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Node Smith, ND

Motivation. It’s a common obstacle for many individuals striving to better their health. And a new research study suggests that chronic inflammation impacts dopaminergic signalling in the brain, thus impacting motivational drive.

Chronic inflammation impacts dopaminergic signalling in the brain

The study, released in the journal, Trends in Cognitive Sciences, links reduced dopamine release in the brain, with the presence of inflammation in the body, and suggests this may be a factor impacting motivation to do things. A further conclusion is that the decrease in dopamine may be the body’s effort to conserve energy use during times of crisis.

Foundational hypothesis is vitalistic in nature

The foundational hypothesis is vitalistic (which is to say, naturopathic) in nature – that the body needs more energy to heal from an infection, or wound, and adapts neural signalling in a way that ultimately decreases energy expenditure in other areas – i.e. by decreasing chemical signalling for motivation, rest is a more likely outcome, allowing the body to do the healing it needs to do.

Manner in which this adaptive response occurs is through the following disruption

According to the study, the manner in which this adaptive response occurs is through immune-mediated disruption of the dopamine pathway – thus reducing dopamine release.

The method researchers used to assess how inflammation affects the amount of viable energy

The method the researchers used to assess how inflammation affects the amount of energy available is a computational technique that could allow for further research into chronic inflammation and motivation in various specific diseases, such as depression.

If theory is correct, it could have a HUGE impact on treating depression

Andrew Miller, co-author of the study, says, “If our theory is correct, then it could have a tremendous impact on treating cases of depression and other behavioral disorders that may be driven by inflammation. It would open up opportunities for the development of therapies that target energy utilization by immune cells, which would be something completely new in our field.”

Source:

  1. Treadway M. T. et al., (2019). Can’t or Won’t? Immunometabolic Constraints on Dopaminergic Drive. Trends in Cognitive Sciences. https://doi.org/10.1016/j.tics.2019.03.003

Node Smith, ND, is a naturopathic physician in Humboldt, Saskatchewan and associate editor and continuing education director for NDNR. His mission is serving relationships that support the process of transformation, and that ultimately lead to healthier people, businesses and communities. His primary therapeutic tools include counselling, homeopathy, diet and the use of cold water combined with exercise. Node considers health to be a reflection of the relationships a person or a business has with themselves, with God and with those around them. In order to cure disease and to heal, these relationships must be specifically considered. Node has worked intimately with many groups and organizations within the naturopathic profession, and helped found the non-profit, Association for Naturopathic Revitalization (ANR), which works to promote and facilitate experiential education in vitalism.

Node Smith graduated from the National University of Natural Medicine (NUNM) in 2017, and is currently licensed as a naturopathic physician in Oregon and working towards becoming licensed in Saskatchewan, Canada as well.

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Node Smith, ND

A simple tweak to the sleeping patterns of ‘night owls’ – people with extreme late sleeping and waking habits – could lead to significant improvements in sleep/wake timings, improved performance in the mornings, better eating habits and a decrease in depression and stress.

It’s possible to shift circadian rhythm of ‘night owls’ using non-pharmacological & practical interventions

New international research by the Universities of Birmingham and Surrey in the UK, and Monash University in Australia, showed that, over a three-week period, it was possible to shift the circadian rhythm of ‘night owls’ using non-pharmacological and practical interventions.

Participants reported a decrease in feelings of depression and stress

The study, published in Sleep Medicine, showed participants were able to bring forward their sleep/wake timings by two hours, while having no negative effect on sleep duration. In addition, participants reported a decrease in feelings of depression and stress, as well as in daytime sleepiness.

Research findings

“Our research findings highlight the ability of a simple non-pharmacological intervention to phase advance ‘night owls’, reduce negative elements of mental health and sleepiness, as well as manipulate peak performance times in the real world,” lead researcher Dr Elise Facer-Childs from Monash University’s Turner Institute for Brain and Mental Health said.

Who(ot) are ‘Night owls’?

‘Night owls’ are individuals whose internal body clock dictates later-than-usual sleep and wake times – in this study participants had an average bedtime of 2.30 am and wake-up time of 10.15 am.

Disturbances to sleep/wake system linked to a variety of health issues

Disturbances to the sleep/wake system have been linked to a variety of health issues, including mood swings, increased morbidity and mortality rates, and declines in cognitive and physical performance.

Having a late sleep pattern is in-congruent with standard societal days

Having a late sleep pattern puts you at odds with the standard societal days, which can lead to a range of adverse outcomes – from daytime sleepiness to poorer mental wellbeing.”

Co-author Dr Andrew Bagshaw from the University of Birmingham

“We wanted to see if there were simple things people could do at home to solve this issue. This was successful, on average allowing people to get to sleep and wake up around two hours earlier than they were before. Most interestingly, this was also associated with improvements in mental wellbeing and perceived sleepiness, meaning that it was a very positive outcome for the participants. We now need to understand how habitual sleep patterns are related to the brain, how this links with mental wellbeing and whether the interventions lead to long-term changes.”

Twenty-two healthy individuals participated in the study

For a period of three weeks participants in the experimental group were asked to:

  • Wake up 2-3 hours before regular wake up time and maximize outdoor light during the mornings.
  • Go to bed 2-3 hours before habitual bedtime and limit light exposure in the evening.
  • Keep sleep/wake times fixed on both work days and free days.
  • Have breakfast as soon as possible after waking up, eat lunch at the same time each day, and refrain from eating dinner after 7 pm.
Results highlighted increase in cognitive (reaction time) and physical (grip strength) performance

The results highlighted an increase in cognitive (reaction time) and physical (grip strength) performance during the morning when tiredness is often very high in ‘night owls’, as well as a shift in peak performance times from evening to afternoon. It also increased the number of days in which breakfast was consumed and led to better mental wellbeing, with participants reporting a decrease in feelings of stress and depression.

Establishing simple routines

Establishing simple routines could help ‘night owls’ adjust their body clocks and improve their overall physical and mental health. Insufficient levels of sleep and circadian misalignment can disrupt many bodily processes putting us at increased risk of cardiovascular disease, cancer and diabetes,” said professor Debra Skene from the University of Surrey

Dr Facer-Childs said ‘night owls’, compared to ‘morning larks’, tended to be more compromised in our society due to having to fit to work/school schedules that are out of sync with their preferred patterns.

Acknowledging differences and providing tools to improve outcomes

“By acknowledging these differences and providing tools to improve outcomes we can go a long way in a society that is under constant pressure to achieve optimal productivity and performance,” she said.

This intervention could also be applied within more niche settings, such as industry or within sporting sectors, which have a key focus on developing strategies to maximize productivity and optimize performance at certain times and in different conditions.

From University of Birmingham

Node Smith, ND, is a naturopathic physician in Humboldt, Saskatchewan and associate editor and continuing education director for NDNR. His mission is serving relationships that support the process of transformation, and that ultimately lead to healthier people, businesses and communities. His primary therapeutic tools include counselling, homeopathy, diet and the use of cold water combined with exercise. Node considers health to be a reflection of the relationships a person or a business has with themselves, with God and with those around them. In order to cure disease and to heal, these relationships must be specifically considered. Node has worked intimately with many groups and organizations within the naturopathic profession, and helped found the non-profit, Association for Naturopathic Revitalization (ANR), which works to promote and facilitate experiential education in vitalism.

Node Smith graduated from the National University of Natural Medicine (NUNM) in 2017, and is currently licensed as a naturopathic physician in Oregon and working towards becoming licensed in Saskatchewan, Canada as well.

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Node Smith, ND

New research presented at this year’s Euroanaesthesia congress in Vienna, Austria (1-3 June) shows that mortality in patients who had undergone heart bypass surgery was over 4 times higher in individuals with a high body fat mass, while body mass index (BMI) by itself was not associated with an increase in mortality. The research was conducted by Dr Xavier Leroy of the Department of Anaesthesia and Resuscitation, CHU Lille, Lille, France and colleagues.

Mortality 4 x higher for heart bypass recipients with high body fat mass, while (BMI) by itself was not associated with increased mortality

There is conflicting evidence about the existence of the so-called obesity paradox when it comes to cardiac surgery, which is the theory that obesity as defined by BMI may offer a protective effect to the patient and reduce their risk of post-operative mortality. The authors suggest that other factors which are known to impact clinical outcomes in a range of settings such as body composition, referring to fat mass (FM) and lean body weight (LBW), may complicate the situation and lead to the inconsistent results seen in previous research.

Retrospective study analyzed 3373 patients who had undergone elective cardiac surgery with cardiopulmonary bypass

The team performed a retrospective study of 3373 patients who had undergone elective cardiac surgery with cardiopulmonary bypass from January 2013 until December 2016. Patient BMI (measured using the WHO definition) and body composition were calculated from clinical and administrative records and compared to patient mortality within 30 days of the operation. A further analysis was performed to investigate the association of BMI and body composition with a prolonged stay in the intensive care unit (ICU), with prolonged defined as being in the uppermost quartile (patients in the highest 25%) of length of stay (LOS).

Findings

Across the entire sample of patients, mortality within 30 days occurred in 2.1% of cases and significant differences were observed among BMI, FM, and LBW categories. Unlike BMI however, FM and LBW were found to be independently associated with mortality.

The 25% (quartile) of patients with the highest fat mass (FM) were 4.1 times more likely to die than 25% with the lowest fat mass; and the 25% of patients with the lowest lean body weight (muscle) were 2.8 times more likely to die than the 25% of patients with the highest lean body weight.

Authors did find an independent association between BMI and length of stay in the ICU

There was no observed association between BMI and 30-day mortality but the authors did find an independent association between BMI and length of stay in the ICU.

The authors conclude: “BMI was independently associated with a prolonged ICU length of stay, as were being in the highest fat mass and lowest lean body weight categories,” explains Dr Leroy. “The lower the LBW or the higher the FM and BMI were, the longer the length of stay in intensive care.”

Here’s what the findings revealed

He concludes, “overall, our findings showed that unlike BMI, lower lean body weight and higher fat mass in patients were independently associated with increased mortality after heart bypass surgery.”

Source

Node Smith, ND, is a naturopathic physician in Humboldt, Saskatchewan and associate editor and continuing education director for NDNR. His mission is serving relationships that support the process of transformation, and that ultimately lead to healthier people, businesses and communities. His primary therapeutic tools include counselling, homeopathy, diet and the use of cold water combined with exercise. Node considers health to be a reflection of the relationships a person or a business has with themselves, with God and with those around them. In order to cure disease and to heal, these relationships must be specifically considered. Node has worked intimately with many groups and organizations within the naturopathic profession, and helped found the non-profit, Association for Naturopathic Revitalization (ANR), which works to promote and facilitate experiential education in vitalism.

Node Smith graduated from the National University of Natural Medicine (NUNM) in 2017, and is currently licensed as a naturopathic physician in Oregon and working towards becoming licensed in Saskatchewan, Canada as well.

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Node Smith, ND

The WHO met last week for its week long annual meeting, which included approval of the ICD-11 coding system. The most overarching component of the new system will be its online accessibility, which is intended to create consistency in diagnosis and assessment across the globe.

Just when you thought that you’d figured out ICD-10 coding

Because of its inclusive nature, the ICD-11 will include traditional medical systems, such as Chinese medicine. This is a huge step, considering millions of people use traditional medicine worldwide, though it has never been recognized by this classification system. There are other changes and additions that some will be glad to begin using.

The WHO will no longer categorize transgender as a “mental disorder”

The WHO will no longer categorize transgender as a “mental disorder.” This will be reflected in the ICD-11 manual. The official language will change from “gender dysphoria” to “gender incongruence.” This diagnosis will be listed under the classification chapter on “sexual health” rather than “mental disorders.” This change will come into effect in January 2022.

Recognition of burnout added to ICDd-11

Another exciting addition, is the recognition of burnout as a “factor influencing health status or contact health services.” Burnout will be defined in the ICD-11 manual as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

Gaming disorder to be added to the list of addictions

Gaming disorder will be added to the list of addictions with a list of diagnostic criteria:

  1. impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context);
  2. increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities; and
  3. continuation or escalation of gaming despite the occurrence of negative consequences. The behavior pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
These changes and others available on the WHO website

These changes and others can be viewed on the WHO website, and are set to take effect in 2022, just in time for another couple of graduating classes to get familiar with the ICD-10 system.

WHO News

Node Smith, ND, is a naturopathic physician in Humboldt, Saskatchewan and associate editor and continuing education director for NDNR. His mission is serving relationships that support the process of transformation, and that ultimately lead to healthier people, businesses and communities. His primary therapeutic tools include counselling, homeopathy, diet and the use of cold water combined with exercise. Node considers health to be a reflection of the relationships a person or a business has with themselves, with God and with those around them. In order to cure disease and to heal, these relationships must be specifically considered. Node has worked intimately with many groups and organizations within the naturopathic profession, and helped found the non-profit, Association for Naturopathic Revitalization (ANR), which works to promote and facilitate experiential education in vitalism.

Node Smith graduated from the National University of Natural Medicine (NUNM) in 2017, and is currently licensed as a naturopathic physician in Oregon and working towards becoming licensed in Saskatchewan, Canada as well.

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Node Smith, ND

The body’s endocannabinoid system, due to the critical role it plays in regulating neurotransmitter signaling, is an enticing target for drug development against disorders associated with anxiety, stress, and repetitive behaviors, such as obsessive-compulsive disorder (OCD). A comprehensive new review article that provides an overview of this complex system, endogenous and exogenous cannabinoids, results of animal studies and human trials to date, and recommendations for future directions is published in Cannabis and Cannabinoid Research, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers.

Endocannabinoid system plays a critical role in regulating neurotransmitter signaling

The article entitled “The Endocannabinoid System: A New Treatment Target for Obsessive Compulsive Disorder?” was coauthored by Reilly Kayser, MD, Ivar Snorrasson, PhD, Margaret Haney, PhD, and H. Blair Simpson, MD, PhD, Columbia University Vagelos College of Physicians and Surgeons, and Francis Lee, MD, PhD, Weill Cornell Medical College, (New York, NY). The researchers present the evidence that links the endocannabinoid system to the pathology underlying OCD. They also explore the potential for targeting this system to relieve symptoms of OCD and related disorders such as anxiety, tic, and impulse control disorders. The review includes and extensive overview of cannabinoids made by the body, and exogenous cannabinoids, including phytocannabinoids found in the marijuana plant and purified and synthetic cannabinoids.

Authors suggest continued pharmaceutical development is warranted

Based on both animal study data showing anti-anxiety and anti-compulsive effects of cannabinoid agents and on preliminary human clinical trial data, the authors suggest that continued pharmaceutical development is warranted. Which cannabinoid agents to test and how to measure their effects will be among the important questions to consider in designing future studies.

“A place for cannabinoid-based medicines in psychiatry?”

“Is there a place for cannabinoid-based medicines in psychiatry? Evidence from animal and human studies points to the endocannabinoid system as an important regulator of emotionality, but how can we exploit this knowledge for therapy? This review article offers a critical assessment of the evidence, focused on obsessive compulsive disorder, and clues to future research,” said Daniele Piomelli, PhD, Editor-in-Chief, University of California-Irvine, School of Medicine.

Source:

  1. Kayser, R R. et al. (2019) The Endocannabinoid System: A New Treatment Target for Obsessive Compulsive Disorder?. Cannabis and Cannabinoid Research. doi.org/10.1089/can.2018.0049.

Node Smith, ND, is a naturopathic physician in Humboldt, Saskatchewan and associate editor and continuing education director for NDNR. His mission is serving relationships that support the process of transformation, and that ultimately lead to healthier people, businesses and communities. His primary therapeutic tools include counselling, homeopathy, diet and the use of cold water combined with exercise. Node considers health to be a reflection of the relationships a person or a business has with themselves, with God and with those around them. In order to cure disease and to heal, these relationships must be specifically considered. Node has worked intimately with many groups and organizations within the naturopathic profession, and helped found the non-profit, Association for Naturopathic Revitalization (ANR), which works to promote and facilitate experiential education in vitalism.

Node Smith graduated from the National University of Natural Medicine (NUNM) in 2017, and is currently licensed as a naturopathic physician in Oregon and working towards becoming licensed in Saskatchewan, Canada as well.

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Node Smith, ND

A new study conducted by researchers at the University of Illinois at Chicago and published in JAMA Network Open has found that 81% of antibiotics prescribed by dentists – who are among the top prescribers in the U.S., accounting for about 10% of all antibiotic prescriptions – to prevent infections prior to dental visits are unnecessary.

81% of prescriptions did not align with the national guidelines

The researchers, led by Katie Suda, associate professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy, say that this surprising finding highlights the need for improved antibiotic stewardship in dental practices, especially those located in the Western U.S., which were associated with the highest rates of unnecessary prescribing.

Using Truven, a national integrated health claims database, the researchers retrospectively analyzed dental visits occurring between 2011 and 2015. They compared antibiotic prescriptions — which were dispensed prior to 168,420 dental visits — to the number of high-risk cardiac patients who, per national guidelines, are the only patients recommended for antibiotics prior to a dental procedure.

They found that 81% of prescriptions did not align with the national guidelines and were provided for patients without high-risk cardiac conditions.

Use of preventive antibiotics in these patients increases the risks associated with antibiotic use

Use of preventive antibiotics in these patients opens them up to the risks associated with antibiotic use — increasing bacterial resistance and infections, for example — when the evidence used to develop the guidelines suggests that the risks outweigh the benefits in most patients,” said Katie Suda, the corresponding author on the study

‘Results point to trends by geography that are unexpected’

The researchers also looked at dentists’ antibiotic prescribing patterns by geography. They found that the Western U.S. and urban areas were more likely to have unnecessary prescribing. Among patients most likely to fill prescriptions for unnecessary antibiotics are those with prosthetic joint implants and those receiving clindamycin.

“These results point to trends by geography that are unexpected — they are the opposite of what is seen in medical clinics — and to an alarming tendency of dental providers to select clindamycin, which is associated with a higher risk of developing C. difficile infections when compared to some other antibiotics,” Suda said.

An opportunity for dentists to reevaluate necessity and incorporate renewed commitments to antibiotic stewardship

UIC’s Susan Rowan, a dentist, worked with Suda on the research, said “[d]ental providers are very thoughtful when they develop care plans for their patients and there are many factors that inform dentists’ recommendations and the medications they prescribe, but this study shows that there is an opportunity for dentists to reevaluate if necessary and incorporate renewed commitments to antibiotic stewardship into their practices that limit preventive prescriptions to a small group of patients,” said Rowan, executive associate dean and associate dean for clinical affairs at the UIC College of Dentistry. “I think dental providers should view this study, which is the first to look at preventive antibiotic prescribing for dental procedures and provide this type of actionable information, as a powerful call to action, not a rebuke.”

Per the authors, findings may actually underestimate unnecessary prescribing of antibiotics

The authors noted that because the study was limited to patients with commercial dental insurance and the analysis used a broad definition of high-risk cardiac patients, the findings may actually underestimate unnecessary prescribing of antibiotics.

  1. Suda, K.J. et al. (2019) Assessment of the Appropriateness of Antibiotic Prescriptions for Infection Prophylaxis Before Dental Procedures, 2011 to 2015. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2019.39.

Node Smith, ND, is a naturopathic physician in Humboldt, Saskatchewan and associate editor and continuing education director for NDNR. His mission is serving relationships that support the process of transformation, and that ultimately lead to healthier people, businesses and communities. His primary therapeutic tools include counselling, homeopathy, diet and the use of cold water combined with exercise. Node considers health to be a reflection of the relationships a person or a business has with themselves, with God and with those around them. In order to cure disease and to heal, these relationships must be specifically considered. Node has worked intimately with many groups and organizations within the naturopathic profession, and helped found the non-profit, Association for Naturopathic Revitalization (ANR), which works to promote and facilitate experiential education in vitalism.

Node Smith graduated from the National University of Natural Medicine (NUNM) in 2017, and is currently licensed as a naturopathic physician in Oregon and working towards becoming licensed in Saskatchewan, Canada as well.

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Naturopathic Perspective

Paul Theriault, BSc, ND, VNMI

Discussions of homeopathy within the naturopathic profession have emerged recently, which have been predicated on the assumption that there is no evidence for homeopathy. This assumption is false. The evidence base, when taken as a whole and evaluated in light of the way homeopathy is practiced, is positive. Homeopathic methodology does indeed contain many aspects that make it difficult to evaluate homeopathy in a clinical trial; however, these problems are slowly being overcome through improved clinical methodologies. Other lines of evidence supporting homeopathy include laboratory studies and historical records of homeopathy’s use, particularly in infectious diseases, but will not be the subject of this article. Rather, this discussion will focus on meta-analyses of homeopathy research, taken as a whole.

Homeopathy has been evaluated by means of clinical trials for hundreds of years. However, the nature of homeopathic prescribing, the deeply detailed nature of case-taking, the therapeutic nature of case-taking itself, and the multiple adjustments and refinements of potency needed during therapy – all of which make placebo control difficult – combine together to make it challenging to undertake clinical trials for genuine, pure homeopathy. Methodological refinements have indeed been made to the clinical trial procedure over the past several decades, but they have not been completely successful, often creating outcomes in which the controls of a clinical trial result in data that are inferior to what one would expect from clinical practice.

Earlier Reviews

Throughout the years, homeopathy has been examined by multiple clinical trials to determine its efficacy. Many of these trials have been negative. Until recently, the compilation of the data from homeopathy trials had not been done in a way that examined the validity of homeopathy as a whole. In recent decades, the volume of clinical trials – and the development of meta-analysis as a methodology – has enabled the clinical trials to be evaluated en masse. This has resulted in more positive outcomes.

The first meta-analysis of homeopathic clinical trials was performed in 1991 by Kleijnen et al and published in the British Medical Journal.1 It produced, among the small amount of clinical trials available at the time, a positive result.

The next meta-analysis was published in the Lancet in 1997 by Linde et al.2 Of 185 trials found, 119 met inclusion criteria, and 89 of these had adequate data for inclusion and analysis. Rather than differentiate methodologies, they pooled studies of all varieties of homeopathy, regardless of methodology. Linde et al delivered an odds ratio (OR) of 2.45 (with a 95% confidence interval of 2.05-2.93) – a strongly positive result. When corrective factors for publication bias were added, the OR decreased to 1.78 (1.03-3.1) – weaker but still positive. Analyzing only high-quality trials resulted in an OR of 1.66 (1.33-2.08).2 Linde was repeatedly criticized for lumping data of varying quality together, and for lumping together trials of individualized and non-individualized homeopathy; consequently, further studies were conducted.

Ernst also conducted several reviews of homeopathy during this period. His first, published in 1998,3 purported to reanalyze Linde’s 1997 meta-analysis, in light of criticisms that it evaluated many conditions, included non-individualized trials, and examined lower-potency preparations that could potentially contain molecules of the original substance. Ernst’s analysis of what he viewed as higher-quality studies produced an OR of 0. Hahn4 has criticized Ernst’s review as including only 5 studies, and thus being far less valid than Linde’s original 1997 analysis despite its flaws.

Questionable Methodologies

In 1998, Linde conducted a review of clinical trials examining individualized homeopathy.5 He encountered a number of methodological and quality issues; nevertheless, pooling the data yielded a positive result, with an OR of 1.62 (95% CI 1.17-2.23). However, when the analysis was restricted to higher-quality trials, no significant effect was seen, although a positive trend was observed, with an OR of 1.12 (0.77-1.44). As discussed above, the many issues in clinical trials of homeopathy at the time make this conclusion not terribly surprising, though this problem has been remedied in more current research. Linde explored this in a subsequent article in 1999,6 in which he examined the effect of trial quality on effect size in homeopathy studies. He found that higher trial quality often produced smaller effect sizes. This is important, as many critics seized upon this as proof of lack of efficacy of homeopathy, forgetting that other research7 has shown this effect to be consistent throughout medical research (ie, not a problem unique to homeopathy).

In 2000, Ernst published another meta-analysis,8 in which he criticized Linde’s 1998 analysis as flawed due to the weaknesses of the studies used. Ernst extrapolated trends based on Linde’s 1999 study of trial quality, and suggested a linear trend (when in fact the data is asymptotic); using this approach, trials with a perfect quality would theoretically move towards results of 0. This tactic is strongly criticized by Hahn4 as prioritizing imagined and extrapolated data over real data – particularly bizarre considering he had access to the real data.

The next meta-analysis of homeopathy was performed in 2000 by Cucherat et al and published in the European Journal of Pharmacology.9 They took 118 trials, judged 16 of them to meet inclusion criteria, and then combined p values to form a grand p value – an extremely unusual method of analysis and one which Hahn4 notes is likely to deliver the least favorable statistical result for homeopathy. Despite this odd method, the results of the analysis were positive, with a grand p value of <0.000036. Studies with less than 10% dropouts had a slightly lower p value of 0.0084 (ie, 8.4 out of a 1000 chance of being due to placebo), and studies with less than 5% dropout had a p value of 0.082 – marginally above the generally accepted threshold for statistical significance.9 However, this standard was extraordinarily rigorous, with dropout rates of less than 20% being commonly accepted as adequate.10

The next meta-analysis of homeopathy as a whole was by Shang et al, published in the Lancet in 2005.11 This study took an extraordinarily bizarre approach of choosing 110 randomized, controlled, double-blind trials, and then “matching” them to 110 comparable allopathic trials; some high-quality homeopathy studies were excluded solely due to an inability to find comparable allopathic trials. The data in these 110 trials were not combined to create an odds ratio. Instead, the data from all but 21 trials of homeopathy were excluded due to unspecified quality measures. The authors then excluded, for unclear reasons, all but 8 trials, and came up with an insignificant OR of 0.88 (0.65-1.19). Fascinatingly, the identities of these 8 studies were not listed in the original publication, but were released several months later, after the media circus around this result had died down.11

These results have been heavily criticized by homeopaths and statisticians, with the overall opinion that this trial should not have been published. These arguments are summarized by the Homeopathy Research Institute; however, perhaps the most significant arguments belong to Ludtke and Hahn. Ludtke12 analyzed Shang’s review, concluding that the results from Shang’s analysis were highly dependent on the subsection of trials selected, with his results being almost entirely due to a single, large, non-individualized trial of homeopathy. Hahn4 comments that the funnel plot tool used by Shang was completely inadequate to evaluate treatment effects in different medical conditions, and that in order to reach his conclusion that homeopathy lacks effect beyond placebo, 90% of clinical trials must be excluded. In fact, it has been determined by Ludtke12 that if Shang had included all 21 higher-quality trials, even using his bizarre selection criteria, he would have found a statistically significant effect that was greater than placebo.

More Recent Reviews

The next major meta-analysis of homeopathy was by Mathie et al in 2014.13 It included all available randomized controlled trials (RCTs) and rated all of them using several quality assessment measures. Unfortunately, again likely due to methodological issues, no trial was rated as having no risk of bias, in all domains. However, those trials that had low or unclear risk of bias in 1 domain were analyzed. Twenty-two trials had extractable data and were thus subject to analysis, creating a significant OR of 1.53 (1.22-1.91). Restricting the analysis to trials rated as reliable evidence produced an even higher OR of 1.93 (1.16-3.38). This is wonderfully explained by Mathie, himself, in a presentation available on YouTube.14

At the present time (May 2019, as of this writing), Mathie’s analysis still stands as the most current, complete, and unbiased of all reviews of homeopathy. The low quality of evidence does merit caution, but the results clearly indicate that the existing data do suggest that homeopathy has an effect greater than placebo. This is the current state of the evidence from clinical trials, and to deny this is to go against the existing data.

Ernst has criticized the results as excluding one of his own trials. Mathie graciously explained on Ernst’s blog his exclusion criteria, yet redid the analysis with the addition of Ernst’s data (despite not meeting the criteria), and arrived at the same results. This is published in a PDF separate from Mathie’s original article.15

The next, and probably lowest quality of analysis, is the 2015 NHMRC review,16 commissioned by the Australian government to evaluate the evidence of homeopathy. This review had a number of methodological problems, which have been summarized expertly by the Homeopathy Research Institute (HRI); much gratitude to HRI for presenting their points so succinctly. I will summarize them as follows17:

  • NHMRC conducted the review twice
  • The first review, and even its existence, was not disclosed to the public
  • The NHMRC, upon questioning, responded that the first review was low quality despite being conducted by the individual responsible for developing NHMRC’s guidelines on how to conduct evidence reviews
  • FOI (Freedom of Information) requests confirm that a member of NHMRC, Fred Mandelsohn, confirmed the first review to be high quality, stating, “I am impressed by the rigor, thoroughness and systematic approach given to this evaluation …. Overall, a lot of excellent work has gone into this review and the results are presented in a systematic, unbiased and convincing manner.”
  • NHMRC stated their results were based on over 1800 studies, when in fact they were based on only 176
  • NHMRC has used a method which has never been used in any other review, declaring that only trials of over 150 participants would be accepted, excluding the vast majority of high-quality homeopathic trials, which due to lack of funding tend to be smaller, and despite the fact that the NHMRC routinely conducts studies of fewer than 150 participants
  • The above rules resulted in exclusion of 171 of 176 studies, leaving only 5 to be used as the basis of the study
  • The chair of the second review, Peter Brooks, signed a “conflict of interest” form declaring himself “free from any association with any organization whose interests are either aligned or opposed to homeopathy” when he was a member of the anti-homeopathy lobby group “Friends of Science in Medicine”
  • The NHMRC review included no homeopaths or experts in homeopathy research, despite the NHMRC guidelines requiring such an inclusion

Rachel Roberts of the HRI presents this set of circumstances expertly in a presentation delivered at HRI.18

The evidence against the NHMRC in frank academic bias and misconduct is so strong that the HRI is pursuing a complaint with the relevant ombudsman in Australia. The initial investigation has found sufficient evidence to warrant a full investigation of NHMRC’s conduct, at the expense of the ombudsman, which is ongoing.19

Another meta-analysis of homeopathy was conducted by Mathie et al in 2017.20 This review focused on non-individualized, randomized, double-blinded control trials of homeopathy, and found 75. Forty-eight of these trials had a high risk of bias, 23 were uncertain, and 3 had a low risk of bias and were thus listed as reliable. The standard mean deviation (SMD) was the measure used. Fifty-four trials had extractable data, and the pooled data showed a SMD of -0.33 (95% CI -0.44, -0.21), which was statistically significant. Adjusting for publication bias, this was adjusted to a still significant -0.16 (95% CI -0.46, -0.09). Reliable data resulted in an insignificant result of -0.18 (95% CI -0.46, 0.09). This result has gone unremarked upon in the greater skeptical literature on homeopathy, despite both major negative reviews of homeopathy (Shang; NHMRC) failing to differentiate these 2 types of studies.

In 2018, Mathie et al performed another meta-analysis of RCTs of homeopathy, this time non-placebo-controlled. These studies examined homeopathy in comparison to another treatment, homeopathy alongside another intervention, or homeopathy compared to a no-treatment group.21 Eleven RCTs were found, 10 of which had a high risk of bias, and 1 of which had a high risk of bias solely due to participant blinding – something inherent to the study’s design. For 4 heterogeneous designs based on comparative treatments, the pooled odds ratio was non-significant. In 1 remaining trial, homeopathy was found to be non-inferior to fluoxetine for treatment of depression. For trials examining homeopathy alongside another intervention, there was a statistically significant mean SD favoring homeopathy. This review – due to a lower quality of evidence, the small number of trials, and trial heterogeneity – precludes any definitive conclusions.21

Mathie’s most recent meta-analysis, in 2019,22 examined non-randomized, other-than-placebo-controlled trials of homeopathy. Seventeen RCTs were found, with 10 containing data extractable for analysis. Fourteen trials showed a high risk of bias, and 3 had an unknown risk of bias. Heterogeneity prevented much comparison; however, 3 trials that were able to be compared had a non-significant pooled effect size.

Existing meta-analyses of homeopathy as a whole (and the NHMRC report, often lumped into this category) are summarized in Table 1.

Table 1. Meta-analyses of Homeopathy

Kleijnen, 19911

All types of homeopathy (eg, single remedy vs combination). Methodological quality assessed; 105 trials. Results: Positive trend, regardless of type of homeopathy; 81 trials were positive, 24 showed no effect.

Linde, 19972

All types of homeopathy. Out of 185 trials, 119 met inclusion criteria; 89 of these had extractable data. Results: OR = 2.45 (95% CI 2.05-2.93).

Ernst, 19983

Individualized homeopathy; 5 trials determined to be high-quality. Results: OR = 0.

Linde, 19985

Individualized homeopathy; 32 trials, 19 of which had extractable data. Results: OR = 1.62 for all trials (95% CI 1.17-2.23). Only high-quality trials produced no significant trend.

Cucherat, 20009

All types of homeopathy; 118 trials, 16 of which met inclusion criteria. Used unusual method of combining p values. Results: All trials = p< 0.000036. Less than 10% dropouts: p<0.084; less than 5% dropouts (higher standards than most trials considered reliable): p<0.08 (non-significant).

Shang, 200511

All types of homeopathy; only 8 trials selected from 21 high-quality trials of 110 selected with unusual criteria. Results: OR = 0.88 (0.65-1.19). Result strongly disputed by statisticians.

Mathie, 201413

Individualized homeopathy; of the analysis pooled data from 22 higher-quality, individualized, double-blind RCTs. Results: OR = 1.53 (1.22-1.91) for all trials pooled; OR = 1.93 (1.16-3.38) for the 3 reliable trials.

NHMRC, 201516

Out of 176 studies, 171 were excluded, leaving only 5 for the study. Investigators used unprecedented methods, did not combine data, and are currently under investigation for outcome shopping. Results: Negative results.

Mathie, 201720

Non-individualized homeopathy; very few higher-quality trials. Results: For 54 trials with extractable data, SMD = -0.33 (-0.44, -0.21). When these were adjusted for publication bias, SMD = -0.16 (-0.46,-0.09). The 3 high-quality trials had non-significant results: SMD = -0.18 (-0.46, +0.09).

Mathie, 201821

Individualized, other-than-placebo-controlled trials; 11 trials found, 8 with extractable data. Results: 4 heterogeneous comparative trials showed a non-significant difference. One trial in this group was positive. Three heterogeneous trials with additive homeopathy showed a statistically significant SMD. No definitive conclusion possible due to trial heterogeneity, poor quality, and low number of trials.

Mathie, 201922

Non-individualized, other-than-placebo-controlled trials; 17 RCTs found, 14 with high risk of bias. Results: Significant heterogeneity prevented much comparison; 3 comparable trials showed a non-significant SMD.
Conclusions

In recent decades, homeopathy has been examined via a number of clinical trials, the number of which now allow meta-analysis. As we can see from the study findings, the type of homeopathy research (ie, individualized vs non-individualized, placebo-controlled vs non-placebo-controlled) can have a strong influence on the results, although trial quality also has a strong effect.

All meta-analyses performed in at least a somewhat open and rigorous manner have found statistically significant effects. This suggests that homeopathy has a greater-than-placebo effect, or at least a strong trend in that direction, when using data from the totality of homeopathy research, or from individualized, placebo-controlled trials. The meta-analyses with questionable methodology, one of which is undergoing government investigation for academic irregularities, have produced negative results, which have been demonstrated to be a direct result of their exclusion of vast swathes of the homeopathic clinical trial literature (based on arbitrary and unexplained criteria), as well as of their failure to differentiate – as Mathie has done – different types of homeopathic research.

The clinical data are flawed. Issues with methodology used in homeopathy RCTs, combined with a lack of research funding, have produced a lack of high-quality trials and data. However, the data we do have point towards homeopathy as having an effect greater than that of placebo.

There can be no argument with this conclusion, aside from possible new data emerging. Anyone who disputes this is going against the existing set of the highest-quality evidence on homeopathy.

References:

  1. Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homeopathy. BMJ. 1991;302(6772):316-323.
  2. Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997;350(9081):834-843.
  3. Ernst E. Are highly dilute homeopathic remedies placebos? Perfusion. 1998;11(7):291-292.
  4. Hahn HG. Homeopathy: meta-analysis of pooled clinical data. Forsch Komplementmed. 2013;20(5):376-381.
  5. Linde K. Melchart D. Randomized controlled trials of homeopathy: a state of the art review. J Altern Complement Med. 1998;4(4):371-388.
  6. Linde K, Scholz M, Ramirez G, et al. Impact of study quality on outcome in placebo-controlled trials of homeopathy. J Clin Epidemiol. 1999;52(7):631-636.
  7. Hempel S, Miles J, Suttorp MJ, et al. Detection of Associations Between Trial Quality and Effect Sizes (Internet). Jan 2012. Agency for Healthcare Research and Quality (US). Report No: 12-EHC010-EF.
  8. Ernst E, Pittler MH. Re-analysis of previous meta-analysis of clinical trials of Homeopathy. J Clin Epidemiol. 2000;53(11):1188.
  9. Cucherat M, Haugh MC, Gooch M, Boissel JP. Evidence of clinical efficacy of homeopathy. A meta-analysis of clinical trials. HMRAG. Homeopathic Medicines Research Advisory Group. Eur J Clin Pharmacol. 2000;56(1):27-33.
  10. National Heart, Lung, and Blood Institute. Study Quality Assessment Tools. NIH Web site. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed May 12, 2019. Accessed May 12, 2019.
  11. Shang A, Huwiler-Müntener K, Nartey L, et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005;366(9487):726-732.
  12. Lüdtke R, Rutten AL. The conclusions on the effectiveness of homeopathy highly depend on the set of analyzed trials. J Clin Epidemiol. 2008;61(12):1197-1204.
  13. Mathie RT, Lloyd SM, Legg LA, et al. Randomised placebo-controlled trials of individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev. 2014;3:142.
  14. Mathie RT. Systematic review and meta-analysis of randomized, placebo-controlled, trials of individualised homeopathic treatment. Homeopathy Research Institute. 2nd HRI International Homeopathy Research Conference; Rome, 2015. [YouTube presentation] Available at: https://youtu.be/3KMN7P6EaJk. Accessed May 12, 2019.
  15. Mathie RT, Lloyd SM, Legg LA, et al. Meta-analysis of randomised controlled trials (RCTs) of individualised homeopathy: sensitivity of results to using original authors’ ‘primary outcome measure’. Available at: https://www.britishhomeopathic.org/wp-content/uploads/2015/01/BHA-16-Jan-2015.pdf. Accessed May 12th 2019.
  16. National Health and Medical Research Council. Australian Government. NHMRC Statement: Statement on Homeopathy. March 2015. Downloadable PDF available at: https://www.nhmrc.gov.au/about-us/publications/homeopathy#block-views-block-file-attachments-content-block-1. Accessed May 12, 2019.
  17. Homeopathy Research Institute. The Australian report. Available at: https://www.hri-research.org/resources/homeopathy-the-debate/the-australian-report-on-homeopathy/. Accessed May 12th, 2019.
  18. Roberts R. The Australian report – an in-depth analysis of the highly influential 2015 overview report on homeopathy. June 9, 2017. 3rd HRI International Homeopathy Research Conference; Malta, 2017. [YouTube presentation] Available at: https://youtu.be/dWKHFsRJhWk. Accessed May 12, 2019.
  19. Roberts R. NHMRC Commonwealth Ombudsman Investigation. Homeopathy Research Institute. [YouTube presentation] Available at: https://www.youtube.com/watch?v=oTNwT53qaGc&t=2s. Accessed May 12, 2019.
  20. Mathie RT, Ramparsad N, Legg LA, et al. Randomised, double-blind, placebo-controlled trials of non-individualised homeopathic treatment: systematic review and meta-analysis. Syst Rev. 2017;6(1):63.
  21. Mathie RT, Ulbrich-Zürni S, Viksveen P, et al. Systematic Review and Meta-Analysis of Randomised, Other-than-Placebo Controlled, Trials of Individualised Homeopathic Treatment. Homeopathy. 2018;107(4):229-243.
  22. Mathie RT, Fok YYY, Viksveen P, et al. Systematic Review and Meta-Analysis of Randomised, Other-than-Placebo Controlled, Trials of Non-Individualised Homeopathic Treatment. Homeopathy. 2019;108(2):88-101.

Paul Theriault, BSc, ND, VNMI, graduated from CCNM in 2010. He maintains a practice in Calgary that is dedicated to treating chronic infections, elimination of blockages to healing, digestive problems, and autism using homeopathy,..

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Education

David J. Schleich, PhD

In the world of regulatory and public policy debate, some sighing from time to time among healthcare providers is understandable. The road is long. Naturopathic leaders in many states can spend years in the pursuit of legislative parity and social closure. And even when a law is enacted, the biomedicine profession continues to eschew inter-professional collaboration, understanding acceptance to mean co-option, most often. Nevertheless, recent successes in New Mexico, Idaho, Massachusetts, Pennsylvania, Rhode Island, Maryland, North Dakota, Colorado, and Minnesota encourage persistence and bring the medicine to more and more people.

It is probably inevitable, though, that those who are longer-in-the-tooth experientially in this key element of professional formation can occasionally slip into a feeling of “plus ça change, plus c’est la même chose” [the more things change, the more they stay the same]. Take the recent legislative hearing in Alaska (May 2019) – yet another in a series of efforts to improve access to naturopathic medicine in America.

Finding Common Terrain

The recent Alaska hearings were brisk. In early May 2019, a dozen or so Alaskan medical doctors formed a queue to tell legislators that naturopathic doctors should not have their scope expanded. Supporters of naturopathic medicine experienced the presentations of the allopaths as overly reliant on anecdotal references, more emotive than analytical, and certainly regressive. Alaskan MDs did not appear to have benefitted from current data and information about the profession to which they were opposed. Unfortunately, such lopsided tangling persists in the American healthcare terrain as we seek ways to overcome health crisis crescendos, such as opioid misuse, the exponential incidence of chronic disease, the persistence of lethal iatrogenic disease, the endless upward spiral of healthcare costs, and the dubious effectiveness and sustainability of our current model.

Not only do the data indicate that Alaskan patients, as a case in point, beg to differ about the role and importance of naturopathic medicine in choices available to them as healthcare consumers, but so too do patients from the almost 2-dozen states in America which do credential naturopathic medicine doctors. At the root of the problem is that the sparring professional camps do not have enough bandwidth on the one side to educate their detractors, and on the other to take an interest in the continuum of medical history in America. How did we get here?

Alaskan allopathic doctors, likely as weary of the recurrent jousting as the naturopathic doctors themselves, would probably welcome historical and recent national as well as state-specific data about the qualifications, training, research, health outcomes, and licensing standards of groups other than themselves, since they are not going away anytime soon, and since the orthodox profession has long lost its moral high ground. There is enough disruption all around for everyone that reliable information and perspective are desirable in a time when the health of Americans is seriously and protractedly compromised. There is a way through. It may lie in giving more shelf space to history.

It is a challenge for conventional medical doctors to welcome new colleagues at the best of times, given the habits and privileges of authority of an established order. Biomedicine has had the advantage and also the burden of controlling the levers of health promotion and delivery for many decades. MDs and DOs, when presented with objective, helpful information about the unrelenting growth and popularity of holistic medicine knowledge content eschew it less as the evidence accumulates about the limits of reductionist medicine and the benefits of holism and collaboration. Like all providers, they are interested in proven efficacy of approaches. In the last half-century there has been much to check out.

Keeping in Mind Historical Context & Facts

The “integrative medicine” initiatives in America actually welcome more new “old” ideas about nutrition, whole-patient care, spirituality in medicine, and the danger of excessive reliance on pharmaceuticals. The Academy of Integrative Health & Medicine (AIHM) is a case in point. The rise in new codifying knowledge signaled by terminology such as “functional medicine” and “holistic medicine” is unstoppable because of the insistence on data and outcomes. This complex terrain makes more sense if we make the effort to investigate what’s new, keeping historical context and facts in mind. Surprisingly, what seems new may not be new at all, though – just new to certain groups. Despite the exasperation of biomedicine assimilating without apology treatment protocols long protected by naturopathic medicine, let’s do the history to figure out what can be done going forward.

The word “history” comes from the Greek istor, meaning “eyewitness.” We often study history using a rear-view chronology, perhaps too often habitually assessing outcomes in terms of present status. When we calibrate our current tools for health from that perspective, though, we risk missing the facts before us. For example, there is little broad discussion or debate about disease caused by medical treatments, even though the numbers in the tens of thousands are outrageously and unacceptably high. Why the silence? As well, there is veiled understanding of the types of illnesses that were fatal a century ago, compared to today’s statistics. Yet, well documented juxtapositions (historical, current) are illuminating.

Seeing no end in sight, sometimes contemporary naturopathic doctors often experience an ennui that they may have to give up precious values and principles from their past to have a place in the present. They will not go the way of the osteopathic profession whose educational and professional practice certifications and accreditation are subsumed within the orthodox MD agencies for these processes. The forces in play from biomedicine affect their confidence and strategic direction as they confront current historical shifts, reminiscent, in fact, of similar pressures a century ago. As everyone steams towards 2020, a look at how we have understood our own particular history is critical if we are not to repeat it. It is not a revisionist goal that contemporary historical scholars want to encourage. Rather, it is a clarifying intention which motivates, to see again, as if for the first time, what we have been doing during the last 12 decades to establish an alternative path to reductionist medicine. Even though Aristotle declared that history ranked below poetry and tragedy, a quick snapshot of the literature of our medical history, coupled with a parallel look at the structure of that history, can provide useful insights into what we should be doing next.

In the high-stakes professional playing field of healthcare delivery, we risk needlessly reinventing wheels. Recent allopathic discoveries in nutrition are not news to the elders of naturopathic medicine. New understanding of the links between gut health and the brain is old wisdom in the naturopathic profession. As time passes, and the tensions and emotions which affected judgment and action at one particular time dissipate, we risk becoming fuzzy about how we got to our present circumstances, about where we have been, and about why we sought the path we did. Contemporary historical scholarly inquiry, however, is increasingly multi-dimensional and nudges us to have a closer look at those “how’s, where’s and why’s.”

A quick look at the work of key historians such as Mészáros, Schmidt, and Toynbee can help us get perspective on awkward questions such as the underlying simmer of unfair competition from biomedicine, so evident in the lineup of testimony in the Alaska hearings, for example. Complicating the efforts of North American naturopathic medicine leaders to achieve recognition (translate: political legitimacy, making a living, social closure) is that holistic and reductionist practitioners alike yearn, like every small stream for an imagined faraway sea, for a time when respect for choice was less carved up by very big dollars, political entitlement, public policy, and regulatory red tape.

The study of the history of medicine, in any case, begs an understanding of the structure of that history. The classical historical scholarship formats of brilliant thinkers, such as Toynbee (1954), help sort out this complex turf. His definitions and classifications of civilizations, for example, and his well-known “laws” of genesis, growth, decay, death, and reincarnation give us a framework for understanding the rhythms and cycles of historical phenomena in our own world. Using such tools, we can understand our history more completely and imagine a future that doesn’t feel and look like repetition. Texas used to be licensed, for example. Florida, too.

Without our getting unduly distracted by the academic debate concerning the dialectic of “history vs structure,” let us reflect a moment on something Hegel called the “dialectical mediation” of logic and history. In this regard, what the history of naturopathic medical education reveals is a tension in how we experience “history as narrative” (a running debate about what is OK and not OK about how and what educational objectives, outcomes, and methodologies have evolved). Factions in the profession, for example, point at the schools as culprits in the abandonment of traditional values and practices. Essentially, as Schmidt (2013) points out, we may well have forgotten to cut ourselves some slack. The frequently linear nature of our historical narrative doesn’t make room for a more holistic sense of our own history. Schmidt calls this a loss of “historical consciousness” (Schmidt, MIT Press, 2013). The truth is that as we slip inexorably into the fast-running river of primary care, our idea of what health is, shifts.

It’s Dangerous to Abandon Our Roots

Specifically, in our highly evolved era of commodity exchange (provider receives benefit in exchange for a valued service, and competing providers jockey for control and advantage of their respective markets to get those benefits), and in an era which some historians believe to have reached a tipping point in capitalist enterprise (that is, when the exchange value does not have to address specifically any human need … only economic ones), we tend to separate out our knowledge and record of experience to do good in human society, from the sustained application of that knowledge in the marketplace. We divide our knowledge into didactic and clinical components which have not only utility and effectiveness as their measuring benchmarks, but also as political and regulated scope concerns in particular jurisdictions. These concerns arise as one group tries to control the marketplace and assert a particular point of view or “paradigm” and other groups expend their treasuries and their integrity to keep an oar in the race.

Thus, a strong link keeping past practice, philosophy, and principles present and valued (in the process of achieving social closure for the profession) has a dubious future unless the past is continually assessed in terms of present and near-future criteria. As I listened to the Alaska testimonies, I was uncomfortably aware of that dynamic. Mézáros puts it this way: “… the investigation of the dialectical relationship between structure and history is essential for a proper understanding of the nature and the defining characteristics of any social formation in which sustainable solutions are being sought to the encountered problems.” (Mézáros, 2011, p.ix)

This counsel is valuable, especially if taken in as a support and direction for strategic planning. Figuring out where we have fit, do fit, and will fit in the terrain of healthcare providers means we face the entire gamut of optimism, pessimism, and places in between. There is, of course, an assumption in the very statement that we have to “fit” anywhere. Some would argue, why can we not just be who we are, and other professional bodies can adjust to us? The realpolitik, however, is that the naturopathic medical system is a component of the larger, dominative US taxonomy of systems, notwithstanding our size. Hans Baer, a medical anthropologist, provided an analysis of this hierarchy of systems almost 2 decades ago (Baer, 2001), that very depiction of a hierarchy of systems itself being a reflection of what historical perspective we are assuming about the evolution of naturopathic medicine.

What we have to decide these days is which perspective to anchor our planning to. In this regard, there are 5 focus areas (or clusters of questions) for the planning agencies of naturopathic medicine to consider:

  1. Should we study more closely the specific history of the profession’s formation (accreditation, regulation, political status) or, instead, concentrate on regional differences as a platform from which to proceed? In practical terms, would this mean adopting a different legislation agenda in some states than in others?
  2. In considering differences in the profession’s location in civil society, might we examine scope, participation in clinical impact, research achievements, or public understanding and awareness of the medicine before aiming at a particular legislative outcome? If the latter, from which “culture” should we proceed: for example, the functioning of naturopathy in an unlicensed jurisdiction such as Wisconsin, a modified licensed jurisdiction such as North Dakota, or a primary care platform such as Oregon or Washington?
  3. What broad patterns from naturopathic medicine’s past are most useful going forward? Are those patterns deterministic, in the main, or can we isolate clear evidence of progress, confident that naturopathy as a medical system is unfolding as it should across the whole profession? Should we be trying to achieve homogeneity of standards of care, as the allopathic doctors have done?
  4. What individual changes or patterns are evident which can guide us in terms of the strongest position to take?
  5. Where are we headed, really? What, in the most realistic, pragmatic sense, characterizes what we understand to be progress?

Hans Baer has long been interested in the study of heterodox medical traditions. His position is that despite the efforts of Lust and others, naturopathy has not articulated in a consistent or standardized way a philosophical foundation or a treatment taxonomy embraced by all factions. He does, as pointed out in Table 1, locate naturopathy among a category of “Professionalized Heterodox Medical Systems.” (Baer, 2001, p.43) Baer explains, “Biomedicine is unable to establish complete hegemony in part because elites permit other forms of therapy to exist, but also because patients seek the services of alternative healers for a variety of reasons, such as the bureaucratic and iatrogenic drawbacks of biomedicine, as well as its therapeutic limitations.” (Baer, 2001, p.44)

Table 1. The American Dominative Medical System

Professionalized Orthodox Medical Systems

Biomedicine [allopathic medicine]

Osteopathic Medicine (a parallel medical system focusing on primary care)

Professionalized Heterodox Medical Systems

Chiropractic

Naturopathy [naturopathic medicine]

Acupuncture

Partially Professionalized or Lay Heterodox Medical Systems

Homeopathy

Herbalism

Bodywork

Body/Mind Medicine

Midwifery

Anglo-American Religious Healing Systems

Spiritualism

Seventh-day Adventism

New Thought Healing Systems (Christian Science, Unity, Religious Science, etc)

Pentecostalism

Scientology

Folk Medical Systems

European American Folk Medicine

African American Folk Medicine

Vodun

Curanderismo

Espiritismo

Santeria

Chinese American Folk Medicine

Japanese American Folk Medicine

Hmong American Folk Medicine

Native American Folk Medicine

(Baer, 2001, p.43)

Back in that same year, 2001, Kaptchuk and Eisenberg contributed to our understanding of these historical questions. They proposed a “taxonomy of unconventional healing practices” that included, like Baer, naturopathic medicine within a “professional system” category. They point out in their model that “professionalized or distinct medical systems” are most readily recognized by laypersons and other professionals. (Kaptchuk & Eisenberg, 2001) They explain further:

Probably the most recognizable alternative healing practices are those that are organized into medical movements with distinct theories, practices, and institutions. Licensure as an independent profession is a goal if not always an actuality. Medical institutions, such as schools, professional associations, and offices with secretaries and billing procedures, are readily visible. An extensive corpus of technical literature helps guide therapy and practice and sharpens distinctiveness. (Kaptchuk & Eisenberg, 2001, p.197)

Their taxonomy separates out professional medical systems from popular health reform activity in the health services and public domain healing practices of the period. In effect, they take an historical perspective on these systems, rather than a political one. In their attempt to propose a taxonomy to describe unconventional healing within a “far-flung landscape of diverse practices” (p.201), they conclude that “defining unconventional medicine by ‘what it is’ does not work” (p.196). Citing Gevitz (1995), they contend, that…

… alternative medicine is an umbrella-like term that represents a heterogeneous population promoting disparate beliefs and practices that vary considerably from one movement or tradition to another and form no consistent body of knowledge. (Gevitz, 1995, p.128)

Essentially, then, paying attention to the larger historical filaments and aspects of what is going on for our profession is extremely important in fashioning strategy for expanded licensing, for expanded scope, and for expanded funding. We can get far clearer insights by knowing our history and by paying attention to those 5 question clusters every time we revise a curriculum, every time we frame legislation and seek a sponsor for it in state and provincial legislatures, and every time we focus precious resources on research. History may not have been as prominent in Aristotle’s taxonomy of intellectual pursuits, but it should rank very highly for us these days.

References:

Baer, H. A. (2001). Biomedicine and Alternative Healing Systems in America: Issues of Class, Race, Ethnicity, & Gender. Madison, WI: University of Wisconsin Press.
Gevitz, N. (1995). Alternative medicine and the orthodox canon. Mount Sinai Journal of Medicine, 62: 127-131.
Kaptchuk, T. J. & Eisenberg, D. (2001). Medical pluralism in the United States. Annals of Internal Medicine, 135 (3): 189-195.
Mészáros, I. (2011).  Social Structure and Forms of Consciousness, Volume 2: The Dialectic of Structure and History. New York, NY: Monthly Review Press.
Schmidt, A. (1983). History and Structure. From: Studies in Contemporary German Social Thought. Cambridge, MA: MIT Press.
Toynbee, A. (1954). A Study of History, Volumes VII-X.  London, England: Oxford University Press: 772, 732, 759, 422.

David J. Schleich, PhD, is president and CEO of the National University of Natural Medicine (NUNM), former president of Truestar Health, and former CEO and president of CCNM, where he served from 1996 to 2003. Previous posts have included appointments as vice president academic of Niagara College, and administrative and teaching positions at St. Lawrence College, Swinburne University (Australia) and the University of Alberta. His academic credentials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s University (BEd), and the University of Toronto (PhD).

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Tolle Totum

Ashley L. Russell, ND, BCST

While 2017 was winding down, I received the following plea from a woman named Paula, via a Facebook message:

My sister came across your name while searching for the best naturopathic doctors in the area, and you are familiar to me from [networking]. I am in acute need of your services. Just released from 4 days at [the hospital] with continuing debilitating symptoms. Stroke-like symptoms. Stroke ruled out. Had MRIs, CT-scans, cardio work-up, lumbar puncture, etc… The only diagnosis I left with was white matter disease. I have a lap band and think it has led to serious malabsorption issues, etc. I’m grasping, but at this point I’m not functioning, can’t work—can’t drive—can’t stand for long. 

Like most of us that go into the healing professions, my heart went out to her, and I quickly arranged a free 15-minute consult to determine if I could possibly help, or to give her some ideas of whom she might consult.

Even though my city is the second-largest in Maryland, there are relatively few naturopathic doctors in the area. We currently have only around 50 for the entire state and are trying, as of this writing – it appears unsuccessfully – for scope expansion to include prescriptive rights.

After listening to her case for a few minutes and hearing the desperation in her voice, I explained to Paula that I had never even heard of white matter disease, but that if she wanted to work with me, I’d be happy to research different naturopathic treatment options. Paula quickly agreed to come in the following week.

What prompted Paula – a white woman in her early 50s – to reach out was the development of stroke-like symptoms a few weeks prior. She had muscle weakness (temporary, thank goodness) and elevated blood pressure. After a battery of tests at the hospital to rule out stroke and multiple sclerosis, they found nothing of note other than “multiple bilateral foci of increased T2 signal in the periventricular and subcortical white matter.” Subsequently, she was diagnosed with “white matter disease” and discharged.

Patient Presentation & History

About 4 days before going to the hospital for her symptoms, Paula had fallen in a parking lot and had an overall sense of extreme fatigue and muscle weakness. When Paula arrived at my office, her gait was slow and she had noticeable tremors in her upper extremities. While she wasn’t currently experiencing muscle weakness, her fatigue was still profound. Her head, in particular, felt extremely heavy, which was helped by lying down. The heaviness was so severe at one point during the visit that we moved to a different room so she could lie down for the rest of the intake. She would also lose her train of thought easily – which occurred a few times during the visit – and she experienced fairly significant aphasia, sometimes using the wrong word in a sentence (eg, “enchilada” instead of “antibiotic”).

Prior to this temporary bout of muscle weakness and fatigue, she was experiencing severe abdominal pain, bloating, and constipation. She would sometimes not have a bowel movement for 10 days at a time. After having had a lumbar puncture as part of her workup at the hospital, she developed a chronic headache, which had not yet abated. Along with her other symptoms, the vision in her eyes was also affected, which made it difficult to focus. Additionally, her hearing would randomly decrease, sometimes to the point where she couldn’t hear at all.

In addition to these newer and more frightening symptoms, Paula reported that the tremors in her upper extremities, which had developed approximately 10 years prior, had significantly worsened. About 7 years ago, in an effort to reduce her weight, she had lap-band surgery. A few years after her surgery, she began experiencing difficulty with word recall, and eventually had a “psychotic break,” which lasted for a few months and ended after being put on a host of medications, including divalproex and lamotrigine (anti-seizure meds), buproprion, trazodone, and a commonly prescribed amphetamine drug. Other relevant history included prediabetes and a pulmonary embolism at 15 years old.

Impressions

From a naturopathic perspective, my primary interest was her poor eating habits. Paula recently had her doctor dilate her lap band so that she could eat more, but what she was eating was concerning. She didn’t like eating fruits or vegetables because of their texture, and she wasn’t a fan of trying new foods. She would only drink diet soda (ie, no water), and mainly consumed different versions of beef and potatoes.

Paula reported that she had a history of smoking and minimal stress. However, she had smoked an entire pack of cigarettes the previous weekend due to her dog suddenly dying in front of her. Upon further questioning, Paula confessed that she was not “body attuned,” and she believed she was having symptoms because of a long-ignored imbalance in her body. This was most likely due to her strong history of abuse.

Interestingly, in spite of her learned disconnect with her body, Paula was aware of a plummeting of “energetic energy” when she had to go out in public, due to noise, lights, etc. It was to the point that she was almost debilitated from going out. Her symptoms were significantly less severe when she stayed home.

Due to the severity of her case and the seemingly ambiguous diagnosis of white matter disease, I suggested Paula see another neurologist for a second opinion. However, since white matter disease involves demyelination and is associated with increased cardiovascular risk, I recommended food antibody testing to identify any food sensitivities that might be contributing to her disease progression.

Treatment & Follow-ups

Since Paula was on multiple medications and was likely nutrient deficient due to her bariatric surgery and diet, our first focus was on improving her nutrition. I referred her to a wonderful occupational therapist, to help with introducing new foods and textures that should ultimately increase her vegetable and fruit intake. I also recommended that she stop drinking diet soda, due to its negative impact on the nervous system, and to replace it with 30 oz of water each day as a starting point.

As for supplements, we started with a multivitamin and fish oil to help supplement nutrients she clearly wasn’t getting from her diet. We also added a probiotic, due to the strong links between gut and nervous system health.1,2 In addition, I thought a homeopathic remedy would help hasten her improvement as we slowly worked on improving her foundations of health. Based on her symptoms of heaviness of the head, aphasia, and tremors, I recommended Phosphoric acid 30C, 3 pellets twice a day.

Because of Paula’s strong motivation and desire to improve quickly, mostly because she was eager to return to work, I also suggested acupuncture and craniosacral therapy as adjunctive modalities.

Five Days Later

We followed up 5 days later by phone. Paula had already scheduled an appointment with a second neurologist. She had also spoken to her psychiatrist in the interim, who strongly believed that nutrition would have no impact on her case and who dismissed a lot of her symptoms, attributing them to panic attacks. Unfortunately, it is not uncommon for me to hear of women’s serious symptomatology being dismissed as “in your head.”

Paula had already experienced some symptomatic improvement when she went to the grocery store and suffered a minor setback. While the store was quiet, once she got to the register, the loud “dings” from the checkout area worsened her tremors, and she had to walk to the back of the store for some time to recover. However, while she was “uncomfortable,” the noise did not aggravate her symptoms as severely as before. Her other symptoms were about the same, but the heaviness of her head was slightly better.

Eighteen Days Later

Two and a half weeks later, Paula came to visit in-person. The second neurologist had diagnosed her with a migraine variant, so Paula had decided to see a third neurologist for another opinion. Her aphasia and tremors were noticeably improved. The feeling of heavy fatigue was gone and her headache was also significantly improved. She had seen the craniosacral therapist in our office for a few sessions, and felt a “huge shift” after each treatment. She was also seeing the occupational therapist, and felt encouraged by the improvement.

I decided to continue the current course of treatment (ie, multivitamin, probiotic, fish oil, and homeopathic remedy, along with some minor nutritional changes), though reduced her Phosphoric acid dose to once per day. We planned to follow up once we had the results of her IgG food antibody panel.

Subsequent Follow-ups

I followed up with Paula 1 month later by phone. She had seen a third neurologist between our visits, who ordered further imaging; she was to follow up with him after our visit. Amazingly, Paula reported she had been completely asymptomatic for the previous 2 weeks, except for a mild return of a few symptoms a few nights earlier. She was happy to report that she was back to working her normal hours, which I suspected caused the brief worsening of symptoms.

We reviewed the results of her IgG food antibody panel, which was highly suggestive of increased intestinal permeability, due to the large number (>20) of foods showing moderate-to-very high antibody levels. Elimination of these reactive foods was coordinated with the occupational therapist. In addition to continuing our previous treatments, a powdered combination of nutraceuticals and herbs was also introduced to help heal the intestinal lining. The only other change was that Paula had decreased the dosing of the Phosphoric acid to more of an as-needed basis.

Later that same day, Paula giddily called to inform me that the third neurologist agreed with my assessment that her disease was nutritional in origin and that she had been having “mini-strokes” that would likely resolve if she continued to improve her diet.

A few follow-ups later, Paula had reintroduced her reactive foods and experienced adverse reactions to gluten, dairy, and sugar. Interestingly, sugar caused her to have temporary aphasia. Other than symptoms experienced during food reintroduction, she had been completely asymptomatic and was still working her normal hours.

In Closing

I last heard from Paula about 9 months after her last visit, again through Facebook, which seemed appropriate, considering how our journey began:

I have long wanted to tell you something. If you remember, my psychiatrist was poo-pooing naturopath[ic medicine] and food effects on the body. Once I stabilized, I scheduled an appointment to show him that my tremors and speech problems (that I’d had for years) were gone. He argued at first, but I Googled gluten and forced him to read. When I left, he looked bewildered.

A couple of weeks later, he emailed me asking where he could refer another client with the same symptoms for naturopathic care.  

I thought you’d appreciate hearing that we turned him!

While I sit here feeling discouraged about our impending failure for scope expansion in Maryland this year, I take hope in Paula’s words. Our medicine, as simple as it may sometimes be, is effective and life-giving.

We are an integral part of the healthcare profession at large, as demonstrated by the dramatic improvement in this complicated case. Even while we may be constrained by the state of our licensure or our scope, we still have powerful tools that can have a large impact on our patients’ lives. Our medicine is valuable beyond measure to the patients we help, and one day our licensure in the United States will reflect its true worth.

References:

  1. Tremlett H, Bauer KC, Appel-Cresswell S, et al. The gut microbiome in human neurological disease: A review. Ann Neurol. 2017;81(3):369–382.
  2. Fung TC, Olson CA, Hsiao EY. Interactions between the microbiota, immune and nervous systems in health and disease. Nature Neurosci. 2017;20(2):145-155.

Ashley L. Russell, ND, BCST, is owner and naturopathic doctor at Frederick Natural Health Center in Frederick, MD. She is currently writing her first book, Reclaim Your Cycle: The savvy woman’s guide to naturally balance your hormones to live a PMS-free and energy-filled life. Dr Russell is currently adjunct faculty at Frederick Community College, teaching nutrition, anatomy, and physiology. She has previously taught biochemistry and genetics. In her spare time, Dr Russell enjoys baking vegan, gluten-free treats, knitting, curling up with a good book, and spending time with her dog, Honey, and partner, Mark.

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Education

Susan H. Mueller, ND

Nourishing Space Within: Essentials of Self-Care

In her practice, Allegra Hart, ND encourages gentle, loving, incremental changes in her patients. With her book, Nourishing Space Within, Dr Hart has effectively and succinctly given her patients (and ours) a road map for bringing their lives – and subsequently their health – gently back into balance with Nature’s flow.

Dr Hart states that self-care is about more than brushing our teeth and eating healthy; she tells us it’s about extending that intention to encompass our bodies, minds, and spirits. With this book, she highlights tools to accomplish just this.

In each chapter, Dr Hart introduces 1 of 8 essential foundational aspects of self-care. As she does this, she offers simple exercises and recipes to help the reader gently incorporate these aspects of self-care into their everyday life.

Emunctories: Opening the Doors

In this chapter, Dr Hart explains the importance of the emunctories (skin, lungs, lymph, kidneys, colon) for elimination and how to engage and unlock them.

Food: Nourishing our Bodies

In this section, Dr Hart encourages us to go back to our roots and enjoy whole, local, and clean foods.

Sleep: Rejuvenate and Rebuild

This chapter lists basic sleep hygiene strategies and illuminates the importance of not operating on a sleep debt.

Hormones: Cyclic Balance

In this section, Dr Hart alerts us to the hormone-disrupting chemicals we are exposed to in our daily lives. She then offers safe alternatives to toxic products, which we can make at home, along with healthy choices we can make in our shopping habits in order to lower our toxic burden.

Emotions: Root Cultivation

It’s clear that emotions affect our health and well-being. After reading this chapter, the reader will have tools to improve their emotional intelligence and to calm their mind enough to improve awareness of their emotions.

Grounding: Building a Foundation

In this chapter, Dr Hart highlights the need for grounding, and suggests simple ways to accomplish it.

Movement: One Step at a Time

We now know sitting is the new smoking. In this section, we are encouraged to gently add more movement to our daily routine.

Rest: The Art of Inaction

In this section, Dr Hart emphasizes the importance of having nothingness in our lives.

In less than 100 pages, Dr Hart has provided us with a quick and empowering guidebook to better self-care. By offering recipes, personal examples, and exercises, she has made the task accessible and attainable.

JUST THE FACTS
  • Title: Nourishing Space Within: Essentials of Self-Care
  • Author: Allegra Hart, ND
  • Publisher: Naturae Publishing
  • Available from: Barnes & Noble; Amazon (widely available)
  • Pages: 98
  • Style: Trade Paperback, Kindle
  • Copyright: 2015
  • MSRP: $19.99

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