Western Herbal Medicine in the Context of Complementary and Alternative Medicine - Literature review Example

Western Herbal Medicine Introduction There is increasing evidence supporting the efficacy of complementary and alternative medicine (CAM). Therefore, there is a need to evaluate and refine this healing system using a method that obtains a more holistic idea of the CAM interventions. Whole system research was developed on basis of CAM interventions and integrates treatment modalities as well as diagnosis and patient-practitioner interactions, practices for changing patient behavior as well as CAM approaches to healing and therapy. Whole system research aims at studying the efficiency of an intervention, the process, context, outcomes as well as the philosophy of the intervention. It assesses and compares real-world, multi-modality systems of care where the research reflects distinctive aspects of the intervention theory as well as therapeutic context (Niemeyer et al, 2013). WSR focuses of studies that evaluate interventions allied to whole systems of care such as naturopathic medicine, integrative medicine or Traditional Chinese Medicine (TCM), that integrate a broad range of therapies within an aim of providing holistic individualized treatment. The focus of this essay is critical analysis of whole systems research in order to identify the positive and negative aspects of this research approach. Additionally, this essay will compare WSR with the evidence-based medicine research model. Difference between Drug Treatments and CAM Interventions As Zick et al (2009) provide that the nature of CAM systems like traditional Chinese medicine or naturopathy differ in many ways from CAM interventions. First, convectional drugs normally contain one single therapy while CAM interventions normally consist of multiple factors. The relationship between the patients and practitioners is a very important factor in CAM interventions because the relation is also used in impacting the healing process of the patient (Niemeyer et al, 2013). The expectations of the patients are also an important factor in CAM because this also impacts the healing process. These are some of the factors that make the conventional research methods inappropriate for CAM interventions because the research methods consider such factors as placebo effect in conventional treatment (Greene et al, 2009). Consequently, most of CAM interventions are personalized and hence the treatment outcomes are dependent on distinct aspects of the patient, practitioner as well as the context and therefore standardisation of interventions is difficult. CAM modalities focus on the whole person and this is attained by addressing physical, mental as well as spiritual aspects as well as restoring the health unlike conventional treatments that just focus on the pathological processes. Greene et al (2009) further explains outcomes in CAM interventions normally incompetently defined and hence measuring research variables such as spiritual growth or positive expectations is difficult since there are no standardised measures for measuring these aspects. As aforementioned, evidence-based medicine research model focuses on effectiveness of the remedy as the active agent and ignores the treatment context. According to Cheryl et al (2003) RCT are not the research model of choice in CAM. This is because CAM interventions normally involve a combination of components that act synergistically and studies show that RCTs alone are not able to provide adequate information. Basically, theoretical models that underpin CAM processes entail stimulation of the whole person’s self-healing response and utilize both non-specific and specific treatment effects (Cheryl et al, 2003). For instance, RCTs are not suitable in measuring interactions as well as therapeutic relationships because naturally they cannot be condensed into one active ingredient. Additionally, unlike CAM, convectional medicine does not work synergistically with psychological and other general care effects. Therefore, whole system research has been proposed in CAM research because the utmost consideration is given to evaluation of general efficacy of the intervention through potential outcome studies. Outcome studies reflect more precisely daily practice and hence provide high external and real-world validity (Greene et al, 2009). Therefore, whole systems research should complement RCTs in CAM due to its high internal validity. Whole Systems Research in CAM For a long time complementary and alternative medicine (CAM) methodology has been confined to drug-based RCT methods. A convectional RCT method aims to establish the cause and effect of a single variable and it has been used in drug efficacy studies for long. RTC’s do not suit complementary and alternative medicine (CAM) well because there are several known components to CAM that have an effect on health outcome, for instance therapeutic relationship, the setting as well as the expectations of the patients, among other aspects (Cheryl et al, 2004). Sarris (2011) is in line with this and explains that assessing the efficacy of a CAM approach involves all aspects of an individual including their feelings. A whole system research approach to health research seeks to integrate the assessment of the whole individual, and therefore focuses on understanding that total quality of life is influence by all elements such as physical, social, functional, emotional, psychological as well as spiritual health. This means that WSR involves more variables when performing statistical analysis because it acknowledges the larger effects of holistic health care in a manner that research RCT designs do not. Positive Aspects in Whole System Research According to Sarris (2011) the exclusivity of WSR is reflected in its focus to the process of healing as well on the outcomes as well as on its ability to acknowledge philosophical assumptions as an important element to the research design. Normally, the healing process refers to the journey of the patient from the time an individual gets an illness. This journey is accompanied with physical, biological, social as well as spiritual outcomes. Therefore, the process of care should take into consideration all these factors because it is entangled with circumstantial aspects and thus influences the healing process as well as treatment outcome. For instance, patients and therefore patient-practitioner relationship becomes a part of the treatment process as the two parties engage in the healing process. The WSR takes into account all the contextual factors by describing how the intervention process will be delivered in order to allow generalizability. Describing the healing process is important in advancing understanding of the effect of whole systems on diverse factors in the lives of patients (Koithana et al, 2012). Description of the intervention delivery process is supposed to encompass design details, development, as well as delivery of different intervention approaches and attributes of individuals whose intervention was effective or not. Moreover, description of the healing process should also encompass documentation of changes in outcomes significant to patients and healthcare practitioners with time throughout the intervention process. Ritenbaugh et al (2008) carried out a study to evaluate the impact of whole system TCM contrasted with naturopathic medicine vs. standard of care for in treating tempromandibular disorders. According to the study results, there was marked improvement in temporomandibular disorders for the patients who received whole systems treatment as compared to the patients who received standard care. This study showed that whole systems research is more effective in CAM treatments. This is because whole systems research attempts to evaluate the impact of a multi-modality health care approach in order to offer personalized treatment because this approach is more accurate and effective in evaluating the health care provided to patients (Greene et al, 2009). It is also important to note that WSR gives utmost importance to the theory. This is because WSR requires a priori that researchers have good theory for basing the study design and to take into consideration the variables to be measured as well as the precision level (Liebert, 2006). Accordingly, WSR is valuable in demonstrating the significance of theory in showing that a specific treatment works or not. Additionally, whole system research demonstrates the importance of diversity since RCTs on treatment interventions for a specific population are based on hypothesis of homogeneity and hence by WSR integrating diversity reflects a major aspect of research methodology, in particular in the period of personalized medicine (Liebert, 2006). In a nut shell, the diverse interactions at multiple levels of measurement, both qualitatively and quantitatively makes the data set rich and also is important in identifying the vital study outcomes or study trials that can indicate how practitioners can best care for their patients. Whole systems research examines all factors that impact the health of the individual as well as other factors that impact the aspects of health system and the health system as a whole. Therefore, the whole systems research has a very higher level of measurement because it focuses on the dynamics of normal function and the disease. There are many factors that contribute to an illness and not just the clinical aspects and hence it is important to evaluate all factors that contribute to a disease process in a research. This indicates the significance of using WSR in conducting research because all factors that influence the disease process are taken into account. Sarris (2011) conducted a study on whole system research of naturopathy and medical herbalism. According to Sarris (2011) CAM treatments such as naturopathic practice in treatment of depression whose basis is biopsychosocial model that perceives the causation of the condition as multifactorial where many inter-related factors contribute to the depression. The biopsychosocial model fits the CAM model that treats individuals from a “whole system” perspective where difference factors are viewed to have influenced the disease causation (Koithana et al, 2012). This again justifies employment of whole system research particularly when conducting research on CAM interventions because they take into consideration different factors during treatment due to their holistic approach. Parsonson (2012) also highlighted the positives of whole systems research against other research methods used such as RCTs. According to Parsonson (2012) other research methods have problems with aspects such as translation of research findings into practice because the applicability of the results might vary in various ways. On the contrary, WSR takes into consideration all variables of each specific person in the population under study. This means that factors such as psychological and physiological variables of each individual are integrated. Therefore, applicability of the study outcomes in the general population is much more practical in the whole systems research. This is supported by Sim et al (2014) who conducted a study on perspectives and attitudes of lactating mothers utilizing herbal galactagogues while breastfeeding. This study employed an exploratory research method where in-depth semi-structured interviews were used to collect information. The study focused on the whole person including the feelings and perspectives of the study participants (Sim et al, 2014). The study focused more on the experience of the study participants and hence focused more on theory which in turn ensured that enormous information was collected. Negative Aspects in Whole System Research However, whole system research seems more complex when compared to traditional research methods such as RCTs. In addition, WSR has more elements due to its holistic approach and this means that there is an increase in information regarding the methodologies, interactions as well as outcomes to have a fully and accurate representation of the underlying situation for a certain disease and its treatment (Liebert, 2006). Another complexity when carrying out whole system research in CAM interventions is that processes used in the delivery of the interventions and healing of the patients are complicated. Basically, these processes are personalized pathways that change dependent on distinct patient experiences, needs, beliefs, preferences and social context (Liebert, 2006). The process of delivering interventions involves services and activities that the practitioners provide to the patients. Whole system research involves multiple levels of measurement and this is a very vital aspect in this research approach. This can include the individual, the professional, the relationship, the family in addition to other levels (Liebert, 2006). At the individual level of the patient, it is important to measure physiologic, psychological and behavioral aspects, among other measurement levels in order to obtain a highly multidimensional outcome. Similarly, the study population in a WSR is extremely complex and hence an enormous amount of data is obtained. This is because more qualitative data is obtained from the patients because patient statements capture really vital information (Liebert M, 2006). Basically, handling such a vast amount of data is quite a challenge when conducting research and also some of the statistical methods that are normally utilized in clinical research are not suitable in WSR. In addition, Ritenbaugh et al (2003) reported some challenges and problems that come with whole system research. Some of the challenges include problems in developing methodologies for studying whole systems because of many and multifaceted factors involved. Basically, whole systems research is used in studies that involve complex interactions between diverse factors such as patients and professionals as well as settings where provision of care occurs when measuring CAM whole systems and developing suitable study outcomes. Sarris (2011) also noted that CAM has its unique challenges when conducting research, for example, a single type of CAM is made up of different herbal compounds and it is extremely difficult to analyze the extracts or pharmaceutical studies. Therefore, when conducting research on CAM, it is necessary to have a careful in-process quality control as well as inventive technologies during extraction of the extracts to ensure the consistency of the extracts. Rationale for the Use of a WSR Approach in Terminal Illnesses Current research on treatment and care of terminal diseases is normally inadequate in tackling the complexity inherent in the multifaceted and personalized care in patients with terminal diseases. Normally, convectional studies evaluate the efficacy one standardized aspect of care, for instance psychological care on a specific set of outcomes such as survival rate or disease progression (Jonas et al, 2006). Therefore, convectional studies such as RCTs ignore the impact of individual and circumstantial factors or other treatments on the treatment as well as potential interaction impacts between treatments and process and circumstantial factors. As Jonas et al (2006) elaborate, such types of studies might lack external validity because the studies fail to reflect actual situation that patients with terminal disease go through. Accordingly, there it is necessary to have a methodological approach that can effectively evaluate multifaceted systems of care. Research studies ought to be more and better theorized to demonstrate their complexity in order to identify factors that influence the application of intervention and realization of expected outcomes, measure the factors and evaluate their effect on the anticipated intervention effects (McClure et al, 2014). Contextual factors such as factors allied to patients on treatment, healthcare providers delivering the nursing or medical care or the setting in which care provision occurs normally interact and end up affected the projected treatment outcomes (Liebert, 2006). The whole systems research approach presents a clear research framework whose focus is on the processes of care at various levels that in one way or another contribute to outcomes assessment (McClure et al, 2014). Recommendations Combining the quantitative and qualitative research methods seems to have high potential of efficiently evaluating whole systems of healthcare (Parsonson, 2012). Whole systems of healthcare are multifaceted and WRS assesses the structure and process of interventions as well as the outcomes of an intervention. Qualitative research includes investigating the phenomena, characteristically in an in-depth and holistic manner by collecting rich narrative materials through a flexible research design. Therefore, qualitative methods can offer an opportunity for exploring the meaning that patients attribute to the specific intervention, the process as well as the context through which healing takes place, the treatment outcomes and the effect of patient’s expectations in the healing. In addition, qualitative methods are important in generation of new hypotheses and also in informing the theoretical connection between treatment and outcome (Liebert, 2006). Accordingly, quantitative methods and qualitative methods can be combined by nesting qualitative studies in adaptations of the random control trials. This will enable implementation of suitable research designs and methods to ensure that all components of a whole system are evaluated within its unique exploratory model. This approach is very applicable to CAM as well as other therapy systems like palliative care or psychotherapy. Secondly, as Liebert (2006) suggested, the society is constantly evolving and this definitely has an effect on the health or illness. Accordingly, the constant progress should be integrated in the healthcare delivery because the system is affected as a whole. Therefore, it would be recommendable to consider integrating Web technologies and in particular social media in order to enhance whole systems research in terms of infrastructure as well as in enriching the social outcomes of treatment interventions and in assisting in resolving several other questions about mechanisms on how health and healing occur. It is evident that communication technologies such as Web and social networks present opportunities of researchers to access experiences of patients that patients would not express during clinic visits or clinical trials yet these experiences have big effects in their lives and what they are going through (McClure et al, 2014). Conclusion CAM systems differ from drug treatment in various ways and hence they require a different research system other than the one used in conventional treatments. Research methods using conventional methods such as RCTs to evaluate medicines used in CAM have mostly indicated that no specific affects yet CAMs such as Chinese Alternative Medicine or homeopathy are popular types of alternative medicine. CAM interventions focus on the “whole person” and not just pathological processes of a disease and hence CAM aims at maximizing the ability of the patient to attain mental, physical balance as well as health restoration. Therefore, whole systems research is the preferred research method in CAM because they assess the efficacy of interventions as a complex treatment intervention by assessing all factors that affect an individual’s health as a whole. There are several positives of using WSR such as the research system being able to integrate all factors that impact the treatment/healing process as a whole unlike RCTs that only evaluate a single factor in the treatment/healing process. Whole systems research evaluates the efficacy of an intervention, the process, the treatment context, outcomes and also an intervention’s philosophy and hence covers everything that affects treatment and healing of an individual. However, whole systems research is complex and involves a lot of time as well as enormous information because diverse factors are assessed during the research. Combination of quantitative and qualitative research methods has been proposed to ensure high potential of effective assessment of whole systems of healthcare. References Koithana M, Niemeyera B & Pincus D, 2012, A Complex Systems Science Perspective for Whole Systems of Complementary and Alternative Medicine Research, Forsch Komplementmed, 19(suppI1):7-14. 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