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Among the most controversial health-care professionals you might run into these days are those who practice what’s known as naturopathic medicine.
That approach to health care is based on the belief that the human body possesses “an inherent self-healing” ability, according to the American Association of Naturopathic Physicians, or AANP. Naturopathic practitioners resist drugs and surgery, relying instead on giving patients lots of attention and personalized advice, and turning to a variety of “natural” or “holistic” treatments.
Those include approaches — such as changes in diet, exercise and lifestyle — that medical doctors (MDs) and doctors of osteopathic medicine (DOs) also often embrace.
But critics say that many keystones of naturopathic care, such as homeopathy and intravenous vitamin treatment, haven’t been scientifically proved.
To make matters even more confusing for consumers, there are two main branches of naturopathic practitioners: naturopathic doctors (NDs), who have graduated from a four-year naturopathic school and passed a licensing exam given by the Council on Naturopathic Medical Education; and unlicensed naturopaths, who have not completed those steps but practice anyway. That’s generally legal as long as they stick to basic lifestyle advice.
The AANP says it wants NDs in all states to be recognized as licensed medical professionals because that would differentiate its members from unlicensed naturopaths.
And it argues that NDs should be allowed to work as primary-care physicians, prescribe medication, diagnose diseases and seek insurance payment just as MDs and DOs do. Lobbying by the AANP has prompted 15 state legislatures to consider bills that would expand or clarify the scope of what NDs can do.
But critics — including the American Academy of Family Physicians, or AAFP, which represents many primary-care doctors — worry that granting NDs the same rights and privileges as MDs and DOs could harm consumers. They say that NDs aren’t as rigorously trained as medical doctors and that many naturopathic treatments are ineffective and potentially dangerous.
The scope of what NDs can now do varies widely by state.
In 20 states plus the District of Columbia, NDs are generally allowed to order certain medical tests, such as blood tests and X-rays, and write at least some prescriptions. But in other states they are no different from naturopaths: restricted to offering health advice and nonprescription treatments.
The AANP says that distinguishing between NDs and untrained naturopaths would protect consumers. “If anyone can call themselves a naturopath, you end up with people going to completely untrained practitioners, thinking that they’re seeing a real doctor,” says Robert Kachko, an ND in Connecticut and a board member of the organization.
But opponents worry that allowing NDs to practice like MDs would add to the confusion. “Patients can easily be misled into thinking that an ND license is the same as an MD’s,” says Britt Hermes, a former naturopathic doctor who says she grew disillusioned with the field after observing what she considered unethical treatment of cancer patients.
Timothy Caulfield, a professor of health law at the University of Alberta in Edmonton and a longtime skeptic of alternative medicine, says he understands why naturopathic medicine appeals to some consumers: NDs are attentive, and treatment plans are personalized.
The problem, Caulfield says, is that many of their treatments aren’t evidence-based. Homeopathy, for example, is based on the notion that tiny doses of a toxin can cure certain medical conditions — drinking small doses of pollen dissolved in large quantities of water to cure a pollen allergy, for example. But a large and growing body of research has found that homeopathy doesn’t work any better than a placebo.
Some critics say that even less contentious parts of naturopathy tend to be steeped in pseudoscience. “No one disagrees that diet and lifestyle are important,” says Michael Munger, president of the AAFP. “But a lot of the specifics naturopathy offers are bogus.”
For example, NDs sometimes base dietary advice on a patient’s blood type. But a 2013 review in the American Journal of Clinical Nutrition concluded that there was no scientific evidence to back that approach.
NDs say that homeopathy and other “natural” therapies are worth trying first because they’re less toxic than pharmaceuticals. “We’re not against drugs or surgery,” Kachko says. “But that shouldn’t be the first thing that we do.”
The AAFP and other supporters of standard medical care say that argument fails on several counts.
First, MDs are also trained to focus on doing the least harm and to avoid riskier treatments until safer ones have been exhausted. “Naturopaths like to say that they focus on health, while we just treat illness,” Munger says. “But that’s not true. Preventive health care is a staple of primary medicine.”
Second, many treatments that NDs offer aren’t, in fact, natural. “There is nothing natural about infusing massive doses of herbs or vitamins into your bloodstream,” says Pieter Cohen, an associate professor at Harvard Medical School who studies the dietary-supplement industry.
And last, while standard medical care can harm patients, so can naturopathic care. There’s no reliable information on how often such harm occurs, but there are some documented cases.
For example, the Food and Drug Administration reported last year that a 30-year-old woman died after receiving an intravenous infusion of curcumin (an ingredient in the spice turmeric) from a naturopathic practitioner to treat eczema, a relatively benign skin condition that’s usually treated with steroids. According to the FDA, medical authorities concluded that the curcumin — which was deemed ineffective by a comprehensive 2017 scientific review — caused her death.
If you’re considering naturopathic medicine, first talk with your primary-care doctor. If your goal is to improve your health through diet, exercise or other lifestyle changes, your MD or DO may well be able to help just as well.
If you opt for naturopathic medicine anyway, be skeptical of claims that it’s safer, more natural or less profit-oriented than conventional medicine.
And keep in mind that most naturopathic treatments are usually not covered by insurance, so you’ll most likely have to foot the bill yourself.
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