Conventional medicine
Cholesterol reality check
28/Nov/12 11:46 AM
by Kate Whimster, BCom, MIFHI, ND
This is the third year in a row I am giving community talks on cholesterol and it is clear that this topic is one of the most popular, year after year. I think this is because “high cholesterol” is one of the easiest medical conditions to diagnose and is aggressively treated. I mean, statin medications like Lipitor did not become the top-selling drug (1) (at $7.2 billion!) and simvastatin (94.1 million prescriptions!) the second most-prescribed drug (1) in the United States for no reason!
I’m writing this blog because I want to bring to light the reality of health and cholesterol and bust some of the myths in this area!
I was originally going to name this blog “The Cholesterol Myth” but I guess I’m not the only person who thought that was a catchy title, because I found this book, The Great Cholesterol Myth which covers the same topic. I haven’t read the book, but it looks interesting!
What is cholesterol?
When people talk about “cholesterol,” they are usually actually talking about fat in the blood, either carried by lipoproteins (proteins that escort fat around) or as lipids. There are three kinds:
Coronary atherosclerosis (aka “hardening of the arteries”) “occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques (2).” These plaques decrease blood flow through arteries by taking up space and making the artery walls less flexible. They can also grow so large they completely block blood flow or pieces of them can break off and also causes blockages. Blockages like this can cause heart attacks and strokes.
The extra-simple explanation for why your doctor and the media care so much about your cholesterol numbers is that they believe that high total cholesterol is an important risk factor that predicts atherosclerosis. Therefore, prescribing medication to lower cholesterol can prevent atherosclerosis and its consequences. This approach still ignores WHY cholesterol is elevated and how such causes can also contribute to atherosclerosis in many other ways... I’ll get to that later.
So, if plaques in arteries are a problem, how can we measure them? Turns out this is not so hard! There are good imaging techniques to help measure coronary plaques (plaques in the arteries feeding blood to the heart muscle), such as Electron Beam Tomography (EBT) and computed tomography (CT) angiography (3). The most risky plaques are calcified, which makes them easier to see via such imaging.
Reality check
So, the next logical question is, does elevated cholesterol correlate well with arterial plaques? And therefore, is cholesterol a useful measure to assess risk of coronary atherosclerosis? The answer is NO.
Last year I read a great article called “Does cholesterol drive coronary atherosclerosis?” (3) in Integrated Healthcare Practitioners magazine summarizing a great deal of evidence from many other sources over years. Here are a few highlights:
So what is up with anyone and everyone taking statin medications? Some young doctors start taking these medications “preventatively” and some doctors have gone as far as to suggest that every adult should be on them!
The reality is that statin medications block cholesterol production by interfering with a natural process in the body (ie: the way most pharmaceuticals work). This is not insignificant, as your body is created to work efficiently and healthily given a supportive environment. Changing this environment and important processes such as this not only ignores the real issue of WHY is the body producing higher levels of cholesterol but also leads to a huge list of adverse effects.
I recently read a blog “Possible pitfalls of statins” which highlights some of the important consequences of taking these medications - check that out for more info.
How can we better understand cardiovascular risk?
We’ve established that total cholesterol and LDL are not as useful for predicting risk as previously believed, so now what? Another great article “Novel cholesterol subtypes” in Integrated Healthcare Practitioners magazine looks at evidence for several lesser-known lipid markers to assess risk. Here is a brief summary of each from this article:
So many patients are worried about cholesterol and I am really disappointed to observe that often this fear and anxiety is fostered by their medical doctors. I’ve become tired of hearing that my patients feel forced or even “bullied” into taking statin medications while not being fully informed about the true risks and benefits of these medications. Most of all, I feel frustrated that as a society, we do not use cholesterol information as a CLUE to what is out of balance about a patient’s diet, lifestyle, health, etc and work on these issues instead, which actually make a major impact on long-term health and wellness.
High cholesterol, atherosclerosis, heart disease, etc are the result of a lifetime of choices and are almost entirely preventable. Naturopathic treatment in this area is highly personalized, but should take into account:
This is the third year in a row I am giving community talks on cholesterol and it is clear that this topic is one of the most popular, year after year. I think this is because “high cholesterol” is one of the easiest medical conditions to diagnose and is aggressively treated. I mean, statin medications like Lipitor did not become the top-selling drug (1) (at $7.2 billion!) and simvastatin (94.1 million prescriptions!) the second most-prescribed drug (1) in the United States for no reason!
I’m writing this blog because I want to bring to light the reality of health and cholesterol and bust some of the myths in this area!
I was originally going to name this blog “The Cholesterol Myth” but I guess I’m not the only person who thought that was a catchy title, because I found this book, The Great Cholesterol Myth which covers the same topic. I haven’t read the book, but it looks interesting!
What is cholesterol?
When people talk about “cholesterol,” they are usually actually talking about fat in the blood, either carried by lipoproteins (proteins that escort fat around) or as lipids. There are three kinds:
- LDL (low density lipoprotein): Often called “bad cholesterol,” this type of lipoprotein carries cholesterol from the liver to tissues, so the thinking is that it can “build up” where it shouldn’t be (ie: arteries).
- HDL (high density lipoprotein): Often called “good cholesterol”, this type of lipoprotein does the opposite of LDL; it carries cholesterol from tissues back to the liver where it is broken down or eliminated from the body. HDL is considered to be preventative of disease.
- Triglycerides: These are literally fats in the blood. Extra calories in the body are converted into triglycerides and stored in fat cells for a “rainy day” when your body might need more energy.
Coronary atherosclerosis (aka “hardening of the arteries”) “occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques (2).” These plaques decrease blood flow through arteries by taking up space and making the artery walls less flexible. They can also grow so large they completely block blood flow or pieces of them can break off and also causes blockages. Blockages like this can cause heart attacks and strokes.
The extra-simple explanation for why your doctor and the media care so much about your cholesterol numbers is that they believe that high total cholesterol is an important risk factor that predicts atherosclerosis. Therefore, prescribing medication to lower cholesterol can prevent atherosclerosis and its consequences. This approach still ignores WHY cholesterol is elevated and how such causes can also contribute to atherosclerosis in many other ways... I’ll get to that later.
So, if plaques in arteries are a problem, how can we measure them? Turns out this is not so hard! There are good imaging techniques to help measure coronary plaques (plaques in the arteries feeding blood to the heart muscle), such as Electron Beam Tomography (EBT) and computed tomography (CT) angiography (3). The most risky plaques are calcified, which makes them easier to see via such imaging.
Reality check
So, the next logical question is, does elevated cholesterol correlate well with arterial plaques? And therefore, is cholesterol a useful measure to assess risk of coronary atherosclerosis? The answer is NO.
Last year I read a great article called “Does cholesterol drive coronary atherosclerosis?” (3) in Integrated Healthcare Practitioners magazine summarizing a great deal of evidence from many other sources over years. Here are a few highlights:
- Total cholesterol and LDL cholesterol do not correlate with coronary artery calcium burden or total plaque burden (calcified or not).
- The commonly accepted idea that saturated fat in the diet leads to atherosclerosis has been repeatedly challenged and is not supported by research literature. This article points out that “increased saturated fat intake leads to a beneficial decrease in small dense LDL, and greater intake in saturated fat was found to reduce progression of coronary atherosclerosis (4).”
- Lower LDL does not reduce the prevalence or progression of coronary plaque.
- Treatment with statins does not affect coronary calcification.
- For women, men over 47, and the elderly in general, elevated cholesterol is a “very weak risk factor” for coronary heart disease or “not a risk factor at all.”
So what is up with anyone and everyone taking statin medications? Some young doctors start taking these medications “preventatively” and some doctors have gone as far as to suggest that every adult should be on them!
The reality is that statin medications block cholesterol production by interfering with a natural process in the body (ie: the way most pharmaceuticals work). This is not insignificant, as your body is created to work efficiently and healthily given a supportive environment. Changing this environment and important processes such as this not only ignores the real issue of WHY is the body producing higher levels of cholesterol but also leads to a huge list of adverse effects.
I recently read a blog “Possible pitfalls of statins” which highlights some of the important consequences of taking these medications - check that out for more info.
How can we better understand cardiovascular risk?
We’ve established that total cholesterol and LDL are not as useful for predicting risk as previously believed, so now what? Another great article “Novel cholesterol subtypes” in Integrated Healthcare Practitioners magazine looks at evidence for several lesser-known lipid markers to assess risk. Here is a brief summary of each from this article:
- Lipoprotein-associated phospholipase A2 (Lp-PLA2): Can be a strong predictor of cardiovascular events (eg: heart attack, stroke) and can be reduced via omega-3 fatty acid intake and weight loss.
- Apolipoprotein (Apo) B: Can more accurately pinpoint the number of LDL particles and therefore can better estimate risk.
- LDL particle concentration (LDL-P): Another measure of the number of LDL particles, as above.
- Lipoprotein(a) (Lp(a)): Number of these molecules is a strong predictor of cardiovascular risk, especially in patients with strong family history.
- LDL and HDL subfractions: Seek to understand more detail about size, density, and cholesterol content of LDL and HDL. These measurements appear to be less useful than other tests listed above.
- Extent of calcified plaque in arteries (measured as described above via EBT or CT)
- Hypertension (elevated blood pressure)
- Diabetes and insulin resistance (which is the result of long-term blood sugar dysregulation)
- Smoking
- Being overweight or obese (result of long-term excess calories stored as fat)
- Inflammation in the body (can be measured using tests such as high sensitivity CRP (hs-CRP))
- Lack of physical activity
- Stress (lots of evidence that stress plays a major role in developing heart disease)
- Mood (depression also increases risk of heart disease!)
So many patients are worried about cholesterol and I am really disappointed to observe that often this fear and anxiety is fostered by their medical doctors. I’ve become tired of hearing that my patients feel forced or even “bullied” into taking statin medications while not being fully informed about the true risks and benefits of these medications. Most of all, I feel frustrated that as a society, we do not use cholesterol information as a CLUE to what is out of balance about a patient’s diet, lifestyle, health, etc and work on these issues instead, which actually make a major impact on long-term health and wellness.
High cholesterol, atherosclerosis, heart disease, etc are the result of a lifetime of choices and are almost entirely preventable. Naturopathic treatment in this area is highly personalized, but should take into account:
- Nutrition and diet changes appropriate to the individual
- Weight reduction where necessary
- Consistent and challenging physical activity
- Appropriate stress and mood management
- Reversing conditions which promote heart disease, such as insulin resistance and inflammation in the body
- Healthy function of the liver, which produces cholesterol
- Treatment for other risk factors as listed earlier (eg: smoking cessation, blood pressure regulation)
- Appropriate nutritional and botanical supplementation for the individual
- http://www.webmd.com/news/20110420/the-10-most-prescribed-drugs
- http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001224/
- Ware WR. Does cholesterol drive coronary atherosclerosis? Integrated Healthcare Practitioners. 2011 Oct: 64-68.
- Accurso A, et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab (Lond). 2008 Apr 8;5:9. PMID: 18397522
- Habib C, Rouchotas P. Novel cholesterol subtypes. Integrated Healthcare Practitioners. 2012 Oct: 53-57.
Comments
What is your health worth?
24/May/11 07:31 PM
by Kate Whimster, BCom, MIFHI, ND
What is wellness worth?
If you ask a healthy person, they would probably give you a far different answer than someone who was once healthy and is now dealing with illness.
In Canada, we are accustomed to health care being “free”. It really isn’t free; we pay taxes to provide all of us (even those who don’t pay tax) with healthcare, but we don’t pay directly, so it seems free... Because we are used to getting the care we need as we need it without hassle (for the most part) and with no need to make a decision about our health based on money, it can be difficult to consider all the health care options for which we must pay out of pocket. Naturopathic medicine is one of these (along with massage therapy, chiropractic, osteopathic, physiotherapy, etc).
A lot of people ask me if/when naturopathic medicine will be covered by OHIP. I have no idea if this is even a possibility at this point, but the more important question is, should it be? Sure, this would cover the cost for everyone but it would also likely eliminate the most valuable aspect of naturopathic medicine, which is the ability to treat people individually. Under our provincial healthcare plan, medical doctors do not have this freedom; they are bound by “standard of care” and algorithms and “first-line” drug therapy for many chronic diseases.
Naturopathic doctors have the freedom to spend a lot of time with each patient and to create a personalized treatment plan for each. That means that one patient with diabetes may be treated entirely different from the next. Not only does this kind of care require longer visits, but it also requires a lot more time spent by the doctor outside the visit to research, analyze, and prepare an appropriate plan. My patients understand the value of their naturopathic treatment and view their insurance coverage as a helping hand. However, many chronic health issues will require treatment beyond what insurance will subsidize.
People will often tell me how much they think they could benefit from naturopathic care, but they can’t afford it. I think the actual number of people who truly can’t afford it is much smaller.
What is your health worth to you?
Most people don’t think twice about paying for clothing, purses, hair styling, entertainment, eating out, travel, etc and would never expect these “essentials” to be paid for by the government. Far too many people are eager to live beyond their means in a home that is more than they need, driving a car that is too expensive, and buying themselves and their kids enough toys to entertain many families. However, these same people balk at paying for healthcare, which is hands-down far more valuable and essential. Investment in your health is just another place for your discretionary spending, something that improves your quality of life and in fact is an investment in the most valuable asset you will ever own - your health.
But, but, but... What about people who can barely make ends meet, who are on disability, social assistance, etc? You know, the people who really need help with many aspects of their lives, especially health? That is where there is a problem. I challenge you to find a naturopathic doctor who doesn’t make exceptions for this kind of case in his or her practice. This helps some people, but not all. And that’s why places like this exist:
Consider what your health is worth, what health allows you to do in your life. Consider what you think is a reasonable investment to maintain that. Finally, consider what it will cost you (in money but also in quality of life) to regain health once it has suffered.
What is wellness worth?
If you ask a healthy person, they would probably give you a far different answer than someone who was once healthy and is now dealing with illness.
In Canada, we are accustomed to health care being “free”. It really isn’t free; we pay taxes to provide all of us (even those who don’t pay tax) with healthcare, but we don’t pay directly, so it seems free... Because we are used to getting the care we need as we need it without hassle (for the most part) and with no need to make a decision about our health based on money, it can be difficult to consider all the health care options for which we must pay out of pocket. Naturopathic medicine is one of these (along with massage therapy, chiropractic, osteopathic, physiotherapy, etc).
A lot of people ask me if/when naturopathic medicine will be covered by OHIP. I have no idea if this is even a possibility at this point, but the more important question is, should it be? Sure, this would cover the cost for everyone but it would also likely eliminate the most valuable aspect of naturopathic medicine, which is the ability to treat people individually. Under our provincial healthcare plan, medical doctors do not have this freedom; they are bound by “standard of care” and algorithms and “first-line” drug therapy for many chronic diseases.
Naturopathic doctors have the freedom to spend a lot of time with each patient and to create a personalized treatment plan for each. That means that one patient with diabetes may be treated entirely different from the next. Not only does this kind of care require longer visits, but it also requires a lot more time spent by the doctor outside the visit to research, analyze, and prepare an appropriate plan. My patients understand the value of their naturopathic treatment and view their insurance coverage as a helping hand. However, many chronic health issues will require treatment beyond what insurance will subsidize.
People will often tell me how much they think they could benefit from naturopathic care, but they can’t afford it. I think the actual number of people who truly can’t afford it is much smaller.
What is your health worth to you?
Most people don’t think twice about paying for clothing, purses, hair styling, entertainment, eating out, travel, etc and would never expect these “essentials” to be paid for by the government. Far too many people are eager to live beyond their means in a home that is more than they need, driving a car that is too expensive, and buying themselves and their kids enough toys to entertain many families. However, these same people balk at paying for healthcare, which is hands-down far more valuable and essential. Investment in your health is just another place for your discretionary spending, something that improves your quality of life and in fact is an investment in the most valuable asset you will ever own - your health.
But, but, but... What about people who can barely make ends meet, who are on disability, social assistance, etc? You know, the people who really need help with many aspects of their lives, especially health? That is where there is a problem. I challenge you to find a naturopathic doctor who doesn’t make exceptions for this kind of case in his or her practice. This helps some people, but not all. And that’s why places like this exist:
- Community PHA Naturopathic clinic at Sherbourne Health Centre
- Anishnawbe Health Toronto
- Lakeshore Area Multi-service Project naturopathic clinic
- Queen West Community Health Centre
- Parkdale Community Health Centre
Consider what your health is worth, what health allows you to do in your life. Consider what you think is a reasonable investment to maintain that. Finally, consider what it will cost you (in money but also in quality of life) to regain health once it has suffered.
Naturopathic medicine is worth it
17/Apr/11 08:39 AM
by Kate Whimster, BCom, MIFHI, ND
I just read a great blog by an Dr. Steve Nenninger, ND in New York called “Naturopathic Medicine is the Treatment of Choice for the Uninsured.”
In Canada we are fortunate enough not to have to deal with the same private insurance landscape (nightmare?) as in the US, but the parallel here is our provincial healthcare plan. Some of my patients have additional insurance through their workplace that provides some coverage for naturopathic medicine, but about half of them don’t, which means they pay 100% out-of-pocket. Regardless, for most chronic health concerns, and depending on the insurance plan (which you pay for as well!), most patients are paying a portion of the cost for naturopathic treatment themselves. So why is it worth it?
“The treatment you get from insurance is not the treatment that will get you better.”
Doctors in Canada are also bound by “standard of care” and those protocols for treating patients are based on their medical training. This medical training is based mostly on pharmaceutical medication and does not include much on nutrition, botanical medicine, lifestyle counselling, or other holistic and gentle therapies. Seeing an MD (for “free” in Canada, although we all know it’s not really free) is not the same as seeing an ND.
“The most expensive treatment is the one that doesn’t work.”
Naturopathic medicine is focused on true healing. As an ND I am constantly focused on our goal of wellness and I am fortunate enough to have the time to spend with patients to discuss honestly how our treatment is progressing. Being ill or even just not being truly well is far more expensive than just the cost for medications and treatments. As Dr. Nenninger says: “Nothing affects your ability to be a productive human being more than being ill.”
I just read a great blog by an Dr. Steve Nenninger, ND in New York called “Naturopathic Medicine is the Treatment of Choice for the Uninsured.”
In Canada we are fortunate enough not to have to deal with the same private insurance landscape (nightmare?) as in the US, but the parallel here is our provincial healthcare plan. Some of my patients have additional insurance through their workplace that provides some coverage for naturopathic medicine, but about half of them don’t, which means they pay 100% out-of-pocket. Regardless, for most chronic health concerns, and depending on the insurance plan (which you pay for as well!), most patients are paying a portion of the cost for naturopathic treatment themselves. So why is it worth it?
“The treatment you get from insurance is not the treatment that will get you better.”
Doctors in Canada are also bound by “standard of care” and those protocols for treating patients are based on their medical training. This medical training is based mostly on pharmaceutical medication and does not include much on nutrition, botanical medicine, lifestyle counselling, or other holistic and gentle therapies. Seeing an MD (for “free” in Canada, although we all know it’s not really free) is not the same as seeing an ND.
“The most expensive treatment is the one that doesn’t work.”
Naturopathic medicine is focused on true healing. As an ND I am constantly focused on our goal of wellness and I am fortunate enough to have the time to spend with patients to discuss honestly how our treatment is progressing. Being ill or even just not being truly well is far more expensive than just the cost for medications and treatments. As Dr. Nenninger says: “Nothing affects your ability to be a productive human being more than being ill.”
Naturopathic doctor licensing in Colorado
21/Feb/11 07:55 PM
by Kate Whimster, BCom, MIFHI, ND
Good article in the New York Times today about efforts (and opponents) to licensing NDs in Colorado (currently an unlicensed state).
Mark Cooper is spot-on when he says “The whole issue is fear-based ignorance.” I find that even in Ontario (a province which licenses NDs) most critics of naturopathic medicine are ignorant as to the training we have and treatment we provide. This is pretty ironic considering that these critics also demand evidence for naturopathic medicine yet neglect to seek out evidence of the claims that they are making against naturopathic medicine! If they took some time to learn about the profession, they would find lots of information in support of naturopathic doctors and the efficacy and safety of naturopathic medicine. In many cases, the evidence for naturopathic interventions (diet, lifestyle, botanical medicine, Asian medicine, homeopathy) is far more compelling than for the conventional medical treatments.
One of the biggest issues in unlicensed states/provinces is that there are also practitioners who can call themselves naturopathic doctors who have not had the same training required in licensed areas. In some cases, these groups have incredible lobbying powers and can block regulation for decades. As a naturopathic doctor who has spent years training and a fortune on tuition, I’m really glad I practice in a province that recognizes this and protects my ND title!
Find more information on my pages about naturopathic medicine and frequently asked questions. I’ve also written blogs entitled “Curriculum comparison,” “The power of natural medicine,” and “Alternative medicine debate.”
Good article in the New York Times today about efforts (and opponents) to licensing NDs in Colorado (currently an unlicensed state).
Mark Cooper is spot-on when he says “The whole issue is fear-based ignorance.” I find that even in Ontario (a province which licenses NDs) most critics of naturopathic medicine are ignorant as to the training we have and treatment we provide. This is pretty ironic considering that these critics also demand evidence for naturopathic medicine yet neglect to seek out evidence of the claims that they are making against naturopathic medicine! If they took some time to learn about the profession, they would find lots of information in support of naturopathic doctors and the efficacy and safety of naturopathic medicine. In many cases, the evidence for naturopathic interventions (diet, lifestyle, botanical medicine, Asian medicine, homeopathy) is far more compelling than for the conventional medical treatments.
One of the biggest issues in unlicensed states/provinces is that there are also practitioners who can call themselves naturopathic doctors who have not had the same training required in licensed areas. In some cases, these groups have incredible lobbying powers and can block regulation for decades. As a naturopathic doctor who has spent years training and a fortune on tuition, I’m really glad I practice in a province that recognizes this and protects my ND title!
Find more information on my pages about naturopathic medicine and frequently asked questions. I’ve also written blogs entitled “Curriculum comparison,” “The power of natural medicine,” and “Alternative medicine debate.”
Alternative medicine debate
07/Jul/10 10:14 PM
by Kate Whimster, BCom, MIFHI, ND
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):
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.
Is naturopathic medicine evidence-based?
08/Feb/10 05:50 PM
by Kate Whimster, BCom, MIFHI, ND
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.
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.
Science-based medicine flaws
12/Jan/10 04:30 PM
by Kate Whimster, BCom, MIFHI, ND
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.
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.
Medical curriculum comparison
18/Sep/09 12:21 PM
by Kate Whimster, BCom, MIFHI, ND
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).
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).