Conventional medicine
Alternative medicine debate on the Michael Coren show
07/07/10 22:14
Check out this debate on the Michael Coren show about “Alternative Medicine.” Incidentally, I prefer the term natural medicine (versus conventional medicine), since for many people, there is nothing “alternative” about it...
A few of my thoughts (in chronological order with the video):
- What do NDs do that MDs don’t? A lot! See my blog Top ten reasons you need a naturopathic doctor.
- For a comparison of the training of an MD versus and ND, see my blog Curriculum comparison.
- There is research on homeopathy and evidence to support its efficacy as a healing modality. Just because most people are ignorant of this does not mean it doesn’t exist! For more about that, see my blog Homeopathy literature review.
- Many conventional medical interventions actually lack research evidence. I wrote about this in my blog Mythology of science-based medicine.
- I’m not a chiropractor and cannot speak to much in this area, however one example of when a chiropractor may require an x-ray is not to diagnose, but to screen for/rule out any conditions that are contraindications for chiropractic treatment. This is a basic safety procedure which is prudent and responsible. Another example may be to confirm a diagnosis before proceeding with treatment, which is another valid and reasonable use of such technology.
- One of the major problems in conventional medicine is the idea of “standard of care” which denies individuals care that targets the cause of illness, which may be different for the same “disease.” The “standard of care” in conventional medicine is often inferior to even the most basic common sense... For example, if high cholesterol is caused by poor dietary habits and lack of physical activity, how does the “standard of care” prescription of statin drugs solve these issues?
- Michael Coren makes a great point that many of the cases against alternative medicine are “hysteria.” In any profession, there are practitioners who are not ethical or safe. Naturopathic medicine is a regulated health profession in most provinces and therefore naturopathic doctors are held to a professional standard of safety and ethics. For more info on naturopathic medicine, read more on my Naturopathic Medicine and FAQ pages. This marks a major difference between NDs and many other “alternative” practitioners.
- Why aren’t naturopathic doctors MDs? Because there is a fundamental philosophical difference. This is not to say that we can’t work together and that patients cannot take advantage of both, but the training and approach to treatment are vastly different. Specialization leads to greater and deeper expertise in all kinds of professions which provides value to the consumer.
A few of my thoughts (in chronological order with the video):
- What do NDs do that MDs don’t? A lot! See my blog Top ten reasons you need a naturopathic doctor.
- For a comparison of the training of an MD versus and ND, see my blog Curriculum comparison.
- There is research on homeopathy and evidence to support its efficacy as a healing modality. Just because most people are ignorant of this does not mean it doesn’t exist! For more about that, see my blog Homeopathy literature review.
- Many conventional medical interventions actually lack research evidence. I wrote about this in my blog Mythology of science-based medicine.
- I’m not a chiropractor and cannot speak to much in this area, however one example of when a chiropractor may require an x-ray is not to diagnose, but to screen for/rule out any conditions that are contraindications for chiropractic treatment. This is a basic safety procedure which is prudent and responsible. Another example may be to confirm a diagnosis before proceeding with treatment, which is another valid and reasonable use of such technology.
- One of the major problems in conventional medicine is the idea of “standard of care” which denies individuals care that targets the cause of illness, which may be different for the same “disease.” The “standard of care” in conventional medicine is often inferior to even the most basic common sense... For example, if high cholesterol is caused by poor dietary habits and lack of physical activity, how does the “standard of care” prescription of statin drugs solve these issues?
- Michael Coren makes a great point that many of the cases against alternative medicine are “hysteria.” In any profession, there are practitioners who are not ethical or safe. Naturopathic medicine is a regulated health profession in most provinces and therefore naturopathic doctors are held to a professional standard of safety and ethics. For more info on naturopathic medicine, read more on my Naturopathic Medicine and FAQ pages. This marks a major difference between NDs and many other “alternative” practitioners.
- Why aren’t naturopathic doctors MDs? Because there is a fundamental philosophical difference. This is not to say that we can’t work together and that patients cannot take advantage of both, but the training and approach to treatment are vastly different. Specialization leads to greater and deeper expertise in all kinds of professions which provides value to the consumer.
Comments
The secrets of sleep
28/06/10 11:23
Fascinating National Geographic article about sleep. Also, check out my previous blog on Sleep and Metabolic Syndrome.
Is evidence-based medicine compatible with naturopathic principles?
08/02/10 17:50
One of the most common criticisms of natural medicine is that it lacks supportive evidence. This is simply not true! In many cases, there is as much or more research evidence for natural medicine as conventional medicine. However, there are also areas in which the research evidence is sparse or incomplete. The purpose of this blog is to clarify the true meaning of evidence-based medicine (EBM) and explore its role in contributing to natural medicine.
Evidence-based medicine (EBM) is defined as the “conscientious, explicit and judicious use of current best evidence in making decisions about care of individual patients (1).” Furthermore:
“The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice (1).”
This definition of evidence-based medicine does not conflict with the principles of naturopathic medicine. Naturopathic medicine is based on a large body of evidence gathered through systematic research and knowledge gained through clinical experience. Its principles support the application of this information to devise the most effective treatment for our patients.
However, the colloquial understanding of EBM supports randomized, double blind, placebo-controlled studies as gold standard of knowledge and leaves little room for other forms of research or for clinical experience.
Conventionally understood EBM is limited in encouraging health care that adheres to naturopathic principles. First, EBM does not recognize holistic treatment of individuals, and in fact seeks to boil down complex information to a simple conclusion recognizing only how the majority of subjects respond to a single intervention. Not only does this ignore the knowledge that could be gained through examining all the subjects in a study and why they each responded in the way that they did, but also is not necessarily applicable to real life health care since patients are nearly never under controlled conditions and subject to only one intervention. Naturopathic doctors are interested in treating real patients in the real world and therefore in gathering knowledge in any area that will serve this purpose. In many cases, this knowledge includes clinical observation and experience with real patients.
Second, funding committed to research is not allocated based on what areas of knowledge are the most interesting, warrant the most investigation, or even may be the most beneficial to the public. Most research is conducted by pharmaceutical companies on products they hope to bring to market in order to earn profits for shareholders. Unfortunately, this capitalist drive behind health knowledge is not conducive to researching how low-cost treatments such as diet and lifestyle changes can be far more effective than any drug. It is also not conducive to gaining knowledge through “failed” experiments, such as when pharmaceutical research does not yield results favourable to the drug being researched. Currently, pharmaceutical companies are not required to publish such research, although there is a movement to change this, thankfully. Naturopathic doctors are interested in achieving results, even if there is no particular product to sell.
Finally, naturopathic doctors also act as teachers, seeking to empower patients with information so that they can care for themselves. EBM places power in a faceless research environment, removing it from clinicians with decades of experience, and therefore also removing it from individual patients who may know their unique needs best.
Therefore, while the official definition of EBM does fit with naturopathic principles, the applied definition, in terms of how the health care system actually operates, does not.
For more information and more of my thoughts on conventional medical research, please see my previous blog Mythology of science-based medicine.
1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312 (7023):71–2.
Evidence-based medicine (EBM) is defined as the “conscientious, explicit and judicious use of current best evidence in making decisions about care of individual patients (1).” Furthermore:
“The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice (1).”
This definition of evidence-based medicine does not conflict with the principles of naturopathic medicine. Naturopathic medicine is based on a large body of evidence gathered through systematic research and knowledge gained through clinical experience. Its principles support the application of this information to devise the most effective treatment for our patients.
However, the colloquial understanding of EBM supports randomized, double blind, placebo-controlled studies as gold standard of knowledge and leaves little room for other forms of research or for clinical experience.
Conventionally understood EBM is limited in encouraging health care that adheres to naturopathic principles. First, EBM does not recognize holistic treatment of individuals, and in fact seeks to boil down complex information to a simple conclusion recognizing only how the majority of subjects respond to a single intervention. Not only does this ignore the knowledge that could be gained through examining all the subjects in a study and why they each responded in the way that they did, but also is not necessarily applicable to real life health care since patients are nearly never under controlled conditions and subject to only one intervention. Naturopathic doctors are interested in treating real patients in the real world and therefore in gathering knowledge in any area that will serve this purpose. In many cases, this knowledge includes clinical observation and experience with real patients.
Second, funding committed to research is not allocated based on what areas of knowledge are the most interesting, warrant the most investigation, or even may be the most beneficial to the public. Most research is conducted by pharmaceutical companies on products they hope to bring to market in order to earn profits for shareholders. Unfortunately, this capitalist drive behind health knowledge is not conducive to researching how low-cost treatments such as diet and lifestyle changes can be far more effective than any drug. It is also not conducive to gaining knowledge through “failed” experiments, such as when pharmaceutical research does not yield results favourable to the drug being researched. Currently, pharmaceutical companies are not required to publish such research, although there is a movement to change this, thankfully. Naturopathic doctors are interested in achieving results, even if there is no particular product to sell.
Finally, naturopathic doctors also act as teachers, seeking to empower patients with information so that they can care for themselves. EBM places power in a faceless research environment, removing it from clinicians with decades of experience, and therefore also removing it from individual patients who may know their unique needs best.
Therefore, while the official definition of EBM does fit with naturopathic principles, the applied definition, in terms of how the health care system actually operates, does not.
For more information and more of my thoughts on conventional medical research, please see my previous blog Mythology of science-based medicine.
1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312 (7023):71–2.
Mythology of science-based medicine
12/01/10 16:30
This blog emerged after reading several different articles about the state of conventional medical care and some of the misperceptions surrounding efficacy of conventional medical treatments.
First, an article titled The Mythology of Science-Based Medicine provides examples of conventional medical interventions considered to be safe, valid, or effective when in fact they lack scientific basis or have been proven ineffective. This article provides links to sources and some responses from the authors and other medical experts in the comments. Here is an addendum to that article further addressing comments.
Second, an article titled How Common Are Medical Mistakes? which delves into the startling fact that the third leading cause of death of Americans is iatrogenic causes, meaning caused by doctors, medical treatment, or diagnostic procedures.
Finally, a few of my thoughts on this topic:
The “gold-standard” of medical research is the double-blind randomized controlled trial, which attempts to isolate the effect of a single intervention and control all other factors (including many features of patients such as pre-existing conditions, medications, lifestyle, diet, etc.) This makes sense in a research context but has little bearing on reality, in which medical interventions are used in conjunction with other treatments in a wide variety of patients. It is important to understand that a clinical trial is only the first step in evaluating treatment. It provides information on how something works and verifies safety in the short-term but is most definitely not a verdict on the effectiveness in the real world. This can only truly be gauged in the context of an uncontrolled patient population over time.
Something important to note about bypass surgery and angioplasty is that while they do not extend life (which is the case for many common medical treatments), this is not the only important measure to consider! Quality of life is also incredibly important and these procedures can make a major difference here. Patients with cardiovascular disease who in the past would not have these options would be severely limited by the inability to engage in even the most basic everyday activities but would also not be ill enough that they would pass away. These procedures have allowed many patients to return to a more normal level of activity and participation in life which is invaluable, even if their lifespan remains the same.
Regarding antidepressants, it should not be surprising that they are not very effective except in cases of severe depression. In most cases, antidepressants are the sole treatment prescribed despite mountains of evidence that combining them with other treatments (most notably psychotherapy) is far more effective. For many patients with depression, there are valid reasons to feel depressed, such as grief, declining health, emotional stressors, post-partum changes, etc. Depression is a natural human response to life’s ups and downs. Unfortunately most of us are just not equipped to accept and work through life’s challenges on our own. Psychotherapy can be enormously helpful in arming patients with coping and self-care skills. There are also many patients for whom antidepressants are very useful in boosting them up enough so that they can actively seek other treatments to address the underlying causes of depression, but the key here is that the cause must be addressed and corrected. Otherwise antidepressants either just don’t cut it or simply mask a problem that will re-emerge once the patient discontinues the medication. This is common considering the many uncomfortable and intolerable side-effects of these medications. There are so many proven and safe treatments for depression (such as nutrition, exercise, supplements, lifestyle changes, homeopathy, therapy) that can be used in place of or in conjunction with antidepressants to achieve much better outcomes.
First, an article titled The Mythology of Science-Based Medicine provides examples of conventional medical interventions considered to be safe, valid, or effective when in fact they lack scientific basis or have been proven ineffective. This article provides links to sources and some responses from the authors and other medical experts in the comments. Here is an addendum to that article further addressing comments.
Second, an article titled How Common Are Medical Mistakes? which delves into the startling fact that the third leading cause of death of Americans is iatrogenic causes, meaning caused by doctors, medical treatment, or diagnostic procedures.
Finally, a few of my thoughts on this topic:
The “gold-standard” of medical research is the double-blind randomized controlled trial, which attempts to isolate the effect of a single intervention and control all other factors (including many features of patients such as pre-existing conditions, medications, lifestyle, diet, etc.) This makes sense in a research context but has little bearing on reality, in which medical interventions are used in conjunction with other treatments in a wide variety of patients. It is important to understand that a clinical trial is only the first step in evaluating treatment. It provides information on how something works and verifies safety in the short-term but is most definitely not a verdict on the effectiveness in the real world. This can only truly be gauged in the context of an uncontrolled patient population over time.
Something important to note about bypass surgery and angioplasty is that while they do not extend life (which is the case for many common medical treatments), this is not the only important measure to consider! Quality of life is also incredibly important and these procedures can make a major difference here. Patients with cardiovascular disease who in the past would not have these options would be severely limited by the inability to engage in even the most basic everyday activities but would also not be ill enough that they would pass away. These procedures have allowed many patients to return to a more normal level of activity and participation in life which is invaluable, even if their lifespan remains the same.
Regarding antidepressants, it should not be surprising that they are not very effective except in cases of severe depression. In most cases, antidepressants are the sole treatment prescribed despite mountains of evidence that combining them with other treatments (most notably psychotherapy) is far more effective. For many patients with depression, there are valid reasons to feel depressed, such as grief, declining health, emotional stressors, post-partum changes, etc. Depression is a natural human response to life’s ups and downs. Unfortunately most of us are just not equipped to accept and work through life’s challenges on our own. Psychotherapy can be enormously helpful in arming patients with coping and self-care skills. There are also many patients for whom antidepressants are very useful in boosting them up enough so that they can actively seek other treatments to address the underlying causes of depression, but the key here is that the cause must be addressed and corrected. Otherwise antidepressants either just don’t cut it or simply mask a problem that will re-emerge once the patient discontinues the medication. This is common considering the many uncomfortable and intolerable side-effects of these medications. There are so many proven and safe treatments for depression (such as nutrition, exercise, supplements, lifestyle changes, homeopathy, therapy) that can be used in place of or in conjunction with antidepressants to achieve much better outcomes.
Curriculum comparison
18/09/09 12:21
Have you ever wondered what the difference is between naturopathic medical education and conventional medical education? Check out this comparison of accredited naturopathic schools, conventional medical schools, and non-accredited “ND” programs.
In sciences, naturopathic and conventional medical schools are on par. Naturopathic doctors must complete required science courses and pass licensing exams in basic sciences in order to become licensed to practice in North America. These exams are administered by the North American Board of Naturopathic Examiners (NABNE).
A very interesting area is nutritional education. Given that food is literally the material that fuels all the processes in our bodies and from which all our cells and bodily structures are constructed, one would expect (not unreasonably) that any professional in the health care field would be educated in the use of nutrition as medical therapy (which includes therapeutic use of vitamins and minerals in addition to diet). Nutrition is most certainly a first line therapy and is repeatedly confirmed to produce dramatic clinical improvements in the prevention and treatment of chronic disease.
Another interesting area is botanical medicine, which is included under naturopathic therapeutics. Most pharmaceuticals are inspired by or made directly from plant constituents, which is why naturopathic medical students are required to complete courses in both pharmacology and botanical medicine and also pass licensing exams in both these subjects. There is a movement now to treat botanicals as drugs since many of them have powerful actions and carry risks if used improperly. Again, one would expect that any medical professional be trained in both these areas.
The last key point here is the vast difference in education between accredited and non-accredited ND programs. The Council on Naturopathic Medical Education (CNME) accredits naturopathic medical programs. NDs from accredited schools have a minimum of 7 years of post-secondary education. This includes at least three years of university and prerequisites in chemistry, biology, and psychology. Naturopathic medicine is a four year program offered by six schools in North America. Upon completion of the program, naturopathic doctors are qualified to work as primary care physicians.
Naturopathic medicine is a regulated profession in five Canadian provinces (BC, Saskatchewan, Manitoba, Ontario, and Nova Scotia) and many states in the US. For more information on naturopathic medicine, check out the Canadian Association of Naturopathic Doctors (CAND) and the Ontario Association of Naturopathic Doctors (OAND).
In sciences, naturopathic and conventional medical schools are on par. Naturopathic doctors must complete required science courses and pass licensing exams in basic sciences in order to become licensed to practice in North America. These exams are administered by the North American Board of Naturopathic Examiners (NABNE).
A very interesting area is nutritional education. Given that food is literally the material that fuels all the processes in our bodies and from which all our cells and bodily structures are constructed, one would expect (not unreasonably) that any professional in the health care field would be educated in the use of nutrition as medical therapy (which includes therapeutic use of vitamins and minerals in addition to diet). Nutrition is most certainly a first line therapy and is repeatedly confirmed to produce dramatic clinical improvements in the prevention and treatment of chronic disease.
Another interesting area is botanical medicine, which is included under naturopathic therapeutics. Most pharmaceuticals are inspired by or made directly from plant constituents, which is why naturopathic medical students are required to complete courses in both pharmacology and botanical medicine and also pass licensing exams in both these subjects. There is a movement now to treat botanicals as drugs since many of them have powerful actions and carry risks if used improperly. Again, one would expect that any medical professional be trained in both these areas.
The last key point here is the vast difference in education between accredited and non-accredited ND programs. The Council on Naturopathic Medical Education (CNME) accredits naturopathic medical programs. NDs from accredited schools have a minimum of 7 years of post-secondary education. This includes at least three years of university and prerequisites in chemistry, biology, and psychology. Naturopathic medicine is a four year program offered by six schools in North America. Upon completion of the program, naturopathic doctors are qualified to work as primary care physicians.
Naturopathic medicine is a regulated profession in five Canadian provinces (BC, Saskatchewan, Manitoba, Ontario, and Nova Scotia) and many states in the US. For more information on naturopathic medicine, check out the Canadian Association of Naturopathic Doctors (CAND) and the Ontario Association of Naturopathic Doctors (OAND).