NATUROPATHY – NATUROPATHIC MEDICINE
Naturopathy or naturopathic medicine is a form of alternative medicine employing a wide array of “natural” treatments, including homeopathy, herbalism, and acupuncture, as well as diet and lifestyle counseling. Naturopaths favor a holistic approach with non-invasive treatment and generally avoid the use of surgery and drugs. Naturopathic philosophy is based on a belief in vitalism and self-healing, and practitioners often prefer methods of treatment that are not compatible with evidence-based medicine. Naturopathic medicine is replete with pseudoscientific, ineffective, unethical, and possibly dangerous practices.
The term “naturopathy” was created from “natura” (Latin root for birth) and “pathos” (the Greek root for suffering) to suggest “natural healing.” Modern naturopathy grew out of the Natural Cure movement of Europe. The term was coined in 1895 by John Scheel and popularized by Benedict Lust, the “father of U.S. naturopathy”. Beginning in the 1970s, there was a revival of interest in the United States and Canada, in conjunction with the holistic health movement.
Naturopathic practitioners in the United States can be divided into three categories: traditional naturopaths; naturopathic physicians; and other health care providers that provide naturopathic services. The scope of practice varies widely between jurisdictions, and naturopaths in unregulated jurisdictions may use the Naturopathic Doctor designation or other titles regardless of level of education. Naturopathic physicians employ the principles of naturopathy within the context of conventional medical practices.
Much of the ideology and methodological underpinnings of naturopathy are in conflict with the paradigm of evidence-based medicine. Their training adds up to a very small amount of that of primary care doctors. Any naturopaths oppose vaccination based in part on the early views that shaped the profession. According to the American Cancer Society, “scientific evidence does not support claims that naturopathic medicine can cure cancer or any other disease, since virtually no studies on naturopathy as a whole have been published.” Naturopaths claim the ancient Greek “Father of Medicine”, Hippocrates, as the first advocate of naturopathic medicine, before the term existed. Naturopathy has its roots in the 19th century Nature Cure movement of Europe.
Benedict Lust defined naturopathy as a broad discipline rather than a particular method, and included such techniques as hydrotherapy, herbal medicine, and homeopathy, as well as eliminating overeating, tea, coffee, and alcohol. He described the body in spiritual and vitalistic terms with “absolute reliance upon the cosmic forces of man’s nature”.
Naturopaths became licensed under naturopathic or drugless practitioner laws in 25 states in the first three decades of the twentieth century. Naturopathy was adopted by many chiropractors, and several schools offered both Doctor of Naturopathy (ND) and Doctor of Chiropractic (DC) degrees. Estimates of the number of naturopathic schools active in the United States during this period vary from about one to two dozen.
Beginning in the 1970s, interest waxed in the United States and Canada in conjunction with the holistic health movement. Naturopathic practice is based on a belief in the body’s ability to heal itself through a special vital energy or force guiding bodily processes internally. Diagnosis and treatment concern primarily alternative therapies and “natural” methods that naturopaths claim promote the body’s natural ability to heal. Naturopaths focus on a holistic approach, often completely avoiding the use of surgery and drugs. Naturopaths aim to prevent illness through stress reduction and changes to diet and lifestyle, often rejecting the methods of evidence based medicine.
A consultation typically begins with a lengthy patient interview focusing on lifestyle, medical history, emotional tone, and physical features, as well as physical examination. Many naturopaths present themselves as primary care providers, and some naturopathic physicians may prescribe drugs, perform minor surgery, and integrate other conventional medical approaches such as diet and lifestyle counselling with their naturopathic practice. Traditional naturopaths deal exclusively with lifestyle changes, not diagnosing or treating disease. Naturopaths do not generally recommend vaccines and antibiotics, based in part on the early views that shaped the profession, and they may provide alternative remedies even in cases where evidence-based medicine has been shown effective.
The particular modalities used by a naturopath vary with training and scope of practice. These may include: herbalism, homeopathy, acupuncture, natural cures, physical medicine, applied kinesiology, brainwave entrainment, colonic enemas, chelation therapy for atherosclerosis, color therapy, cranial osteopathy, hair analysis, iridology, live blood analysis, ozone therapy. Nature cures include a range of therapies based on exposure to natural elements such as sunshine, fresh air, or heat or cold, as well as nutrition advice such as following a vegetarian and whole food diet, fasting or abstention from alcohol and sugar. Physical medicine includes naturopathic, osseous, or soft tissue manipulative therapy, sports medicine, exercised and hydrotherapy. Psychological counseling includes meditation, relaxation, and other methods of stress management.
Naturopathic practitioners in the United States can be divided into three groups, naturopathic physicians, traditional naturopaths, and other health care providers who offer naturopathic services. Naturopathic doctors are licensed in 17 US states and 5 Canadian provinces. In jurisdictions where Naturopathic doctor (ND or NMD) or a similar term is a protected designation, naturopathic doctors must pass the Naturopathic Physicians Licensing Examinations administered by the North American Board of Naturopathic Examiners (NABNE) after graduating from a college accredited by the Council on Naturopathic Medical Education (CNME). Residency programs are offered at four of these colleges. NDs are not required to engage in residency training except in the state of Utah.
In 2005, the Massachusetts Medical Society opposed licensure based on concerns that NDs are not required to participate in residency and are trained in inappropriate or harmful treatments. The Massachusetts Special Commission on Complementary and Alternative Medical Practitioners rejected their concerns and recommended licensure.
Many naturopaths present themselves as primary care providers. Doctor of Naturopathy training includes basic medical diagnostic tests and procedures such as medical imaging and blood tests, as well as vitalism and pseudoscientific modalities such as homeopathy.
Texas has begun establishing practice guidelines for doctors who integrate alternative and complementary medicine into their practice. Continuing education in naturopathic modalities for health care professionals varies greatly.
Traditional naturopaths are represented in the United States by the American Naturopathic Association (ANA), representing about 1,800 practitioners and the American Naturopathic Medical Association (ANMA).
The level of naturopathic training varies among traditional naturopaths in the United States. Traditional naturopaths may complete non-degree certificate programs or undergraduate degree programs and generally refer to themselves as Naturopathic Consultants. These programs often offer online unaccredited degrees, but do not offer proper biomedical education or clinical training. Those completing a Doctor of Naturopathy (ND) degree from an ANMCB approved school can become a Board Certified Naturopathic Doctor. This board certification is in no way the same as holding an ND license and holds no weight in states that regulate the practice of naturopathic medicine.
Traditional naturopathic practitioners surveyed in Australia perceive evidence based medicine to be an ideologic assault on their beliefs in vitalistic and holistic principles. They advocate the integrity of natural medicine practice. Some naturopaths have begun to adapt modern scientific principles into clinical practice.
Naturopathy lacks an adequate scientific basis, and it is rejected by the medical community. Some methods rely on immaterial “vital energy fields”, the existence of which has not been proven, and there is concern that naturopathy as a field tends towards isolation from general scientific discourse. Naturopathy is criticized for its reliance on and its association with unproven, disproven, and other controversial alternative medical treatments, and for its vitalistic underpinnings. Although some neutraceutical substances used in naturopathy have some promise in laboratory experiments, there is no evidence this translates to a benefit to human health. According to the American Cancer Society, “scientific evidence does not support claims that naturopathic medicine can cure cancer or any other disease, since virtually no studies on naturopathy as a whole have been published.
“Naturopathic physicians now claim to be primary care physicians proficient in the practice of both “conventional” and “natural” medicine. Their training, however, amounts to a small fraction of that of medical doctors who practice primary care. An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices”. Physicians who consider naturopaths to be their colleagues thus find themselves in opposition to one of the fundamental ethical precepts of modern medicine. If naturopaths are not to be judged “nonscientific practitioners”, the term has no useful meaning”. “All forms of naturopathic education include concepts incompatible with basic science, and do not necessarily prepare a practitioner to make appropriate diagnosis or referrals.”
Naturopaths often recommend exposure to naturally occurring substances, such as sunshine, herbs and certain foods, as well as activities they describe as natural, such as exercise, meditation and relaxation. Naturopaths claim that these natural treatments help restore the body’s innate ability to heal itself without the adverse effects of conventional medicine. However, “natural” methods and chemicals are not necessarily safer or more effective than “artificial” or “synthetic” ones, and any treatment capable of eliciting an effect may also have deleterious side effects.
Many forms of alternative medicine, including naturopathy, homeopathy, and chiropractic are based on beliefs opposed to vaccination and have practitioners who voice their opposition. The reasons for this opposition are based, in part, on the early views which shaped the foundation of each profession In general, evidence about associations between naturopathy and pediatric vaccination is sparse, but “published reports suggest that only a minority of naturopathic physicians actively support full vaccination” and that most recommend against them.
Naturopathy is practiced in many countries and is subject to different standards of regulation and levels of acceptance. The scope of practice varies widely between jurisdictions, and naturopaths in some unregulated jurisdictions may use the Naturopathic Doctor designation or other titles regardless of level of education. The practice of naturopathy is illegal in two USA states.
In five Canadian provinces, seventeen U.S. states, and the District of Columbia, naturopathic doctors who are trained at an accredited school of naturopathic medicine in North America, are entitled to use the designation ND or NMD. Elsewhere, the designations “naturopath”, “naturopathic doctor”, and “doctor of natural medicine” are generally unprotected or prohibited.
In North America, each jurisdiction that regulates naturopathy defines a local scope of practice for naturopathic doctors that can vary considerably. Some regions permit minor surgery, access to prescription drugs, spinal manipulations, obstetrics and gynecology and other regions exclude these from the naturopathic scope of practice or prohibit the practice of naturopathy entirely.
The province of Quebec does not directly regulate naturopathy. The Quebec Ministry of Education has prohibited schools from offering doctoral programs in the subject, and there are no universities with a naturopath program. Therefore, studies must be done out of province. Furthermore, in Quebec, the College des medecins du Quebec (CMQ) has exclusive rights to perform certain activities including but not limited to: ordering diagnostic examinations, prescribing medication and other substances and clinically monitoring the condition of patients whose state of health presents risks. This severely restrains the scope of practice for a naturopathic doctor. In Quebec, group benefits insurance is mandatory if offered by the employer, and coverage for a naturopathic doctor is typically included in these policies. As a result of the limitations (scope of practice, title, education) in Quebec concerning naturopathic doctors, the term naturotherapy has been accepted by some insurance carriers.