Overview of Naturopathic Medicine
Naturopathic medicine is a distinct system of health care first developed in the late 1890’s in Europe which emphasizes the natural self-healing processes of the human body. Central principles include using healing approaches which derive from nature, encouraging self-responsibility for health, using therapies that promote the body’s ability to heal itself, and treatment which takes into account the whole person. A naturopathic physician typically combines several kinds of therapies, including diet, lifestyle changes, vitamins, minerals, and herbal (plant) medicines to prevent illness, treat disease, and promote well-being.
Naturopathy evolved as a commonly practiced comprehensive health system in the early 1900’s, and its origins are mainly from European herbal and water therapy traditions. It grew in popularity in the United States until the 1940’s, then waned in popularity during the ‘50’s and ‘60’s, and has experienced resurgence since then. Currently it is estimated that up to 70% of Americans have tried some form of complementary and alternative medicine (CAM), and annual visits to CAM practitioners exceed visits to conventional primary care providers in this country.
Since the 1990’s, there has been a trend towards more formalized, rigorous, and standardized training for naturopathic physicians. Increased oversight and regulation through state licensure is a priority for the profession. Also, greater focus on the importance of clinical evidence for naturopathic therapies and research in the field is resulting in a growing body of scientific evidence supporting approaches used by naturopathic physicians. In the United States, there are currently more than 2000 licensed naturopathic physicians.
There are currently four schools in the United States which offer accredited programs towards a Doctorate in Naturopathic Medicine (ND). The two largest are Bastyr University in Seattle and the National College of Natural Medicine in Portland. The other two accredited schools are Southwest College of Naturopathic Medicine in Phoenix, and Bridgeport University in Bridgeport, Connecticut. National University of Health Sciences in Illinois has applied for accreditation. There are two accredited schools offering a Doctorate in Naturopathic Medicine in Canada; Canadian College of Naturopathic Medicine in Toronto, and The Boucher Institute of Naturopathic Medicine in Vancouver, BC. The four year curricula at these schools are similar in many ways to conventional medical schools, beginning with two years of a wide range of courses in basic science and normal physiology and ending with two years of clinical rotations in predominantly primary care outpatient settings.
Since 1999, a national licensing exam termed NPLEX (Naturopathic Physicians Licensing Exam) has been administered in two parts. This exam is modeled closely after conventional medicine’s USMLE Steps 1 and 2. Graduates of accredited programs must pass this licensing examination to become eligible for obtaining a license to practice naturopathic medicine.
Most graduates go directly from one of these programs into practice, but a few go on to receive additional residency training, typically lasting one year. These residency slots are generally in short supply and tend to be very competitive, accepting top students who are interested in pursuing additional clinical training.
Licensure and Regulation
As of January, 2008, fourteen states license naturopathic physicians: Alaska, Arizona, California, Connecticut, Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington. In addition, Puerto Rico, US Virgin Islands, and Washington, DC also license qualified naturopathic doctors. Although not officially regulated, legal provisions allow the practice of naturopathic medicine in several other states. There are currently active efforts to pass legislation authorizing licensing of naturopathic physicians in several states, including New York, North Carolina, Massachusetts, Colorado and Illinois.
States with licensure laws require an ND degree from an accredited school and a passing score on both parts of the NPLEX exam. Some states, such as Utah, also require one year of post-graduate residency training.
Philosophy of Practice
Principles central to the practice of naturopathic medicine include:
- The healing power of nature. Recognize the body's inherent ability to heal itself, and the naturopathic physician's role in promoting and enhancing self-healing.
- First do no harm. Emphasize the importance of minimizing harmful side effects of treatment. Whenever possible choose gentler, less strong, therapeutic options.
- Find the cause. Awareness that suppressing symptoms alone may sometimes get in the way of discovering the cause of a disease.
- Doctor as teacher. The role of the naturopathic physician is to educate and encourage individuals to take responsibility for their own health.
- Treat the whole person. Naturopathic physicians strive to take into account all aspects of their patients’ health including emotional, social, and spiritual aspects.
- Prevention. Emphasize the importance of disease prevention through the use of effective disease prevention techniques.
Scope of Practice
Naturopathic physicians perform a history and a physical exam, order lab tests, and record findings using a “SOAP” format, in very similar ways to that of conventional medicine practitioners. A typical visit with a new patient will last one hour, and return visits typically range between 30 and 45 minutes.
Naturopathic physicians order many of the same lab tests as conventional practitioners, such as tests for anemia, thyroid disease, diabetes, etc, but in addition may also order some lab tests which are unfamiliar to conventional physicians, such as stool analysis for digestive disorders and salivary hormone panels. Radiology studies, such as mammograms, may be ordered, and Pap smears are commonly performed.
Naturopathic physicians typically combine several kinds of treatments in their practice. The methods employed usually include: herbal (plant) medicine and the use of other dietary supplements such as vitamins and minerals, modifications of diet and other lifestyle changes, hydrotherapy (water therapy), naturopathic physical manipulation, and homeopathy. Those who also have received training in Traditional Chinese Herbal Medicine or acupuncture may use these methods as well in some jurisdictions. Most naturopathic physicians have a small dispensary for herbs and other supplements in their office of products which they feel are of sufficiently high quality.
In 14 states naturopathic physicians are licensed as primary care practitioners and in 8 states are given the authority to write prescriptions for some medications. Washington State, Oregon, and Arizona are 3 states in the U.S. that allow broad prescribing rights for naturopathic physicians.
Most naturopathic physicians (ND’s) view themselves as general practitioners and refer patients for conventional medical care when appropriate. It is also common for ND’s to co-manage conditions with conventional providers. Some ND’s specialize, for example in women’s health, or cancer care, or musculoskeletal medicine.
Scientific Basis for Naturopathic Medicine
There is a small but growing body of scientific research into the clinical effectiveness of naturopathic medicine and the modalities commonly used in naturopathic medicine. Much of the clinical practice of naturopathic medicine is based on traditional empirical evidence, expert opinion, current best practice, and individual therapeutic trials. There is growing interest and resources available to conduct clinical research in naturopathic medicine. Due to the individualized treatment approaches and multiplicity of therapeutic agents used in treating patients, however, designing rigorous clinical trials is challenging.