Naturopathy
Naturopathy (also known as naturopathic medicine or natural medicine) is an eclectic alternative medical system that focuses on natural remedies and the body's vital ability to heal and maintain itself. The philosophy of naturopathy favours a holistic approach and minimal use of surgery and drugs. Naturopathy comprises many different treatment modalities of varying degrees of acceptance by the medical community; diet and lifestyle advice may be substantially similar to that offered by non-naturopaths, and acupuncture may help reduce pain in some cases, while homeopathy is often characterised as pseudo science or quackery.
Naturopathy has its origins in the Nature Cure movement of Europe. The term was coined in 1895 by John Scheel and popularised by Benedict Lust, the "father of U.S. naturopathy".
Naturopathy is practiced in many countries, especially the United States and Canada, and is subject to different standards of regulation and levels of acceptance. The level of medical education in naturopathy also varies, though no naturopathic training program reaches the same level of training as an MD or DO. In the United States and Canada, the designation of Naturopathic Doctor (ND) may be awarded after completion of a four year program of study at an accredited Naturopathic medical school that includes the study of basic medical sciences as well as natural remedies and medical care. The scope of naturopathy varies widely between jurisdictions, and naturopaths in unregulated jurisdictions may use the Naturopathic Doctor designation or other titles regardless of level of education.
History of Naturopathy
Some see the ancient Greek "Father of Medicine", Hippocrates, as the first advocate of naturopathy, before the term existed. The modern practice of naturopathy has its roots in the Nature Cure movement of Europe. In Scotland, Thomas Allinson started advocating his "Hygienic Medicine" in the 1880s, promoting a natural diet and exercise with avoidance of tobacco and overwork. The term sanipractor has sometimes been used to refer to naturopaths, particularly in the Pacific Northwest region of the United States.
The term naturopathy was coined in 1895 by John Scheel, and purchased by Benedict Lust. Father Sebastian Kneipp had schooled Lust in hydrotherapy and other natural health practices in Germany; and sent Lust to the United States to spread his drugless methods. 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 giving up 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."
In 1901, Lust founded the American School of Naturopathy in New York; in 1902 he founded the Naturopathic Society of America (reorganized in 1919 as the American Naturopathic Association, ANA). 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 (N.D.) and Doctor of Chiropractic (D.C.) degrees. Estimates of the number of schools of naturopathy active in the United States during this period vary from about one to two dozen.
After a period of rapid growth, naturopathy went into decline for several decades after the 1930s. In 1910, the Carnegie Foundation for the Advancement of Teaching published the Flexner Report, which criticised many aspects of medical education, especially quality and lack of scientific rigour. The advent of penicillin and other "miracle drugs" and the consequent popularity of modern medicine also contributed to naturopathy's decline. Following Lust's death in 1945, the ANA split into six distinct organisations. In the 1940s and 1950s, a broadening in scope of practice laws led many chiropractic schools to drop their N.D. degrees, though many chiropractors continued to practice naturopathy. From 1940 to 1963, the American Medical Association campaigned against heterodox medical systems. By 1958, practice of naturopathy was licensed in only five states. In 1968, the United States Department of Health, Education, and Welfare issued a report on naturopathy concluding that naturopathy was not grounded in medical science and that education in naturopathy was inadequate to prepare graduates to make appropriate diagnosis and provide treatment; the report recommends against expanding Medicare coverage to include naturopathy oriented treatments. In 1977, an Australian committee of inquiry reached similar conclusions; it did not recommend licensure for naturopaths. As of 2009, fifteen of fifty U.S. states licensed naturopathic doctors, and some also require insurance companies to offer reimbursement for services provided by naturopathic physicians.
Naturopathy never completely ceased to exist. Beginning in the 1970s, interest waxed in the United States and Canada in conjunction with the holistic health movement.
Today, there are six accredited naturopathic medical schools in North America. In 1956, Charles Stone, Frank Spaulding, and W. Martin Bleything established the National College of Natural Medicine (NCNM) in Portland, Oregon in response to plans by the Western States Chiropractic College to drop its N.D. program. In 1978, Sheila Quinn, Joseph Pizzorno, William Mitchell, and Les Griffith established John Bastyr College of Naturopathic Medicine (now Bastyr University) in Seattle, Washington. That same year, the Canadian College of Naturopathic Medicine was founded in Toronto, Canada. More recently founded schools include the Southwest College of Naturopathic Medicine, founded in 1992, and Boucher Institute of Naturopathic Medicine, also founded in 1992. The University of Bridgeport in Connecticut grants ND degrees through the College of Naturopathic Medicine, and the National University of Health Sciences in Illinois recently developed a naturopathic program, for which they are currently seeking accreditation.
Principles of Naturopathy
The ideology of naturopathy focuses on naturally-occurring and minimally-invasive methods, trusting to the "healing power of nature." Treatments such as "synthetic" drugs, radiation, and major surgery are avoided, and rejection of biomedicine and modern science in favour of an intuitive and vitalistic conception of the body and nature is common. Prevention through stress reduction and a healthy diet and lifestyle is emphasised. The philosophy of naturopathic practice is self-described by six core values. Multiple versions exist in the form of the naturopathic doctor's oath, various mission statements published by schools or professional associations, and ethical conduct guidelines published by regulatory bodies:
- First, do no harm; provide the most effective health care available with the least risk to patients at all times (primum non nocere).
- Recognize, respect and promote the self-healing power of nature inherent in each individual human being. (Vis medicatrix naturae, a form of vitalism).
- Identify and remove the causes of illness, rather than eliminate or suppress symptoms (Tolle Causum).
- Educate, inspire rational hope and encourage self-responsibility for health (Doctor as Teacher).
- Treat each person by considering all individual health factors and influences. (Treat the Whole Person).
- Emphasize the condition of health to promote well-being and to prevent diseases for the individual, each community and our world. (Health Promotion, the Best Prevention)
Practice of Naturopathy
The focus of naturopathy is on its philosophy of natural self-healing rather than specific methods, and practitioners use a wide variety of treatment modalities. Some methods used in naturopathy 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, though Bastyr, NCNM and CCNM currently maintain research programs. Bastyr also receives research funding from the NIH, a relationship that began in 1984, when Bastyr became the first naturopathic school to receive a research grant from the NIH. The effectiveness of naturopathy as a whole system has not been systematically evaluated, and efficacy of individual methods used varies.
A consultation typically begins with a lengthy patient interview focusing on lifestyle, medical history, emotional tone, and physical features, as well as physical examination. Naturopaths do not necessarily recommend vaccines and antibiotics, and may provide alternative remedies even in cases where evidence-based medicine has been shown effective.
Methods used in Naturopathy
The particular modalities utilised by an individual naturopath varies with training and scope of practice. The demonstrated efficacy and scientific rationale also varies. These include: Acupuncture, Applied Kinesiology, Botanical medicine, Brainwave entrainment, Chelation therapy for atherosclerosis, Colonic enemas, Color therapy, Cranial osteopathy, Hair analysis, Homeopathy, Iridology, Live blood analysis, Nature cure - a range of therapies based upon exposure to natural elements such as sunshine, fresh air, heat, or cold, Nutrition (examples include vegetarian and whole food diet, fasting, and abstention from alcohol and sugar), Osteopathy, Ozone therapy, Physical medicine (includes naturopathic, osseous, and soft tissue manipulative therapy, sports medicine, exercise and hydrotherapy), Psychological counselling (examples include meditation, relaxation, and other methods of stress management), Public health measures and hygiene, Reflexology, Rolfing, and Traditional Chinese medicine.
A 2004 survey determined the most commonly prescribed naturopathy modalities in Washington State and Connecticut were botanical medicines, vitamins, minerals, homeopathy, and allergy treatments.
Practitioners of Naturopathy
Naturopathy is available from three broad categories: practitioners with a four-year Doctor of Naturopathic Medicine degree or similar formal training; practitioners who are self-taught or have been apprenticed to another naturopath; and practitioners who operate under another professional license while also offering some naturopathic methods. In unregulated jurisdictions, the designation Doctor of Naturopathy and similar terms are not protected and may be used by any practitioner regardless of qualifications.
Naturopathic doctors
Naturopathic doctor (ND) or a similar term is a protected designation with some form of licensing and training requirements in at least 15 US states, the District of Columbia, and five Canadian provinces. In these jurisdictions, naturopathic doctors must pass board exams set by the North American Board of Naturopathic Examiners (NABNE) after completing academic and clinical training at a college certified by the Council on Naturopathic Medical Education (CNME). The CNME is formally recognised by the U.S. Secretary of Education as the accrediting body for naturopathic medical programs. Residency programs are offered at Bastyr University, NCNM, SCNM, CCNM, and the University of Bridgeport. NDs are not required to engage in residency training. Many naturopaths present themselves as primary care providers. ND training includes the use of basic medical diagnostic tests and procedures such as medical imaging, minor surgery, and blood tests. The CNME also provides for the inclusion of optional modalities including minor surgery, natural childbirth and intravenous therapy, though they are not generally licensed to perform these functions; these modalities require additional naturopathy training and may not be within the scope of practice in all jurisdictions. This training differs from that undertaken by MDs as it requires therapies, which are not required at medical school, such as botanical medicine, clinical nutrition, naturopathic manipulation and homeopathy.
In 2005, the Massachusetts Medical Society opposed licensure for naturopathy in the commonwealth based on concerns that NDs are not required to participate in residency, and may also suggest inappropriate or harmful treatments. The Massachusetts Special Commission on Complementary and Alternative Medical Practitioners rejected their concerns and recommended licensure.
The core set of interventions defined by the Council on Naturopathic Medical Education and taught at all six accredited schools in North America includes: acupuncture and Traditional Chinese medicine, botanical medicine, homeopathy, nature cure (a range of therapies based upon exposure to natural elements), nutrition, physical medicine, and psychological counselling.
In the state of Washington, where naturopathic doctors are licensed comparably to primary care physicians, many naturopathic doctors also accept insurance, with some plans offering the option of designating a naturopath as a primary care provider. In Connecticut, state law requires insurance providers to provide some coverage of naturopathic services, while Oregon, another state with significant numbers of naturopathic doctors, does not.
Traditional naturopaths
Traditional naturopaths are guided by the same naturopathic philosophies and principles as board-licensed naturopathic doctors and often prescribe similar treatments. Traditional naturopaths however, are not primary care providers, whereas graduates of CNME accredited naturopathic medicine schools are classified as both alternative or complementary practitioners as well as primary care providers. Traditional naturopaths may voluntarily join a professional naturopathy organisation, but these organisations do not accredit educational programs in any meaningful way or license practitioners, per se. The training programs for traditional naturopaths can vary greatly. Compared to naturopathic medical schools, traditional naturopathy training programs are less rigorous and do not provide the same basic and clinical science education. The professional organisations formed by traditional naturopaths are not recognized by the government of the USA or any US State or Territory.
Other health care professionals
According to a 1998 taskforce report, some physicians are choosing to add naturopathic modalities to their practice, and states such as Texas have begun to establish practice guidelines for MDs who integrate naturopathy and other alternative and complementary medicine into their practice. Continuing education in naturopathic modalities for health care professionals varies greatly but includes offerings for many professions, including physicians, physical therapists, chiropractors, acupuncturists, dentists, researchers, veterinarians, physician assistants, and nurses. These professionals usually retain their original designation but may use terms such as 'holistic', 'natural', or 'integrative' to describe their practice.
Conventional evidence basis for Naturopathy
Evidence-based medicine (EBM) has been advocated as an appropriate methodology for investigating natural medicine such as naturopathy, which has been characterised as lacking an adequate scientific basis. Traditional naturopathic practitioners perceive EBM as an ideologic assault on their beliefs in vitalistic and holistic principles. They advocate the integrity of natural medicine practice. Traditional natural medicine practitioners could have problems in understanding and applying the concept of EBM.
Although naturopathy is increasingly accepted by the general public, members of the medical community show a critical or even rejecting view of naturopathy. With greater scientific knowledge of naturopathy, better therapeutic approaches could be achieved, resulting in improved therapy models and an economic benefit for the health care system. Naturopathic physicians have begun to contribute to research and adapt modern scientific principles into clinical practice, further developing and validating the profession. There is growing collaborative efforts between naturopaths and medical doctors to evaluate the safety and efficacy of naturopathy in prevention and management of a broad range of common ailments, and to decide whether accessibility of naturopathic services will enhance patient health in a cost-effective way.
Scepticism
Naturopathy is viewed with scepticism for its reliance on or association with unproven and controversial alternative medical treatments, and for its vitalistic underpinnings. As with any medical care, there is a risk of misdiagnosis; this risk may be lower depending on level of training. There is also a risk that ailments that cannot be diagnosed by naturopaths will go untreated while a patient attempts treatment programs designed by their naturopath. Certain naturopathic treatments, such as homeopathy and iridology, are widely considered pseudoscience or quackery.
Stephen Barrett (of Quackwatch and the National Council Against Health Fraud) has stated that the philosophy of naturopathy is "simplistic and that its practices are riddled with quackery."
K. C. Atwood writes, in the journal Medscape General Medicine, "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." K. C. Atwood writes, in the journal Medscape General Medicine, about doctors with naturopath colleagues that "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 aren't to be judged "nonscientific practitioners," the term has no useful meaning.
According to Arnold S. Relman, the Textbook of Natural Medicine is inadequate as a teaching tool, as it omits to mention or treat in detail many common ailments, improperly emphasizes treatments "not likely to be effective" over those that are, and promotes unproven herbal remedies at the expense of pharmaceuticals. He concludes that "the risks to many sick patients seeking care from the average naturopathic practitioner would far outweigh any possible benefits."
Vaccination
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 negative vaccination view are complicated and rest, at least in part in the early philosophies which shape the foundation of these professions. A survey of a cross section of students of a major complementary and alternative medicine college in Canada reported that students in the later years of the program opposed vaccination more strongly than newer students.
A University of Washington study investigated insurance claim histories for alternative medicine use in relation to the receipt of vaccinations against preventable illnesses, grouped into children aged 1–2 years and 1–17 years. Both groups were significantly less likely to receive a number of their vaccinations if they visited a naturopath. The study found a significant association between visits to naturopaths with a reduced receipt of paediatric vaccinations and with obtaining of vaccine preventable illnesses.
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