Naturopathy

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Alternative medical systems
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  • Mind–body interventions
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Naturopathy, or naturopathic medicine, is a pseudoscientific form of alternative medicine based on a belief in vitalism, which posits that a special energy called vital energy or vital force guides bodily processes such as metabolism, reproduction, growth, and adaptation. Naturopathy favors a holistic approach with non-invasive treatment and generally avoids the use of surgery and drugs. Among naturopaths, complete rejection of biomedicine and modern science is common.

The term "naturopathy" is derived from Latin and Greek, and literally translates as "nature disease". Modern naturopathy grew out of the Natural Cure movement of Europe. The term was coined in 1895 by John Scheel and popularized by Benedict Lust, the "father of U.S. naturopathy". Beginning in the 1970s, there was a revival of interest in the United States and Canada, in conjunction with the holistic health movement. Today, naturopathy is primarily practiced in the United States and Canada. The scope of practice varies widely between jurisdictions, and naturopaths in unregulated jurisdictions may use the Naturopathic Doctor designation or other titles regardless of level of education.

Naturopathic practitioners in the United States can be divided into three categories: traditional naturopaths; naturopathic physicians; and other health care providers that provide naturopathic services. Naturopathic physicians employ the principles of naturopathy within the context of conventional medical practices. Naturopathy comprises many different treatment modalities such as nutritional and herbal medicine, lifestyle advice, counseling, flower essence, homeopathy and remedial massage.

Much of the ideology and methodological underpinnings of naturopathy are in conflict with the paradigm of evidence-based medicine. Many naturopaths have opposed vaccination based in part on the early views that shaped the profession. According to the American Cancer Society, "scientific evidence does not support claims that naturopathic medicine can cure cancer or any other disease, since virtually no studies on naturopathy as a whole have been published."

History

Monsignor Sebastian Kneipp, 1821–1897
Benedict Lust, 1872–1945

Some see the ancient Greek "Father of Medicine", Hippocrates, as the first advocate of naturopathic medicine, before the term existed.[1][2] The modern practice of naturopathy has its roots in the Nature Cure movement of Europe during the 19th century.[3][4] In Scotland, Thomas Allinson started advocating his "Hygienic Medicine" in the 1880s, promoting a natural diet and exercise with avoidance of tobacco and overwork.[5][6]

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 drugless methods.[9] 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.[10] He described the body in spiritual and vitalistic terms with "absolute reliance upon the cosmic forces of man's nature".[11]

In 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 Benedict Lust founded the American Naturopathic Association to supplant it.[8][12][13] 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 (ND) and Doctor of Chiropractic (DC) degrees.[8] Estimates of the number of naturopathic schools active in the United States during this period vary from about one to two dozen.[7][8][14]

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.[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 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.[14][15] In 1977 an Australian committee of inquiry reached similar conclusions; it did not recommend licensure for naturopaths.[16] As of 2009, fifteen U.S. states, Puerto Rico, the US Virgin Islands and the District of Columbia licensed naturopathic doctors,[17] and the state of Washington requires insurance companies to offer reimbursement for services provided by naturopathic physicians.[18][19] South Carolina and Tennessee prohibit the practice of naturopathy.[20][21][22]

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.[8][10] Today, Naturopathy is practiced primarily in the United States and Canada.[23]

Ideology

Naturopathy focuses on naturally occurring substances, minimally invasive methods, and the promotion of natural healing through vitalism.[14][24] Prevention through stress reduction and a healthy diet and lifestyle is emphasized, and pharmaceutical drugs, ionizing radiation, and surgery, are generally avoided.[25]

Lack of evidence

Naturopathy lacks an adequate scientific basis; it is not evidence-based medicine (EBM).[26] Members of the medical community show a critical or rejecting view of naturopathy.[27] Traditional naturopathic practitioners surveyed in Australia perceive EBM as an ideologic assault on their beliefs in vitalistic and holistic principles.[26] They advocate the integrity of natural medicine practice.[26] Traditional natural medicine practitioners surveyed in Australia could have problems in understanding and applying the concept of EBM.[26] If naturopathy offers verifiable results for specific conditions, greater scientific knowledge of the mechanisms of those naturopathic protocols could result in improved therapy models.[27] Some naturopathic physicians have begun to contribute to research and adapt modern scientific principles into clinical practice.[28]

Naturopathy is criticized for its reliance on and its association with unproven, disproven, and other controversial alternative medical treatments, and for its vitalistic underpinnings.[29] As with any medical care, there is a risk of misdiagnosis; this risk may be lower depending on level of training.[10][30] Certain naturopathic treatments offered by traditional naturopaths, such as homeopathy, rolfing, and iridology, are widely considered pseudoscience or quackery.[31][32][33]

"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.[9][14][34][35]

Stephen Barrett of QuackWatch and the National Council Against Health Fraud has stated that Naturopathy is "simplistic and that its practices are riddled with quackery".[9] "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. Quackery not only harms people, it undermines the ability to conduct scientific research and should be opposed by scientists", says William T. Jarvis.[36]

Kimball C. Atwood IV 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".[37] 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 are not 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.[30]

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".[38]

Practice

Naturopaths use a wide variety of treatment modalities, focusing on the concept of natural self-healing rather than any specific method.[10][39] 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.[2][40][41] The effectiveness of naturopathy as a whole system has not been systematically evaluated, and efficacy of individual methods used varies.[14][42]

A consultation typically begins with a lengthy patient interview focusing on lifestyle, medical history, emotional tone, and physical features, as well as physical examination.[10] The traditional naturopath focuses on lifestyle changes, not diagnosing or treating diseases. Practitioners of naturopathic medicine hold themselves to be primary care providers and in addition to various natural approaches seek to prescribe prescription drugs, perform minor surgery and apply other conventional medical approaches to their practice. Naturopaths do not generally recommend vaccines and antibiotics, and may provide 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."[42][44][45]

Methods

The particular modalities used by an individual naturopath varies with training and scope of practice. The demonstrated efficacy and scientific rationale also varies. These include: Acupuncture, applied kinesiology,[46] botanical medicine, brainwave entrainment, chelation therapy for atherosclerosis,[30] colonic enemas,[9] color therapy,[46] cranial osteopathy,[44] hair analysis,[44] homeopathy,[47] iridology,[46] live blood analysis, nature cures—i.e. 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,[48] ozone therapy,[14] physical medicine (e.g., naturopathic, osseous, and soft tissue manipulative therapy, sports medicine, exercise, and hydrotherapy), Psychological counseling (e.g., meditation, relaxation, and other methods of stress management[48]), public health measures and hygiene,[25] reflexology,[46] rolfing,[13] 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.[47]

Vaccination

See also: Vaccination and Vaccine controversies

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, on the early views which shape the foundation of these professions.[49] 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.[50]

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 increased infection by vaccine-preventable diseases.[43]

Practitioners

A consultation with a naturopathic practitioner typically begins with a lengthy patient interview focusing on lifestyle, medical history, emotional tone, and physical features, as well as physical examination.[10] Naturopathic practitioners can be divided into three groups, naturopathic physicians, traditional naturopaths and other health care providers who offer naturopathic services.[14][51][52][53][54]

Doctors of Naturopathic Medicine

Many naturopaths present themselves as primary care providers.[10][55] Doctor of Naturopathy (ND) training includes basic medical diagnostic tests and procedures such as medical imaging and blood tests, as well as vitalism and pseudoscientific modalities such as homeopathy.[9][10][29][30][37]

The core set of interventions defined by the Council on Naturopathic Medical Education (CNME) and taught at accredited naturopathic 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 counseling.[55]

Licensure

In jurisdictions where Naturopathic doctor (ND or NMD) or a similar term is a protected designation, naturopathic doctors must pass the Naturopathic Physicians Licensing Examinations administered by the North American Board of Naturopathic Examiners (NABNE)[56] after graduating from a college accredited by the CNME.[55] Residency programs are offered at four of these colleges.[57][58][59][60] NDs are not required to engage in residency training, except in the state of Utah.[14][61]

In 2005, the Massachusetts Medical Society opposed licensure in that commonwealth based on concerns that NDs are not required to participate in residency, and are trained in inappropriate or harmful treatments.[45] The Massachusetts Special Commission on Complementary and Alternative Medical Practitioners rejected their concerns and recommended licensure.[62]

Naturopathic doctors are licensed in the state of Washington.[63]

Traditional naturopaths

Traditional naturopaths are those who have not graduated from accredited naturopathic medical colleges and are not eligible to obtain a license to practice naturopathic medicine.[64] In licensed states they are not permitted to refer to themselves as NDs or NMDs. They are represented in the United States by national organizations, including the American Naturopathic Association (ANA) founded in 1919 by Benedict Lust,[12][10] representing about 1,800 practitioners [65] and the American Naturopathic Medical Association (ANMA).[66]

The level of naturopathic training varies among traditional naturopaths in the United States. Traditional naturopaths may complete non-degree certificate programs or undergraduate degree programs and generally refer to themselves as Naturopathic Consultants. These programs are often online "degrees" and offer no biomedical education as well as no clinical training. Those completing a Doctor of Naturopathy (ND) degree from an ANMCB approved school can become a Board Certified Naturopathic Doctor.[67][68] This board certification is in no way the same as holding an ND license and holds no weight in states that regulate the practice of naturopathic medicine.

Traditional naturopathy as defined by the profession and the U.S. Congress in the early twentieth century[69] does not require a license in the United States.[70] Traditional naturopaths are not permitted to practice as NDs or NMDs in the 17 states where naturopathic medicine is regulated.[71]

Other health care professionals

Texas has begun establishing practice guidelines for MDs who integrate alternative and complementary medicine into their practice.[72] 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.[46]

Regulation

Naturopathy is practiced in many countries, primarily the United States and Canada, and is subject to different standards of regulation and levels of acceptance. The scope of practice varies widely between jurisdictions, and naturopaths in some unregulated jurisdictions may use the Naturopathic Doctor designation or other titles regardless of level of education.[52] The practice of naturopathy is illegal in two states.[20][21][22]

North America

In five Canadian provinces, seventeen U.S. states, and the District of Columbia, naturopathic doctors who are trained at an accredited school of naturopathic medicine in North America, are entitled to use the designation ND or NMD. Elsewhere, the designations "naturopath", "naturopathic doctor", and "doctor of natural medicine" are generally unprotected or prohibited.[22][52]

In North America, each jurisdiction that regulates naturopathy defines a local scope of practice for naturopathic doctors that can vary considerably. Some regions permit minor surgery, access to prescription drugs, spinal manipulations, obstetrics and gynecology and other regions exclude these from the naturopathic scope of practice or prohibit the practice of naturopathy entirely.[22][73]

Canada

Several Canadian provinces license naturopathic doctors: British Columbia, Alberta, Ontario, and Saskatchewan.[74] British Columbia has regulated naturopathic medicine since 1936 and together with Ontario (since 2009) are the only two Canadian provinces that allow certified NDs to prescribe pharmaceuticals and perform minor surgeries.[75]

The province of Quebec does not directly regulate naturopathy. The Quebec Ministry of Education has prohibited schools from offering doctoral programs in the subject, and there are no universities with a naturopath program. Therefore, studies must be done out of province. Furthermore, in Quebec, the Collège des médecins du Québec (CMQ) has exclusive rights to perform certain activities including but not limited to: ordering diagnostic examinations, prescribing medication and other substances and clinically monitoring the condition of patients whose state of health presents risks. This severely restrains the scope of practice for a naturopathic doctor.[76]

In Quebec, group benefits insurance is mandatory if offered by the employer, and coverage for a naturopathic doctor is typically included in these policies. As a result of the limitations (scope of practice, title, education) in Quebec concerning naturopathic doctors, the term naturotherapy has been accepted by some insurance carriers.[77][78]

The minimum requirement for a naturotherapist is usually between 400 or 800 hours of study.[79]

Medavie Blue Cross is an insurance provider, and listed ten associations it accepted as naturopathic providers for compensation and thirty it refuses to pay in a contract document with Syndicat des employés de métiers d'Hydro-Québec published on March 20, 2013.[80]

United States

Naturopathic doctors are not mandated to undergo residency between graduation and commencing practice,[14] except in the state of Utah.[61]

Australia

Currently the industry is self-regulated. There is no protection of title, meaning that technically anyone can practice as a naturopath.

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 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. People 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 were 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.[16]

India

In India there is a 5½-year degree course offering a "Bachelor of Naturopathy and Yogic Sciences" (BNYS) degree. The first college of naturopathy was started in Hyderabad, Andhra Pradesh by B. Venkatrao which offered a Diploma in Naturopathy (ND). There are a total of fifteen naturopathy colleges in India.[82]

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

The National Institute of Naturopathy in Pune was established on December 22, 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.[84]

United Kingdom

Naturopathy is not regulated in the United Kingdom. In 2012, publicly funded universities in the United Kingdom dropped their alternative medicine programs, including naturopathy.[85]

See also

References

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  53. ↑ The Platform of the American Naturopathic Association as drawn up by the Golden Jubilee Congress. July 27th – August 2nd, 1947
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  56. ↑ "About Us". North American Board of Naturopathic Examiners website. Retrieved 2013-09-03. 
  57. ↑ "Academic Degree Programs: Naturopathic Medicine Degree Program". Bastyr University website. Archived from the original on 2010-01-28. Retrieved 2009-09-22. 
  58. ↑ "Doctor of Naturopathic Medicine Residency Program". National College of Natural Medicine website. Retrieved 2013-09-03. 
  59. ↑ "Residencies". Southwest College of Naturopathic Medicine website. Archived from the original on 2010-05-27. Retrieved 2009-09-22. 
  60. ↑ "Residency Programs at Bridgeport". University of Bridgeport. Retrieved 2010-11-19. 
  61. ↑ 61.0 61.1 Division of Occupational and Professional Licensing, Utah Department of Commerce, State of Utah (February 17, 2012). "Application for Licensure: Naturopathic Physician". p. 1. Retrieved 2013-09-08. 
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  63. ↑ "Revised Code of Washington: Title 18, Chapter 18.36A: Naturopathy". Washington State Legislature. January 1, 1988 (effective). Retrieved 2009-09-22. 
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  65. ↑ Swartout, Kristy A., ed. (2006). Encyclopedia of Associations. Thomson Gale. pp. 1777–1778. ISBN 9780787682866. Retrieved 2013-09-04. 
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  68. ↑ Wendel, Paul (1951). Standardized Naturopathy. Brooklyn, NY: Wendel. OCLC 6617124. 
  69. ↑ "The Healing Arts Practice Act, District of Columbia 1928." Chap. 352 @ 1326, 5.3936, Public Law 831 [also found as 45 St. 1339] dated February 27, 1929 and its clarifying amendments H.R. 12169 of May 5, 1930 & January 28, 1931 and corresponding House Report #2432 of January 30, 1930.
  70. ↑ Lawton v. Steele, 152 U.S. 133 (1894).
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  72. ↑ "Practice Guidelines for the Provision of Complementary and Alternative Medicine". Texas Administrative Code, Title 22, Part 9, Chapter 200, Rule 200.3,. Secretary of State, Texas. November 22, 1998 (effective). 
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  74. ↑ "Questions: Education and Regulation". Canadian Association of Naturopathic Doctors website. Retrieved 2013-09-06. 
  75. ↑ "B.C. gives naturopaths right to prescribe drugs". CBC News. April 10, 2009. 
  76. ↑ "Illegal practice of medicine". Collège des médecins du Québec website. 2009. 
  77. ↑ "Welcome". Association des Naturothérapeutes du Québec website. 
  78. ↑ "Naturopathie - Présentation". PasseportSanté.net website (in French). 
  79. ↑ "Description of Represented Therapies". Alliance Québécoise des Thérapeutes Naturels website. 
  80. ↑ "Régime D’assurance Maladie et Hospitalisation et Santé D’hydro-Québec" (in French). Syndicat des employés de métiers d'Hydro-Québec. March 20, 2013. 
  81. ↑ "Ley para Reglamentar el Ejercicio de la Medicina Naturopática en Puerto Rico [Law to Regulate the Practice of Naturopathic Medicine in Puerto Rico]" (in Spanish). December 30, 1997. Archived from the original on 2008-10-02. 
  82. ↑ No author given (nd). "BNYS (list of colleges with university affiliation / government recognition)". Hosted on the National Institute of Naturopathy website (Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy, Ministry of Health and Family Welfare, Government of India). Retrieved 2013-09-08. 
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  85. ↑ Bevanger, Lars (January 18, 2012). "UK universities drop alternative medicine degree programs". Deutsche Welle. Retrieved 2012-02-05. 

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