background resources in PDF |
|
some CAM/IM publication links |
|
|
Positive Naturopathic Integrative Medicine Cardiovascular Risk Study Provokes CMAJ Editors |
|
|
|
Written by John Weeks
|
Positive Naturopathic Integrative Medicine Cardiovascular Risk Study Provokes Editorial in Canadian Medical Journal
"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.
 Dugald Seely, ND: lead on whole practice project
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."
 CMAJ's Stanbrook: damning with faint praise
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.
 Canada Post: employees in ND care have less CV risk
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."
 Canadian Medical Association Journal: credit for publishing
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.
 Institutional base for project
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.
|
|
|