Transcript Naturopathic Medicine: Legitimate medical therapy or quackery?

Allopaths, Naturopaths,
Osteopaths…,
Oh My!
NUTR 547 - Nutrition Update
Summer 2006
David L. Gee, PhD
Central Washington University
Naturopathic Medicine
Two views of naturopathy
• Bastyr University (web page, 2006)
• “Naturopathic medicine is a distinct
profession of primary health care,
emphasizing prevention, treatment and
the promotion of optimal health through
the use of therapeutic methods and
modalities, which encourage the selfhealing process…”
Bastyr University (web page, 2006)
“The scope of practice includes all aspects of
family and primary care, from pediatrics to
geriatrics, and all natural medicine
modalities.”
Two views of naturopathy
• Quackwatch.org
– A Close Look at Naturopathy, S Barrett, MD
• Naturopathy, sometimes referred to as
"natural medicine," is a largely
pseudoscientific approach
• a close look will show that naturopathy's
philosophy is simplistic and that its
practices are riddled with quackery.
Quackwatch.org
A Close Look at Naturopathy, S Barrett, MD
• the average naturopath is a muddlehead
who combines commonsense health and
nutrition measures and rational use of a
few herbs with a huge variety of
unscientific practices and anti-medical
double-talk.
Definition of naturopathy:
Practices to improve health and treat disease by
assisting the body’s natural healing process
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herbology
homeopathy
massage
hydrotherapy
Chinese medicine
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Ayurvedic medicine
accupuncture
pharmacology
minor surgery
obstetrics
History of Naturopathy
• Earliest medical therapy used naturopathic
methods
– Hippocrates:
• “nature is the healer of all diseases”
– Greek root of ‘physician’ is ‘nature’
• American use of naturopathy
– very popular until 1920’s
• advent of modern medicines (antibiotics,
corticosteroids, vaccines)
The Principles of Naturopathic Medicine
Amer. Assoc. of Naturopathic Physicians
Physician’s Oath
• Do no harm
– symptoms of disease part of healing; avoid suppression
of symptoms
• Act in the cooperation with the healing
powers of nature
– physician facilitates this natural process
• Address the fundamental causes of
disease
– physician identifies and treat root causes
• physical, mental, spiritual, emotional
The Principles of Naturopathic Medicine
Amer. Assoc. of Naturopathic Physicians
Physician’s Oath
• Heal the whole person through
individualized treatment
– health goes beyond treating the symptoms
• Teach the principles of healthy living and
preventive medicine.
– Building health, not fighting illness
Naturopathy vs Naturopathic Medicine:
Controversy within CAM
• Naturopathic physicians
– formalized course of study
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4 year graduate course of study
professional board exams
may prescribe some drugs, minor surgery, obstetrics
ND degree
• American Association of Naturopathic
Physicians (AANP)
– promote state licensure
– values standardization & improvement of practice
(research)
Naturopathy vs Naturopathic Medicine:
Controversy within CAM
• Traditional Naturopaths
– holistic approach to health
– drugs, surgery, and other invasive techniques
outside scope of traditional naturopathy
– training from correspondence school or from
practitioners
• no programs accredited by US Dept. Ed.
• some grants ND
Legal Status of Naturopathic Medicine
• 13 states with licensure (WA)
– Scope of practice prohibits major surgery and
prescribing controlled substances
• 1 state with registration
• 2 states with legal basis for practice
• 2 states prohibit practice (SC, TN)
Legal Status of Naturopathic Medicine
• American Association of Naturopathic
Physicians
– represents NDs
– goal: have licensure in 50 state
• American Naturopathic Medical
Association
– represents traditional naturopaths
– Opposes licensure
Medicare/Medicaid/Insurance
and Naturopathic Medicine
• Currently not covered by Medicare
– 2003 two ND (from Bastyr) appointed to US
Medicare Advisory Committee
• In Washington state, an "every category of
provider" law requires private insurers to
reimburse naturopaths.
Quackwatch
National Council Against Health Fraud
Concerns about Naturopathic Medicine
• Allopathic medicine
– Based on measurable causative factors
– Treatment proven using scientific methods
• Naturopathic medicine
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Based on ‘glib generalities’
Simplistic theories
May contradict science based knowledge
Assumes safety
Cited examples of Naturopathic Quackery
K. Atwood, Medscape General Medicine, 2003
http://www.medscape.com/viewarticle/465994_1
• The repudiation of standard treatments of asthma,
offering instead, for example, a hydrogen peroxide
bath to "bring extra oxygen to the entire surface of the
skin, thus making the lungs somewhat less oxygen
hungry" or "gems and minerals ... worn as jewelry, or
placed around the home in special places."
• This quotation is from "Articles written by
Naturopathic Physicians for the general public" (on the
AANP Web site). The author is listed as a "senior
editor of the Journal of Naturopathic Medicine, the
official publication of the AANP."
Cited examples of Naturopathic Quackery
• The insertion of endonasal balloons,
followed by their inflation in the
nasopharynx, to "release tensions stored in
the connective tissue and return the body to
its original design," thus curing learning
disorders and a host of other problems.
Cited examples of Naturopathic Quackery
• Treatment of the acute stroke patient for at least 20
minutes with an "ice-cold compress ... over the carotid
arteries under the jaw bone on the neck" (which "may
even abort the stroke") and subtle energy medicine.
• The author of these recommendations is listed as a
"senior editor of the Journal of Naturopathic
Medicine, the official publication of the American
Association of Naturopathic Physicians."
Osteopathic Medicine
Osteopathic Medicine:
Features
• Whole person approach
– not only treating specific symptoms
• Focus: preventive health care
• Extra training: musculoskeletal system
– 2/3 rd of total body mass
• Osteopathic manipulative treatment (OMT)
– use hands to diagnose and encourage body’s
natural tendency to heal itself
Osteopathic Medicine:
Scope of Practice & Current Status
• Doctor of Osteopathic Medicine (DO)
– fully trained and licensed to prescribe
medication and perform surgery
• Separate but equal branches of medicine
– DO’s full active members of AMA
• 65% of DO’s in primary care
– family practice, pediatrics, internal medicine,
OB/GYN
Osteopathic Medicine:
A brief history
• Late 19th Century
– Andrew T. Still, MD, OD
• over prescription of
medications
• origins of disease in
dysfunctional
musculoskeletal system
• ‘rational medical therapy’
includes manipulation and
limited use of medications
• ‘osteo’ - ‘pathos’
Osteopathic Medicine:
A brief history
• Early 20th century
– DO’s adopt use of medicines and
surgery
– Chiropractors limit to manipulation
• 1960’s AMA lobbies to end
practice of osteopathy in CA
– referendum passed to end osteopathy
– OD’s become MD’s
– College of Osteopathic Physicians &
Surgeons absorbed in UC system
(Irvine)
Osteopathic Medicine:
A brief history
• 1974
– CA Supreme Court overrules referendum
• Professional equivalency for OD’s
– 1960 incorporation of OD’s into MD’s
– US Army allows OD’s as physicians
Comparative training for MD’s, DO’s & ND’s
Pre-requisites
MD’s
DO’s
ND’s
4 yr degree expected
4 yr degree expected
4 yr degree expected
2 yrs of chemistry
1 yr of biology
1 yr of biology
4 courses in
chemistry
1 yr of biology
1 yr of physics
1 yr of physics
1 course in physics
2 yrs of chemistry
1 course in math
MCAT required
MCAT required
V:10.5, PS: 10.6, BS: 11
avg GPA 3.69
V: 8.0, PS: 7.7, BS: 8.3
Avg GPA 3.38, 3.25
Comparative training for MD’s, DO’s & ND’s
Medical Schools
MD’s
DO’s
ND’s
# medical
schools
125
22
4
Accreditation
Yes
Yes
Yes
Liason Committee on
Medical Education
American
Osteopathic
Association
Council on
Naturopathic Medical
Education
2001-2003
Curriculum
• Kirksville College of Osteopathic Medicine
– http://www.kcom.edu/
• Bastyr University
– http://www.bastyr.edu/academic/naturopath/curriculum.asp?track=4
• UW School of Medicine
– http://apps.medical.washington.edu/somoc/index.asp
Comparative training for MD’s, DO’s & ND’s
Post-Graduate Education
• MD’s
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Residency Program (3-7 yrs, depending on specialty)
Fellowships (1-3 yrs, subspecializations, optional)
License to practice (examination)
Board Certification (optional)
• DO’s
– Internship (1 year)
– Residency (2-6 years, optional)
• ND’s
– Residency Program (Bastyr 2 yr, optional)
Conclusions:
• Who should patients turn to for nutrition
information and counseling?
– MD’s, DO’s, or ND’s??
• How about RD’s !!