Defining a Profession
By Tina Beychok, Associate Editor
An abundance of research shows that individual treatments utilized by naturopathic physicians work for specific conditions; but what about the effectiveness of naturopathic medicine as an overall healing system?Researchers may have taken the first step toward answering that question.
A number of recent studies have shown benefits for individual naturopathic treatments for a wide range of individual conditions. However, these studies have all focused on the benefit of a single therapy, compared to traditional Western medicine and/or placebo, rather than examining the benefit of the entire system of naturopathic medicine. By defining the benefits of the system, naturopathic "best practices" can be established – an important stepping stone toward increasing professional credibility in the eyes of the public, third-party payers and other health care professionals.
The concept of "best practices" is quite familiar to Western medicine. When two drugs are compared, there is a strict protocol in place to determine that the only difference between the two treatment groups is the drug and that the difference itself is statistically significant. This ensures proper treatment fidelity or criteria. From this, researchers can derive the best practices for treating various medical conditions.
Applying this concept to the naturopathic medical profession, the question then becomes: How can naturopathic medicine as a whole show valid treatment criteria, and thus derive best practices? A 2003 study compared naturopathic treatment as a whole to conventional therapy for the treatment of menopausal symptoms.1 The researchers found that naturopathic medicine was seven times more effective than conventional treatment for six specific conditions associated with menopause. However, that study considered only one particular medical condition.
Now, a more recent study by researchers at Bastyr University and the University of Arizona has developed a method for examining naturopathic treatment criteria for three common medical conditions: menopausal symptoms, bowel dysfunction and fatigue/fibromyalgia.2 In doing so, the researchers hope their criteria will allow for naturopathic medicine to be examined as a whole treatment system, similar to Western medicine.
The researchers started by determining treatment criteria that defined naturopathic medicine. Criteria were based on the six fundamental aspects of naturopathic medicine:
Based on these principles, the researchers then developed a set of five treatment components that could be applied to all treatments for all conditions:2
Additionally, the researchers developed a set of criteria that would apply only to patient visits for a specific condition. For example, the treatment criteria specifically for menopausal symptoms included addressing hormonal imbalance, heart disease prevention, osteoporosis prevention and breast cancer prevention.
Once the criteria were developed, actual "prescribed" therapies were matched to the treatment criteria to determine what percentage of the therapies was covered by the treatment criteria. These therapies were based on a random sample of treatments prescribed by licensed naturopathic physicians, in order to properly test the validity of the treatment criteria.
Overall, the researchers found that "the treatment criteria developed generally 'fit' (could have generated) 82% (354 of the 432) of the total treatments prescribed for menopausal symptoms, 93% (698 of 752) of the total treatments prescribed for bowel dysfunction, and 87% (472 of 542) of the total treatments prescribed for fatigue/fibromyalgia. ... The criteria developed could have generated the majority (82% to 93%) of the specific treatment prescriptions. Therefore, there is evidence that a naturopathic theory-based set of treatment criteria may work to provide meaningful measures by which to ensure treatment fidelity."2
The end result of these findings could potentially provide a basis for developing best practice guidelines for the field of naturopathic medicine. This will allow for even more serious scientific research that can lend credibility to the use of naturopathic medicine. The researchers outlined several benefits that could be derived from their findings:
Overall, despite study limitations, such as the treatment criteria only being derived from written sources and two doctors of naturopathy, and that treatment fidelity was determined from the treatments themselves, rather than from diagnoses, the researchers believe their study represented an important first step in deriving best practices for naturopathic medicine.
They concluded, "In addition to ensuring model validity, treatment criteria also can be used to identify the critical components of each system with respect to outcomes, are critical to the replication of studies, ensure that the best form of each system is represented in comparison studies, and are a measure of quality of care. The development of treatment criteria is 1 step toward allowing CAM to be studied as it is generally practiced – as distinct systems of medicine."2
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All Rights Reserved, Naturopathy Digest, 2011.
Date Last Modified - Friday, 17-Oct-2008 12:11:07 PDT