Treat the Individual

I can’t really say that I’m a creature of habit. I easily tire of routine and consistency.  Maybe it was for this reason that I felt the need to take off from Canada for a few years and travel, why I remain a perpetual student (no two days are the same and we get a 4-month summer of something radically different).  The student life serves me well in breaking up the routine.

It’s for this reason that I am drawn to the eclecticism of naturopathic medicine.  According to a great naturopath, Dr. Sharma, three patients can walk in with the exact same medical condition, be given the exact same treatment regime and experience three completely distinct results.  However, naturopathic medicine is becoming modernized.  Our various therapeutic techniques that have stood the test of time must now be subjected to the test of Randomized Double-Blind Placebo-Controlled Trials, commonly referred to as RCTs.  Many of you know what I’m talking about: two statistically identical groups are randomly created, one group is given the therapy, one group is given a placebo.  No one in the group and none of the clinicians evaluating the subjects know which individual has a placebo or the therapy.  After the meta-analysis, this is our “Gold Standard” of evidence based medicine.

Since naturopathic therapies have stood the test of time they have also inevitably been able to stand the test of evidence based criteria.  As researchers slowly begin to conduct trials to study the efficacy of naturopathic intervention, we find that our therapies do work, even when all variables have been teased out of the tangle of the totality of the therapeutic experience.

It seems, however, that we’ve come to a cross-roads with our style of medicine.  “If you set up a diabetes clinic, you could help a LOT of people”, one of our endearing professors assures us.  His protocol? A special diet involving eliminating grains and limiting carbohydrates, incorporating healthy fats, lean protein, lots of fruits and vegetables, 2 tablespoons of olive oil and a handful of almonds.  Does his therapy work with “curing” type II diabetes?  It certainly does.  However, I wonder if his “one size fits all” method to therapeutics is really in line with our naturopathic principles.

In medical science there are clinical guidelines, diagnostic algorithms and standards of care.  This is important.  It is the diagnostic algorithm that pulls people back from death’s door.  It handles emergency situations beautifully and without it we wouldn’t enjoy the longevity that comes with modern age.  The medical model is also extreme: high doses of epinephrine to start a stopped heart, shocks with a defibrillator and shots of corticosteroids. Powerful drugs dramatically alter the delicate flow of the body’s natural rhythms and bring people back from the dead.  Medical science has near-perfected the art of revival and dealing with acute conditions.  It saves many, many lives, there is no doubt.

However, where we run into trouble is when we try to treat chronic diseases, which are   diseases of lifestyle, with this same reductionistic mindset. We never really achieve that delicate balance using the “nature cure” that we always hear about.  Things become patentable, profitable, marketable.

I remember one nutrition class in which we had a guest speaker come in who was a spokesperson for an important supplement company.  We learned about the digestive system and commensal bacteria.  He talked about the super strain of his company’s acid and heat-resistant probiotic, designed and created in a lab somewhere, which could potentially cure all of mankind of every ill that has ever befallen us.  Everyone of all ages, races and walks of life could benefit from this patent, he assured us.  In this model, the naturopath acts as the “herb-pusher”, the go-between who passes product from corporation to client in a sort of happy, three-way marketing marriage.

In India, things were slightly different. Patients would move into the Ayurvedic practitioner’s home.  Not only would they learn how to grow and prepare their own herbs and spices, but they would also learn cooking, observe the practictioner in his home environment and live amongst his family.  Talk about “doctor as teacher”!  Therefore, each treatment protocol, wasn’t really a protocol at all, but a conversation between the patient and practitioner, an experience. With each patient picture and therapeutic interaction so vastly different and each healing story so vague, how do you create an RCT to measure it?

With every case of diabetes there is a story. The story contains explanations, excuses, hang-ups, past traumas, fears and uncertainties.  Can one regime or supplement really apply to everyone?  In homeopathy it is believed that we have our own constitutional remedy, and in getting closer to the client, one can get closer to the remedy.  So is it with naturopathic medicine.  Ours is a medicine that takes into account the whole patient picture, not just the foods, supplements and exercise that describe their lifestyle.  While we have people who make our supplements, tinctures and create dietary standards of care for certain diseases, we can’t really patent our medicine.  A naturopathic therapy can’t be googled or shopped for in a health food store.  That’s what makes it so special.

It’s also what allows us to break from the comfort and predictable rhythm of routine and experience the uniqueness of our next patient encounter.  There are no fortunes to be made, no diagnostic algorithms to cling to and no methods to patent.  The naturopathic doctor coaches the patient through the growing relationship they begin to develop with their own body.

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