Introducing Greg Livingston, PhD (China), LAc – Master’s Faculty
When his father died young, at age 53, Greg Livingston began to contemplate how to avoid a similarly premature death. This first step towards a path in medicine and health care was the question, “How do you take care of yourself?” Upon finishing his biology degree, Livingston decided he needed a career. He looked at all kinds of medical traditions, but after growing up in San Francisco’s Chinatown, with herb shops around every corner and the strange but familiar smells of decoctions from friends’ homes, he felt drawn to Chinese medicine.
While licensing and a well developed educational structure supported a profession and career in the U.S., he didn’t foresee what a journey he was undertaking when he started at Five Branches University — at the time, he hadn’t even had an acupuncture treatment!
Quickly realizing that a master’s degree wasn’t enough, he felt he needed to study in China. Shortly after graduating in 1997, he lived in China for two years, following senior practitioners in Hangzhou outpatient clinics and Beijing’s Academy of Chinese Medicine. He then moved to Suzhou, where his specialty as a classical jong fang style herbalist coalesced during a year-long mentorship.
After five years of practice in San Francisco, he returned to Hangzhou to pursue his PhD and received a license to practice in China. He completed his PhD degree in 2009 and published three articles on Shang Han Lun related topics, particularly on the treatment of cold pathogens in Westerners with classical formulas.
In 2012, the question of “how to live well” drew Dr. Livingston away from China. The constant effects of urban pollution — bronchitis, fevers, fatigue — led him to seek an open faculty position at OCOM. Based upon its reputation in the professional community and the calibre of the graduates he had met, he relocated his family before even visiting the college. As a full-time faculty member for the last two years, Dr. Livingston notes, “OCOM is obviously not like institutions in China, but it’s also clearly not run by your average Westerner. OCOM people are progressive, alternative and fair-minded. They really care — about the school, the students, the employees, the patients. The faculty cooperates, even honoring varying strengths and weaknesses. In some corporate cultures, you might be afraid of showing weakness, because people will take advantage. At OCOM, they help you improve.”
As someone who has spent twenty years bridging East and West, Dr. Livingston observes, “If you study the China model of health care, there is much you have to change when you move the medicine here. The fundamentals don’t change — the herbs, the acupuncture — it’s all the same. But Western patients differ significantly from Chinese patients when it comes to the clinical encounter. China is so crowded, and largely poor, so health care has to be delivered without a lot of time or privacy. In America, Chinese medicine practitioners don’t need to see as many patients per day and we’re required to give them privacy. It’s a different way of practicing the medicine.”
In October 2014, Dr. Livingston served as faculty for OCOM’s clinical studies program in Nanjing University of Chinese Medicine (NJUCM). “With students that study in the West versus those studying in China, one of the shortcomings is the amount of clinical herbal experience they receive. In the United States, we have limited resources and patient access to herbal internal medicine. This is why going to Nanjing is so valuable, even though it is only a five-week externship, those students saw more patients in those weeks than they saw the whole time they were interns at OCOM. You can see between 40-60 patients a day in clinical settings in China, and you get to watch really experienced doctors treat them. One of the big things is that beyond sitting in class or doing rounds, you need to chao fang, where you follow doctors and write their prescriptions down.”
Although Dr. Livingston began his clinical career in 1997, he didn’t start teaching until 2005, when he was living in China. At the Long Island University program on Zhejiang University campus, he taught introductory Chinese medicine and health cultivation classes to visiting foreign students and, ultimately, to Chinese graduate students studying family medicine.
Chinese students, he found, tended to have more rigid thinking. “However, when you find someone who can think outside the box and they get clinical herbal training in China, they will be unstoppable.” He believes OCOM strikes the right balance. “We have a wide range of faculty with different backgrounds and experience. If students here use all the resources available to them and have a natural ability for medicine, they can go far and get a lot out of the program. In medicine, you have to have some natural ability, a certain strength with logic and memory. If you possess those and you take advantage of everything, you can graduate from here and go right to seeing patients.”
On March 20, OCOM’s former campus and clinic buildings were sold to Adult Learning Systems of Oregon (ALSO), which supports adults with developmental and intellectual challenges by providing vocational and residential services. To sustain their growth across the greater Portland area, OCOM’s property provides a more centrally located base of operations.
“It is truly a gift to know our former home is occupied by providers working to care for those with developmental challenges,” said OCOM President Michael Gaeta. “The college wishes Adult Learning Systems of Oregon nothing but the greatest of successes as they get settled in their new home and continue to administer their healing work.”
The outer southeast Portland location was expanded in 1999 to include the addition of a clinic facility and doctoral classrooms with the assistance of a $100,000 grant from Meyer Memorial Trust. Construction of the two-story building and parking lot were completed in 2000 with broad community and political support. As enrollment continued to grow in both the master’s and doctoral programs, with growth within the staff and students services team as well, additional space was leased, including a second location for clinic facilities in the Hollywood district.
Under the leadership of President Michael J. Gaeta, EdD, who joined the college in 2005 , the college adopted its first six-year strategic and operational plan. OCOM’s relocation to Old Town Chinatown was a signature outcome of that planning process. The “Cherry Blossom” property sale improves OCOM’s balance sheet and marks the completion of a significant period of change and growth for the institution, setting the foundation for operations under the new 2015 six-year strategic plan.
OCOM’s current campus and clinic facility features upgrades in sustainability, including LEED Gold certification and enhanced access to public transportation. Located at 75 NW Couch Street in the historic Old Town Chinatown district of downtown Portland, the ground floor includes herbal medinary and bookstore with natural products and acupuncture supplies for practitioners. Public wellness offerings such as the Lan Su Chinese Garden lecture series and qigong classes can be found at the college’s website: ocom.edu/events.
A $130,000 capacity building grant awarded to Oregon College of Oriental Medicine by Meyer Memorial Trust on March 1 will fund a new Director of Annual Giving position over the next three years. This new full-time staff position and expansion of OCOM's annual fund will increase the ability to build long-term, sustainable funding for the college.
Since relocating our campus to Portland’s Old Town Chinatown neighborhood in 2012, we have initiated a successful annual fundraising event and built a more visible community presence in the new neighborhood. While these successes mark important milestones for the college, an increased need to expand development efforts became clear after OCOM's February 2014 six-year strategic planning session.
The planning group identified the need to create a more diverse funding base to support our mission by expanding efforts to move away from tuition dependence. Like many universities and colleges across the U.S., a downturn in enrollment in 2012 and 2013 which, coupled with campus relocation operational costs, led OCOM to prioritize an expansion of our Institutional Advancement department in 2015. The new director position will support growth of OCOM's annual fund, deepened collaborative partnerships, and expanded capacity for community giving.
The greatest beneficiary of enhanced fundraising capacity will be OCOM’s clinics. Our teaching clinics intentionally provide low-cost health care options for the Portland metro region to ensure broad access to affordable integrative health care. While the college charges $25 per treatment, the full cost of each visit is $40. Foundation grants, individual donations, and revenues from student tuition cover the difference between the actual cost of delivering the care and the patient fee.
In 2013, the college's two master's program teaching clinics provided 22,000 patient visits; 85 percent of those visits were for individuals who self-identified as low-income. In addition, OCOM's community partnership projects and externship opportunities are focused on expanding access to low-cost or free acupuncture health care in the region to underserved community members and chronically ill patients at other health care institutions. Those include organizations such as Outside In, Central City Concern, Hooper Detox, and other Coalition of Community Health Clinics’ locations.
Oregon College of Oriental Medicine (OCOM) has received a $15,000 grant award from the Kaiser Permanente supporting access to acupuncture care for low-income patients in the Portland metro area.
Thanks to Kaiser Permanente’s support, OCOM will provide qualifying low-income community members $15 acupuncture and Chinese medicine treatments. Enrollment in the program, "Expanding Health Care Access to Low-Income Patients," begins January 20, 2015. Qualifying individuals will be eligible to enroll for five $15 visits between January and October 2015.
OCOM’s Chinese medicine teaching clinics see more than 20,000 patient visits each year. Analysis of patient survey data from 2013 grantees shows that those who receive at least five treatments at our clinics get better. Among low income patients who received a course of five treatments, 92 percent reported having a chronic conditions and 100 percent reported that their conditions improved. Fifty-four percent indicated they rely on safety-net clinics even though 58 percent of them have some health insurance. Ninety-six percent of patients reported they were "extremely" or "very" satisfied with their treatments, and 22 percent reported they did not use the emergency room due to access to health care at OCOM.
"Many of our patients are dealing with serious, chronic conditions, including long-term pain. The acupuncture treatments made available through this grant support our patients to stay engaged with the people and activities that make life worth living," says Miles Sledd, LAc, OCOM Director of Clinic Operations.
Download an application or call OCOM’s Patient Services Team: OCOM Clinic, 503-445-0951; or OCOM Hollywood Clinic at 503-281-1917.
Beth Burch, ND, Dean of Doctoral Studies, is the first member of OCOM's staff and faculty to complete the Human Investigations Program (HIP) at Oregon Health and Sciences University. She graduated in 2012, earning a Certificate of Human Investigations. The HIP certificate track consists of 24 credits and offers advanced training in clinical and/or translational research. Subject matter taught in the program includes research study design, statistics, protection of human subjects, and evidence-based medicine theory, among other topics.
The HIP culminates with a capstone project of either a student-designed and executed research study or an NIH-compatible grant application. Dr. Burch chose to use OCOM's clinic data for an investigation into the treatment of musculoskeletal complaints with acupuncture and Chinese medicine. Her study, "Results of Four Acupuncture Treatments for Muscle and Joint Pain: An Analysis of Patient-Reported Outcomes Data from an Acupuncture and Oriental Medicine Teaching Clinic," demonstrated significant improvement in pain and function amongst OCOM patients returning for a fifth visit over an 18-month period. The study is an excellent example of the utilization of data from OCOM's patient-centered outcomes research program, and its potential to provide valuable insight into the effect of acupuncture and Chinese medicine treatment on a variety of health conditions.
Dr. Burch presented her work at the 2013 Symposium for Portland Area Research on Complementary and Alternative Medicine (SPARC) and plans to submit the paper to a peer-reviewed journal for publication.
In addition to her role as Dean of Doctoral Studies, she teaches Oriental Medicine Research II in the master's program and oversees the doctoral capstone research projects, personally mentoring several of these projects each year.
Two papers by members of the OCOM Research Department were recently published in peer-reviewed journals. One highlights the OCOM-developed AcuTrial® database, while the other offers a case study of treatment for recurrent pregnancy loss.
The first article, written by Ben Marx, Ryan Milley, Dara Cantor, Deborah Ackerman and Richard Hammerschlag, is entitled "AcuTrials®: An Online Database of Randomized Controlled Trials and Systematic Reviews of Acupuncture." Published in the July 2013 issue of BMC Complementary & Alternative Medicine, it details the development of AcuTrials®, a unique bibliographic database of randomized clinical trials and systematic reviews. It was created and is maintained by members of the OCOM Research Department to streamline literature searches in the field of acupuncture and Oriental medicine (AOM).
AcuTrials® went live in January 2010 and currently contains nearly 1,400 abstracts from over 300 medical journals. The department is continually working to source and add new articles to the database to keep it current. AcuTrials® provides multiple acupuncture-specific search options which are currently unavailable in PubMed or any other database of complementary and alternative medicine (CAM) research. Included among these is an innovative keyword catalogue which allows users to search by such categories as treatment protocol, control type, and style of acupuncture.
Prior to the release of AcuTrials®, literature searches for acupuncture studies could only be conducted across multiple databases, none of which were cataloged with acupuncture-specific language. The authors hope that AcuTrials® will continue to grow and realize its potential to improve the accessibility and quality of acupuncture research.
The second article — "Recurrent Pregnancy Loss and Traditional Chinese Medicine" — was authored by Lee Hullender Rubin, Dara Cantor and Ben Marx. It was published in the June 2013 issue of Medical Acupuncture. This paper presents a case report of a 42-year-old woman with the diagnoses of recurrent pregnancy loss and diminished ovarian reserve. The patient was tracked from six months prior to conception through the delivery of a healthy baby boy while receiving acupuncture treatments and Chinese herbal therapy from Dr. Hullender Rubin.
Case studies are an important component of the AOM evidence base, as they allow clinicians to share a richness of clinical detail that isn't possible in other types of evidence. Often, slight modifications to the acupuncture protocol or an herbal formula, are the keys to clinical success. Case studies permit a more detailed description of these modifications, and allow practitioners to share their work with colleagues without having to adhere to a restrictive study design.
Congratulations to these authors for their fine work!
A collaborative effort between the OCOM Research Department and the Oregon Association of Acupuncture and Oriental Medicine (OAAOM) is resulting in a steady expansion of coverage for acupuncture under the Oregon Health Plan (OHP), which provides health care coverage to low-income Oregonians. Each month, more than 600,000 people receive health care coverage through the OHP.
Under the OHP, individual condition/treatment pairs are rank-ordered and assigned a place on an official prioritized list according to their impact on health, the clinical effectiveness of available treatments, and cost-effectiveness. Beginning in 2009, the OCOM Research Department and the OAAOM began locating, assessing and submitting high-quality research demonstrating acupuncture's effectiveness for a variety of conditions to the Oregon Health Evidence Review Commission (HERC). Shelley Stump (OCOM's Planning, Operations, and Assessment Officer), Laura Ocker (President Emeritus of the OAAOM), Ryan Milley (OCOM Adjunct Research Faculty) and Ben Marx (OCOM Research Associate) worked closely with successive groups of OCOM master's students to identify research evidence for submission. Ocker, Milley and Marx also appeared before the HERC to provide expert testimony regarding the research, and answer the commission's questions as they arise during debate.
Since the start of this collaborative effort in 2009, acupuncture has been paired with eight conditions on the OHP prioritized list: pregnancy-related hyperemesis gravidarum (extreme, persistent nausea and vomiting) , breech presentation, back and pelvic pain of pregnancy, post-stroke depression, disorders of the spine with neurologic impairment, chronic low back pain, migraine headaches, and tension-type headaches. Two additional conditions, chronic neck pain and osteoarthritis of the knee — both for up to 12 acupuncture sessions — have been approved by the HERC in 2013.
Seven of these conditions currently reside above the funding line on the prioritized list, while three conditions — chronic neck pain, chronic low back pain, and tension headaches — are all "below the line" conditions, meaning they are not currently reimbursed. Though not reimbursed, having such recognition of the evidence for acupuncture to address these conditions serves as a model for other state plans, and is a formal acknowledgement by the Oregon Health Authority of acupuncture's effectiveness.
This ongoing work shows the valuable role research can play at the public policy level in validating acupuncture's clinical effectiveness, expanding access to low-income citizens, and supporting the expansion of the acupuncture profession.
— Ben Marx, OCOM Research Associate