Allopathy is the form of medicine most familiar to Americans. It is so familiar, in fact, that it is more commonly called conventional medicine. Guidelines that are currently recognized in the United States for evidence-based medicine have all been developed by researchers and clinicians who practice allopathic approaches to medicine.

Naturopathic practitioners often describe themselves as treating people as opposed to treating disease, the latter of which is considered to be the purview of allopathic medicine. The truth is, however, that naturopaths also treat diseases, but regard them differently. That is, while conventional practitioners consider illness to be a sign of operational failure in a biological organism, naturopaths view it to be a sign of functional success. Naturopaths know that people manifest symptoms when the body and mind are in the process of attempting to restore balance after some sort of dysregulation has occurred.

A fever is a good example of one of the body's mechanisms for successfully dealing with an infection. While a allopath will probably tell you to take something to suppress a fever, like aspirin or ibuprofen, a naturopath will tell you to support yourself while allowing the fever to take its course naturally, and to use physical medicine, such as a cool cloth or a tepid bath, to keep the fever at a level high enough to do its job but not so intense as to cause a febrile seizure (a seizure due to a fever).

Similarly, allopaths do indeed treat people, but they view their role in the healing process differently from naturopaths. For allopaths, people are viewed as passive beneficiaries of their treatments. For naturopaths, people are active participants.

Naturopaths know that people heal themselves. Allopaths, on the other hand, believe that medications and other therapeutic interventions such as surgery, heal.

Some people find it easier to understand allopathy by comparing it with another approach to medicine. If you'd like do this, go to homeopathy.

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Best evidence refers to medical research that is well-designed and pertinent to your medical condition. Of particular interest is patient-centered research into the validity of diagnostic testing for your condition, the reliability of chemical markers for predicting your future health, and the effectiveness and safety of different therapies.

Clinical expertise refers to the proficiency and judgement that your clinician has acquired through previous experience diagnosing and treating people like yourself.

For Sackett, clinical expertise also includes the "thoughtful identification and compassionate use of patients' predicaments, rights, and preferences in making clinical decisions about their care". That is, he regards your clinician's ability to take your wishes into account when giving you treatment recommendations to be part of your clinician's professional expertise. However, this aspect of EBM as defined by Sackett has been more recently separated out as a distinct variable in what is more broadly called evidence-based practice.

Reference: Sackett, D. Evidence-based Medicine - What it is and what it isn't. BMJ 1996; 312:71-72. http://www.bmj.com/cgi/content/full/312/7023/71

Evidence-base practice involves a series of discrete steps.

1. Identify a clinical problem. For example, a person has acute diarrhea.

2. Formulate a well-focused question that includes the (a) problem (P), (b) the intervention under consideration (I), (c) alternative interventions to which the target intervention is being compared (C), and (d) the desired outcome (O). For example, will a change in diet (I), as opposed to no change in diet (C) resolve (O) the person's diarrhea (P)?

3. Find available medical research that is relevant to the question.

4. Review the research.

5. Evaluate the quality of the research.

6. Distill the results of the research.

7. Consider the results in light of the practitioner's clinical expertise.

8. Discuss the results with reference to patient values that may impact the applicability (or not) of the results to the current problem.

9. Decide upon whether or not to utilize the intervention.

10. Apply the intervention.

11. Evaluate the outcome of the intervention.

12. Determine if anything else needs to be done. For example, if the desired outcome is not achieved, then the process must begin again.

Although this process, when laid out step-by-step, appears to be a lengthy one, it actually can unfold quite easily during a single appointment with electronic access to medical research.

Reference: Expanded and adapted from EBP Tutorial prepared by Duke University Medical Center and Health Services Library UNC-Chapel Hill, 2010.

Values refer to the internal world -- the consciousness that we bring to a situation -- beliefs, opinions, preferences, attitudes, fears and our awareness of these aspects of our internal world. Some of what we bring is unconscious. This means that we don't know it is influencing us. Some of it is conscious; we do know that it is affecting us. Values clarification is a process whereby we consciously try to increase our personal degree of self-awareness, so that our choices can become as reasoned as possible, i.e. less affected by unconscious values. In integral EBP, both you and your clinician are invited to clarify your values and to articulate them as part of the EBP process.

Why are our values important? Much as we would like to believe otherwise, there is no such thing as pure objectivity, i.e. the absolute absence of bias. What we perceive depends entirely upon our personal perspective on the situation we are experiencing. This phenomenon is well-documented in cross-cultural studies and you see its effect in the various misunderstandings to which we regularly fall prey with the people we meet during the course of our lives. We see what we are prepared to see, and what we are prepared to see depends upon a myriad of factors, including but not limited to, our past experience, our cultural and personal values, our cognitive capabilities, and our likes and dislikes.

Like you, your doctor brings a personal perspective to the the therapeutic relationship that affects, just as profoundly as your perspective, what transpires between the two of you, the outcome of which becomes part of your total experience of health care. It determines, at least in part, what the two of you talk about, as well as how you talk it. It affects the kinds of recommendations that are made, as well as the nature of the responses your receive to your opinions and concerns. Even the length of your appointment reflects clinician bias. Consider, for example, what being offered a ten minute appointment versus a 45 minute consultation tells you about how your clinician views the role of time in promoting an effective therapeutic outcome.

In integral EBP, your clinicians recognize and explicitly acknowledge they are not neutral. They acknowledge their personal bias and how it is affecting their comments on your situation so that together you can identify points of convergence in how you are looking at their clinical situation as well as divergence.

The final type of bias -- researcher bias -- is perhaps the most difficult one to integrate into integral EBP because most research studies in modern medicine claim to be objective. But objectivity is an illusion: the mere act of chosing a problem to research is determined by clinician bias. For example, the fact that there are so many more studies concerned with the effects of drugs, than with the effect of foods and herbs on various medical conditions, is a function of researcher bias, albeit perhaps buried under the guise of funding availability. But the fact that funding in the medical community today is geared towards supporting pharmaceutical interventions reflects a pervasive set of beliefs about what medicine is, and what it is not, as well as about who should benefit from it and who should pay for it.

Finally, in a truly integral medical praxis, not only are clinician and researcher values integrated into the process, but also both the clinician and the individual seeking care are involved in all steps of the process.

In fact, in Vermont, medical practices must demonstrate that they use EBG for the management of at least four medical conditions before they can be certified as an Advanced Primary Care Practices. This status then makes these practices eligible for enhanced payments and support services through the Vermont Blueprint.

The science and methodology of guideline development has evolved over time to include primarily recommendations based upon evidence gleaned from allopathic medical literature based upon clinical trials (experiments) where the effect of one medication or medical treatment is compared to a placebo (no treatment). For this reason, guidelines based on consensus, clinical experience or tradition, or expert opinion alone, are becoming less acceptable, except in clinical settings where limited empirical evidence is available.

The creation of evidence-based guidelines involves conducting a comprehensive literature search, critically evaluating the quality of the evidence and generating recommendations based upon the results of the studies examined.

Many EBG also grade the quality of the evidence upon which the recommendations are based. This offers users a more uniform interpretation of the recommendations. Grades are used to distinguish interventions that are clearly beneficial (or harmful) from those where benefits and risks are uncertain. The grading system uses particular criteria to evaluate the quality of any evidence used to support a recommendation (EBG).

It is assumed that transparency in reporting how an evidence-based guidelines is developed, together with an assessment of the quality of the medical research upon which the guideline recommendations are based, plus a grading of the guidelines themselves, will help users employ EBG effectively when making clinical decisions. (http://asheducationbook.hematologylibrary.org/content/2008/1/26.full.)

EBG pose a unique challenge for integral medical praxis, which embraces all medical traditions, because they have all been developed within a single medical paradigm -- that of allopathy and empirical clinical research as defined by modern western medicine.