Naturopathy: Wikis

  
  

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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. Naturopathic philosophy favors 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 characterized as pseudoscience or quackery.[1][2][3][4][5] Evidence-based medicine (EBM) has been advocated as an appropriate methodology for determining the scientific basis of naturopathy.[6] Naturopaths have opposed vaccination based in part in the early philosophies which shaped the profession.[7]

Naturopathy has its origins in the Nature Cure movement of Europe.[8][9] The term was coined in 1895 by John Scheel and popularized by Benedict Lust,[10] the "father of U.S. naturopathy".[11] Beginning in the 1970s, there was a revival of interest in the United States and Canada in conjunction with the holistic health movement.[1][11]

Naturopathy is practiced in many countries, especially the United States and Canada, and is subject to different standards of regulation and levels of acceptance. Naturopathic medicine is a recent manifestation of the field of naturopathy, a 19th-century health movement espousing "the healing power of nature." 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.[12] 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.[13][14] 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.[15]

Contents

History

Some see the ancient Greek "Father of Medicine", Hippocrates, as the first advocate of naturopathic medicine, before the term existed.[16][17] The modern practice of naturopathy has its roots in the Nature Cure movement of Europe.[8][9] In Scotland, Thomas Allinson started advocating his "Hygienic Medicine" in the 1880s, promoting a natural diet and exercise with avoidance of tobacco and overwork.[18][19] The term sanipractor has sometimes been used to refer to naturopaths, particularly in the Pacific Northwest region of the United States.[11]

Monsignor Sebastian Kneipp, 1821-1897

The term naturopathy was coined in 1895 by John Scheel,[10] and purchased by Benedict Lust, the "father of U.S. naturopathy".[11] Lust had been schooled in hydrotherapy and other natural health practices in Germany by Father Sebastian Kneipp; Kneipp sent Lust to the United States to spread his drugless methods.[3] 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.[1] He described the body in spiritual and vitalistic terms with "absolute reliance upon the cosmic forces of man's nature."[20]

Dr. Benedict Lust, 1872 - 1945

1901, Lust founded the American School of Naturopathy in New York. In 1902, the original North American Kneipp Societies were discontinued and renamed "NATUROPATHIC™ Societies". In September 1919 the Naturopathic Society of America was dissolved and Dr. Benedict Lust founded the “American Naturopathic Association” to supplant it.[11][21][22][22] Naturopaths became licensed under naturopathic or drugless practitioner laws in 25 states in the first three decades of the twentieth century.[11] Naturopathy was adopted by many chiropractors, and several schools offered both Doctor of Naturopathy (ND) and Doctor of Chiropractic (DC) degrees.[11] Estimates of the number of naturopathic schools active in the United States during this period vary from about one to two dozen.[5][10][11]

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 criticized 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. In the 1940s and 1950s, a broadening in scope of practice laws led many chiropractic schools to drop their ND 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.[11] 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 naturopathic education was inadequate to prepare graduates to make appropriate diagnosis and provide treatment; the report recommends against expanding Medicare coverage to include naturopathic treatments.[5][23] In 1977, an Australian committee of inquiry reached similar conclusions; it did not recommend licensure for naturopaths.[24] As of 2009, fifteen of fifty U.S. states licensed naturopathic doctors,[25] and two states (WA, VT) require insurance companies to offer reimbursement for services provided by naturopathic physicians.[26]

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.[1][11]

Today, there are nine schools of Traditional naturopathy offering certificate or degree programs accredited by the American Naturopathic Medical Accredation Board [27] The National Board Of Naturopathic Examiners of the ANA currently recognizes two schools offering Doctor of Naturopathy Degree programs [28]

Naturopathic Medicine is represented with six accredited schools accredited naturopathic medical schools and one candidate for accreditation 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 ND 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 and is currently a candidate for accreditation.

Principles

Naturopathic ideology focuses on naturally-occurring and minimally-invasive methods, trusting to the "healing power of nature."[5] Such treatments as "synthetic" drugs, radiation, and major surgery are avoided, and rejection of biomedicine and modern science in favor of an intuitive and vitalistic conception of the body and nature is common.[5][22] Prevention through stress reduction and a healthy diet and lifestyle is emphasized. The philosophy of naturopathic practice is self-described by six core values.[29] Multiple versions exist in the form of the naturopathic doctor's oath,[30] various mission statements published by schools[31] or professional associations, and ethical conduct guidelines published by regulatory bodies:[32]

  1. First, do no harm; provide the most effective health care available with the least risk to patients at all times (primum non nocere).
  2. Recognize, respect and promote the self-healing power of nature inherent in each individual human being. (Vis medicatrix naturae, a form of vitalism).[33]
  3. Identify and remove the causes of illness, rather than eliminate or suppress symptoms (Tolle Causum).
  4. Educate, inspire rational hope and encourage self-responsibility for health (Doctor as Teacher).
  5. Treat each person by considering all individual health factors and influences. (Treat the Whole Person).
  6. 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

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.[1][34] 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,[17][35][36] though Bastyr, NCNM and CCNM currently maintain research programs.[37][38][39] 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.[40] The effectiveness of naturopathy as a whole system has not been systematically evaluated, and efficacy of individual methods used varies.[5][41]

A consultation typically begins with a lengthy patient interview focusing on lifestyle, medical history, emotional tone, and physical features, as well as physical examination.[1] The traditional naturopath focuses on lifestyle changes and approaches that support the body's innate healing potential. Traditional naturopaths do not undertake to diagnose or treat diseases but concentrates on whole body wellness and facilitating the body healing itself. Traditional Naturopaths neither prescribe nor undertake to engage in the use of drugs, serums, potions, surgery or disease specific treatments or otherwise practice conventional medicine.[42] Practitioners of naturopathic medicine hold themselves to be primary care providers and in addition to various natural approaches seek to prescribe legend drugs, perform minor surgery and apply other conventional medical approaches to their practice. Naturopaths do not necessarily recommend vaccines and antibiotics, and may provide inappropriate alternative remedies even in cases where evidence-based medicine has been shown effective.[43][44] All forms of naturopathic education include concepts incompatible with basic science, and do not necessarily prepare a practitioner to make appropriate diagnosis or referrals.[41][44][45]

Less than 50% of naturopaths saying they would refer a 2-week-old infant with a fever resulting in a situation were real harm could result.[46]

Methods

The particular modalities utilized by an individual naturopath varies with training and scope of practice. The demonstrated efficacy and scientific rationale also varies. These include: Acupuncture, Applied kinesiology,[47] Botanical medicine, Brainwave entrainment, Chelation therapy for atherosclerosis,[4] Colonic enemas,[3] Color therapy,[47] Cranial osteopathy,[44] Hair analysis,[44] Homeopathy,[48] Iridology,[47] 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 wholefood diet, fasting, and abstention from alcohol and sugar),[49] Ozone therapy,[5] Physical medicine (includes naturopathic, osseous, and soft tissue manipulative therapy, sports medicine, exercise and hydrotherapy), Psychological counseling (examples include meditation, relaxation, and other methods of stress management[49]), Public health measures and hygiene,[29] Reflexology,[47] Rolfing,[22] and Traditional Chinese medicine.

A 2004 survey determined the most commonly prescribed naturopathic therapeutics in Washington State and Connecticut were botanical medicines, vitamins, minerals, homeopathy, and allergy treatments.[48]

Practitioners

Naturopathic practitioners can be split into two groups.[42][50][51][52][53]

1. 'Traditional' naturopaths are represented in the US by two National Organizations, The American Naturopathic Association (ANA) founded in 1919 by Benedict Lust,[54] representing about 5000 certified practitioners,[55]

ANA Incorporation Certificate of Standing

and the American Naturopathic Medical Association (ANMA) founded in 1981 and representing about 4500 practitioners with several levels of certification.[56] The ANMA also recognizes MDs, DOs and other conventional medical professionals who have integrated naturopathy into their practices.[5]

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 can certify at a practitioner level with the American Naturopathic Medical Certification Board (ANMCB) and generally refer to themselves as Naturopathic Consultants.[57] There are also post graduate doctoral degrees for traditional naturopaths. Those completing a Doctor of Naturopathy (ND) degree from an ANMCAB approved school can become a Board Certified Naturopathic Doctor with the ANMCAB [58] traditional naturopaths completing a Doctor of Naturopathy (ND) degree at an National Board of Naturopathic Examiners of the ANA (NBNE) approved school can obtain certification becoming a delegate of the ANA [59]. Medical Doctors (MD) or Doctors of Osteopathy (DO) with supplemental training in Naturopathy can become National Board Certified Naturopathic Physicians through the ANMCAB.[60]

Traditional naturopathy, as defined by the profession and the US Congress in the early twentieth century[61] does not require a license.[62] Because naturopathic medicine undertakes to engage in activities generally requiring a medical license, its practice is only legal in those 15 states that regulate the profession; however practitioners of naturopathic medicine may practice traditional naturopathy throughout the United States.[citation needed]

2. Naturopathic Medicine is represented in the US by the American Association of Naturopathic Physicians (AANP) founded in 1985 and representing 2000 student, physicians, supporting and corporate members.[5][63]

Doctors of Naturopathic Medicine

Naturopathic doctor (ND or NMD) 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, the US territories of Puerto Rico and the US Virgin Islands, and five Canadian provinces.[64][65] In these jurisdictions, naturopathic doctors must pass board exams set by the North American Board of Naturopathic Examiners (NABNE)[66] after completing academic and clinical training at a college certified by the Council on Naturopathic Medical Education (CNME).[67] The CNME is formally recognized by the U.S. Secretary of Education as the accrediting body for naturopathic medical programs.[68] Residency programs are offered at Bastyr University,[69] NCNM,[70] SCNM,[71] CCNM,[72] and the University of Bridgeport.[73] NDs are not required to engage in residency training.[5] Many naturopaths present themselves as primary care providers.[1][13][12] 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 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.[74] Naturopathic school also teach vitalism,[1] a concept that has been called irreconcilable with modern science and medicine.[1][3][4][12][75] Homeopathy is highly disputed, and is often cited as "quackery" or "pseudoscience".[1][4][5]

In 2005, the Massachusetts Medical Society opposed licensure in the commonwealth based on concerns that NDs are not required to participate in residency, and may also suggest inappropriate or harmful treatments.[45] The Massachusetts Special Commission on Complementary and Alternative Medical Practitioners rejected their concerns and recommended licensure.[76]

The core set of interventions defined by the Council on Naturopathic Medical Education and taught at all six accredited schools in North America includes:[2] 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 counseling.

In the state of Washington, where naturopathic doctors are licensed comparably to primary care physicians,[77] many naturopathic doctors also accept insurance, with some plans offering the option of designating a naturopath as a primary care provider.[26] In Connecticut and Washington, state law requires insurance providers to provide some coverage of naturopathic services, while Oregon, another state with significant numbers of naturopathic doctors, does not.[26]

Other health care professionals

According to a 1998 taskforce report, some physicians are choosing to add naturopathic modalities to their practice,[78] and states such as Texas have begun to establish practice guidelines for MDs who integrate alternative and complementary medicine into their practice.[79] 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.[80] These professionals usually retain their original designation but may use terms such as 'holistic', 'natural', or 'integrative' to describe their practice. The American Naturopathic Medical Association (ANMA) and American Naturopathic Medical Certification and Accreditation Board (ANMCAB) has recognition and certification programs for Medical Doctors (MD) and Doctors of Osteopathy (DO) who have supplemented their education with naturopathic studies and integrate naturopathy into their practice.[60]

Regulation

Australia

There is no state licensure in Australia, rather the industry is self-regulated. There is no protection of title, meaning that technically anyone can practise as a naturopath. The only way to obtain insurance for professional indemnity or public liability is by joining a professional association, which can only be achieved having completed an accredited course and gaining professional certification. Currently the only registered modalities of natural medicine in Australia are those relating to Chinese medicine, and only in the state of Victoria.[81]

In 1977 a committee reviewed all colleges of naturopathy in Australia and found that, although the syllabuses of many colleges were reasonable in their coverage of basic biomedical sciences on paper, the actual instruction bore little relationship to the documented course. In no case was any practical work of any consequence available. The lectures which were attended by the Committee varied from the dictation of textbook material to a slow, but reasonably methodical, exposition of the terminology of medical sciences, at a level of dictionary definitions, without the benefit of depth or the understanding of mechanisms or the broader significance of the concepts. The Committee did not see any significant teaching of the various therapeutic approaches favoured by naturopaths. Persons reported to be particularly interested in homoeopathy, Bach's floral remedies or mineral salts were interviewed, but no systematic courses in the choice and use of these therapies were seen in the various colleges. The Committee was left with the impression that the choice of therapeutic regime was based on the general whim of the naturopath and since the suggested applications in the various textbooks and dispensations overlap to an enormous extent no specific indications are or can be taught.[24]

India

In India there is a 5 1/2 year degree course offering a Bachelor of Naturopathy and Yogic Sciences (BNYS) degree. There are a total of 11 colleges in India, of which four colleges are in the state of Tamil Nadu.[82]

Naturopathy and Yoga, as an Indian system of medicine, falls under the Department of AYUSH, Ministry of Health & Family Welfare, Government of India.[83]

The Indian government established the "Central Council for Research in Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy” in 1969 as an autonomous organization under the Ministry of Health and Family Welfare. This organization was tasked to conduct scientific research into those branches of alternative medicine, until 1978. During this period, the development of Naturopathy was looked after by the Ministry of Health & Family Welfare directly. In March 1978 the composite Council was dissolved and replaced by four independent Research Councils, one each for Ayurveda and Siddha, Unani, Homoeopathy and Yoga & Naturopathy.[84]

The National Institute of Naturopathy, Pune was established on the 22 December 1986. It encourages facilities for standardization and propagation of the existing knowledge and its application through research in Naturopathy throughout India. This Institute has a Governing Body", with the Union Minister for Health as its President.[85]

North America

In five Canadian provinces, fifteen US 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.[15]

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.[86]

Canada

There are five Canadian provinces which license naturopathic doctors: British Columbia, Manitoba, Nova Scotia, Ontario, and Saskatchewan.[87] British Columbia has regulated naturopathic medicine since 1936 and is the only Canadian province that allows certified ND's to prescribe pharmaceuticals and perform minor surgeries.[88]

United States

Naturopathic doctors are not mandated to undergo residency between graduation and commencing practice,[5] except in the state of Utah.[93]

United Kingdom

In the United Kingdom, as there is no government sponsored regulation of the naturopathy profession, naturopaths are unregulated. The largest registering 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 BSc Health Science (Naturopathy) course.[citation needed]

There is also the Association of Naturopathic Practitioners and The British Naturopathic Association.

Evidence basis

Evidence-based medicine (EBM) has been advocated as an appropriate methodology for investigating natural medicine such as naturopathy, which has been characterized as lacking an adequate scientific basis.[6] Traditional naturopathic practitioners surveyed in Australia perceive EBM as an ideologic assault on their beliefs in vitalistic and holistic principles.[6] They advocate the integrity of natural medicine practice.[6] Traditional natural medicine practitioners surveyed in Australia could have problems in understanding and applying the concept of EBM.[6] Although naturopathy is increasingly accepted by the general public, members of the medical community show a critical or even rejecting view of naturopathy.[94] 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.[94] Naturopathic physicians have begun to contribute to research and adapt modern scientific principles into clinical practice, further developing and validating the profession.[95] There is growing collaborative efforts between naturopaths and medical doctors to evaluate the safety and efficacy of naturopathic medicine 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.[96] In Germany a host of naturopathy alternative treatments are sold as reliable science such as reflexology. However, reflexology is an unconventional method that has nothing in common with serious naturopathic treatments and any scientific value to reflexology is not merited.[97] Contrary to reflexology, scientifically genuine naturopathic methods are not an alternative, but a supplement to modern medicine.[97]

Criticism

Naturopathy medicine is criticized for its reliance on and its association with unproven, disproven, and other controversial alternative medical treatments, and for its vitalistic underpinnings.[75] As with any alternative care, there is a risk of misdiagnosis; this risk may be lower depending on level of training.[1][4] 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.[98][99][100] Natural methods and chemicals are not necessarily safer or more effective than artificial or synthetic ones; any treatment capable of eliciting an effect may also have deleterious side effects.[3][5][101][102]

Non-scientific health care practitioners, including naturopaths, use unscientific methods and deception on a public who, lacking in-depth health care knowledge, must rely upon the assurance of providers.[103] Quackery not only harms people, it undermines the ability to conduct scientific research and should be opposed by scientists, says William T. Jarvis.[103]

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."[3]

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."[12] In another article, Atwood writes 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. An article by a physician exposing quackery, moreover, does not identify its author as "biased," but simply as fulfilling one of his ethical obligations as a physician."[4]

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."[104]

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. This includes non-medically trained naturopaths. 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.[7] 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.[105]

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 pediatric vaccinations and with obtaining of vaccine preventable illnesses.[43]

See also

References

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