The other day I posted an article on one of my facebook pages about the role nutritional deficiencies may play in mental health conditions, such as anxiety and panic attacks. A lady commented on the post who brought up some valid concerns about the tone of the article being potentially misleading for the general public as to clinical best practices regarding the incorporation of nutritional supplementation with medical intervention. She questioned the validity of the research article, which she had a right to do, but it brought up for me the often confused differences between researchers, especially those in medical fields where clinical best practice guidelines are based on 20 to 30 years of solid gold standard research, versus the quality of evidence found for researchers in emerging fields, such as rehabilitative science (in which I’m currently finishing my masters), or what the world of epigenetics was when I did my undergrad in molecular biology (we still used coffee filters and paper clips for our DNA extractions, and yes I’m a lot older than I look…)
Since this is a common point of misunderstanding for a lot of people in the traditional medical world, I felt it necessary to write a blog post of the difference between the standards of evidence in both cases to help educate the public so that those concerns may begin to be addressed for anyone reading future social media posts by me. I often assume that we are all working from a similar context, and that’s not always the case.
So, what are the differences and how can the general public tell when they should be incorporating alternative therapies or lifestyle changes into their routines based on the information they are reading online?
First off – in no way am I advocating not using medication, should that be required. I believe wholeheartedly in modern medicine. I just also believe that all advances in best clinical practice have to begin somewhere. And in the world of rehabilitative science, the interplay of the effects of the microbiome and gut health on mental health, the integration of alternative medicine and traditional medicine best practices, etc., there isn’t always a lot to go on, research-wise. So best clinical-practice is a much more fluid process than it is in fields such as traditional medicine, where, again, there is typically a larger base of well-done, peer-reviewed, meta-analysis of meta-analyses done over many, many years to determine how much of what you should take when for what results. So typically this is where the emerging fields tend to butt heads with the traditional fields. Traditionalists need that solid evidence. Emergents tend to find some interesting studies, think ‘hey – that’s neat. I wonder if it’s replicatable?’ and off they go from there. Emergents are interested in furthering the body of scientific evidence on a topic of interest where there isn’t much research already done. Traditionalists are concerned with implementing best practices based on the mountains of evidence collected over years by emergents. So the two are very linked – you can’t have one without the other – and yet the traditionalists often go to ‘there isn’t enough evidence to make a best clinical practice from this’. Yes. Correct. But that’s what emergent science is for. And that’s a fundamental key to understanding those conversations, when they occur. It’s also fundamental for your own understanding when reading articles as to whether or not you should be bringing that information to your practitioner or incorporating what you’ve read into your daily habits. It’s also important for anyone in the emergent fields to understand that you can’t claim that an intervention that has a few research studies is the same as one that is backed by years of research. Which is often where some of the disagreements lie. But when you have a patient with a sprained knee who wants to use arnica cream and asks you whether or not it’s a good idea, you can at least have the discussion from a, ‘there are a few studies that suggest it might be beneficial. It’s not harmful so you can try it and see if it helps. However, that said, here are some things you might want to watch out for and should any of them occur than stop using it and see your doctor. Your pharmacist might be a good source of information on this, if you’re interested in more information’ standpoint.
I think a lot of the conflict from traditionalists comes from a concept of ‘either/or’, such as, “either we give you traditional medical treatment OR we do an alternative one instead’. But that’s not what I’m advocating. I advocate, ‘okay, how do we incorporate other factors, like nutrition and lifestyle changes, into your daily habits to optimize the medical treatments that you are receiving for this condition?’ I’m not saying that going against traditional practices is a good idea. I believe in combined approaches – for example, an often useful kind of research practice when it comes to alternative therapies is to use two groups of people in your study – those receiving the gold standard medical treatment alone, and those receiving the gold standard medical treatment combined with the new intervention or treatment that you’re studying. This way, everyone gets the same base level of care, and if the intervention improves that care, then it might be worth conducting further research to better understand the mechanisms behind why it works and better characterize how best to use it for optimal results. I like to think of it as ‘how do we optimize the treatment you are already receiving?’
Another important thing to note is that there are adverse events that can occur when incorporating new therapies, treatments, or even diet and lifestyle changes into your life. This is why integrative medicine is so very important. It’s important to have that traditional medicine oversight to ensure that the alternative medicine therapies are actually benefiting YOU as a person. Without that piece, it’s kind of a no man’s land that a patient is left to navigate alone. So working with a team of professionals – both traditional and alternative - who collaborate to get you to your best healthy state is the safest option for incorporating the emergent therapies into your life.
So how can you tell the difference between research used to generate discussion and further exploration into an emerging field of study, versus a well-characterized field of study that has enough research conducted to be able to make solid clinical best practice guidelines? Well, unfortunately, you have to do your homework. And our commentor highlighted how to do this very well. Check the sources of the information. Is it reputable? How many studies have been done on this? Are they from creditable universities or hospitals?
The interesting thing about the transition from emergent fields into traditional fields is that you can watch the progress over time, if you’re paying attention. And this is often where I forget that people online don’t know me so don’t understand that I do this. Research has to start somewhere. And usually that’s in less reputable places. It usually starts with one person in some University somewhere who thinks ‘here, this might be interesting to try…’ That may or may not get published, but it usually inspires someone to take that concept and try something else with it. That becomes another experiment. Which again, may or may not get published. But now other people have become involved, and so that idea grows, and depending on the results of the experiment, may be getting a bit of backing from department heads. More research happens, maybe a few papers get published by a master’s student. Now that research area is out into a larger audience of people. Someone in another country might find it interesting and try a variation of it. That might get published. Now we have an accumulating body of evidence. That sparks more people’s interest. If the results are intriguing enough, it will spark a lot more people’s interest – either to refute or validate the claims. This is where the scientific debate begins. What even IS this thing we’re studying? Well, it is this under these conditions, but not under these conditions. But can you really trust the results from that one because the way they designed this experiment it’s not really showing that the result is only from that thing, it could have been from these 3 other things. We should make 3 more experiments to test THAT out. And on and on it goes until, 20 to 30 years later we can DEFINITELY say that this thing is THIS and NOT that under these specific conditions. So, now that we know that information, how do we use it to make a policy on how we treat patients who come in with this specific condition to make their lives better? Best Clinical Practice Guidelines.
That is my summary of the scientific process as it pertains to health related disciplines. You can see how somewhere in that ‘scientific debate’ stage that you will start to have a pretty good indication that something is happening here that deserves further research, versus we know that this thing is at least helpful and not harmful so it’s safe to try, but we’re not exactly sure under what specific conditions yet it’s the most benefical, versus we have years of data to say that this thing is the most beneficial under these specific conditions so you should definitely do it this way only every time.
So… that. I should come up with a colour coding system or something for my social media posts that can organize my posts into one of those categories… That would probably help limit the confusion…
Stay tuned for that! And thank you so very much to the commentor who sparked my interest in writing this post! This was so much fun!
Till next time, Folks!