Naturopaths

Definition

Naturopaths are practitioners of naturopathic medicine, a type of alternative medicine that includes a variety of therapies, ranging from herbal preparations, therapeutic massage, aromatherapy, hydrotherapy , and acupuncture to nutritional counseling and homeopathy. In general, naturopaths avoid the use of drugs and surgery, recommending natural agents (e.g., herbs, water, and mineral and vitamin supplements) and mind/body treatments (e.g., massage, physical exercise , hydrotherapy, and meditation).

Description

The word naturopathy was coined around 1902 by John Scheel, a medical doctor, and popularized by Benedict Lust (1872–1945), a German immigrant to the United States who founded the world's first college of naturopathy in New York City in 1905. Lust had become interested in natural methods of healing when his health improved after taking the water cure offered in Wörishofen, Bavaria, by Sebastian Kneipp (1821–1897), a Roman Catholic priest. Father Kneipp recommended a complete lifestyle regimen based on herbal medications, a whole-grain low-fat diet , regular exercise, and spiritual practice as well as hydrotherapy—all of which are commonly recommended by contemporary naturopaths.

By 1935, Lust had opened a number of health food stores, started several naturopathic magazines, and founded other schools of naturopathy. He lobbied for official recognition of naturopathy as a healthcare profession, succeeding in having licensing laws passed in six states (Arizona, California, Connecticut, Hawaii, Oregon, and Washington). Lust also became interested in Ayurveda, the traditional system of Indian medicine, and in yoga , asking several well-known yogis to contribute articles to Nature's Path, one of the magazines he started.

Naturopathy obtained a considerable following in the United States and Canada until the end of World War II, when the introduction of antibiotics and other so-called miracle drugs brought conventional medicine back into the limelight. In the 1970s, however, interest in naturopathy began to increase among people attracted to the New Age movement and others disillusioned with mainstream medicine. As of 2004, about 1 percent of adults in the United States had consulted a naturopath; most of these were middle-aged, as surveys from the early 2000s indicate that naturopathy is more popular among adults between 40 and 60 than in either younger or older age groups.

Naturopathic treatment is highly individualized, so that a senior who consults a naturopath will be evaluated and treated as an individual rather than as a member of an age group. The initial interview of a new patient is extensive, typically lasting from 60 to 90 minutes; follow-up interviews are usually between 30 and 60 minutes in length. Individuals are asked in detail about their past medical and surgical history, family history, present dietary and sleep habits, and current health issues. The naturopath inquires about the level of stress in the patient's life and offer lifestyle and nutritional counseling as appropriate. Following a physical examination, the naturopath may order laboratory or imaging tests as necessary. At the end of the initial appointment, the naturopath will set up a health management plan together with the patient.

Work settings

Naturopathic physicians usually work in walk-in (ambulatory) outpatient primary care settings, as they are not trained to use highly technical mainstream treatments for life-threatening illnesses. They are, however, trained to perform a standard physical evaluation and to use laboratory tests or request diagnostic imaging as the patient's condition may require. Some naturopaths offer hydrotherapy, acupuncture, spinal manipulation, or massage therapy within their offices.

As of the early 2000s, naturopathic physicians work increasingly closely with mainstream physicians—particularly family practice physicians and internists—in managing such common health conditions or concerns in seniors as overweight, muscle and joint pain , the need to quit smoking, alcohol abuse, insomnia and other sleep disorders, depression, diarrhea, constipation , and fatigue.

Care team role

The extent to which a naturopath can be part of a senior's health care team varies somewhat from state to state, depending on the naturopath's training. Naturopaths who have graduated from one of the six schools (four in the United States and two in Canada) accredited by the Council on Naturopathic Medical Education (CNME) and have obtained the N.D. degree (Doctor of Naturopathic Medicine) can be legally licensed to practice as primary health care givers in Alaska, Arizona, California, Connecticut, the District of Columbia, Hawaii, Idaho, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, Washington, and in Puerto Rico and U.S. Virgin Islands; in Canada, they can be licensed to practice in British Columbia, Manitoba, Ontario, and Saskatchewan. In Utah, however, naturopaths can prescribe only drugs that are listed in the Naturopathic Physicians' Formulary. South Carolina and Tennessee explicitly prohibit the practice of naturopathy.

Naturopaths with the N.D. degree receive extensive training during their professional education in order to identify life-threatening illnesses and other conditions outside the scope of their training and to make appropriate referrals when needed. Their distinctive contribution as part of a senior's healthcare team is their focus on individualized care, their concern for the whole patient, their emphasis on preventive care, and their ability to take more time with the patient than most mainstream physicians do.

Education/Training

One of the confusing aspects of naturopathic practice in the United States and Canada as of 2008 is the variety of licensing standards in the various states and provinces. It is, therefore, important for any senior (or family member) interested in naturopathy to inquire carefully about a practitioner's training and qualifications. Naturopaths with an N.D. degree are graduates of one of the six accredited four-year institutions described above; they must also pass a national test, the Naturopathic Physicians Licensing Examination (NPLEX) in order to be licensed in the states and provinces that recognize naturopaths as primary care providers. A prospective student must be a graduate of an accredited four-year college or university and have successfully completed a premedical course of study in order to apply for admission to one of the accredited naturopathic schools. The curricula of these schools include courses in current mainstream medical science as well as naturopathic principles. As in other medical schools, the first two years focus on basic sciences and the third and fourth years on clinical practice. Faculty members at these schools include M.D.s, Ph.D.s, and D.O.s, as well as N.D.s.

Some credentialed naturopaths are M.D.s or D.O. s with conventional medical training who have pursued additional professional education in naturopathy.

As of 2008, however, there are several lawsuits pending regarding the use of the term “naturopath.” In addition to holders of the N.D., there is a group of so-called traditional naturopaths who are guided by the same principles of naturopathic medicine as N.D.s but lack their rigorous training. Traditional naturopaths may offer hydrotherapy, acupuncture, massage, and other therapies recommended by N.D.s, but they do so as alternative practitioners rather than as licensed primary health care providers. The training of traditional naturopaths ranges from high-school diplomas and correspondence courses to apprenticeships with established traditional naturopaths or simply self-teaching. The professional organizations of traditional naturopaths are not recognized by any U.S. or Canadian authorities.

Family teaching

The practitioner's role as a teacher is one of the six basic principles of naturopathic medicine. Naturopaths are strongly committed to teaching each patient (and his or her family members) to take responsibility for their own health. A senior who consults a naturopath can expect to receive extensive counseling and advice about preventive health care, diet and nutrition , other lifestyle issues, exercise, and other treatment modalities that may be helpful, as well as answers to questions about specific health conditions or treatments.

KEY TERMS

Ambulatory —Applied to patients who are able to walk or move about. Applied to a clinic or medical center, it is a synonym for “outpatient” or “walk-in.”

Ayurveda —The traditional system of medicine practiced in India. Ayurveda is the oldest system of natural medicine in the world.

Holistic medicine —Any approach to health care that emphasizes treatment of the whole person, mind and spirit as well as body. Naturopathy is one form of holistic medicine.

Hydrotherapy —The use of water to relieve pain and treat diseases. Hydrotherapy may involve drinking water (usually mineral or spring water), but more commonly involves the external use of water, as in hot or cold baths, exercising in water, the use of wet soaks and compresses, or whirlpool baths.

Naturopathic physician —In the United States and Canada, a primary healthcare provider who holds the degree of Doctor of Naturopathic Medicine from an accredited institution, has passed the national licensing examination (NPLEX), and has been licensed in one of the states or provinces that recognizes naturopathy.

Naturopathy —An alternative approach to healing that avoids surgery and prescription medications, relying instead on natural agents and therapeutic techniques.

Traditional naturopath —A practitioner of alternative medicine who uses some of the alternative or complementary therapies recommended by naturopathic physicians but lacks their training in conventional medicine and is not licensed to offer primary health care.

The other five basic principles of naturopathic medicine are:

• Nature is the best healer; the human healthcare professional should promote the healing power of nature rather than interfere with it.
• First, do no harm. Naturopaths choose therapies that are least likely to have harmful side effects for the patient.
• Treat the whole person, not just the disease.
• Treat the cause of the disease rather than focusing on removing the symptoms. Naturopaths believe that the symptoms of illness are signs that the body is trying to fight off disease or recover from it.
• Prevention of illness is the best cure.

Resources

BOOKS

Pizzorno, Joseph E., Jr., and Michael T. Murray. Textbook of Natural Medicine, 3rd ed. St. Louis, MO: Churchill Livingstone Elsevier, 2006.

PERIODICALS

Dunne, N., W. Benda, L. Kim, et al. “Naturopathic Medicine: What Can Patients Expect?” Journal of Family Practice 54 (December 2005): 1067–1072. Available online at http://www.naturopathic.org/images/bulletins/0aanp_naturopathic_med_what_can_patients_expect_dec_05.pdf. [cited March 21, 2008].

Votova, K., and A. V. Wister. “Self-care Dimensions of Complementary and Alternative Medicine Use among Older Adults.” Gerontology 53 (January 2007): 21–27.

OTHER

National Center for Complementary and Alternative Medicine (NCCAM). Backgrounder: Introduction to Naturopathy. Bethesda, MD: NCCAM, 2007. Available online at http://nccam.nih.gov/health/naturopathy/April,2007 [cited March 21, 2008].

ORGANIZATIONS

American Association of Naturopathic Physicians (AANP), 4435 Wisconsin Ave. NW, Suite 403, Washington, DC, 20016, (202) 237-8150, (866) 538-2267, (202) 237-8152, http://www.naturopathic.org/index.php.

Bastyr University, 14500 Juanita Drive NE, Kenmore, WA, 98028, (425) 823-1300, (425) 823-6222, http://www.bastyr.edu/default.asp.

Council on Naturopathic Medical Education (CNME), PO Box 178, Great Barrington, MA, 01230, (413) 528-8877, (413) 528-8880, [email protected], http://www.cnme.org/index.html.

Rebecca J. Frey Ph.D.