Monthly Online Newsletter – November 2010

We’d like to welcome you to our monthly newsletter, intended to inform, heal and unite. Articles are contributed by professional members of the NYANP. Please direct questions and submissions to Caroline Budhan at caroline@nyanp.org.
To find out more about NYANP, become a member and/or sign up for our Lobby Day, please visit us at www.nyanp.org.
Dr. Donielle Wilson
NYANP President and Executive Director

In This Month’s Newsletter:

News and Events!

  • Events: We are pleased to let you know about public and professional events, including nearby conferences
  • Media Clips: Check out daily media articles related to natural medicine, click here!
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Dr. Peter Bongiorno

Calcium Supplements Linked to Heart Attacks

A no brainer right? You are at risk for osteoporosis – so, you should take calcium?
Now, some research is suggesting that calcium supplements by themselves not only provide little benefit for the bones, but that they can even be harmful, increasing the risk of heart attacks by nearly a third. Interestingly, these results do not apply to calcium ingested in food, which is beneficial for the bones.
A study this year from the British Medical Journal reported that there was a 31% increase in the risk of heart attack and smaller, non-significant increases in the risk of stroke and death. In this study, with equal numbers of women receiving calcium or placebo, 143 of those who received calcium suffered a heart attack while only 111 who received a placebo had a problem. Overall, the risk increase with calcium is small, but given all the women taking poor quality high dose supplementation, this may be a problem.
As a naturopathic note, most of these studies were with patients using calcium carbonate, a very inexpensive version of calcium supplementation. And these studies did not use vitamin D, and important nutrient/hormone that helps move calcium into bone, and is also protective of the heart in other ways.
From a naturopathic perspective, to treat osteoporosis, it is important to use an approach that includes changing the diet, strengthening digestion to absorption nutrition, increasing resistance exercise like gardening and weights work, and using a synergy of minerals like magnesium with some calcium (in a high quality form like citrate or malate) and boron, silica and horsetail, and of course checking vitamin D levels. There is also a genetic test that helps to see if a patient has a genetic predisposition to vitamin D imbalance and osteoporosis, and there are urine tests that help decide how much calcium a person is losing from the bone.
Since osteoporotic drugs have shown to increased fracture rates in other parts of the body, osteonecrosis of the hip and jaw, and esophageal changes that can become cancerous, it is may be prudent to use naturopathic therapies for osteopenia and osteoporosis first, and consider medication only as a last resort.
BMJ 2010 341:c3691 doi: 10.1136/bmj.c3691 (Published 29 July 2010)
Peter Bongiorno ND, LAc
Doctor of Naturopathic Medicine (WA state licensed), Licensed Acupuncturist (NY licensed)
Vice President, NY Association of Naturopathic Physicians
www.InnerSourceHealth.com
Order a signed copy of Dr. Peter’s new textbook Healing Depression: Integrating Naturopathic and Conventional Treatments at: www.InnerSourceHealth.com/depression
NY City and Long Island appointments: info@innersourcehealth.com, 631.421.1848

What happens when researchers take a break from technology:

Feeling overwhelmed by your handheld devices and computer. Does the fact that you are always accessible via voice, text or e-mail concern you? While these devices have enhanced some aspects of our lives they have also made it harder to concentrate and increased our level of distractibility.
To look at this further several brain scientists took a week long retreat to a remote part of Utah. No cell phones were allowed on the trip and no internet access was available. Basically there were no technological distractions. The scientists reported positive changes by the third day that they could not use their devices. While away from technology they felt more relaxed and reported improved communication skills.
While this is not a rigorously controlled scientific study, it sheds light on the issue of information/digital overload. Technology is a part of our lives yet we still need some down time, e.g., quiet time, relaxation, silence, 5 minutes free of distractions. Make it a priority to give yourself some time. Enjoy!
What happens when researchers take a break from technology:
Sean E. Heerey, ND
Naturopathic Doctor (Oregon Naturopathic Doctor License)
www.drseanheerey.com
Individualized Nutrition for Chronic Disease
212.239.4544

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Toxic Ingredients Are Often Unlisted

A study recently published in the Environmental Impact Assessment Review evaluated common household products. Toxic ingredients were found in every single sample and nearly half contained cancer-causing compounds.
Researchers at the University of Washington investigated chemicals released from 25 fragranced products. The samples came from widely-used and top-selling brands of laundry detergent, dryer sheets, fabric softener, soap, shampoo, lotion, hand sanitizer, deodorant, dish detergent, household disinfectant, all-purpose spray, and air fresheners in the form of solids, sprays and oils. Each product was placed in an enclosed glass container at room temperature and surrounding air was analyzed for evaporated chemicals using gas chromatography/mass spectrometry (GC/MS).
All together, the products released 421 chemicals, including 133 different volatile organic compounds (VOCs), contaminants with known effects on the environment and/or human health. Of the 133 VOCs identified, 24 are classified as toxic or hazardous under US laws. Each product emitted an average of 17 VOCs and one or more toxic or hazardous compounds. Almost half of the products tested (11 out of 25) contained carcinogens recognized by the US Environmental Protection Agency. And emissions from products promoted as “green,” “organic,” and “natural” did not significantly differ from other products.
Manufacturers of household products are not required to list all ingredients on product labels, nor are they required to disclose any ingredients regarded as “fragrance.” And a single “fragrance” can contain several hundred ingredients. Only 1 of the 133 VOCs (ethanol) was listed on a product label and only 2 were listed on any material safety data sheet. (MSDS is a widely used system for cataloging information about a chemical’s risks, safety and effect on the environment).
The Household Product Labeling Act is currently being reviewed by the U.S. Senate. Contact your senators and urge them to require product labeling that protects consumers and the environment, not manufacturers.
What else can you do?
• Look for fragrance-free products and remember that labels like “green,” “organic” and “natural” are not legally defined.
• Research personal products on the Environmental Working Group’s Skin Deep Cosmetics Safety Database. Search by product, ingredient or company to read safety reviews and make good choices.
http://www.cosmeticsdatabase.com/
• If your air is malodorous, open the windows or use diffusers with 100% pure essential oils instead of air fresheners. Avoid perfume oils.
• Use soaps made from olive, coconut or jojoba oils.
• Clean with natural materials instead of store-
bought products. Baking soda can be used as an abrasive agent to remove residue from surfaces like stove tops and ovens. Vinegar and essential oils can be used to clean and disinfect. Try my recipe for a home-made all-purpose cleaner:
Non-Toxic All-Purpose Cleaner
Use this all-purpose cleaner on counters, sinks, stove tops, appliances and tiles. Do not use it on wooden or delicate surfaces.
1 cup white vinegar
5 drops tea tree essential oil
5 drops lavender essential oil
½ cup water (optional)
Add all the ingredients to a new, clean spray bottle. Label the container with the ingredients and date. Store it out of the reach of children, for several months.
To use, shake the bottle gently to incorporate any essential oils that may have separated. Spray the cleaner on dirty surfaces and wipe off with a clean wet sponge. For tougher cleaning jobs, omit the water and leave the solution a few minutes longer before wiping it off.
Reference:
Steinemann AC et al. Fragranced Consumer Products: Chemicals Emitted, Ingredients Unlisted. Environmental Impact Assessment Review, 2010. DOI: 10.1016/j.eiar.2010.08.002
Sarah Cimperman, ND
Doctor of Naturopathic Medicine
19 West 34th Street, Penthouse
New York, NY 10001
646-234-2918

What We Can Learn from the French

November 20, 2009

by Peter Bongiorno ND, LAc and Pina LoGiudice ND, LAc (www.InnerSourceHealth.com)

Health care reform – the topic of the day. According to the World Health Organization (WHO), the US stands at 37th in terms of quality health care (between Slovenia and Costa Rica), even though we pay more than 2.5 times in health care per person (1). Properly used medications are the fourth leading cause of death (2).

Some kind of change is needed. Unfortunately, it looks like the major players involved in making the change (pharmaceutical companies, the American Medical Association, and the government) are unfortunately looking only to change some economics, as opposed to improving the quality of care. As a result, drugs are still the focus, and pharmaceutical prices are being raised now, in anticipation of health change and loss of profit. This avarice may add more than $10 billion to the nation’s drug bill, which is on track to exceed $300 billion this year (3).

Usually, when you want to learn to do something well, it is always a good idea to look to who is doing it best. Well, according to the WHO (not the 60’s rock band), France leads the world in quality of health care. Their system of integrative care (using natural and complementary medicines along with conventional diagnostics) seems to be a good model from which we can learn.

We can all try to get out there and tell our government’s legislators to start learning from those who are doing it best, instead of simply catering to those with investment in the status quo.

references:
1. 21 June, in The World Health Report 2000
2. Jason, et al. Incidence of Adverse Drug Reactions in Hospitalized Patients, Journal of the American Medical Association (JAMA), Vol. 279. April 15, 1998, pp. 1200-05.
3. Wilson D. NY Times Rising Prices of Drugs Lead to Call for Inquiry. Nov 18, 2009.

Working Moms Undiagnosed for Depression

by Peter Bongiorno ND, LAc and Pina LoGiudice ND, LAc (www.InnerSourceHealth.com)

An evaluation of national data on 2,130 mothers revealed that working mothers with depression were less likely to receive adequate treatment, possibly because excessive work hours do not allow time for proper care. It seems working mothers are greater risk for more difficulty from depression, for more than 65 percent of U.S. mothers with depression don’t receive adequate treatment, a new study has found. Even more, Black, Hispanic and other minority mothers are least likely to receive adequate treatment. Moms with health insurance are three times more likely to receive adequate treatment. Depression in mothers can have a major impact on the entire family, especially on the health and well-being of their children, the researchers noted. Treating depression in mothers can improve the long-term health of their families. Mothers with depression have children with higher incidences of a number of diseases, including asthma and psychological illness.

Commentary: Given this information, it seems crucial that the workplace becomes a place where working moms can have access to proper diagnostic techniques and integrative health solutions. Oftentimes, discussion of the condition with an empathic ear can be a part of the healing. Furthermore, there are numerous natural remedies that are very useful to help moms feel better while lifestyle and environmental changes are sought.

Note: Dr. Peter Bongiorno’s book: Naturopathic Treatments for Depression will be released in January of 2010 (CCNM Press).

Reference: Litzelman et al. Journal of Behavioral Health Services and Research e-publication ahead of print (November 2009)

Meditation Lowers Heart Attack Risk Highest Risk Group of African Americans find benefit

by Dr. Peter Bongiorno and Dr. Pina LoGiudice (www.InnerSourceHealth.com)

In most cases of naturopathic care, stress reduction techniques are a central part of helping the body to heal itself. In our practice, we find for virtually any condition, stress reduction modalities such as meditation, yoga, exercise, and acupuncture will help patients get healthier faster, decrease their dependence on medications, and sustain any gains. Heart disease is the number killer in the United States.

One recent study announced at the most recent American Heart Association gives credence to this approach. A major study of stress reduction with the Transcendental Meditation program was associated with 43% reduction in risk for all cause mortality, myocardial infarction and stroke in a high-risk sample of African Americans. A selected stress reduction approach may be useful in the secondary prevention of atherosclerotic CVD. The subjects were 201 African American participants (half male and half female) with documented coronary artery disease. Subjects performed either Transcendental Meditation or another program called “health education control.” Regular care was continued in all subjects.

After 5 years of follow-up, the heart attack risk in the meditation patients was 43% reduced. Systolic blood pressure (the top number) decreased by mean of 5.1 mm Hg. Also, there were reductions in psychosocial stress in a high stress subgroup. There were no significant changes in diastolic blood pressure (the bottom number) or Body Mass Index.

It was concluded that stress reduction with the Transcendental Meditation program was associated with 43% reduction in risk for all cause mortality, myocardial infarction and stroke in a high-risk sample of African Americans. A selected stress reduction approach may be useful in the secondary prevention of atherosclerotic CVD. It is likely that even greater benefits would be achieved in lower risk individuals. Also, greater benefits would probably result in those doing other lifestyle changes like exercise, the Mediterranean Diet, and proper nutrients.

It is not known if other methods are equally as effective at this point. If you are not including some kind of relaxation program as part of your health regimen, this is a great time to start.

ref: Schneider R et al. Effects of Stress Reduction on Clinical Events in African Americans With Coronary Heart Disease: A Randomized Controlled Trial. Abstract 1177: Circulation. 2009;120:S461

Peter Bongiorno ND, LAc
Doctor of Naturopathic Medicine (WA state licensed), Licensed Acupuncturist (NY licensed)
Vice President, NY Association of Naturopathic Physicians
NYANP Physician of the Year 2008
http://www.InnerSourceHealth.com
email: drpeter@innersourcehealth.com
appointments: reception@innersourcehealth.com, 631.421.1848

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High Blood Pressure in Kids from TV and Computer Use.

by Dr. Pina LoGiudice (www.InnerSourceHealth.com)

Date: August 8, 2009

TV and computer screen time has been linked to high blood pressure in youngsters. Recent evidence shows that children who watch television for 1.5hrs to 5.5hours of televsion a day shows that even if a children is trim and active, they will still have higher blood pressure. A study of 111 children from age 3 to age 8 showed that the increased blood pressure wasn’t associated with the sedentary behavior overall, but specifically linked to increased TV viewing. Two possible reasons are because children tend to snack unhealthy foods while watching TV, or because they watch material that is stressful or represent overactivity for their minds and reduce the ability to keep an increased metabolism. One other possibility is because it cuts into sleep time, which is needed for a host of healthy body processes. Surprisingly, the Amercian Academy of Pediatrics recommend children watch no more than 2 hours of ‘high quality’ television a day. In light of this information, this recommendation needs to be lowered.

Invented in 1929, television was first introduced to the public at a World’s Fair in 1939. The first licenses issued were for commercial stations – this fact tells us that the motivation for TV was to be a vehicle for selling advertising for goods and services while providing entertainment. In the early 1960s, the first educational stations (later Public Broadcasting) began offering programs with the aim to educate and enrich people’s lives. Regarding computers, in 1953, the UNIVAC was the first commercial computer and was able to pick presidential winners. In 1983, Apple introduced the first home computer.

Although these inventions can enrich our lives, this study emphasizes how they can also disrupt normal physiology. It is important limit TV to the minimum possible, and keep computer use in balance with other, more natural and healthful activities. written by Dr. Pina LoGiudice – http://www.InnerSourceHealth.com.

references:
http://www.mediafamily.org “the history of televsion” accessed August 8, 2009
Eisenmann J. Archives of Pediatrics and Adolescent Medicine. August 2009

The Biggest Quack School in Natural Medicine Closes

Dr. Andrew Lange

Dr. Andrew Lange

Physician, author and lecturer

Clayton College of Natural Health, a Birmingham-based, unaccredited Internet correspondence school that has faced criticism over its academic standards, is preparing to cease operations.

The Clayton school for years has been a classic diploma mill operation, offering doctorates and other degrees to students of natural health care, without providing clinical training or educational standards of any kind. They have unceasingly been opponents of accredited schools of Naturopathic medicine and licensing for Naturopathic Physicians who attend four year graduate schools of Naturopathic Medicine.

Well-known graduates of Clayton include television nutrition personality Gillian McKeith, controversial naturopath Hulda Regehr Clark, author Robert Young, and author Kim Barnouin, co-author of the diet book, Skinny Bitch.

The danger has been that Clayton graduates have represented themselves as Naturopathic doctors and have mislead consumers into believing they are seeing a graduate of an accredited medical school. It has been this misrepresentation that has caused their discredit, not any attempt to limit the study or use of natural medicines. The graduates of the Clayton school and other unaccredited programs have been represented and supported by the American Naturopathic Medicine Association.

Accredited programs of Naturopathic medicine are represented by the American Association Of Naturopathic Physicians (AANP). A licensed naturopathic physician (N.D.) attends a four-year graduate-level naturopathic medical school and is educated in all of the same basic sciences as an M.D., but also studies holistic and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness. In addition to a standard medical curriculum, the naturopathic physician is required to complete four years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, psychology, and counseling (to encourage people to make lifestyle changes in support of their personal health). A naturopathic physician takes rigorous professional board exams so that he or she may be licensed by a state or jurisdiction as a primary care general practice physician.
Additional information on naturopathic schools can be found through the American Association of Naturopathic Medical Colleges at http://www.aanmc.org or the AANP at www.naturopathic.org.

The professional growth of Naturopathic, Chiropractic, and Oriental medicine has been based on standards of education that reflect the need for competent health care. Medicine is not the exclusive domain of any one profession and health education is the prerogative of any individual. Its misrepresentation however is not. The growth of good health care is dependent on honesty and integrity as well as adequate training.

1. Hough HJ, Dower C, O’Neil EH (September 2001). “Profile of a profession: Naturopathic practice”. San Francisco: Center for the Health Professions, University of California, San Francisco. http://www.futurehealth.ucsf.edu/pdf_files/Naturo2.pdf.

http://www.huffingtonpost.com/dr-andrew-lange/the-biggest-quack-school_b_641931.html

Preventing Chronic Diseases through State Licensure of Naturopathic Medicine

By Serena Goldstein

Barrett Honors College at Arizona State University

Naturopathic medicine acknowledges medicine as the study and celebration of nature’s healing powers. It also focuses on viewing the body as an integrated whole that honors the body’s innate wisdom to heal, as well as recognizing the interconnection and interdependence of all living things (NCNM, 2009). Sixteen states in the U.S. have licensed naturopathic doctors as medical practitioners, and granted its citizens the most appropriate care for cures and prophylactic measures. Medical care for chronic diseases requires a solution comprised of diverse techniques that address multiple types of risk factors, and a doctor who spends time with their patient to encourage compliance for their personalized treatment plan. The exponential increase of chronic diseases has lead to an epidemic that has doubled mortality rates and increased health care costs due to people who are deprived of merited care. Naturopathic doctors (N.D.s) are experts in the use of many modalities such as, natural therapies and drug/nutrient, drug/herb interactions, use a variety of natural and non-invasive therapies like clinical nutrition and hydrotherapy, and are trained to perform physical exams, lab tests, gynecological exams, imaging, and other means of diagnosis, to accommodate the numerous risk factors for chronic diseases. All states in the U.S. should license naturopathic doctors because they are the only ones who are trained and taught a variety of modalities to treat the growing outbreak of chronic diseases.

1) Chronic diseases

Chronic diseases can be controlled, but not always cured, as they will require a lifetime treatment plan. They are usually characterized by acute episodes of illness followed by a period of time when symptoms may be reduced or absent, and some may cause permanent disability (Scheuler, Beckett, & Gettings, 2008). The rise of chronic diseases began around the mid 20th century, but requires a different type of management than infectious diseases. The 19th century population shift from country to city brought industrialization and immigration, which led to poor conditions (i.e. inadequate or non-existent public water supplies and waste-disposal systems) and resulted in repeated outbreaks of infectious diseases such as TB, typhoid fever, yellow fever, influenza, malaria, dysentery, and cholera (“Achievements”, 1999). Infectious diseases could be restrained by treatments that targeted microorganisms, such as vaccinations and antibiotics (“Achievements”, 1999), because they were typically caused by a single risk factor, such as bacteria, which was either cured or prevented by other microbes. Once vaccinations eradicated nearly all infectious diseases, chronic diseases progressively increased as the new killer. Chronic diseases, however, have multiple risk factors in that some cannot be controlled (i.e. genetics), and the solution to reduce the disease usually rests within the patient’s responsibility to make lifestyle changes of eating healthier, increasing exercise, and quitting unhealthy habits. The prevalence of chronic disease has risen over the past 50 years, proving acute care practices from the present healthcare system that arose in response to acute disease to be increasingly inefficient and ineffective (Holman & Lorig, 2000). “Chronic diseases are now the major cause of death and disability worldwide, and already account for 7 of every 10 deaths in the U.S.” (“Infectious”, 2009) People dying from chronic diseases are double that of all infectious diseases (including HIV/AIDS, tuberculosis and malaria, which are still currently around), maternal and perinatal conditions, and nutritional deficiencies combined (“Chronic diseases”, 2009).

The common risk factors of chronic disease are identifiably well known: an unhealthy diet and excessive energy (calorie) intake, physical inactivity, and tobacco use (“Chronic diseases”, 2009). Although people cannot control their age or genetics, they can decrease their risks by actively participating in creating a healthy lifestyle change with their physician’s guidance. Both major modifiable risk factors and non-modifiable risk factors (those that can be controlled) of age and heredity explain the majority of new incidents of heart disease, stroke, chronic respiratory diseases, and some important cancers (“Chronic diseases”, 2009).

2) How to manage chronic diseases

Managing chronic diseases depends on the persons’ desire to improve their condition, which involves more effort than remembering to take a pill every day. People may have to change their eating habits and incorporate physical activity, which can be difficult tasks for anyone because it involves restructuring ingrained habits and practicing a modified way of life. Every day, patients already decide what to eat, if they will exercise, the extent to which they will consume medications, and when they leave the clinic or office, they can also reject a health professional’s recommendations (Bodenheimer, Lorig, Holman, & Crumbach, 2002). Caring for and preventing future chronic diseases can be emotionally exhausting, even though patients already have a sense of control and autonomy in living one’s life. “Patients facing the discomforts and demands of chronic illness struggle to maintain a productive, hopeful life.” (Wagner, Austin, & Von Korff, 1996) The time allotted, set by both physician and patient, for new habits to develop is indicative of the success in diminishing or eradicating the problem. Self-management tasks (described as tasks incorporating activities and cognition into one’s life that help prevent disease) have been described and placed into 4 categories: 1) engage in activities that promote health and build physiological reserve, such as exercise, proper nutrition, social activation, and sleep, 2) interact with health care providers and systems and adhere to recommended treatment protocols, 3) monitor their own physical and emotional status and make appropriate management decisions on the basis of symptoms and signs, and 4) manage the impact of the illness on their ability to function in important roles, on emotions and self-esteem, and on relations with others (Wagner, 1996). Motivation for persisting in behavior change can include informing someone about how they can help prevent other chronic diseases and their likelihood of reducing treatment costs for those who have a variety of chronic conditions (Bodenheimer et al., 2002). Successful self-management also requires patients’ knowledge about their condition in order to make informed decisions about their care, performing activities to be in charge of the condition (i.e. a certain amount of physical activity), and maintaining adequate psychosocial functioning (i.e. regulate feelings with a disease that may or may not change) (Clark et al., 1991).

The purpose of patients managing chronic diseases is to improve their health and learn prophylactic measures to decrease any chances of developing new chronic ailments. There are no “magic bullets” for improving the quality of health care, but there is a need for health care professionals to develop appropriate diagnostic strategies (to determine the reasons for suboptimal performance of following through with treatment and identifying barriers related to non-compliance) and to carefully select the most effective interventions (Oxman, Thomson, Davis, & Haynes, 1995). “Magic bullets” are drugs created by scientists who search for a molecule that could cure a (usually deadly) disease (Strasser, 2008). High blood pressure, for example, can be eradicated if the person takes blood-thinning pills, but a sedentary lifestyle coupled with a diet of fast food would still clog arteries and probably inhibit the pill’s effectiveness. Alternatively, naturopathic doctors are trained in pharmacology and alternative treatments, but would favor the least invasive treatment starting with a lifestyle change to exercise and healthful eating, and depending on the severity of the disorder, would include vitamin and herbal supplements (Swiezewski, 2000). Obesity, another chronic disease, is characterized by a slow progression throughout life, and its etiology consists of genetic, environmental, metabolic and behavioral issues (Rippe, Crossley, & Ringer, 1998). A drug can be added into someone’s life as a quick fix to weight loss, but once someone decides not to take the drug, the weight may return. In contrast, a lifestyle change will teach the person strategies to incorporate permanent changes into their daily life, which will also help prevent them from developing other diseases associated with obesity (i.e. diabetes and high blood pressure). Someone can take a pill for weight loss and still eat a high-fat diet, which adds plaque to their arteries and increases their chance of a heart attack from high blood pressure. The latter method allows for more efficiency in a treatment plan because it works to reduce a variety of ailments.

3) Role of physicians and patients in dealing with chronic diseases

In addition to the shift from infectious diseases to chronic diseases, the doctor-patient relationship has also been altered. The former emphasis on paternalism until about 20-30 years ago, where the doctor was in control of the passive patient, turned into a new idea of recognizing the importance of an informed and autonomous patient (Kraetschmer, Sharpe, Urowitz, & Deber, 2004). Insurance companies may create some difficulty in allowing allopathic and osteopathic doctors to form a close relationship with their patients, because seeing more patients translates to more profit for both parties. Naturopathic doctors, on the other hand, focus their practice around a doctor-patient relationship that includes empowering the patient, an achievable goal with visits ranging from about a half hour to an hour and a half, depending on the patient’s concerns and ailments. Disregarding the aspect of time, patient visits should incorporate a ‘shared’ or ‘participatory’ decision-making style, instead of the paternal relationship, to accommodate the patient’s desire to be in control of their health. Participatory decision-making refers to physicians who routinely involve patients with chronic diseases in deciding their own treatment by presenting options, discussing the pros and cons of those options, eliciting patient preferences, and reaching mutually agreed-on treatment plans (Kaplan, Greenfield, Gandek, Rogers, & Ware, 1996). Participation should be defined by the patient’s comfort level, beyond the response of “You decide for me doctor”, such as the patient discussing his or her values and preferences with the physician in regards to the outcomes associated with the treatment alternatives. Then the physician can think of and describe the patients’ choices where they can choose the one they liked best (Guadagnoli & Ward, 1998).

Patients who need to deal with their chronic diseases are encouraged to follow a protocol developed in association with their physician. There are four components recommended, to varying degrees, which make up a successful program. The first one states that in collaborative problem definition, both patients and providers contribute their perspectives and priorities to defining the issues to be addressed by clinical and educational interventions. Enhancing the patient’s participation may require the aid of questionnaires, interactive computers, and patient-centered interviewing techniques (Wagner, 1996). The physician’s vast knowledge of solutions can be narrowed down to specific choices through the patient’s preference of treatment. A naturopathic doctor who is trained in both allopathic and homeopathic medicine, grants them the ability to draw upon a broad spectrum of conventional and homeopathic treatments, while their education allows an understanding of which method will produce favorable or adverse reactions.

The second element suggests targeting, goal setting, and planning. Approaches that target the issues of greatest importance to both patient and provider are the ability to set realistic goals, and an effort to develop a personalized treatment plan is more likely to have long-term success, particularly if the progress is guided by considering the patients’ readiness to change and their self-efficacy (Wagner, 1996). Recent theoretical and empirical research has indicated how a shift in focus from the patients’ knowledge of the disease and its treatment, to emphasizing how their confidence and skills in managing their condition by setting limited and achievable goals, can increase self-esteem when following through with their treatment plan (Wagner et al., 2002). Congruently, psychologists use a similar method, called the Beck Depression Inventory, for their patients who feel helpless in their situation. It follows the same idea of setting small goals and working with patients towards successful achievement when both doctor and patient plan a reasonable goal. Fortunately, psychology is a prerequisite for naturopathic medical school and then reinforced throughout the medical school curriculum.

Next, a continuum of self-management training and support services for most chronic illnesses should include instruction in disease management, behavioral change support programs (e.g., smoking or dietary interventions), exercise options, and interventions to deal with the emotional demands of chronic disease (Wagner, 1996). People may differ in how they can adjust to a lifestyle change. If results aren’t happening as soon as they want, for example, patients may feel discouraged and return to their old habits. Fortunately, Naturopathic Doctors (N.D.s) understand each person’s individual differences and develop solutions to their needs. Flourishing interventions also reinforce the patient’s (and family’s) crucial role in managing the condition (Wagner, 2002). Even individual and group instruction and high-quality educational materials with personalized feedback are effective ways of teaching skills and providing support, although methods should be designed towards each individual patient (Von Korff, Gruman, Shaefer, Curry, & Wagner, 1997). N.D.s are able to allot hours with a patient to relieve them of any questions and concerns from both them and their families, and it is also part of their job to develop an optimal treatment including involvement in a support group.

Finally, evidence suggests that when reliable, active and sustained follow-up occurs at regular intervals, and initiated by the provider, leads to improved health outcomes (Wagner, 1996). Contacting patients at specific time intervals allows care providers to obtain information on medical and functional status, identify potential complications early, check progress in implementing the care plan, make necessary modifications, and reinforce patient efforts, any or all of which can be done by return visits, telephone calls, electronic mail, or mailed forms (telephone is preferred) (Von Korff et al., 1997). In chronic diseases such as systemic lupus erythematosus, telephone interventions, especially using the treatment counseling approach rather than just monitoring symptoms, are effective for improving patients’ functional status (Car & Sheikh, 2003). Treatment counseling shows that someone is actively involved in helping the patient through any psychological qualms about dealing with the disease, while monitoring symptoms could be just based on what the patient is feeling, devoid of any emotional encouragement. Telephone support also increased adherence to drug treatment and behavioral recommendations in patients with type 2 diabetes mellitus (Car & Sheikh, 2003). Psychological benefits to telephone communication include allowing patients to directly participate by asking questions and receiving support without the stress, expense, or time commitment of face to face contact (Car & Sheikh, 2003). Rich et al. evaluated an intervention for patients with congestive heart failure that included predischarge planning, a prescribed and individualized diet, a simplified medication regimen, and an active physician follow-up by home visits and telephone contacts. Patients who received the intervention, relative to controls, showed an increased quality of life and had fewer readmissions over a 90-day follow-up period (Rich et al., 1995). Naturopathic doctors, who will most likely see fewer patients in the same period of time when compared to allopathic and osteopathic doctors, understand how communication outside the office fosters a positive doctor-patient relationship increases that treatment compliance.

4) Increased doctor’s visits allos for more effective communication/description

For a variety of reasons, patient care is more likely to improve when a doctor can devote additional time to patients. Although the amount of time is not always defined, such as fifteen minutes versus a half hour, research has correlated increased personal interest with increased time spent with the patient. “Longer visits seem to allow for more attention to several aspects of care, including increased patient participation, patient education, preventative health, and performance of immunizations.” (Dugdale, Epstein, & Pantilat, 2001) Doctors can give patients information materials (i.e. brochures and pamphlets for additional information and/or support groups) to allow patients to think through their preference of treatment (Coulter, 2002). Doctors should also prompt their patients to ask questions and provide emotional support and written information packages as surplus learning equipment (Stewart, 1995). Extra material may also convey to patients that their doctor cares about their health and wants them to know as much as possible about their disease so that they can gain control of their situation and maybe take comfort in knowing that other people may have similar dilemmas. Chronic diseases, such as heart disease, cancer, and obesity, are induced by a variety of factors over a person’s lifetime, some of which can be controlled or altered. Smoking, for example, is linked to cancer and heart disease, but remains a habit that may be hard to quit. The doctor who has the time to explain the short and long-term repercussions of smoking (i.e. chronic diseases, lowered immune system), encourage inquiry, and discuss reasons why people start may help prevent that person from considering starting the habit. In an expansion of time without the burden of seeing as many patients as possible, effective communication of ailments, treatment, and preventative measures against other illnesses should also include terms and examples that patients can understand, so they can comprehend the importance of following a treatment regimen or life-style change. Doctors should not assume that others have knowledge of biology vocabulary; therefore a productive conversation is imperative to help patients achieve optimal health. It has been suggested that patients just extract the gist of any information—not the details—to make decisions, and then those decisions are determined not by facts but by emotions (Paling, 2003). Patients’ feelings towards a doctor can skew their understanding of the facts and therefore inhibit their ability to make objective decisions about clinical management (Paling, 2003). When communication between a patient and physician does not “feel good”, important information is often withheld, and apparent agreement about a care plan may belie different interactions (Saba et al., 2006).

Positive emotions about a doctor, however, can increase the benefits of the patient’s psychological health, and additionally promote effective communication. With a collaborative relationship, associated with positive feelings, both may consider engaging in more shared decision making communication behavior, such as eliciting and offering more information and expressing feelings and beliefs (Saba et al., 2006). Increased time also allows for productive communication that exerts a supportive influence not only on the emotional health of the patient, but also on the symptom resolution, functional and physiological status and pain control (Stewart, 1995). Emotional dimensions, as previously noted, have favorable effects on a variety of treatment and curing outcomes such as: successful readjustment after a traumatic irrevocable stigmatizing impairment, adherence to medical regimens, and recovery from surgery. (Carmel & Glick, 1996) Genuine care for the patient increases the benefits of the treatment because a kind and knowledgeable doctor may not produce stress and worry, physiological states that can lower an immune system and hinder good health. “Physician and patient education were found to improve patient health outcomes, as physician education was demonstrated to affect the patient’s emotional status. Patient education (usually by the physician) was also shown to affect physical health, level of function, blood pressure, and blood glucose level.” (Stewart, 1995) In addition, when patients enjoy being in the company of their doctor, they are more likely to follow treatment and therefore notice an improvement in their health. Naturopathic doctors require at least a half hour with the patient, and an hour or longer in the first consultation, so they can develop a doctor-patient relationship to increase the patients’ treatment compliance, and, most importantly, to treat the patients’ mind and body (the whole person), and not just the disease. Both physiological and functional statuses have favorable outcomes if the physician encourages the patient to become more involved in their treatment decisions (Kaplan et al., 1995).

More time=more communication for better diagnosis/treatment

Additional time also allows for increased communication in discussing the patients’ diagnosis and how they plan to adhere to their treatment. Patients need to feel that they are active participants in their own care and that their problems have been fully been discussed (Stewart, 1995) and that they can request any amount of information from their physician they need (Kaplan, Greenfield, & Ware, 1989). A naturopathic doctor may think of and research various modalities of treatment to present to the patients so they can choose the most appropriate regimen available that will fit their lifestyle. Patients prefer a proactive role in deciding their treatment, as agreement between patient and physician both about the nature of the problem and the following course of action appears to bode well for a successful health outcome (Stewart, 1995). Each individual could require or want a different amount of time during the visit, but it is strongly recommended that they understand their healing process to make permanently healthy lifestyle changes. A naturopathic physician also is trained to treat the mind and body as one entity, as physiological processes may inhibit improving any of the patients’ ailments. A lengthened visit also allows the physician to attain an in-depth history of each patient’s life, which may help the physician extract information to explain a patient’s lack of motivation. A genetic predisposition toward depression, for example, could hinder them from implementing a lifestyle change to improve their chronic disease. The range from mild to severe depression may alter the N.D.’s suggestions on which goals can be achieved during a certain period of time, as each treatment plan is patient-specific. Patients who express opinions, draw out treatment options, ask questions, and state preferences about treatment during office visits with physicians have notably better health outcomes than patients who do not (Kaplan et al., 1996). Although everyone has the same organs that have the same function (i.e. food going through the esophagus into the stomach), genetics and someone’s emotional and biological past and present should individualize their treatment plan. N.D.s are prepared to spend any amount of time with the patient, especially during the first session, to understand the patient’s past, present, and future.

More time=more compliance with medication

Compliance with their medication and treatment is imperative, especially in the case of chronic diseases where many have similar risk factors. Obesity is a common risk factor for cardiovascular diseases, certain cancers, diabetes, and mortality. It also exacerbates other chronic diseases such as hypertension, osteoarthritis, and gallstones (Field et al., 2001). A healthy and active lifestyle can reduce obesity, therefore serving as prophylactic measures to diminish the patients’ chances of developing other chronic diseases.

Patients are more likely to adhere to their medication when they understand its purpose and benefits. Predetermined time for an office visit may not allow the patient, whose number of ailments is unknown, to grasp the idea of their conditions and treatment and ask any further questions. The additional time a physician requires in the same visit to formulate a comprehensive explanation of both the patients’ ailments and treatment plan, which can vary depending on their conditions and severity of their ailments, is considerable. Doctor’s appointments with flexible time availability, such as a naturopathic doctor provides, is necessary to treat each patient effectively because more time grants an increased opportunity to educate patients and discuss their treatment plan, all dimensions that are linked to higher compliance in following through with their treatment plan. Highly relevant information about concerns (of the illness, family’s expectations for the medical visit, and what to expect regarding patient’s fears) can be obtained with the simplest interview questions, but these concerns are given insufficient attention during doctor-patient consultations where insurance companies are in control (Korsch, Gozzi, & Frances, 1968).

The main reason patients will comply with their treatment is if they are able to work with the physician in developing their course of action. Research on patients with chronic diseases such as hypertension, non-insulin-dependent diabetes mellitus, peptic ulcer disease, and rheumatoid arthritis showed they had better functional status and lower follow-up glycosylated hemoglobin levels, blood pressure, and arthritis severity than patients of less participatory (more controlling) physicians (Kaplan et al., 1996). A participatory style of doctor and patient relationship is defined as the physician who presents options, discusses the pros and cons of these options, elicits patient preferences of medication, reaches mutually agreed-on treatment plans (Kaplan et al., 1996), provides patient control over treatment decisions, and establishes patient responsibility for care (Kaplan et al., 1995). Naturopathic medical schools prepare future N.D.s with the classroom knowledge and resources to present and discuss with the patients the various choices of treatment that they believe will fit their patients’ lifestyle and therefore encourage them to continue their regimen. Patient success of improving health is most likely based on the fact that they were also more compliant with their treatment due to a N.D. having the time to develop a preferred participatory style relationship. Patients who feel that they have contributed in decision-making are more likely to follow through on those decisions than those who do not (Kaplan et al., 1995). This type of involvement has particular relevance for chronic disease care, in which most of the treatment plan must be carried out by patients (Kaplan et al., 1996). Infectious diseases, on the other hand, usually require a vaccination every few years while the doctor keeps track of their patients’ records to remind them.

5) Consequences of not having access to these aspects

The epidemic of chronic diseases requires preventative measures such as a balanced diet and exercise, because both work together to provide the body with optimal performance in daily life. Screenings and yearly checkups are also considered ways to prevent disease and complications, because even if a diagnosed abnormality may or may not be cured, it can be monitored to reduce complications. Colonoscopies and mammograms, for example, when performed on a yearly basis help doctors determine whether or not a person has cancer and positive results are followed by additional tests for its stage. Then physicians can determine the best course of action. Catching cancer in the beginning stages could mean a successful surgical removal of the tumor before it spreads to the rest of the body and becomes fatal. A recent study of family practices in Michigan showed that relevant cancer screening tests, including breast, cervical, colorectal, and prostate cancer screening, was achieved for only 3% of women and 5% of men aged 50 and older (Yarnall, Pollak, Ostbye, Krause, & Michener, 2003). Variations in patterns of illness and treatments with unknown outcomes create skepticism about prognosis, further verifying the importance of effective management (Holman & Lorig, 2000). Similarly, low national rates of preventative services are also common, with the most common reason being lack of time during the office visit (Yarnall, 2003). A study done by Zyzanski and colleagues (1998) discovered that doctors who have a high influx of patients are sacrificing their efficiency for lower rates of preventive services (Zyzanski, 1998). Ironically, the number of recommended prophylactic aid is increasing as new tests are developed, while research shows the value of preventative care for chronic diseases (Yarnall, 2003). Naturopathic doctors are trained to become primary physicians, among other professions, where they can also perform any amount of these prophylactic tests and, most importantly, have the time to do so.

The inability to address patients’ concerns during development of an optimal treatment plan can be detrimental to their health. Patients may not always reveal personal information for a multitude of reasons and not recognize that it could completely alter their diagnosis and treatment. The patient usually provides the individual information and the doctor the general information, and both are necessary for effective management (Holman & Lorig, 2000). Once a doctor imparts information to his or her patients, the patients’ desire to know and understand what is wrong and where the pain comes from may lead to additional information-seeking about what has just been learned (Ong, de Haes, Hoos, & Lammes, 1995). The length of the visit, however, alters the patients’ curiosity for knowledge. Studies have shown that appointments below the median of eighteen minutes resulted in substantially less information seeking, even for patients who rated themselves as having a high level of interest for information. For visits longer than eighteen minutes, the patients’ interest in knowledge became an important determinant of how much information seeking occurred (Dugdale, Epstein, & Pantilat, 2001). Extended visits seem to allow for increased attention to various aspects of care, including increased patient participation, patient education, preventative health, and performance of immunization (Dugdale et al., 2001). Responsibility for tending to chronic diseases appears to require all these aspects of care, as the more involved a patient is in understanding their ailment and feeling like they helped create their treatment, the higher their rate of treatment compliance becomes along with the greater chance to improve their health.

M.D.’s and D.O.’s may not be able to impart as much information to the patient as they would like, for they suffer under the time constraints dictated by insurance companies. Physician information giving, highly valued by patients, takes time, and physicians cannot expect the appointment to go well if they are busy. As a result, the quality of medical management and outcomes may be in serious jeopardy (Davidoff, 1997), especially for diseases caused by a variety of factors that need more than just medication to cure the problem. There also seems to be a failure during shorter visits to obtain the requisite history about potential hazardous interactions to other forms of therapy (Davidoff, 1997). Certain pharmaceuticals and homeopathic remedies may have negative side effects when taken together, and limited office time leads to the possibility of the patient unintentionally leaving out important information. Doctors ask more questions and patients then answer more questions in longer consultations, allowing doctors to gain knowledge of additional history to make informed judgments, compared to doctors who work with less patient information (Risdale, Carruthers, Morris, & Risdale, 1989). Morell et al. (1986) also found that when doctors had more time to talk to their patients they detected more problems and patients were more satisfied. In addition, doctors were able to teach patients about prevention and health through a lengthened visit that allowed for increased communication between doctor and patient.

Limited time at an appointment prompts conflict for both doctors and patients because, usually, neither of their needs will be met. If doctors cannot develop good relationships with their patients, then it is less likely the patients will be contented with their visits and comply with any type of treatment. Most importantly, doctors who are unable to collect a patients’ history or current information may incorrectly diagnose patients and/or place them on a treatment that interacts with other drugs they are ingesting, thus leading to a possibility of malpractice lawsuits. Levinson et al. found that compared with primary care physicians with two or more lifetime malpractice claims, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the ease of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients’ opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than primary care physicians who had malpractice claims. Longer visits, which can positively increase the rapport between patient and physician, allows time for comprehending the patients’ background and could reduce the chance of doctors being sued as long as they heed these recommendations. Shorter visits were associated with more inappropriate prescribing of nonsteroidal anti-inflammatory drugs, further emphasizing a relationship between encounter length and quality of care (Dugdale et al., 2001).

Due to the multiple causes of chronic diseases where some of them are uncontrollable, such as those related to genetics, relief from a prescription pill might only mask symptoms of the disease instead of aiding in the healing process. Rethinking prescribing, reviewing individual patients, using the potential of computer systems, and changing patients’ expectations all take a longer than the allotted period of time, while an abbreviated office visit may imply that prescribing comes to be used more often as a “quick fix” for ending encounters (Dugdale et al., 2001). There are no “magic bullets” for improving the quality of health care, although a wide range of available interventions, if used appropriately, could lead to substantial improvements in clinical care (Oxman et al., 1995). A race to beat the clock to continue seeing a high volume of patients can make it almost impossible to consider educating and working with patients to formulate a treatment plan, some of the ingredients necessary to help manage and to prevent chronic diseases from occurring. In a 2005 weight loss study, Wadden and colleagues confirmed previous reports that the benefits of lifestyle modification used alone had greater success clinically and statistically than those who received the drug sibutramine (a weight loss pill) during the first 18 weeks. This study not only conveys the importance of a lifestyle change for improved health, but also reiterates the need for allowing patient autonomy when deciding their treatment plan and how a shared relationship between doctor and patient count as factors associated with increased treatment compliance.

6) Training

Future naturopathic doctors in medical school are taught the six guiding principles of naturopathic medicine, such as 1) healing power of nature (trusting in the body’s inherent wisdom to heal itself), 2) identifying and treating the causes (looking beyond the symptoms to the underlying cause), 3) first do no harm (utilizing the most natural, least invasive and least toxic therapies), 4) doctor as teacher (educating patients in the steps to achieving and maintaining health), 5) treat the whole person (viewing the body as an integrated whole in all its physical and spiritual dimensions), and 6) prevention (focusing on overall health, wellness and disease prevention) (NCNM, 2009). The majority of these principles, such as ‘doctor as teacher’ to educate the patient about their health, pertain to solutions suggested to prevent chronic diseases. Seeking to understand the clients’ health to formulate their diagnosis is pivotal to all else in health care, as this knowing is the basis for actual ‘doctoring’—teaching the client about his or her own health, including how it might be changed for the better (Miettinen & Flegel, 2003). Once doctors have confidence in their knowledge, they can help patients understand how their body works and how to manipulate it into good health, thereby increasing patient autonomy in comprehending treatments, which will, therefore, inspire more compliance when both physician and patient decide on a certain plan.

Applicants to naturopathic medical school need to complete the given basic science prerequisites, which consist of completing a year of general chemistry, general biology, organic chemistry, and physics with lab. In the U.S., naturopathic physicians and conventional physicians also require, in addition to the sciences, pathology, patient evaluation, and profession-specific clinical intervention training, although some variation exists within both programs in terms of quality and quantity of exposure (Cherkin et al., 2002). Humanities, social science, and human psychology are additional required courses to help prepare future naturopathic students for working closely with patients, as average appointments can range from a half hour to an hour and a half. Once in naturopathic medical school, medical students complete the majority of the treatment-based courses in the first three years, while the fourth year emphasizes a major focus on clinical training by having students work closely with licensed physicians in caring for patients where a clinical proficiency exam at the end of their four years ensures clinical competency (NCNM, 2009).

After the four years, just like allopathic and osteopathic students, naturopathic students have a cumulative exam to license them as Naturopathic Doctors. The Naturopathic Physicians Licensing Examination (NPLEX) includes a basic sciences examination and clinical examinations in clinical, physical, and laboratory diagnosis; diagnostic imaging; botanical medicine; pharmacology; nutrition; physical medicine; homeopathy; minor surgery; psychology; lifestyle counseling; and emergency medicine (Eisenberg et al., 2002). Graduates are expected to pass by exhibiting competence in a variety of factors imperative to patient care and healing chronic diseases. The physicians’ knowledge of homeopathy, nutrition, and pharmacology enables them to develop a remedy that will best fit the patient (without adverse side effects of different medicines interacting), while proficiency in psychology and lifestyle counseling aid in establishing a doctor-patient relationship to increase treatment compliance.

Conventional Medical Schools 4-year Naturopathic Medical Schools
Bachelors Degree Required YES YES
Premed Prerequisites Required (i.e. chemistry, biology, physics, psychology) YES YES
4 year Graduate Level Program YES YES
# of Hours of Basic & Clinical Sciences ≈1524 ≈1535
# of Hours of Conventional Therapeutics ≈3393 ≈2029
# of Hours dedicated to Alternative Medicines ≈0 f≈842
Naturopathic Allopathic Osteopathic
Anatomy (gross/dissection) 350 380 362
Physiology 250 125 126
Biochemistry 125 109 103
Pharmacology 100 114 108
Pathology 125 166 152
Microbiology/ Immunology 175 185 125
Total Hours 1125 1079 976

(“MSND”, 2005)

Subject Allopathic-MD Naturopathic-ND
Anatomy & Embryology 25 26
Histology 8 4
Physiology 11 19
Biochemistry 6 12
Pathology 25 12
Microbiology/Immunology 12 9
Naturopathic Therapies 19.2** 98.5**

*Figures compare number of quarter credits for each area of study between the University of Arizona School of Medicine-MD (2005-2006) and Southwest College of Naturopathic Medicine-ND (2006-2007).

**Social and Behavioral Sciences

***Includes Homeopathy, Botanical Medicine, Oriental Medicine, Clinical Nutrition, Naturopathic Manipulative Treatment, Environmental Medicine, Acupuncture, Minor Surgery, and Mind-Body Medicine/Counseling

Graduates are ready to practice after graduating, but they are advised to complete at least a year of residency to increase their preparation to work with patients (NCNM, 2009). “Limited post graduate training opportunities for naturopathic physicians have become available only recently, likely explaining the higher prevalence of residency training observed among more recent graduates.” (Cherkin et al., 2002) The demand for naturopathic doctors encourages the field to increase the amount of residencies, as the few available are already very competitive. Residencies can be for more than a suggested year, although as of now they are not yet a prerequisite for practice.

7) Increasing prevalence of people using naturopathic medicine

Pharmaceutical companies persuade allopathic and osteopathic doctors (M.D.’s and D.O.’s) to visit as many patients as possible in order to increase the companies’ profits. Medical doctors are also viewed as having little respect for their patients, who often are not informed of the nature of their illnesses, diagnoses and prognoses (Siahpush, 1998). Frustration with a system that does not cater to the patients’ desire to take an active role in their health care and develop a relationship with the doctor renders naturopathic medicine as a favorable option. Some of the major reasons for this change include resentment with the health outcomes of conventional medicine, dissatisfaction with the medical encounter, and the emergence of a new (the postmodern) value system (Siahpush, 1998). Siahpush (1998) concluded that even though demographic variables (i.e. gender, age, and education) don’t impact attitudes towards alternative medicine, malcontent with a medical encounter, defined by how traditional doctors act towards people, is what leads to a favorable attitude towards alternatives. Patients have become disheartened by the current health care system, which continues to encourage speedy doctor visits ending in a drug prescription that either proves to be a temporary solution, or worse, has ill effects. Patients seek alternative therapies to cure a health problem and alleviate a pain that allopathic and osteopathic general practitioners have not been able to treat effectively (Siahpush, 1998). In addition, patients are irritated with the ineffectiveness of conventional treatment because it is seen as too technologically oriented, impersonal, and/or too costly (Astin, 1998). “Technology, for example, is regarded as tampering with and transforming nature and creating invasive modes of patient treatment.” (Siahpush, 1998)

A result of this dissatisfaction is patients’ increasing use of naturopathic medicine, which encompasses alternative therapies. According to estimates in 1997, the U.S. public spent between $36 billion and $47 billion on complementary and alternative medicine (CAM), and of this amount, between $12.2 billion and $19 billion was paid out-of-pocket for services of the professional CAM health care providers such as chiropractors, acupuncturists, and massage therapists (Barnes, Powell-Griner, McFann, & Nahin, 2004). Naturopathic doctors were not specifically mentioned as CAM providers, but they learn some of the same therapies used by these alternative specialists, such as chiropractors, suggesting how people’s acceptance of alternative therapies will include their welcoming of other training that N.D.’s have to offer. Alternative (defined as other than allopathic) treatments are usually not covered by insurance plans, but people seem to value this type of care regardless of the price. In addition, financial analysts have suggested that consumer spending on alternative medicine may have surged 69% from 1989, and the market could be growing as fast as 30% annually (Studdert et al., 1998). A bit more recently, in 1997, an estimated 4 in 10 Americans used at least one alternative therapy, compared with 3 in 10 in 1990 (Eisenberg et al., 1998). Rising demand for alternative care, also leads to an 88% projected increase in chiropractic, naturopathic, and licensed acupuncturists from 1994-2010, as the 92% growth in membership of the American Association of Naturopathic Physicians (AANP) from 1997-2000 adds validation to these sharp statistical increases (Smith & Logan, 2002). On a similar note, even if states do not license naturopathic doctors, they can still practice in states, often under a licensed physician and independently (Eisenberg et al., 1998).

Drugs are introduced and advertised to health care practitioners to prescribe to patients when they are deemed safe and beneficial. Scientists develop clinical trials only after testing therapies on animals to determine any potential toxicity, and then proceed to test treatments (i.e. medical device, vaccine, gene therapy, drug, or blood product) in human volunteers to find out if they should be approved for wider use in the general population (Gordon, 2003). This tedious process is how pharmaceutical companies, for example, bring their drugs onto the market. Despite scientific trials and studies to prove the legitimacy of their research, people will still seek alternative medicine regardless of whether or not studies declare it unsafe. Statistically, there is always a possibility that scientific research of a treatment could yield effective results due to either a fluke or an actual effect, and therefore these tests do not represent success of a treatment one hundred percent of the time. Many alternative practitioners feel that their therapies are so unlike conventional therapies and so complex or esoteric that they require different or even brand new research methodologies and statistical procedures to adequately capture their benefits (Levin et al., 1997). “It is interesting that users tend to be better educated than non users despite the general lack of established efficacy and long-term safety associated with most of these procedures.” (MacLennan, Wilson, & Taylor, 2002) Patients judge their quality of treatment based upon the physician’s behavior towards them, instead of a scientific study, where perceiving their physician to be caring and sensitive to their needs increases their satisfaction with medical care (Carmel & Glick, 1996).

The government and other large companies seem to have noticed the increasing prevalence of people spending money and visiting doctors who practice alternative methods of care, as this number has been growing nearly exponentially over the past twenty years. Several major managed care organizations, such as Oxford Health Plans and Health Net, have recently begun to respond to this demand by adding alternative therapies to their insurance plans (Studdert et al., 1998). State legislatures also have enacted laws that require health insurers to include alternative treatments in the benefits they cover (Firshein, 1995). Using state and provincial audits, insurance company rate policies, and measures of utilization, one study determined that naturopathic medicine, particularly through prevention, is able to minimize medical costs (Smith & Logan, 2002). In 2002, data showed that the average total charge for treating a heart attack patient rose from $20,578 in 1993 to $28, 663 in 2000. Hospital charges are generally higher than the amounts that facilities are reimbursed by the public and commercial insurers, but the average hospital charge itself only includes nursing care, laboratory analysis, diagnostics tests, medications, use of operating rooms and patient rooms, but not physicians’ fees (“AHRQ”, 2002). These costs, regardless of who pays the bill, are a high price to pay for an occurrence that could have been prevented had it not manifested over time. New technologies and rising medication costs explain much of the increase in average hospital charges (“AHRQ”, 2002).

As alternative medicine becomes more prevalent in mainstream society, especially when patients are satisfied with their care, they may also recommend naturopathic doctors (and other alternative care) to other people. An estimated 90% of patients using alternative medical therapies are referred by other patients and not by their physicians (M.D.’s or D.O.’s) (Studdert et al., 1998). Satisfied patients who encourage people to seek naturopathic doctors for their ailments may help contribute to the escalating numbers. Claims or testimonies for the efficacy of alternative medicines often seem to be made by third parties who are apparently unassociated with the product manufacturer (MacLennan et al., 2002). In the home, parents who raise their children around administering alternative medicines, may without questions continue the tradition to their own children (MacLennan et al., 2002). Parents should, however, still discuss with their children the situations of when or when not to use these therapies (i.e. breaking a bone) and how important it is for every type of doctor to know about any treatments patient’s consume. Patients usually do not tell their M.D. or D.O. about any alternative remedies they are using, which can be detrimental to their health if they begin taking a drug that has negative interactions. Harmless therapies may have both poorly identified side effects or interactions with a drug, delay effective treatment with increasing morbidity and disillusionment of success, and lead to disappointment and depression after a lack of effect is apparent and raised hopes are dashed (MacLennan et al., 2002). People who decide to take proactive care in their health by seeking doctors who can act as both physicians and lifestyle coaches should not be penalized for wanting alternative therapies, but do increase their safety by communicating all their treatments to their various physicians. Their physicians, in turn, should be familiar with their treatment (and if not, consult their other physician) to avoid dangerous prescription interactions. Increased prevalence of alternative therapies may just mean increased mindfulness of both physician and patient to communicate their regimens.

8) Circumstance of M.D.s and D.O.s who are afraid of liability

A professional in a subject implies that someone has proficiency in their field of study and can be used as a reference to educate others both inside and outside of their field. A licensed professional means that they have a certain basis of background knowledge and possibly have passed tests to gain admission to specialized schools or jobs. Every profession has legally sanctioned control over a specific body of knowledge and commitment to service, while other citizens who have not been educated in that area develop an understanding that these professionals will put the welfare of both the patient and society above their own and that they will be governed by a code of ethics (Cruess, & Cruess, 1997). The Council on Naturopathic Medical Education (CNME) accredits the six naturopathic medical schools, and senior students take a standardized exam to get their license by passing the Naturopathic Physicians Licensing Examinations (NPLEX).

If naturopathic doctors are licensed in a state and able to call themselves naturopathic doctors, instead of naturopaths (like in unlicensed states) who typically do not have medical training synonymous to N.D.s, medical doctors and osteopathic doctors may feel more at ease in referring patients to receive a different type of care. Licensure has thus far been the decisive piece of evidence in determining whether an identifiable school of thought in medicine exists (Studdert et al., 1998). The effectiveness of alternative medicine can be difficult to establish because it is based upon someone’s subjective experience and not the scientific method. On the other hand, there may not be studies available for the doctor who prescribes someone an anti-depressant and a blood-thinner, making it necessary to rely on other opinions about interaction without side effects. The long-standing professional rivalry between organized medicine (allopathic) and unorthodox (alternative) health care practitioners may hinder improving a patient’s quality of care, as each may try to keep the patient in the physician’s respective school of thought while ignoring the patient’s needs. The fundamental obstacle, however, is the physician’s lack of knowledge about the appropriateness and efficacy of alternative medicine (Studdert et al., 1998). Allopathic doctors are still being taught how to treat acute diseases, where there is one solution to a problem, even though other doctors, like N.D.s, are more equipped to treat the epidemic of chronic diseases caused by multiple factors.

Studdert et al. (1998) believes that (conventional medical) physicians worry that they will be sued if they refer a patient to an alternative medicine practitioner, if the patient then suffers a poor outcome despite their independent choice to submit to an alternative treatment. Physicians may be reluctant to discover or discuss this care with patients for fear that if they know about it, doctors will be forced to have an opinion pertaining to these treatments. If physicians are learning medicine to help others, then it should be in their best interest to be open-minded to other treatments that will help their patient. Licensing and acknowledging alternative medicine may place its therapies at the same standard of pharmaceuticals (already a type of comfort zone in prescribing based upon scientific evidence of clinical trials) and encourage doctors to be more at ease in both referring and educating patients about how alternative therapies can currently help their ailment and aid as a prophylaxis to other chronic diseases.

Once states license naturopathic doctors, medical and osteopathic doctors may still be hesitant about referring patients to a N.D. who may administer and/or prescribe alternative therapies. The same rule applies, however, that a physician’s referral of a patient to another physician does not subject the referring physician to liability (Studdert et al., 1998). If the latter doctor places the patient at risk, then they may not place as much trust in the previous doctor as they did before. The only times a referring doctor can be sued are when they refer a patient to an alternative medicine practitioner instead of to another, more appropriate practitioner, including a N.D., and when they are referred to an appropriate practitioner, the referred doctor delays, decreases, or eliminates the opportunity for the patient to receive important care (Studdert et al., 1998). An ailment that could have been holistically treated could have escalated to the need for surgery in a hospital, for example, but the alternative doctor decided to keep the person as their patient.

Malpractice liability of licensed doctors in referring patients to naturopathic doctors has the same type of chance for liability as referring their patients to medical doctors or osteopathic doctors. Any qualms about a physician’s practice should probably be addressed by the competency of the doctor, who is the one equipped with the reason and medical knowledge for encouraging the patient in following that certain method of treatment. Studdert and colleagues recommend that a skeptical physician ask themselves four questions: Answering ‘no’ to questions asking, if evidence from the medical literature suggests that the therapies the patient will receive as a result of the referral will offer no benefit or will subject the patient to unreasonable risks, and if the referring physician has any special knowledge or experience that may make them think that this particular physician is incompetent; responding ‘yes’ to questions about whether the practitioner is licensed in their state (can provide comfort in knowing that the practitioner carries malpractice insurance), and if it is a usual kind of referral (i.e. without intrusive supervision of the patient’s management where the referred physician takes priority as the main doctor for a certain problem). As previously stated, it is the alternative practitioner who is responsible held for their autonomous actions and judged according to standards set by fellow practitioners.

9) Opinions of states

Currently, sixteen states license Naturopathic Doctors (N.D.s) who hold degrees from the seven accredited four-year universities in the U.S., Puerto Rico, the Virgin Islands, and four Canadian provinces (Tippens & Connelly, 2007) where range of practicing modalities varies by state. According to a 1996 article from the New York Times, as Washington state licensed naturopathic medicine, the King County Council, where Republicans are the majority (a traditionally conservative group), discussed each of their various ailments, and how vitamins, enzymes and acupuncture helped restore their health. Separate from the committee but in favor of alternative treatments, Merrily Manthy, a trustee at both a naturopathic medical school and a big urban hospital in Seattle, understands the consumer driven demand of ‘people who want to get well in a world where costs and an obsession with high technology are forcing cutbacks in conventional medicine.’ From a medical doctor’s perspective, Dr. George Rice, president of the Washington State Medical Association, which represents 7,000 medical doctors in Washington, states, “As long as they are held to the same kind of standards as we are, then we’re not opposed to it.” (Egan, 1996) This article represents how parties who are not normally in favor of change or competition, Republicans and medical doctors, respectively, can appreciate and share positive opinions and experiences regarding naturopathic medicine. Republicans acknowledged their individual success when following treatment, such as garlic pills and gingko tree extract, prescribed by a naturopathic doctor. Medical doctors and those working in the allopathic health care field are likely to be critical of naturopathic medicine because a lot of the modalities and treatments are not scientifically proven. Ms. Manthy and Dr. Rice, however, bridge the gap between the allopathic and naturopathic worlds by placing the importance of healing the patient over a priority for scientific studies. No one wants to be billed for excessive medical costs or worry about whether or not their insurance will cover their medication. As a result, patients will most likely favor effective and cheaper therapies that can also serve as a prophylaxis to other ailments when recommended by a naturopathic doctor.

Other states, however, may license naturopathic doctors but have different regulations. A few states, such as Arizona, allow naturopathic doctors the freedom to perform minor surgery or obstetrics (Baer, 2001), and Washington N.D.s can practice midwifery with a midwifery license and prescribe a limited range of drugs, while drug prescription is not part of the scope of practice in Connecticut, (Boon, et al., 2004).

Florida, as a state that does not presently recognize naturopathic physicians, once licensed naturopathic physicians from 1929-1959. A probable cause of revoking licensure was the rise of “scientific medicine,” the discovery and increasing use of “miracle drugs” like antibiotics, and the institutionalization of a large medical system primarily based (both clinically and economically) on high-tech and pharmaceutical treatments. All of these were associated by mid-century with the temporary decline of naturopathic medicine and most other methods of natural healing (“History”, 2009). In 1985, individuals who were licensed prior to 1959 were granted active licenses under a grandfather clause. Re-licensing existing individuals from that 30 year time period may have been in response to the 1970s American public who first began to experience repulsion from the clinical limitations and obvious out of control costs of conventional medicine, which inspired them to seek “new” options and alternatives (i.e. naturopathy and all of complementary and alternative medicine) (“History”, 2009). Currently, only a few individuals are practicing naturopathy in Florida with an active license, and those without one can be prosecuted for unlicensed activity (Hamby, Collins, & Mitchell, 2004). The Interim Project report submitted to Florida’s House of Representatives in January 2004 titled Sunrise Report on Proposed Licensure of Naturopathic Physicians, helps provide insight into why Florida, and possibly other states, would be opposed to licensing Naturopathic Medicine. The Florida Naturopathic Physician Association (FNPA) distinguishes naturopathic practice from other health care practitioners by its holistic approach, not the specific treatments it uses. “Therapy is directed at the whole person and at the underlying cause of illness, such as the patient’s lifestyle, diet, and emotional state.” (Hamby et al., 2004) Reasons for opposition, however, state that the public can receive naturopathic modes of treatment from licensed allopathic and other physicians and from other licensed health professionals and that the state currently permits many non-invasive, traditional, and alternative health procedures as practiced by traditional naturopathy without state regulation (Hamby et al., 2004). Assuming people go to these licensed or unlicensed practitioners for a certain treatment (i.e. a chiropractor or massage therapist), there is already an intention to receive a specific form of treatment. The benefit of visiting a N.D., on the other hand, is that their training in conventional sciences and alternative practices allows the patient and doctor to discuss and tailor an individualized combination of treatments instead of requiring the patient to know what treatment to expect. As previously mentioned, this allows a N.D. to foster a shared participation relationship with the patient to determine a reasonable and effective treatment, which correlates to increased compliance and presumably improved health. A doctor who provides only one form of treatment for an ailment does not allow patients autonomy in customizing their treatment, making them less likely to follow through with their plan so they continue to be plagued with the same health problems.

Some additional arguments against naturopathic medicine from the Sunrise Report include how the proponents of regulation do not provide evidence that there is substantial harm or that the public is endangered by the unregulated practice of the profession, a risk of harm to the public from licensing naturopathic physicians with an expanded scope of practice (i.e. surgery), and that licensing of naturopathic physicians would negatively impact practitioners of traditional and alternative health healing techniques that currently do not have to be licensed (Hamby et al., 2004). Naturopathic physicians graduate with a wide range of medical training from one of the seven CNME accredited four-year naturopathic medical schools, while traditional naturopaths (or naturopathic practitioners) do not incorporate surgical, non-natural pharmaceutical or obstetrical care where training ranges from self-instruction to formal courses of study (Hamby et al., 2004).

Curriculum at one of the four, 4-year federally accredited Naturopathic medical schools:

Year 1
Fall Courses Credits Winter Courses Credits
Biochemistry 1

Human Physiology 1 Lec/Lab

Histology

Human Anatomy 1 Lec/Lab

Naturopathic Clinical Theory 1

Clinic Entry 1

4

5.5

5

5.5

2

1

Biochemistry 2

Human Physiology 2 Lec/Lab

Embryology

Human Anatomy 2 Lec/Lab

Research Methods & Design

The Determinants of Health

Principles of Chinese Medicine

Massage

Hydrotherapy/Physiotherapy Lecture

4

5.5

3

5.5

2

1.5

3

1.5

2

Spring & Summer Courses Credits
Fundamentals of Ayurvedic Med

Biochemistry 3

Human Physiology 3

Gross Human Anatomy 3 Lec/Lab

Neuroscience

Botanical Medicine 1

The Vis Medicatrix Naturae

Hydrotherapy/Physiotherapy Lab

Physician Heal Thyself

2

4

3

5.5

5.5

2

1.5

1

2

Year 2
Fall Courses Credits Winter Courses Credits
Human Pathology 1

Immunology

Botanical Medicine 2

Homeopathy 1

Clinical Lab Diagnosis 1

Physical/Clinical Dx 1 Lec

Physical/Clinical Dx 1 Lab

Naturopathic Counseling 1

Foods, Dietary Systems & Assessment

4

4

2

2

3.5

2

2

3

3

Human Pathology 2

Infectious Diseases

Botanical Medicine 3

Homeopathy 2

Clinical Lab Diagnosis 2

Physical/Clinical Diagnosis 2 Lecture

Physical/Clinical Diagnosis 2 Lab

Naturopathic Counseling 2

Macro & Micronutrients

4

5.5

3

5.5

2

1.5

3

1.5

2

Spring & Summer Courses Credits
Human Pathology 3

Pharmacology

Homeopathy 3

Clinical Lab Diagnosis 3

Physical/Clinical Diagnosis 3 Lecture

Physical/Clinical Diagnosis 3 Lab

Clinic Entry 2

Preceptorship 1

Naturopathic Manipulation 1

4

5

3

3.5

2

2

1

1

2

Year 3
Fall Courses Credits Winter Courses Credits
Botanical Medicine 4

Normal Maternity

Environmental Medicine

Public Health

Gastroenterology

EENT

Naturopathic Manipulation 2

Orthopedics

Psychological Assessment

Diet & Nutrient Therapy 1

1-2 Clinic Shifts

2

3

1.5

1.5

2

2

3

2

2

3

2-4

Botanical Medicine 5

Naturopathic Clinical Theory 2

Dermatology

Oncology

Gynecology

Pediatrics 1

Naturopathic Manipulation 3

Sports Medicine/Therapeutic Exercise

Addictions & Disorders

Diet & Nutrient Therapy 2

1-2 Clinic Shifts

2

1

2

2

3

2

3

2

2

3

2-4

Spring & Summer Courses Credits
Botanical Medicine Dispensary Lab

Practice Management 1

Clinical Ecology

Neurology

Pediatrics 2

Family Medicine

The Healing Systems

Naturopathic Manipulation 4

Naturopathic Counseling 3

1-2 Clinic Shifts

Naturopathic Case Analysis & Mgmt 1

Cardiology

Minor Surgery

Medical Procedures

1-2 Clinic Shifts

1

2

2

2

2

2

1

3

2

2-4

1.5

3

3

3

2-4

Year 4
Fall Courses Credits Winter Courses Credits
Geriatrics

Urology

Naturopathic Case Analysis & Management 2

Adv. Naturopathic Ther. 1

3-4 Clinic Shifts

2

1.5

1

2

6-8

Ethics

Diagnostic Imaging

Rheumatology

Adv Naturopathic Therapeutics 2

Preceptorship 2

3-4 Clinic Shifts

1

2

1.5

2

1

6-8

Spring & Summer Courses Credits
Jurisprudence

Practice Management 2

Radiographic Interpretation 2

Pulmonary Medicine

Preceptorship 3

3-4 Clinic Shifts

Radiographic Interpretation 1 Lecture

Radiographic Interpretation 1 Lab

Endocrinology

3-4 Clinic Shifts

1

2

3

1.5

1

6-8

3

1

3

6-8

Curriculum at one of the naturopathic correspondence schools:

History of Naturopathy

Foundations of Naturopathy

Nutrition & Disease

Detoxification & Healing

Iridology

Body Awareness & Physical Movement

Alternative Approaches to Arthritis

Manual Therapies: Massage, Reflexology & Acupressure

Building & Maintaining a Consulting Practice

The Client-Practitioner Relationship

3 Electices

Consulting Practicum

Essentials of Nutrition 1

Essentials of Nutrition 2

Intro to Herbology

Intro to Homeopathy

Classical Homeopathy

Herbology 2

Holistic Human Development

Holistic Human Development

(“MSND”, 2005)

The third group that practices naturopathic techniques are licensed practitioners of medicine, dentistry, and nursing, where knowledge of modalities is less formal than the emphasis from an accredited naturopathic medical school. In addition, allopathic physicians tend to practice within the structured framework of their medical doctor license (Hamby et al., 2004) without upholding the six principles of naturopathic medicine as the guiding reason for selecting specific treatment modalities. There is a considerable difference between how allopathic and naturopathic doctors are taught to treat their patients, which can create a difficulty when attempting to practice both schools of thought in a treatment. Therefore, if other physicians can practice alternative care, which seems to be the controversial factor because a lot of the methods are not scientifically proven, then N.D.s should be licensed to practice because their profession is not just about performing or prescribing a few unconventional remedies, but it involves understanding pharmacology interactions of supplements and allopathic drugs, developing treatment to accommodate the person’s mind, body, and lifestyle, and allowing the patient to be in control of their treatment and health.

The Florida Naturopathic Physicians Association (FNPA) refutes these arguments by stating how licensure sets minimum standards for the educational and training qualifications for being a qualified naturopathic doctor and that people deserve access to highly trained licensed Primary Care Physicians who provide safe, regulated, less invasive treatments to typical conventional medical treatments (FNPA, 2006). A lack of regulation means that any person may refer to himself or herself as a Naturopath or Naturopathic Physician, an error that has already caused the deaths of several people in North Carolina, Colorado, and California (FNPA, 2006). In Colorado, Brian O’ Connell claimed to be a N.M.D. (naturopathic medical doctor), and his credentials and certificates conveyed to parents Dave and Laura Flanagan that this man could honor the parent’s request of helping their son, Sean, live out his remaining months in less pain. In the first of four treatments, O’Connell injected the teenager with hydrogen peroxide and withdrew his blood with the same syringe. The blood then was exposed to a UV light machine before being returned to his body – a process called “photoluminescence.” Meanwhile, an IV drip administered a cocktail of vitamins into the bloodstream (Wilcock, 2006). Nine days after beginning treatment, the oxygen level in Sean’s veins fell to about 18% of its normal level, and the teen’s skin turned grey, resulting in his death on Dec 19th, 2003. Three months later, O’Connell was arrested and booked on 14 counts, including reckless manslaughter, multiple assaults, fraud, theft, practicing medicine without a license, and possession of controlled substances. In addition, O’Connell assaulted other patients, causing one to go into cardiac arrest, another died with large open wounds after O’Connell brought him to the emergency room at Lutheran Medical Center in Wheat Ridge, and he still had the audacity to resume seeing patients in the summer of 2004, when he was tagged with another round of criminal charges (Wilcock, 2006). Proponents of regulation argue that he never should have been able to present himself as a naturopathic doctor because he possessed only flimsy credentials from a correspondence course in Arkansas (Wilcock, 2006), further emphasizing how important it is for doctors to receive a certain standard of medical training specified by the state law.

The FNPA also recognizes the growing demand for safe and natural health care, as well as being able to save the U.S. millions of dollars a year by preventing common debilitating diseases (FNPA, 2006). Naturopathic medicine teaches people how to take preventative measures, for investing in a healthy dietary and active lifestyle is probably less expensive in the short- and long-term than the costs of going to the emergency room for multiple heart attacks and/or insulin shots for diabetes.

With the patient’s health at stake, many states are taking a gamble on how they license naturopathic doctors. Some may specify that a N.D. must have graduated from one of the seven accredited schools in the U.S. and Canada, or vaguely describe which types of homeopathic therapies they can practice.

10) Why the AMA wants to ‘shut down’ legislation

The American Medical Association (AMA) is made up of medical doctors (M.D.s) from all 50 states, and through the AMA, M.D.s argue against licensing naturopathic medicine. New York State, for example, has been ricocheting between deciding whether or not to license naturopathic doctors for the past few years. The New York Association of Naturopathic Physicians (NYANP), has pre-written letters for people to sign and email to their legislatures in favor of licensing, while the Medical Society of the State of New York (MSSNY, 2006) also has a pre-written standard letter that can be emailed just by signing one’s name. Explaining why naturopathic should not be licensed, the text of the letter reads:

“As a practicing physician in New York State, and a constituent of yours, I am writing to you in opposition to A.1370 (Hoyt), a bill that would license naturopaths and allow them to prescribe, administer, diagnose and treat patients.

The definition of scope in this legislation is indistinguishable from the scope of licensed physicians. The definition of naturopathy included in the bill is the ability to support and stimulate a patient’s inherent self-healing processes and diagnose, prescribe, and treat human health conditions consistent with naturopathic practice. However, “naturopathic practice” and natural therapies remain undefined, leaving the interpretation of the scope of practice to the board created under the bill, and to a degree, to the educational institutions that prepare naturopaths and even to the practitioners themselves.

It should be noted that the preparation to become a graduate of a naturopathic education program is far less rigorous than that required to become a physician. The classroom work may have similar basic requirements, but the clinical preparation of a medical student, including years of post-graduate residency, includes far greater exposure to patient care in acute, chronic and primary/preventive settings, involvement in the formation of complex diagnoses and requires years of supervised service, all prior to licensure. This legislation does not require such clinical experience, and does not require residency except for new licensees after the year 2013, and then only one year of residency would be expected.

Furthermore, the legislation will mislead the public who will expect that they are receiving services from a physician. The bill authorizes the use of the title “naturopathic doctor” or “doctor of naturopathic medicine.” While the bill prohibits such licensee from practicing or claiming to practice another licensed profession, including medicine, the title itself will convey to the public that the naturopathic practitioner is in fact, the equivalent of a licensed physician. This will be grossly misleading.

Far from protecting the public from harm, this bill will put them in harm’s way. I urge you to vote against A.1370 and also to encourage your colleagues to vote against it.”

Much of this information is simply incorrect or misleading. Data about naturopathic medicine is readily available on many websites and in journal articles, which describe how the multitude of modalities in naturopathic medicine is utilized to help heal the patient. The second paragraph refers to how the bill is too vague and leaves the term ‘natural therapies’ open to interpretation by the alternative care practitioner. The bill that the NYANP is trying to pass, however, specifically states that a licensed naturopath must have received a doctoral diploma from a registered school of Naturopathic Medicine (by the CNME), satisfactorily have completed clinical post-graduate residency training in an approved program with five years of clinical supervision of not less than twelve months in duration and have passed a national examination. Currently, N.D.s are viewed as the same as naturopaths, who can get their license from schools nicknamed ‘diploma mills’ that typically give people degrees only after a few months of training whether it is online or in class. The proposed bill also states, “Naturopaths use standard medical diagnostic techniques and treat disease with natural medicines and therapies including clinical nutrition, botanical medicine, homeopathy, lifestyle counseling, and naturopathic physical medicine. Naturopathic doctors also have the training to prescribe certain medications when they are indicated.” (NYANP, 2009)

The opposing side also states that the education received at a naturopathic medical school is far less rigorous than that required to become a physician. Teachers at the naturopathic medical schools, just like the allopathic medical schools, include Ph.D.s and M.D.s, who expect the same type of effort in their coursework as they would from an allopathic medical student. Both schools have many of the same classes (usually in core sciences), making it difficult to determine if coursework in one school is more rigorous than in another, because the end result of healing patients contributes to how well doctors utilize their knowledge. Naturopathic medical schools prepare their students well enough in the four years that they are ready to begin practicing, and while the residencies are very competitive due to the small number available, more residencies are developing in response to the growing student body at all seven schools. The challenges for an increased number of residencies for N.D.s include standardization of curriculum and identification of appropriate training sites and mentors, as well as issues regarding scope of practice and reimbursement (Dunne et al., 2005). Currently, students and faculty at National College of Natural Medicine (NCNM) in Portland, Oregon are trying to get the opportunity to go on rounds with other third and fourth year allopathic medical students from Oregon Health and Sciences University (OHSU) at one of the hospitals in the area to further expand their knowledge about pathology.

The public will be protected from harm by licensing naturopathic doctors through standards of regulating where they get their diploma and the type of modalities they can practice. “Naturopathic physicians are also trained to recognize serious and life-threatening situations and to identify conditions outside of the scope of their professional or legal limitations.” (Dunne et al., 2005) If someone enters a naturopathic doctor’s office with a mangled body after being in a car accident, for example, the doctor would advise the other person to rush them to the emergency room in a hospital because they are more equipped to deal with trauma.

The medical establishment in the mid twentieth century also was keen on dismissing any type of alternative treatment, even by someone with two Nobel Prizes. Linus Pauling, son of a druggist, was born in 1901 (died in 1994) and is best known for his work on global peace and debates about the effectiveness of his vitamin C research. He was also one of the original founders of the National Institute of Health (NIH) (Linus Pauling, 2008). Pauling earned his Ph.D. in chemistry then won the 1954 Nobel Peace Prize in chemistry, followed by the 1964 Peace Prize to further add prestige and creditability to his name. After winning the 1954 prize, however, he decided to pursue his controversial work on vitamin C and its effectiveness for ailments when taken instead of pharmaceuticals (Weisstein, 2007). Pauling states, “there is no doubt that vitamin C is far less toxic and has far fewer side effects than aspirin and other commonly used cold medicines. Vitamin C taken in proper amounts has the effect of decreasing the incidence and severity of the common cold, whereas the ordinary cold medicines do not have this effect. I find it shocking that physicians and nutritionists should misrepresent the facts and should refuse to recognize the value of this important food, vitamin C, in improving health.” (Pauling, 1971) Pauling also believed that vitamin C could cure everything from heart disease to cancer, but medical experts performed some experiments and determined that vitamin C had little effect on the common cold and no effect on cancer, therefore disparaging vitamin supplements (Hickey, 2004). Conventional medical practice demands proof of vitamin C’s benefits, although science works by showing ideas are wrong, since there is no such thing as a scientific proof. Yet innovation can always be stifled with a claim that there isn’t any scientific proof, regardless of the strength of the evidence (Hickey, 2004). If claims of vitamin C’s efficacy are correct, however, there is a real chance that it might replace many lucrative and expensive medications and threaten the profitability of medication (Hickey, 2004). Current research shows that a series of case reports indicated that high dose intravenous vitamin C was associated with long-term tumor regression in three patients with advanced renal cell carcinoma, bladder carcinoma, or B-cell lymphoma (Frei, & Lawson, 2008).

Pauling also developed ortho-molecular medicine, which referred to “the right molecules” as the major players in health and disease, as he devoted the last thirty years of his life to the study of nutritional substances in medicine (basis for ortho-molecular medicine) (Kunin, 2007). Even without being a physician, his reputation for scientific knowledge and insight drew respect from the allopathic medical community. His writing on ortho-molecular medicine succeeded in having the medical establishment allow nutrition to become a primary part of medicine, despite controversy and ridicule (Kunin, 2007). The backlash, however, against Dr. Pauling’s reputation was greater than anticipated. When his 1970 book, Vitamin C and Common Cold was published, the public and medical and science establishments dismissed his qualifications as a medical authority. His applications for vitamin C research were turned down eight times by the NIH, as his mastery of mathematics, statistics, and scientific method was over-looked by this new generation of academians and physicians, who were caught up in the entrenched political-power structure (Kunin, 2007). N.D.’s, who already attract many skeptics about their methods of treatment, are not the only people who recognize the importance of utilizing nutrition as a treatment with the same effect as pharmaceutical drugs and fewer side effects. Through his education, Linus Pauling’s academic background, research credentials, and awards, represents someone who also supported one of the modalities of naturopathic medicine (i.e. nutrition) through proofs in his research. He utilized the scientific method, an approach regarded by the allopathic medical community as a requirement to test new treatments, to prove how nutrition can impact one’s health.

Despite only sixteen states licensing naturopathic doctors, organizations, hospitals, research facilities, and the government have not discriminated against allowing naturopathic doctors into their committees. When conducting research, N.D. faculty submit to the same rigorous review, scoring, and recommendation processes that take place at other medical institutions in the U.S. The naturopathic research community is absorbed in collaborative investigations with conventional medical schools and patient-care centers, and the accredited U.S. naturopathic medical schools have assurances of compliance filed with the US Department of Health and Human Services. This allows them to receive federal funds for human subjects research, as these centers also host studies in epidemiology, bench research, and clinical outcomes further funded through both private foundations and federal and state health agencies, including the National Institute for Health (NIH), the National Cancer Institute, and the Office of Dietary Supplements (Dunne et al., 2005). Enlarging their field of occupations beyond that of a general practitioner, they have participated in the establishment of the Office of Alternative Medicine (now the NCCAM), held seats on the NCCAM Advisory Council, and represented their profession on the White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP) and presently serve on the Department of Health and Human Services Medicare Coverage Advisory Committee, the American Medical Association CPT Editorial Panel/HCPAC (Healthcare Professionals Advisory Committee), the Center for Medicare Services, the National Cancer Institute, and the Office of Dietary Supplements at the National Institutes of Health (Dunne et al., 2005). Jobs that span up to the White House would most likely require expertise on a certain body of knowledge (a professional) in order for people to trust the experts; this fact, therefore, subliminally validates the legitimacy of the education these naturopathic doctors received. On a different level, conventional universities also have included naturopathic doctors to partake in their research, such as Emory University’s investigation of the clinical effects of antioxidant therapy, Arizona State University’s Diabetes Collaborative to evaluation naturopathic diabetes care, the University of Washington School of Pharmacy to examine the anti-HIV activity of botanical preparations, and Oregon Health Science University to assess naturopathic treatment for multiple sclerosis (Dunne et al., 2005).

State licensure of an untraditional type of medicine seems threatening to allopathic and osteopathic doctors, who have been in control of the medical world for the past 150 years. Naturopaths also oppose the idea of state licensure for naturopathic doctors because they believe it will discredit the legitimacy of their practice, and that they will lose their patients. The benefits of licensing N.D.s, however, are that it will help people get the safest and most effective care for their chronic diseases, reduce spending on unnecessary tests, procedures, and pharmaceuticals, and patients will learn prophylactic measures to diminish their chances of developing other chronic diseases. Michelle Clark, president of the Florida Naturopathic Physicians Association (FNPA), stated that the purpose of licensure is to allow the term ‘Naturopathic Doctor’ to be applied to people who graduated from any of the seven accredited naturopathic medical schools (M. Clark, 2009). People who have not graduated from these schools can alternatively call themselves naturopathic physicians, or naturopathic practitioners, leaving the name ‘Naturopathic Doctor’ for those with a N.D. degree. Health care practitioners, regardless of which perspective they practice, all have a common background, having been trained to help the patient. Chronic diseases, twice as rampant as infectious diseases, require a different amount of care that only N.D.s can provide with their special education and extended time spent with a patient. The allopathic and osteopathic doctors will always serve people whose chronic diseases have gotten so bad they need surgery, whose serious accidents also require surgeons, as well as those whose infections require pharmaceutical drug. Every doctor treats different aspects of the patient when needed, as no one has the same risk factors or genetics, and N.D.s serve a vital role in the mission of improving the health and well-being of America.

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