Naturopathy | Wikipedia audio article

Naturopathy or naturopathic medicine is a
form of alternative medicine that employs an array of pseudoscientific practices branded
as “natural”, “non-invasive”, and as promoting “self-healing”. The ideology and methods of
naturopathy are based on vitalism and folk medicine, rather than evidence-based medicine.
Naturopathic practitioners generally recommend against following modern medical practices,
including but not limited to medical testing, drugs, vaccinations, and surgery. Instead,
naturopathic study and practice rely on unscientific notions, often leading naturopaths to diagnoses
and treatments that have no factual merit.Naturopathy is considered by the medical profession to
be ineffective and possibly harmful, raising ethical issues about its practice. In addition
to accusations from the medical community, such as the American Cancer Society, naturopaths
have repeatedly been accused of being charlatans and practicing quackery. Over the years, many
practitioners of naturopathy have been found criminally liable in the courts of law around
the world. In some countries, it is a criminal offense for naturopaths to label themselves
as medical professionals. Naturopaths are campaigning for more recognition
in the United States.==History==
The term “naturopathy” originates from “natura” (Latin root for birth) and “pathos” (the Greek
root for suffering) to suggest “natural healing”. Naturopaths claim the ancient Greek “Father
of Medicine”, Hippocrates, as the first advocate of naturopathic medicine, before the term
existed. Naturopathy has its roots in the 19th-century Natural Cure movement of Europe.
In Scotland, Thomas Allinson started advocating his “Hygienic Medicine” in the 1880s, promoting
a natural diet and exercise with avoidance of tobacco and overwork.The term naturopathy
was coined in 1895 by John Scheel, and purchased by Benedict Lust, whom naturopaths consider
to be the “Father of U.S. Naturopathy”. Lust had been schooled in hydrotherapy and other
natural health practices in Germany by Father Sebastian Kneipp; Kneipp sent Lust to the
United States to spread his drugless methods. Lust defined naturopathy as a broad discipline
rather than a particular method, and included such techniques as hydrotherapy, herbal medicine,
and homeopathy, as well as eliminating overeating, tea, coffee, and alcohol. He described the
body in spiritual and vitalistic terms with “absolute reliance upon the cosmic forces
of man’s nature”. According to the Merriam-Webster Dictionary, the first known use of “naturopathy”
in print is from 1901.From 1901, Lust founded the American School of Naturopathy in New
York. In 1902, the original North American Kneipp Societies were discontinued and renamed
“Naturopathic Societies”. In September 1919, the Naturopathic Society of America was dissolved
and Benedict Lust founded the American Naturopathic Association to supplant it. Naturopaths became
licensed under naturopathic or drugless practitioner laws in 25 states in the first three decades
of the twentieth century. Naturopathy was adopted by many chiropractors, and several
schools offered both Doctor of Naturopathy (ND) and Doctor of Chiropractic (DC) degrees.
Estimates of the number of naturopathic schools active in the United States during this period
vary from about one to two dozen.After a period of rapid growth, naturopathy went into decline
for several decades after the 1930s. In 1910, the Carnegie Foundation for the Advancement
of Teaching published the Flexner Report, which criticized many aspects of medical education,
especially quality and lack of scientific rigour. The advent of penicillin and other
“miracle drugs” and the consequent popularity of modern medicine also contributed to naturopathy’s
decline. In the 1940s and 1950s, a broadening in scope of practice laws led many chiropractic
schools to drop their ND degrees, though many chiropractors continued to practice naturopathy.
From 1940 to 1963, the American Medical Association campaigned against heterodox medical systems.
By 1958, practice of naturopathy was licensed in only five states. In 1968, the United States
Department of Health, Education, and Welfare issued a report on naturopathy concluding
that naturopathy was not grounded in medical science and that naturopathic education was
inadequate to prepare graduates to make appropriate diagnosis and provide treatment; the report
recommends against expanding Medicare coverage to include naturopathic treatments. In 1977
an Australian committee of inquiry reached similar conclusions; it did not recommend
licensure for naturopaths.Beginning in the 1970s, there was a revival of interest in
the United States and Canada, in conjunction with the “holistic health” movement. As of
2009, fifteen U.S. states, Puerto Rico, the US Virgin Islands and the District of Columbia
licensed naturopathic doctors, and the State of Washington requires insurance companies
to offer reimbursement for services provided by naturopathic physicians. On the other hand,
some states such as South Carolina and Tennessee prohibit the practice of naturopathy.In 2015,
a former naturopathic doctor, Britt Marie Hermes, began writing critically about her
experience being trained in and practicing naturopathic medicine.The United States IHS
(Indian Health Service) began accepting naturopathic doctors in their clinics and practice in 2013,
also making loan repayment available to ND’s.==Practice==The
practice of naturopathy is based on a belief in the body’s ability to heal itself through
a special vital energy or force guiding bodily processes internally. Diagnosis and treatment
concern primarily alternative therapies and “natural” methods that naturopaths claim promote
the body’s natural ability to heal. Naturopaths focus on a holistic approach, completely avoiding
the use of surgery and conventional medicines. Naturopaths aim to prevent illness through
stress reduction and changes to diet and lifestyle, often rejecting the methods of evidence-based
medicine.A consultation typically begins with a lengthy patient interview focusing on lifestyle,
medical history, emotional tone, and physical features, as well as physical examination.
Many naturopaths present themselves as primary care providers, and some naturopathic physicians
may prescribe drugs, perform minor surgery, and integrate other conventional medical approaches
such as diet and lifestyle counselling with their naturopathic practice. Traditional naturopaths
deal exclusively with lifestyle changes, not diagnosing or treating disease. Naturopaths
do not generally recommend vaccines and antibiotics, based in part on the early views that shaped
the profession, and they may provide alternative remedies even in cases where evidence-based
medicine has been shown effective.===Methods===
Naturopaths are often opposed to mainstream medicine and take an antivaccinationist stance.The
particular modalities used by a naturopath vary with training and scope of practice.
These may include herbalism, homeopathy, acupuncture, nature cures, physical medicine, applied kinesiology,
colonic enemas, chelation therapy, color therapy, cranial osteopathy, hair analysis, iridology,
live blood analysis, ozone therapy, psychotherapy, public health measures and hygiene, reflexology,
rolfing, massage therapy, and traditional Chinese medicine. Nature cures include a range
of therapies based on exposure to natural elements such as sunshine, fresh air, or heat
or cold, as well as nutrition advice such as following a vegetarian and whole food diet,
fasting, or abstention from alcohol and sugar. Physical medicine includes naturopathic, osseous,
or soft tissue manipulative therapy, sports medicine, exercise, and hydrotherapy. Psychological
counseling includes meditation, relaxation, and other methods of stress management.A 2004
survey determined the most commonly prescribed naturopathic therapeutics in Washington State
and Connecticut were botanical medicines, vitamins, minerals, homeopathy, and allergy
treatments. A examination published in 2011 of naturopathic clinic websites in Alberta
and British Columbia found that the most commonly advertised therapies were homeopathy, botanical
medicine, nutrition, acupuncture, lifestyle counseling, and detoxification.===Evidence basis===Naturopathy lacks an adequate scientific basis,
and it is rejected by the medical community. Some methods rely on immaterial “vital energy
fields”, the existence of which has not been proven, and there is concern that naturopathy
as a field tends towards isolation from general scientific discourse. Naturopathy is criticized
for its reliance on and its association with unproven, disproven, and other controversial
alternative medical treatments, and for its vitalistic underpinnings. Natural substances
known as nutraceuticals show little promise in treating diseases, especially cancer, as
laboratory experiments have shown limited therapeutic effect on biochemical pathways,
while clinical trials demonstrate poor bioavailability. According to the American Cancer Society,
“scientific evidence does not support claims that naturopathic medicine can cure cancer
or any other disease”. According to Britt Hermes, naturopath student programs are problematic
because “As a naturopath [student], you are making justifications to make the rules
and to fudge the standards of how to interpret research all along the way. Because if you
don’t, you’re not left with anything, basically”.In 2015, the Australian Government’s
Department of Health published the results of a review of alternative therapies that
sought to determine if any were suitable for being covered by health insurance; Naturopathy
was one of 17 therapies evaluated for which no clear evidence of effectiveness was found.
Kimball C. Atwood IV writes, in the journal Medscape General Medicine, Naturopathic physicians
now claim to be primary care physicians proficient in the practice of both “conventional” and
“natural” medicine. Their training, however, amounts to a small fraction of that of medical
doctors who practice primary care. An examination of their literature, moreover, reveals that
it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices.
In another article, Atwood writes that “Physicians who consider naturopaths to be their colleagues
thus find themselves in opposition to one of the fundamental ethical precepts of modern
medicine. If naturopaths are not to be judged “nonscientific practitioners”, the term has
no useful meaning”.A retired licensed naturopathic doctor, Britt Marie Hermes, states that “any
product that is sold by a naturopath almost guarantees that there is no reliable scientific
data to support whatever health claims are made, and that while some naturopaths claim
to only practice evidence based medicine, “the problem is, all naturopaths in an accredited
naturopathic program are required to extensively study homeopathy, herbal medicine, energy
healing, chiropractic techniques, water therapy” and other pseudoscientific practices.According
to Arnold S. Relman, the Textbook of Natural Medicine is inadequate as a teaching tool,
as it omits to mention or treat in detail many common ailments, improperly emphasizes
treatments “not likely to be effective” over those that are, and promotes unproven herbal
remedies at the expense of pharmaceuticals. He concludes that “the risks to many sick
patients seeking care from the average naturopathic practitioner would far outweigh any possible
benefits”.The Massachusetts Medical Society states, “Naturopathic practices are unchanged
by research and remain a large assortment of erroneous and potentially dangerous claims
mixed with a sprinkling of non-controversial dietary and lifestyle advice.”===
Safety of natural treatments===Naturopaths often recommend exposure to naturally
occurring substances, such as sunshine, herbs and certain foods, as well as activities they
describe as natural, such as exercise, meditation and relaxation. Naturopaths claim that these
natural treatments help restore the body’s innate ability to heal itself without the
adverse effects of conventional medicine. However, “natural” methods and chemicals are
not necessarily safer or more effective than “artificial” or “synthetic” ones, and any
treatment capable of eliciting an effect may also have deleterious side effects.Certain
naturopathic treatments offered by naturopaths, such as homeopathy, rolfing, and iridology,
are widely considered pseudoscience or quackery. Stephen Barrett of QuackWatch and the National
Council Against Health Fraud has stated that naturopathy is “simplistic and that its practices
are riddled with quackery”. “Non-scientific health care practitioners, including naturopaths,
use unscientific methods and deception on a public who, lacking in-depth health care
knowledge, must rely upon the assurance of providers. Quackery not only harms people,
it undermines the ability to conduct scientific research and should be opposed by scientists”,
says William T. Jarvis. In the 2018 Australian case against Marlyin Bodnar, who advised a
mother to treat her infant son’s eczema with a raw food diet which nearly led to the child’s
starvation death, Judge Peter Berman said, “Well intentioned but seriously misguided
advice is, as the facts of this case demonstrate, capable of causing great harm and even death
to vulnerable children.” Furthermore, Britt Hermes criticizes the “pervasive culture
of patient blaming” among naturopathic practitioners, where “when something doesn’t work for
the patient and the patient is not experiencing all of the positive effects and zero side-effects
that are promised with the therapy, it’s never because the therapy doesn’t work,
it’s because the patient didn’t do something right.”===
Vaccination===Naturopathy practitioners voice their opposition
to vaccination. The reasons for this opposition are based, in part, on the early views which
shaped the foundation of this profession. A naturopathy textbook, co-authored by Joseph
Pizzorno, recalls anti-vaccine beliefs associated with the founding of naturopathy in the United
States: “a return to nature in regulating the diet, breathing, exercising, bathing and
the employment of various forces” in lieu of the smallpox vaccine.In general, evidence
about associations between naturopathy and pediatric vaccination is sparse, but “published
reports suggest that only a minority of naturopathic physicians actively support full vaccination”.
In Washington state from 2000 to 2003, children were significantly less likely to receive
immunizations if they had seen a naturopath. A survey of naturopathic students published
in 2004 found that students at the Canadian College of Naturopathic Medicine became less
likely to recommend vaccinations to their patients and became more distrustful of public
health and conventional medicine as they advanced in the program.The British Columbia Naturopathic
Association lists several major concerns regarding the pediatric vaccine schedule and vaccines
in general, and the group’s policy is to not advocate for or against vaccines. The Oregon
Association of Naturopathic Physicians reports that many naturopaths “customize” the pediatric
vaccine schedule.As of 2016, the American Association of Naturopathic Physicians, which
is the largest professional organization for licensed naturopaths in the U.S., is “still
discussing its stance on vaccinations.”==
Practitioners==Naturopaths represent a diverse group of practitioners.
In general, they can be categorized into three groups: 1) those with a government issued
license; 2) those who practice outside of an official status (“traditional naturopaths”);
3) those who are primarily another kind of health professional who also practices naturopathy.In
Switzerland, these divisions fall between those with a federal diploma, those recognized
by health insurances, and those with neither federal diploma nor recognition by health
insurances. Naturopaths with federal diploma can be divided into four categories: European
traditional medicine, Chinese traditional medicine, ayurvedic medicine and homeopathy.
The number of listed naturopaths (including traditional healers) in Switzerland rose from
223 in 1970 to 1835 in 2000.===Licensed naturopaths===
Licensed naturopaths may be referred to as “naturopathic doctors” or “naturopathic physicians”
in 17 US states and 5 Canadian provinces. Licensed naturopaths present themselves as
primary care providers. Licensed naturopaths do not receive comparable training to medical
doctors in terms of the quality of education or quantity of hours. In British Columbia,
licensed naturopaths are permitted to refer to themselves as simply “doctor” or “physician”.====Education====Licensed naturopaths must pass the Naturopathic
Physicians Licensing Examinations (NPLEX) administered by the North American Board of
Naturopathic Examiners (NABNE) after graduating from a program accredited by the Council on
Naturopathic Medical Education (CNME). Training in CNME-accredited programs includes basic
medical diagnostics and procedures such as rudimentary physical exams and common blood
tests, in addition to pseudoscientific modalities, such as homeopathy, acupuncture, and energy
modalities. These accredited programs have been criticized
for misrepresenting their medical rigor and teaching subjects that are antithetical to
the best understandings of science and medicine. The CNME as an accrediting authority has been
characterized as unreliable and suffering from conflicts of interest. The naturopathic
licensing exam has been called a mystery by those outside the naturopathic profession
and criticized for testing on homeopathic remedies, including for the use to treat pediatric
emergencies.Naturopathic doctors are not eligible for medical residencies, which are available
exclusively for medical doctors and doctors of osteopathic medicine. There are limited
post-graduate “residency” positions available to naturopathic doctors offered through naturopathic
schools and naturopathic clinics approved by the CNME. Most naturopathic doctors do
not complete such a residency, and naturopathic doctors are not mandated to complete one for
licensure, except in the state of Utah. Continuing education in naturopathic modalities for health
care professionals varies greatly.====Political activity====
Naturopaths affiliated with the CNME-accredited schools lobby state, provincial, and federal
governments for medical licensure and participation in social health programs. The American Association
of Naturopathic Physicians represents licensed naturopaths in the United States; the Canadian
Association of Naturopathic Doctors represents licensed naturopaths in Canada. Naturopathic
lobbying efforts are funded by vitamin and supplement makers and focus on portraying
naturopathic education as comparable to medical education received by physicians and on having
high professional standards. Medical societies and advocacy groups dispute these claims by
citing evidence of licensed naturopaths using pseudoscientific methods without a sound evidence
basis and lacking adequate clinical training to diagnose and treat disease competently
according to the standard of care. Jann Bellamy has characterized the process by which naturopaths
and other practitioners of pseudoscience convince lawmakers to provide them with medical licenses
as “legislative alchemy.”Since 2005, the Massachusetts Medical Society has opposed licensure based
on concerns that NDs are not required to participate in residency and concerns that the “practices”
of naturopaths included many “erroneous and potentially dangerous claims.” The Massachusetts
Special Commission on Complementary and Alternative Medical Practitioners rejected their concerns
and recommended licensure. The Massachusetts Medical Society states: Naturopathic medical school is not a medical
school in anything but the appropriation of the word medical. Naturopathy is not a branch
of medicine. It is a hodge podge of nutritional advice, home remedies and discredited treatments…Naturopathic
colleges claim accreditation but follow a true “alternative” accreditation method
that is virtually meaningless. They are not accredited by the same bodies that accredit
real medical schools and while some courses have similar titles to the curricula of legitimate
medical schools the content is completely different.
In 2015, a former naturopathic doctor, Britt Marie Hermes, who graduated from Bastyr University
and practiced as a licensed ND in Washington and Arizona, began advocating against naturopathic
medicine. In addition to opposing further licensure, she believes that NDs should not
be allowed to use the titles “doctor” or “physician,” and be barred from treating children. She
states: Naturopaths aggressively lobby for laws to
issue them medical licenses. I would characterize this political effort as a perverted redefinition
of the words “physician,” “doctor,” “medical school,” and “residency”
in order to mask the inadequacy of the training provided in naturopathic programs. ND students
do not realize that they are taking educational shortcuts and therefore do not possess any
demonstrable competencies found in modern medicine.===Traditional naturopaths===Traditional naturopaths are represented in
the United States by the American Naturopathic Association (ANA), representing about 1,800
practitioners and the American Naturopathic Medical Association (ANMA).The level of naturopathic
training varies among traditional naturopaths in the United States. Traditional naturopaths
may complete non-degree certificate programs or undergraduate degree programs and generally
refer to themselves as Naturopathic Consultants. These programs often offer online unaccredited
degrees, but do not offer comprehensive biomedical education or clinical training.
Traditional naturopathic practitioners surveyed in Australia perceive evidence-based medicine
to be an ideological assault on their beliefs in vitalistic and holistic principles. They
advocate the integrity of natural medicine practice.Naturopaths graduating from accredited
programs argued in 2002 that their training used evidence-based scientific principles
unlike traditional naturopathic programs, but this claim remains inaccurate.==Regulation==
Naturopathy is practiced in many countries and is subject to different standards of regulation
and levels of acceptance. The scope of practice varies widely between jurisdictions. The practice
of naturopathy is illegal in two USA states.===Australia===
In 1977, a committee reviewed all colleges of naturopathy in Australia and found that,
although the syllabuses of many colleges were reasonable in their coverage of basic biomedical
sciences on paper, the actual instruction bore little relationship to the documented
course. In no case was any practical work of consequence available. The lectures which
were attended by the committee varied from the dictation of textbook material to a slow,
but reasonably methodical, exposition of the terminology of medical sciences, at a level
of dictionary definitions, without the benefit of depth or the understanding of mechanisms
or the broader significance of the concepts. The committee did not see any significant
teaching of the various therapeutic approaches favoured by naturopaths. People reported to
be particularly interested in homoeopathy, Bach’s floral remedies or mineral salts were
interviewed, but no systematic courses in the choice and use of these therapies were
seen in the various colleges. The committee were left with the impression that the choice
of therapeutic regime was based on the general whim of the naturopath and, since the suggested
applications in the various textbooks and dispensations overlapped to an enormous extent,
no specific indications were or could be taught.The position of the Australian Medical Association
is that “evidence-based aspects of complementary medicine can be part of patient care by a
medical practitioner”, but it has concerns that there is “limited efficacy evidence regarding
most complementary medicine. Unproven complementary medicines and therapies can pose a risk to
patient health either directly through misuse or indirectly if a patient defers seeking
medical advice.” The AMA’s position on regulation is that “there should be appropriate regulation
of complementary medicine practitioners and their activities.”In 2015, the Australian
government found no clear evidence of effectiveness for naturopathy. Accordingly, In 2017 the
Australian government named Naturopathy as a practice that would not qualify for insurance
subsidy, saying this step would “ensure taxpayer funds are expended appropriately and not directed
to therapies lacking evidence”.===India===
In India, naturopathy is overseen by the Department of Ayurveda, Yoga and Naturopathy, Unani,
Siddha and Homoeopathy (AYUSH); there is a 5½-year degree in “Bachelor of Naturopathy
and Yogic Sciences” (BNYS) degree that was offered by twelve colleges in India as of
August 2010. The National Institute of Naturopathy in Pune that operates under AYUSH, which was
established on December 22, 1986 and encourages facilities for standardization and propagation
of the existing knowledge and its application through research in naturopathy throughout
India.===North America===
In five Canadian provinces, seventeen U.S. states, and the District of Columbia, naturopathic
doctors who are trained at an accredited school of naturopathic medicine in North America
are entitled to use the designation ND or NMD. Elsewhere, the designations “naturopath”,
“naturopathic doctor”, and “doctor of natural medicine” are generally unprotected or prohibited.In
North America, each jurisdiction that regulates naturopathy defines a local scope of practice
for naturopathic doctors that can vary considerably. Some regions permit minor surgery, access
to prescription drugs, spinal manipulations, midwifery (natural childbirth), and gynecology;
other regions exclude these from the naturopathic scope of practice or prohibit the practice
of naturopathy entirely.====Canada====
Five Canadian provinces license naturopathic doctors: Ontario, British Columbia, Manitoba,
Saskatchewan, and Alberta. British Columbia has the largest scope of practice in Canada,
allowing certified NDs to prescribe pharmaceuticals and perform minor surgeries.====United States====
U.S. jurisdictions that currently regulate or license naturopathy include Alaska, Arizona,
California, Connecticut, Colorado, District of Columbia, Hawaii, Kansas, Maine, Maryland,
Minnesota, Montana, New Hampshire, North Dakota, Oregon, Puerto Rico, US Virgin Islands, Utah,
Vermont, and Washington. Additionally, Florida and Virginia license the practice of naturopathy
under a grandfather clause.U.S. jurisdictions that permit access to prescription drugs:
Arizona, California, District of Columbia, Hawaii, Kansas, Maine, Montana, New Hampshire,
Oregon, Utah, Vermont, and Washington. U.S. jurisdictions that permit minor surgery:
Arizona, District of Columbia, Kansas, Maine, Montana, Oregon, Utah, Vermont, and Washington.
U.S. states which specifically prohibit the practice of naturopathy: South Carolina and
The Swiss Federal Constitution defines the Swiss Confederation and the Cantons of Switzerland
within the scope of their powers to oversee complementary medicine. In particular, the
Federal authorities must set up diplomas for the practice of non-scientific medicine. The
first of such diplomas has been validated in April 2015 for the practice of naturopathy.
There is a long tradition for naturopathy and traditional medicine in Switzerland. The
Cantons of Switzerland make their own public health regulations. Although the law in certain
cantons is typically monopolistic, the authorities are relatively tolerant with regard to alternative
practitioners.===United Kingdom===
Naturopathy is not regulated in the United Kingdom. In 2012, publicly funded universities
in the United Kingdom dropped their alternative medicine programs, including naturopathy.==See also

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