NPRI | Letter to the Editor
Naturopathic Physicians Research Institute: research on the practice for patients and health policy
Naturopathic medicine in North America at this point in its history has persistent and particular needs in understanding and improving its practice. The profession has had insufficient scientific infrastructure to evaluate its effectiveness, safety and cost-effectiveness, to inform practice for ongoing improvement. The lack of descriptive and outcomes data on naturopathic practice has left many of the profession’s organizational and policy initiatives without the convincing evidence necessary for success. However, given the growing cadre of naturopathic physician-scientists and the availability of new technology, we are on the verge of efficiently and effectively filling a critical knowledge gap: the fuller description and evaluation of real-word naturopathic medicine.
To help generate the data, studies and research infrastructure needed on an ongoing basis, we were motivated in 2010 to initiate the Naturopathic Physicians Research Institute (NPRI; http://nprinstitute.org), non-profit organization lead by naturopathic scientists and clinicians. Its mission is to “stimulate, organize, fund, conduct and disseminate research on the clinical practice and outcomes of naturopathic physicians in order to improve practice and the health of our patients and communities“ with a focus on licensed North American practice. NPRI is the home of the Naturopathic Physicians Research Network, now with 120 members in the US and Canada and registered as a primary care research network with the US Agency for Healthcare Research and Quality.
Naturopathic academic programs—the logical setting for clinical and basic research—have struggled to support a few researchers with varying success. There has been little collaboration among the schools. The need for external research funding has been the essential element for sustaining their efforts. The randomized single agent trial, usually considered the gold standard of clinical research, is the kind of study that the federal and industry funders of research are most likely to support, but is not the methodology best suited for the present needs of naturopathic medicine. Alternative methods better suited to the evaluation of naturopathic practice are less likely to attract support. Descriptive studies, an important need in setting the groundwork for future work, are rarely funded. Key pieces of preliminary data and infrastructure that will allow the research efforts at the individual schools to flourish are neglected without the external funding that conventional colleagues are more likely to enjoy. Similarly, policy and advocacy organizations of the profession such as the American Association of Naturopathic Physicians (AANP) have a complex agenda that so far has precluded a significant research data focus, though organizing efforts and policy influence would be greatly aided by appropriate data.
While we have excellent scientific minds in the profession, they are still few due our size. Fewer still of our physician-researchers have been able to devote their talents to the scientific challenges the profession faces because of the paucity of funding for these lines of work. The data that the licensed naturopathic profession needs include description of practice in character and magnitude, studies investigating the theories/principles of naturopathic medicine, whole practice outcomes, influence on overall health rather than individual diseases, the effectiveness of the practice in those who choose naturopathic care rather those who are randomized to it and data on costs and safety. Also needed is research and infrastructure towards the internal improvement of naturopathic practice, for example, program evaluation research, electronic health records standards, patient registries, dissemination and analysis. The needed work is challenging to organize and is unlikely to occur with the resources and expertise at any single institution. At the same time, the skill and resources need not be replicated at every institution if the assessment capacity is shareable.
To help determine best directions, NPRI recently organized the Naturopathic Science & Policy Summit, co-sponsored by the AANP and the Association of Accredited Naturopathic Medical Colleges, a day long conference on discipline-specific research towards evidence-informed health policy regarding naturopathic physicians. We are also engaged in several research projects including the basic descriptive analysis of data contained in de-identified practice-management databases of naturopathic clinics beginning with academic clinics, a review of published naturopathic whole practice (multi modality) clinical studies and a workforce description. Federal grant applications for research using the NPRNetwork have been submitted and its members have been surveyed on research interests and capacities. On the website, we have compiled the published research studies most closely relevant to North American licensed naturopathy, list current studies and created a portal for the submission of case reports. We are developing the capacity for online longitudinal data collection from naturopathic doctors and patients beginning with pain cases. We consult on a variety of initiatives involving the assessment of naturopathic practice within the NPRI mission
We continue to seek input from all quarters of the profession. Our present vision is for NPRI to collaborate with all naturopathic academic institutions, professional associations, and relevant industry partners and in consultation with scientific and clinical agencies to ensure a focused and balanced approach to naturopathic research which respects its principles and improves practice. We intend to support the work of academic investigators at each of the colleges, providing infrastructure and assistance for their research applications and protocols. Data and protocols generated in collaborations will remain the property of the investigators and the institutions producing them. While the NPRI’s work will address healthcare policy questions, as a 501c3 corporation, it will not seek to influence policy directly.
The collaborations resulting in the Naturopathic Medical Research Agenda 2002-5 and the Naturopathic Physicians Research Network established in 2009 were steps forward for joint research action. From about 1985, the profession began to do its own research; in the 90’s, we gained experience and academic research departments came into being. In the last decade, we clarified the right research questions and the general methodologies while a growing number of naturopathic physicians have been trained at research universities across the country. Now, especially with the intersection of health reform and technology advances, it is time to build upon these gains and produce the studies and data that can transform the profession. With the establishment of NPRI, we seek to assist in refreshing the profession’s research agenda and facilitate routes to the development of collaborations, methods and infrastructure in naturopathic medicine for continuous practice improvement and to inform educational programs and public health policy.
Carlo Calabrese, ND, MPH
Executive Director, NPRI