Judy Lederman had killer migraines, the kind that forced her to lie motionless in a darkened room for at least two days a month. Frustrated with prescription medication that wasn’t quelling the pain and put off by what she considered a “less than sympathetic” doctor, she made an appointment with a naturopathic physician recommended by a friend. Maybe alternative medicine would come to her rescue, she figured.
Everything started out well. “He spent an hour and a half just ‘talking to me, asking me questions no physician had ever asked: what my childhood was like, what foods I craved,” says Lederman, a 39-year-old public-relations executive with three children who lives in Westchester County, NY. “I was very impressed by his thoroughness.” The second time she visited, a migraine was just beginning, and “he gave me what he called homeopathic medicine, little white balls I had to let dissolve under my tongue.
“Almost immediately, while I was still in his office, my heart began to race so violently I thought I was having a heart attack,” she says. “I flushed severely, and my migraine became so bad, I could barely see. The naturopath told me it was a side effect that sometimes happens. I just needed to take some more, which he offered me.” She refused and stumbled out of his office. “I don’t know how I drove home, my vision was so bad. I was frightened to death.”
Once she was home, her heartbeat and eyesight returned to normal. Badly shaken, she called the naturopath and asked what he had given her. It was lachesis, which, she later learned, is derived From snake venom and has been known to trigger heart problems.
Lederman’s flirtation with alternative medicine had crashed and burned. ‘Td been so impressed With him that first visit,” she says ruefully. “I believed everything he said.”
Healers or scam artists? That’s the question swirling around naturopathic doctors (N.D.’s), practitioners of “natural” medicine, who are becoming increasingly popular. About 65 health-insurance plans across the country now cover some naturopathic treatments, and two states–Connecticut and Alaska–have made coverage mandatory.
The majority of patients who consult naturopaths are women, and some 70 percent of naturopathy students are female. “Natural medicine, when practiced at its best, is nurturing, which appeals to women,” says Joseph Pizzorno, N.D., president of Bastyr University, a Seattle-based school of naturopathy.
But critics worry that consumers are placing their health in the hands of people who, however well meaning, lack the medical training to detect and treat serious problems. “All naturopaths are practicing pseudoscience,” says William Jarvis, Ph.D., executive director of the National Council Against Health Fraud and a professor of public health and preventive medicine at Loma Linda University in California. Comparing naturopathy with modem medicine is, he says, “like comparing the space program with someone who meditates and thinks he’s on the moon.”
The Practice of Unscientific Medicine
The “nature cure” was introduced to North America in the 1890’s by a European named Benedict Lust, who credited his recovery from tuberculosis to bathing in the Danube River. In 1918, Lust wrote that naturopathy is “based on a return to nature in regulating the diet, breathing, exercising, bathing, and the employment: of various threes to eliminate the poisonous products in the system, and so raising the vitality of the patient to a proper standard of health.”
Today’s naturopaths employ a wide range of alternative therapies: acupuncture, herbal medicine, nutritional counseling, biofeedback, water therapy, relaxation techniques, massage therapy, and homeopathy. The naturopath’s goal the least-invasive treatment, which means avoiding surgery and drugs — unless absolutely necessary.
In many states, N.D.’s can function almost as general practitioners-and the resulting consumer confusion is what has the traditional medical community up in arms. “That N.D.’s and M.D.’s have the same training–an assertion N.D.’s often make–is fallacious,” says Wallace Sampson, M.D., a clinical professor of medicine at Stanford University in California and editor of the medical journal Scientific Review of Alternative Medicine. “N.D.’s are taught ideological principles that have no logic and no consistency.” For instance, an article written by an editor at The Journal of Naturopathic Medicine advises adult diabetics to wear certain colors to improve their health-magenta boosts circulation; yellow controls hunger; orange, green, and indigo worn in combination can help improve insulin function–advice that is considered hocus-pocus by most M.D.’s.
Another mainstay of naturopathy is colonic irrigation, which involves taking a powerful enema that N.D.’s claim will help “detoxify” the body. Yet “there’s no research I know of to prove this,” says Yank D. Coble, M.D., farmer chair of the American Medical Association’s Council on Scientific Affairs and a clinical professor of medicine at the University of Florida in Jacksonville.
In Fact, “there are no adequate studies to document anything naturopaths do,” says Dr. Coble. The American Association of Naturopathic Physicians (AANP) doesn’t dispute this. “The AANP stands for the profession not accepting anecdotal information without validation, but it’s difficult to get funding to test our practices,” says Sheila Quinn, AANP’s executive director.
Still, plenty of patients are convinced that naturopathy really works. One is Debbie Decker, 43, of Arlington, TX, who switched from an M.D. to an N.D. seven years ago after, she says, “becoming fed up with the limitations of conventional medicine.” Years of suffering from chronic allergies and premenstrual syndrome had left her never really feeling well, but after following a regimen of herbs, vitamins, and minerals, “I’m so healthy I rarely even sneeze. I never use antibiotics or take aspirin anymore.”
How does she explain it? “A medical doctor is trained to look at individual organs, not the person as a whole,” she says. “I believe N.D.’s are more knowledgeable about our health because they understand how everything in our bodies works in unison.”
Patients often praise the fact that naturopaths spend more time with them than M.D.’s do, asking detailed questions. But critics question such priorities. “Does one want a listener or a knowledgeable professional who can size up a problem efficiently to advise correct action?” asks Dr. Sampson.
How Much Training Is Enough?
Some 900 licensed naturopaths practice in the United States, a tiny number compared with the nation’s 600,000 M.D.’s, though how many unlicensed N.D.’s are out there is anyone’s guess. If you live in one of the 11 states that licenses naturopaths–Alaska, Arizona, Connecticut, Hawaii, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington–your N.D. must have a state license to practice legally. The AANP is lobbying for licensing in California, Massachusetts, Minnesota, Oklahoma, and Texas.
To become licensed, students must attend a four-year naturopathic medical school, where they study anatomy, cell biology, physiology, epidemiology, and biochemistry, as well as such nontraditional subjects as homeopathy and herbal medicine. After graduation, naturopaths must take an exam administered by the state. The Council on Naturopathic Medical Education (CNME), which has been granted Federal authority to accredit naturopathy schools, currently recognizes just two: Bastyr University and the National College of Naturopathic Medicine in Portland, OR. Admission to these schools is restricted to students who have taken undergraduate premed courses. Two other four-year institutions are hoping to be accredited soon.
Once licensed, naturopaths can begin practicing–even though most have never undergone residency training, which is mandatory for M.D.’s. (Utah is the only state that requires N.D.’s to complete a residency program.) Naturopaths can perform breast exams and Pap tests, take blood samples, order X rays, set broken bones, and perform minor outpatient surgery, such as stitching up small wounds. Some states also allow N.D.’s to order CAT scans and MRIs and to deliver babies. But N.D.’s can’t perform major surgery or prescribe drugs, except for certain antibiotics, hormones, and steroids.
South Carolina and Tennessee don’t permit naturopaths to practice at all. In the 37 states where naturopaths don’t need a license to practice, anyone can hang out a shingle–even if her experience is limited to applying Band-Aids and dispensing aspirin. While state laws prohibit people from practicing medicine without a license, each state has a different definition of what it means to practice medicine, and some states aren’t strict about enforcement.
In most states, naturopaths remain totally unregulated. Should something go wrong and a patient wish to sue for malpractice, it could prove difficult to find a lawyer who’d take the case, because unlicensed naturopaths don’t carry malpractice insurance. The AANP itself warns medical consumers that “not all naturopathic physicians, or naturopathic educational programs, are created equal. Buyer beware is the rule for those seeking an alternative-healthcare provider.”
Many unlicensed practitioners assure consumers that they hold degrees–but these are often from correspondence schools that aren’t accredited by the Federally recognized CNME. These programs may say they are accredited, but accrediting laws are so lax that virtually anyone can declare herself a medical-school accrediting body.
Obtaining such a mail-order degree is often a snap. As a test, Dr. Jarvis applied for an N.D. from a “diploma mill,” a school that churns out spurious degrees. “It cost me fifty dollars,” he says. “I had to write a four-page paper, the sort of thing you produce in high school, on how Mother Earth is alive and well.”
In worst-case scenarios, N.D.’s try to pass themselves off as M.D.’s. When Brian Dussault, 52, a carpenter, consulted James McKee in Winter Park, FL, he had good reason to believe he was seeing a conventional physician. McKee called himself a doctor, employed a nurse and a receptionist, and wore a stethoscope.
Dussault went to McKee for eczema treatment. What he got was a high dose of the steroid prednisone–about four times the usual dose–for nearly three years. (Those who became licensed naturopaths in Florida prior to 1959 may continue to practice and are allowed to prescribe medication.) The drug was not helping, so McKee raised the dosage. When a sprained ankle sent Dussault to the emergency mom, a horrified M.D. said the drug was devastating his hormonal and gastrointestinal systems, causing severe muscle, bone, and eye damage. More than 60 surgeries followed, but it was too late–Dussault is now disabled and in constant pain.
“We thought this man was a real doctor; he was recommended by Brian’s supervisor at work,” says Dussault’s wife, Mary. “In fact, he was a witch doctor.”
The Dussaults filed a malpractice suit and won $250,000, but McKee immediately declared bankruptcy and did not have to pay a cent. Naturopaths in Florida are not required to carry insurance.
Doctors’ Orders: Proceed with Caution
Of course, McKee is not representative of all naturopaths; there are many licensed practitioners who work alongside M.D.’s in a complementary, mutually beneficial fashion. Tori Hudson, an N.D. practicing in Portland, OR, accepts frequent referrals from M.D.’s for patients seeking drug-free relief from menstrual pain, menopausal symptoms, and osteoporosis. She prescribes dietary changes, exercise, and supplements. “In turn,” she says, “I refer patients I suspect have cancer to oncologists.” When Hudson’s sister broke her arm, she referred her to an orthopedist, because “I wanted someone who sets bones frequently to put her arm in a cast.
“I look forward to a time when there will be more integrated medicine,” says Hudson. “The divisions between alternative practices and mainstream medicine are breaking down all the time.”
For now, however, caution is still the order of the day. The best protection against an unscrupulous naturopath is licensing: “This gives the public the right of review, by both professional organizations and the state,” says Quinn of the AANP. “If you have a complaint, it’s a way to get recompense. Patients in states where N.D.’s aren’t licensed have no protection.”
And if you do choose to visit a naturopath, don’t stop seeing your regular physician. Inform your M.D. of any “natural” therapies your N.D. prescribes.