Whole complementary and alternative medical systems and complexity: creating collaborative relationships

Lessons from Outside and Within: Exploring Advancements in Methodology for Naturopathic Medicine Clinical Research

INTRODUCTION

Naturopathy is a mixture of both traditional and complementary medicine. It incorporates a broad set of health care practices that may or may not be traditional to that country or conventional medicine and are not fully integrated into the dominant health care system. Research required to evaluate or substantiate naturopathic medicine may not fall under the testing of randomized clinical trials, which opens up discussions on what is the best practice for research in naturopathic medicine.

DISCUSSION

Not only do advances in health research methodology offer important opportunities to progress naturopathic research, there are also areas where the unique characteristics of naturopathic philosophy and practice can impact other areas of health research. Some of the new advances in health research methodology involve whole-system research, pragmatic trials, template for intervention description and replication protocols for complex interventions, patient-centered care models, and the pragmatic-explanatory continuum indicator summary tool for designing pragmatic trials. Discussion and critique of these health-related methodologies shows that these research methods are more suited for the philosophy and treatment options that naturopathy is based on.

CONCLUSIONS

Successful implementation of naturopathic research methodologies, and translation and dissemination of research will require a substantial paradigm shift in which naturopathic practitioners adopt a greater level of responsibility for developing an evidence base for naturopathic medicine.

Medicina Tradicional Complementar e Integrativa: desafios para construir um modelo de avaliação do cuidado

Resumo A complexidade e a diversidade do que se propõe sob a lógica da Medicina Tradicional Complementar e Integrativa (MTCI) constituem um desafio para os interessados em evidências de sua efetividade. Seu crescimento, oferta e uso justificam a necessidade de construir referenciais metodológicos mais complexos e mais adequados para explicitar a singularidade do cuidado e a diversidade de suas técnicas. Este artigo, partindo de uma revisão narrativa da literatura, visa contribuir para a construção de um modelo de avaliação que, centrado na compreensão da singularidade e nas diversas dimensões do cuidado, busca refletir sobre os desafios de se buscar evidências do êxito terapêutico. O modelo proposto tem como base as abordagens qualitativas em saúde em que experiências dos agentes envolvidos (profissionais e usuários) no processo terapêutico ganham centralidade. Avaliar a efetividade do cuidado significa reconhecer a cadeia de processos interligados e suas diversas dimensões: acolhimento, diálogo, diagnóstico, ação e resultados alcançados.

Are Allopathic and Holistic Medicine Incommensurable?

The shift from the Aristotelian to the Newtonian scientific paradigm gave birth to progresses in the natural, hard sciences and contributed to the emergence of modernity. Allopathic medicine gradually implemented those progresses, transforming itself into contemporary biomedicine. In the early 20th century, replacement of Newtonian physics by quantum mechanics and Einstein's theory of relativity resulted in a new paradigm shift in the natural, hard sciences. This shift gave birth to post-modern perceptions, which attempt to put those changes in context. Within this new context, holistic therapeutic approaches are considered more compatible with the new paradigm. Different paradigms in the natural, hard sciences are considered to be incommensurable (in the Kuhnian sense). This incommensurability is also transferred to the different societal contexts, the different «Weltanschauungen» that rely on different scientific paradigms. However, drawing on arguments that range from historical and philosophical to practical and sociological ones, we argue that, although based on different scientific paradigms, allopathic and holistic medicine are not incommensurable, but rather complementary. This may be related to the inherent attributes of medicine, a fact that reinforces the debate on its epistemological status.

Challenges and Opportunities Faced by Biofield Practitioners in Global Health and Medicine: A White Paper

Biofield therapies (BTs) are increasingly employed in contemporary healthcare. In this white paper, we review specific challenges faced by biofield practitioners resulting from a lack of (1) a common scientific definition of BT; (2) common educational standards for BT training (including core competencies for clinical care); (3) collaborative team care education in complementary and alternative medicine (CAM) and in integrative health and medicine (IHM); (4) a focused agenda in BT research; and (5) standardized devices and scientifically validated mechanisms in biofield research. We present a description of BT and discuss its current status and challenges as an integrative healthcare discipline. To address the challenges cited and to enhance collaboration across disciplines, we propose (1) standardized biofield education that leads to professional licensure and (2) interprofessional education (IPE) competencies in BT training required for licensed healthcare practitioners and encouraged for other practitioners using these therapies. Lastly, we discuss opportunities for growth and a potential strategic agenda to achieve these goals. The Academy of Integrative Health and Medicine (AIHM) provides a unique forum to facilitate development of this emerging discipline, to facilitate IPE, and to further increase the availability of BT to patients.

Homeopathy and integrative medicine: keeping an open mind

Some physicians have incorporated some forms of complementary and alternative medicine (CAM) or related medicinal products in their clinical practices, suggesting that an unconventional treatment approach might be seen as an integration rather than as an alternative to standard medical practice. Among the various CAMs, homeopathy enjoys growing popularity with the lay population, but it is not acknowledged by academia or included in medical guidelines. The major problem is to establish the effectiveness of this clinical approach using the strict criteria of evidence-based medicine. This issue of the Journal of Medicine and the Person collects contributions from some of the most prestigious centers and research groups working in the field of homeopathy and integrative medicine. These contributions are not specialized information but are of general interest, focusing on this discipline as one of the emerging fields of personalized medical treatment.

Ayurveda: between religion, spirituality, and medicine

Ayurveda is playing a growing part in Europe. Questions regarding the role of religion and spirituality within Ayurveda are discussed widely. Yet, there is little data on the influence of religious and spiritual aspects on its European diffusion. Methods. A survey was conducted with a new questionnaire. It was analysed by calculating frequency variables and testing differences in distributions with the χ (2)-Test. Principal Component Analyses with Varimax Rotation were performed. Results. 140 questionnaires were analysed. Researchers found that individual religious and spiritual backgrounds influence attitudes and expectations towards Ayurveda. Statistical relationships were found between religious/spiritual backgrounds and decisions to offer/access Ayurveda. Accessing Ayurveda did not exclude the simultaneous use of modern medicine and CAM. From the majority's perspective Ayurveda is simultaneously a science, medicine, and a spiritual approach. Conclusion. Ayurveda seems to be able to satisfy the individual needs of therapists and patients, despite worldview differences. Ayurvedic concepts are based on anthropologic assumptions including different levels of existence in healing approaches. Thereby, Ayurveda can be seen in accordance with the prerequisites for a Whole Medical System. As a result of this, intimate and individual therapist-patient relationships can emerge. Larger surveys involving bigger participant numbers with fully validated questionnaires are warranted to support these results.

A complex, nonlinear dynamic systems perspective on Ayurveda and Ayurvedic research

The fields of complexity theory and nonlinear dynamic systems (NDS) are relevant for analyzing the theory and practice of Ayurvedic medicine from a Western scientific perspective. Ayurvedic definitions of health map clearly onto the tenets of both systems and complexity theory and focus primarily on the preservation of organismic equanimity. Health care research informed by NDS and complexity theory would prioritize (1) ascertaining patterns reflected in whole systems as opposed to isolating components; (2) relationships and dynamic interaction rather than static end-points; (3) transitions, change and cumulative effects, consistent with delivery of therapeutic packages in the reality of the clinical setting; and (4) simultaneously exploring both local and global levels of healing phenomena. NDS and complexity theory are useful in examining nonlinear transitions between states of health and illness; the qualitative nature of shifts in health status; and looking at emergent properties and behaviors stemming from interactions between organismic and environmental systems. Complexity and NDS theory also demonstrate promise for enhancing the suitability of research strategies applied to Ayurvedic medicine through utilizing core concepts such as initial conditions, emergent properties, fractal patterns, and critical fluctuations. In the Ayurvedic paradigm, multiple scales and their interactions are addressed simultaneously, necessitating data collection on change patterns that occur on continuums of both time and space, and are viewed as complementary rather than isolated and discrete. Serious consideration of Ayurvedic clinical understandings will necessitate new measurement options that can account for the relevance of both context and environmental factors, in terms of local biology and the processual features of the clinical encounter. Relevant research design issues will need to address clinical tailoring strategies and provide mechanisms for mapping patterns of change that account for the contiguous, self-replicating, cumulative, and synergistic theories associated with successful Ayurvedic treatment approaches.