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The Naturopathic Medical Research Agenda: The Future and Foundation of

Naturopathic Medical Science

Article in Journal of alternative and complementary medicine (New York, N.Y.) · May 2006
DOI: 10.1089/acm.2006.12.341 · Source: PubMed

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Southern Cross University
ePublications@SCU
School of Health and Human Sciences School of Health and Human Sciences

2006

The naturopathic medical research agenda: the

future and foundation of naturopathic medical
science
Leanna J. Standish
Bastyr University

Carlo Calabrese
National College of Natral Medicine, Canada

Pamela Snider
Bastyr University

Konrad Kail
Southwest College of Naturopathic Medicine, Canada

Edward Mills
Center for International Health and Human Rights Services, Toronto

See next page for additional authors

Suggested Citation
Standish, LJ, Calabrese, C, Snider, P, Kail, K, Mills, E, Myers, SP, Traub, M & Zwickey, H 2006, 'The naturopathic medical research
agenda: the future and foundation of naturopathic medical science', Journal of Alternative and Complementary Medicine, vol. 12, no. 3,
pp. 341-345.
This is a copy of an article published in the Journal of Alternative and Complementary Medicine© 2006 [copyright Mary Ann Liebert,
Inc.]; Journal of Alternative and Complementary Medicine is available online at: http://www.liebertonline.com
The definitive publisher-authenticated version is available online at http://dx.doi.org/10.1089/acm.2006.12.341

ePublications@SCU is an electronic repository administered by Southern Cross University Library. Its goal is to capture and preserve the intellectual
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Authors
Leanna J. Standish, Carlo Calabrese, Pamela Snider, Konrad Kail, Edward Mills, Stephen P. Myers, Michael
Traub, and Heather Zwickey

This article is available at ePublications@SCU: http://epubs.scu.edu.au/hahs_pubs/733

THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 12, Number 3, 2006, pp. 341–345
© Mary Ann Liebert, Inc.

EXECUTIVE SUMMARY

The Naturopathic Medical Research Agenda: The Future and

Foundation of Naturopathic Medical Science*

LEANNA J. STANDISH, N.D., Ph.D., L.Ac. (Principal Investigator), CARLO CALABRESE, N.D., M.P.H.
(Co-Principal Investigator), and PAMELA SNIDER, N.D. (Co-Investigator)
with KONRAD KAIL, P.A., N.D., Southwest College of Naturopathic Medicine; EDWARD MILLS, Ph.D.,
Canadian College of Naturopathic Medicine; STEPHEN MYERS, Ph.D., B.Med., N.D., Australian Centre for Complementary
Medicine Education and Research, University of Queensland and Southern Cross University, MICHAEL TRAUB, N.D.,
D.H.A.N.P., C.C.H., Chair of Scientific Affairs, American Association of Naturopathic Physicians;
and HEATHER ZWICKEY, Ph.D., National College of Naturopathic Medicine.

T his report documents the process and findings of the

Naturopathic Medical Research Agenda, a project
funded by NIH-NCCAM through a grant that ran from Au-
ing guiding principles emerged: The Agenda should be de-
signed to test three fundamental hypotheses:

gust 1, 2002 through August 31, 2004. The goals of this • Naturopathic medicine is safe and effective for health pro-
project were: motion and for the prevention and management of a broad
range of common conditions.
• Goal 1: To bring together naturopathic physicians and • Increased availability of the services of naturopathic
conventional research scientists in order to establish the physicians will improve patient health in a cost-effective
Naturopathic Medical Research Agenda Workgroup; manner.
• Goal 2: From this process, to produce a document enti- • The scientific exploration of naturopathic medical prac-
tled “The Naturopathic Medical Research Agenda” that tices and principles will yield important, perhaps even rev-
includes a prioritized list of research questions and areas, olutionary, insights into the nature of health and the biol-
coupled with appropriate research design methods for ogy of healing.
each.
The Agenda should use the following prioritization crite-
Participants in the project included over 1200 individuals, ria in determining the specific focus of future research ef-
representing a broad range of scientific and clinical back- forts:
grounds. Input from the naturopathic profession itself was
substantial, involving participants from the naturopathic • Study conditions with the highest burden of illness.
medical colleges and the national professional association, • Study problems of existing and emerging public health
and encompassing many of the profession’s leading faculty, significance.
researchers, clinicians, and writers. Conventional physicians • Study those naturopathic treatments thought to be most
and scientists also participated broadly and made significant effective.
contributions through the NMRA Workgroup. • Study naturopathic approaches with real potential to make
A series of meetings was held during the project period significant advances in patient care.
to elicit, discuss, analyze and prioritize feedback on the di- • Foster the development of needed methods and infra-
rection of the Agenda, and on the criteria by which deci- structure
sions would ultimately be made. Articulation of the follow- • For initial studies, focus on near-term feasibility.

*This report was produced through a grant from the National Institutes of Health—National Center for Complementary and Alter-
native Medicine. Funded by grant R21 AT833 from the National Institutes of Health—National Center for Complementary and Alter-
native Medicine.

341
342 EXECUTIVE SUMMARY

The Agenda should reflect the following goals: first, to im- priorities. Rising rates of conditions such as asthma, aller-
prove the health of patients; second, to improve naturopathic gies, attention disorders, obesity, and type 2 diabetes in chil-
medical practice; third, to focus primarily on populations, dren do not bode well for a healthy older population in those
not diseases; fourth, to conduct research on the whole prac- who are at the beginning of their lives. Therefore, research
tice of naturopathic medicine rather than on single agents. on a pediatric population was identified as an important fu-
ture priority.
The NMRA calls for systematic reviews and the collec-
RESEARCH RECOMMENDATIONS tion of preliminary clinical data in preparation for a large
randomized controlled trial assessing the effect of individ-
Consistent with the emphasis on studying people and pop- ualized naturopathic medical care in comparison to con-
ulations, and with the prioritization criteria stated above, two ventional care in a population of individuals with type 2
populations were identified for the initial focus of naturo- diabetes. Outcomes of whole-practice research on a diabetic
pathic medicine research: the first is defined by a diagnosis population will include biomedical disease markers, includ-
(type 2 diabetes) and the second by a stage of life (elderly). ing assessment of co-morbidities, and health and health ser-
The significance of diabetes can scarcely be overstated; vices indicators.
the Centers for Disease Control and Prevention recently es- Controlled studies of naturopathic medical care for the
timated that one in three children born in the year 2000 will preservation and the promotion of optimal health in geri-
eventually become diabetic. Demographics make studying atric populations are specified in the Agenda. The NMRA
the elderly an extremely high priority—as the “baby also recommends the collection of data from demonstration
boomers” age, a major impact on costs and suffering can be projects with health plans that include naturopathic physi-
achieved by reducing the incidence of serious chronic dis- cians, as these are clinical sites where outcomes and cost of
ease, of secondary complications from chronic disease, and service can be studied. Neurogerontology and diabetes pre-
of debility associated with aging. vention and treatment in the elderly have been identified as
Healthy aging, of course, must begin with infants and an initial focus of NMRA gerontology/geriatrics research.
children, and the development of habits and physiological The NMRA can help naturopathic medicine be part of the
predispositions from childhood on will be important future healthcare solutions our nation clearly needs by doing ex-

Workshop Session II Participants, November 2003

Top row, left to right: William Lafferty, M.D., Pauline Baumann, N.D., Clark Johnson, Ph.D., Leanna Standish, N.D.,
Ph.D., L.Ac., Carlo Calabrese, N.D., M.P.H., Daniel Leahy, M.D., Michael Traub, N.D., D.H.A.N.P., C.C.H., Ronald
Chez, M.D., Konrad Kail, P.A., N.D., and Peter Martin N.D., D.C.
Bottom row, left to right: Babette Brumback, Ph.D., Lynn Shinto, N.D., M.P.H., Annette Fitzpatrick, Ph.D., Cheryl Riten-
baugh, Ph.D., M.P.H., Janet Stecher, B.A., Dan Cherkin, Ph.D., Heather Zwickey, Ph.D., Pamela Snider, N.D., June Reid-
linger, R.Ph., Pharm.D., Linda Kim, N.D., Richard Lyons, M.D., M.P.H., Alan Trachtenberg, M.D., M.P.H., Diana
Miglioretti, Ph.D., Mark Mattie, M.D., Ph.D. and Stephen Myers, Ph.D., B.Med., N.D.
FIG. 1.
344 EXECUTIVE SUMMARY

cellent research in critically important areas. Through the apy for women in their peri- and postmenopausal years. At
NMRA process, the following recommendations were made the 2004 annual national meeting of the Association of
regarding the priorities for how to approach naturopathic Naturopathic Physicians held in Portland, Oregon there was
medical research in the two populations: widespread agreement that the evaluation of the safety and
efficacy of bio-identical steroid hormones for the treatment
• Design and execute whole-practice research protocols, of menopausal women was of high priority. A group of
with a focus on naturopathic medicine as a primary care naturopathic physicians specializing in women’s health met
practice for the two populations (diabetics and the elderly); with NMRA leadership at this national meeting. From these
• Continue research on the components of naturopathic meetings this physician group committed themselves to or-
medicine (e.g., single agents for a particular diagnosis, ganizing research trials on bio-identical estrogens and pro-
mechanism of action studies); and gesterone.
• Perform contextual research, examining important as-
pects of the practice of naturopathic medicine (e.g., the
patient-practitioner interaction) or its relationships with RESEARCH READINESS
the larger health system (integration) through observa-
tional studies. In order to consolidate naturopathic medical research, the
team and institutions that developed the NMRA will form
Most research to date on naturopathic medicine has been the basis for an ongoing collaborative network. Each of the
component research. As yet, little work has been done in the naturopathic institutions represented on the Workgroup Core
areas of whole-practice and context research. has already committed to, and is engaged in, lines of work
Finally, there was strong support for women’s health re- related to at least one of the populations of interest. Col-
search among naturopathic physicians in the field, especially laborative partnerships with researchers in conventional
component research on natural hormone replacement ther- medicine, public health, and other disciplines will be ac-

TABLE. SCIENTIFIC RESEARCH DIRECTIONS CALLED FOR BY NATUROPATHIC MEDICINE

PRINCIPLES AND THEORY

Principle Topics

First do no harm Drug–herb, drug–nutrient, herb-nutrient interactions

Evaluation of symptom suppression
Safety and efficacy of vaccinations
Theory of least force
Vis medicatrix naturae Biology of healing
Healing crisis
Theory of the therapeutic order
Consciousness science
Hering’s Rules of Cure
Spirituality and health
Investigate natural medicine modalities:
Botanicals
Homeopathy
Hydrotherapy
Nutrition and nutrients
Physical medicine
Psychology/counseling
Nature and healing (“nature cure”)
Whole-person care Optimal healing environments
Multiple determinants of health and co-morbidity
Individualization of care
Treat the cause Environmental medicine
Psychoneuroimmunology
Genomics
Toxemia and inflammation
Doctor as teacher Effectiveness and cost of teaching self-care
Doctor–patient relationships
Role of intention
Prevention Genomics
Wellness, health promotion
Lifestyle
EXECUTIVE SUMMARY 345

tively pursued or strengthened where they currently exist. • Diabetes Track (Southwest College of Naturopathic
Many of the consulting scientists in the Workgroup have Medicine; Bastyr University; National College of Naturo-
also committed to participate in the areas discussed in this pathic Medicine);
report. More formal consortia are expected to arise around • Gerontology Track: Health of the Elderly (Bastyr
each specified research direction. University; National College of Naturopathic Medi-
In addition, certain methodological challenges inherent in cine); and
researching the whole practice of naturopathic medicine • Whole Practice and Methods Track (National College
were identified and must be resolved. These include notably: of Naturopathic Medicine).

1. Standardization of treatment substances such as botani- These Tracks will allow each institution to appropriately fo-
cal medicines and practices such as mind–body inter- cus its infrastructure development, as well as assist faculty,
ventions; clinicians, and researchers to develop skills in specific ar-
2. The identification and study of non-specific healing ef- eas of interest.
fects and the use of health outcomes and measures, as Other implementation steps include:
well as disease outcomes, to evaluate effectiveness;
3. Study designs (including the use of controls and blind- • Preparation of grant proposals to both government agen-
ing) that will accommodate individualization of treatment cies and private foundations to fund the activities recom-
and the use of combination therapies, both of which are mended by this report;
established naturopathic practices. • Development of a Web-based network and annual meet-
ings to facilitate communication about the ongoing work,
Finally, the infrastructure that will enable collaborating and to enable institutions and individuals that are geo-
NMRA institutions and individuals to respond with excel- graphically distant to collaborate effectively and effi-
lence to these research goals is growing but needs further ciently;
support. The NMRA identified four research methods and • Establishment of a mentorship program to match inexpe-
strategies for which infrastructure development is needed: rienced naturopathic physician researchers with senior
ones, and to disseminate information about training op-
• High validity randomized controlled trials (RCTs) of portunities; and
whole-practice naturopathic medicine for the evaluation • Submission of papers based on work arising from the
of efficacy of “best” protocols; NMRA project to peer-reviewed journals in order to more
• Observational studies and health services research to as- formally analyze many of the suggestions that emerged
sess safety, cost, and effectiveness of current practice and and disseminate the findings.
integration;
• Laboratory studies to establish standards and investigate Tangible and immediate outcomes of the NMRA included
critical effects and mechanisms; and the production of one NMRA book, three NIH grant pro-
• Basic and clinical capacities for the exploration of natur- posals, and facilitation of the start-up of the peer-reviewed
opathic medical principles. journal, the International Journal of Naturopathic Medicine.
A visual overview of the Naturopathic Medical Research
Agenda 2005–2010 is presented in Figure 1.
IMPLEMENTATION
Leanna J. Standish, N.D., Ph.D., L.Ac.
Four tracks have been identified to foster diverse research
Research Professor
leadership and broad participation in research initiatives
Bastyr University
among the participating naturopathic medical colleges:
School of Naturopathic Medicine
14500 Juanita Dr NE
• Publications and Information Dissemination Track
Kenmore WA 98028
(Canadian College of Naturopathic Medicine, Bastyr Uni-
versity, and Australian Centre for Complementary Medi-
cine Education and Research); E-mail: [email protected]
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