Joshua Z. Goldenberg1, Bonnie S. Burlingham MPH2, Jane Guiltinan ND3, Erica B. Oberg ND MPH4
1 Bastyr University, Kenmore WA, USA
2 Washington State Hospital Association, Seattle WA, USA
3 School of Naturopathic Medicine, Bastyr University, Kenmore WA, USA
4 Bastyr University Research Institute, Kenmore WA, USA
Submitted: 19 September 2012
Accepted for publication: 14 November 2012
Naturopathic medicine (NM) is a distinct system of primary health care often considered a form of complementary and alternative medicine. Evidence-based medicine (EBM) is an approach to medicine which has gained increasing prominence over the past 2 decades. Like other health professions, as the influence of EBM grew in the global medical community, NM had to discover, explore and take stock of it through the lenses of its own unique culture, history and values. We conducted a phenomenological qualitative research study to explore attitudes toward EBM, probe for evidence of cultural change, and to investigate the drivers of said change within the naturopathic medical community.
Participants were selected by purposive sampling and interviews were based on semi-structured questionnaires focusing on the participants’ perceptions of research, EBM, and their relationship to the field of naturopathic medicine. All interviews were transcribed and then coded independently and in duplicate by two investigators who assigned thematic codes to relevant excerpts. Themes and a concept map were identified, reviewed, and analyzed by investigators. Atlas.ti (version 6.2) software was used for coding and concept mapping.
Seventeen interviews were conducted of which 15 were available for transcription and ranged in length from 17 to 55 minutes. A total of 34 codes were identified, which we aggregated into three themes: (1) a spectrum of EBM definitions, (2) attitudes towards research and EBM, and (3) drivers of change. Interviewees used a spectrum of definitions for EBM which informed their reported attitudes toward it. While current attitudes toward research and EBM were generally described as favorable, “spectrums,” “subgroups,” or even “factions” were described representing a continuum of attitudes within the naturopathic community. Overall, the interviewees described a rapid cultural shift in attitudes from hesitancy to the cautious embrace of research and EBM. Numerous promoters of this cultural change were described with the majority of interviewees emphasizing the importance of influential people within the profession, research and EBM funding, and the desire for acceptance from the larger medical community.
As a profession which developed from vitalism on the margins of the larger medical community, naturopathic medicine has grown rapidly in size and influence and, as it has entered new non-vitalistic (mainstream) practice environments, it has incorporated new peers and new role models. Research and EBM acculturation may represent a flashpoint example of a professional adolescence for naturopathic medicine. In which case a relevant question becomes, will the profession be able to adequately integrate the values of its youth/roots with the values of the EBM-driven medical community?