Although the use of complementary medicine (CAM) is widespread, it is often denounced by doctors as unfounded or bogus. However, there is evidence for some practices that fall under the CAM umbrella, and there may even be lessons for physicians.
What is natural therapy?
Naturopathy is a health practice defined by its principles and philosophy.
This makes it a little different from the work of other complementary medicine (CAM) professionals, such as herbalists, homeopaths, acupuncturists, and chiropractors, whose work is defined by their specialized tools.
For this reason, the latter are often referred to as CAM general practitioners.
The main principle of naturopathy is that its practitioners cooperate with the body’s natural physiological processes to promote healing. A complete list of these principles can be found here.
Nearly one in 10 Australians sees a naturopath, and the profession has recently received a lot of attention, often for the wrong reasons, particularly in relation to ignorance of evidence-based medicine. I am.
So, are natural remedies evidence-based?
Natural therapy based on scientific evidence
Not all natural remedies are completely esoteric. Some naturopathic treatments, such as using the herb St. John’s wort for mild to moderate depression or using ginger to treat morning sickness, are well-known examples of CAM that are supported by sufficient evidence. .
And while much has been said about the potential risks of other treatments such as kava, it has been shown to have a lower risk profile than conventional drugs currently in use and to be effective for symptoms such as anxiety. is shown.
Evidence-based naturopathic treatments are not limited to these therapies. I recently co-edited the first international evidence-based naturopathic desktop clinical text. It contains over 4000 scientific references on naturopathic treatments.
There is also a wide range of traditional knowledge that may not be scientifically verified, but should not necessarily be completely discarded.
Traditional knowledge is very helpful. For example, the malaria drug (artemisinin) was (very recently) extracted from traditional Chinese medicine.
However, it should also be noted that much of this “traditional evidence” is being misused to make claims about CAM products that bear little resemblance to the original shape. This is especially an issue with new “nutraceutical” or “herbal extract” products.
In the early 2000s, major medical journals rejected suggestions that fish oil could improve cardiovascular health.
Currently, the Heart Foundation offers fish oil with minimal recommendations. It has also been found to be the least cost-effective. Number needed to treat (NNT) All interventions for secondary prevention of further heart disease in patients who have had a heart attack.
Overwhelmingly, most evidence for almost any condition belongs to diet and lifestyle modifications.
Health promotion counseling regarding diet, physical activity, and stress management is incorporated into nearly all naturopathic treatments.
This forms the backbone of any naturopathic practice and is reinforced by ongoing patient visits.
Some naturopathic doctors have developed a reputation as “product pushers” who ignore this factor, but their practices are contrary to and consistent with naturopathic principles. It does not mean.
Several other long-standing concepts that have long been part of naturopathic treatment are also gaining validity.
For example, regulating insulin levels was recommended as a standard treatment in natural medicine books for women with polycystic ovary syndrome long before it became common practice.
And naturopathic doctors were observing the link between vitamin D in immunity and gut health even before vitamin D became widely accepted in the scientific community.
So what’s the problem?
Of course, there are problems with naturopathic camps.
some practitioners do Continue to focus on treatments that are clearly not evidence-based, such as the use of Vega machines and other dubious or untested diagnostic techniques, or advice on homeopathic vaccinations.
They may promote these as valid alternatives to traditional methods and obscure and dubious disease theories.
However, it should be noted that these treatments have little to do with natural medicine or its underlying principles, just as many homeopaths refuse to support homeopathic vaccinations.
The problem, as some commentators have suggested, is that some naturopaths are actually shaped by their status as a marginal profession. Therefore, they have taken an opposing stance, regardless of the core tenets and principles of naturopathy.
There are certainly fringe groups that oppose many traditional interventions for no apparent reason other than the opposition itself.
However, in most cases individuals natural therapistdo not have natural therapy That in itself remains a problem.
Because naturopathy is unregulated, anyone can call themselves a naturopath, and the well-known fact that this term is often adopted by individuals with little connection to the profession This gets even worse.
This was seen with the introduction of GST-free status for naturopathic practices at the beginning of the last decade. In the absence of property rights protection, non-naturopathic physicians of all persuasions could suddenly reclassify themselves as naturopathic physicians overnight in order to take advantage of this benefit.
Regulations to ensure minimum standards of education and accountability for practitioners will help make the profession more evidence-based.
Ensuring that practitioners receive a minimum of traditional health science, public health, and critical analysis training in their courses promotes a culture of respect for evidence.
It can also be used by practitioners who make unsubstantiated claims (as a rule of thumb, if a practitioner makes an incredible claim, there needs to be incredible evidence), who exploits patients financially, or who simply It may also help address some of the other issues in natural medicine, such as not having a cure. Training to recognize serious problems that require referral.
In fact, following an evidence-based naturopathy model actually strengthens the principles of naturopathy and helps remove the influence of various fringe therapies and commercial interests evident in any profession, including this profession. .
CAM practitioners have attracted criticism from proponents of evidence-based medicine. However, we must also remember that there are problems with the evidence-based medicine movement that exists outside the CAM sector.
A recent Australian Doctor article called this a home without foundations, saying it is “in its ‘most absolutism’…incapable of recognizing real patients in all their bewildering evidence-based complexity.” “It was a form of enthusiasm” that had never existed before.
David Sackett, co-founder of the modern evidence-based medicine movement, says, “Good physicians draw on both their individual clinical expertise and the best available external evidence, but not only one or the other. That’s not enough.”
There is no denying that the CAM sector has problems. However, it is also possible that CAM has attracted enough attention to serve as a ‘canary’ for broader evidence issues in the health field.
As it turns out, the lack of evidence is not unique to CAM. We know nothing about the effectiveness of more than half of CAM. all Health intervention.
Natural remedies and evidence – no need to contradict each other
However, there is no doubt that CAM practitioners also need to embrace the principles of evidence-based practice more actively than they currently do, even if this means becoming more dogmatic in their approach to evidence-based medicine. .
In fact, there’s no philosophical reason why it shouldn’t.
This does not need to preclude the use of conventional treatments without double-blind, placebo-controlled trials where appropriate, but there must be clinical justification for the choice of treatment.
Protocols or shotgun medicine that are typically designed to change the product rather than the disease are not acceptable under such a model, as are unsubstantiated diagnostic techniques.
Naturopathic doctors should also not wait for pet therapy to work, but instead change or refer patients if they are not seeing results.
A lack of modern scientific evidence shouldn’t mean throwing out the baby of natural remedies with the bath water. Rather, it should serve as a call for broader research into natural remedies and CAM.
This can build on emerging evidence or traditional evidence that many practitioners must now rely on, as little else currently exists for many treatments (positive or negative).
Evidence-based practice requires using the best available evidence. Naturopathic education providers, practitioners, and CAM companies, which now form a multi-billion dollar industry, need to be actively involved to ensure better evidence becomes available over time. there is.
However, it is simply false to say, as many critics do, that natural remedies themselves are not evidence-based.
