Is naturopathic medicine science-based?

I had a great question about naturopathic medicine and science:

You say that your medicine is evidence-based. Would you define "evidence" in the same way that the traditional medical model would (peer-reviewed journals, RCTs, meta-analyses, etc.)? Are all of your treatments supported by research?

Thanks Anonymous! I'll do my best to answer your question...

Though there are many types of scientific research, I generally split research into two main categories: 1) single agent trials, and 2) research based on clinical practice (e.g., case studies, retrospective studies, etc.).

The gold standard of scientific research is double-blind placebo-controlled trials. This is the final stage of research that pharmaceutical companies go through before they can legally sell their product to consumers. Double-blind trials (for the lay reader) means that each patient enrolled in the study gets either a sugar pill (placebo), or the active pill, and neither the patient nor the person who gives the patient the pills knows which one is active or placebo. Only the person analyzing the data knows who received which pill. Double-blind placebo-controlled trials are important because they take the “placebo effect” and observer bias out of the equation, so theoretically only the biochemical effects of the pill are recorded.

Do natural medicines undergo the same research as pharmaceuticals? The answer is yes and no. Natural medicines do undergo double-blind placebo-controlled trials, but the number of people enrolled in these trials are generally much less than pharmaceutical trials. This is mainly due to the difference in funds (pharmaceutical companies fund their research with their multibillion dollar sales). As my research methods professor once told me, the easiest way to show no difference between two groups is to enroll too few patients in a trial. There are thousands of herbs, foods and nutrients potentially used by naturopathic physicians - some of these have undergone rigorous double-blinded studies (like St. John’s wort), others have not (like Yarrow).

So why do we use natural medicines that do not necessarily have research supporting them? This is a tricky subject. In naturopathic medical school we learn the biochemical and physiologic mechanisms of herbs, drugs, nutrients and foods. Most of the time the research supports our use of these natural medicines, but sometimes it does not. Why? Because there are many problems with single-agent trials and natural medicines:

1. As stated above, there is a huge discrepancy in funds for research, which means we cannot study all natural medicines, and many medicines studied have poor enrollment. This leads to false negative effects of these agents.
2. Many of the agents studied are used improperly, or in dosages comically low. What would the allopathic community say if we studied the effects of aspirin on pain at a level of 0.1 mg? Similarly many studies of natural medicines (herbs in particular) use doses at a fraction of the therapeutic level. Similarly, many studies used improper forms of the herbs (e.g., Echinacea purpurea instead of Echinacea angustifolia), or attempted to study herbs or nutrients for conditions in which they were never intended to treat (like vitamin C for tumor reduction).
3. We rarely use single agents! Often our treatment plans are multi-factorial, and rightly so. A common treatment for a patient may include dietary changes, prescription for exercise, counseling, and multiple herbs or vitamins. Many of these interventions have shown to have a synergistic effect, but this is nearly impossible to study in a double-blinded trial.
   

I don’t want to give the impression that naturopaths dismiss all scientific research. When research trials are well designed and show positive or negative results, all good naturopaths use that knowledge to influence their clinical practice. Research is extremely helpful at elucidating which natural medicines are most helpful for certain conditions, and at mapping out the biochemical reactions.

Whew...this turned out to be a much longer post than I intended. I would like to talk a bit about how we use research based on actual practice to make many of our clinical decisions, but I think I will save that for my next post.