Naturopathy: A Critical Appraisal

Kimball C. Atwood IV, MD

Disclosures

Medscape General Medicine. 2003;5(4) 

In This Article

Comment

"Naturopathic medicine" is an eclectic assortment of pseudoscientific, fanciful, and unethical practices. Implausible naturopathic claims are still prevalent and are no more valid now than they were in 1968. The current wave of unexamined CAM fascination, however, appears to have helped naturopaths convince some that they have special abilities and that they are trained to be primary care physicians.

Most treatises on naturopathy that physicians and the public are likely to read are uncritical promotions that simply restate what naturopaths claim. Yet these views are found on the Web sites of academic medical centers and the large commercial sites for the general public. For several years, the Caregroup/Harvard Medical School Web site urged readers, without further comment, to "please consult your local telephone yellow pages" for "naturopathic physicians" and other CAM practitioners.[43] The Web site of the University of Washington School of Medicine portrays "naturopathic physicians" as well trained to practice "primary care integrative natural medicine," with a "scope of practice [that] includes all aspects of family and primary care, from pediatrics to geriatrics, and all natural medicine modalities." It further asserts that "naturopathic diagnosis and therapeutics are supported by scientific research drawn from peer-reviewed journals from many disciplines."[44] None of these statements can withstand rigorous scrutiny.

InteliHealth, a joint venture between Harvard Medical School and Aetna, promises to "[provide] credible information from the most trusted sources."[45] As recently as the spring of 2002 InteliHealth stated, "NDs are trained as family physicians"; they "treat the whole patient, not just the disease symptoms"; they "successfully combine so many therapies"; "Naturopathic doctors throughout the country are becoming increasingly recognized as primary care providers." The article suggested that if the reader were already consulting an ND, she might reasonably choose not to see an MD.[46] When InteliHealth replaced this article with a new one, it did so without explanation, failing to warn readers of the dangers of having trusted the previous information. The replacement article, moreover, approvingly describes naturopaths as "[concentrating] on principles of holistic health (pertaining to body, mind and soul), prevention and self-care." It does not address the serious shortcomings of the field.[47]

WebMD, the parent corporation of Medscape, offers this:

A naturopathic doctor often combines many different complementary therapies to enhance the body's natural vital force.

A licensed naturopathic physician (ND) attends a 4-year, graduate-level naturopathic medical school and is educated in the same basic sciences as a medical doctor (MD). [48]

Naturopathic medicine is used for health promotion, the prevention of disease, and treatment of illness. Most naturopaths can treat earaches, allergies, and other common medical problems. Naturopathic medicine tries to find the underlying cause of the person's condition rather than focusing solely on symptomatic treatment. [49]

The WebMD treatise also advises, "Naturopathy should not replace conventional methods of treatment for certain conditions,"[49] but how is the patient to know? The assumption is that naturopaths will act responsibly, but they have neither the medical training nor the requisite scientific skepticism to do so. On the contrary, they portray themselves as primary care physicians. The unwary reader might conclude that naturopaths are trained to provide "conventional methods" when appropriate, but NDs have had only a small fraction of the training of primary care MDs. Instead they have been steeped in homeopathy and other highly implausible, ineffective practices. It is unlikely that readers of WebMD and the other sources mentioned here will appreciate this dichotomy.

The National Center for Complementary and Alternative Medicine (NCCAM) has had 3 naturopaths on its advisory council in the past 3 years.[50] It proposes to conduct research into CAM methods advocated by "licensed/certified CAM practitioners (Doctors of chiropractic, naturopathy, [etc.])."[51] The NCCAM advises citizens who consult CAM practitioners to ask about licensure or certification early in the process.[52]

Like the NCCAM, WebMD also admonishes readers to seek only licensed naturopaths: "without licensing standards, individuals with little or no formal education may proclaim themselves naturopathic physicians without medical school education or board testing."[48] The clear message is that such licensing implies competence. There is, however, no evidence that "educated" naturopaths -- the most prominent of whom provided the clinical examples for this article -- are more competent than others.[9] If anything, "traditional naturopaths" (ie, those who did not attend the "approved" schools) may be less of a threat to public health because they do not pretend to be primary care physicians.

Graduates of campus-based, 4-year naturopathic programs who have passed a standardized examination may demonstrate consistency from one practitioner to the next. But that says nothing about the validity of what they do -- which can be determined only by reference to the facts of nature and by rigorous testing of biologically plausible claims. At least one leading CAM researcher has acknowledged this fact:

Those who believe that regulation is a substitute for evidence will find that even the most meticulous regulation of nonsense must still result in nonsense. [53]

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