Evidence and Non-Evidence Based Treatment Options

UAGC | Case studies in non evidence based treatment Part two Hello, and welcome to this second audio file regarding non-evidence-based treatment. I hope you had fun with the discussion last week. My name is Dr. Steven Brewer. And I'm, again, joined by Dr. Erick Cervantes, assistant professor and chair of the Complementary and Alternative Health Program at Ashford University.

And before we get into the non-evidence-based treatments with those cases that Dr. Cervantes presented on last week, I'd like to first talk about evidence-based practices a little bit and the three general types of evidence-based practices out there.

So the first general type of evidence-based practice is the known efficacious or well-established treatment. Those are the ones that we hear about quite often like, cognitive behavioral therapy for anxiety or interpersonal psychotherapy for depression.

Those are all well-established treatments. The second area is probably efficacious. And these are treatments that have some peer- reviewed scientific literature that support them but not enough to where the field will point to the treatment and say yes, that's a definite go-to treatment for this condition.

And then three are the experimental treatments. These are the cutting-edge treatments that don't have almost any peer-reviewed literature. But they're still being explored as treatments. So I guess, Dr. Cervantes, my question is, is there something in complementary and alternative health or not of this evidence-based practice that is similar to these three categories?

Well, I mean, not necessarily similar to, per say, in these categories, because I think some of these categories would basically have-- you know what they would have, these logarithms that they follow-- think it's basically from top to bottom, the approach is that.

That way, from a naturopathic perspective as well as if anything, an alternative perspective, we consider empirical evidence the most important evidence, really. So if something works, we just follow that. We know that that specific thing works.

But we also do not limit ourselves and put ourselves in a box and say like, well, if that works, well, if we've seen that that works, then we should just approach it that way. We think of following as like, well, that works for that person. That's one individual.

What if we add that with another thing for the next individual? Because, again, from our perspective, this is individualistic medicine or individualistic approaches to any case-- any case. So again, empiricism to adaptation rather than believed that everybody is the same and then approaching that sameness with the same approach is more of let's actually look at the individual and what that individual needs.

So this isn't like as you would with a keyboard, a hunt and peck for the letters. This is more of an informed approach that will hopefully help the person that it was informed by what is informed by previous experience by shared knowledge in the field.

Yeah, actually, it's from many, many years of no knowledge in the field. It's passed down from practition to practition or from specific disciplines to different disciplines within the alternative health realm. So like, let's say, for example, someone comes in with a specific headache-- specific headaches that also have vertigo and ringing in the ears.

Some people would just approach it, well, that might be a neurological thing, of course. But let's provide them some medication so that they can actually tone down that. But for my approach, it's like, well, what else is going on structurally? What else is going on and to emotionally? What else is going on, perhaps, spiritually?

But what's interesting, not a lot of conventional doctors or maybe, perhaps, even other disciplines from the conventional side will look at it like, maybe structurally, we could do something. And when you look at structure and maybe, perhaps, a vertebrates out of place, then boom, you've put that vertebra back in place. And all the sudden, you have this flow again of the nervous tissue as well as blood flow, et cetera. So you got to think outside the box rather than just simply thinking, oh, reductionistically, oh, that must be just only nervous system stuff.

Right. And the great point about thinking outside the box, more and more psychologists are starting to recognize the importance of thinking outside the box even though for the past 50, 60 years or so, the zeitgeist has been evidence-based practice and that being the practices that are supported by scientific literature.

We're recognizing now that there are more and more practices out there that have been passed down through the generations that have maybe we don't know the why it works, but we know that it works. There are more and more of those out there that we have to embrace and that we have to, at least, recognize, especially when we're working with people from different cultures.

I hear more and more psychologists using their own personal definition of evidence-based approaches and that being combining their experiences as a healer, the patient's values and preferences, and the scientific theories that many psychologists use. So it's the middle ground between, I guess, what you're saying and what the field has been demanding for such a long time now.

Yeah, Dr. Brewer, if I may add, for me from my standpoint, it's rather arrogant to state that one knows everything just based on what they're reading as evidence-based. That's rather arrogant. It's more because I have to like, really pound this belief or this philosophy that we and the alternative people believe, is that no individual's the same.

Everyone has lived in a different environment. So therefore, a different expression of being. So you can't approach one perspective every individual. You have to approach an individual with multiple perspectives and different approaches. And again, beating this horse here, I'm thinking outside the box.

Well, it can't be a cookbook.

Yeah, exactly. You can't just cook book treatment approach for everybody even though it may be easier to do that sort of thing on paper. In reality, when we get into the field, that is not the case.

Cook book's rather bland then, right?

So this leads to another point regarding any practices that are not within the quote, unquote, "evidence-base being regarded as quackery." This has been the more extreme reaction I would say from the evidence-based camp in trying to discredit any practices that don't yet have any scientific support to them.

To me, it seems like it's throwing the baby out with the bathwater. There may be some practices out there that are harmful and that over time, we can show through the peer-reviewed literature, the scientific literature that they are indeed harmful.

But we shouldn't throw out every practice out there just because we haven't gotten around to actually researching them. So I know that you have something to say about the quackery aspect of the field.

Sure and sure. That's a really good point. Without going to a lot, a lot detail with the rest of the history of basically the territorial fight between conventional doctors and alternative practitioners, the split actually between conventionals and alternative practitioners took place probably in the years in the 18-- no, actually the 19th century.

What began to happen was René Descartes, actually, a little bit before René Descartes began to separate the human being into three components, basically, which was one was a mental emotional component. And the other one was a body component. But interesting enough, what he didn't regard was the spiritual component, which came way before that, because there is sufficient literature out there and historical literature that states that all cultures, specifically also Western cultures speaking of European cultures that they all treated individuals from the spiritual aspect first and then treated them into emotional and then the body perspective.

We knew much more back in the day because we only knew about our environment before we knew the microlevel aspects of our life. I'm specifically speaking to chemistry and constituents of chemistry.

We as human beings literally were much more connected to the spiritual aspect and then the mental, emotional, and then the body aspect through rituals, ceremonial rites, and customs, as well as what we have around us, which were mostly herbs and other things.

Again, back to the 1900s, René Descartes really split us in that his philosophy was that we were more like a machine rather than an actual-- from our regard, a miracle of life. Often, we don't think of ourselves as these entities that traverse shortly around the world-- I mean, for a short time around the world. And then we move on.

So I know that's more of an esoteric kind of perspective. But so that-- they call that a Decartesian split. Alternative folks didn't have a split. But conventional doctors wrote on that wave for a long time and begin to really provide evidence that they were at a very micro level that there was these little machines or like in molecules working to express who we are.

So back to the issue of quackery, I think what it is, the difference between our approaches is that you have medical doctors that treat only physical disease from one-- I mean, if you can reduce it that way, they mostly treat traumas even like mechanical trauma, like in accidents or like burns, et cetera.

But they also treat chronic disease and some acute diseases. But again, for more from a body perspective. Then you have the other split where you see counselors and psychologists and psychiatrists used only in the mental/emotional aspect. Then the other conventional side, which is spiritual people, meaning like, religious individuals, clerks, clerics, et cetera, the treating the spiritual aspect.

So you have this like, three different entities trying to address the population where from our side, you say, well, we don't think of them all separately. We'll think of them all as an entity. So every individual is compulsive, the spiritual aspect of mental/emotional aspect as well as the mental emotional.

So all of those together, that's the way we approach it. And we're called quacks for that. And it's interesting that that's the default when that is the whole human being. And every individual, again, is very unique in the way of living, the way of expression, the way they express themselves in their living environment. So maybe, perhaps, that's part of-- your question or when I'm answering. But maybe perhaps you can lead me on a little bit further into other things.

I think that's you come to a great explanation and understanding of why you're being called quacks as a field, which I think is unfortunate because, again, if you're able to take all three of these components, combine them, and understand the whole of the human being, that's there in is the holistic healing.

Absolutely.

So you hear about holistic healing quite a bit. We don't really understand what that means. But what you just described, that is holistic healing. And it could be that people in your field are ahead of your time. It could be 100-- 200 years from now, we finally have all the literature to back up what the treatments that you have and the approaches that your field is proposing.

But for now, because we have such a medicalized model-- and the medicalized model is so attached to the evidence base that it's almost like there's a willful ignorance of anything that's outside of that evidence base, unfortunately.

So if you just take all the research from each of these three areas currently and combine them, which hasn't been done yet to my knowledge, then we will have more support for your area. And perhaps, that will leave fewer people to call you quacks. Maybe they're afraid of that.

Mm-hmm. Mm-hmm.

That could be the case.

When you were adding this, I was thinking that from a medical standpoint, it's hard to understand that you would approach someone only from a body perspective. And you only put someone only for mental/emotional perspective and then a spiritual.

It's hard to believe that, because what that happens is that from an economic perspective, I mean, you're approaching someone monetarily. You're not approaching someone, from, again, what you said is holistically, you're not-- that is, in essence, our medicine is one of sustainability rather than a something that would be splitting them up to just always money.

We know that there's in a pharmaceutical industrial complex in some regard. And we know that there's a lot of money going into our medical system, unfortunately, where we're having a lot of issues. And the--

We have sickness management--

Absolutely.

--system right now rather than a health enhancement system.

Right, rather than a preventive as well. Yeah, yeah, to add into that. So anyway, it's a really interesting point you make.

Well, fascinating discussion on both of these topics. And now, Dr. Cervantes will be talking briefly about what actually happened with those case studies that we learned about last week.

Ivan, though, is a traditional-- the name, Navajo. And instead of continuing on with the conventional practice or follow-up treatment, he decided to seek out a medicine man in the Navajo Indian reservation.

So he and his wife and children went to seek out help from these elders. And he sought out a medicine man there. Basically, he took over a ceremony that took place for three days. He entered at sundown on the first day. He did not come out of what they call a hogan until three years later-- also, after sunset.

During that time, they did performed that what they call the calling the spirit back or calling the warrior back certainly, then Indian reservation. And Ivan returned from that trip from that medicine man from that ritual and little by little, regained his old self.

So I think the point of this is that there are elements of from different disciplines, specifically natural medicine where one really needs to approach a case not solely from a chemical perspective outside a trauma perspective. So a mental/emotional perspective, but also seek out one that treats the spirit.

So from that medicine man, what he did was call a spirit back into his life. And then therefore, the item returned to becoming a more sustained individual. He came off of the medications on his own. He no longer sought out the individual counseling and began to practice other traditional Navajo ceremonies, which include the sweat lodges, good sun dance, and tepee ceremonies.

So that's the first case for alignment where he's now a better person-- doesn't have any behavioral issues in PTSD symptoms that he described previously or no longer with him.

The second case is of a 29-year-old female who sought out counseling due to being gang raped when she was 14 to 16 years old. She had a lot of issues with, obviously, with her parents due to the projection that, obviously, they didn't protect her at a youthful age.

She began using drugs after that and drugs and alcohol, specifically, methamphetamine and heroin and which is interesting, though. She also began to seek out Native American ceremonies to also help her. During that process, though, one of her elders she states began to tell her that she acquired a specific spirit at a very young age.

And what that elder was saying is basically that she began to manifest the spirit that was put on to her from males, because she was a very aggressive individual, always fought with everybody. So her demeaning was very-- I guess you would describe it from a Chinese perspective as a young energy rather than more of a female essence of a yin.

So in any event, the reason I'm mentioning this case is because this 29-year-old finally decided to take a further step and do what they call also in Native American ways a spirit ceremony as a previous case was. So a spirit retrieval ceremony. And that took place when, again, when she had no resolved issues with Western medicine or Western approaches which would be counseling and other medication.

She began to experience after the ceremony a lot of alleviation of her symptoms, specifically actually the anxiety, a lot of issues with her sleep patterns. And she wouldn't be able to sleep very much. She would have constant nightmares. And she had panic attacks.

But little by little after the ceremony, she began to find relief from that. She's currently seeking also further assistance from a naturopathic doctor who provides herbs and other types of counseling that are different than approaches from the conventional approaches of counseling. And that's it for that case.