Can naturopaths call themselves ‘physicians’?
Twenty-two states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands have licensing or registration laws for naturopathic doctors. Three states – South Carolina, Tennessee, and Florida – prohibit practicing naturopathic medicine without a license, according to the AANP.
States that license NDs differ in what they permit them to do.
Nine states allow licensed NDs to use the term “physician,” although this is prohibited in seven states. Most licensed states allow naturopathic practitioners some prescribing authority, including the prescribing of many controlled substances, although only a few states permit full prescribing rights. Most states that license NDs allow them to prescribe and administer nonprescription therapeutic substances, drugs, and therapies.
Twelve states and the District of Columbia allow licensed naturopathic doctors to perform some minor procedures, such as stitching up wounds. Additionally, 13 states allow NDs to order diagnostic tests.
Although the AANP lobbies to get licensure in more states and to expand the activities that NDs can perform, the medical establishment in those states nearly always opposes the legislation, as do national organizations, such as the American Academy of Family Physicians and the American College of Physicians.
“They absolutely will not stop until they get licenses. They’ve done a really good job of selling themselves as legitimate health care professionals to state legislatures,” said David Gorski, MD, PhD, FACS, a surgical oncologist and managing editor of Science-Based Medicine, a blog that attacks unproven medical claims and defends traditional medicine. Naturopathy is a favorite target.
Are naturopaths gaining ground anyway?
Despite the opposition of the medical establishment and many individual health care professionals, a growing number of health care systems are adopting alternative medicine.
In 2018, the AANP stated that 28 prominent health systems, hospitals, and cancer treatment centers had one or more licensed NDs on staff. Among them were Cancer Treatment Centers of America, Cedars-Sinai, Columbia University’s Herbert Irving Comprehensive Cancer Center, and the Fred Hutchinson Cancer Research Center.
Other health care systems may not have NDs on staff but provide naturopathic treatments, usually under the heading of “complementary medicine” or “integrative medicine.” For example, the Cleveland Clinic’s Center for Integrative and Lifestyle Medicine offers acupuncture, Chinese herbal medicine, Reiki, yoga, and culinary medicine.
Critics find this appalling.
“I think it’s a mistake to integrate that kind of practice into a science-based health care setting. If we learned anything over the past year, it’s that medicine based on magical thinking is dangerous,” said Timothy Caulfield, LLM, FCAHS, research director at the Health Law Institute of the University of Alberta, Edmonton.
Dr. Gorski added: “I’m not exactly sure why doctors who should know better have become more accepting of practices that aren’t science-based or are outright quackery.”
Becoming part of the system
Beaumont Health, Michigan’s largest health care system, added integrative medicine in 2006 and hired its first naturopathic practitioners a year later.
The integrative practitioners began in oncology, offering such things as massage therapy, acupuncture, guided imagery, and Reiki. “Very quickly, people outside oncology began saying, ‘I’ve got a cardiology patient who would really benefit from this ... I’ve got a GI patient who could benefit from this...,’” said Maureen Anderson, MD, medical director of Beaumont Integrative Medicine.
Beaumont now offers integrative medicine at three locations. They average 20,000 visits a year and work with 50 to 60 practitioners, many of whom work part-time.
Because Michigan does not license NDs, their scope of practice at Beaumont is limited. They take patient histories, provide advice on nutrition, diet, and exercise, and prescribe herbs and supplements. Beaumont operates its own herbal and supplement pharmacy.
NDs work under the medical supervision of Dr. Anderson, an emergency medicine physician who became interested in naturopathy because she thought traditional medicine doesn’t do a good job of providing care for chronic conditions. Any initial skepticism on the part of the medical staff has been overcome by seeing the benefits naturopathy provides, Dr. Anderson said. The claim is echoed by Mr. Armstrong, an ND who works in the system part-time: “As soon as [doctors] understand our schooling and where we’re coming from and understand that we want to do the same things, then they’re very accepting.”
The University of California, Irvine, health care system has one of the largest naturopathic medicine programs in the country, the result of a $200 million donation in 2017 from a couple who champion alternative medicine. The Susan Samueli Integrative Health Institute includes 28 health care professionals, including MDs, NDs, RNs, acupuncturists, dietitians, yoga instructors, and others. It includes a research arm, which is focused primarily on acupuncture.
The alternative medicine offerings benefit the system, said Kim Hecht, DO, medical director of inpatient and ambulatory services at the Samueli Institute.
“I’m not against traditional medicine, because I think everything has a time and a place,” Dr. Hecht said. However, she rejects the idea that MDs can offer the same holistic approach as NDs.
“Medical science likes to say we’re interested in treating the whole person, but if you look at medical school courses, that’s not what’s being taught,” she said.
The chance to work within a traditional health care system was attractive to Arvin Jenab, ND, medical director of naturopathic medicine at the institute.
“It offers the opportunity to refine our medicine and trim the things that aren’t necessary or are controversial and concentrate on the things at the core of what we do,” he said.
UCI Health practices a conservative model of naturopathy that supports traditional practitioners, Mr. Jenab said.