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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:

  • The healing power of nature (vis medicatrix naturae). Support, facilitate, and augment the inherent ability of the body to heal itself by identifying and removing obstacles to health and recovery and by gently stimulating the body's vital force.
  • Identify and treat the causes (tolle causam). Seek to remove the underlying causes of disease rather than simply eliminating or suppressing symptoms.
  • First do no harm (primum non nocere). Use methods that minimize harmful side effects, using the least force necessary to diagnose and treat; avoid suppression of symptoms; and respect each individual's self-healing process.
  • Doctor as teacher (docere). Emphasize patient education and self-responsibility for health and the therapeutic potential of the doctor-patient relationship.
  • Treat the whole person. Take into account the complex interaction of physical, mental, emotional, social, spiritual, environmental and other factors that affect health and disease.
  • Prevention. Encourage and emphasize disease prevention.2

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

  • healthy lifestyle promotion;
  • stimulating the vis medicatrix naturae;
  • individualization of treatment;
  • using least-force interventions and avoiding symptom suppression; and
  • patient education.

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:

  • Measurement of treatment fidelity allows researchers to begin to determine which elements of the system had the most influence on patient outcomes.
  • Replication studies are difficult if there is no assurance of what was done before.
  • In CAM, more than one medical system can use the same treatments, and philosophies often overlap. Without a clear understanding about what is essential, unique and prohibited in treatment under each system, effect sizes will suffer.
  • Treatment criteria can be used to communicate best treatment under each medical system and provide a way to document differences between CAM systems.
  • Higher fidelity interventions may have higher retention rates and better outcomes through providing better quality of care. Fidelity measures allow for comparison of practitioners across locations and over various types and levels of education.2

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

References

  1. Cramer EH, Jones P, Keenan NL, Thompson BL. Is naturopathy as effective as conventional therapy for treatment of menopausal symptoms? J Altern Complement Med Aug. 2003;9(4):529-38.
  2. Herman PM, Sherman KJ, Erro JH, Cherkin DC, Milliman B, Adams LA. A method for describing and evaluating naturopathic whole practice. Altern Ther Health Med July-Aug. 2006;12(4):20-8.



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Date Last Modified - Friday, 17-Oct-2008 12:11:07 PDT