Naturopathic medicine

Naturopathic medicine includes a variety of practices aiming to improve health and treat disease by assisting the body's natural healing. It includes nutrition, exercise, and application of heat and cold. Naturopathic medicine uses physiological, psychological and mechanical methods, such as air, water, light, heat, earth, phytotherapy, food and herb therapy, psychotherapy, electrotherapy, minor and orificial surgery, mechanotherapy, naturopathic corrections and manipulation and natural methods or modalities, together with natural medicines, natural processed foods and herbs and natural remedies. Naturopathic medicine excludes major surgery, x-rays and the use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and are physiologically compatible to body processes for maintenance of life.[1].

History of naturopathic medicine

The term naturopathy was coined before 1900, by John Scheel, and used by Benedict Lust. Lust had been schooled in hydrotherapy and other natural health practices in Germany by Father Sebastian Kneipp, who sent Lust to the United States to bring them Kneipp's methods. In 1905, Lust founded the American School of Naturopathy in New York, the first naturopathic college in the United States. Lust took great strides in promoting the profession, culminating in passage of licensing laws in several states prior to 1935, including Arizona, California, Connecticut, Hawaii, Oregon, and Washington and the existence of several naturopathic colleges.

Naturopathic medicine went into decline, along with most other natural health professions, after the 1930s, with the discovery of penicillin and advent of synthetic drugs such as antibiotics and corticosteroids in the post-war era, Lust's death, conflict between various schools of natural medicine (homeopathy, eclectics, physio-medicalism, herbalism, naturopathy, etc.), the rise of medical technology, and consolidation of political power in conventional medicine were all contributing factors. In 1910, when the Carnegie Foundation for the Advancement of Teaching published the Flexner Report which criticized many aspects of medical education in various institutions (natural and conventional), it was mostly seen as an attack on low-quality natural medicine education. It caused many such programs to shut down and contributed to the popularity of conventional medicine.

Naturopathic medicine never completely ceased to exist, however, as there were always a few states in which licensing laws existed—though at one point there were virtually no schools. One of the most visible steps towards the profession's modern renewal was the opening in 1956 of the National College of Naturopathic Medicine in Portland, Oregon. This was the first of the modern naturopathic medical schools offering four-year naturopathic medical training with the intention of integrating mainstream science and naturopathic principles and practice.

Naturopathic physicians and traditional naturopaths

There are two groups calling themselves "naturopaths" who have recently been engaged in legal battles. The term when originally coined by John Scheel, and popularized by Dr. Benedict Lust (a German name pronounced "loost") was to apply to those receiving an education in the basic medical sciences with an emphasis on natural therapies:

• Naturopathic physicians
• "Traditional" naturopaths

Naturopathic physicians

Naturopathic physicians in the United States are independent providers with training in conventional medical sciences, diagnosis and treatment, and natural therapeutics with licenses or registration granted by an individual state Naturopathic Board of Medical Examiners. They graduate from four-year nationally accredited naturopathic medical graduate schools. Naturopathic physicians training with respect to modalities is different, with a focus on nutrition, botanical medicine, homeopathy, hydrotherapy, physical manipulation, pharmacology, and minor surgery. Some naturopathic physicians have additional training in the following: natural childbirth, acupuncture, and Chinese medicine. These subspecialties often involve additional years of study. Naturopathic physicians are required to attend continuing education yearly in order to maintain and renew their license.

Naturopathic physicians are licensed to diagnose and treat disease in Alaska, Arizona, California, Connecticut, District of Columbia, Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, Washington, US Territories: Puerto Rico and Virgin Islands.

Naturopathic Physicians are working in cooperation with both conventional and alternative practitioners to provide patients with complete medical care. Naturopathic physicians can bridge disparate fields with their training in both conventional and non-conventional treatment. Naturopathic physicians are able to identify and prescribe appropriate treatment including referral to conventional medical doctors.

Traditional Naturopaths

Vis medicatrix naturae, or the healing power of nature, is the central tenet of Traditional Naturopathy. Bacteria and viruses, which are always present, seldom cause problems in a healthy body. According to naturopathic practice, disease occurs when toxins that have accumulated internally – often due to incorrect lifestyle, a poor diet, and improper care of the body - weaken a person. While conventional medical treatments may rid the body of symptoms, these treatments alone do not bring about true healing. Rather than trying to attack specific symptoms and diseases, Traditional Naturopathy offers a holistic approach to the individual that supports the body in finding its way back to homeostasis.

Traditional Naturopathy is not a medical practice. While prescribing drugs and pharmaceuticals, performing surgery, and other invasive procedures clearly have their place in the hands of properly trained medical doctors, these practices are outside the scope of Traditional Naturopathy and are at odds with its fundamental principles. Instead Traditional Naturopaths focus on educating clients to lead healthier lives and on the use of naturopathic modalities such as light, water, herbs, healthy foods, and exercise to cleanse and strengthen the body and support its natural healing process.

The Principles of Naturopathic Medicine

Naturopathy is based on six tenets or principles [2][3]:

1. "The healing power of nature"
2. "Identify and treat the cause"
3. "First do no harm"
4. "Treat the whole person"
5. "The physician as teacher"
6. "Prevention"

"The healing power of nature"

The healing power of nature (vis medicatrix naturae), has two aspects: first that the body has the ability to heal itself and it is the naturopathic doctor's role to facilitate this natural process, and second that nature heals. Following this principle includes getting enough sleep, exercising, feeding the body nutritional food and, if needed, additional earth food, such as herbs, or algae, which is a living organism. It is asserted, yet strongly refuted by critics, that plants can gently move the body into health without side effects posed by some synthetic chemicals in modern pharmaceuticals.

"Identify and treat the cause"

The underlying root causes of disease must be removed for complete healing to take place (tolle causam). These root causes can exist at many levels: physical, mental, emotional, and spiritual. It is the naturopathic doctor's ostensible role to identify this root cause, in addition to alleviate suffering by treating symptoms.

"First do no harm"

The process of healing includes the manifestations of symptoms, so that any therapy that interferes with this natural healing process by masking symptoms is considered suppressive and should be avoided (primum no nocere). The natural life force of the individual should be supported to facilitate healing.

"Treat the whole person"

A core tenet of naturopathy is the belief that health must go beyond treatment of immediate symptoms (as with medicine), and instead treat the entire person's well being. That means treating the entire body, as well as the spirit and mind.

"The physician as teacher"

It is the role of the naturopath to educate an individual in their practices and encourage that individual to "take responsibility for their own health" (docere). This cooperative relationship between doctor and patient is essential to healing.

"Prevention"

The ultimate goal of the naturopathic physician is prevention. The emphasis is on building health, not fighting illness. This is done by fostering healthy lifestyles, healthy beliefs, and healthy relationships.

Regulation in North America

Jurisdictions that currently regulate naturopathic medicine include:

• U.S. jurisdictions with full licensure: Alaska, Arizona, California, Connecticut, District of Columbia, Hawaii, Idaho, Maine, Montana, Vermont, New Hampshire, Oregon, U.S. Virgin Islands, Utah, Washington
• U.S. state with registration for naturopathic physicians: Kansas
• U.S. jurisdictions with two-tier licensure: Puerto Rico
• U.S. states with legal basis for practice: Minnesota, Rhode Island
• U.S. states which specifically prohibit the practice of naturopathy: South Carolina, Tennessee
• Canadian provinces with full licensure: British Columbia, Manitoba, Ontario, Saskatchewan

Regulation in the United Kingdom

In the United Kingdom, naturopathy as a profession is very closely aligned with osteopathy. There is no government sponsored regulation of the profession, the largest body, The General Council & Register of Naturopaths recognises three courses in the UK, two being taught at osteopathic schools: the British College of Osteopathic Medicine; The College of Osteopaths Educational Trust; and one at the University of Westminster School of Integrated Health under the auspices of the B.Sc Health Science (Naturopathy) course.

Members of this register will either have completed a three or four year full time degree level course or possibly be a healthcare professional (Medical Doctor, Osteopath, Chiropractor, Nurse) who has completed a two year post-graduate Naturopathic Diploma, the N.D. As the naturopathic profession has developed along different lines in the UK, naturopaths do not perform minor surgery or have prescribing rights.

Scope of practice

In the United States both naturopathic physicians and traditional naturopaths use the degree designation of N.D. (doctor of naturopathic medicine), leading to considerable confusion about the scope of practice, education and training of a naturopathic practitioner (in the United Kingdom, N.D. stands for Diploma in Naturopathy). There is great contention between the two factions, as their political agendas are in opposition to each other: Naturopathic physicians, whose national professional organization is the American Association of Naturopathic Physicians, strive to recover licensure in all 50 states, whereas traditional naturopaths, whose professional organization is the American Naturopathic Medical Association, oppose licensure and often block licensing attempts. Negotiation is currently in progress between naturopathic physicians and traditional naturopaths to come to a resolution to this problem and agree to use different degree titles and designations, but so far this has not been a successful endeavour.

Science and naturopathy

There is scientific agreement that an evidence based medicine framework should be used to assess health outcomes and that systematic reviews with strict protocols are essential. Organisations such as the Cochrane Collaboration and Bandolier publish such reviews.

There are reports of evidence based medicine trials published for naturopathy. (See discussion page)

Some forms of naturopathy are pseudoscience. Medical doctors often cite the large differences between naturopathic practitioners and the lack of scientific documentation of the safety and efficacy of their practices in order to justify limiting naturopathic scope. Advocates claim that naturopathic practitioners find it difficult to obtain financing for research due to the lack of prior research in many areas. Proponents state that this is slowly changing as naturopathic physicians develop research programs to help build up a foundation for evidence based treatment.

Conventional medicine is required to undergo rigorous testing; drug trials often last for a decade. A criticism of alternative therapies is that they are not subject to detailed safety assessment. Restrospective analysis of various herbal agents have found many to be of little therapeutic value and others to be harmful. This can be tied to the fact that 'natural' does not necessarily correspond to being beneficial or even benign. Also of concern is the ambiguity of the word "natural" and poor agreement as to its meaning.

While the above addresses a primary challange to the validation process for "natural" remedies, perhaps of greater concern amongst critics is the lack of regulation of manufacturer claims in advertising. Common labeling practices suggest that herbal extracts are devoid of "drugs" or "chemicals". Claims of this type are patently false as every component of any plant extract is a chemical by definition. Likewise, claims as to the relative absence of toxicity in herbal extracts, when compared to conventional pharmaceutical preparations, are tainted by incongruent regulations for reporting of side effects. The manufacturers of conventional pharmaceutical agents are legally bound to record and report any perceived negative experiences during large scale clinical trials, though there may be no actual link between the tested drug and the perceived side effect. To wit, it is often the case that drugs are labelled with side effects such as headache, constipation, diarrhea, or sleep disturbance. These "side effects" are required to be listed even if they are found with no more regularity than they are in a placebo control group or within the general populace for that matter. Conversely, herbal manufacturers are not required to carry out such clinical studies nor to report any known adverse effects, even if said effects have been directly linked to injestion of the herbal preparation in question. While these advertising techniques do not negate the potential for some beneficial uses of various herbal agents, and they do not necessarily reflect upon the validity of naturopathic medicine as a field of study, critics suggest that they do serve to beguile the public through the employment of nothing more than legally permissible semantics and selective reporting.

See also

• Complementary and alternative medicine
• Osteopathy
• Homeopathy
• Medicine
• Metamorphic Technique

External links

Advocacy

Naturopathic physicians:

• American Association of Naturopathic Physicians
• Canadian Association of Naturopathic doctors
• What is Naturopathic Medicine? by Gary Piscopo, ND, LAc and Eric Yarnell, ND, RH
• Naturopathyworks - What is Naturopathic Medicine Link to research on naturopathy.

Traditional naturopaths:

• Association of Naturopathic Practitioners
• Coalition for Natural Health

Certifying Organizations:

• American Naturopathic Certification Board
• UK General Council and Register of Naturopaths

Criticism

• Index to Information about Naturopathy – Quackwatch
• Naturopathy by Robert T. Carroll – The Skeptic's Dictionary
• The National Council Against Health Fraud

Support:

"Profile of Profession: Naturopathic Practice" Center for the Health Professionals UCSF

• http://www.futurehealth.ucsf.edu/pdf_files/Naturo2.pdf

"National Public Health Partnership publication Preventing chronic disease: a strategic framework." http://www.nphp.gov.au/publications/strategies/chrondis-bgpaper.pdf

North American Schools

• National College of Naturopathic Medicine - Portland, Oregon
• Bastyr University - Seattle, Washington
• Southwest College of Naturopathic Medicine - Tempe, Arizona
• Canadian College of Naturopathic Medicine - Toronto, Ontario
• College of Naturopathic Medicine of University of Bridgeport - Bridgeport, Connecticut
• Boucher Institute of Naturopathic Medicine - New Westminster, British Columbia
• Association of Accredited Naturopathic Medical Colleges - Association of the six above schools

Australian Schools

• Australian College of Natural Medicine - Brisbane, Queensland and Melbourne, Victoria
• Southern Cross University - Lismore, New South Wales

UK Schools

• College of Osteopaths
• British College of Osteopathic Medicine
• The College of Naturopathic Medicine
• The College of Natural Nutrition

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