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Science-based medicine

Let’s start with science.  The Oxford Dictionary says it is:


“The intellectual and practical activity encompassing the systematic study of the structure and behavior of the physical and natural world through observations and experiment.”


Or, “A systematically organized body of knowledge on a particular subject.”


The origin of the word is from the Latin scire, that is, to know.  Let’s keep these definitions handy as we examine how science is involved in medicine.


Through observations and experiment,” medical scientists and researchers, as well as physicians and other clinicians, have humanity as the subject of our studies.  Double-blind, placebo controlled trials are often considered the ideal form of research, but are done very infrequently for a variety of reasons: cost; difficulty of maintaining truly double-blind conditions, when very different outcomes become apparent to those involved early in the experiment; and the compassionate early termination of a study in which the group faring worse is then given the same conditions as the group faring well.


Double-blind, placebo-controlled safety studies in humans have not been done, for example, with such widely used products as vaccines and chemotherapy drugs.  Part of the obstacle is the widely held view that it would be unfair to those in the control group to treat them differently from those in the experimental group.  In the US, the Belmont Report of 1979 establishes ethical principles and guidelines for human research.  Such principles as respect for persons, beneficence and justice are primary in determining the conduct of research with human beings, so any control group and experimental group treatment differences must not be known to damage the health and wellbeing of either group.  Hence, lots of such experiments with mice, a marginally similar but unprotected species, and few with humans.


Our goal is to know and to understand, as much as possible of, “the structure and behavior of the physical and natural world.”  In the case of medical scientists and physicians, we examine the human being.


Naturopathic physicians examine and study not only the contemporary Western human being, but also reach back throughout the known history of humanity, to medicine that we can learn from any and all of the continents.  Naturopathic medicine for example makes use of traditional Chinese medicine, a 5,000 year-old system that has not only proven beneficial and time-honored for earlier eras in Chinese history, but also down to the local street-corner Walgreens, with the steady market in the Sea-Band Wristband accessing that acupressure point on the wrist that for thousands of years has alleviated motion sickness, morning sickness in pregnancy, and other nausea and vomiting.  Walgreens advertises that “clinical trials prove” the use of the Sea-Band, but millennia of human history give an even more resounding approval.


Many thousands of clinical studies have been conducted with the tools used by naturopathic physicians.  Alan Gaby MD’s 9-pound, 1300 page book, Nutritional Medicine, with thousands of studies cited from the medical literature, addresses over 400 health conditions treated with foods and basic nutrients such as vitamins and minerals.  It gives an overview of the kind of observation and knowledge of human health, as impacted by nutrition, that naturopathic physicians learn and draw from.  There are other sciences gathered under the naturopathic umbrella.  One such science is homeopathy, for example, the nanopharmacology topics raised in the work of Bellavite and Signorini, The Emerging Science of Homeopathy.  Another is botanical medicine, likely representing one of the longest and most widely used kinds of interactions between our human ancestors and their natural environments.  Although current information from all of human history with botanical medicine is far from complete, what we do know has been meticulously logged and documented by naturopathic physicians and our predecessors.


An unfortunate trend among those who would place the use of pharmaceuticals above natural, unpatented alternatives, even to the exclusion of the latter, is the casual use of the word “pseudoscience.”  This word has been used to attempt to broadly dismiss data, evidence, research, meta-analyses, canonical literature and epidemiology that is inconvenient or contradictory to the viewpoints being purveyed.  In fact, it has been used to dismiss any medical data and knowledge that is not of the last century, or from just the pharmaceutical culture of mainly just one country, the US, which is about 4% of the world's population.


The big challenge for those critics of natural medicine (pharmaceutical lifestyle advocates) is to convince the public that the evidence in front of them is the opposite of what it appears:  That Whole Foods customers look great and perky, but actually feel lousy and are going down.  And that drugstore customers look like wreckage, but actually feel great and are headed toward the nirvana promised by Zoloft/Lipitor/Viagra/Ativan/Prednisone.  Selling that story compares to selling print encyclopedias door-to-door.  The times move on, leaving such vendors behind.  As the old expression goes, "Who are you going to believe: me or your lying eyes?"


The naturopathic physician on the other hand objectively assesses both the natural world and the pharmaceutical world as sources of medicine, because our education and clinical training include both.  In this way, a treatment plan can be prepared for an individual patient drawing from the widest array of possible interventions.  Thus, with naturopathic medicine, a patient would have a statistically likelier chance of being offered treatment(s) most helpful for his or her condition, and to achieve healing.


And healing would seem to be a worthy goal of scientific observation of human medical data.





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