"Can naturopaths deliver complementary preventive medicine?" Thus ran the headline in a recent editorial in the Canadian Medical Association Journal.
The editorial was written in reference to the publication in the same edition of a randomized clinical trial led by Dugald Seely, N.D. Seely and 13 colleagues, most from the Canadian College of Naturopathic Medicine, published their findings that individualized, whole person-oriented naturopathic care produced reduced cardiovascular risk for a group of Canadian postal workers.
The study, and the editorial, illuminate both the benefits and challenges in research on any trial of a kind of care that lives up to either naturopathic medicine principles or integrative medicine principles. It also points the way to the kind of research we need to create cost savings through reformed care delivery.
The study ran under a typically-bland title that captured none of the momentous nature of the publication for the naturopathic medicine field: "Naturopathic medicine for the prevention of cardiovascular disease: a randomized controlled trial."
Since the study focused on the addition of naturopathic care to routine treatment, the 124 patients in the group who saw naturopathic doctors continued with their family physicians for routine care. The treated group engaged a scheduled series of seven visits -- the first for one hour and the subsequent six for 30 minutes -- in a 12-month period. "For consistency with naturopathic practice," Seely and his co-authors write, treatment was "individualized." The practitioners did agree to make their choices from a set of "specific diet and lifestyle recommendations and the prescription of selected natural products."
The protocol -- called "pragmatic" -- was meant to leave room for the diversity of "real world" integrative medicine practice by naturopathic doctors. Yet the limits placed on the naturopathic clinicians reflected a compromise with the desire of a reductive research protocol to strictly control inputs, regardless of whether or not such reduction has any resemblance whatsoever to the treatment individuals receive.
The results: In those with naturopathic treatment, the researchers "found a significant reduction in the risk of cardiovascular disease." The benefits were captured across a range of measures. The lead indicators were the extent to which these human beings, after treatment, had metabolic syndrome and cardiovascular risk. The naturopathic care group showed statistically significant health gains in both areas.
Not surprisingly, the treatment group also showed betterment "for almost all secondary outcomes" such as weight, exercise and general well-being.
The Canadian Medical Association Journal's deputy scientific editor, Mathew Stanbrook, M.D., Ph.D., answered the question in the title of his editorial affirmatively: "The results of Seely and colleagues' provide proof of principle that some aspects of cardiovascular prevention could feasibly and effectively be delegated to naturopaths."
The statement comes 80 percent of the way through a column that first raises many questions about the methods of Seely's group. Stanbrook sounds rather like he is damning with faint praise. One notes that he chooses to call the practitioners "naturopaths" rather than the "naturopathic doctors" in the text of the article and in the Ontario law based on the medical education the practitioners receive. Then, while Stanbrook notes that the researchers chose a "pragmatic trial" that is used to "validate the effectiveness of real-world health care decisions," he jabs them because "we can learn nothing new from this trial about supplements or any other individual components of care."
What we have learned about, however, is the outcomes of care by naturopathic doctors. It proved to be darned good. And this is just what the naturopathic medical profession needs to prove in order to drive decisions of employers, such as Canada Post and other health care purchasers and decision-makers.
This is also what the emerging specialty of board-certified integrative M.D.s and D.O.s will need to show. Does their care, following their principles and individualized methods, create health in the populations they serve?
From the perspective of the naturopathic medical profession's research base, this research on the discipline of naturopathic medicine pairs nicely with a recent trial led by Ryan Bradley, N.D., MPH, one of Seely's co-authors. Via Group Health Research Institute, Bradley and his team found significant patient benefits from adjunctive naturopathic treatment for individuals with adult-onset diabetes. In fact, the lifestyle change outcomes were so good they stimulated a subsequent Group Health analysis of the "secret sauce" of naturopathic care that led to the outcomes.
In accordance with the typical researcher's reductive bent, Stanbrook essentially recommends examining the individual supplements used, for instance, rather than the whole protocol. These might presumably be valuable if slipped into conventional medicine's drug model of cardiovascular treatment.
Yet there was a much better recommendation Stanbrook might have made, given the importance of cardiovascular disease in the high costs of health care.
But why not start by noting that optimal care of most individuals with cardiovascular risk involves multiple etiologies? Care is complex. Of necessity, it demands the kind of individualization of treatment and whole person approaches such as the naturopathic doctors and their integrative medicine brethren practice. A good clinician doesn't treat patients with lifestyle risks who are at differing levels of readiness for change with the same prescriptions.
Why not, then, Stanbrook might have recommend, a follow-up in which the naturopathic doctors are working in a primary care capacity, rather than adjunctively, with these individuals. This would not only be money saving. This is in fact typically the way these naturopathic doctors practice their brand of integrative medicine, in Ontario and elsewhere.
Such a study would limit costs of conventional care. Or, put differently, it would make the integrative medicine as provided in the naturopathic medical model the basic treatment. Such a study could prove very useful. It just might give us the kind of real-world, cost-saving guidance that health care needs for the treatment of those with cardiovascular and other expensive chronic conditions.
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