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Naturopathy, sometimes referred to as "natural medicine," is a largely pseudoscientific approach said to "assist nature" , "support the body's own innate capacity to achieve optimal health" , and "facilitate the body's inherent healing mechanisms."  Naturopaths assert that diseases are the body's effort to purify itself, and that cures result from increasing the patient's "vital force." They claim to stimulate the body's natural healing processes by ridding it of waste products and "toxins." At first glance, this approach may appear sensible. However, a close look will show that naturopathy's philosophy is simplistic and that its practices are riddled with quackery.
The notion of a "vital force" or "life force" -- a nonmaterial force that transcends the laws of chemistry and physics -- originated in ancient times. Historians call it the doctrine of vitalism. No scientific evidence supports this doctrine, but a huge body of knowledge, including the entire discipline of organic chemistry, refutes it. Vitalistic practitioners maintain that diseases should be treated by "stimulating the body's ability to heal itself" rather than by "treating symptoms." Homeopaths, for example, claim that illness is due to a disturbance of the body's "vital force," which they can correct with special remedies, while many acupuncturists claim that disease is due to imbalance in the flow of "life energy" (chi or Qi), which they can balance by twirling needles in the skin. Many chiropractors claim to assist the body's "Innate Intelligence" by adjusting the patient's spine. Naturopaths speak of "Vis Medicatrix Naturae." Ayurvedic physicians refer to "prana." And so on. The "energies" postulated by vitalists cannot be measured by scientific methods.
According to a comprehensive report presented to the United States Congress in 1970 by the now-defunct National Association of Naturopathic Physicians (NANP):
Naturopathy . . . is the technique of treatment of human disease which emphasizes assisting nature. It can embrace minor surgery and the use of nature's agencies, forces, processes, and products, introducing them to the human body by any means that will produce health-yielding results.
Naturopathy is based upon the tendency of the body to maintain a balance and to heal itself. The purpose of naturopathic medicine is to further this process by using natural remedies . . . as distinct from "orthodox" medicine (allopathy and osteopathy), which seeks to combat disease by using remedies which are chosen to destroy the causative agent or which produce effects different from those produced by the disease treated. . . .
Naturopathy places priority upon these conditions as the bases for ill health: (1) lowered vitality; (2) abnormal composition of blood and lymph; (3) maladjustment of muscles, ligaments, bones, and neurotropic disturbances; (4) accumulation of waste matter and poison in the system; (5) germs, bacteria, and parasites which invade the body and flourish because of toxic states which may provide optimum conditions for their flourishing; and (6) consideration of hereditary influences, and (7) psychological disturbances.
In applying naturopathic principles to healing, the practitioner may administer one or more specified physiological, mechanical, nutritional, manual, phytotherapeutic, or animal devices or substances. The practitioner's end aim is to remove obstacles to the body's normal functioning, applying natural forces to restore its recuperative facilities. Only those preparations and doses which act in harmony with the body economy are utilized, to alter perverse functions, cleanse the body of its catabolic wastes, and promote its anabolic processes .
The American Association of Naturopathic Physicians (AANP) states that "naturopathic medicine has its own unique body of knowledge, evolved and refined for centuries" and is "effective in treating all health problems, whether acute or chronic."  According to a 1989 AANP brochure:
The main difference [between naturopathic and conventional medicine] is in philosophic approach. Naturopathic physicians treat patients by restoring overall health rather than suppressing a few key symptoms. Naturopathic physicians are more concerned with finding the underlying cause of a condition and applying treatments that work in alliance with the natural healing mechanisms of the body rather than against them. Naturopathic treatments result less frequently in adverse side effects, or in the chronic conditions that inevitably arise when the cause of disease is left untreated." 
Naturopaths offer treatment at their offices and at spas where patients may reside for several weeks. Their offerings include fasting, "natural food" diets, vitamins, herbs, tissue minerals, homeopathic remedies, cell salts, manipulation, massage, exercise, colonic enemas, acupuncture, Chinese medicine, natural childbirth, minor surgery, and applications of water, heat, cold, air, sunlight, and electricity. Radiation may be used for diagnosis, but not for treatment. Many of these methods are said to "detoxify" the body.
Scientific research has identified measurable, causative factors and specific methods of preventing and/or treating hundreds of health problems. Naturopaths have done little more than create glib generalities. The above theories are simplistic and/or clash with science-based knowledge of body physiology and pathology. For example:
Naturopaths assert that their "natural" methods, when properly used, rarely have adverse effects because they do not interfere with the individual's inherent healing abilities. This claim is nonsense. Any medication (drug or herb) potent enough to produce a therapeutic effect is potent enough to cause adverse effects. Drugs should not be used (and would not merit FDA approval) unless the probable benefit is significantly greater than the probable risk. Moreover, medically used drugs rarely "interfere with the healing processes." The claim that scientific medical care "merely eliminates or suppresses symptoms" is both absurd and pernicious.
Most of the things naturopaths do have not been scientifically substantiated; and some -- such as homeopathy -- clearly are worthless. In many cases, naturopaths combine sensible dietary advice (based on medically proven strategies) with senseless recommendations for products.
Modern-day naturopathy can be traced to the concepts of Sebastian Kneipp (18211897), Benedict Lust (18721945), Henry Lindlahr (18531925), Bernarr Macfadden (18681955), and John H. Tilden, M.D. (1851-1940). Father Kneipp, a German priest, opened a "water cure" center after becoming convinced that he and a fellow student had cured themselves of tuberculosis by bathing in the Danube River. Kneipp also developed herbal methods using whole plants. Lust, also German, was treated by Kneipp and in 1892 was commissioned to establish Kneipp's practices in the United States. In 1895, he opened the Kneipp Water-Cure Institute in New York City and began forming Kneipp Societies whose members had been using Kneipp's methods or other "drugless therapies." Subsequently, he acquired degrees in osteopathy, chiropractic, homeopathic medicine, and eclectic medicine .
In 1901, Lust organized a national convention and chaired a committee that endorsed the use of massage, herbs, homeopathy, spinal manipulation, and various types of occult healing. In 1902, he purchased the rights to the term "naturopathy" from John H. Scheel, another Kneipp disciple, who had coined it in 1895. That same year, he began referring to himself as a naturopath, opened the American Institute of Naturopathy, and replaced the Kneipp Societies with a national naturopathic organization. Lindlahr further systematized naturopathy and opened a sanitarium and a school in a Chicago suburb. Macfadden popularized exercise and fasting. Tilden contributed notions about "auto-intoxication" (said to be caused by fecal matter remaining too long in the intestines) and "toxemia" (alleged to be "the basic cause of all diseases"). 
Naturopathy's grandiose claims attracted the sharp pen of Morris Fishbein, M.D., who edited the Journal of the American Medical Association and spearheaded the AMA's antiquackery campaign for several decades. He noted:
Whereas most cults embrace a single conception as to the cause and healing of disease, naturopathy embraces everything in nature. . . .
The real naturopaths were, of course, such healers as Father Kneipp . . . and others who advocated natural living and healed by use of sunlight, baths, fresh air, and cold water, but there is little money to be made by these methods. Hence the modern naturopath embraces every form of healing that offers opportunity for exploitation. 
The practices Fishbein debunked included:
Most of these methods disappeared along with their creators, but some (or their offshoots) are still used today.
The total number of naturopathic practitioners in the United States is unknown but includes chiropractors and acupuncturists who practice naturopathy. The AANP was founded in 1985 and is closely allied with the 4-year naturopathic colleges. Its membership is said to be limited to individuals who are eligible for licensing in states that issue licenses. Its online directory contains about 500 names. The American Naturopathic Medical Association (ANMA), founded in 1981, claims to represent about 2,000 members worldwide. Although some have recognized credentials in other health disciplines, others merely have an "ND" degree obtained through a nonaccredited correspondence school. The Homeopathic Academy of Naturopathic Physicians (HANP), which requires a recognized professional degree and additional homeopathic training, lists about 50 members in the United States and Canada.
The AANP publishes the Journal of Naturopathic Medicine, which has been issued six times between 1990 and 1996. The issues have run from about 80 to 100 pages. The third issue is devoted to "Non-Standard HIV/ARC/AIDS Management." The fifth, which attacks immunization, contains papers suggesting that vaccines may be a factor in causing cancer and that homeopathic prophylaxis using nosodes would be effective and safer than standard vaccines. (Nosodes are homeopathic products made from pathological organs or tissues: causative agents such as bacteria, fungi, ova, parasites, virus particles and yeast; disease products; or excretions.) The sixth issue promotes the use of "natural" products for cancer and contains an absurd article claiming that measuring the electrical resistance of the skin may be a useful way to diagnose the early stages of cancer and AIDS.
A 1927 AMA study listed 12 naturopathic schools with fewer than 200 students among them . During the 1920s and 1930s, about half the states passed laws under which naturopaths and/or "drugless healers" could practice. However, as modern medicine developed, many of these laws were repealed and all but a few mail-order schools ceased operations. The doctor of naturopathy (N.D.) degree was still available at several chiropractic colleges, but by 1957, the last of these colleges stopped issuing it. The National College of Naturopathic Medicine (NCNM) was founded in 1956 in Portland, Oregon, but, until the mid-1970s, had very few students. From 1960 through 1968, the average enrollment was eight and the total number of graduates was 16. 
Today, within the United States, a "doctor of naturopathy" (N.D.) or "doctor of naturopathic medicine" (N.M.D.) credential is available from four full-time schools of naturopathy and at least eight nonaccredited correspondence schools, of which seven maintain Web sites [A, B, C, D, E, F, G]. (One correspondence school, the Progressive Universal Life Church, offers a "Ph.D. in Naturopathy" for $250 plus "life experience with no coursework.) Another nonaccredited school offers a "Naturopathic Practitioner" diploma to eligible individuals who complete a 15-month program of home-study plus a dozen weekend seminars. Training at the full-time schools follows a pattern similar to that of chiropractic schools: two years of basic science courses and two years of clinical work. Three years of preprofessional college work are required for admission.
The leading naturopathy school, Bastyr University, in Seattle, Washington, was founded in 1978. Besides its N.D. program, Bastyr offers a B.S. degree program in Natural Health Sciences with majors in nutrition and Oriental medicine; a B.S. program in psychology; B.S. and M.A. programs in applied behavioral sciences; M.S. programs in nutrition and acupuncture/oriental medicine; and a certificate in midwifery. Bastyr has also provided health-food retailers and their employees with home-study programs that promote "natural" approaches for the gamut of disease. Students in the naturopathic degree program are required to take three courses in homeopathy and can elect to take three more. The Southwest College of Naturopathic Medicine and Health Sciences in Scottsdale, Arizona, was founded in 1992. The University of Bridgeport College of Natural Medicine in Bridgeport, Connecticut, began classes in 1997. Naturopathy schools receive much of their financial support from companies that market dietary supplements, homeopathic products, and/or herbal remedies.
In 1987, the U.S. Secretary of Education approved the Council on Naturopathic Medical Education (CNME) as an accrediting agency for the full-time schools. As with acupuncture and chiropractic schools, this recognition was not based upon the scientific validity of what is taught but on such factors as record-keeping, physical assets, financial status, makeup of the governing body, catalog characteristics, nondiscrimination policy, and self-evaluation system. NCNM, Bastyr, and Southwest became accredited.
In 1999, the U.S. Department of Education staff and the National Advisory Committee on Institutional Quality and Integrity (NACIQI) asked U.S. Secretary of Education Richard W. Riley to deny CNME's application for renewal of recognition. The recommendation was based on evidence that CNME did not respond appropriately to violations of its standards at Southwest College. The staff report  and testimony at a NACIQI meeting  indicated that in 1997 and 1998, the school underwent an administrative upheaval that had nearly led to its closure. Several officials resigned or were abruptly fired, classes were suspended for two weeks, and the school's bank accounts were temporarily frozen after the school's chief financial officer was fired. CNME testified at the hearing that it had closely followed the situation and urged school officials to correct the problems. However, the Department of Education staff and a majority of NACIQI members concluded that CNME had failed to issue a timely order to show cause why Southwest should not have its candidacy for accreditation ended .
In January 2001, Riley agreed that CNME's approval should not be renewed, which means that naturopaths in the United States no longer have a national accrediting agency recognized by the United States Education . Curiously, none of the naturopathic college Web sites mentions that CNME lost its recognition. Three of the schools remain accredited and the fourth is a candidate for accreditation by recognized regional accrediting agencies that are not health-related. Although Riley's decision may make it more difficult to promote licensing, it has received almost no publicity. Riley's decision cannot be appealed, but CNME is likely to reapply for accreditation in the future.
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 . The AANP and the 4-year schools have formed the Alliance for the State Licensing of Naturopathic Physicians to press for licensure in the remaining states. They assert that licensing is needed to protect the public from unqualified practitioners. However, the existing naturopathic licensing boards have done little or nothing to protect the public from naturopathy's widespread quackery.
Since the proposed laws would set educational requirements that many of ANMA's members could not meet, ANMA has vigorously opposed the licensing efforts. The National Council Against Health Fraud has pointed out:
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" are more apt to refer patients to M.D.'s for additional care .
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.
Most naturopaths allege that virtually all diseases are within their scope. The most comprehensive naturopathic publications illustrating this belief are two editions of A Textbook of Natural Medicine (for students and professionals) [16,17] and two editions of the Encyclopedia of Natural Medicine (for laypersons). [18,19] The text, which has more than forty contributors and more than a thousand pages, was issued in 1986 and updated with loose-leaf inserts until 1996 . A bound second edition was published in August 1999 . The encyclopedia had 630 pages in its first (1990) edition and has 958 in the second (1998) edition. Joseph E. Pizzorno, N.D., president of Bastyr University, and Michael T. Murray, N.D., a faculty member, edited the textbook and co-authored the encyclopedia. Both books recommend questionable dietary measures, vitamins, minerals, and/or herbs for more than 70 health problems ranging from acne to AIDS. For many of these conditions, daily administration of ten or more products is recommended -- some in dosages high enough to cause toxicity. Some treatments are recommended even though the authors indicate that the evidence supporting them is preliminary, speculative, or even conflicting. Both books discuss dubious diagnostic tests as though they have validity. Arnold Relman, M.D., Editor-in-Chief Emeritus of The New England Journal of Medicine; has written a devastating review of the 1999 textbook in which he concludes:
Many of the treatments recommended in the Textbook . . . are not likely to be effective, and treatments proven to be effective are often totally ignored. This could endanger the health and safety of patients with serious diseases who relied solely on care from a naturopathic practitioner .
Pizzorno and Murray have claimed that "in most instances, the naturopathic alternative offers significant benefits over standard medical practices."  For the few illnesses where their encyclopedia acknowledges that medical treatment is essential (because otherwise the patient may die), they propose naturopathic treatment in addition. In many passages, they describe prevailing medical practices inaccurately.
The encyclopedia claims, for example, that medical treatment of hypothyroidism involves the use of desiccated thyroid or synthetic thyroid hormone, but that naturopaths prefer desiccated thyroid. Pizzorno and Murray also claim that "health-food-store thyroid preparations . . . . may provide enough support" to help a mild thyroid problem, even though the FDA requires such products to be hormone-free. Scientific physicians consider desiccated thyroid (made from dried animal glands) inferior because its potency can vary from batch to batch. Synthetic thyroid hormone does the job efficiently. Using a product that might contain no hormone is even more ridiculous. The book also claims (incorrectly) that taking one's armpit temperature upon awakening is a reliable test for thyroid function.
The chapter on angina gives a glowing recommendation for chelation therapy, which the scientific community regards as worthless. The chapter on "detoxification" claims that 25% of Americans suffer from heavy metal poisoning and advocates periodic fasting plus various supplements and herbs. The chapter on "cellulite" claims that a gotu kola extract has "demonstrated impressive results." The "Candidiasis" chapter espouses Dr. William Crook's fad diagnosis of "candidiasis hypersensitivity" and includes Crook's three-page questionnaire for determining the probability that "yeast-connected problems are present." The questionnaire does not have the slightest validity.
In The Complete Book of Juicing, Murray recommends juices for treating scores of ailments. He also advises everyone to use supplements because "even the most dedicated health advocate . . . cannot possibly meet the tremendous nutritional requirements for optimum health through diet alone."  These ideas lack scientific validity.
In another book, Murray claims that juicing is valuable because fresh juice provides the body with "live" enzymes . This idea is absurd. The enzymes in plants help regulate the metabolic function of plants. When ingested, they do not act as enzymes within the human body, because they are digested rather than absorbed intact into the body .
Pizzorno's book Total Wellness: Improve Your Health By Understanding Your Body's Healing Systems contains a chapter titled "Strengthen Your Immune System," in which the following anecdote is used to illustrate how naturopaths regard "immune suppression" as an underlying cause of disease:
Several years ago I began to develop large warts on several of my fingers. Warts are an interesting phenomenon; they tend to grow or recede according to how well the immune system is functioning. Although I treated them several times with thuja oil (a standard naturopathic treatment for warts), they had not responded very well. I was perplexed because I was living a pretty healthful lifestyle and using a therapy I'd used successfully for a lot of patients.
Then I visited the dentist. As I've only had one cavity, I hadn't been to the dentist for several years. Surprisingly, X-rays revealed an abscess in that one tooth -- the filling had not been sealed properly. A week of antibiotics cleared the infection, and within three months all my warts were gone. Even though I had had no other symptoms, the abscess was continually draining my immune system. 
Any sensible preventive dental-care program should include visits every 6-12 months for professional cleaning (to remove gumline calculus to prevent gum disease), a check for early signs of tooth decay (cavities), and occasional x-ray examination to look for hidden problems. How come Pizzorno -- despite all his talk about prevention -- does not believe he should have dental check-ups like the rest of us? What does it mean that he permitted large warts to develop on his fingers without seeking medical treatment? (You can decide this for yourself.)
Did fixing the abscess actually lead to the disappearance of the warts? I doubt that this has been scientifically studied. However, it is well known that most common warts disappear spontaneously within two years or can be effectively removed with simple, nonscarring medical treatment .
The AANP claims that "naturopathic physicians are not opposed to invasive and suppressive measures when these methods are necessary [and] make referrals for such treatment when appropriate."  I doubt that the majority of naturopaths fit this description. Many naturopaths espouse nutrition and lifestyle measures that coincide with current medical recommendations. However, this advice is often accompanied by nonstandard advice that is irrational. Although naturopaths claim to emphasize prevention, most oppose or are overly critical of immunization. The AANP is opposed to compulsory immunization .
Recently, as part of a child-custody evaluation, I examined records from nine naturopaths who had treated a child whose mother was antagonistic to medical care and was briefly enrolled as a naturopathy student. The child was not properly immunized and did not see a medical doctor until she developed insulin-dependent diabetes mellitus (IDDM) shortly before her eighth birthday. Although episodes of "chest congestion," "chronic cough," "vaginitis," "urinary burning" and "asthma" were noted in the records, there were no indications that these problems had been adequately diagnosed or appropriately treated. (One episode of "chest congestion," for example, was treated with homeopathic remedies.) Three of the practitioners used a Vegatest device to diagnose "allergies" to sugar and many other foods and had recommended severe dietary restrictions, even though the child had not reacted adversely to any of the foods. (The Vegatest is quack device that merely measures the amount of moisture on the skin and how hard the practitioner presses a probe against the patient's fingers or toes.) Another practitioner recommended chelation therapy after diagnosing "heavy metal poisoning" with a hair analysis. The recommended treatments for both actual and nonexistent conditions included regimens of up to 35 pills a day, including some supplements in potentially toxic doses. The only medical referral took place after the child developed severe signs of diabetes. Although the nine naturopaths do not constitute a random sample, their unscientific practices were consistent with typical naturopathic writings.
In May 2001, the Arizona Naturopathic Physicians Board of Medical Examiners fired its executive director, John L. Brewer, D.C., following allegations that he shredded documents, copied exams, and misrepresented his credentials. According to a report in the Arizona Republic, a board member had discovered that Brewer did not receive a naturopathic degree from a college in Los Angeles as he had claimed on his license application .
In June 2000, the Arizona Auditor General had severely criticized the board's performance. The most serious deficiencies involved the naturopathic licensing examination, which had not been validated to ensure that it tests what naturopaths would need to practice safely. Even worse, the board consistently "adjusted" scores upward so that everyone taking the exam since 1998 passed it. With the February 1999 exam, for example:
The Auditor General's report also noted that complaints to the board had not received adequate attention and that record-keeping and overall management had been inadequate .
In 1968, the U.S. Department of Health, Education, and Welfare (HEW) recommended against Medicare coverage of naturopathy. HEW's report concluded:
Naturopathic theory and practice are not based upon the body of basic knowledge related to health, disease, and health care which has been widely accepted by the scientific community. Moreover, irrespective of its theory, the scope and quality of naturopathic education do not prepare the practitioner to make an adequate diagnosis and provide appropriate treatment. 
Although some aspects of naturopathic education have improved in recent years, I believe this conclusion is still valid. I believe that 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.