Naturopathy
pharmaceutical drugs, surgery, and other treatments within evidence-based medicine, not seen as "natural"), comprising widely ranging "nature cures" and any form of alternative medicine that may be labelled as "natural" | |
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Related fields | Alternative medicine |
Original proponents | Benedict Lust; Sebastian Kneipp |
MeSH | D009324 |
See also | Humorism, heroic medicine, vitalism |
This article is part of a series on |
Alternative medicine |
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Naturopathy, or naturopathic medicine, is a form of
Naturopathic practitioners commonly encourage alternative treatments that are rejected by conventional medicine, including resistance to
Naturopaths frequently campaign for legal recognition in the United States. Naturopathy is prohibited in three
History
The term "naturopathy" originates from "natura" (Latin root for birth) and "pathos" (the Greek root for suffering) to suggest "natural healing".[18] Naturopaths claim the ancient Greek "Father of Medicine", Hippocrates, as the first advocate of naturopathic medicine, before the term existed.[18][19] Naturopathy has its roots in the 19th-century Natural Cure movement of Europe.[20][21] In Scotland, Thomas Allinson started advocating his "Hygienic Medicine" in the 1880s, promoting a natural diet and exercise with avoidance of tobacco and overwork.[22][23]
The term naturopathy was coined in 1895 by John Scheel,
From 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.[25][29] Naturopaths became licensed under naturopathic or drugless practitioner laws in 25 states in the first three decades of the twentieth century.[25] Naturopathy was adopted by many chiropractors, and several schools offered both Doctor of Naturopathy (ND) and Doctor of Chiropractic (DC) degrees.[25] Estimates of the number of naturopathic schools active in the United States during this period vary from about one to two dozen.[11][24][25]
After a period of rapid growth, naturopathy went into decline for several decades after the 1930s. In 1910, the
Beginning in the 1970s, there was a revival of interest in the United States and Canada, in conjunction with the "holistic health" movement.[25][1] As of 2009[update], fifteen U.S. states, Puerto Rico, the US Virgin Islands and the District of Columbia licensed naturopathic doctors,[32] and the State of Washington requires insurance companies to offer reimbursement for services provided by naturopathic physicians.[33][34] On the other hand, some states such as South Carolina and Tennessee prohibit the practice of naturopathy.[35][36][37]
In the United States, the Indian Health Service began accepting naturopathic doctors in their clinics and practice in 2013, also making loan repayment available to ND's.[38]
In 2015, a former naturopathic doctor,
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Sebastian Kneipp c. 1898, a Bavarian priest and forefather of naturopathy[26]
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Benedict Lust c. 1902, the founder of naturopathy in the U.S.[25]
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Britt Marie Hermes c. 2016, a former naturopathic doctor and major critic of naturopathic medicine[40]
Practice
In 2003, a report[45] was presented by Kimball C. Atwood, an American medical doctor and researcher from Newton, Massachusetts, best known as a critic of naturopathic medicine, stating among other criticisms that "The practice of naturopathy is based on a belief in the body's ability to heal itself through a special vital energy or force guiding bodily processes internally".[8]
Diagnosis and treatment concern primarily
A consultation typically begins with a comprehensive patient interview assessing lifestyle, medical history, emotional tone, and physical features, as well as physical examination.[1] Many naturopaths present themselves as primary care providers, and some naturopathic physicians may prescribe drugs, perform minor surgery, and integrate other conventional medical approaches such as diet and lifestyle counselling with their naturopathic practice.[1][49] Traditional naturopaths deal exclusively with lifestyle changes, not diagnosing or treating disease. Naturopaths do not generally recommend vaccines and antibiotics, based in part on the early views that shaped the profession, and they may provide alternative remedies even in cases where evidence-based medicine has been shown effective.[10]
Methods
Naturopaths are often opposed to mainstream medicine and take an
The particular modalities used by a naturopath vary with training and scope of practice. These may include
A 2004 survey determined the most commonly prescribed naturopathic therapeutics in Washington state and Connecticut were botanical medicines, vitamins, minerals, homeopathy, and allergy treatments.[42] An examination published in 2011 of naturopathic clinic websites in Alberta and British Columbia found that the most commonly advertised therapies were homeopathy, botanical medicine, nutrition, acupuncture, lifestyle counseling, and detoxification.[43]
In 2020, a survey of methods used by naturopaths in fourteen countries reported that 27% of clients received acupuncture, 22% homeopathy, 16% "other energetic medicines", and 13.5% were given hydrotherapy. A mean of 4.0 "treatments" were provided to each customer. One-third (33%) of patients consulted with only the naturopath to manage their primary health concern.[52]
Evidence basis
Naturopathy as a whole lacks an adequate scientific basis,
In 2015, the
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.
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".[12]
A former licensed naturopathic doctor, Britt Marie Hermes, states that "any product that is sold by a naturopath almost guarantees that there is no reliable scientific data to support whatever health claims are made,[60] and that while some naturopaths claim to only practice evidence based medicine, "the problem is, all naturopaths in an accredited naturopathic program are required to extensively study homeopathy, herbal medicine, energy healing, chiropractic techniques, water therapy" and other pseudoscientific practices.[58] Hermes further notes that, while some naturopaths claim that their method can be effective treatments for psychological disorders, "no naturopathic treatment has been clinically proven to be safe and effective for bipolar disorder or any other condition."[61]
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".[62]
The Massachusetts Medical Society states, "Naturopathic practices are unchanged by research and remain a large assortment of erroneous and potentially dangerous claims mixed with a sprinkling of non-controversial dietary and lifestyle advice."[63]
Safety of natural treatments
Naturopaths often recommend exposure to naturally occurring substances, such as
Certain naturopathic treatments offered by naturopaths, such as
Vaccination
Many naturopathy practitioners voice their opposition to vaccination. The reasons for this opposition are based, in part, on the early views which shaped the foundation of this occupation.[72] A naturopathy textbook, co-authored by Joseph Pizzorno, recalls anti-vaccine beliefs associated with the founding of naturopathy in the United States: "a return to nature in regulating the diet, breathing, exercising, bathing and the employment of various forces" in lieu of the smallpox vaccine.[73]
In general, evidence about associations between naturopathy and pediatric vaccination is sparse, but "published reports suggest that only a minority of naturopathic physicians actively support full vaccination".[74][75] In Washington state from 2000 to 2003, children were significantly less likely to receive immunizations if they had seen a naturopath.[74] A survey of naturopathic students published in 2004 found that students at the Canadian College of Naturopathic Medicine became less likely to recommend vaccinations to their patients and became more distrustful of public health and conventional medicine as they advanced in the program.[15]
The British Columbia Naturopathic Association lists several major concerns regarding the pediatric vaccine schedule and vaccines in general,[76] and the group's policy is to not advocate for or against vaccines.[77] The Oregon Association of Naturopathic Physicians reports that many naturopaths "customize" the pediatric vaccine schedule.[78]
As of April 25, 2022, a British Columbia government report found that 69.2% of naturopaths reported having received at least two COVID vaccines or receiving a medical exemption. This was much lower than all the other regulated medical professions in the report. The number for two professions – dieticians and physicians/surgeons – was 98%.[79][80]
As of 2016[update], the American Association of Naturopathic Physicians, which is the largest professional organization for licensed naturopaths in the U.S., is "still discussing its stance on vaccinations".[81]
Practitioners
Naturopath practitioners can generally be categorized into three groups: 1) those with a government issued license; 2) those who practice outside of an official status ("traditional naturopaths"); 3) those who are primarily another kind of health professional who also practices naturopathy.[11][82][83][84][85]
In Switzerland, these divisions fall between those with a federal diploma, those recognized by health insurances, and those with neither federal diploma nor recognition by health insurances. Naturopaths with federal diploma can be divided into four categories: European traditional medicine, Chinese traditional medicine, ayurvedic medicine and homeopathy.[86][87] The number of listed naturopaths (including traditional healers) in Switzerland rose from 223 in 1970 to 1835 in 2000.[88]
Licensed naturopaths
Licensed naturopaths may be referred to as "naturopathic doctors" or "naturopathic physicians" in 26 US states or territories and 5 Canadian provinces.[89] Licensed naturopaths present themselves as primary care providers.[1][49] Licensed naturopaths do not receive comparable training to medical doctors in terms of the quality of education or quantity of hours.[8][17]
In British Columbia, legislation permits licensed naturopaths to use the title "doctor" or "physician".[90] However, section 102 of the bylaw of the College of Naturopathic Physicians of British Columbia (CNPBC), the terms "naturopathic" or "naturopathic medicine" must be included anytime the term doctor or physician is used by a member of the CNPBC.[91][92][93][94]
Education
Licensed naturopaths must pass the Naturopathic Physicians Licensing Examinations (NPLEX) administered by the North American Board of Naturopathic Examiners (NABNE)[95] after graduating from a program accredited by the Council on Naturopathic Medical Education (CNME).[49][96] Training in CNME-accredited programs includes basic medical diagnostics and procedures such as rudimentary physical exams and common blood tests, in addition to pseudoscientific modalities, such as homeopathy, acupuncture, and energy modalities.[8][12][26][1]
These accredited programs have been criticized for misrepresenting their medical rigor and teaching subjects that are antithetical to the best understandings of science and medicine.
Several schools in North America exist for the study of naturopathic medicine, some accredited by the CNME.[102] The CNME and the Association of Accredited Naturopathic Medical Colleges (AANMC) claim entrance requirements and curricula at accredited colleges are often similar or comparable to those required and offered at conventional medical schools.[103] However, the lack of accreditation by the Liaison Committee on Medical Education may indicate insufficiency of scientific medical training and/or quantifiable positive results, and accordingly it remains disputed whether graduates of medical colleges accredited by the CNME have the competency of Medical Doctors and Doctors of Osteopathy.[17][104]
Naturopathic doctors are not eligible for medical residencies, which are available exclusively for medical doctors and doctors of osteopathic medicine. There are limited post-graduate "residency" positions available to naturopathic doctors offered through naturopathic schools and naturopathic clinics approved by the CNME.[105] Most naturopathic doctors do not complete such a residency,[42] and naturopathic doctors are not mandated to complete one for licensure,[11] except in the states of Utah and Connecticut.[106] Continuing education in naturopathic modalities for health care professionals varies greatly.[50]
Political activity in the United States
Naturopathic practitioners affiliated with the CNME-accredited schools lobby state, provincial, and federal governments for medical licensure and participation in social health programs.
Since 2005, the Massachusetts Medical Society has opposed licensure based on concerns that NDs are not required to participate in residency and concerns that the practices of naturopaths included many "erroneous and potentially dangerous claims".[112] The Massachusetts Special Commission on Complementary and Alternative Medical Practitioners rejected their concerns and recommended licensure.[113] The Massachusetts Medical Society states:[63]
Naturopathic medical school is not a medical school in anything but the appropriation of the word medical. Naturopathy is not a branch of medicine. It is a hodge podge of nutritional advice, home remedies and discredited treatments ... Naturopathic colleges claim accreditation but follow a true "alternative" accreditation method that is virtually meaningless. They are not accredited by the same bodies that accredit real medical schools and while some courses have similar titles to the curricula of legitimate medical schools the content is completely different.
In 2015, a former naturopathic doctor, Britt Marie Hermes, who graduated from Bastyr University and practiced as a licensed ND in Washington and Arizona, began advocating against naturopathic medicine.[114][39][115] In addition to opposing further licensure, she believes that NDs should not be allowed to use the titles "doctor" or "physician",[39] and be barred from treating children.[116][117] She states:[118]
Naturopaths aggressively lobby for laws to issue them medical licenses. I would characterize this political effort as a perverted redefinition of the words "physician", "doctor", "medical school", and "residency" in order to mask the inadequacy of the training provided in naturopathic programs. ND students do not realize that they are taking educational shortcuts and therefore do not possess any demonstrable competencies found in modern medicine.
Traditional naturopaths
Traditional naturopaths are represented in the United States by the American Naturopathic Association (ANA), representing about 1,800 practitioners[119] and the American Naturopathic Medical Association (ANMA).[25]
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 often offer online unaccredited degrees, but do not offer comprehensive biomedical education or clinical training.
Traditional naturopathic practitioners surveyed in Australia perceive evidence-based medicine to be an ideological assault on their beliefs in vitalistic and holistic principles.[5] They advocate for the integrity of natural medicine practice.[5]
Naturopaths graduating from accredited programs argued in 2002 that their training used evidence-based scientific principles unlike traditional naturopathic programs,[120] but this claim remains inaccurate.[8][26]
Regulation
Naturopathy is practiced in many countries and is subject to different standards of regulation and levels of acceptance. The scope of practice varies widely between jurisdictions, with some covering naturopathy under medical regulation and allowing practitioners to prescribe drugs and perform minor surgery, while other jurisdictions outlaw naturopathy entirely.[citation needed]
Australia
In 1977, a Commonwealth Government inquiry reviewed all colleges of naturopathy in Australia and found that despite having syllabuses appearing to cover the basic biomedical sciences, actual lectures had little connection to those syllabuses and no significant practical work was available. In addition, there did not appear to be significant or systematic coverage of techniques favoured by naturopaths, such as homeopathy, Bach's floral remedies, or mineral salts.[31]
The position of the Australian Medical Association is that "evidence-based aspects of complementary medicine can be part of patient care by a medical practitioner", but it has concerns that there is "limited efficacy evidence regarding most complementary medicine. Unproven complementary medicines and therapies can pose a risk to patient health either directly through misuse or indirectly if a patient defers seeking medical advice." The AMA's position on regulation is that "there should be appropriate regulation of complementary medicine practitioners and their activities".[121]
In 2015, the Australian government found no clear evidence of effectiveness for naturopathy.[59] Accordingly, In 2017 the Australian government named naturopathy as a practice that would not qualify for insurance subsidies, saying this step would "ensure taxpayer funds are expended appropriately and not directed to therapies lacking evidence".[122]
India
In India, naturopathy is overseen by the
North America
In five Canadian provinces, seventeen U.S. states, and the
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, midwifery (natural childbirth), and gynecology; other regions exclude these from the naturopathic scope of practice or prohibit the practice of naturopathy entirely.[37][126]
Canada
Five Canadian provinces license naturopathic doctors: Ontario, British Columbia, Manitoba, Saskatchewan, and Alberta.[127][128] British Columbia has the largest scope of practice in Canada, allowing certified NDs to prescribe pharmaceuticals and perform minor surgeries.[129] Ontario also permits prescription from a modified formulary list, following separate examination.[130]
United States
- U.S. jurisdictions that currently regulate or license naturopathy include Alaska, Arizona, California, Connecticut, Colorado, Delaware, District of Columbia, Hawaii, Idaho, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Pennsylvania, Rhode Island, Wisconsin, Puerto Rico,[131] US Virgin Islands, Utah, Vermont, and Washington.[130][32] Additionally, Virginia licenses the practice of naturopathy under a grandfather clause. (This was previously also the case in Florida, though currently no practitioners remain active under the grandfather provisions).[37][132]
- U.S. jurisdictions that permit access to prescription drugs: Arizona, California, District of Columbia, Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, New Mexico, Oregon, Utah, Vermont, and Washington.[130]
- U.S. jurisdictions that permit minor surgery: Arizona, District of Columbia, Kansas, Maine, Montana, Oregon, Utah, Vermont, and Washington.
- Three U.S. states specifically prohibit the practice of naturopathy: Florida,[133][134] South Carolina[35][37] and Tennessee.[36][37]
Switzerland
The Swiss Federal Constitution defines the Swiss Confederation and the Cantons of Switzerland within the scope of their powers to oversee complementary medicine.[135] In particular, the Federal authorities must set up diplomas for the practice of non-scientific medicine. The first of such diplomas has been validated in April 2015 for the practice of naturopathy.[86] There is a long tradition of naturopathy and traditional medicine in Switzerland.[136] The Cantons of Switzerland make their own public health regulations. Although the law in certain cantons is typically monopolistic, the authorities are relatively tolerant with regard to alternative practitioners.[87]
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.[137]
See also
- Appeal to nature
- Arnold Ehret
- Essential nutrient
- Friedrich Eduard Bilz
- Barbara O'Neill
- Health freedom movement
- Heilpraktiker
- Kneipp facility
- List of ineffective cancer treatments
- List of topics characterized as pseudoscience
- Megavitamin therapy
- Orthomolecular medicine
- osteopathic medicine
- Phytonutrient
- Therapeutic nihilism
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