- Naturopathic medicine
Naturopathic medicine (also known as naturopathy, or natural medicine) is a
complementary and alternative medicinewhich emphasizes the body's intrinsic ability to heal and maintain itself. Naturopaths prefer to use natural remedies such as herbs and foods rather than surgeryor synthetic drugs. Naturopathic practice includes many different modalities. Practitioners emphasize a holistic approach to patient care, and may recommend patients use conventional medicine alongside their treatments.
Naturopathy has its origins in the Nature Cure movement of Europe [citation|url=http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1139856&pageindex=1|title=Nineteenth-century American health reformers and the early nature cure movement in Britain|author=P S Brown|journal=Medical History|date= April 1988|volume=32(2)|pages=174–194] [cite web|title=History of Naturopathy|url=http://www.naturopathy-uk.com/library/2007/03/12/history-of-naturopathy/|year=2007] . It is practiced in many countries but subject to different standards of regulation and levels of acceptance.
Naturopathic doctors who are trained at an accredited North American school are entitled to use the designation ND or NMD which is legally protected in sixteen US states and five Canadian provinces. [ [http://medicalboard.iowa.gov/Naturopathy.html A Policy Statement on Naturopathy] ] They are trained to use diagnostic tests such as
imagingand blood testsbefore deciding upon the full course of treatment. [http://www.cnme.org/resources/2007_hoa.pdf Handbook of Accreditation for Naturopathc Medicine Programs, p45] ] and to refer to other health professionals for standard medical care where it is required. Scope of practice for Naturopathic doctors varies widely amongst jurisdictions. Naturopaths in unregulated jurisdictions may use the ND designation or other titles regardless of level of education.
History of naturopathic medicine
Some see the ancient Greek "Father of Medicine",
Hippocrates, as the first advocate of naturopathic medicine, before the term existed. [cite web|url=http://www.naturopathy-uk.com/home/home-what-is-naturopathy/|title=What is Naturopathy?|year=1998] In Scotland, Dr Thomas Allinson started advocating his "Hygienic Medicine" in the 1880s, promoting a natural diet and exercise with avoidance of tobacco and overwork. [cite web|url=http://www.allinsonflour.co.uk/history/|title=How it all began] [citation|url=http://www.bmj.com/cgi/content/extract/336/7651/1023-a|journal=British Medical Journal|title=Views & Reviews Medical Classics A System of Hygienic Medicine (1886) and The Advantages of Wholemeal Bread (1889)|author=John A S Beard|year=2008|issue=336|pages=1023|date=3 May 2008|doi=10.1136/bmj.39562.446528.59]
In the USA, the term naturopathy was coined before 1900 by John Scheel, and used by
Benedict Lust. Lust had been schooled in hydrotherapyand other natural health practices in Germanyby Father Sebastian Kneipp, who sent Lust to the United Statesto bring them Kneipp's methods. In 1905, Lust founded the American School of Naturopathy in New York, the first naturopathic college in the United States. Lust took great strides in promoting the profession, culminating in passage of licensing laws in several states prior to 1935, including Arizona, California, Connecticut, Hawaii, Oregon, and Washingtonand the founding of several naturopathic colleges.
Naturopathic medicine went into decline, along with most other natural health professions, after the 1930s, with the discovery of penicillin and advent of synthetic drugs such as
antibioticsand corticosteroids. In the post-war era, Lust's death, conflict between various schools of natural medicine ( homeopathy, eclectics, physio-medicalism, herbalism, naturopathy, etc.), and the rise of medical technology were all contributing factors. In 1910, when the Carnegie Foundation for the Advancement of Teachingpublished the Flexner Reportwhich criticized many aspects of medical education in various institutions (natural and conventional), it was mostly seen as an attack on low-quality natural medicine education. It caused many such programs to be shut down by the U.S. Government and contributed to the popularity of conventional medicine.
Naturopathic medicine never completely ceased to exist, however, as there were always a few states in which licensing laws existed—though at one point there were virtually no schools. One of the most visible steps towards the profession's modern renewal was the opening in 1956 of the
National College of Naturopathic Medicinein Portland, Oregon. This was the first of the modern naturopathic medical schools offering four-year naturopathic medical training with the intention of integrating science with naturopathic principles and practice. Today there are six accredited naturopathic medical schools in North America.
The philosophy of naturopathy is often described by six core values.citation|url=http://books.google.co.uk/books?id=cwYnA1qunUwC&pg=PA58&dq=modalities+naturopathy&lr=&sig=ACfU3U3Z418Eg_P2yDetYOMmsclZ9mJGpg#PPA57,M1|title=Encyclopedia of Complementary Health Practice|author=Carolyn Chambers Clark|pages=57-58|year=1999|isbn=9780826112392] Multiple versions exist in the form of the naturopathic doctor's oathcite web|title=Naturopathic Doctor's Oath|url=http://www.naturopathic.org/viewbulletin.php?id=62] , various mission statements published by schoolscite web|title=Principles of Naturopathic Medicine|url=http://www.ccnm.edu/?q=about_ccnm/principles_naturopathic_medicine] or professional associations, and ethical conduct guidelines published by regulatory bodies cite web|title=Guide to the Ethical Conduct of Naturopathic Doctors| url=http://www.boardofnaturopathicmedicine.on.ca/pdf/guide_ethical_conduct.pdf] :
# First, do no harm; provide the most effective health care available with the least risk to patients at all times ("Primum Non Nocere").
# Recognize, respect and promote the self-healing power of nature inherent in each individual human being. ("Vis Medicatrix Naturae").
# Identify and remove the causes of illness, rather than eliminate or suppress symptoms ("Tolle Causum").
# Educate, inspire rational hope and encourage self-responsibility for health ("Doctor as Teacher").
# Treat each person by considering all individual health factors and influences. ("Treat the Whole Person").
# Emphasize the condition of health to promote well-being and to prevent diseases for the individual, each community and our world. ("Health Promotion, the Best Prevention")
Naturopathy's focus is upon its philosophy of natural health rather than specific methods and so practitioners use a wide variety of treatment modalities. The core set of interventions defined by the Council on Naturopathic Medical Education and taught at all seven accredited schools in North America includes:cite web|url=http://www.cnme.org/resources/2007_hoa.pdf|title= Handbook of Accreditation for Naturopathic Programs|year=2008|page=51]
acupunctureand oriental medicine
nutrition(examples include vegetarianand wholefooddiet, fasting, and abstentioncitation|url=http://books.google.co.uk/books?id=LH2gD6eQnZAC|title=Complementary Medicine for Dummies|author=Jacqueline Young|chapters=8, 13|isbn=9780470026250|year=2007] from alcoholand sugar)
physical medicine(includes naturopathic, osseous and soft tissue manipulative therapy, physiotherapy, sports medicine, exercise and hydrotherapy)
*"nature cure" - a range of therapies based upon exposure to natural elements such as
sunshineand fresh air
*psychological counseling (examples include
meditation, relaxationand other methods of stress management)
The CNME also provides for the inclusion of optional modalities including minor
surgery, natural childbirthand intravenous therapy. These modalities require additional training and may not be within the scope of practice in all jurisdictions.
In addition to the standard modalities used by naturopathic doctors listed above, individual naturopaths may incorporate practices from other disciplines:
color therapycitation|url=http://www.pewscholars.com/pdf_files/Naturo2.pdf|title=Profile of a Profession: Naturopathic Practice|author=Holly J. Hough, Catherine Dower, Edward H. O’Neil|publisher=Center for the Health Professions, University of California|date=September 2001|pages=54]
public healthmeasures and hygiene
There are two groups in North America calling themselves "naturopaths". The term when originally coined by John Scheel, and popularized by Dr.
Benedict Lustwas to apply to those receiving an education in the basic medical sciences with an emphasis on natural therapies. This usage best describes modern day naturopathic doctors. In the absence of universal regulation of naturopathy, another group of practitioners (the so-called 'traditional naturopaths') has emerged. Additionally, a variety of health care professionals may incorporate naturopathic principles and modalities into their practice.
Naturopathic doctors in North America are primary care providers trained in conventional medical sciences, diagnosis and treatment, and are experts in natural therapeutics. Licensing and training requirements vary from state to state, but at least 16 states , the District of Columbia, and five Canadian provinces have formal licensing and educational requirements. [http://www.naturopathic.org/viewbulletin.php?id=118 American Association of Naturopathic Physicians] ] [ [http://www.cand.ca Canadian Association of Naturopathic Doctors - Welcome! ] ] - In these jurisdictions, naturopathic doctors must pass comprehensive board exams set by the North American Board of Naturopathic Examiners(NABNE) [ [http://www.nabne.org NABNE ] ] after having completed academic and clinical training at a college certified by the Council on Naturopathic Medical Education(CNME) [ [http://www.cnme.org Council on Naturopathic Medical Education ] ] . The letters ND usually designate a naturopathic doctor in jurisdictions where such a title is protected by law, although other designations exist. In unregulated jurisdictions, the ND title is not protected and may be used by any practitioner regardless of qualifications.
Traditional naturopaths are guided by the same naturopathic philosophies and principles as board-licensed naturopathic doctors and often prescribe similar treatments. Traditional naturopaths however, are not primary care providers, whereas graduates of CNME accredited naturopathic medicine schools are classified as both alternative or complementary practitioners as well as primary care providers. Traditional naturopaths may voluntarily join a professional organization, but these organizations do not accredit educational programs in any meaningful way or license practitioners per se.  The training programs for traditional naturopaths can vary greatly, are less rigorous and do not provide the same basic and clinical science education as naturopathic medical schools do.  The professional organizations formed by traditional naturopaths are not recognized by the government of the USA or any US State or Territory.
Other health care professionals
According to a 1998 taskforce report, manyweasel-inline conventionally trained physicians are choosing to add naturopathic modalities to their practice, [http://www.futurehealth.ucsf.edu/pdf_files/RTF.PDF] Request quotation|date=July 2008 and states such as Texas have begun to establish practice guidelines for MDs who integrate alternative and complementary medicine into their practice. [Texas Administrative Code title 22, part 9 § 200.3, 1998] Continuing education in naturopathic modalities for health care professionals varies greatly but includes offerings for practitioners:
physicians, chiropractors, acupuncturists, dentists, researchers, veterinarians, physician’s assistants, and nurses [ [http://www.futurehealth.ucsf.edu/pdf_files/Naturo2.pdf Profile of Profession: Naturopathic Practice] ] . These professionals usually retain their original designation but may use terms such as 'holistic', 'natural', or 'integrative' to describe their practice.
In some jurisdictions the practice of naturopathic medicine is unregulated and so the titles like "naturopath", "naturopathic doctor", and "doctor of natural medicine" are not protected by law. This may lead to difficulty in ensuring that a practitioner is trained to a particular standard or has adequate liability insurance.
There is currently no state
licensurein Australia, rather the industry is self-regulated. There is no protection of title, meaning that technically anyone can practise as a naturopath. The only way to obtain insurancefor professional indemnityor public liability is by joining a professional association, which can only be achieved having completed an accredited course and gaining professional certification. Currently the only registered modalities of natural medicine in Australia are those relating to Chinese medicine, and only in the state of Victoria. [The Royal Australian College of General Practitioners. [http://www.racgp.org.au/racgpaimajwp Joint RACGP/AIMA Working Party Terms of Reference] ]
In 1977 a committee reviewed all colleges of naturopathy in Australia and found that, although the syllabuses of many colleges were reasonable in their coverage of basic biomedical sciences on paper, the actual instruction bore little relationship to the documented course. In no case was any practical work of any consequence available. The lectures which were attended by the Committee varied from the dictation of textbook material to a slow, but reasonably methodical, exposition of the terminology of medical sciences, at a level of dictionary definitions, without the benefit of depth or the understanding of mechanisms or the broader significance of the concepts. The Committee did not see any significant teaching of the various therapeutic approaches favoured by naturopaths. Persons reported to be particularly interested in homoeopathy, Bach's floral remedies or mineral salts were interviewed, but no systematic courses in the choice and use of these therapies were seen in the various colleges. The Committee was left with the impression that the choice of therapeutic regime was based on the general whim of the naturopath and since the suggested applications in the various textbooks and dispensations overlap to an enormous extent no specific indications are or can be taught. [http://www.naturowatch.org/hx/australia.html]
In North America, each jurisdiction that regulates naturopathic medicine defines a local scope of practice for Naturopathic doctors that can vary considerably. Some regions permit minor surgery, access to prescription drugs, spinal manipulations, obstetrics and gynecology and other regions exclude these from the naturopathic scope of practice. [http://www.dora.state.co.us/OPR/archive/2008NaturopathicPhysiciansSunrise.pdf 2008 Sunrise Review: Naturopathic Physicians, p19] ]
*US jurisdictions that currently regulate naturopathic medicine include:
Alaska, Arizona, California, Connecticut, District of Columbia, Hawaii, Idaho, Maine, Minnesota, Montana, Vermont, New Hampshire, Oregon, Puerto Rico[cite web|url=http://www.oslpr.org/download/ES/1997/208s0783.pdf|title=Ley 208] , US Virgin Islands, Utah, Washington.
**US jurisdictions that permit access to prescription drugs:
Arizona, California, District of Columbia, Idaho, Kansas, Maine, Montana, Vermont, New Hampshire, Oregon, Utah, and Washington.
**US jurisdictions that permit minor surgery:
Arizona, District of Columbia, Idaho, Kansas, Maine, Montana, Vermont, Utah, and Washington.
*US states which specifically prohibit the practice of naturopathy:
South Carolina, Tennessee
Canadian provinces which license naturopathic doctors:
British Columbia, Manitoba, Ontario, Saskatchewanand Nova Scotia. [ [http://www.cand.ca/index.php?40 Canadian Association of Naturopathic Doctors] ]
United Kingdom, as there is no government sponsored regulation of the naturopathy profession, naturopaths are unregulated. The largest registering body, The General Council & Register of Naturopaths, recognises three courses in the UK, two being taught at osteopathic schools: the British College of Osteopathic Medicine; The College of Osteopaths Educational Trust; and one at the University of WestminsterSchool of Integrated Health under the auspices of the BSc Health Science (Naturopathy) course.Fact|date=July 2008 These organisations are not recognized by the UK regulatory frameworks.
Members of this register will either have completed a three or four year full time course or possibly be a healthcare professional who has completed a two year post-graduate Naturopathic Diploma (ND).
Alternatively, there are the Association of Naturopathic Practitioners and The British Naturopathic Association whose members can practice and get indemnity insurance.Fact|date=July 2008
In India there is a 5 1/2 year degree course offering a Bachelor of Naturopathy and Yogic Sciences (BNYS) degree. There are a total of 7 colleges in India, of which 4 colleges are in the state of Tamilnadu. Fact|date=September 2008
Naturopathic medicine is viewed with skepticism by critics who contend that it relies on unproven and controverisal alternative medical treatments, for example Dr.
Stephen Barrett(of Quackwatchand the National Council Against Health Fraud) has claimed that the philosophy of naturopathic medicine is "simplistic and that its practices are riddled with quackery." [ [http://www.quackwatch.org/01QuackeryRelatedTopics/Naturopathy/naturopathy.html A Close Look at Naturopathy] ] Barrett concludes that "Although some aspects of naturopathic education have improved in recent years, I believe this conclusion is still valid. I believe that the average naturopath is a muddlehead who combines commonsense health and nutrition measures and rational use of a few herbs with a huge variety of unscientific practices and anti-medical double-talk."
Evidence Based Medicine
Health freedom movement
Osteopathyand osteopathic medicine
* [http://www.futurehealth.ucsf.edu/pdf_files/Naturo2.pdf Profile of Profession: Naturopathic Practice] (312 Kb) at UCSF Center for the Health Professions
* [http://www.anma.com/ American Naturopathic Medical Association]
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