Secret Sauce and Positive Side Effects in Whole-Person Care
Those who grow up experiencing medicine and medical treatment as pharmaceuticals, diagnostic procedures, and surgery can have trouble with the idea of “positive side effects.”
Multiple pages of small print warn us of nagging and sometimes awful adverse effects of drugs. Diagnostic imaging shoots rays through the system that can be harmful. Any incision is stress on the body, even if there is no adverse event from a surgery.
Regular medicine teaches us to weigh pros and cons. The end justifies the means.
The knees of a medical doctor, researcher, or even a patient who is born, bred, and educated in this context can quickly jerk to dismiss anyone who has the audacity to claim that there are beneficial side effects from their treatment process. The therapy itself may be suspicious. Now I am to believe there are positive side effects?
Such claims easily evoke the image of some huckster on the back of a covered wagon.
This theme has interested me for years. My spouse is a doctor of naturopathic medicine. Like most integrative health and medicine practitioners she mainly uses various natural modalities while partnering with her patients to engage diet, lifestyle, stress, emotional, and other issues related to their health: classic whole-person care.
In talking with her about her practice, I sometimes hear a common theme regarding those who come to her with particularly challenging cases. A patient might present with X—say, a digestive problem. A month later, following treatment, the patient comes back. X, the presenting condition that was the focus when the patient made the appointment, might not have budged. Yet Y, a skin condition; Q, a problem with sleep; and H, a tendency toward depression, may have all gotten better.
X might budge the next month, or in six, or it might keep rebounding. Yet other individualized symptoms that may or may not be perceived as linked to the presenting problem keep getting better.
Hard evidence is building to support these claims of “positive side effects.” Group Health Research Institute senior research scientist Dan Cherkin, PhD, is a specialist in complementary and alternative medicine treatments for back pain. He has published randomized, controlled trials on the effects of chiropractic, acupuncture, massage, and other treatments. Often, but not always, these showed better outcomes than traditional care.
Cherkin grew curious about what was going on between these practitioners and their patients. These weren’t, after all, merely disembodied therapies delivered as impersonally as a pill. He examined what he called the “patient experience” of this type of care. The team published their findings as: “Unanticipated Benefits of CAM Therapies for Back Pain.”
The benefits were individualized and all over the map. They found for all the types of treatment “increased options and hope, increased ability to relax, positive changes in emotional states, increased body awareness, and changes in thinking that increased the ability to cope with back pain.” These themes, he wrote, “were mentioned for all of the CAM treatments.” More treatment-specific were patient experiences such as “increased sense of well-being, improvement in physical conditions unrelated to back pain, increased energy, increased patient activation, and dramatic improvements in health or well-being.”
Canadian researcher Dugald Seely, ND, included patient self-reports in a study that found lower cardiovascular risk via a population given whole-person integrative care. Similarly diverse “secondary outcomes” emerged. Subjects reported positive changes related to “fatigue, sleep, weight, stress, allergic symptoms, hypertension, coffee consumption, and musculoskeletal problems.”
Ryan Bradley, ND, MPH, found similar benefits among patients with type 2 diabetes who were participating in a health maintenance organization. He and a group (which included Cherkin, the Group Health researcher) reported these in a study entitled “Adjunctive Naturopathic Care in Type 2 Diabetes.” Their primary objective measure was the level of hemoglobin A1c—for our purposes, read this as “condition X.” Hemoglobin levels did not show improvement to the point of “statistical significance.” Then consider conditions Y, Q, and H: Subjects reported that “mood, self-efficacy, and motivation to change lifestyle” were all bettered to statistically significant levels.
The hucksters would seem to have had a point about their positive side effect claims, at least in these examples.
When I shared these studies, my spouse was not surprised. What to Cherkin was “unexpected” to her was not. She anticipated the other outcomes based on the health-oriented, whole-person philosophy organizing her practice.
Is there something special in the type of treatment that engages patients?
An article in an internal newsletter from Group Health Research Institute called it a “secret sauce.” The newsletter reported a follow-up study from the Cherkin team. This one, led by Erica Oberg, ND, MPH, dove more deeply into the patients’ experience of their care in the Bradley trial. The report, entitled “Patient-Reported Experiences with First-Time Naturopathic Care for Type 2 Diabetes,” highlighted three characteristics reported by patients: Their care was patient-centered, collaborative, and “holistic health rather than diabetes focused.”
The interviews yielded additional characteristics. One was being counseled on an individualized and detailed health-promotion plan. Tactics viewed as “practical” enhanced engagement with self-care. They liked that this patient education addressed not just diabetes self-care but also general health issues. Finally, the “novel treatment options” of the naturopathic doctors “fostered hopefulness.”
These data, these positive side effects, and these patient experiences would seem a terrific guide in this era in which the remedial banner of “patient-centered” flies from nearly every hospital, medical group, and community clinic. Yet such evidence of whole-person treatment is typically sidelined if considered at all.
One begins to wonder, amidst the present disregard, if it is time to level an accusation of hucksterism not at the whole-person practitioners but at the business entities flying those “patient-centered” banners.
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.