Friday, December 10, 2010

First in a Series

December 9, 2010

As my first ‘real’ post on my blog, I’ve decided to write on a subject that I plan on returning to many times in the future, that of evidence-based medicine (EBM) and naturopathic practice. While this is certainly a huge topic, and one that can hardly be laid to rest by a single clinician, I’d like to put my thoughts out there to encourage discussion and reflection.

I am asked about this topic very frequently, usually by people questioning the efficacy of naturopathic medicine and citing a relative lack of evidence. Over time, my response has developed and matured, and where once I would have brushed the question aside, citing the inherent superiority of naturopathic medicine, I have developed a much more ‘middle of the road’ approach to EBM, seeking to balance published evidence with clinical experience. This is a shift that I have seen many naturopathic students undergo. As one of my teachers loves to say, ‘There’s no place for dogma in medicine’.

The point I’d like to make today is this: I don’t think that the question ‘Is naturopathic medicine evidence-based?’ can be applied across the board. For example, naturopaths have long been advocates for healthy eating, including high fiber, low fat, low sugar, moderate animal protein, and above all, whole foods. In light of this, it is almost ironic to accuse naturopaths of operating without evidence, because this approach has been shown to be preventive against a broad range of diseases by some of the best-documented studies in the entirety of medicine.

On the other hand, some naturopathic methods, such as homeopathy, have traditionally performed poorly in scientific trials, despite considerable success in clinical care. Taking up the middle ground between these two extremes, we have both herbal medicine and nutritional supplementation. Supplementation is a bit of a battleground for research, with recommendations going back and forth with some regularity; a supplement is shown beneficial one year, then falls out of favor the next. Herbal medicine is an interesting case, because many herbs are now being studied for their effects at the cellular level, providing a level of knowledge similar to pharmaceuticals, but clinical trials still have not caught up. Because of this uneven-ness of evidence, many naturopaths simultaneously practice at both polar ends of the evidence spectrum, and all the way in between.

As I’ve tried to illustrate here, I don’t believe that evidence-based medicine is not an all-or-nothing situation, instead being a spectrum of evidence. This is true of traditional medicine just as it is of naturopathic medicine. In the future, I’ll talk more about my own approach to integrating evidence-based medicine into practice and the principles I use to guide me. The scientific method provides information, but it is ultimately up to the clinician to apply it in practice.