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A Method for Describing and Evaluating Naturopathic Whole Practice

Patricia M. Herman, ND, MS; Karen J. Sherman, PhD, MPH; Janet H. Erro, RN, MN, PNP; Daniel C. Cherkin, PhD; Bruce Milliman, ND; Lizbeth A. Adams, PhD

Even though complementary and alternative medicine (CAM) is generally practiced as distinct systems of medicine, virtually all CAM research has focused on single therapies.1-3 In order to more adequately evaluate the effectiveness of these medical systems, studies that characterize and evaluate the outcome of intact whole systems are needed. One challenge lies in defining the whole medical system (and any medical system it is compared to) in a way that ensures treatment fidelity.

Several researchers have recommended that specific medical systems be studied, each as a “black box,”4,5 often defined minimally as treatment by a practitioner of that medical system with, say, X years of experience. Others recommend that the box be unpacked.1,6 The simply defined “black box” approach offers no assurance that the box contents are a valid representation of the medical system; however, given the number of different diagnosis schemes and treatments available, complete “unpacking” may prove an insurmountable measurement, analysis, and interpretation challenge.

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