After Developing a TCM Protocol to Treat Polycystic Kidney Disease, Dr. Jennifer Ashby, DAOM, Proposes Clinical Pilot Study
Research into the efficacy of acupuncture and traditional Chinese medicine (TCM) has come a long way in the past few decades. However, trying to fit TCM into the research standards set for Western medicine can feel like fitting a square peg in a round hole.
Dr. Jennifer Ashby, DAOM, an integrative Chinese medicine practitioner at UCSF’s Osher Center, is working on designing a study that meets stringent research criteria, while still staying true to the tenets of TCM. Read below about her proposal, the challenges she’s come up against, and how she is shifting the research paradigm.
Q: Tell me about the research proposal that you are currently developing, and how you got interested in the topic.
A: I’m developing a proposal for a clinical pilot study to look at the effects of a four-component Chinese medicine approach to treating polycystic kidney disease (PKD), a genetic disorder. I had a PKD patient who didn’t respond to the usual treatment – acupuncture and lifestyle change – so I decided to learn more about the disease. I researched the effects of the genetic mutations and found that they resulted in three basic dysfunctions. When I started thinking about what these dysfunctions were, I realized that TCM already had theories for each one. For example, if we’re talking about effects on the structure of the kidney, the Wood element holds structure, so we treat the Liver. In doing so, I realized that I had come up with a hypothesis for treating a genetic kidney disorder: If I could correlate these mutational dysfunctions to TCM theory, and I treated the organs that address these pathologies, I might be able to delay the progression of the disease.
A doctor at the Osher Center heard about my idea, and asked me to present it at grand rounds, which I did, and secured the necessary support for moving forward with the research. I identified a collaborator: Dr. Meyeon Park, a nephrologist at UCSF, who heads the Center of Excellence for PKD at UCSF and was recently honored by the PKD Foundation for her work. She’s wonderful.
Q: What have you learned through the process of designing this study?
A: There have been so many things to figure out. My initial learning was that research is really hard, and that I was in way over my head. I’d been involved in research before, but had never written a research proposal, so I took a class at UCSF that helped me understand how to do that.
During that time, I realized that because most research is done on a single component, most research tests acupuncture alone, and usually just standardized protocols. Which is frustrating! But I am fully dedicated to staying true to traditional Chinese medicine (TCM), which requires a multifactorial study – because, really, nobody just does acupuncture. Nobody walks in a room and just sticks needles in someone. We talk, we engage in human interaction, we discuss lifestyle, exercise, diet, sleep; there are so many components. This idea of just testing acupuncture is like trying to knit with a single finger.
Q: Where are you currently in the design process?
A: I started with my hypothesis with six research components. But, as I learned more about multifactorial research I realized it would be more achievable if narrowed down to four components. These include acupuncture, diet, exercise, and qi gong, both as a form of meditation and to strengthen the Kidney and other organs that I had identified. Because multifactorial studies are so much work, I want to first figure out if patients will even stick to the plan that I’ve developed. So step one is to design a pilot study for feasibility and acceptability, to check for adherence to what I’m asking patients to do.
Once I’ve finished the research proposal, I’ll apply for a grant for funding within UCSF. I’ll be competing against the entirety of UCSF – up against research for things like pediatric heart transplant devices. What makes things a little more likely for this study to gain acceptance is that Western medicine has nothing to offer for PKD patients until they have end stage renal disease, and then it’s either transplant or dialysis. One drug was recently approved for a rapid form of this disease, but it only affects a very small subgroup. This study is also unique and integrative, so that might catch their interest as well.
Q: How is UCSF supporting you in this research?
A: UCSF is a great supporter of clinical research. The integrative Chinese medicine team at the Osher Center is faced with a ton of medically complex patients, and the beauty of doing that work is that you get to identify patterns and you and develop new ideas worth looking at that may be worthy of looking at. We have an entire floor of researchers. One person is our lead for TCM research – Maria Chao – and she’s brilliant; we can all run ideas by her. We also have our lead MD, Dr. Sanjay Reddy, who has likewise studied TCM, and helps to identify and develop research ideas, as well as conducts research. At the end of the day, the center wants to improve integrative healthcare for patients, and so they are always open to new and innovative ideas.
What I’m finding, in the four years that I’ve worked there, is that this openness is growing, and it’s really exciting. It almost makes your head explode, because there’s so much to do, and there’s only so many of us to do it. I’m very proud to say that the integrative Chinese medicine team at Osher outnumbers any other discipline within the center. It’s really awesome.
Q: Have you been working on other research projects at UCSF?
A: I just wrote the TCM component of the treatment manual for a big study we’re doing right now on treating pain in oncology patients – to reduce opioid use and the need for pain medication both in the hospital and after release. Maria Chao, who is the principle investigator, allowed me to write it pragmatically, to reflect the way that we practice. But I had to write it detailed enough that practitioners and non-practitioners alike reading it could replicate what we are doing.
I also have an upcoming meeting with neurology, so that we can discuss the supplements that I recommend for multiple sclerosis patients. I am also going to meet with neurology to discuss research related to supplements that I recommend for multiple sclerosis patients. This will allow us to devise a definitive list to ensure an equal standard of care.
Q: How did your education at ACTCM – in the DAOM and Master’s programs – prepare you for this research?
A: My master’s degree program at ACTCM gave me an excellent foundation. One of the things that I always tell my students is not to specialize too soon, because you lose your diagnostic skills. You need to remain open to recognizing red flags, when to refer out. When you get too specialized, you forget how to identify and treat other issues. Even when I started at Osher, my oncology experience was minimal. I kept telling myself, “Stick with the basics, stick with the basics. What’s going on with this person from a TCM perspective?” I had to avoid overwhelming myself and try not to over treat, so I could really just stick to what I do well.
The DAOM program gave me a valuable “think tank” for three years. That think tank, with so many other opinions and varying schools of thought, gave me an openness that I didn’t have before. It taught me how to think deeper and open myself wider to possibilities.
Q: What do you see as a good path for TCM students and practitioners interested in advancing research in TCM?
A: First of all, don’t try to oversimplify research – it’s complicated. If you really want to understand how to structure effective clinical research, take classes in research design. Studying anything that’s multifactorial is going to be incredibly difficult. But, to that end, I would say that there’s nothing wrong with doing really in-depth case studies, and looking at outcomes. Unfortunately though, in the world of research, case studies are not looked at as a stringent gold standard.
The question is: What is our intention, ultimately? I believe that forcing us to fit into the Western Medicine model is barking up the wrong tree. The scientific method was never intended to measure the human experience. It’s the best method that we have, but I think we can do better. If we really want to drive a paradigm shift, we have to think outside the box and work together to figure out how to really make this happen. How do we validate a medicine that takes into account a whole human being? It won’t be easy, but, dammit, we are working on it!
Interviewing by Dr. Stephanie Albert
Dr. Stephanie Albert holds a Doctorate of Acupuncture and Chinese Medicine from the American College of Traditional Chinese Medicine in San Francisco, CA. She runs a private practice out of the Lotus Center in the Mission district of San Francisco, where she works with patients to address stress, insomnia, pain, women’s health issues, and other health complaints through acupuncture, herbal medicine and lifestyle modification. www.stephalbert.com