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
Kaiser Permanente Hospitals Foundation’s Community Gives program recently awarded Oregon College of Oriental Medicine (OCOM) $20,000 to provide discounted treatments to low-income community members seeking health care at the college’s downtown clinic, OCOM Clinic.
The program, Expanding Health Care Access to Low-Income Community Members, will provide 160 community members who fall at or below the federal poverty line access to $15 acupuncture treatments. Current OCOM patients will be eligible to participate as well as interested community members. The college will also partner with Central City Concern’s Old Town Clinic to refer new patients directly to the Health Care Access program.
OCOM clinics have seen a continuous growth in patients seeking Chinese medicine health care options, in part thanks a growing base of research that demonstrates the effectiveness and preventative nature of acupuncture and Chinese herbal medicine. Over the last 30 years, OCOM clinics have provided more than 10 million patient visits to the Oregon community. In 2012, OCOM's clinics provided 24,000 patient visits — more than 80 percent of those patients identified as living at or above the poverty line.
“Even though our teaching clinics provide low-cost acupuncture options to patients,” says OCOM’s Director of Clinic Operations, Miles Sledd, “we still have a large number of patients who can’t afford health care services.”
“Most don’t have health insurance to begin with, and many can’t afford consistent out-of-pocket care. Funding from Kaiser Permanente’s Hospital Foundations allows us to support our community members who need access to health care the most.”
Founded in 1983, Oregon College of Oriental Medicine (OCOM) is a nonprofit single-purpose professional graduate school offering master’s and doctoral degrees in acupuncture and Oriental medicine. Named the number one acupuncture college in 2012, OCOM’s mission is to transform health care by educating highly skilled and compassionate practitioners, providing exemplary patient care, and engaging in innovative research within a community of service and healing.
In 2011, OCOM Chair of Biomedicine Dr. Joe Coletto and Director of Student Affairs Nancy Grotton traveled to Baltimore, Maryland to participate in a Mind-Body Medicine training offered by Georgetown University Medical Center’s Dr. Aviad Haramati. The objective was to train facilitators from medical schools around the world in a program designed to support students in reducing stress levels and increasing self-awareness, so as to become more compassionate people and practitioners.
While Haramati developed the Mind-Body Medicine program to help medical school students, the program also realized additional benefits with the inclusion of faculty and staff in the process. Ultimately, Georgetown’s program proved so successful in reducing stress and increasing compassion that Haramati expanded its reach by offering the training to other medical school faculty and administrators across the US and around the world.
Coletto and Grotton attended Haramati’s training with the intention of introducing the Mind-Body Medicine curriculum to OCOM students, as well as interested faculty and staff, who would then lead Mind-body groups for students. Intention became reality in the winter of 2012, when they introduced the course. To date, OCOM’s Mind-Body Medicine program has engaged more than 70 students, faculty and staff.
An experiential meditation course, the 11-week Mind-Body Medicine program introduces a variety of mind-body approaches — including meditation, guided imagery, biofeedback, breathing techniques, art, music and movement — that can alleviate stress and foster self-awareness and self-care. Groups of 10 participants and two facilitators meet for two hours each week. Participants are asked to assess their levels of stress in the first class and again in the final class — this information is tracked via surveys and provides valuable feedback about the impact of the program on participants’ stress levels. At the end of the course, participants are encouraged to continue to engage in one or more of the meditation techniques they learned through the program, to help them maintain healthy levels of stress and continue to connect to their compassionate natures.
OCOM participant survey results have been extremely positive in demonstrating decreased stress levels. Given the great source of data the pre and post surveys provide, Coletto and Grotton have now developed a research project that tracks the course’s survey results to document quantitative and qualitative results. Their goal is to share those results with other medical schools to help inspire other schools to adopt the Mind-Body Medicine program. Coletto has successfully done so in Scotland and most recently for Georgetown’s Integrative Physiology master’s students.
Given the program’s success at OCOM over such a short period of time, Coletto believes the number of participants will not only continue to grow each year, but will help the entire college engage in a more positive way. “This program really represents cultural change,” says Coletto, “If enough people — students, staff, faculty — are more self-aware, it will make OCOM’s overall community a better educational institution and workplace, and help us provide better patient care.”
OCOM’s Mind-Body Medicine program is now a noncredit elective for master’s students, and has a growing waitlist. Students and facilitators who have completed the course continue to engage in the techniques they found most useful. “The meditation techniques I learned in the Mind-Body program are still as relevant to me now as when we were all going through the class it together,” said one participant. “It really helped me prioritize taking care of me so I could be more effective in other areas of my life, including work — and helped me build stronger ties to the OCOM community, too.”
Adding acupuncture to regular medical care is an effective treatment for moderate to severe depression.
A large research study from Britain brings good news to those suffering from depression. If you have moderate to severe depression, the typical treatment may include antidepressants or painkillers. The trouble is, those medications may not be effective to reduce depressive symptoms. In an effort to find better ways to improve the lives of those struggling with this mood disorder, researchers found that adding acupuncture to the usual medical treatment provided more relief than just the usual medical treatment alone.
In this trial, three interventions similar to what a patient would experience in the real world were compared. The researchers wanted to see which of the treatments would be the most effective at reducing the symptoms of moderate to severe depression. Seven hundred fifty-five people who were receiving the regular medical treatment for depression were randomized into one of the following groups: 1) 302 people received the addition of acupuncture, 2) 302 received the addition of counseling, and 3) 102 received usual medical treatment alone. The usual medical treatment could include antidepressants or painkillers. Those who received the addition of acupuncture received up to 12 weekly acupuncture sessions based on their Traditional Chinese Medicine diagnosis by a qualified British acupuncturist. Those who received the addition of counseling also received up to 12 sessions by a qualified British counselor.
After three months of treatment, adding acupuncture to the usual medical treatment was more effective to reduce the symptoms of depression as measured on the Patient Health Questionnaire (PHQ-9). Also of interest, the addition of acupuncture was just as effective in reducing depression symptoms as the addition of counseling to the usual medical treatment.
Why is this important? For those that have not had success with regular medical treatment or are seeking treatment alternatives, this study suggests acupuncture is an effective addition to usual medical care. Together, they manage the symptoms of moderate to severe depression at least as well as counseling added to usual care, but better than usual care alone.
How does acupuncture improve symptoms of depression? Moderate to severe depression is a complex disorder and can manifest in many ways. It can also coexist with pain or other medical conditions. A primary manifestation of depression is feeling an abundance of sadness, anger, fear, worry, etc. In Chinese medicine theory, unbalanced and unresolved emotions can also be a cause of disease. An excess of these emotions was identified as a cause of imbalance and dysfunction in early Chinese medicine classical texts. When acupuncture is used, like it was in the study mentioned above, it can help resolve the emotional upset and encourage the body to return to an optimal state of function. It helps a person to become more emotionally resilient.
The exact mechanisms explaining how acupuncture works are not yet well understood. But, we do know that acupuncture can regulate the nervous system, brain, neurotransmitters and hormones, which may partially explain why some of these improvements occurred in the treatment of depression. While more research is needed to better understand how acupuncture can treat depression, this large study provides substantial evidence that acupuncture is a relevant and effective treatment for depression. If you or a loved one suffers from moderate to severe depression, consider adding acupuncture to your current depression treatment.
Guest Column by Lee Hullender Rubin, DAOM, LAc
1. MacPherson H, Richmond S, Bland M, Brealey S, Gabe R, et al. (2013) Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial. PLoS Med 10(9): e1001518. doi:10.1371/journal.pmed.1001518
Lee Hullender Rubin, DAOM, LAc is an acupuncturist, herbalist and clinical researcher specializing in reproductive medicine and pelvic/vulvar pain. She is a faculty member in OCOM's doctoral program. and has taught in the master’s program. She is currently funded by the National Vulvodynia Association to complete a feasibility pilot study to investigate acupuncture as a treatment for provoked, localized vulvodynia. She practices at the Portland Acupuncture Studio.
Student loan debt and the cost of higher education have been in the spotlight at a time when the United States economy continues its recovery from a protracted recession. The cost of higher education has doubled over the last 15 years, while the cost of living has gone up less than 50 percent during that same period.
The OCOM Board of Trustees has taken up this issue over the course of the last year, engaging in discussions with key faculty and college leaders. For the current academic year, OCOM instituted the smallest tuition increase — only 2.8 percent — in the history of our master's degree program. The Board of Trustees went a step further by voting to freeze tuition for the master's and doctoral programs for the 2014-2015 academic year.
Board Chair Peter Martin summarized the Board's judgment: "The cost of higher education has far outstripped inflation for years. OCOM is committed to finding new sources of revenue that complement our mission, while further reducing our dependence on tuition revenue."