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Naturopathy

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Naturopathy (also known as naturopathic medicine or natural medicine) is an 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; some herbal remedies may be effective in some cases; but homeopathy is often characterized as pseudoscience or quackery.[1][2][3][4]

Naturopathy has its origins in the Nature Cure movement of Europe.[5][6] The term was coined in 1895 by John Scheel and popularized by Benedict Lust,[7] the "father of U.S. naturopathy".[8]

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 among naturopaths also varies, though Atwood concluded that no naturopathic training program reaches the same level of training as an MD.[9] 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.[10][11] 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.[12]

History

Some see the ancient Greek "Father of Medicine", Hippocrates, as the first advocate of naturopathic medicine, before the term existed.[13] The modern practice of naturopathy has its roots in the Nature Cure movement of Europe.[5][6] In Scotland, Thomas Allinson started advocating his "Hygienic Medicine" in the 1880s, promoting a natural diet and exercise with avoidance of tobacco and overwork.[14][15] The term sanipractor has sometimes been used to refer to naturopaths, particularly in the Pacific Northwest region of the United States.[8]

The term naturopathy was coined in 1895 by John Scheel,[7] and purchased by Benedict Lust, the "father of U.S. naturopathy".[8] 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 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 giving up 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."[16]

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).[8][17] Naturopaths became licensed under naturopathic or drugless practitioner laws in 25 states in the first three decades of the twentieth century.[8] Naturopathy was adopted by many chiropractors, and several schools offered both Doctor of Naturopathy (N.D.) and Doctor of Chiropractic (D.C.) degrees.[8] Estimates of the number of naturopathic schools active in the United States during this period vary from about one to two dozen.[8][7]

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. Following Lust's death in 1945, the ANA split into six distinct organizations. 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.[8] 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 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.[18] In 1977, an Australian committee of inquiry reached similar conclusions; it did not recommend licensure for naturopaths.[19]

Naturopathy never completely ceased to exist, and beginning in the 1970s interest has waxed in the United States and Canada.[1] 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. The rise of the holistic health movement in the early 1970s contributed to this revival.[8]

Principles

The philosophy of naturopathic practice is often described by six core values.[20] Multiple versions exist in the form of the naturopathic doctor's oath,[21] various mission statements published by schools[22] or professional associations, and ethical conduct guidelines published by regulatory bodies:[23]

  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 vitalismCite error: The <ref> tag has too many names (see the help page).).
  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)

Modalities

Since Naturopathy's focus is upon its philosophy of natural health rather than specific methods, practitioners use a wide variety of treatment modalities.[1] Effectiveness of naturopathy as a whole system has not been systematically evaluated, and efficacy of individual methods used varies.[24][25] Naturopaths typically begin with a lengthy patient interview focusing on lifestyle, medical history, emotional tone, and physical features, as well as physical examination.[1] 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]

The CNME also provides for the inclusion of optional modalities including minor surgery, natural childbirth and intravenous therapy. These modalities require additional training and may not be within the scope of practice in all jurisdictions.

Modalities that may be used by practitioners, but are not sanctioned by CNME and not taught in accredited schools include:

Practitioners

There are two groups in North America calling themselves "naturopaths". The term when originally coined by John Scheel, and popularized by Benedict Lust was to apply to those receiving an education in the basic medical sciences with an emphasis on natural therapies. This usage best describes modern day naturopathic doctors. In the absence of universal regulation of naturopathy, another group of practitioners (the so-called 'traditional naturopaths') has emerged. Additionally, a variety of health care professionals may incorporate naturopathic principles and modalities into their practice.

Naturopathic doctors

Main article: Doctor of Naturopathic Medicine

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.[28][29] In these jurisdictions, naturopathic doctors must pass comprehensive board exams set by the North American Board of Naturopathic Examiners (NABNE)[30] after completing academic and clinical training at a college certified by the Council on Naturopathic Medical Education (CNME).[31] ND training includes the use of basic medical diagnostic tests and procedures such as medical imaging, minor surgery, and blood tests, and many naturopaths present themselves as primary care providers.[10][9][1] This training differs from that undertaken by MDs in that it includes scientifically disproven modalities, such as homeopathy, and concepts irreconcilable with modern medicine, such as vitalism.[1][3][9][4][10][32]

In unregulated jurisdictions, the designation Doctor of Naturopathy and similar terms are not protected and may be used by any practitioner regardless of qualifications.

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 organization, but these organizations do not accredit educational programs in any meaningful way or license practitioners, per se.[citation needed] The training programs for traditional naturopaths can vary greatly. Compared to naturopathic medical schools, traditional naturopaths' training programs are less rigorous and do not provide the same basic and clinical science education.[citation needed] The professional organizations 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,[33] and states such as Texas have begun to establish practice guidelines for MDs who integrate alternative and complementary medicine into their practice.[34] Continuing education in naturopathic modalities for health care professionals varies greatly but includes offerings for practitioners: physicians, chiropractors, acupuncturists, dentists, researchers, veterinarians, physician’s assistants, and nurses.[35] These professionals usually retain their original designation but may use terms such as 'holistic', 'natural', or 'integrative' to describe their practice.

Regulation

Australia

There is currently 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.[36]

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.[37]

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 4 colleges are in the state of Tamilnadu. [citation needed]

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

"Central Council for Research in Naturopathy & Yoga": The Government of India after having recognized the need for systematic Research and Development of Yoga & Naturopathy in the country, 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, first of its kind was established in India by the Central Government to conduct Scientific Research in Ayurveda, Siddha, Unani and Yoga, existed upto 1978. During this period, the development of Naturopathy was looked after by the Ministry of Health & Family Welfare directly. Later, in March 1978, this composite Council was dissolved to pave way for the formation of four independent Research Councils, one each for Ayurveda and Siddha, Unani, Homoeopathy and Yoga & Naturopathy. [citation needed]

Hence, this Council (CCRYN) was established in 1978 with a view to provide better opportunities for alround development of Yoga and Naturopathy independently according to their own doctrines and fundamental principles. [citation needed]

"National Institute of Naturopathy" - Department of AYUSH, Ministry of Health & Family Welfare, Government of India: The National Institute of Naturopathy, Pune came into existence on 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” headed by Union Minister for Health as its President. [citation needed]


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.[12]

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.[38]

Canada

Canadian provinces which license naturopathic doctors: British Columbia, Manitoba, Ontario, Saskatchewan and Nova Scotia.[39] 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.[40]

United States

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] These organisations are not recognized by the UK regulatory frameworks.

Members of this register will either have completed a three or four year full time course or possibly be a healthcare professional who has completed a two year post-graduate Naturopathic Diploma (ND).

Alternatively, there are the Association of Naturopathic Practitioners and The British Naturopathic Association whose members can practice and get indemnity insurance.[citation needed]

Criticism

Naturopathy is viewed with skepticism for its reliance on or association with unproven, disproven, and controversial alternative medical treatments, and for its vitalistic underpinnings.[32] As with any alternative care, there is a risk of missed diagnosis; 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.[45][46][47] 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][25][48]

Naturopathic doctors are not mandated to undergo residency between graduation and commencing practice,[25] except in the state of Utah.[49]

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."[9]

See also

References

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  2. ^ a b "Handbook of accreditation for Naturopathic Programs" (PDF). Council on Naturopathic Medical Education. 2008. p. 51.
  3. ^ a b c d e f Barrett S. "A close look at naturopathy".
  4. ^ a b c d Atwood KC (2004). "Naturopathy, pseudoscience, and medicine: myths and fallacies vs truth". Medscape Gen Med. 6 (1): 33. PMC 1140750. {{cite journal}}: Unknown parameter |day= ignored (help); Unknown parameter |month= ignored (help)
  5. ^ a b P S Brown (April 1988), "Nineteenth-century American health reformers and the early nature cure movement in Britain", Medical History, 32 (2): 174–194, PMC 1139856, PMID 3287059 {{citation}}: Unknown parameter |day= ignored (help); Unknown parameter |month= ignored (help)
  6. ^ a b "History of Naturopathy". 2007.
  7. ^ a b c "Report 12 of the Council on Scientific Affairs (A-97)". American Medical Association. 1997.
  8. ^ a b c d e f g h i Baer, H.A (2001), "The sociopolitical status of US naturopathy at the dawn of the 21st century", Medical Anthropology Quarterly, 15 (3): 329–346, doi:10.1525/maq.2001.15.3.329
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  10. ^ a b c "Handbook of Accreditation for Naturopathic Medicine Programs" (PDF). Council on Naturopathic Medical Education. p. 45.
  11. ^ ^"Academic Curriculum". 2008. http://www.aanmc.org/education/academic-curriculum.php.
  12. ^ a b "A Policy Statement on Naturopathy".
  13. ^ "What is Naturopathy?". 1998.
  14. ^ "How it all began".
  15. ^ John A S Beard (3 May 2008), "Views & Reviews Medical Classics A System of Hygienic Medicine (1886) and The Advantages of Wholemeal Bread (1889)", British Medical Journal, 336 (336): 1023, doi:10.1136/bmj.39562.446528.59
  16. ^ Benedict Lust, cited in: Whorton, James C. (2002). Nature cures: the history of alternative medicine in America. Oxford [Oxfordshire]: Oxford University Press. p. 224. ISBN 0-19-517162-4.
  17. ^ Beyersteine, Barry L. "Naturopathy: a critical analysis". Retrieved 2009-03-21. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  18. ^ Cohen, Wilbur J (1968-12). Independent Practitioners Under Medicare: a report to the Congress. United States Department of Health, Education, and Welfare. {{cite book}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)
  19. ^ Webb, Edwin C (1977). Report of the Committee of Inquiry into Chiropractic, Osteopathy, Homoeopathy and Naturopathy. Canberra: Australian Government Publishing Service. ISBN 064292287X.
  20. ^ a b Clark, Carolyn Chambers (1999), Encyclopedia of Complementary Health Practice, New York: Springer, pp. 57–58, ISBN 9780826112392
  21. ^ "Naturopathic Doctor's Oath".
  22. ^ "Principles of Naturopathic Medicine".
  23. ^ "Guide to the Ethical Conduct of Naturopathic Doctors" (PDF).
  24. ^ Singh S; Ernst E (2008). Trick or treatment : the undeniable facts about alternative medicine. New York: W. W. Norton. ISBN 0393066614. OCLC 181139440.
  25. ^ a b c d "Naturopathic medicine". American Cancer Society. 2007-03-26. Retrieved 2009-03-21. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
  26. ^ a b Jacqueline Young (2007), Complementary Medicine for Dummies, Chichester, England: Wiley, ISBN 9780470026250, OCLC 174043853 {{citation}}: Unknown parameter |chapters= ignored (help)
  27. ^ a b c d Holly J. Hough, Catherine Dower, Edward H. O’Neil (September 2001), Profile of a profession: naturopathic practice (PDF), Center for the Health Professions, University of California, p. 54{{citation}}: CS1 maint: multiple names: authors list (link)
  28. ^ a b "American Association of Naturopathic Physicians".
  29. ^ "Welcome". Canadian Association of Naturopathic Doctors.
  30. ^ "NABNE". North American Board of Naturopathic Examiners.
  31. ^ "Council on Naturopathic Medical Education". {{cite web}}: Cite has empty unknown parameter: |1= (help)
  32. ^ a b McKnight, P (2009-03-07). "Naturopathy's main article of faith cannot be validated: Reliance on vital forces leaves its practises based on beliefs without scientific backing". Vancouver Sun. Retrieved 2009-03-21. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
  33. ^ Finocchio LJ, Dower CM, Blick NT, Gragnola CM and the Taskforce on Health Care Workforce Regulation (1998). "Strengthening Consumer Protection: Priorities for Health Care Workforce Regulation" (PDF). San Francisco: Pew Health Professions Commission. Retrieved 2009-04-01. {{cite web}}: Unknown parameter |month= ignored (help); line feed character in |author= at position 54 (help); line feed character in |publisher= at position 23 (help)CS1 maint: multiple names: authors list (link)
  34. ^ Texas Administrative Code title 22, part 9 § 200.3, 1998
  35. ^ "Profile of Profession: Naturopathic Practice" (PDF).
  36. ^ "Joint RACGP/AIMA Working Party Terms of Reference". The Royal Australian College of General Practitioners.
  37. ^ "Naturopathy: Report of the Australian Committee of Inquiry (1977)". NaturoWatch. Retrieved 1 April 2009. {{cite web}}: line feed character in |title= at position 28 (help)
  38. ^ "Sunrise Review: Naturopathic Physicians" (PDF). State of Colorado. 2008. p. 19.
  39. ^ Canadian Association of Naturopathic Doctors
  40. ^ CBC News - B.C. gives naturopaths right to prescribe drugs
  41. ^ "Ley para Reglamentar el Ejercicio de la Medicina Naturopática en Puerto Rico [Law to Regulate the Practice of Naturopathic Medicine in Puerto Rico]" (PDF) (in Spanish). 30 December 1997.
  42. ^ a b c "Reports to the Board of Trustees" (PDF). American Medical Association. 2006-11. Retrieved 2009-03-19. {{cite news}}: Check date values in: |date= (help); Cite has empty unknown parameter: |coauthors= (help)
  43. ^ "South Carolina Code of Laws Section 40-31-10".
  44. ^ "Tennessee Code 63-6-205". Tennessee State Legislature.
  45. ^ National Science Board (2002). "Science and engineering indicators". Arlington, Virginia: National Science Foundation Directorate for Social, Behavioral and Economic Sciences. {{cite web}}: |chapter= ignored (help); Unknown parameter |chapter_title= ignored (|chapter= suggested) (help); Unknown parameter |month= ignored (help); Unknown parameter |section_title= ignored (help)
  46. ^ Wahlberg A (2007). "A quackery with a difference—new medical pluralism and the problem of 'dangerous practitioners' in the United Kingdom". Social Science & Medicine. 65 (11): 2307–2316. doi:10.1016/j.socscimed.2007.07.024. PMID 17719708.
  47. ^ "Iridology is nonsense"., a web page with further references
  48. ^ Carroll, Robert. "Natural". The Skeptic's Dictionary. Retrieved 2009-03-21.
  49. ^ "Application for licensure : naturopathic physician" (PDF). State of Utah Division of Occupational and Professional Licensing.
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