R-E-S-P-E-C-T in the Research Community

A few months ago I unexpectedly found myself gathered around my boyfriend’s grandmother’s kitchen table, munching on dosas and chutney with an anesthesiologist. Ever since I’ve been digging my brain into the tortuous research issue that I am often confronted with when one discovers that I am studying naturopathic medicine. I’d dreamed of this moment for a long time; the moment where I would, by happenstance, find myself at dinner with a doctor where we would both discuss our philosophies and listen to each other with sincere interest and appreciation. The doctor would be taken aback by my verbal fluency and savvy medical knowledge, and after hours of meaningful conversation when we are parting ways, the doctor would walk away having a new found respect and understanding for naturopathic medicine.

This isn’t quite how things went down.

Understandably, and quite respectfully, this doctor had a plethora of questions as to what role naturopathic medicine has to play in this modern era. He admitted his doubt and his skepticism, both qualities which I consider necessary for any doctor, scientist, philosopher, or human attempting to expand their understanding of the world to which we belong. Contrary to my fantasy dinner, his skepticism seemed to create a harsh, dismissive tone and made it difficult for me to trudge my way through the conversation with the poise I had imagined. I was intimidated and overwhelmed. It seemed that questions were being thrown at me at a pace that was too fast to give a fulfilling answer.

With each question I was scrounging for the correct words and self-assurance to provide this doctor with the explanation that he deserved, the explanation that anyone who is inquiring about this affective, gentle, holistic philosophy of medicine deserves. After about fifteen minutes, the doctor bid his farewell and I was left humbly at the table perplexed, wondering how I could have better handled that treasure of an encounter.

Though Emerson boldly pronounced that “to be great is to be misunderstood”, I felt like this was a cop out in my situation. The most frustrating aspect of this encounter was my inability to express what I know is indeed expressible. Since that dreary December evening, I’ve made it my mission to understand how to convey the gentle, tenacious, credible nature of this medicine, and in particular, the research “issue” revolving holistic health care.

What is this research issue anyway? The question I find that I am most often confronted with by medical and scientific professionals concerns our relationship to the Randomized Controlled Trial (RCT). The RCT is a kind of omniscient force within the health care industry and is definitely held as the gold standard within the conventional medical community. Therefore, my first aim has been to understand RCT and how it relates to naturopathic research. Thus far in my research-issue exploration, I’ve learned that the RCT is indeed a cherished asset to all medical fields. It is with this type of study that we have been able to infer causal relationships, test the efficacy of therapeutic interventions, and, when performed correctly, RCTs have an effective method to control for research bias.

So why is the RCT not held with the same esteem within the naturopathic medical community? In regards to holistic medicine, it is the exclusive nature of RCT upon which we base medical intervention that is the problem. RCTs isolate a single variable to fix a single problem of a very complex system. It has undoubtedly been advantageous in testing the effectiveness of that isolated variable on a specific mechanism. However, it is inherently against the philosophy of naturopathic medicine function in this way. Naturopathic medicine is a whole systems approach to health care and this form of study is not reflective of that philosophy. This is not to say that we should not test the safety and efficacy of our methods, we are just requiring an exhaustively comprehensive method of testing our interventions.

While the RCT takes into account a single variable, the holistic model aspires to factor in the doctor-patient relationship, the patient’s family, personality, sense of well-being, emotional state, spiritual life, diet, stress, sense of self, and the list continues…. Isolating a single factor, as in the RCT, simply isn’t enough to capture all the humanity in our patients. This type of research design treats participants one of two ways. In naturopathic medicine, there is not necessarily a single standard of care for a given ailment. An individual may leave the doctor’s office with one treatment option while another individual with a seemingly similar diagnosis will leave with a completely different treatment plan.

I believe the naturopathic research community is proposing a balance between the preponderate RCT, inclusion of other studies, and development of a type of whole-systems study design that encompasses the true nature of holistic medicine. It is important to remember to not throw the baby out with the bath water. Despite the RCT’s limitations in regards to holistic medicine, there is a reason it is held with such high regard in the conventional medical community.

Though all designs will innately have their own shortcomings, I believe that if we are approaching research with integrity, solidarity and the wholehearted intention of forming a better world, we are on the most auspicious path.

As health professionals and researchers, we bear a responsibility to keep medical practices pure, beneficial, and altruistic in nature. Therefore, we must be willing to forgo our pride, cooperate with one another, and see our shortcomings from a brave perspective so that we can progress on our path to excellence, understanding, and unity.

I hope that in future encounters when I find myself munching on dosas with a doctor or any other inquisitive individual, I will be so dignified as to honorably share the philosophy of naturopathic medicine while respecting my counterpart in conversation.  I will accept the constructive criticism, especially if its intent is to make our health care system better, and to always remember that behind our arguments and differences, we’re all people.