Alternative und integrative Medizin

Estimated Effects of Whole-system Naturopathic Medicine in Select Chronic Disease Conditions: A Systematic Review

Abstract

Erica B. Oberg, Ryan Bradley, Kieran Cooley, Heidi Fritz, Joshua Z. Goldenberg, Dugald Seely, Jane D. Saxton and Carlo Calabrese

Background: Naturopathic medicine (NM) is a holistic approach to primary care that almost always employs multi-modal interventions, i.e. nutrition and lifestyle change recommendations plus dietary supplements. While evidence supports individual elements of NM, the whole practice is often critiqued for its lack of evidence. Methods: We systematically searched PubMed/MEDLINE, EMBASE, CINAHL, Cochrane Library and AMED from inception to April, 2012 as well as conducting hand searches of existing grey literature. For inclusion, studies had to report results from multi-modal treatment delivered by North American naturopathic doctors. The effect size for each study was calculated; no pooled analysis was undertaken. Risk of bias was assessed using the Cochrane risk of bias as well as Downs and Black tools. Results: Fifteen studies met inclusion criteria, investigating a range of chronic diseases of public health significance. Studies were of good quality and had low to medium risk of bias including acknowledged limitations of pragmatic trials. Effect sizes (Cohen's d ) for the primary medical outcomes varied and were statistically significant (p<0.05) in 10 out of 13 studies. A quality of life metric was included in all of the randomized controlled trials with medium effect size and statistical significance in some subscales. Conclusions: Previous reports about the lack of evidence or benefit of NM are inaccurate; a small but compelling body of research exists. Further investigation is warranted into the effectiveness of whole practice NM for across a range of health conditions. [PROSPERO 2012:CRD42012002176]