Naturopaths push for greater acceptance

Kansas is the latest state to regulate naturopathy, as public acceptance of alternative practitioners grows.

By Myrle Croasdale, AMNews staff. Oct. 28, 2002. Additional information

Physicians who beat back scope-of-practice incursions in statehouses across the country are meeting a new foe as naturopaths take advantage of the public's increasing interest in alternative and complementary medicine.

Several states already license naturopaths, and naturopaths are actively seeking licensing in several more. But physicians remain firm in their opposition to using state legislatures to expand naturopathic scope, or any scope for that matter.

"We believe the way to become trained is by education not legislation," said John C. Nelson, MD, secretary-treasurer of the American Medical Association.

The issue isn't likely to go away anytime soon.

According to some studies, 43% of Americans have used some form of alternative or complementary medicine and are spending $40 billion a year on such treatments or remedies.

"The trends are clear," said Michael Traub, ND, president of the American Assn. of Naturopathic Physicians, a group aggressively lobbying state legislatures to expand naturopathic scope of practice. "The use of alternative medicine in the United States is well recognized. People are not getting what they need with conventional physicians. People are looking for forms of medicine that are less invasive, less harmful and have fewer side effects."

43% of Americans have used alternative or complementary remedies.

Dr. Nelson acknowledged that the pull of alternative medicine is stronger these days for a variety of reasons. He said that traditional medicine still has its limits and that people with terminal or chronic illnesses are now turning to unproven alternative therapies when they feel their traditional avenues of treatment have been exhausted.

He said managed care constraints have dented the physician-patient relationship, sending some people in search of a different approach to care.

"Sometimes naturopaths and others take more time with patients, to be frank. Pressured by managed care, doctors are rushed and people are not pleased," said Dr. Nelson.

Naturopaths in Kansas sought to expand their scope with a bill that would have given them the right to prescribe certain prescription drugs, perform minor surgery and deliver babies.

The legislation, which was in committee for several years and was contested by the Kansas Medical Society, was eventually whittled down. The final bill, enacted in July, merely requires naturopaths to be registered.

The bill's greatest distinction is to separate naturopaths trained at an accredited four-year college from those that got their title from unaccredited sources, according to the AANP.

Americans spend $40 billion a year on alternative or complementary remedies.

"I'm glad Kansas did pass this bill, and every state should, to protect the public," said Mehdi Khosh, ND, an avid supporter of the legislation. "This bill says who is qualified and who is not."

Jerry Slaughter, executive director of the Kansas Medical Society, said the KMS was able to gut the bill but state government felt it had to take some action.

"Our goal was to make sure we didn't have folks out there practicing medicine without a medical license and doing things that they weren't trained to do," he said. "Kansas ultimately decided to create a law to get a handle on the people who were out there doing this."

The AANP estimates there are 4,000 to 5,000 naturopathic practitioners in the United States who've graduated from one of five accredited colleges in the United States and Canada.

Eleven states license naturopaths, and their licensing requirements vary widely. In states silent on the topic, naturopaths are guided by how the state defines the practice of medicine.

In New York, for example, where naturopaths are not licensed, they aren't allowed to diagnose patients, but they can treat them with vitamins and herbs.

A licensed naturopathic practitioner attends a four-year graduate-level program and is educated in basic sciences and holistic approaches with an emphasis on disease prevention. Their studies include clinical nutrition, acupuncture, homeopathic medicine and botanical medicine.

Part of the team

Some physicians are tapping into naturopaths' knowledge of nutrition and natural remedies.

Family physician Lynn Durand, MD, of Concord, N.H., said naturopaths make a valuable contribution to patient care.

11 states license naturopaths.

"The reason that I got interested is that I listened to people who were getting better," Dr. Durand said of his introduction to naturopaths.

He said many physicians are afraid they'll lose their patients to such alternative doctors but shouldn't be.

"Doctors don't admit it, but their core concern is 'If patients go to another kind of doctor, does that mean they won't come back to me?' Demographics show they go to alternative and conventional people" so they don't drop one for the other, he said.

The other assumption physicians make is that naturopaths are quacks.

"Physicians don't know what's included in a naturopathic education and assume it's substandard," Dr. Durand said. "I feel it's quite good, and in some areas it's superior, like in the area of nutrition."

Bethany Hays, MD, an ob-gyn who is medical director for True North in Falmouth, Maine, also shares patients with naturopaths and is looking to hire one to join the practice. While on the board of the American Holistic Medicine Assn., she researched their educational background and was impressed with what she found.

"My goal is to practice the best medicine available," Dr. Hays said. "When I realized there were big holes in my knowledge base, I found there were other practitioners who could fill in those holes in complementary modalities."

What she values about naturopaths is that they'll spend time educating patients on healthy eating and lifestyles, she said. Patients with complex multisystem disorders like chronic fatigue, fibromyalgia and irritable bowel syndrome often benefit from the naturopathic approach.

"These are problems conventional doctors don't have much patience or time for and often don't feel like they're helping," Dr. Hays said.

ADDITIONAL INFORMATION:

State control

Several states monitor naturopaths through some form of licensing or registration.

States that require licensing: Alaska, Arizona, Connecticut, Hawaii, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, Washington

States that require registration: Kansas, District of Columbia

Source: American Assn. of Naturopathic Physicians, American Naturopathic Medical Assn.

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