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Integrating naturopathic and allopathic care.

Naturopathic medicine, with its holistic, individualized approach, ill suits randomized placebo-controlled trials, designed to test isolated interventions. "In contrast to traditional Chinese medicine, which the allopathic community reduces to acupuncture, and chiropracty [sic], which the allopathic community reduces to spinal manipulation, naturopathy has defied reduction to a single modality," says Charles R. Elder, MD, MPH. Elder is Physician Lead for Integrative Medicine at Kaiser Permanente Northwest (KPNW). Isolated treatments used in naturopathic care--such as diet, exercise, herbs, and stress reduction techniques--have been studied, but few trials have investigated the effectiveness of naturopathic medicine protocols. As a result, insurers have little data to support the inclusion of naturopathic care.

When Washington State required health insurers to cover the services of naturopathic doctors, KPNW investigators asked respected naturopaths to tell them which conditions were appropriate for naturopathic care. The investigators then searched the medical literature for studies involving those conditions and treatments associated with naturopathy. Using this "modified, evidence-informed approach," KPNW was able to create its medical necessity criteria for naturopathic use. Referrals to naturopathic care are available to KPNW clients with osteoarthritis, menopausal symptoms, irritable bowel, headache, chronic fatigue, eczema, and conditions that have not responded to conventional care.

In his editorial, Elder discusses paradigm conflicts that hamper the integration of naturopathic and allopathic care. When dealing with hypothyroidism, for example, naturopaths often measure T3 and T4 levels in addition to ordering the thyroid stimulating hormone (TSH) test, and they recommend T3-T4 preparations, such as desiccated thyroid, instead of standardized Levothroid T4 supplementation. To a conventional physician, the extra tests are unnecessary and the nonstandardized treatment suspect. Patients may be confused by contradictory advice from medical practitioners with differing paradigms. Patients may also feel forced to choose sides in a tug-of-war between conventional and naturopathic medicine.

Broadening the scoop of allopathic and naturopathic continuing medical education to include both types of practitioners would increase interaction and understanding, making collaboration possible, says Elder. In addition to becoming familiar with naturopathic perspectives and skills, allopathic doctors could learn about herbs and noninvasive treatments for chronic disease. Naturopathic physicians could identify practices that might augment a patient's allopathic care. Both types of practitioners would gain a better understanding of when to consult or collaborate with the other. "Establishing and improving lines of open, respectful, constructive communication," Elder writes, "will be a first step toward developing the type of collaboration between allopathic and naturopathic physicians that our patients deserve."

Elder CR. Integrating naturopathy: can we move forward? Permanente J. Fall 2013; 17(4):80-83. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3854814. Accessed November 22, 2014.

briefed by Jule Klotter

jule@townsendletter.com

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Title Annotation:Shorts
Author:Klotter, Jule
Publication:Townsend Letter
Geographic Code:1USA
Date:Feb 1, 2015
Words:441
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