Naturopathic medicine is a distinct system of primary health care that emphasizes prevention and supporting innate human self-healing through the use of natural therapies. Naturopathic doctors (NDs) blend the curative powers of human healing traditions that have been proven over centuries and modern, scientific and empirical methods of diagnosis and treatment that are backed by current research on health and human biology.
The naturopathic system of care is organized around the philosophy that nature is often the most effective healer, and that its potential should be tapped first when it is in the best interest of a patient. In diagnosis and treatment this means NDs work from the principle of “Identify and Treat the Causes” (tolle causam): First identify and then remove the underlying causes of illness, rather than merely eliminating or suppressing a patient’s symptoms. This philosophy underlies the Six Principles of Naturopathic Medicine, which are described below.
Naturopathic practice is distinguished by treatments individualized to a patient’s physical condition and environmental circumstances and requiring combined therapies adjusted over time according to patient response. Modalities most often used with conventional treatments include clinical nutrition and dietary revision, counseling for lifestyle modification, homeopathy, physical medicine, and mind-body therapies.
Naturopathic Physicians in the US and Canada: 5,000
States where NDs are licensed: 17
District of Columbia
Puerto Rico (territory)
Virgin Islands (territory)
|Examples of Use||Education & Certification||References|
|In US health||Insurance||Research|
Examples of Use
Doctors of naturopathic medicine (NDs) are trained as primary care providers, although they are not yet always licensed in their state of practice to provide full primary care services (see “Licensure” below). The ND’s Scope of Practice may include treatment modalities such as:
Physical and clinical diagnosis
Laboratory diagnosis and diagnostic imaging
(In some US states and Canadian provinces acupuncture and oriental medicine are included in scope of practice.)
Six Principles of Naturopathic Medicine
The approach taken by NDs in assessing, diagnosing and treating any ailment, condition or illness is based on the Six Principles :
- Above All, Do No Harm: Apply the most natural, least invasive and least toxic therapies.
- The Healing Power of Nature: Trust in the body’s inherent wisdom to heal itself.
- Identify and Treat the Causes: Look beyond the symptoms to the underlying cause.
- Doctor as Teacher: Educate patients in the steps to achieving and maintaining health.
- Treat the Whole Person: View the body as an integrated whole in all its physical and spiritual dimensions.
- Prevention: Focus on overall health, wellness and disease prevention.
In practice, and depending on their state of license, naturopaths work as independent providers or often closely with medical doctors (MDs) and doctors of osteopathy (DOs).
Conditions Treated by Naturopathic Doctors
The Top 10 Conditions that naturopathic doctors have reported treating in recent years:
Other key ill health conditions that respond to naturopathic care: fatigue — celiac disease and gluten intolerance — digestive issues — aging-based issues — auto-immune disorders — pain — weight management — and women’s health issues.
(For more about conditions treated by NDs, see The Reference Section at the end of this article.)
The commitment to safe practice for naturopathic doctors is embodied in their earliest training in the principle: “Above All, Do No Harm” (primum non nocere). In practice, this means following three guidelines to ensure safe treatment for the patient:
Apply methods and medicinal substances that minimize the risk of harmful side effects and that require the least force necessary to diagnose and treat;
Avoid when possible the harmful suppression of symptoms; and
Acknowledge, respect, and work with individual patients’ own self-healing process.
(The “harmful suppression” of symptoms refers to a treatment principle that views symptoms as the body’s healing powers at work: say inflammation or fever or pain. As in homeopathy, the ND’s first job is to support this natural healing process.)
Some therapies used in naturopathic medicine have the potential to be harmful if not used under the direction of a well-trained practitioner. For example, herbs can cause side effects on their own and may also interact with prescription or over-the-counter medicines or other herbs. Their use by people on restrictive or unconventional diets may also be unsafe.
Here is a good overview of safety concerns in naturopathic medicine from the National Center for Complementary and Alternative Medicine (NCCAM).
Education, Training, Certification and Licensure
Naturopathic Doctors complete their education at one of six accredited schools of naturopathic medicine that have been established since the 1980s. During their first two years of study, students participate in a curriculum that focuses on basic biomedical and clinical sciences. For at least the final two years of their medical training, students intern in clinical settings under the close supervision of licensed professionals.
In terms of clinical training hours, at Bastyr University for example, students are required to complete 132 hours shadowing health care professionals in their practices. They also participate in some 600 patient contacts through a minimum of 1,200 clinical training hours. These take place at a university’s teaching clinics and at clinics in local communities.
Naturopathic Medical Schools in the U.S.
National University of Health Sciences, Chicago, Ill.
Southwest College of Naturopathic Medicine, Phoenix, Ariz.
University of Bridgeport College of Naturopathic Medicine, Bridgeport, Conn.
Clinical training emphasizes patient assessment, differential diagnosis, medical record documentation, referral practices and patient follow-up. While the majority of clinical training shifts concentrate on general medicine, specialized training shifts, which vary at each clinic, also are available in:
Acupuncture and Oriental Medicine
Minor Office Procedures
Currently, naturopathic graduate residency programs are available at: Bastyr University; Canadian College of Naturopathic Medicine; National College of Natural Medicine; and Southwest College of Naturopathic Medicine & Health Sciences. These residencies are not required but are very popular, and many NDs elect to practice in a residency setting for one or two years before striking out on their own. Residency programs are also available at some hospitals and private clinics.
SECTION 2706 NOTE: As of the fall of 2014, 17 states, five Canadian provinces, the District of Columbia, and the US territories of Puerto Rico and the US Virgin Islands have laws regulating naturopathic doctors. Only in these states, therefore, would insurer compliance with Section 2706 mean reimbursement for naturopathic services.
Licensure as a primary care, general practice naturopathic physician in states or territories that provide for a license require:
- Graduation from a four-year, professional-level program at a federally accredited naturopathic medical school.
- Successful completion of the Naturopathic Physicians Licensing Exam, a rigorous test of basic sciences, diagnostic and therapeutic subjects and clinical sciences.
In states where the profession awaits licensing, naturopathic doctors often focus on providing wellness, prevention, nutrition and lifestyle counseling. In cases where new blended integrative medicine clinical practices are being established, NDs may provide consults for which patients pay out-of-pocket.
Scope of Practice
Scope of practice regulations vary from state to state. However throughout their four-year education, NDs are trained to be able to practice to the fullest scope, including but not limited to:
Physical and clinical diagnosis
Laboratory diagnosis and diagnostic imaging
Acupuncture and Oriental medicine*
*Included in scope of practice in some states and provinces.
Naturopathic Medicine in US Healthcare
Roles in Primary Care
Although trained NDs practice in many US states, the profession enjoys licensed status in only 17, the District of Columbia, and in two US territories. In a few states such as Oregon and Washington, NDs are licensed as primary care providers. This role may prove to be important for accelerating further licensing, as the U.S faces a growing shortage of primary care physicians. As a result the nation’s health system leadership is considering empowering non-MD health professions with some measure of primary care license. NDs, trained as primary care providers with established clinical track records offer a partial solution for this primary care shortage.
A related U.S. public health objective is the emphasis on lifestyle medicine and preventive medicine to address the increasing incidence of chronic diseases. Again because of their medical education and clinical experience, NDs are adept at delivering nutritional, environmental, behavioral and self-care modifications that are considered essential to lifestyle-focused healthcare.
For example: an important study of Canadian workers who received naturopathic care in addition to typical care showed better results losing weight and lowering blood pressure than did a group who received only typical care. Additional research has shown a correlation between better outcomes and the longer patient-ND diagnostic consultation (on average: 40 minutes vs. 15-17 for conventional counterparts) that emphasizes lifestyle changes first before turning to pharmaceuticals.
Like massage therapy, acupuncture and other integrative care options, naturopathic medicine has proven helpful in cancer treatment, and research is showing effectiveness in extending survival rates for some cancers. Since opening in 2009, the Bastyr Integrative Oncology Research Center (BIORC) at Bastyr University has enrolled 521 patients in a prospective outcomes study, treating breast, lung, colon, pancreatic, brain and skin cancers. For eight patients with stage-4 colon cancer, BIORC reported an 80% survival rate after three years, compared with 15% from a group at Seattle Cancer Care Alliance.
NDs who specialize in oncology work both in hospital settings and in private practices. They collaborate with medical oncologists to delivery complementary co-treatments. The Cancer Treatment Centers of America (CTCA), which operates six centers in the U.S., actively promotes naturopathic medicine as part of its care options. In 2004, the Oncology Academy of Naturopathic Physicians was established to focus on research, education, board certification and continued integration of naturopathic oncology into the healthcare system.
Thousands of studies and articles have been published describing aspects of natural medicine, natural products and complementary and alternative medicine that can be incorporated into naturopathic practices. Studies cataloged at the Naturopathic Physicians Research Institute (NPRI) specifically examine components of naturopathic care in North America, and may include: a therapeutic or preventive intervention, a diagnostic method, a theory or approach to a health condition.
Top research studies underway in the fall of 2014 that examine the role of naturopathic treatments for selected conditions:
- Breast Cancer and other Integrative Oncology studies
- Parkinson’s Disease
- Multiple Sclerosis
- Type 2 Diabetes
- Detoxification for (PCB) concentrations
- Pediatric Diabetes
References for Naturopathic Medicine
REGULATORY AND LICENSING
Federal governing bodies regulating naturopathic medical education:
U.S. Department of Education and its regional college-accrediting bodies:
For example: Northwest Commission on Colleges and Universities (NWCCU) governs the accreditation of colleges and universities in northwestern United States, where Bastyr University and the National College of Natural Medicine are located.
MORE ABOUT CONDITIONS TREATED BY NDs
A collaboration of academic and community health clinicians, clinical researchers and health scientists who are developing original data and analysis on the practice of naturopathic medicine.