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Evidence-Based Naturopathic Medicine (a continuation of my last post)

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Natural Medicine is the Best Medicine: Evidence-Based Naturopathic Medicine (a continuation of my last post)

Monday, October 4, 2010

Evidence-Based Naturopathic Medicine (a continuation of my last post)

It’s been a long time since I’ve posted and I apologize. Summer happened!

This post will be about evidence other than double-blind placebo-controlled trials. Naturopathic physicians often have to use alternate forms of evidence since funding for trials of natural remedies is often seriously lacking. 

First we have the most general form of evidence: historical use. Some people argue that historical use has no place in evidence, but I would like to counter that. The fact is, historical use of medicines (herbals in particular) followed their own form of “scientific” rigor. That is, midwives, herbalists and healers passed down their knowledge word-of-mouth, and remedies that continued to work through the generations were passed down, whereas ones that were harmful were not. There is, of course, the chance that all of these remedies were simply acting as placebo, which is entirely possible. Even if it is placebo, however, we cannot say that the remedy doesn’t work (just the mechanism is different).

Next we have case-studies and evidence from personal experience. Case studies (published or unpublished) are very interesting to illuminate the exact presentation of a patient before and after a specific treatment. We can use case studies to speculate on what the mechanism of action of a particular intervention is. Though it is difficult to take a case study and project this to a general population, nevertheless it is still useful when we encounter a patient with a similar presentation. Similarly, we have evidence from personal experience in practice. Much of scientific research is based on what practitioners have seen work consistently in practice (for example, Omega 3 oils were used in naturopathic practice many years before research confirmed their validity for use in inflammatory processes). This is the value in working with experienced practitioners who can truthfully say that a particular nutrient, drug, herb, or other treatment modality has worked for them for 20+ years.

In our naturopathic education we generally learn the historical use of a treatment first. I find this to be a good foundation to lay the rest of our knowledge upon. After this we take our knowledge of biochemistry and physiology to make an educated guess as to whether the historical use seems plausible. When combined with repeated case studies or a long history of personal experience, we can start to become more convinced that a particular intervention will work. Of course, when using these treatments in a clinical context, we must always take the individual patient into account, and tailor the treatment plan for that singular person.

What happens when scientific research contradicts personal experience or historical use? Well, we have two options: 1) reframe or alter our current model for the particular disease and treatment, or 2) evaluate the research for consistency between what/who we are treating and what the research states.

Whew, that was a lot, and I could write a whole lot more. Questions? Feel free to post them under the comments section.

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