Research on complementary and alternative medicine (CAM) has grown rapidly over the last five years. One obvious sign of this growth is the National Center for Complementary and Alternative Medicine’s budget, which topped $116 million in fiscal year 2004. But far too much CAM research is designed and conducted by people who have little experience with the modalities they’re trying to study. Many studies thus far have had serious design flaws. NCCAM studies are typically single agent trials that do not reflect how holistic modalities are actually practiced.
Naturopathic medicine is a system of primary healthcare, and it needs to be studied in its own context. For many years, as Chair of Scientific Affairs and then as President of the American Association of Naturopathic Physicians, I have been in discussions with researchers in the naturopathic profession about the need for a research agenda that addresses these issues. These discussions led to the development of the Naturopathic Medical Research Agenda (NMRA), and I feel privileged to have participated in its emergence.
The NMRA is the result of a two-year process of meetings, debates, retreats, and reviews funded by NCCAM. A total of 28 authors were chosen as NMRA Workgroup members. The ideas and conclusions presented in the NMRA were reviewed by over 1,200 other scientists and physicians from both conventional and naturopathic institutions.
The NMRA takes into account the historical tradition of naturopathic medicine, the observations of current naturopathic scholars and physicians on its health benefits, and existing science on its practices. The core NMRA hypotheses are:
- Naturopathic medicine is safe and effective for health promotion and for the prevention and management of a broad range of common conditions.
- Increased availability of the services of naturopathic physicians will improve public health in a cost-effective manner.
- The scientific exploration of naturopathic medical practices and principles will yield important insights into the nature of health and healing.
The goal of the NMRA is to indicate lines of research to validate these hypotheses, and to increase efficiency of naturopathic research efforts.
The NMRA also identifies 3 major categories of naturopathic research:
- Whole-practice research, with a focus on research on naturopathic medicine as primary care.
- Research on specific components of naturopathic medicine (e.g., single agents for a particular diagnosis, mechanism of action studies).
- Contextual research, with a focus on observations about aspects of the practice of naturopathic medicine (e.g., the patient-practitioner interaction) or its relationships with the larger health system (integration).
In practice, naturopathic physicians use multi-modal combination treatments individualized based on a whole-person approach. Yet most research to date has been on specific components; little work has yet been done in the areas of whole practice and contextual research. The ideal of whole-practice research with an orientation towards health, wellness, and healing, and not just disease, is a central value of the NMRA.
The NMRA’s priorities are to study conditions with the highest burden of illness; to address problems of emerging public health significance; to study the most effective naturopathic approaches with the most revolutionary potential; to foster development of needed infrastructure; and, for initial studies, to focus on near-term feasibility. Based on this, the Workgroup has selected three populations for initial focus: people with type 2 diabetes mellitus, the elderly, and children.
The NMRA calls for systematic reviews and collection of preliminary data in preparation for a large randomized trial comparing naturopathic medical care with conventional care for type 2 diabetes. Outcomes of whole practice research will include bio-medical disease markers, as well as health and health services endpoints. This research will adhere to the basic naturopathic premise that health outcomes are as important as disease outcomes.
Our aging demographic calls for controlled studies of naturopathic approaches to geriatric care. Likewise, naturopathic pediatric care could result in lower risks for allergies, asthma, obesity, behavioral disorders, depression, and autoimmune disease. Such beliefs can best be evaluated in large controlled cohort studies. The study of childhood vaccination practices of naturopathic physicians is also considered a priority.
In order to consolidate naturopathic medical research, the team and institutions that developed the NMRA will form an ongoing collaborative network. Each of the naturopathic institutions represented in the Workgroup is already engaged in lines of work related to at least one of the populations of interest. A publications track and a whole-practice track will enhance infrastructure in NMRA’s focus areas.
We are also actively pursuing new partnerships with researchers in conventional medicine, public health, and other disciplines, and strengthening alliances that already exist. More formalized consortia are expected to arise around the specified research directions in the near future. Stay tuned!
Copies of the NMRA will be available from Bastyr University Press in September 2004.
Michael Traub, ND, is immediate past-president of the American Association of Naturopathic Physicians. He practices in Kailua-Kona, Hawaii, and is on staff at North Hawaii Community Hospital.
