About Naturopathic Medicine
The Nature of Naturopathic Medicine
By Glenn Cassie, MA
Alternative medicine is the medicine of the new millennium, a symbol of reflective thinking about health care. Increased interest and use of botanical and non-drug remedies, non invasive medical techniques, an emphasis on disease prevention and lifestyle change characterize a paradigm shift in people’s attitudes towards their health. For most of the last century health care has meant diagnosis of germs and viruses, prevention in the forms of vaccinations, a myriad of drug treatments for ailments as common as flu or as complicated as AIDS, surgical treatments when applicable and little emphasis on diet, exercise and non-drug treatments. Now people are forming new ideas on health care, taking into consideration what they eat and drink and breathe, and, when they take prescription drugs, they are asking themselves what the side effects are and if are there alternatives to costly drug treatments. No longer is health the incidence or presence of disease, but a concept embracing physical, social and mental well-being.
One of the problems with this shift in thinking is that there is so much choice in alternative health services but little emphasis on education, research and effectiveness. Many alternative practitioners are not regulated or licensed, and there is no assurance that staff in a health food store have any medical knowledge required for the prescription of natural remedies. Amidst this plethora of choice, many people have chosen naturopathic doctors (NDs) as their primary health care professional. The field of naturopathic medicine is now 100 years old in North America and in some provinces is the fastest growing health profession. Further, in some American jurisdictions, state governments and health insurers have recognized NDs on a platform equivalent to MDs. This article looks at the field of naturopathic medicine, how NDs are educated, what they treat and protocols followed in their clinics.
When patients consider alternatives to mainstream medicine they are faced with a range of options. Some of the most common questions are “What exactly is naturopathic medicine?” “How is a naturopathic doctor different from a homeopath or herbalist?” and “What are the philosophical differences between NDs and MDs?” The first difference is that NDs receive an eclectic four year degree, covering a range of alternative therapies. NDs are generalists in alternative medicine in the same fashion that most MDs are family physicians. The second difference is that naturopathic protocols are based on research and study. Naturopathic medicine is science based natural medicine. The third major difference is the philosophy of naturopathic treatment, which is threefold.
First, Vis medicatrix naturae: the body has the inherent capacity to heal in the proper therapeutic environment. NDs believe in the recuperative power of the organism, given the correct climate for healing. Determining the correct individualized therapeutic environment is at the core of naturopathic medicine.
Second, Tollum causum: remove the cause. Instead of treating the symptoms of disease the ND tries to cure the cause of the disease.
Third, Prima non nocere: do not harm. The ND is trained to use therapies that will not cause adverse side effects or cause secondary problems (iatrogenic disease) as serious or more serious than the original disease.
Embracing these tenets, on a science-based platform, is at the heart of naturopathic care. Finally, an important difference between herbalists, homeopaths, and other alternative health practitioners that specialize in a particular discipline, is that NDs complete a doctorate in the same way MDs do. If a province or a state has legislation, then NDs must complete three years of pre-medical training and four years full-time at an accredited naturopathic college. This includes all the basic sciences any general practitioner receives—anatomy, physiology, pharmacology and so forth. But while an MD focuses on drug and surgical treatments, the doctorate in naturopathy emphasizes seven natural healing acts. They are: botanical medicine; clinical nutrition; naturopathic manipulation; hydrotherapy; acupuncture and oriental medicine; homeopathy; disease prevention and lifestyle counselling. Obviously, the ND is an eclectic medical degree!
In Canada, naturopathic medicine is regulated in BC, Alberta, Saskatchewan, Manitoba, Ontario and Nova Scotia. There are six accredited naturopathic colleges in North America, located in BC, Ontario, Washington, Oregon, Illinois, Connecticut and Arizona. Licensed NDs complete internationally standardized board exams upon completion of their degree, and, where there is legislation, are self-regulated in the same way MDs are.
In Oregon, the office of education policy and planning, which regulates all academic degrees in the state, reviewed the education and examination procedure of NDs, concluding: “...it would not be possible for an individual to pass all of the tests—which is necessary for licencure—without having a comprehensive foundation in the biological and biomedical sciences.” In other words, NDs complete “a biological and biomedical education of the same breadth and depth that prepares an MD to be a primary care physician.” Their report concluded that naturopathic medicine diverges from allopathic medicine only “at that point where professionals in common possession of scientific facts conscientiously disagree on how best to use their shared knowledge in treating patients.” This is a key point to patient care under an ND—it is simply primary health care, in the same scientific fashion af allopathic care, but without the use of drugs and surgery.
Given that the scope of training for NDs is similar to MDs, can a patient expect the same sort of treatment protocols? Yes and no. Yes in that NDs are general family practitioners trained to diagnose and treat acute and chronic illnesses. The foundation of naturopathic diagnosis is a detailed patient history, physical examination, review of medications and evaluation of appropriate laboratory tests and diagnostic imaging. A difference between allopathic and naturopathic care may lie in the NDs emphasis on nutrition and diet, lifestyle change, and the importance for patients to manage their own long-term health.
While many people see their ND for all manner of health concerns, a large number of patients turn to naturopathic medicine when diagnosed with ailments for which there is no allopathic cure. These ailments may include cold and flu, food allergies and sensitivities, candidiasis and chronic fatigue, muscle aches, sprains and strains and so forth. Many naturopathic protocols have results similar or equal to standard medical treatments, but without adverse affects and risks.
One typical example of a naturopathic protocol is the treatment of rheumatoid arthritis. Conventional treatments consist of drug therapy to manage pain, reduce inflammation and slow progression of the disease. The ND attempts to reduce pain with non-toxic or non-pharmacological agents, and also to instil positive lifestyle factors such as weight reduction, increased exercise, and improved diet. Attention is put on the digestive and eliminative processes, to encourage the body’s own self-healing mechanisms. As there is no known cure for arthritis, most allopathic treatments include nonsteroidal anti-inflammatory drugs (NSAIDS). Some patients receiving drug treatment require stronger drugs, such as gold injections, penicillamine and methotrexate. Potentially life-threatening side effects from gastrointestinal bleeding occur on two to four per cent of patients taking NSAIDS. Further, drug-induced infection and gastrointestinal bleeding can contribute to an increased mortality rate. Care under an ND is substantially different. After a routine health history, physical, lab work and diagnosis, a naturopathic protocol may include: nutritional analysis; dietary adjustments; food allergy screen; exercise assessments; treatment with natural anti-inflammatories such as bromelain, licorice root, turmeric; hydrotherapy and/or homeopathic treatments; acupuncture, among other protocols. A number of double-blind clinical trials and related studies have proven the efficacy of these treatments (see: Cleland 1998; Gibson1980; Gibbson 1980; Ruchkin 1987).
While many patients receive successful treatment from NDs, there is a common assumption that such treatment is largely a placebo effect. This is an unfortunate misconception. There is a wealth of research, both controlled and double-blind clinical studies, showing the scientific basis and validity of naturopathic protocols. Research is being carried out all the time at each of the accredited colleges. In addition, many naturopathic textbooks have indexed test and research results for naturopathic protocols—The Encyclopaedia of Natural Medicine by Murray & Pizzorno being an excellent example. Research on naturopathic protocols is published regularly in allopathic and naturopathic scientific journals, and in journals from many other disciplines including clinical nutrition, oriental medicine, phytotherapy, pharmacognosy, psychology and so forth. The Townsend Letter for Doctors and Patients is an accessible, thorough journal which produces recent research information on a broad range of ailments and disorders. The recent University of Glasgow double-blind study on homeopathic treatments for asthma, published in the Lancet, is another example of alternative medicine being validated in an allopathic environment. Further, the Complementary Medicine Index is an index of article citations for the methods of naturopathic medicine published by the British National Library each month, drawn from more than fifty journals.
Given the relative effectiveness of naturopathic protocols, there is too the interrelatedness of naturopathic/allopathic medicine. True complementary medicine includes treatment by all appropriately trained health professionals. Naturopathic medicine is not opposed to orthodox medicine; allopathic medicine is a requisite part of the health care system, and NDs do not presume to be specialists in surgical techniques or pharmaceuticals. However, many medical organizations in North America acknowledge the value of naturopathic protocols but oppose the practice of naturopathy. Despite this opposition, many NDs receive referrals from MDs and, similarly, NDs refer back to specialists then appropriate. In Europe allopathic and naturopathic medical practices are much more inter-related. A government appointed committee in the Netherlands, comprised of scientists and physicians studying the regulation of complementary medicine concluded: “The commission believes that the division between alternative and orthodox medicine is not of a scientific nature, but owes its origin and its continued existence to both politico-social and scientific factors.”
A recent essay by a health economist at the Fraser Institute noted that “with constant concern about the rising costs of health care, patients should be encouraged to seek preventive, less costly and less risky treatments than those that are now readily available to them. And they should be able to receive these treatments from qualified practitioners of several disciplines.”
This article originally appeared in the Rehab Review, the news magazine of the Canadian Association of Rehabilitation Professionals, Volume XVII, number 1