Naturopathy
Naturopathy, or naturopathic medicine, is a form of alternative medicine. A wide array of practices branded as "natural", "non-invasive", or promoting "self-healing" are employed by its practitioners, who are known as naturopaths. These treatments range from the pseudoscientific and thoroughly discredited, such as homeopathy, to the widely accepted, such as certain forms of psychotherapy. The ideology and methods of naturopathy are based on vitalism and folk medicine rather than evidence-based medicine, although practitioners may use techniques supported by evidence. The ethics of naturopathy have been called into question by medical professionals and its practice has been characterized as quackery.
Naturopathic practitioners commonly encourage alternative treatments that are rejected by conventional medicine, including resistance to surgery or vaccines for some patients. The diagnoses made by naturopaths often have no basis in science and are often not accepted by mainstream medicine.
Naturopaths frequently campaign for legal recognition in the United States. Naturopathy is prohibited in three U.S. states and tightly regulated in many others. Some states, however, allow naturopaths to perform minor surgery or even prescribe drugs. While some schools exist for naturopaths, and some jurisdictions allow such practitioners to call themselves doctors, the lack of accreditation, scientific medical training, and quantifiable positive results means they lack the competency of true medical doctors.
History
The term "naturopathy" originates from natura and 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. After graduating as a licenciate of the Royal College of Physicians of Edinburgh in 1879, Thomas Allinson began promoting his hygienic medicine in London, advocating a natural diet, exercise, and avoidance of tobacco and overwork.The term naturopathy was coined in 1895 by John Scheel, and bought 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 and Doctor of Chiropractic 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 of 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., 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 the United States, the Indian Health Service began accepting naturopathic doctors in their clinics and practice in 2013, also making loan repayment available to NDs.
In 2015, a former naturopathic doctor, Britt Marie Hermes, began writing critically about her experience in naturopathic medical training and practice. Her blog garnered a large following among skeptics while enraging some proponents of alternative medicine.
Practice
In 2003, a report was presented by Kimball C. Atwood, an American medical doctor and researcher from Newton, Massachusetts, best known as a critic of naturopathic medicine, stating among other criticisms that "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. Many naturopaths in India now use modern diagnostic techniques in their practice. Naturopaths focus on a holistic approach, 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 comprehensive patient interview assessing 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. An 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.
In 2020, a survey of methods used by naturopaths in fourteen countries reported that 27% of clients received acupuncture, 22% homeopathy, 16% "other energetic medicines", and 13.5% were given hydrotherapy. A mean of 4.0 "treatments" were provided to each customer. One-third of patients consulted with only the naturopath to manage their primary health concern.
Evidence basis
Naturopathy as a whole lacks an adequate scientific basis, and it is rejected by the medical community. Although it includes valid lifestyle advice from mainstream medicine, it typically adds a range of pseudoscientific beliefs. 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 , 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, 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 former 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. Hermes further notes that, while some naturopaths claim that their method can be effective treatments for psychological disorders, "no naturopathic treatment has been clinically proven to be safe and effective for bipolar disorder or any other condition."
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."