A Policy Statement on Naturopathy
Approved by the Iowa Board on February 7, 2002
Naturopathy has recently re-emerged as a practice in Iowa. This policy statement is not a legally binding opinion of the board, but is only intended to provide guidance to the public. The board may make formal policy only through administrative rules, declaratory orders or contested case decisions.
1. History of naturopathy
Naturopathy had its beginnings in Germany in the late 1800’s with a group of therapists who were followers of Sebastian Kneipp, a proponent of the healing powers of water. Benedict Lust brought the philosophy to the United States and opened the Kneipp Water Cure Institute in New York City in 1895. Later he founded the American Institute of Naturopathy and began referring to himself as a naturopathist. While the profession is a little over 100 years old, its basic concepts date back to the ancient Greeks’ principles of health; only nature heals, disease is an expression of purification, and all disease is a result of a build up of toxins in the body.
At the crest of its popularity, 20 naturopathic medical schools existed in the United States and naturopathic physicians were licensed in most states. Naturopathy declined beginning in the late 1930’s as the use of pharmaceuticals increased. Naturopathy re-emerged in the latter part of the 20th century and enjoys a high degree of popularity, especially in the western United States. One writer estimated there are 10,000 naturopaths in the United States.
2. Description of naturopathy
The National Center for Complementary and Alternative Medicine categorizes naturopathy as an alternate medical system because it has a complete system of theory and practice that evolved independent of the conventional biomedical approach.
Naturopathy emphasizes the overall restoration of health rather than treatment of disease. It is a label for an eclectic approach using multiple therapies constrained by the use of natural methods. Naturopathic physicians believe that disease is brought on by a number of factors such as bad eating habits, restricted breathing, improper posture, muscular tension and emotional factors. Naturopaths attempt healing by combining dietary and nutritional counseling and selected vitamins, minerals and herbs with other therapies like osteopathy, chiropractic, acupuncture, homeopathy, and colonics.
Naturopathic physicians believe that there is a natural equilibrium and harmony toward which the body will strive and its natural ability to do this is expressed as the bodies “vital force.” They believe the body can build up toxins that disturb its equilibrium, which results in disease. Naturopaths believe that it is the suppression of acute illness that causes chronic illness. They see acute illness as a natural healing or cleansing process manifested by such things as colds, vomiting, diarrhea, fever, sweating and skin rash. These are positive processes by which the body detoxifies itself and brings about restoration of equilibrium or good health.
Naturopathic physicians utilize a full case history that looks at such things as the present condition of diet, lifestyle, substance abuse, medical history and medications. The naturopath sees the relationship with the patient as a partnership in which the patient learns to take responsibility for his or her own health and make positive lifestyle changes.
3. A dichotomy in naturopathy
A dichotomy in naturopathy is well delineated by its two major professional organizations: the American Association of Naturopathic Physicians (AANP) and the American Naturopathic Medical Association (ANMA).
The AANP is a Seattle-based organization whose members have completed four years of academic training at the doctoral level and who are licensed or could be licensed and who want the profession regulated. Its directory lists about 500 members. Generally, this group favors extensive scientific education and licensing. It represents something of a cross between traditional naturopathy and conventional medicine and would like to achieve the status of primary care physicians. These naturopaths are trained in clinical pathology and use many conventional diagnostic procedures including, x-rays, electrocardiograms, ultrasound, and clinical laboratory tests to make a conventional western diagnosis. These practitioners also make a diagnosis using physical and laboratory procedures to assess nutritional status, metabolic function and toxic load. They may use virtually any known natural remedy, which is viewed as a great advantage because it allows tailoring of the remedy to the individual without the need for multiple referrals. They perform minor surgeries, prescribe drugs, deliver babies, and diagnose and treat illness. In those states where they are licensed their role is much like a family practitioner or internist. When treating serious illness, they may choose to work jointly with the patient’s doctor, as their training recognizes that conventional healthcare is sometimes necessary.
The ANMA, based in Las Vegas, Nevada, maintains an open membership policy to any who support the principles of naturopathic medicine. Although the membership list is not available to the public, ANMA is believed to have 2,000 to 3,000 members. Its members have varying preparation to be in the field. ANMA members view themselves as the “true” naturopathists. True naturopathy is not a medical practice but one that performs non-invasive procedures, provides information on herbs and other natural foods, and teaches the benefits of a healthy lifestyle. Members maintain a non-exclusive practice and refer to themselves as counselors rather than physicians. This group eschews practices common to medical care; members do not diagnose or treat disease, prescribe drugs or pharmaceuticals, give injections, draw blood, deliver babies, or perform invasive surgeries. ANMA believes the AANP is suppressing traditional naturopathy by changing the practice to a medical model. ANMA opposes licensure because it would decrease consumer choice by limiting the number of practitioners.
4. Is naturopathy a safe practice?
The Board of Medical Examiners cannot name all possible methods naturopaths use or identify the safety of each of these modalities. Most natural methods utilized in naturopathy are largely unproven and are not grounded in peer reviewed scientific research. They do not appear to be harmful when practiced by an M.D. or D.O. trained in these modalities of care,2 except the board has serious concerns about the efficacy and safety of the practice of colonics. The board has found colonics to be unsafe because of the potential for electrolyte imbalances, loss of essential vitamins, bowel perforation, and disease from poor sanitary practices. The board questions the utility of some naturopathic practices, e.g., homeopathy, and has serious concerns that naturopathic modalities may divert individuals from other, more efficacious modalities of care and delay appropriate treatment. In addition, patients may spend considerable money for treatments that may not be effective. The board’s position is “buyer beware.”
5. Is it okay for an M.D. or D.O., i.e. physician, to practice naturopathy?
An M.D. or D.O. licensed in Iowa and trained in the various modalities used in naturopathy, may utilize those natural methods of healing as an adjunct to traditional medicine. The board does not approve the use of colonics by physicians. Physicians are encouraged not to use naturopathic treatments on patients without offering conventional alternatives if the naturopathic treatments are not grounded in peer-reviewed research. A physician needs to be aware when time is of the essence and conventional therapies are more suitable for a patient’s condition. A physician must utilize informed consent when not utilizing conventional therapies. The physician is subject to discipline for errors of omission or commission when utilizing naturopathic modalities. The board recommends a physician who utilizes naturopathy not advertise as a naturopathic physician but advertise as a physician who utilizes naturopathic modalities in his or her practice. When further scientific evidence is available, the board may change its position on the modalities and practice of naturopathy.
6. Is it okay for an acupuncturist trained in naturopathy to practice naturopathy?
No. Acupuncturists trained in naturopathy may not call themselves a naturopath or describe themselves as practicing naturopathy because such practices are outside of the scope of the acupuncture license. Naturopathy is not included in the statutory definition of acupuncture. (See Iowa Code section 148E.1(1).) Acupuncturists may only perform adjunctive therapies within the scope of acupuncture which: “may include manual, mechanical, thermal, electrical, and electromagnetic treatment, and the recommendation of dietary guidelines and therapeutic exercise based on traditional oriental medicine concepts.”
7. Is it okay for another Iowa -licensed professional trained in naturopathy to practice naturopathy?
That depends on the selected natural method of healing utilized and the individual’s licensing board. The Board of Medical Examiners may consider some of the methods of natural healing to be the practice of medicine.
8. What about a non-M.D. or D.O. naturopath who puts the public more at risk than when naturopathic modalities are practiced by an M.D. or D.O.?
An M.D. or D.O. is trained to diagnose human conditions using a myriad of diagnostic techniques and treats those conditions using a wide variety of modalities. An M.D. or D.O. is better prepared to identify what conditions are more threatening and require traditional care. An M.D. or D.O. has research experience in which to evaluate the efficacy and safety of alternative and complementary therapies in comparison to traditional care. An M.D. or D.O. is regulated and must comply with the applicable standard of care, and the public has a state agency to go to with complaints.
9. Is it okay for a naturopath to practice in Iowa?
No. It is unlawful to practice medicine in Iowa without a license, pursuant to Iowa Code sections 147.74, 148.1, and 150A.1. It is also unlawful for an unlicensed individual, i.e., naturopath, to hold him- or herself out as a “doctor” or “physician.” Naturopathy is the practice of medicine because it involves the diagnosis and treatment of human conditions. Diagnosis can mean diagnosis of disease or conditions that may include symptoms of disease or ill health. Treatment can mean providing a remedy, cure or recommending care of some nature, e.g., diet, prescription and non-prescription medications or herbs.
1 This description of naturopathy comes largely from naturopaths and does not indicate the Board’s acceptance of the beliefs as scientifically sound.
2 See the Board’s A Policy Statement on Homeopathy, approved June 28, 2001.