Is Naturopathic care worth the money spent on it?
Sponsored by Canadian College of Naturopathic Medicine
By Bob Bernhardt, PhD
September 19, 2017
Naturopathic doctors may at times receive this question from their patients. It is nice to know that there is an evidence-based response that says “Yes!”
Rising health care costs have been a fact for some time. Evidence is now emerging that adding or enhancing adjunctive care services can serve to reduce overall costs. Much of the evidence relates to treating chronic conditions that can be major cost drivers within health care. This article highlights the findings from four randomized clinical trials conducted in partnership with a major Canadian corporation and a major union, and examines public polling data suggesting that the savings identified can be anticipated in other settings.
The genesis of the four corporate clinical trials was a joint (union/management) health and wellness committee created to improve the health of union members within the corporation. Although it was understood that improved employee health could relate to cost savings, this was not the initial focus. The studies examined:
- cardiovascular health as measured by the risk of a cardiovascular event
- chronic back pain
- rotator cuff tendonitis
- anxiety
The largest, and most recent of these studies, was multi-centered (Toronto, Edmonton and Vancouver) and focused on the reduction of the risk of a cardiovascular event (myocardial infarction, stroke, etc.) among volunteer union employees whose physical examinations revealed significant risk. Over 1,100 study candidates were screened; 246 were admitted to the study and randomized to one of two groups. Members of the control group were encouraged to continue to see their standard medical providers as deemed appropriate for managing their condition. Members of the active treatment group were also encouraged to continue to see their standard medical providers, but in addition they received naturopathic care consisting of some combination of lifestyle counselling, nutritional counselling, and dietary supplementation. The study showed that the group receiving naturopathic care experienced a significant risk reduction for cardiovascular events, as well as a reduction in the frequency of metabolic syndrome. The results of this study were published in the Canadian Medical Association Journal.1
A companion economic study published in the Journal of Occupational and Environmental Medicine determined that the significant reduction in cardiovascular risk resulted in a net study year savings of $1,187 to the employer, and an additional $1,138 for society (all figures in Canadian dollars).2
The chronic back pain study involved workers aged 18 to 65 with a clinical diagnosis of low back pain of at least six months duration. Both the active treatment group and the control groups had bi-weekly meetings with a healthcare provider. The control group received standard physiotherapy advice, while the active treatment group received naturopathic care consisting of exercise and dietary advice, relaxation training, and acupuncture. The study found that those receiving naturopathic treatment reported significantly lower back pain (P<0.0001) as measured by the Oswestry questionnaire. Quality-of-life was also significantly improved in the group receiving naturopathic care in all domains except for vitality. All secondary outcomes were also significantly improved in the group receiving naturopathic care: spinal flexion (P<0.0001), weight-loss (P=0.0052) and Body Mass Index (P= 0.01). The paper was published in the Public Library of Science One online journal.3
According to a companion economics study, researchers concluded that the impact of naturopathic care would “significantly reduce societal costs by $1,212 per participant.”4
References
- Seely et al. Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. CMAJ. 2013 Jun 11;185(9):E409-16. Epub 2013 Apr 29.
- [Herman PM, Szczurko O, Cooley K, Seely D. A Naturopathic Approach to the Prevention of Cardiovascular Disease. J Occup Environ. 2014 Feb; 56(2):171-6.]
- Szczurko O, Cooley K, Busse J, et al. Naturopathic Care for Chronic Low Back Pain: A Randomized Trial. PLoS ONE. 2007 2(9): e919.
- Herman P, Szczurko O, Cooley K, Mills E. Cost-Effectiveness of Naturopathic Care for Chronic Low Back Pain. Altern Ther Health. 2008 Mar-Apr; 14(2):32-
Two more studies are discussed below, followed by data on patient behavior, which indicates significant cost savings for those who seek naturopathic care.
The two other studies did not have companion economic analyses, but they did show significant health improvements. Adjunctive naturopathic care for workers with rotator cuff tendinitis (duration of greater than six weeks) produced statistically significant decreases in shoulder pain and disability (P<0.0001); quality-of-life measures; and shoulder extension, flexion, and abduction.5
The study on anxiety found that the group receiving the full naturopathic care experienced significant reductions (P=0.003) in their scores on the Beck Anxiety Index as compared to the control group participants, as well as improvements in mental health, concentration and overall quality-of-life.6
The major Canadian firm that participated in the studies felt that the findings were so significant that they sent out information pamphlets, “Naturopathic Medicine and You”, to approximately 40,000 employees and they increased their coverage for complementary health care by 50%.
The Canadian College of Naturopathic Medicine (CCNM) conducted the four clinical trials referenced in the two blogs. Based on these studies we were curious as to whether patients who were receiving care from naturopathic doctors in the community were reducing their use of other health care resources. CCNM hired Innovative Research, Inc. to conduct a study of attitudes toward naturopathic medicine in Ontario. The study contacted 606 respondents through phone polling and the results are accurate within 4%, 19 out of 20 times. One of the questions asked in the survey was: for those reporting they were seeing naturopathic doctors (N=101), had doing so reduced their use of other health care resources? 30% said it reduced their visits to specialists, 42% claimed it reduced their visits to their family doctor, and 29% stated that it reduced their visits to hospitals. One of the most significant results was the reduction in use of pharmaceuticals: 48% claimed a reduction and 11% stated that the reduction was “substantial”.
To further assess whether these changes could be expected in actual patient behavior, we asked patients who were visiting the naturopathic clinic at CCNM how this impacted their visits to general practitioners (GPs), and 63% claimed doing so reduced their GP visits. Finally, we opened a new teaching clinic within Brampton Civic Hospital, and we asked those patients, many of whom were new to naturopathic medicine, the same questions and the results were again very similar: 77% claimed coming to the clinic reduced their visits to general practitioners; 19% reduced their visits to specialists; 14% reduced their visits to Brampton Civic Hospital, and 59% claimed it reduced their use of pharmaceuticals.
The evidence of safety for naturopathic care has always been strong. The evidence of efficacy is becoming increasingly stronger and the evidence of significant financial benefit is becoming compelling.
Note: Parts of this submission have been extracted from an article that the author wrote in the Benefits and Pension Monitor.
For more information on the Canadian College of Naturopathic Medicine, visit http://www.ccnm.edu/.
- Szczurko O, Cooley K, Mills E et al. Naturopathic Treatment of Rotator Cuff Tendinitis among Canadian Postal Workers: A Randomized Controlled Trial. Arthritis Care Res. Vol. 61, No. 8, August 15, 2009, pp 1037–1045.
- Cooley K, Szczurko O, Perri D, et al. Naturopathic Care for Anxiety: A Randomized Controlled Trial. PLoS ONE. 2009 4(8): e6628.
Bob Bernhardt, PhD, has been president of the Canadian College of Naturopathic Medicine (CCNM) since 2004. Bernhardt has broad experience encompassing post-secondary education, international education, administrative law and medical education, and an academic background spanning science, information systems, education, administrative law and leadership in higher education. He has led the creation of new post-secondary education departments overseas, consulted on teacher education programs in the Middle East, and is a past president of the Association of Accredited Naturopathic Medical Colleges. He has also served as director of education for the Law Society of Upper Canada, where he was responsible for Ontario’s bar admission process, continuing legal education and lawyer specialist certification. Dr. Bernhardt believes that future health care must focus on genuine partnerships engaging the patient and their range of health care providers, and he sees this as a key to reversing the trend of ever-rising costs.