The Initiative for the Summit
The first Naturopathic Science & Policy Summit was organized by the Naturopathic Physicians Research Institute (NPRI) and the American Association of Naturopathic Physicians (AANP) and cosponsored with the Association of Accredited Naturopathic Medical Colleges. On August 16, 2011, in Arizona Biltmore, leaders from the naturopathic profession’s agencies in the United States and Canada were invited along with interested media, policy activists, clinicians, academics, and researchers for the meeting. More than 100 attendees brought their interest and commitment, ideas and creativity for the next phase of scientific development for the naturopathic profession.
The conclave addressed the value of data on the character and outcomes of naturopathic medicine. We considered discipline-specific research for purposes of informing government and corporate healthcare policy. One goal of the summit was to define the role of research data in multiple policy domains. Among these domains are licensing efforts and scope of naturopathic practice issues, insurance coverage, participation in federal and state public health and clinical programs, and the position of naturopathic physicians in federal health reform. Another goal was to assess the commitment to naturopathic discipline-specific studies in the major sectors of the naturopathic profession, including academic institutions; state, national and specialty associations; individual clinicians and group practices; ND and non-ND scientists; and industry serving the naturopathic community. Finally, we hoped to set directions for obvious next steps in research.
The meeting was dedicated to the memory of Konrad Kail, ND, who passed on July 18, 2011. Konrad was a leader in the renaissance of naturopathic medicine, a founder and past-president of the AANP, a consummate practitioner who was also a researcher and advocate for naturopathic research, the first ND to sit on a National Institutes of Health advisory committee and, among many other roles, a founding director of Naturopathic Physicians Research Institute (NPRI).
Konrad Kail, ND
Financial support for the summit was provided by the AANP, NPRI and its donors, Canadian College of Naturopathic Medicine, and the Bastyr University Center for Health Policy and Leadership.
The Summit Agenda
For these ambitious goals, the day began with a view of science and policy during 3 keynotes from the perspectives of professions that share characteristics in the marketplace and policy arena. It was followed by a lunch presentation on the state of research specific to naturopathic practice, highlighting recent projects that illustrate the types of research that have the potential to address discipline and polic- specific topics. A panel followed on the needs for policy-informing naturopathic data, presented by 4 of the profession’s policy and political activists. The panel was capped by a presentation summarizing the federal funding climate for naturopathic health research. Finally, four breakout sessions were held to consider the way forward in terms of naturopathic agencies’ and physicians’ roles, most pressing issues, needs and resources. The breakout sessions included participants from:
- Naturopathic colleges and educations programs
- National and state associations
- Independent clinicians and the members of the Naturopathic Physicians Research Network (a component of NPRI with 145 ND members recognized by the Agency for Health Quality & Research as a primary care research network)
- Specialty societies
Findings from the breakouts were summarized by reporters from each group and then overall by the AANP President Carl Hangee-Bauer, ND, LAc, and NPRI’s Executive Director Carlo Calabrese, ND.
Conclusions and Directions
The principal overarching conclusions, expressed by speakers and confirmed in audience responses and common to the reports from the breakout groups were clear.
1. There was consensus that research toward policy objectives in the field is essential to the profession’s identity and advancement. Simultaneously, better focus on critical goals is needed. This means that research on naturopathic practice, naturopathic physicians and their patients, and naturopathic medical theory is required, and not simply studies on single agents and modalities. Broad outcome measures are necessary to measure the impact of naturopathic medicine on whole health and prevention, not just biomarkers of disease progression.
2. The most compelling work has been and will be outcomes studies in naturopathic practice in comparison to conventional medical models, particularly on clinical effectiveness, safety, and cost, published in peer-reviewed journals. These are the primary goals for research development. In cost data, the issue of whether costs of naturopathic care are add-on or replacement is of high importance. Data are also needed on practice description, workforce, utilization of naturopathic care, patient satisfaction, and the systematic review of the existing data on naturopathic outcomes at this early stage. Such early smaller studies will provide preliminary data, hypotheses, and rationale for expensive and challenging large-scale effectiveness studies. Safety data is an early hurdle for legislators to consider full-scope laws.
3. Financial and other resources from within the profession will need to be accessed for additional early work. Federal funding of research (eg, from the National Center for Complementary and Alternative Medicine [NCCAM]) is important but cannot be relied upon alone. The success of other professions for early discipline-specific research has been funded by the members of the professions themselves (eg, through donations and fees from membership associations and even contributions from tuition revenues at schools). Naturopathic colleges and programs have a critical role to play in demonstrating to the public and policy makers the safety and effectiveness of the practitioners they are training, the standards to which they are trained, and the care they provide. Though research expertise and infrastructure has grown substantially in the last two decades, the profession needs to grow the capacity for more studies by training researchers, identifying additional funding sources, and submitting more successful research grant applications. Necessary support will also include collaboration and participation in the conduct of research, at times in the absence of fair compensation.
4. Research data on naturopathic practice is necessary for informing developing health policy and supportive of, though not necessarily sufficient in, changing legislation. Data may be more important to corporate and government administrators, who are faced daily with decisions on effectiveness and costs, than to elected legislators, who may be more swayed by constituent argument and consumer pressure. Government administrators and corporate managers from insurance companies and self-funded large employers make many of the decisions regarding inclusion of naturopathic doctors, access to coverage for patients, and reimbursement levels for providers.
5. We must take advantage of growing health information technology including:
- Electronic medical records, in planning of implementation at most schools and a growing number of independent practices
- REDCap, an online data collection, data, and study management tool currently in use at Bastyr University
- NIH advances like PROMIS (Patient Reported Outcomes Medical Information Systems) for data collection and analysis
6. Collaborations within and outside the profession must be developed and improved to access expertise, comparative practice arms, avenues of research funding, and allies in the evidence-based improvement of public health. Initiate and maintain engagement with federal, state, and private agencies involved in defining agendas and developing or analyzing research data. This calls for a growing core of physician-scientists who should be supported by their naturopathic constituencies.
7. A central clearing house to collect and disseminate the existing relevant data is needed (eg, by expansion of the NPRI website published studies database) to make available the best information for the profession’s policy efforts, to inform policy makers, and to guide the growing naturopathic research enterprise.
8. We have the potential to be leaders in health and healthcare research by honoring naturopathic principles with a focus on broad health improvement.
Each of the four breakout groups had its distinct perspectives to contribute to the general discussion. Additional insights, opinions and conclusion specific to the four groups were as follows.
Colleges and Programs
Reporter: Jane Guiltinan, ND
- Colleges are in the dominant position to do research. They have the talent and much of the concentrated resources within the naturopathic profession. Research is a part of their mission.
- Each college is in a unique position, given its clinical and educational resources, to build research capacity, advance knowledge, and demonstrate the safety and effectiveness of the clinical skills they teach.
- Participation in collaborations with other colleges, and with NPRI and the Naturopathic Physicians Research Network, is an efficient way to accomplish this.
- Some suggest it is the wider profession’s role is to fund research that impacts policy rather than using student tuition and funds from colleges.
National and State Associations
Reporter: Ryan Bradley, ND, MPH
There is enthusiasm and interest in the associations to serve the profession, and associations may entertain NPRI proposals for funding of specific projects.
NPRI (or other center) is important for the compilation and dissemination for naturopathic data for state efforts.
Members can be encouraged to submit case reports. Case report submissions could be made a membership criterion.
There is a need to develop tools and training for association and specialty society clinicians to participate in in-office outcomes studies.
The ND workforce and distribution and how NDs are used and integrated into the health system are considered important research topics in jurisdictions.
Independent Clinicians and Naturopathic Physicians Research Network Members
Reporter: Erica Oberg, ND, MPH
- Clinicians in the field are enthusiastic about participating in research.
- They need simple approaches to contribute to research, mentorship, and recognition for participation.
- Approaches to develop include training (ideally web-based), case reports, and practice-based outcomes studies, perhaps facilitated by electronic health records and/or web-based patient-reported outcomes.
- Clinicians bring to the table research ideas, access to clinical populations, and real-world data.
Reporter: Michael Cronin, ND
- Guidance and entry-level tools are needed in getting started in research participation.
- Case reports would be a good initiation to research.
- Training and coordination are needed to help specialty societies embark on research in an organized and rigorous fashion.
In convention-related activities with the specialty societies, initial steps were undertaken to include members of the Pediatric Association of Naturopathic Physicians and the Oncology Association of Naturopathic Physicians in the growing Naturopathic Physicians Research Network.
Commenting on the meeting afterwards, Greg Goode, the chief of staff at Bastyr University, expressed his appreciation for the timely focus on the link between science and policy. “Everyone walked away impressed, inspired, and motivated,” he said. As organizers of the summit, we are committed to carrying the work forward in the coming year by implementating key ideas for better-informed local and national health policy and continuing naturopathic practice improvement for the health of our communities and the profession. Your comments and feedback are welcome.