Adam Perlman, MD, MPH: Transformation in Health Care Lies in Finding Potential

Adam Perlman, MD, is currently director for integrative health and well-being for Mayo Clinic, Florida. From 2007 to 2011, Dr Perlman served as the associate vice president for health and wellness for the Duke University Health System and as the executive director for Duke Integrative Medicine. Dr Perlman is also a past chair for the Academic Consortium for Integrative Medicine and Health.

Integrative Medicine: A Clinician’s Journal (IMCJ): What first got you interested in pursuing possibilities in integrative medicine?

Dr Perlman: My interest in medicine evolved from an interest in martial arts. I began practicing martial arts when I was 16, and I got way into it. At one point, it was pretty much all I wanted to do, and I was an instructor for a number of years. In college, I was actually a history major, and I intended to go to law school and probably use that to go into business. My father is a lawyer and businessman.

For a number of reasons, though, after applying to law school late in my junior year, I decided that medical school was a better direction for me. One of the things that I enjoyed most about martial arts was seeing my students get healthier overall. They may have come in to learn how to defend themselves, but their back pain went away, or they felt they were sleeping better. I was also learning some things that may have come from folk medicine, in a way—the effects of eating different foods, for example, and things of that nature. I found it all very interesting and wondered why we didn’t integrate more from other healing traditions into our conventional medical system.

So that initially, on a basic level, got me interested in going to medical school with the goal of trying to validate, or understand, what sort of interventions and approaches worked and what didn’t work. Of the ones that worked, I wanted to try to integrate those more into our conventional system as options for patients who might be interested in them. That was a very clear goal for me, as opposed to getting a degree in traditional oriental medicine. I could have been very happy doing that, but I really connected with the idea of trying to be a bridge to connect the different worlds of conventional medicine with all that is out there (and effective) from other healing traditions.

This was all in the early ‘90s. After completing my undergraduate studies at Tufts University, I deferred my law school admission for a year and stayed at Tufts, enrolling in their new postbaccalaureate premed program. I was one of the program’s first participants and one of the first of its graduates to get into medical school. I also got my EMT license and began working as an EMT to get more exposure. I really loved that.

Eventually, I got into Boston University School of Medicine, but I kept my secret agenda—my interest in what was then often referred to as alternative medicine—pretty quiet. We are talking about the early to mid ‘90s and integrative, as a term, was just starting to be recognized. Certainly, most people within academic medical centers were not very open to it. So I stayed relatively quiet. I was reading Sun Tzu at the time—The Art of War—so as Sun Tzu recommended, I tried to remain formless, like the water.

I made it through medical school and then, during my internal medicine residency, I began to share my interests with some of my advisors. I remember even sharing with the chair of medicine once, after he had been my attending, that I was really interested in this area of complementary and alternative medicine. He just said, “Show me the randomized, controlled trials” and turned his back on me.

In some ways, that was motivational and inspired me to do a research fellowship after my internal medicine residency. Again, because of this goal of mine to be in a position to integrate and change the system from within, I recognized that I needed to have a strong research background. I needed to have enough credentials to be respected within the doctors’ lounge in order to bring about the sort of transformation I hoped to see. I also wanted to help contribute to the evidence base for or against what was out there in the world of complementary and alternative medicine, or CAM. My goal was to help providers and patients in making better decisions.

So the decision to do the research fellowship was very deliberate. I even remember, as a fellow in general internal medicine, when I told my boss at the time. He said, “What, are you, crazy?” He literally said to me, “You’re wasting your time, you’ll never have a career. No one will hire you to do this.” Fortunately, I didn’t listen to him, even though I did respect him. My opportunity came through some interesting connections and through a friendship with Dr David Eisenberg, MD, at Harvard, who was running one of the first National Institutes of Health–funded centers to study complementary medicine. We had met and knew each other, and he was on an advisory board for the Office of Alternative Medicine at the National Institutes of Health.

As I understand it, at an advisory board meeting in 1998, another board member—Richard Panush, MD, the chair of medicine for a medical center in New Jersey called Saint Barnabas—told David that they were trying to develop an integrative medicine program and had received a small gift and a mandate from the CEO, but they were having trouble finding the right candidate. David said something like, “Yeah, I know this kid, Adam Perlman; he’s just finishing up his research fellowship, but this is what he wants to do.” I got a call from David’s office saying, “Do you mind if we send your CV to Dr Panush’s office?” Dr Panush and I spoke and, before I knew it, I was hired. In August of 1998, I became director of integrative medicine for what was then the largest health care system in New Jersey, and medical director of a then yet-to-be-built integrative medicine center, which became one of the earlier hospital-based centers in the country.

It was a tremendous opportunity. I literally bought—no joke—Business Plans for Dummies and the Complete Idiot’s Guide to New Product Development. I had an early vision regarding how to integrate these kinds of services. However, it was a steep learning curve—a really exciting learning curve. Eventually, I realized I could partner with some of the business people in the health system and we began to put the plan together, and, ultimately, put the center together.

A few years later, for a number of reasons, I wanted to get back to an academic setting. At that time, the University of Medicine and Dentistry of New Jersey, or UMDNJ, which is now Rutgers in Newark, New Jersey, came calling.

Again, UMDNJ presented a very interesting opportunity. They were recruiting a director for the Institute for Complementary and Alternative Medicine. The institute was based within the Allied Health School, not even the medical school on campus, which was New Jersey Medical School. It was based in what was called the School of Health-Related Professions. They had an endowed chair position available within that school, and I initially didn’t even go and interview because I thought they were looking for PhD credentials, which was true. I was encouraged, however, by a colleague who was there to go and present to their search committee.

Long story short, I ultimately transitioned most of my time over to UMDNJ, where I was executive director and kept up a 1-day-a-week integrative medicine practice at Saint Barnabas within the center that I built there.

IMCJ: In building the center at Saint Barnabas, were there particular challenges that you faced in trying to get buy-in with some of the stakeholders? What were your experiences like while you were trying to build that program?

Dr Perlman: As a part of the initial model, I would see patients and triage or refer to other services as needed. That was more to put the physicians’ minds at ease, quite frankly. But as we evolved, obviously, there would be direct referrals to our services and we would do that very quickly.

We started it up in a small, organic way in that regard. I had an organizational chart with me at the top seeing patients. The chart also included massage, acupuncture, mind-body medicine, and an herbalist I had met. She was an excellent herbalist, who trained with David Winston, RH (AHG), and she was a nurse as part of her background. She had done herbal medicine within an HIV clinic. With that basic structure set, I got a list of the top 50 physicians, clinicians, and other thought leaders within our health system, locally, and I went on a tour to meet with them, get feedback, and ideally inspire buy-in for the vision.

One thing that happened pretty quickly—and going back 20 years—there was a lot of resistance to the idea of involving herbalists. People said, “We are okay with this, but if you have an herbalist, we are not going to refer anyone,” and “What about drug–herb interactions?” From the mindset of, “Sometimes it’s okay to lose a battle if, ultimately, you’re going to win the war,” I dialed back on the idea of including the herbalist, thinking, “Let’s establish ourselves and let the local medical community see that we are doing this and that it is credible and really helping patients. Then we’ll be able to expand into some of the other clinical lines that might be a little more controversial like the herbalist.” And that’s exactly what we did.

For the first 6 months or so, I saw every patient. I was intentionally trying to build up the practice slowly. I would see them and then refer them out within a very short period of time. It eventually became clear that as long as patients had a physician caring for them on some level, they could go directly to services. If they weren’t already seeing a physician, then I would review it.

An example I still remember began when my administrator at the time, who was booking patients, said, “We have a 23-year-old who has joint pain and wants to get acupuncture, and she doesn’t have a doctor caring for her.” So I said, “Alright, let me give her a call.” The concern was that 23-year-olds shouldn’t typically have joint pain from osteoarthritis. Perhaps there was some sort of injury or another condition that could cause joint pain, like rheumatoid arthritis or lupus, so the patient shouldn’t go directly to acupuncture without a medical evaluation.

I called her up, and it was really more of a miscommunication. She actually did have rheumatoid arthritis, but she was under the care of a physician. He had even recommended she get acupuncture. Somehow that had gotten lost in communication with the person who was triaging her. That was one of maybe two or three times that first year when I actually had to double-check. This wasn’t about my own biases in terms of what I felt an acupuncturist or other providers could or couldn’t do; it was more about trying to find a balance. At that time and place, that called for putting the conventional providers’ minds at ease in terms of what we were and how we operated, in order to grow and flourish in the long run.

The approach worked and we slowly began to build physician referrals. So much of this progress comes out of relationships, and I developed a strong relationship with the rheumatology practice that was in the same outpatient building as the Integrative Center at Saint Barnabas. I used to go to a meeting with them once a month because a lot of those patients are particularly appropriate for integrative interventions. Theirs was a very busy practice with a 3-month wait to get in. At one point, probably 6 months into attending these meetings—and this was before any medications were approved for fibromyalgia—they said, “Why don’t we just send all of our fibromyalgia to Adam and the Integrative Medicine Center?” To which I said, “Great. Thank you!”

So, if you called that practice up and said, “I have fibromyalgia, I would like to see Dr So-and-So,” they would say, “We’re happy to schedule that appointment, he is currently 3 months out, but I’ll let you know that he sends most of his fibromyalgia patients to Dr Perlman at the Integrative Medicine Center.” So overnight, a large proportion of our practice, and obviously my personal patients, became fibromyalgia focused. I welcomed them with open arms. It is certainly a condition that can be challenging to treat, and an integrative medicine approach can be particularly helpful and successful. Events like that helped to grow the practice and increase referrals to the center.

IMCJ: How did your experience in New Jersey evolve?

Dr Perlman: As I transitioned most of my time over to the university in Newark, I wasn’t seeing patients there. I was running the complementary medicine institute, and I was involved in research. Around that time, I got my first funding for a clinical trial—actually through the Centers for Disease Control, or CDC, initially—supporting research that I was doing collaboratively with a physician named David Katz, MD, MPH, who was at Yale-Griffin Prevention Research Center. That led to a line of research that I have continued to be involved in, looking at massage for arthritis of the knee. I also began to take on a lot more leadership and administrative responsibilities, which is something that I particularly enjoy.

For the final 3 years before I left the Allied Health School, I was chair of the Department of Primary Care, so I was overseeing a physician-assistant program and respiratory therapy, as well as the complementary medicine institute. I enjoyed it there, quite a bit. I worked with great people and a nice mix of having a limited clinical practice but also being able to do research and teach to some degree.

In 2011, Duke came calling. Tracy Gaudet, MD, had left Duke to take a position at the VA. She had contacted me, and I went down and interviewed. It seemed like a phenomenal opportunity. So, in 2011, I transitioned to Duke as executive director for Duke Integrative Medicine. They had some other needs there, in terms of oversight and leadership, within what is referred to as the Health and Wellness Portfolio at Duke.

Within a few months, I became associate vice president for health and wellness for the Duke University Health System. In that role, I oversaw not only Duke Integrative Medicine, but also Duke Diet and Fitness Center, which is a residential style weight loss program that’s been around for many years as well as a 2000-member, at the time, now maybe about 2500-member, fitness center that the health system owned and ran as well. Those 3 pieces made up what the health system referred to as their Health and Wellness Portfolio, and that’s what I had responsibility for.

IMCJ: When you were working in these academic positions, did you find any particular resistance to moving the needle in academic medicine toward integrative solutions or integrative education for medical students?

Dr Perlman: I do recognize that that is somewhat of a rhetorical question, right? All of us have met with resistance, but for various reasons. It’s an interesting question, though. Yes, we all have our own biases, and there are clearly physicians—other health care providers and administrators—who just have it in their minds that regarding integrative medicine, there is no evidence. And that is certainly not true. There is a large body of evidence, and for certain interventions, there is stronger evidence than for others. But there certainly is evidence for many, if not most, of the more common complementary modalities that people utilize.

That being said, people have their biases and, sometimes, it can be hard to change peoples’ minds. And that’s fine. What I’ve found though, and more so nowadays, is there are more challenging obstacles when it comes to broader integration of complementary modalities and integrative medicine, whether in a clinical setting or in an educational setting. In the educational setting, my experience was less about “show me the evidence” and more about “we already have so much we have to teach the medical students to get them ready to take their certifying exams and board exams.” There’s just so little room to integrate more content—most of which won’t necessarily be on the exams that they need to take to actually get their medical degrees.

And that is certainly a concern. Now, some of that content has made its way onto those exams as well as the recertification exams that we need to take. But by and large, this problem transcends integrative medicine. There is such growth in the body of medical knowledge that one needs to understand. That, certainly, was the obstacle that I ran up against more often.

The other side often comes from a significant desire on the part of medical students to learn more about integrative medicine and complementary modalities and providers, things that technically fall outside mainstream medicine. That does push medical schools towards finding innovative ways to integrate education—sometimes as electives.

The argument that I have made many times is: The data is really clear on the fact that our patients are using complementary modalities. For me, if a patient can’t turn towards—let’s not just say physician—their health care provider, whomever that may be, for reliable information or an open dialog about all of the options that they may be interested in pursuing or considering—including those that may fall within this world of complementary, integrative, and now functional medicine—then they’re often forced to turn to potentially less reliable resources. Information may be great on the Internet, but it may be put out there by the company that is looking to sell the product. And again, that may be fine or that may not be very accurate or reliable.

I have always felt like we need to educate ourselves. We, the conventional medical side, so that we can provide an informed discussion and support our patients right and have the ability to make informed decisions that feel appropriate for them as it relates to their care. That is an argument for finding ways to make sure that not only medical students and residents, but that practicing physicians and other health care providers on the conventional side have access to information about complementary modalities and are able to stay up-to-date on where the evidence is the strongest, where evidence of safety exists, and where safety or clinical evidence may not exist. All of that is included in our obligation to help inform our patients.

IMCJ: You mentioned that some of the demand for expanded content was generated by the medical students themselves. In a broader sense, where else did you find momentum toward implementing integrative modalities in the educational system?

Dr Perlman: Most of my experience was at UMDNJ. I was asked, at one point, when UMDNJ was looking at revamping its curriculum, to put together a complementary-alternative-integrative medicine curriculum. I actually published a paper on some of the challenges and opportunities.¹

Again, the challenges were, as I stated: There was ultimately an issue with where we can find the time. There was also an issue, just to make this one final point, that a lot of the faculty, let’s say when treating arthritis, didn’t necessarily know the evidence for acupuncture, massage, glucosamine, or some of the other alternatives for complementary, nonmedication, or nonsurgical approaches for treating the symptoms for arthritis. Ideally, existing faculty would integrate that content into the cases and the other content they were presenting. That was hard to implement. And a model where they would stop lecturing, step out, and let me, or someone else, come in and talk about the integrative, complementary modalities and approach didn’t feel like the best way to educate the students. Ultimately, it didn’t move forward.

The momentum was strongest, in my opinion, where the medical students were pushing the most. We had a great interest group; there was a lot of desire from a number of the medical students to see more content integrated into their curriculum. I came to find out that medical students can be really influential. By and large, the administration really takes note of the feedback that the medical students are giving them; at least, that was my experience at New Jersey Medical School. So this idea of it being somewhat organic and driven by the medical students is where I felt integrative medicine was getting the most traction.

IMCJ: Can you address any issues you may have seen in creating research to support or rule out complementary therapies? Do these healing modalities present challenges for randomized, controlled trials to assess properly?

Dr Perlman: There are clearly issues with the reductionist approach and the overarching reliance on large, randomized, controlled trials as the gold-standard methodology for evaluating not only integrative medicine, but many aspects of conventional medicine. I think we are beginning to understand that better. Even our understanding of placebo is evolving from what it was, and I think we are going to see a real shift in our understanding of placebo over the next decade. That will probably lead to some shifts in the way we think about methodology, and certainly the placebo-controlled trial.

It is a better conversation to have with people like Ted Kaptchuck and others who are real experts in the placebo effect. I’m following some of their work and intrigued to see where things go. That being said, for me, integrative medicine is really about an approach more than it is substituting an herb for a medicine. That overall approach, involving a number of components from the concept of partnering with patients to a more whole-person, whole health perspective for addressing whatever the condition may be, is often similar to what we would find in other healing traditions.

Concerning the idea of testing the approach versus isolating the intervention, we don’t put as much emphasis on methodologies that evaluate approaches as we do with individual interventions. Whole system methodology is probably one way to begin to get at some of the answers, in terms of what is the true impact to an individual or a group of individuals, when we take this more whole person or holistic approach to a particular condition. Right now, we limit ourselves because of overreliance on RCTs.

I do think we’re going to see a shift. Obviously, one of the areas driving the cost of health care, a lot of the morbidity that people are suffering from, and the majority of the reasons that people are dying—certainly dying prematurely—includes chronic conditions that are very often preventable or are to some degree treatable through lifestyle intervention and a more comprehensive approach. We need to design studies with the right kind of methodology to really look at comprehensive models of care for complex chronic conditions.

IMCJ: Your career has now carried you beyond Duke. Where has it led since then?

Dr Perlman: By the time this is printed, it will be 2 years since I left Duke. I was very happy there. I certainly had some of the frustrations we all have, trying to be innovative and trying to bring about transformation within a large system, but I was really enjoying what I was doing and the people I was working with. However, 4 to 5 years ago, I began to think about my career, and maybe because I was approaching 50, I had this quirky thought: “Here I am at Duke, and feeling quite blessed in what I’ve been able to do, running the integrative medicine program and overseeing the diet and fitness centers, but I still feel like my parents really have no idea what I do.”

And I considered, “What is it that I’m really interested in, and what is it that really drives and motivates me?” One of the instant connections I made, that I hadn’t realized early on in my career, was this connection back to the martial arts. I began to recognize that I was really interested in helping people explore the potential inside of them. Very often in medicine, we are working hard to get people back to a baseline. Their blood pressure is elevated, or their hemoglobin A_1C or glucose are elevated. And whether it is through lifestyle, medication, or what have you, we are trying to get those markers back into the normal range.

When we do that, we often feel like our job is done and that we have done a good thing, which is true. It was obviously imperative to get those aspects of their diseases under control, but the fact that they don’t have the energy to play with their grandkids, or they suffer in other aspects of their well-being, doesn’t necessarily come into play. In that regard, there is potential inside of everyone for living a better life than they are living now—from a well-being perspective, certainly. For me, as I began to do more integrative and functional medicine—I began to train about 10 years ago in functional medicine, as well—that is what I became particularly interested in. Certainly, addressing the priorities for which the patients came to see me, but there was this broader potential for them to live a better life that may be related to relationships, energy level, sleeping better, more gratitude, purpose and meaning, or other things that contribute to a person’s overall sense of well-being.

I found this old picture from maybe 20 years ago. I think I was about 19 years old, because I was a first-degree black belt. It showed me doing a jump sidekick with me 5 or 6 feet in the air. I’ve used that picture in some talks that I’ve given. I typically say, “Maybe it would be impressive if I could jump and spin 6 feet in the air and break a board, right now—which I definitely could not. But it’s not exactly a marketable skill, other than to become a martial arts instructor. So what was the point? What I have come to realize is the importance of what it took to get there: How much discipline, how much determination?”

If you set your mind on a particular goal, in this case a physical goal, achieving the goal isn’t just about the physical ability. It’s about the mental aspect. It was about exploring potential. That was where I recognized the connection between my career path and interests and being on this personal path where I was interested in exploring the potential in myself: physically, mentally, and spiritually. It is this idea of helping others to explore their well-being potential—based on their vision, values, and priorities, no matter what their overall state of health, that conceptually—I’m bringing to my work within health care. That profound connection to the martial arts is much more relevant for me at this point in my career than, for example, the integration or substitution of an herbal treatment for a medication.

Modalities, such as herbs, and providers, such as acupuncturists or massage therapists, are important to understand and integrate, as are any other interventions or members of the care team, when evidence supports them, and the safety issues are considered. But the broader issue is around helping others to live lives that are more meaningful, complete, healthy, and to the highest degree possible. That premise is particularly motivational for me.

Wanting to find ways to integrate that broader approach into the system, I wrote an opinion piece² that outlined the idea. Even with population health, we tend to be very focused on doing a better job of managing and measuring hemoglobin, A_1c, or blood pressure. And that is understandable in that it’s the way health systems, or physicians, get reimbursed. But in addition, shouldn’t we be talking more about how we help populations to truly flourish or thrive? Or whatever word resonates with you.

Around the time I had written that opinion, I was approached with an opportunity to start a company that focused on trying to do just that—not within health care, per se, but more within the wellness space and looking more broadly at concepts of well-being. We often see a focus on exercise and nutrition, but we wanted to try to take a broader approach. I was also particularly interested in—and am still interested in—the role of health coaches, particularly integrative health coaches. That is at least a part of the solution; one missing link in terms of our health system is someone trained to partner with people in a way that can lead to a heightened level of engagement on the part of a patient and more sustainable behavior change.

And I mean behavior change more broadly defined. Not just exercising more and eating better, which are critically important, but also communicating better with my friends and family and loved ones. Or maybe it’s about incorporating more gratitude in my life. The point is, other things often have a profound impact on our well-being, and health coaches are uniquely trained to have that dialog and go through a process with someone that helps them to define and act on the kind of changes they want to make in their lives.

We called the company Synchronicity but, long story short, it just didn’t work out for me, personally, the way I thought it would. So, I decided to look at what would be my next chapter, so to speak. I knew that I wanted to be involved with this concept I’ve mentioned, where people have an opportunity to look more broadly at their well-being, and the potential inside of themselves. To be very honest with you, I thought I would probably end up back in a large, self-insured entity—a Google, or an Apple—where I would be developing more innovative programming to help with employee well-being. I was seeing more innovation within the employee–well-being space, and I’ve been involved for a number of years now as cofounder and chief medical officer of a company called meQuilibrium. It’s the leader in providing a digital coaching solution for resiliency within the corporate wellness space.

I also considered the consulting space but then was approached by Mayo Clinic. As I began to talk with Mayo Clinic, and continued conversations with other entities, I realized that the corporate wellness space in some ways is struggling to find valid, evidence-based solutions to the broader challenge of how to enhance employee well-being. And. of course, for employers it is about well-being, but it’s also about burnout, productivity, absenteeism, retention, and all those sorts of things. Resiliency is certainly a part of that solution, but I recognized an amazing opportunity at Mayo to do something within academic medicine that could be truly innovative and impactful. I’m unbelievably excited about that opportunity, now having accepted a position at Mayo Clinic Florida, as director of integrative health and well-being, to not only play a role in developing what had been more of a pilot program around integrative medicine, but also to bring in functional medicine and broadly integrate the program across the Florida campus. I will also be getting involved with employee well-being and patient well-being, with the goal of validating things internally that can then be moved into a corporate wellness space or more broadly scaled and integrated. Mayo already does a lot with well-being and I’m fortunate to have many talented and passionate individuals with whom to collaborate.

For me, at the end, it was really about which platform would allow me to have the broadest impact. I’m not even there yet, but I’ve been incredibly impressed with Mayo Clinic and am really excited to get there.

IMCJ: Many larger health systems pay lip service to the benefits of lifestyle, nutrition, and exercise, but when you dig down deep, you find that they are really still stuck in the conventional paradigm. How do you see your presence at Mayo impacting those types of initiatives?

Dr Perlman: It’s a combination for me, personally, of all the things I’ve learned over the last 20 years. For one thing, being at a place like Mayo Clinic, there is an opportunity to study whatever interventions or programs we would choose to put in place. Having that sort of infrastructure is critically important to validate whether or not an innovative approach is effective. With some of the functional medicine approaches, for example, there is an opportunity to work, not only internally within Mayo, but even potentially to partner outside of Mayo with other institutions or organizations. We will be able to really look and see, whether these other sorts of interventions and approaches, whatever they may be, work clinically—particularly for complex chronic conditions. Moreover, do they lead to improved overall value within health care?

I’m very practical in the way that I think about that and, in the end, we want to see that we get even better outcomes or, certainly, at a minimum, equivalent outcomes with lower cost. And that, ultimately, is what will move the needle. I don’t think that is the sole determinant of whether or not something should or will be integrated, because there are things within a portfolio of services that every health care system offers which break even or lose money but have importance for the overall mission. Of course, we also need to enhance the experience for patients and the health care team. Both sides have real and critical needs that we need to find ways of better addressing.

But in terms of truly bringing about meaningful change, these approaches and interventions need to be developed and integrated in a way that establishes the ability to clearly define and articulate the value proposition. To accomplish that, a critical component is relationships. We can’t do it on our own. Each one of us brings a certain perspective—a certain piece of expertise. Transformative change can really only happen through broad collaboration. So, I’m very focused on cultivating the types of relationships that will lead to collaborative innovation.

IMCJ: Have you found ways to affect the system in other ways?

Dr Perlman: I mentioned that I had become really interested in leadership, and I had an opportunity to chair the Academic Consortium for Integrated Medicine and Health a few years back. That consortium now has about 75 medical schools affiliated with it. Because of that experience, I came to appreciate not only the need for leadership, but also that where health systems and medical centers were struggling is not so much where to put the acupuncture needle on the oncology patient, but how to figure out a successful clinical and business model to integrate acupuncture into their oncology center.

We’ve known where to put the needles for 5000 years, give or take. It’s a question of how to make that work within our current system. And that requires business acumen, leadership skills, communication skills, strategic thinking, and relationship building, amongst other things.

I felt very fortunate, 6 years ago, to receive a grant from the Bravewell Collaborative, before they sunset as an organization, to develop a leadership program at Duke. That year-long program enhances people’s leadership skills, business acumen, and other aspects. It includes a deeper dive into integrative models of care and looking at best practices with the goal of supporting individuals who will be out there in various settings, trying to bring about a transformative change.

Our participants have been a very diverse group. We certainly have traditional docs participate who, like me, have the opportunity to become a medical director of an integrative medical center. But we have also had health consultants, administrators, the head of human resources of a bank, and people from all kinds of different settings and health-related backgrounds. For me, that kind of an environment, where people come together from various settings, but all share some commonalities around a sense of purpose and the needs for transformation of the well-being of all members of our society, creates opportunities for amazing personal growth and innovation.

It’s easy to try to blame the health system. “How come we’re not just doing more of this, or that?” The reality is the health system has a responsibility to keep their doors open, too. And the reimbursement system needs to shift in many ways for there to be even more meaningful change in the current care model. The bills need to get paid, and that is just the reality of it. And when you look at health issues in our country and the world, like the obesity epidemic, there are broad cultural and societal issues that need to be addressed.

So, it really is going to take a great effort from all of us, looking at this from various angles and each bringing expertise and passion to the table, in order to bring about the kind of meaningful transformation that is needed.