Are We Finally Heading toward a “Therapeutic Order” for the Nation?
The overlapping fields of complementary, holistic, natural, whole-person, alternative, and integrative health and medicine can seem unruly, confusing, and impossible to get your mind around. With literally hundreds of approaches, therapies, and disciplines in the mix, how do you organize your relationship to it?
When I began learning about natural health care in the 1980s, colleagues in the rebirth of the naturopathic medicine field gave me a useful concept that naturopathic doctors hold as central to their clinical philosophy. They call it the “therapeutic order.”
I recently had a chance to introduce this idea to a leader in the US military’s campaign to promote the use of complementary and alternative therapies for the pain treatment of soldiers in the battlefield and for those returning home scarred. The military is seeking to limit the use of pain medications for reasons ranging from addiction to diminished attentiveness and sleepiness in soldiers on the battlefield.
The military doctor wasn’t familiar with the term. But, on hearing about it, he agreed that it was a helpful term for describing a commonsense perspective that the military appears to be leading US healthcare in finally embracing. I thought that some Alternative Medicine readers might also find it useful, if perhaps not exactly new to many of you.
The therapeutic order was developed and named by two naturopathic clinician educators—Pamela Snider, ND, and Jared Zeff, ND—who have been leaders in the profession for three decades. It’s linked to a well-known concept from the ancient Greek, Hippocrates. Most of us have heard that doctors swear to “above all, do no harm.” All healthcare practitioners, at least in theory, embrace this Hippocratic concept.
But as anyone who has read the small print on pharmaceutical drug packaging will know, this pleasant promise is challenging. How can one avoid harm if one’s practice is dominated by drug prescription? Harm of some kind, as an adverse effect, seems always to be in the picture. This, of course, is not just an issue with pharmaceuticals: anyone who has pushed too hard in a yoga class or taken too much vitamin C will know adverse events can even come from natural approaches inappropriately administered.
The naturopathic doctors take the absolutism of the Hippocratic “above all, do no harm” and give it a more realistic and relativistic spin. They urge a clinical concept of using the “least force” whenever possible.
This idea is not foreign to conventional medical practice: Say a person is in pain. A doctor may start with what they call “watchful waiting” or, more likely, an over-the-counter drug. If the problem continues, more severe steps kick in. This may involve a stronger drug, like oxycodone, with more risk of adverse effects, such as addiction. Eventually the medical doctor may refer the person for a surgical procedure to structurally change something that is related to the pain. These steps follow a path from “least force” (watchful waiting) to greatest force (surgery).
There is a therapeutic order here. Risk increases along the way.
Now look how this order is opened up if one’s naturopathic doctor or some other integrative health practitioner is educated to multiple strategies for patients to enhance their self-care, prevention, and health promotion. They also favor the clinical use of, or referral for, diverse natural health practices. Massage, acupuncture, counseling, chiropractic, dietary supplements, yoga, lifestyle change, mind-body therapies, therapeutic nutrition, and countless other natural health and mind-body practices can be arranged into the order of the clinician’s therapeutic choices. Options expand from the three-step approach of watchful waiting, pharmaceutical drugs, and surgery.
The seminal idea the therapeutic order captures is a philosophic backbone for implementing these expanded treatment options. Here are the components, listed in order: re-establish the basis for health; stimulate the healing power of nature; tonify weakened systems; correct structural integrity; prescribe specific natural substances for pathology; prescribe pharmacological substances for pathology. The final step, should all else fail, is prescribing surgery, suppressive drugs, radiation, and chemotherapy. The clinician will typically work with the patient in multiple areas at the same time.
You can learn more about the “therapeutic order” by putting the term into your browser. I believe it is a great tool for approaching problem solving in other fields where healing is a goal. That is another subject. A critical component of healthcare reform will arrive when all clinicians use this order, and have access to these additional steps in this order, to inform their instincts and decision processes.
We need a new therapeutic order for the nation. It is great news, then, that pain leaders in the US military are not only promoting an integrative model, they are also promoting a new therapeutic order for that integration.
John Weeks is the editor of “The Integrator Blog News and Reports” (theintegratorblog.com), a leadership-oriented news, networking, and organizing journal for the integrative medicine community, and a columnist for Integrative Medicine: A Clinician’s Journal.