself

separate from the phenomenon that it seeks to understand our medicine

did not grow out of Petri dish, experimentation, or double blind studies.

It arose from observing nature.

And our part in it east Asian medicine evolves not from the examination

of dead structures, but rather from living systems with their complex

mutually entangled interactions.

Welcome to qiological.

I'm Michael max, the host of this podcast that goes in depth on

issues, pertinent to practitioners and students of east Asian medicine.

Dialogue and discussion have always been elemental to Chinese

and other east Asian medicines.

Listen into these conversations with experienced practitioners that go deep

into how this ancient medicine is alive and unfolding in the modern clinic.

Today.

We're going to be talking about acupuncture and research.

Lisa Taylor Swanson with me, Lisa actually was on everyday

acupuncture podcast show number 38.

We got into some really cool stuff that she's doing with research in that one.

So that is a show worth listening to if research is your thing.

And actually if research is not your thing, it's worth listening to it.

Lisa is a long-time practitioner.

She had the fantastic abundant health clinic in Tacoma,

Washington for a long time.

She's recently moved to Utah where she's currently an assistant

professor at the college of nursing at the U of U university of Utah.

And she has a PhD in clinical research.

Oh, and one other thing that she's doing is she's got three different studies

going that have to do with acupuncture and cancer, and we'll get into that stuff.

Today, the focus is research, and we're going to come at this from a number of

different angles up to, and including those of you that are considering a Dom

or might be in a doctorate program, and you need to know something about research.

Listen up folks.

I got Lisa here.

Lisa.

Welcome to qiological.

Thank you so much to Michael.

I'm so psyched to be talking to you about this, cause you're such a research.

I've truly died in the wall.

I love it actually makes me happy.

I know it does.

And that's why I love our conversations around it because I'm basically

a guy that's like research.

Eh, it doesn't turn my crank.

And so it's, it's fun for me to go talk to someone who knows something and more

than that is lit up about something that I either don't know much about, or even

the, in some ways I don't care about.

Cause I get to learn something.

I want to start today talking about research, you know, a lot of us in

the acupuncture world, I don't know if we really use research so much in our

clinical work so much as we use it as a way of advertising and marketing.

You know, when there's some research that comes out and they

go, oh, look, acupuncture is better than opioids for pain.

You know, we use it as an advertisement.

We Facebook it, we Instagram it Twitter.

We try to say to the world, look, we are real.

We have this, you know, sort of evidence-based thing that says.

Our medicine really works, but in terms of actually using it in our clinic,

I'm not sure that many of us do that.

And so I'd like to begin today by hearing from you, how can research actually

be helpful to us in the clinical work that we actually do with patients?

Why should we bother?

What's the draw?

How can we engage?

No.

I think those are really essential questions.

And with east Asian medicine, traditionally station medicine, we are

really at the cutting edge of antiquity in terms of nowadays cutting, cutting edge.

When to equity.

Yeah.

And I think it comes full circle that way because where we, and this tradition has

been doing for Melania, what is now really fancy and sexy, that of personalized

medicine or individualized medicine that biomedicine is trying to figure out.

And it's a noble cause, you know, can we figure out which

medication to start a patient with?

For example, Can we tailor, can we individualize our approach to treating

cardiovascular disease or whatever, and that's great, but of course that's

what we've all done for this tradition for millennia and those of us in

our careers where 10, 20, 30 years.

So each patient, of course we diagnose, we treat individually, we

look at their differential diagnosis that often changes over time.

We rarely give the same treatment twice even to the same patient.

So of course.

When we look at most of research, that's randomized controlled

trials, have a set protocol.

Everybody gets the same thing.

I roll my eyes and probably all of our listeners do too, because right.

We're like, why bother this?

This has really nothing to do with how we practice medicine.

Yeah, it's so true.

So there's a really great group of researchers working

with Lisa Conboy and Boston.

She's at Nisa, the new England, new England school of acupuncture.

She's also an instructor at Harvard medical school and Dr.

Convoys team.

It's like my dream team.

It's really fun working with her because it's an interdisciplinary team, mainly

acupuncture researchers like myself, but also Lisa is a sociologist and the most

recent project looked at Gulf world.

So these are folks from the first Gulf war who are really sick and sadly, they're

getting worse over the, what is it, 20 years plus since they served our country.

And they're diagnosed with Gulf war illness by a cluster of symptoms,

there's usually pain, sleep, cognitive and emotional issues.

So these folks, again, sadly, they're getting worse over time.

Biomedicine has not successfully treated.

We had a trial of acupuncture.

Some of the people had acupuncture once a week.

Some of the people had acupuncture twice a week.

The main outcome measure was pain.

There were two assessments of that.

And clinically and statistically, there was significant improvement

over time in the group that had acupuncture twice a week.

So this is relevant to clinicians because we can look at this trial and

it was individualized acupuncture.

They were provided care.

As we clinicians would want them to be provided.

It was according to their presentation and how that changed over time.

And also we can learn in terms of dosing, because I know for myself,

I've treated patients just over 16 years and over time I had my own

clinical experience to draw from.

But as a newbie, I was like, I don't know.

So these people come in every week, twice a week, every other week.

So being able to look at dose, um, from this research study, I think

could be very helpful for clinicians as well as being able to understand.

In a study, we looked at more than just one symptom.

It wasn't only.

Again, pain, sleep, mood, cognitive concerns, and thinking about the whole

person and how they change over time.

That's what we do every day with every patient.

But this is a study that's again, I think really relevant to clinicians.

You know, this dosing thing really catches my attention.

Cause it seems like it's such, it's such a big question, right?

Do you do it once a week?

You know, in China that people might get treated every day

for like two weeks, right?

That's very common.

Sometimes you have people here in the states and, and part of their marketing

spiel is you have to have acupuncture once a month or don't bother coming in

because you know, it's dose dependent.

And if you're not going to do it, then get out of here.

And then there's other people, you do a few treatments and you know,

you never hear from them again.

And it's not because they weren't helped, but it's because their

life was completely changed.

They no longer need us.

And there's the issue of insurance.

Absolutely.

And paying out of pocket, depending upon the state that you're in Washington

state, I was always trying to Dole out visits because we had 12 a year for most

plans here in Utah insurance doesn't cover much like where you're at in St.

Louis.

So we're trying to navigate people's flexible spending

accounts and out-of-pocket costs.

And that's, I think one of the strongest drivers of dos in the

United States, it's quite unforced.

Tell us a little bit about the work that you're involved in right now.

You've got a couple of projects going on.

So it's been such a riot.

So I landed in Utah in July last year.

So I've been here a whopping seven months, almost totally.

And honestly, when I did my PhD at the university of

Washington, I had to be judicious.

I needed to learn about.

Particularly of course, about how to conduct studies.

And I also felt like I needed to kind of have a foot in east Asian medicine

world and a foot in biomedicine world.

So long story short, my work there really focused on midlife women's

health and the menopausal transition.

And not so much on east Asian medicine.

So now here I get to do both and I tell you, Michael, my

phone is ringing off the hook.

Well, nowadays it's email all the time, but there is so much interest.

I have to really be judicious about what I do and what I don't do.

Where's this SunTrust.

Everywhere.

I had a guy come gentlemen, who was interviewing for the school

of dentistry coming from Boston, thinking of relocating to Utah.

He wants to study to TMJ and he wants to study acupuncture as the intervention.

He's got his ground application ready to roll as soon as he lands here this

summer and give us you're on a job talk and job interview and wanted

to meet with me because he needs an acupuncture research college.

I'm collaborating with folks in the Huntsman cancer Institute.

We've got two studies that we're just getting IRB review and whatnot.

We'll launch soon.

I'm collaborating with folks in social work and psychology.

There's a real interest, genuine interest and respect for, for acupuncture research.

Now notice I'm saying acupuncture, sadly.

There's really not any traction around the whole umbrella of

traditional east Asian medicine.

So of course, how you and I, Michael, treat patients.

We provide acupuncture, Chinese herbal medicine.

We not cupping, you know, the whole kitten caboodle.

We're not there yet.

Acupuncture is the sexy one right now.

Well, it is.

And you know, really, when you think about it, it's the first acupuncture

sort of what gave at least Western coast.

You know, the, the foot in the door, it was acupuncture, right.

Not Chinese herbs.

Right.

So I could see it taking a while before that comes along, especially given the

pharmaceutical companies and such, right.

You know, acupuncture is such a fantastic modality and so much can happen by

just encouraging a person's own cheat.

Right.

So it's wonderful to hear.

So I'm curious, these studies that you're doing, are you getting to do

them like we do Chinese medicine or, or are you having to do these more?

Protocol-based things, what's it.

What's it looking like?

Well, hopefully it's looking like, what does it make me sick with protocols ideas?

I just won't do that.

I mean, if I had to, maybe I would, but I don't think so.

I think I would pass up the funding to be honest, which is a very serious

thing to say, especially since I'm on the tenure track and it's a bit

of a treadmill to procure funding.

But I just morally cannot conduct research that does not make sense to me clinically.

So happily one project is for women with breast cancer who have taken paclitaxel.

It's a chemotherapeutic agent known for inducing peripheral neuropathy.

So the term is CIP.

Chemotherapy induced peripheral neuropathy and we're providing

acupuncture will it's a small pilot study.

We'll randomize women into either yes, acupuncture, no acupuncture

and acupuncture will be delivered according to how the clinician sees fit.

Um, happily, I've got a terrific colleague, Dr.

Annie Buddha foci, who I'm collaborating with on this study.

And we're co-PI with another PI primary investigator, Kelsey justice,

sweat lick, and she's a neurologist.

We're also going to do conduct functional MRI at the beginning of the study on

all the participants and at the end.

And basically we're hoping to weave together two literatures there's

one literature on functional MRI regarding people with CIPN and

how there's changes in the brain.

Uh, once they've developed CIPN specifically in physical and

emotional aspects of pain process.

And then also we've got actually quite a bit of research on using functional

MRI regarding acupuncture, but today there's nothing that's looked at people

with CIPN receiving acupuncture can be document, basically these so-called

mechanisms of action that are neurologic.

Um, so we'll look at different areas of the brain.

And compare the group that had acupuncture, the group that didn't

have acupuncture one, how are their symptoms hopefully improved?

Of course, and then two as the brain different.

And that's pretty fascinating question, really, you know, all of a sudden I'm

getting kind of geeky and interested in research that lights me up too.

I'm particularly struck by your you're not just looking at, does it help?

And how does it.

You're looking at what else might be going on in here.

And I mean, back when I was in school, I think they were just beginning

to do some of these FMR cries.

And we were like, oh yeah, look at that.

You know, you do Guang mean gallbladder 37 and it lights up the visual cortex.

How about that?

Isn't that interesting.

Right.

And we thought that was cool.

And it is cool.

You're looking at taking this in and going at a much deeper level with this

to see what might be going on here.

Right.

Well, and I think this is where I really enjoy collaborating again with Dr.

Convoy.

We're working with Rosa, Schneier other colleagues as well at Nissa.

What we wants to do individually and collectively is take this

kind of work one there's for sure.

The aha wow.

Geek factor.

Look at what's happening in the brain.

But then again, so your first question in this podcast, Okay.

So what does that mean to acupuncturists or traditionally

station medicine providers?

Well, what if we can take the brain information basically and

go back to scalp acupuncture.

Could we modify our interventions.

Maybe we use one area of scalp acupuncture versus another there's

I think a way we can take what we learn biomedically, take it back to

the medicine and digest it because of course, this is a tradition that's alive,

it's emergent and it's intelligent.

The one example I often give to patients, or when I'm giving

talks, is that in France?

My understanding is acupuncture.

Any station medicine has been there long enough.

We now have the nausea, you know, ear system of acupuncture.

So again, this alive dynamic, emergent tradition, transplanted

to France, there's this new, you know, rubric to follow in providing

acupuncture with ear acupuncture.

So maybe in, you know, 5, 10, 20 years we'll have some new, I hate

to use protocols because again, that makes us all want to probably vomit.

Well, you know, I like the word that you used.

Interventions.

We have new interventions, we have new ideas.

We have other ways of thinking about it.

Absolutely.

And not always be tailored because that of course, I think is the power and the

strength of this medicine is that it's absolutely tailored to each person.

Each time we see them.

And each time, you know, the herbal formula changes, it

really there's nothing like it.

It's kind of perfect.

Well, and as you mentioned, conventional medicine is starting

to come around to this incredible idea of personalized medicine.

It's like, oh, cool.

There's this new thing, personalized medicine.

We're like, yeah.

And your point points, right?

Yeah.

You don't have to say is sort of an aside, but I think a lot about.

Why research that or does it matter?

And if so, how to clinicians of usage and medicine.

And honestly, I had some really good advice from one of my dear dear

mentors when I was 20, whatever, after I'd finished my bachelor's degree.

And I was trying to figure out what to do.

One half of me wanted to go do a PhD then, because I've always been a research geek.

And one half of me wanting to be a clinician.

Honestly, I was planning on going from Western medical school and long story

short because of dynamic systems theory.

I realized that's how you stage and medicine works,

looking at the whole person.

And I had to go study east Asian medicine asylum, even though I'm needle-phobic.

But my mentor said to me, you know, these stuff, it's not all that different.

When you're seeing a patient, you're doing research, it's just an N of one.

You're figuring out what is happening.

What's not working, what's working with that person.

So you're doing research in the clinic every day.

It's just a different design.

Yep.

It's an N of one, which often from the point of view of conventional medicine and

conventional research and of one studies are considered, well, that's anecdotal.

It's not a big enough.

And I can get that from a research point of view, but from the perspective of a

clinician and a patient that is dealing with something that no one knows what else

is going on and have one is all you got.

Well, and I think clinical expertise is stacking up those animal ones over time,

mentally, if you know, clinicians who are checked in and care and really engaged and

not overworked and not burned out, then you stack up those end of ones and then

you see a pattern and notice, oh yeah.

You know, when I see this general presentation, I'm going to start

with solo Tom, because I think, you know, it's blood deficiency

underlying, you know, or whatever.

So you can have that.

It's like a shortcut that you can have a quicker analysis because you've seen

it before more or less we'll, we're talking about brains and how they work.

And it seems to me that over time of tallying up in a sense, all of these

studies, all this clinical observation that we do that we're involved with,

something gets wired into our brains.

Um, something gets wired into the synopsis patterns arise and we

don't even have to think about it.

It's just, oh yeah.

You know, at a certain point, I mean, all of our learning starts

the software, so to speak, right?

You go to school, you memorize things, you learn theories,

blah, blah, blah, blah, blah.

But at a certain point, that stuff starts to get hardwired.

And that's when stuff really starts to have.

And that's when I think you get really good as a clinician.

Absolutely.

You see better outcomes you have and just clinical confidence.

Being able to sit with a patient and say, yes, I understand this.

And let me tell you, you know what my thoughts are.

There's so many patients I've seen with, uh, for example,

unexplained, infertility women.

They come in and.

Crying.

It's so frustrating because of course we're used to being

able to have everything to the minutia defined biomedically.

So of course it's even more distressing.

If someone has this unexplained, we don't know what's going on, but

for some reason you can't conceive.

And then for me to be able to say, I understand within east

Asian medicine, XYZ is going on.

There's Liberty constraint, underline Jing deficiency, you know, whatever

the differential diagnosis might be.

And when I can say to that woman, I see you and you make sense to me

and we can treat this over time.

Here's what you can do.

Here's what I can do.

It's a sense of.

The patient will often say to me, wow, well, that's still as weird as anything.

Yeah.

And young she blood, what have you, it's still foreign.

It's still strange.

But for them to hear from a clinician, they're understood

and they make sense to them.

And it's not in the patient's mind.

And of course, so much of that is sexism and how medicine is still delivered.

It's really comforting.

And I think there are better outcomes.

And that just comes like we were talking about with stacking up

those end of ones and making sense of clinical presentations.

You, I was just thinking too, as we're having this conversation, so often

people will come in and they'll say, you know, I've, I've been through

the conventional medicine route.

They say there's nothing wrong with me or whatever.

Yeah.

But of course the truth is they don't know what's wrong.

It's not that there's nothing wrong.

It's that they don't know what's wrong.

And often when I'm really truthful with myself, especially when I'm first

seeing somebody, I don't know either.

Totally.

Right.

I don't know either.

And I'll even say that to people.

It's like, you know, I, yeah.

I, I don't know either.

But that's not the stopping point.

This is our starting point.

Absolutely.

And I've got a few ideas of what it could be, but we have to get a little

ways down the road to see which of these ideas it might actually be.

We've got ways of looking at this with Chinese medicine and

we've treated people with this, you know, for hundreds of years.

So I may not know at the moment, but I got something that'll help us know.

Okay.

Well, it's like Michael and the, the shopping malls and the 1980s.

Well, that's the last time I went in the mall, they had those

pictures that were like dots.

And if you looked at them long enough, then you could see whatever the

pattern was in the Sunday paper too.

Yeah, exactly.

They did.

And that's just what you were saying earlier.

Most pattern recognition.

It takes time.

You first see a patient.

In all of their complexities, sometimes chaos and it takes a

while to get to know them and to figure out what's most salient.

That starting point.

I absolutely agree with you, but it can be done.

It happens.

It just takes time and relationship.

I think that's the other thing that never gets studied, rarely gets

studied regarding our medicine.

It started somewhat in biomedicine that patient provider

relationship that really matters.

I found that to be true in my work.

And you know, it's funny cause it's the same time acupuncture has this, uh, sort

of reputation for being, oh, you know, you could go and get a couple of treatments

and you'll never smoke again in your life where you go and you get a few treatments.

You never have any pain again.

I mean, there are those stories, these things sometimes happen, but I think

more often the medicine is something, especially from more difficult issues.

It is.

It happens over a period of time in the relationship that we have with

our patients is absolutely intertwined with everything else that we do.

So here's a cool research.

Geekery backed factoid.

So in patients and providers, there's a term of entrainment.

And when they're in tune with one another, basically there's this entrainment,

including heart rate variability that's associated with better patient outcomes.

Really isn't that wild is astonishing actually.

And it makes sense to me because I remember my very

first little baby case study.

I was a little clinician in Tacoma all by myself, not having had formal training.

And I just did a case study because I had to do research and I, um, had

a consent from the patient and I got a consent form from my mentors.

You know, as much as I could do proper research, even though it wasn't reviewed

by an institutional review board.

And I, I asked her to keep a journal and I kept a journal.

And then I compared our journal notes and I found that as she and

I got to know each other better.

And as she felt more comfortable in that clinical setting, one.

Very highly clinically relevant information that she only felt

comfortable revealing over time.

And she had a much better, there was a pretty dramatic shift in her pain, sleep,

mood, whatever the primary condition was.

I don't even remember now improved greatly once I understood her better,

which makes sense, but it was a way of documenting qualitatively,

my experience and her experience.

And over time.

As she trusted me, she could again talk about things that were relevant

clinically, and then I could modify my plan and make it even more accurate

basically in my differential diagnosis.

I think that was kind of a beautiful study.

Yeah, well, oh, well, you know, you could do it again at some point.

I've thought about it actually.

Yeah.

I mean, you're, you're sitting in the catbird seat there.

What else are you working on right now?

So another project is looking at it's also at Huntsman cancer Institute.

It's a pilot, very, very small pilot on funded.

We're looking at acupuncture and acupuncture plus minus.

So once we're up and running with the trial, basically the clinician will push

play after the needles are in, and the patients will be randomized either to

hear music, everybody, the same music in that arm, or they'll hear a 15 minutes

of mindfulness and it's working with Dr.

Eric Garland and his, uh, pretty long standing work regarding

mindfulness as an intervention.

And we're curious to see who has better outcomes.

We're not going to restrict any particular primary concern.

Most likely it'll be pain of some kind.

Again, it's just preliminary data that we'll use, hopefully to provide some

rationale for a grant application later.

But for me, the fun thing is thinking about when patients are laying there for

however long, 10, 20, 30, 40 minutes with the needles in place, what happens then?

So for sure, we can assume as he stays in medicine providers, she is

being redirected in some way with the needles, the patient sometimes

of course, completely falls asleep.

Sometimes they don't fall asleep.

Actually Michael was one of your classmates, Barb,

she's talked about Accu land.

So patients drift off to Accu land and this very restorative, but one thing that

got me thinking actually, and this is another way that research comes back to

clinical work and vice versa in clinic for me is where I get my research ideas.

I have questions and I want to understand.

So I'd have patients that would say, after I checked the needles out, wow.

You know, I was laying there and I felt like I was moving a floating,

but I knew that I wasn't, or other patients would say, yeah, I was

laying there and I had these like colorful dreams, but I wasn't asleep.

And I thought, huh, I wonder if some people that are kinesthetic learners,

maybe they feel like they're moving.

And maybe some people that are very visual learners, they see things.

But I also thought does acupuncture help people be in their bodies?

Because of course in modern life, we tend to run around and we're in our

heads thinking, thinking, thinking hardly even noticing that we're

working so hard, our back hurts.

You're sitting so long.

Our back hurts know.

I think a part of the effectiveness of acupuncture is basically mindfulness.

I think that it helps people be in their bodies, feel their bodies feel she moving

around or whatever we want to call it.

And that's a part of what I'm really excited to study.

Does it have to be.

That sounds really cool.

Of course.

I often hear people say things like I fell asleep and I've

had this sneaking suspicion.

I've had it for years.

I'm glad we're having this conversation.

Maybe can shed some light on this.

I've had this sneaking suspicion.

It's actually not sleep.

I'm thinking it's something else.

I mean, there are times people sleep, but there's other times.

I'm thinking of my own experience, where I'll be on a table.

I am not sleeping.

I'm very clearly not sleeping.

My consciousness is in some sort of a state I'm clearly not sleeping

and I'm snoring and I've had people describe all kinds of sensations.

And I mean, like you were talking about sometimes it's visual,

sometimes it's kinesthetic, but they're often say sleep and I'm

wondering, has anyone done research?

To see what is actually going on with people's brainwaves when they

get acupuncture, because people say they're taking an Acura nap,

but I don't know if that's true.

I actually don't know what's going on.

Has anyone done research on this?

You know, I don't know.

I'll do a lit search and then we can do the podcast and not tell you what I found.

If anybody I would have guessed, uh, Vitaly Napa Dow, uh, back

east, I think he's in Boston.

He and his group do some awesome, awesome work looking mainly at function.

Oh, uh, uh, MRIs and sometimes pet scans, but looking at neurologic change, you

know, during acupuncture, comparing acupuncture with sham, different parts

of the brain bite up for some points, same parts of the brain light up for

other points, pretty interesting stuff.

But that question of during acupuncture, you know, Are we in alpha beta,

Delta, whatever brainwave activity, it would be really fun to do that study.

Yeah.

And is there an, is there a pattern, is there something, is there something about

acupuncture that's different than a nap?

I think is my main inquiry.

Right.

Well, and my other inquiry with that as sometimes I saw patients who didn't ever

fill that relaxed, they were hypervigilant visit after visit after visit.

They never reported that it was an uncomfortable experience, but they

were just never relaxed and rested.

And some of those people had improvements in whatever they were there for various

symptoms or diagnoses other people didn't.

And honestly, a part of me has always wondered again, that's

the stacking up of, and of one.

Do you see worse outcomes?

If people don't experience whatever it is, we don't know what to

call it right now, Acura land.

And I wonder about that.

Well, keep us posted.

I will, I'd like to shift a little bit, you know, the, uh, doctorate programs

and east Asian medicine, a lot of folks in, in doctorate programs these days

and often research is a piece of it.

And then there's this thing called a capstone and I'm.

Publicly express my ignorance here.

I don't even know what a capstone is, the big projects.

So it's a big project.

Yeah.

Okay.

Smaller than a dissertation.

Probably most of them are smaller than a master's thesis.

Depends on how, uh, how engaged and ambitious the student is.

But it's a big project.

It's a big project.

Okay.

Or might not be a piece of that, or is it often a piece

of it how's that usually work?

Absolutely.

It definitely, I think depends on the school that a student is attending.

For example, in Oregon, we have OCOM with a very strong research

program and actual research.

Same thing at Nissa in Boston, they've got an actual research department.

So they have the infrastructure at those schools, I think in Austin as

well, the acupuncture school there, um, restage medicine school, those

kinds of schools have the research infrastructure to really support.

Actual, you know, pilot studies and whatnot.

I'm sure students at best year, same thing.

Um, but other schools, for example, here's where I fall

into the lack of vernacular CYO.

Ms.

Now S I E a M I don't know how you say that.

Do you know Michael?

Is there Alma mater.

We got to find out.

I think it's, I don't know.

I don't know how to pronounce it.

We'll find out.

I love style.

I do too, but we're old school.

Sure.

Old-school Siam to the core.

Um, yeah, so of course there's not a research department there I'm happily

the new academic Dean, Kathy Terra Amina.

I think she'll help students who want to do research so long story short.

It depends on where you're at and whether or not you have

the support and then internal.

Faculty to really support, uh, an actual research project.

Otherwise students might do, uh, you know, a literature review or translation,

especially if they're at home.

So the, the topic can really vary or a multiple case study or a single case study

depending on what they are interested in.

And whether at, so you just threw around a couple of terms, literature review.

Well case studies, we understand we've missed how we learn, how would,

uh, how our literature reviews.

Great question.

So literature reviews are the most basic, um, it's something we all do all the time.

We do Google searches, right?

And so we're just trying to see whatever there is on our topic of interest.

And it could be, we want to find the various best noodle soup

restaurants in our neighborhood.

Um, but in terms of research, it would be going online, uh, and really surveying

the literature on a particular topic.

Um, what's nice nowadays, is that quite a few east Asian medicine and complimentary,

complimentary and alternative medicine.

Now the more sexy modern term is integrative health or

integrative medicine journals.

Many of them are going to be indexed on pub med.

So that means if you go to pub.

I think it's just pub med.com.

You can run a search and you'll find journal articles that are

relevant to east Asian medicine.

It won't only be, um, JAMA and things like that, which occasionally publishes

some, some papers on acupuncture.

So really, as a literature review, we'll give you a lay of

the land, a survey of the scene.

Of whatever topic you're interested in, uh, if someone's really wanting

to be diligent and be sure they found everything on a topic they're going

to need to use other search engines.

In addition to pub med, uh, cinle is a nursing, uh, search engine often

that will garner a few more papers.

There's also.

Ed and a few other alternative medicines, literally a search

engines that you can use.

The challenge is to access those.

You almost always are going to have to go to the university of wherever you are in

your local town, and either search online.

Sometimes they'll let anyone from the public, you use their databases

for free, and that means you could get PDFs and get the articles you're

looking for, which would be not.

What I had to do before I was a student at the university of Washington.

I just bought a library card.

It was a hundred dollars a year for me, again, as a research geek

worth every pay I had a ball.

If you want to be literally systematic about it, a systematic review is a proper

rigorous review on a topic that's very different than a literature review.

For most doctorate programs, a literature review would probably cut mustard.

It would, because that'll give you the proper background information

really to put in your paper for the background section, what's been

done to date on a topic where are the gaps in the literature, this

project aims to fill that gap.

That's the standard vernacular.

So you could put together a project that you're interested in show.

What's been done.

Show what hasn't been done.

Hey, this thing I've got goes into the thing that hasn't been

done, it's my contribution.

Exactly.

Yep.

And then a student also could actually generate a systematic

review, uh, for a project.

It's a big undertaking.

I've been involved in two systematic reviews.

One very nice set out to, we am the Washington east Asian medical

association, long story short.

We actually affected policy change from the systematic review that we did.

So that's actually to go to the first question you asked,

why do we care about research?

Yes and educate biomedicine and our colleagues acupuncture does something

or usage and medicine does something.

But to, to enact policy change, that's pretty sexy.

Right?

Powerful.

What kind of policy changes as a result of.

Yeah, labor and industries.

So they long story short for almost 30 years.

Acupuncturists in Washington state have been working with labor and industries

to try to get them to cover acupuncture as a covered benefit for injured workers.

So maybe five or so years ago, it's been a long time now.

Um, we started in earnest, uh, having.

Uh, additional more in-depth conversations with the medical director and all of

his team, if they said, okay, what needs to happen is a review of the

literature and see what it says.

Let's just pick a topic low back pain.

We said as clinician researcher, or as I was in my PhD program at the time

with colleagues who also had research training, we said, look, sir, This is

really not going to help us or you.

And most importantly, not the patients because literature on low back pain

most often will include a sham control.

It's not inert.

So it's basically comparing acupuncture to diluted acupuncture,

which is still effective.

And so you're not going to be seeing statistically significant

differences between those two groups.

And so then the typical interpretation of those data

are, oh, acupuncture didn't work.

It wasn't that much stronger than the.

Weekend sham control.

So long story short, we reinterpreted the data.

We said, let's look at these studies look at within group findings.

So those groups that had acupuncture, did they improve statistically significantly

from baseline to the end of the study?

And then look at fam not as a control that really can be respected as such,

but as the weekend acupuncture arm.

So we did that.

We reviewed all the literature.

We made it table after table, after table summarizing the results

presented all that in a PowerPoint, Dr.

Gary Franklin, the medical director said, wow, you guys brought

your heavy hitters this time.

Because as we had acupuncture, researchers who could talk about.

And they changed their policy.

Now they have a pilot study paying for acupuncturists to give acupuncture to

patients, to injured workers with low back pain, the collected data from the pilot.

And I'm sure it'll be very favorable.

We hope so.

And eventually change the policy for good to cover acupuncture.

You know, I hadn't thought about the use of research for changing policies.

Uh, I just, I just thought about how, how can it help me in my clinic, but that

particular vision, that particular scope of looking at how people think about

it, what gets covered, what gets, what doesn't, that sort of thing of course

research would be vital in that situation.

It really is because like at our Lumpa, it's the language of modern science.

And if we cannot speak that language, we are mute better.

If you can be a heavy hitter in that world.

Right.

And honestly, I think that's a very important decision for your listeners.

Want to geek out and do research.

They really have to think hard whether to do the DAF D AOM program

somewhere, or whether to do a PhD.

If they really, really want to do research, I humbly

suggest they consider a PhD.

It's the known degree.

It's the one that has street cred and you forgot to play in that world.

You got to have.

You got to have that kind of a D honestly, no question.

RDA on programs are awesome.

They're amazing.

They are generating clinicians and clinician researchers who are

bright and engaged and well-trained, and again, my just my opinion.

Um, I do think the da IOM is not going to take you as far, if

you really want to do research.

It just isn't that makes sense.

But I don't think that's what it was designed designed for anyway.

And it was designed to, to make clinical practitioners I do believe, right.

Yeah.

So if you want to geek out on research, go where they get geeky with the

research, you know, I have to say thinking of another value of recent.

I'm really struck by my experience at the university of Washington

and the university of Utah in that nowadays, uh, very trendy.

And I think it's pretty cool.

Phenomenon is called interprofessional education.

And so what they'll do is they'll get students from nursing medicine,

dentistry, public health, social work, nutrition, whatever they have on

whichever campus, put all those students together in a room and talk about cases.

Talk about.

Try to get people talking shop to one another, as students in hopes that they'll

play better, basically as colleagues.

Um, and then we'll eventually see better outcomes.

And as I participated in, in a professional education in these two

campuses, I'm struck by the fact that east Asian medicine is so marginalized.

We're not even on the.

So again, I think yet another way to get us on the campus.

So to speak where various health traditions are taught is to really have

research where we can communicate how powerful, how safe, how effective this

medicine is, and that will help our patients that will help the profession

that will help with policy as well.

So often we hear about people.

And their goal is I want to take Chinese medicine.

I want to take east Asian medicine mainstream often.

It's kind of a marketing stance.

Um, you know, and I get it.

You want to, you want to get it out there that people think of it as a, as

an opportunity, as a consideration, as a, as a potential way of getting help.

But as I hear you talking about this, get your Chinese medicine education.

If you've got, if you got the interest in it, go get a PhD.

That's really getting it.

That's just not getting it into the mainstream.

That's getting into the roots that feed the mainstream.

Well, and here's where it gets even more exciting.

So all of our predecessors doing beautiful work, both clinically and in

terms of research have got some thought basically into the system, so to speak.

So NIH has division that funds east Asian medicine research and CCI age,

the division of complimentary and integrative health they have now.

An emphasis on whole systems science and whole systems research.

That's the catch phrase that east Asian medicine, naturopathic medicine,

massage therapy, many so-called alternative medicines function under.

We look at the whole person and treat the whole person over time, basically.

So I think being most strongly who we are as clinicians as a medical

tradition can also influence the.

The dominant tradition of biomedicine.

And I think that whole system science is a part of what

we're seeing with, um, systems.

Oh, the Institute for systems biology systems.

Biology is a big thing right now looking at big data.

That's a very big thing right now, looking at complexity that

really can be well-informed by again, east Asian medicine.

So I think.

Being who we are not diluting the tradition, not trying to fit in or make it

Western or whatever else, being the most.

Again, strong in the tradition that we have can also help and

inform modern science as well.

Let me make sure I'm understanding this correctly.

We have this very holistic medicine.

We know this because this is what we do it.

What I think I'm hearing you say is that.

Research methodologies that are available now that go way beyond

double-blind, they're looking at the interaction of whole emergence systems.

Exactly.

And that's what I want to help.

The methods are just starting to be developed research methods, but that's,

if I can do anything before I die.

In addition to parent my children well and be a loving wife.

Um, I want to see a way for us to use this Uber geekery, you know, the

powerful competing systems that we have now to look at multiple factors,

changing over time, looking for emergent dynamic properties in data.

There's so much that we're going to be doing.

Then the next 10 years, it's really exciting.

And we're just starting, uh, just starting.

That's where it gets really fun.

And that's where I think we're so lucky Michael, to be practicing now and not

even 50 years ago or 30 years ago.

There's so much we can do now to look at really what we do as clinicians.

Again, that end of one, looking at conflicts change over time.

That's what we see in our patients.

And also say they come in for, this is my favorite example.

I had a patient come in for low back pain, and then it turns out.

Chronic fatigue syndrome and fibromyalgia.

She can't sleep.

She's taking a boatload of medication.

She hates her job.

She has to have it for the insurance.

We've all seen this kind of patients, right?

So long story short after whatever it was six months, she comes

back and her sleep is better.

Her mood is better.

Her pain is better.

She says to me, Lisa, I applied for my dream job.

I've jumped it all this job for a decade, but I never dare to do it

because I just felt so horrible.

So I've quit my job.

I hate.

And I got the job I wanted.

And I'm going to move.

So that is change that you can never predict.

And that I think is also the power of east Asian medicine.

So in research later, if we can have our predefined primary

outcomes, secondary outcomes, the same boring stuff we've always been

doing, and somehow capture that.

Um, emergent intelligence, um, dynamic change that does happen with our

patients that I think is going to be a really fine and fun day and research.

I'll say I'm startled, shocked and looking forward to it because

my ideas of research, I mean, they're, they're really old.

I don't think I've, I haven't updated them since I was in

college, you know, decades ago.

Really.

So to be able to sit here with you and have this conversation, uh, first of all,

feel your enthusiasm, it's contagious, and to hear about how research methods.

Transformed over time and how you're on the cutting edge of using this as just

a delightful, any books or websites or resources that you know, people could

go and, uh, get some more information about these Uber geeky methods.

If that happens to be their cup of tea.

Let's see, so there's a lovely society.

It's very small.

The acronym is S C T P L S.

The society for chaos theory and psychology and life sciences.

So my favorite favorite research conference, there are people from

across disciplines, all related to health, though, uh, really using

and developing these methods of looking at complex change over time.

A couple of years ago, the former president of the society,

David Pinkus he's in California at Chapman psychologist.

He and I actually, and Lisa convoy, who I've mentioned several times,

the three of us had this brainstorm.

What if we got together?

People who are really good at crunching numbers in this non-linear way.

People with datasets beautiful, ideally longitudinal, lots of data points,

datasets and content experts did.

We had a weekend, it was called data Palooza and we analyzed that goal.

That was Dave's idea.

We analyze data all weekend and presented preliminary findings

at the end of that conference.

And then we all went our separate ways and worked on papers.

Actually, our paper just got published a couple of months ago in Metro.

Uh, because it was regarding a midlife women going through the menopausal

transition and how they experienced stress and fatigue and the coupling

of those two symptoms, symptoms, and how the coupling changed over time.

So we're not talking about means and standard deviations and absolute change.

We're talking about how.

They came together and fell apart, whether there was resilience in

the system and they could kind of overcome the fatigue and, uh, or not.

And that changed over different stages of the menopause transition.

So long story short, we're going to have data Palooza 2.0 in a couple of years.

So if people are interested, they can find my info and I'll

keep them in the loop about.

But that society has a journal there's conferences.

Uh, usually it's national one-year international and other year.

That's a great opportunity.

There's the Santa Fe Institute in Albuquerque.

Actually they have three.

What are those called?

MOOCs?

Massive online something courses.

Um, so they can check those out so you can just go take a course online.

It's all free.

Great.

Yeah, I'll make sure all this stuff gets on the show notes page.

Thank you.

And I'm proud to think of others.

I'll email you.

And then you can put those on the notes page.

Terrific.

Lisa I'm I'm looking at our time.

I can't believe it's gone by as quick as it has, but you know what I say

that on almost every conversation maybe I should start trying to

do long form three hour talks on, well know, put people that sleep.

I don't know lately, I've had people complaining about it's like, you

know, these podcasts are too short.

I just like, you just get going and then it's over.

And, you know, Hey, next time, Michael, let's do a podcast on

the cusp catastrophe model, and it's really relevant to patients

and clinicians, cusp, catastrophe.

It's basically when you see dramatic, we're seeing the healing crisis.

That's the term we've used for years.

So we can talk about another time if you want.

That'd be really fun.

Okay.

Any closing thoughts you'd like to leave our listeners with before we say goodbye?

Uh, my closing thought would be to, uh, definitely get in touch.

If you're interested in talking shop interested in

talking about the relevance of.

Research to practice and vice versa.

Um, it's obviously something I love to do and I welcome emails.

That would be fun.

Great.

You're probably going to get them.

I hope so.

Or at least, so thanks so much.

Thank you.

Bye Michael.