A case for Case Studies
7 Reasons for sharing CAM case studies
As complementary healthcare practitioners, we rarely share case studies with our clients, our colleagues or the public, although we have a huge database of experiences and knowledge. I want to encourage you to publish your case studies going forward, and here are the seven reasons why you should consider this:
Note: For the purpose of this article, I use the term Complementary Alternative Medicine (CAM) to denote collectively the various forms of p-i-c-h-a-n-t (proactive, integrative, complementary, holistic, alternative, natural, traditional) medicine.
Consumers – Clients – Customers – Patients
The end users of CAM, the clients or patients, are often asking the question: “Does this really work?” and “Is this a viable alternative option?” Many are choosing a conventional approach because they simply lack confidence in alternative medicine, due to a lack of real evidence. This is a tragedy because the client, practitioner and the field of CAM would have benefited from another success story and a lost client is a missed opportunity.
There is also no centralised place for the consumer to go and find real evidence of success stories. Their first call of choice would be Google, but how many of the CAM experts are successfully practising Search Engine Optimisation (SEO )and publishing their case studies online? Not very many at all, so far.
Additionally, awareness of modalities varies by country. For example, Ayurveda is deeply engrained in India’s psyche and very popular in Germany, but there is little awareness of it in the United Kingdom. Moreover, this varying level of awareness affects how the experience of Ayurveda is shared by word of mouth from country to country. In India, it is about what helped Uncle Bill or Auntie Mary to reduce their arthritis by 80% after pancha karma treatment, but in Germany the story will change to how Ayurveda abhyanga treatment improved someone’s mobility and reduced pain. The underlying reason for this is how Ayurveda is practised due to legal restrictions in Europe.
There are hundreds of different types of CAM. The five most well-known modalities in the UK are acupuncture, yoga, Chinese medicine, homeopathy and osteopathy. After that, the consumer’s awareness of CAM drops off dramatically. The modalities are very niche and are often stand-alone; they don’t interact with one another and practitioners are often not aware of the case studies available in their own field, let alone in the field of a colleague healthcare provider.
But there is evidence that clients want to be part of a multi-disciplinary approach; they enjoy the various opinions and supports given by a mix of CAM modalities. Once a client has taken the step to research their condition, they will try and see a variety of practitioners of various modalities until they find the ones they are most comfortable with. This is a process of trial and error which practitioners are ill-equipped to assist.
Practitioners are also often asked to defend their naturally-based approach against conventional allopathic or chemical medicine. It can be very useful to be equipped with case studies from their field, covering a wider array of cases than they have experienced locally, because that is what the practitioners of allopathic medicine are able to do. They quite rightly rely on the experience of other hospitals, approaches and practitioners in their field to educate the consumer about the options available.
Cases studies are road maps for the practitioner in training. Well-documented case studies with pictures will show the practitioner the process of intervention and what to expect – the best possible outcome or a potential setback and problems on the way.
For example, in Ayurveda, some clients may be asked to stick to a strict fasting programme during treatment or arrive to their appointment on an empty stomach. When the clients deviate from this plan, treatments could result in nausea or incorrect assessments. A case study may also list problems as well as achievements during the treatment programme, providing professional development for the learning practitioner.
A practitioner may work in conjunction with other holistic service providers, such as those specialising in yoga or relaxation, and achieve better results by improving their client’s ability to stick to a restricted diet and detox programme. When this is documented in case studies, other practitioners may advise their clients to work in conjunction with these colleagues more often and thereby benefit from better client collaboration and, ultimately, better treatment outcomes.
Changing the Status Quo
The status quo of medical research is quantitative research in the form of Randomised Controlled Trials (RCT). This is squaring a circle to CAM as it curtails the unique opportunities that CAM brings. CAM practitioners do not randomise the study object, in fact the opposite is the case. Instead of reducing their unique characteristics, we are looking to find them and bring them out. It’s the unique characteristics on which a treatment approach is based.
RCTs and quantitative research don’t work for us for other reasons too. In Ayurveda, there are many multi-herbal formulations. It is impossible to research all these individual herbs plus all the possible herbal interactions of formulations with the quantitative methodology, assuming any reasonable time frame and cost to do this.
Multi-herbal formulations reduce side effects whilst having great efficacy. Clients will benefit from these herbal formulations, which have been successfully used for hundreds of years. It’s the success and the degree of success which should inform the practitioner via a case study research approach.
All industry research, including that carried out by the consumer and financial industries, employs both types of research approaches – qualitative and quantitative. Medicine, however, is overly focused on quantitative research methodology, totally ignoring the qualitative approach to the point that the case study approach is not even academically as well developed.
For CAM to flourish, it needs a new approach to research and only by starting to share case studies will this process get a kick-start.
In the US there is “board certification”, which demonstrates a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice. Specialisation is voluntary; a practitioner can choose their field of expertise.
If as a CAM practitioner you specialise in an area, you may want to showcase that through publishing your case studies. This will be attractive to other practitioners in your field, who want to hear you speak about your experiences or come and work with you.
As well as sharing the case study with your colleagues and clients, practitioners in other medical fields may also find it interesting to work with you and refer clients your way.
Develop Case Study Protocol
Evidence-based medicine is a blessing and a curse in one. Since 2000, the academic community has been running with the quantitative RCT research approach to the exclusion of everything else. The RCT protocol was highly in fashion and is by now a very developed approach. It has an important role to play, indeed. But what is lacking is qualitative case study methodology. The industry is only standing on one leg by ignoring the case study research approach completely.
The good news is quantitative research protocol will give us security about the correct research approach to receive a “scientifically valid” peer reviewed certificate. The bad news is that it is also a barrier to entry for many institutions, as the databases – the vaults that hold these standards – are very expensive to access and often not affordable for researchers in many countries outside the West. Many CAM practices, however, originate outside of the rich western countries. Yet, we are asking these practitioners to fit into an ill-fitting system of evidence-based research and without access to what is expected of them in detail.
So, there is always a high chance that research will be easily dismissed as not following the right protocol. This is a waste of time for the medical industry overall and when animal trials are involved, it means unnecessary suffering. CAM Case Studies share the work of practitioners with individuals and are not based on animal trials, and as such are a kinder way to obtain and share information, a benefit which should also be acknowledged.
We cannot wait until western academia offers to discuss a CAM case study approach. This has to come from the practitioners of CAM themselves. There are many different ways to record case studies and best practice has yet to be developed. We have the perfect opportunity to create something that will truly fit our desire to treat the patient in a way which will return them to a healthy balance and vibration and not focus on simply eradicating the disease. Media resources, such as videos and photographs and online platforms, have never been cheaper or more accessible. The time is right for CAM practitioners to discuss, practice and share their case studies.
What we need is to develop platforms that are peer reviewed but free for the contributing user so that everyone who supplies case study research can access this database for free. This will allow smaller institutions and non-western countries to be the driving force in this very valid research methodology.
Sonja Breuer MSc. ayur. med.