The Role Of Naturopathic Medicine

The Role Of Naturopathic Medicine In Addressing Chronic Conditions

First, there is a need to define several terms. When I refer to naturopathic medicine I am referring to a distinct system of primary care that addresses the root cause of illness or disease and promotes health and healing using natural therapies. Naturopathic medicine is practiced by naturopathic doctors (NDs), who are highly educated primary-care providers integrating standard medical diagnostics with a broad range of natural therapies. (In provinces and states in which naturopathic medicine is regulated/licensed it requires a minimum of seven years post-secondary study, the last four of which are in an intensive medical program, in order to practice.) The importance of this distinction is that while individual CAM therapies may have efficacy for certain specific conditions, if we are examining potential roles with respect to the treatment of a broad range of chronic conditions it is important to examine this in the context of highly trained, competent and regulated health-care providers.

In examining whether there are better ways to manage chronic conditions it is instructive to review why current treatments are being judged as inadequate. Halsted Holman MD, writing in the Journal of the American Medical Association (JAMA), highlights the need for new approaches to clinical education because of the impact of chronic illness on the health-care system. He notes:

The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to 2 related transformations in the past 50 years that are central to good health care today. In the first, chronic disease replaced acute disease as the dominant health problem. Chronic disease is now the principal cause of disability and use of health services and consumes 78% of health expenditures. In the second, chronic disease dramatically transformed the role of the patient. [3]

Dr. Holman explains why he believes that the roles of the patient and medical practitioner have changed: Because the patient must usually engage in unending treatment, make behaviour changes, and adjust to consequences of the disease, the patient inevitably becomes a principal caretaker. Preparation of the patient for that role is necessary. … With chronic disease the role of the physician also changes. While still the professional guide and advisor, the physician now teaches healthcare skills and shares decision authority with the patient and other healthcare professionals. [3]

One of the primary tenets of naturopathic medicine is that NDs are to serve as teachers, guiding their patients in establishing and maintaining healthy bodies. Dr. Holman notes that the current training for medical doctors (MDs) does not provide students with the experience of providing longitudinal care over a period of time in which a chronic condition is treated and monitored. The training in longitudinal care that MDs lack is precisely the training that NDs receive. At the Canadian College of Naturopathic Medicine (CCNM), student interns in our on-site clinic see approximately 25,000 patient visits per year. Approximately 90% of these visits are recall visits. For the most part, the student interns do not commence a treatment protocol until the second or third visit.

Although our training involves more longitudinal care than the standard medical school model, is naturopathic medicine effective in managing chronic conditions? To answer this, CCNM is conducting a number of research studies focused on examining naturopathic treatment protocols against standard approaches for select chronic conditions. Some of the most exciting research that we have undertaken has been conducted in conjunction with the Canada Post Corporation and the Canadian Union of Postal Workers (CUPW). The first study examined the use of naturopathic care for chronic low back pain. The study was conducted in the form of a randomized clinical trial with treatment occurring over a 12 week period. After this period, members of the control group were invited to join a cross-over cohort, to receive naturopathic care. Although the use of acupuncture was prominent in the protocol employed, it is important to note that the study was not about the use of a single naturopathic intervention. The naturopathic treatment used a combination of therapies including acupuncture, dietary change and exercise. Participants in the active treatment group demonstrated statistically significant (and lasting) reductions in pain and disability, along with statistically significant improvements in flexibility and quality of life. The study has been published in the Public Library of Science PloS ONE. [4]

Subsequent studies conducted with Canada Post Corporation and CUPW have examined treatment for rotator cuff tendonitis and anxiety, and a study is currently being launched on cardiovascular risk. The two completed studies have both shown statistically significant improvements in the chronic conditions being studied. (The results are not yet available in publication, but it is expected that they will be in the near future.) Beyond these randomized controlled trials, research publications involving CCNM researchers in the study of treatment for chronic conditions include, inter alia, reviews of orthomolecular treatment for schizophrenia [5], cassia and cinnamon bark for type 2 diabetes [6], niacin for migraine headaches [7], orthomolecular treatment for anxiety [8] and melatonin for inhibiting cancer [9].

This evidence of efficacy appears to be being recognized by patients. A study in Britain indicated that 60% of CAM users report a chronic condition (as versus 42% of the general population) [10]. The Saydah review of patterns in the United States indicated that adults with two or more chronic disease are 50% more likely to report the use of CAM, and 25% more likely to have reported the use of CAM in the previous year [2]. An unpublished survey conducted in 2004 by Strategies 360 Corporation on behalf of the Association of Accredited Naturopathic Medical Colleges indicated that of the 3475 North American patients of NDs studied, the following conditions were experienced by more than 30%: fatigue (36%), allergies (33%) and menstrual/hormone imbalances (32%). In addition, most of the other conditions for which treatment was being sought were of a chronic nature.

Given the evidence that is emerging with ever-increasing frequency, is the health-care system ready to embrace naturopathic medicine?

First, perhaps we should examine the conditions under which patients are ready to embrace naturopathic approaches. In 2006, research firm Innovative Research was engaged to perform a study on the attitudes of Ontario residents. (They contacted 602 English-speaking individuals – a sample that produces statistics for Ontario that have a maximum error of four per cent, 19 out of 20 times.) The study revealed that 18% of respondents claimed to have seen a naturopathic doctor for health care, but a full 40% planned to do so in the future. When respondents were informed as to the nature of the education and entrance-to-practice examinations, the number who planned to see a naturopathic doctor jumped to 69%. In other words, if Ontario residents had a better understanding of the education and regulatory structure associated with naturopathic medicine more than 8.5 million of them would be seeking medical help from a ND. The world is changing, but supporters of naturopathic medicine must continue to work to get their messages heard so that the change proceeds.

Few individuals would disagree with the assertion that the existing health-care system is unable to meet societal expectations of treatment for chronic conditions. The procedure-based reimbursement systems tend to promote a focus on brief interventions done to the patient as opposed to longitudinal care undertaken with the patient. Furthermore, the heavy reliance on expensive and powerful medications simply cannot be sustained, either on an individual or a societal level. For the individual, the lack of attention to nurturing healthy bodies and the overuse of prescription drugs can be damaging to both quality of life and life expectancy. At the societal level, governments are spending an ever-increasing share of expenditures on health care and yet the systems are being denounced in so very many ways. The maintenance of healthy bodies and the prevention/reduction of catastrophic illness are primary advantages that naturopathic medicine delivers. Naturopathic medicine is focused on sustainable health interventions – sustainable for the individual in that the least invasive and least destructive interventions are employed, and sustainable for society since the focus on health promotion and disease prevention will result in the need for fewer expensive post-symptom treatments. In Canada, CCNM is developing the skilled practitioners, evidentiary base and public profile to drive the changes required.

CCNM’s research activity is promoting the acceptance of naturopathic medicine; moreover it is doing so in a way that is changing the way that medical research is being conducted. An editorial in Integrative Cancer Therapies [11] lauded the role of primary researcher Dugald Seely, ND, in creating “an apparent degree of collaboration between a college of naturopathic medicine and experts in the area in major universities” in coordinating the work between CCNM, University of Toronto, McMaster University and the London School of Tropical Hygiene in a study on the effect of green tea on breast cancer incidence and recurrence.

As a not-for-profit charity organization CCNM’s role in the health-care debate is to serve as a well respected, trusted expert with regard to the efficacy, safety and practicality of naturopathic approaches. In the role of respected neutral expert, we hope to guide Canadian health-care providers in integrating naturopathic medicine into health care. We are committed to gaining a higher profile for naturopathic medicine and CCNM so that we can effectively promote the increased acceptance and use of naturopathic medicine within Canadian health care.

I understand that in a number of cultures they have a saying, “May your children be born in interesting times.” Well, these are interesting times, but I think they provide an environment in which new approaches will arise. The problems in our current health-care systems, as identified by politicians and pundits, cry out for more naturopathic approaches to public health. It is very clear that tomorrow’s system of health care will be different from that of today; I believe that naturopathic medicine and the Canadian College of Naturopathic Medicine can help make it decidedly better.

references

1. Leonard K (2008) Better Information / Decision Making. thefirstcanadianhealthcareconference.ca
2. Saydah S, Eberhardt MS (2006) Use of Complementary and Alternative Medicine Among Adults with Chronic Diseases: United States 2002.  The Journal of Alternative and Complementary Medicine 12: 805-812.
3. Holman H (2004) Chronic Disease – The Need for a new Clinical Education. JAMA 292: 1057-1059.
4. Szczurko O et al (2007) Naturopathic Care for Chronic Low back Pain: A Randomized Trial. PloS ONE 9: e919.
5. Prousky JE (2007) The Orthomolecular Treatment of Schizophrenia: A Primer for Clinicians. Townsend Letter for Doctors and Patients 283: 86.
6. Dugoua JJ et al (2007) From type 2 diabetes to antioxidant activity: a systematic review of the safety and efficacy of common and cassia cinnamon bark.  Canadian Journal of Physiology and Pharmacology 85: 837-847.
7. Prousky JE, Seely D (2005) The treatment of migraines and tension-type headaches with intravenous and oral niacin (nicotinic acid): systematic review of the literature. Nutrition Journal 4: 3.
8. Prousky JE  (2005) Orthomolecular Treatment of Anxiety Disorders.  Townsend Letter for Doctors and Patients 259: 82-87.
9. Mills EJ et al (2005) Melatonin in the treatment of cancer: a systematic review of randomized controlled trials and meta-analysis.  Journal of Pineal Research 39(4): 360-366.
10. Ong CK et al (2002) Health Status of People Using Complementary and Alternative Medical Practitioner Services in 4 English Counties.  American Journal of Public Health. 92(10): 1653-1656.
11. Block KI (2005) Recapturing the Patient’s Voice. Integrative Cancer Therapies. 4(2): 107-109.
12. www.ccnm.edu

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