By Dr. Sharon Gurm BSc, ND, Naturopathic Physician, Clinic Founder & Clinical Director
The standard health care model practiced by most physicians in North America largely centers on addressing the physical aspect of disease and its symptoms, often viewed as separate or detached from the individual themselves. The goal is to control the physical manifestation (or symptoms) of the disease – often with pharmaceuticals – rather than consider lifestyle practices, dietary habits or stress factors that may be causative, or contributing, to the problem. Unfortunately for most, medications often just mask the problem and, to varying degree, each medication has consequences on human health.
Typically, if a person experiences a side effect or ‘new problem’ from a medication (which can appear days or years later), the standard response of the physician is to use another medication to address the ‘new problem’. It doesn’t take very long for a viscious cycle to ensue. The person’s health deteriorates and quality of life is often compromised. The practice of the ‘disease model’ approach on health care outcomes requires serious reevaluation.
There is sufficient evidence to suggest that there are better ways to practice medicine. Changing the current widely accepted – yet increasingly questioned – dogmatic disease model for health care, needs to be more than just an option for future consideration. It is a must for the present. It is time for health care reformists, policy makers and health care professionals to embrace what is undeniably the future of medical care and what is already a force propelling a paradigm shift in medicine – a medical model that embraces integrative care using a whole person approach.
Supporters of the conventional medical model will argue that there is limited ‘scientific’ evidence to support the use of integrative medicine and its inherent naturopathic principles. When using the term ‘scientific’, they are referring to randomized controlled trials, or RCT’s. RCT’s have long been considered to represent the ‘gold standard’ in medical research. In simple terms, elements of RCT design features random allocation of treatment recipients versus those who do not receive treatment (control group). There are many advantages to this design, but there are also many limitations. One such limitation is that often only one ‘treatment’, ‘intervention’ or ‘substance’ is studied. This reductionist concept simply does not function in the integrative medical setting where health is dependent on a multitude of factors. In addition, RCT’s require large sample groups, so they are rarely used because of the demand of resources and finances required. Furthermore, the RCT-type research trial is typically funded by government-based organizations and large pharmaceutical companies. In the field of integrative medicine, such large and accessible funding is few and far between.
While RCT’s have profound value in medicine, the inherent flaw in the limited, one-dimensional view of RCT’s is that this model does not allow for consideration of multiple factors that in turn can influence outcomes, which is characteristic of real-life (vs experimental design) situations. Fundamental to the whole person approach is the principle of individualized assessment and provision of care that considers a person’s behavior, mental-emotional state and physical factors (such as nutrition and physical activity). The hallmark of integrative, whole person care (whether by naturopathic doctors or integrative medical doctors) is that physicians will rarely treat with a single agent – be it herb, nutrient, drug or behavioral intervention. The multi-dimensional approach to health care may include counseling, dietary suggestions, exercise and other considerations as appropriate to the person – in addition to the bioactive agent (drug, herb or nutrient) that is prescribed. These are offered in a dynamic that honors the therapeutic value of the doctor-patient relationship – one that is attentive, respectful, nurturing and supportive.
Thus, to understand the true value of the whole-person approach to care, the very ‘scientific model’ used to determine whether or not there is value and how much benefit is to be obtained from the intervention, must be adapted to the art of the type of medicine that we are seeking to understand – in this case, whole-person, individualized medical care rather than disease-model medicine.
At the International Research Congress on Integrative Health (May 15-18, 2012), a recently published study of naturopathic treatment for diabetes was presented using a different ‘scientific model’ than the RCT. The study compared type 2 diabetics receiving adjunctive naturopathic care (ANC) with those who did not. The findings revealed significant improvement in several parameters measured for the ANC group (i.e. reductions in blood glucose, self-monitoring, diet, motivation and mood) compared to the group that did not receive ANP. In addition to the diabetes study, a review of 13 outcomes studies of ‘whole practice’ naturopathic treatment was presented, supporting the value in the multiple modality, individualized approach that is also favored by integrative MD’s. Yet despite the evidence presented in these studies, many MD’s and medical researchers would contend that the study does not follow the gold standard in medical research and therefore does not ‘fit’ the definition of ‘scientific evidence’ and is rejected because it is considered to have limited or no value simply because it does not fit the RCT model.
Publisher and editor John Weeks, of Huffpost Healthy Living, summarizes the material presented at the International Research Congress in his article How Naturopathic Doctors are Proving the Value of Integrative Medicine (June 13, 2012). He cites the poster presentation entitled “Systematic Review of Outcomes Studies of Whole Practice Naturopathic Medicine” where the team leading the presentation found “some degree of clinical benefit” that was “sometimes quite strong” in each of the studies involving naturopathic treatment for chronic conditions. While noting many “methodological weaknesses,” the team concluded that the review “provides evidence of effectiveness and cost savings in chronic diseases in the observed or validly-modeled practice of trained and licensed naturopathic doctors.”
In his article, Weeks states:
“Such research is of most value to real world decision makers. The aim is not to show that X therapy caused Y response under controlled conditions. Rather, these help stakeholders — whether employers, individuals, hospitals, or accountable care organization leaders — understand what may happen if a given population of patients is cared for by a set of integrative practitioners. These specifically help answer whether naturopathic doctors will be helpful if included in care teams or benefit plans.
Small as this sample of research projects may be, this baker’s dozen of whole practice studies reflects a significant contribution to the body of knowledge of the outcomes of real world treatment by integrative doctors of any kind.
“In search of the science to support whole person, integrative medical care, the emerging guild of board-certified integrative M.D.s may use a strategy favored by the naturopathic doctors 30 years ago. They too might find it useful to borrow useful research from across a professional aisle. In their case, they will be sampling from their naturopathic doctor colleagues who are forging the path of whole practice integrative medicine research.” – Weeks, 2012.
In B.C., naturopathic physicians are recognized as primary care doctors. Our scope of practice is wider than any other province in Canada and includes prescribing authority, which helps us provide integrative medical care that combines conventional medical wisdom with that of naturopathic healing principles. We are still a long way from truly integrated health care. Among other rights, naturopathic physicians need to have authority to refer directly to specialists and diagnostic studies, to parallel the current mainstream care of M.D. primary care providers. Thanks to the dedication and diligence of our College of Naturopathic Physicians of BC and the BC Naturopathic Association, acquisition of these rights for naturopathic physicians is sure to be in the very near future. You can help our profession acquire these rights by speaking to your local MLA about health care reform and the need to broaden the scope of access for naturopathic physicians.
Access to naturopathic care is still elusive to many, mainly due to associated costs for private health care. Most insurance providers offer little to no coverage for naturopathic care, making affordability an obstacle for many who wish to improve their health by engaging in naturopathic and integrative health care. Health spending accounts (HSA) in lieu of or in addition to group insurance offers greater flexibility and wider coverage for individuals to choose how to apply the additional health care dollars available to them. For more information on extended health plans and health spending accounts, read BCNA Extended Health Plans Online. [Right click and “Save As” to download the PDF]
You can do your part by speaking to those responsible for policy change (such as your local MLA and health minister) and requesting employers to consider HSA in addition or in place of common group insurance policies. If you are self-employed you are eligible for HSA.
Hopefully, information such as what was presented at the recent Congress will fuel the movement for change and force employers, insurance providers and policy makers to shift the concept of health care provision to include, and make more widely accessible, integrative whole-person care. The future of our health care depends on it.
References
http://www.huffingtonpost.com/john-weeks/integrative-medicine_b_1584998.html
Kieran Cooley, Erica Oberg, Joshua Goldenberg, Jane Saxton, Ryan Bradley, Dugald Seely, Carlo Calabrese, Becky Skidmore. Systematic review of clinical studies of whole practice naturopathic medicine. PROSPERO 2012:CRD42012002176 Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012002176
