Brian Berman, MD, is the founder and inaugural Director of the Center for Integrative Medicine at the University of Maryland School of Medicine, where he is now Professor Emeritus. He also co-founded the Cochrane Complementary Medicine Field in 1996, and served as its Director until 2023. In 2007, he established the Nova Institute for Health, where he serves as President.
Dr. Berman has dedicated his academic career to evaluating the efficacy, safety, and cost-effectiveness of complementary and integrative medicine. More recently he has focused on better understanding the complex network of factors that impact health and building a bridge between whole-person health and public health. He recently sat down with colleagues from the Cochrane Complementary Medicine team to talk about his experiences.
Cochrane Complementary Medicine (CAM): Could you tell us a little about your background and what led to your involvement in integrative medicine?
Brian Berman (BB): Of course. It’s been quite a journey. I began my career in family medicine, finishing my residency in 1981. Many of my patients had chronic health problems, and I became frustrated that modern medicine didn’t have enough tools to help them fully. That’s what sparked my interest in exploring alternative approaches that could complement standard treatments.
I decided to study acupuncture through a new course for physicians at UCLA. Shortly afterward, I moved to the UK, where I found a long-standing tradition of using alternative therapies. There I had more opportunities to study Traditional Chinese Medicine, homeopathy, and other complementary approaches, and I began using them in my London practice.
These methods weren’t just new tools—they helped me see medicine in a more holistic, whole-person way. I noticed my patients were doing better, and I felt more fulfilled as a doctor. Still, many of my medical colleagues thought I’d gone off the deep end!
I realized that integrative medicine wouldn’t be widely accepted without scientific evidence showing its safety, effectiveness, and mechanisms. I approached one of my patients Sir Maurice Laing, a well-known UK businessman and philanthropist, about starting a research program. He was friends with Sir James Watt, then President of the Royal Society of Medicine and Surgeon to the Royal Navy. Sir James was already promoting the idea of bridging conventional and alternative medicine, so my proposal came at just the right time.
With funding from my patient and guidance from Sir James, I founded the Center for Integrative Medicine in 1991 at the University of Maryland School of Medicine.
At the Center, we focused on pain management using a multidisciplinary approach. Insurance companies were not very supportive at that time, preferring to cover the new “wonder drug” opioids, which were incorrectly believed to be non-addictive. Despite that, we pressed on. A year later, the National Institutes of Health (NIH) created the Office of Unconventional Therapies—soon renamed the Office of Alternative Medicine—which opened doors for research funding. Our Center was among the first to receive support, and we made the most of those opportunities over the following years.
Another key moment came when I met Iain Chalmers, the founder of the Cochrane Collaboration, by chance during a visit to Salisbury Cathedral. I saw the Cochrane logo on his T-shirt and started a conversation. He encouraged me to set up a Cochrane Field for Complementary Medicine. Soon after, with Andrew Vickers and Klaus Linde, we did exactly that. We also collaborated with leading researchers like Alex Jadad, Lex Bouter, and David Moher, who helped shape our direction.
Later, I met U.S. Senator Barbara Mikulski from Maryland, who helped direct federal funding to NIH’s Office of Alternative Medicine. That support allowed us to secure funding for our Cochrane work. For the past 27 years, we’ve successfully renewed that NIH support every five years through peer review.
These efforts have led to huge growth in research on complementary medicine. When we started in the early 1990s, there were only a few hundred studies. Today, there are more than a hundred thousand. Our collaborations now span the globe, helping to improve access to research, refine study methods, and train new investigators.
Meanwhile, our clinical programs expanded too. We integrated our approaches into the university’s main clinic, trauma center, rheumatology department, and cancer center. As other academic institutions began developing similar programs, we helped create the Consortium of Academic Health Centers for Integrative Medicine. It started with seven centers and now includes about eighty. Seeing this evolution—from skepticism to professional recognition and board certifications—has been incredibly rewarding.
Nancy Owens: You’ve talked about building evidence through research. Is there anything else you’d like to add about that process?
Brian Berman: Yes. I strongly support randomized controlled trials (RCTs) as the gold standard for testing treatment effectiveness. Over the past 30 years, medicine has shifted from relying on expert opinion to using evidence-based practices, thanks to pioneers like Iain Chalmers, David Sackett, and Alvin Feinstein.
However, not all therapies—especially those outside mainstream medicine—have been formally studied. “No evidence of effectiveness” doesn’t mean “evidence of no effectiveness.” The problem is often a lack of research funding.
RCTs also have limits. They don’t always account for real-world factors that affect treatment outcomes, like patient characteristics, adherence, the healer–patient relationship, or the practitioner’s skill. Integrative medicine often involves personalized treatment plans with several therapies used together, which can be hard to evaluate in a traditional RCT.
That’s why innovative research designs are so important—for both integrative and conventional medicine. Approaches like pragmatic trials, case reports, single-patient (n-of-1) studies, cohort studies, and patient preference trials can provide valuable insights.
Our acupuncture research for osteoarthritis followed a stepwise process: basic science studies to explore mechanisms, pilot trials to test treatment doses and control methods, and then large clinical trials. We also used qualitative methods like focus groups and interviews to understand patient experiences, combining that with quantitative data.
At the University of Maryland, and with partners like Sean Tunis at the Center for Medical Technology Policy, we developed a framework for comparative effectiveness research that studies treatments as they’re actually practiced. This helps ensure that findings reflect real-life care.
In the late 1990s, I also learned about practice-based research networks that were emerging in primary care and other fields. I believed these could work well for integrative medicine research, so with support from the Bravewell Collaborative, we helped create one. These networks encourage shared decision-making and inquiry among clinicians, making it easier to explore relevant questions and understand cost-effectiveness and patient outcomes in everyday practice.
CAM: That connects nicely to how evidence is accessed and used. What are your thoughts on improving access to research findings for clinicians and the public?
BB: We’ve made a lot of progress, but there’s still more to do. Our focus has been on producing knowledge and sharing it in ways that meet the needs of different audiences—policymakers, clinicians, and patients. Each group requires information in a format they can use.
It’s not enough to publish in academic journals. We also need blogs, social media, and plain-language summaries that make the evidence understandable. The Cochrane Complementary Medicine Field has worked hard to meet this challenge.
At the Nova Institute for Health, which I now lead, we’ve built an online Integration Hub that brings together researchers and practitioners for interdisciplinary discussion, early-stage research sharing, and exploration of new trends.
We also need to embrace new tools—like artificial intelligence and deep learning—alongside traditional research methods. The Nova Institute is a think-tank that promotes a holistic view of health and takes action to break down silos, recognizing the roles of education, housing, economics, and even climate in well-being. What we research and its relevance to a person’s entire lived experience is a crucial factor that calls for collaboration across sectors, also using tools that have been developed and found useful in fields other than medicine.
I’m optimistic about the future of evidence-based medicine, as long as we stay adaptable, inclusive, and committed to working together.