The Therapeutic Order

An aspect of naturopathic medical training that sets it apart from other medical disciplines is one of its philosophical pillars, the Therapeutic Order (please click the link to view the Therapeutic Order for context regarding this post). While all medical professions have the tenet of “first, do no harm” within their doctrines, the only one that provides an actual framework to navigate this is naturopathic medicine, and it does it with the Therapeutic Order.

The Therapeutic Order provides a hierarchy of least invasive to most invasive health interventions. This can also be viewed as low- to high-risk interventions. In our medical education we are taught to approach patient care starting from the lowest point on the therapeutic order as is appropriate, and offering the least risk and bodily invasiveness to them. For many patients the appropriate starting point may be at the very base of the Order addressing lifestyle factors while, for others, a higher force intervention such as a pharmaceutical or surgery may be the best first-line course of action. We are always working with this order in mind. Even for those that need higher force interventions the goal is to support them in progressing their health toward sustaining itself with measures further down the hierarchy. This approach is completely unique to naturopathic medicine.

As an example, consider a type two diabetes diagnosis. Unlike conventional medicine where the only options for a type 2 diabetic are pharmaceutical, I have several other approaches to weigh. Depending on the severity of the presentation and whether co-morbidities and other factors are present, I might align with the standard of care and prescribe an anti-diabetic medication. In the face of robust disease, not doing this may actually be harmful to the patient and go against “first, do no harm”. That said, I wouldn’t prescribe medication without also addressing other aspects of health. Within the Therapeutic Order this additional treatment would include foundations of health (diet, lifestyle, sleep, stress reduction) and supporting specific body systems in need (digestive, nervous, and hormone systems are most common in this presentation). The goal over time would then be to decrease dependence on the pharmaceutical or higher force intervention, or the need for it altogether.

If I did not decide to lead with a pharmaceutical I would take into account botanical options which fall below pharmaceuticals on the Therapeutic Order. There are several botanicals that have been shown in clinical research to effectively  lower blood sugar in patients, often with lower side effect profiles while also offering additional benefit (e.g. antioxidant properties, antimicrobial properties). Just as with medications, however, botanicals have their limitations and can only do so much; lifestyle modifications and other support must be in place for sustainable outcomes to be achieved.

By working with patients within the context of the Therapeutic Order we are recognizing additional facets of health with the ultimate goal of optimizing the body with the least invasive measures available and, thus, the least amount of “harm”.  Appropriately supported and dependent on patient motivation and extent of the disease process, the patient in the diabetes example may not ever need a pharmaceutical or higher force intervention with this approach, and may even be able to reverse their type two diabetes diagnosis. This is the power of the Therapeutic Order.

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photography: courtneypaigeray.com