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Why Naturopaths Should Not Be Licensed

Kimball C. Atwood IV, M.D.

Naturopaths are licensed as independent practitioners in eleven states (Alaska, Arizona, Connecticut, Hawaii, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington) and the District of Columbia, and can legally practice in a few others. Naturopaths who have attended on-campus schools are pressing for licensure in the remaining states.

Approximately 30 naturopaths are lobbying for licensure in Massachusetts. They portray themselves as "primary care physicians," consider themselves superior to other naturopaths whose "degrees" were obtained from nonaccredited correspondence schools, and assert that licensure is needed to protect the public from unqualified practitioners. However, the existing naturopathic licensing agencies have done little or nothing to protect the public from naturopathy's widespread quackery.

Since treatment by incompetent practitioners can cause great damage, health professions should be held to very high standards. To be considered a health profession, an occupational group should be able to demonstrate an objective, scientific, and ethical basis. Naturopathy fails to meet this standard. I believe that it is dangerous and that no amount of regulation can control the danger. Moreover, as noted by William T. Jarvis, Ph.D., past-president of the National Council Against Health Fraud:

The difference between more and less educated naturopaths is . . . . like comparing more and less educated witch doctors. It could actually be argued that less schooled naturopaths are safer because they may have a smaller bag of tricks and, because they don't consider themselves "primary health physicians," they are more apt to refer patients to M.D.'s for additional care.

The Massachusetts Medical Society strongly opposes naturopathic licensure in Massachusetts. Our reasons include:

• Naturopathy is both potentially and actually injurious when practiced according to the accepted standards of the profession. This injury is likely to be due to the failure of the naturopathic practitioner to recommend appropriate medical treatment.
• Unscientific naturopathic beliefs pose irrational challenges to proven public health measures, most notably childhood immunizations.
• Irrational, unscientific beliefs and practices abound in naturopathy, likening it more to a cult than to a valid form of health care. These beliefs and practices are not merely at the fringes but are the standards of the field. They are advocated by the leaders themselves.
• Naturopathic practitioners are incapable of self-regulation commensurate with public safety. No study has demonstrated that naturopaths who attend full-time schools are any less dangerous than those who have mail-order degrees.
• Naturopaths prescribe numerous "natural medicines" with a standard for safety and efficacy that is unacceptably low, as evidenced by the leading textbook in the field.
• The scientific pretensions of naturopathy and naturopathic training programs are baseless. There is ample evidence that the basic science courses do not teach students to think critically. Research performed at naturopathic colleges is lacking in scientific rigor and has not investigated common naturopathic claims. The libraries at naturopathic colleges are filled with books and journals that promote trendy but implausible notions regarding health care. The major journal in the field is filled with articles that are both absurd and dangerous. The oft-repeated claim that the major textbook in the field cites "more than 10,000 scientific references" is a misrepresentation, as exemplified by the textbook's claims for "natural remedies."
• Collaboration with medical doctors is uncommon in naturopathic practice.
• Naturopathy involves many nonsensical diagnostic practices that mainstream medicine considers quackery but naturopaths consider standard.
• There are ubiquitous claims of dubious clinical "syndromes," among which are multiple "food allergies," "toxemia," and chronic yeast infections, which cast further doubt on the science and ethics of naturopathic practice.
• The duration and setting of naturopathic clinical training, even overlooking its content, is inadequate for producing competent primary care physicians. This is clear from a comparison of the training of medical doctors to that of naturopaths. Just as a newly graduated medical doctor, no matter how well-intentioned, would not be allowed to assume the role of a primary care physician, neither should this be allowed for a naturopath whose training is clearly inferior.

Naturopathic services are not covered by Medicare or most insurance policies. Expansion of naturopathic licensing will make naturopaths appear more legitimate and could help them gain passage of laws forcing insurance companies to cover their services.

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Dr. Atwood, who practices in Newton, Massachusetts, is board certified in anesthesiology and internal medicine. He is also his state medical society's representative on the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners, an ad hoc group whose purpose is to inform state legislators about naturopathy. This article is modified from a lengthy report that Dr. Atwood submitted to the Commission.

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