Naturopathy: A Critical Appraisal

Kimball C. Atwood IV, MD

Disclosures

Medscape General Medicine. 2003;5(4) 

In This Article

Abstract and Introduction

Abstract

"Naturopathic medicine" is a recent manifestation of the field of naturopathy, a 19th-century health movement espousing "the healing power of nature." "Naturopathic physicians" now claim to be primary care physicians proficient in the practice of both "conventional" and "natural" medicine. Their training, however, amounts to a small fraction of that of medical doctors who practice primary care. An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices. Despite this, naturopaths have achieved legal and political recognition, including licensure in 13 states and appointments to the US Medicare Coverage Advisory Committee. This dichotomy can be explained in part by erroneous representations of naturopathy offered by academic medical centers and popular medical Web sites.

Introduction

Two naturopaths were recently appointed to the US Medicare Coverage Advisory Committee (MCAC).[1] This contradicts the conclusions of an inquiry made by the US Department of Health, Education, and Welfare (HEW; now the Department of Health and Human Services), the department that houses Medicare itself.

In 1968, naturopaths asked HEW to consider Medicare reimbursement for their practices. The department conducted an investigation and chose not to do so. Its report concluded:

 

Naturopathic theory and practice are not based on the body of basic knowledge related to health, disease, and health care that has been widely accepted by the scientific community. Moreover, irrespective of its theory, the scope and quality of naturopathic education do not prepare the practitioner to make an adequate diagnosis and provide appropriate treatment. [2]

 

These conclusions are still valid. Thirty-five years later investigators from Simon Fraser University in British Columbia reported similar findings:

 

In our research for this chapter, we provided naturopaths and their professional associations ample opportunity to refute the conclusions of several major commissions of inquiry over the years that deemed their therapeutic rationale lacking in scientific credibility. None of our informants was able to convince us that the field had taken these earlier critiques to heart; in fact, precious few seemed to recognize that a problem still exists. [O]ur own bibliographic searches failed to discover any properly controlled clinical trials that supported claims of the profession, except in a few limited areas where naturopaths' advice concurs with that of orthodox medical science. Where naturopathy and biomedicine disagree, the evidence is uniformly to the detriment of the former.

We therefore conclude that clients drawn to naturopaths are either unaware of the well-established scientific deficiencies of naturopathic practice or choose willfully to disregard them on ideological grounds. [3]

 

What follows is a summary of the current state of "naturopathic medicine." Much of it comes from the position papers and other articles on the Web site of the American Association of Naturopathic Physicians (AANP); from the Textbook of Natural Medicine, the only general textbook of the field, coedited and largely coauthored by one of the Medicare appointees[4,5]; and from the most visible naturopathic school, Bastyr University in Kenmore, Washington, where the coeditor of the Textbook was founder and president and where the other new MCAC appointee is associate dean. Thus, it reflects the health beliefs of these 2 appointees and of the uppermost levels of "naturopathic medicine."

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