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Clinical Research Training Program in Traditional Chinese Medicine Since its introduction to the United States in 1973, traditional Chinese medicine (TCM) has grown enormously in popularity and now ranks as one of the leading alternatives for a variety of common health conditions. There are now over 10,000 licensed acupuncturists and approximately half as many physician acupuncturists. They have collectively treated over 12 million patients. In 1997, a 12-member panel of the NIH issued a consensus statement on acupuncture, noting that it appeared promising in the treatment of post-operative dental pain and in adult post-operative care, as well as for chemotherapy-induced nausea. It was also deemed of possible benefit in the management of narcotic addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, osteoarthritis, low back pain, myofascial pain, carpal tunnel syndrome, and asthma. TCM is one of the oldest, most widely practiced, and most complete systems of medicine in the world. It incorporates a number of subsystems of diagnosis including pulse, tongue, facial, and energetic meridian. Patients are treated with a variety of therapeutic tools including Chinese herbs, acupuncture (the single TCM practice which has captured the greatest degree of public fascination in the U.S.), moxibustion, acupressure, dietetics (based on the principles of yin and yang), meditation, and exercise modalities (e.g., T’ai Ji and Qi Gong). TCM is used for all manner of health concerns including disease prevention, complications of childbirth, pediatric problems, infectious disease, trauma, emergency medicine, care of common adult conditions, women’s health issues, chronic degenerative disease, and palliative care of patients at the end of life. Yet too little research on TCM has been performed that meets the rigor of evidence-based medicine. While much research on TCM has been performed in China, not all incorporates even basic Western standards such as a priori articulation of dosages and outcome measures, use of control groups, calculation of study power and sample size, or identification of possible study biases and confounders. Powerful techniques such as randomization and blinding are rarely used. TCM research in the West has been limited, too, but for different reasons. Few practitioners have been trained in classical Western research methods. The scope of practice of most clinicians has included largely those patients disaffected with or who have not found relief in Western medicine. These individuals frequently present with multifactorial syndromes that do not easily lend themselves to scientific scrutiny. And these difficulties present themselves against the backdrop of the different worldviews and languages of Chinese and Western medicine. The landscape, however, is changing. Increasingly, TCM practitioners are either physicians themselves or are licensed acupuncturists who receive referrals of patients from physicians or have developed their own patient base as an independent practitioner. Growing acceptance of complementary and alternative medicine (CAM) has even led, in some settings, to the inclusion of acupuncturists as members of conventional medical teams. In the process, TCM is being employed with greater frequency, and often with anecdotal success, for common health problems. As a result, more and more individuals are becoming fluent, or at least familiar, with the perspectives and terminology of both Eastern and Western medicine. On occasion, correspondences are being explored, or at least posited, between global Chinese patterns of disharmony and the diseases identified by Western reductionism. However, as the interface between Western medicine and TCM grows larger, so will the need for research on the effectiveness of and appropriate use of TCM in numerous health problems. Therefore, Pacific College of Oriental Medicine is proposing a doctorate, as well as an independant program of study for select healthcare practitioners, that will allow for specialization in a number of areas including integrative medicine, classical TCM, and CAM research. For candidates that select the research specialization, they will learn how to conduct high-quality, multidisciplinary clinical research in Chinese medicine. We hope to participate in the development of a cadre of TCM/CAM clinical researchers who can think critically and analytically, confidently undertake research projects, and obtain grant funding to study all aspects of the clinical interface of Western medicine and TCM. Such projects might range from studies of the validity of Chinese methods of diagnosis to health services studies of TCM utilization to research on the effectiveness of TCM modalities on both intermediate biomarkers and clinical outcomes. While our clinical research program will focus tightly on TCM, the training received by participants will also apply to other CAM modalities. We believe that the juxtaposition of the very different worldviews of TCM and Western science, and the unique research questions that emerge from the clinical application of TCM in Western settings will help to stretch the minds of budding investigators. Therefore, the focus on TCM also provides a vehicle for producing researchers who are comfortable with complexity, can grapple with apparent theoretical paradoxes, and whose careers will be dedicated to CAM research. The goal of this research specialization and program will be to produce CAM clinical researchers who are knowledgeable about the complex issues associated with conducting sound clinical research in the area of Chinese medicine. As a result of this training, participants will be provided with a solid academic and experiential foundation, as well as the tools and skills, upon which they can begin to build careers and confidently compete for grants in areas related to CAM research. It is anticipated that these individuals will, over time, form the nucleus of a research corps dedicated to achieving a scientific understanding of the efficacy and safety of this ancient medicine and gradually establishing a reliable knowledge base needed to guide clinical care in the future. The program will offer participants the training and experience needed to delve deeply into research questions at the interface of TCM and Western medicine. TCM practitioners will be expected to have already had at least a limited-to-moderate research exposure. It is also anticipated that they will also bring a high level of curiosity and a high level of motivation to pursue this area of inquiry. In these and future articles concerning Pacific’s proposed doctorate program, information on the other areas of specialization will be provided to not only inform the Oriental medicine community on this exciting new phase in our professional development, but to invite comments to help us better design relevant courses. As with all articles related to the doctorate in this journal, this one is not meant to solicit applications or advertise an imminent program. Gordon Saxe, M.D., Ph.D., MPH, recently joined the staff of Pacific College of Oriental Medicine as Medical Director. He received his medical degree from Michigan State University, College of Human Medicine, in 1997 and is board-eligible in General Preventive Medicine and Public Health. His professional association memberships include the American Medical Association, American College of Preventive Medicine, American Public Health Association and Massachusetts Medical Society. He has prepared numerous articles for publication in professional journals, most of which explore the relationship between diet and cancer. He will take a leading role in the development of Pacific College’s clinical research training program.
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