Naturopathic Licensing Urged to Follow Marketing

The Mind-Body-Spirit Journal suggests that naturopathic physicians need to rebrand themselves so as to better distinguish "medically-trained" MD's from lay naturopaths, both of which are sometimes known as "naturopathic doctors."

The Mind-Body-Spirit Journal, written by wellness advocate Ken Wiston Caine, kindly cites the Complementary and Alternative Medicine Law Blog as a "great resource," noting:

  "Useful resource for holistic practitioners: Boston-area Attorney Michael H. Cohen's CamLaw Blog -- The Complementary and Alternative Medicine Law Blog. Covers latest developments affecting practice of alternative medicine, as well as updates on key issues. While Cohen is a legal wonk who specializes in litigation affecting the practice of complementary and alternative medicine, he writes clearly and provides a much-needed service with this blog. No gobbledly-gook here. Just the straight dope."

And then asks:

"Wonder what he would make of my position on naturopathic licensing from the piece, "Stop the naturopathy wars"?"

Since I'm grateful for people citing and tracking back to the Complementary and Alternative Medicine Law Blog, here are a few thoughts on "Stop the naturopathy wars. CNME's medically trained naturopaths need a DISTINCT title."

A few years back, I testified before the White House Commission on Complementary and Alternative Medicine Policy on licensing and credentialing issues. I was asked whether I felt naturopaths should be licensed in all 50 states.

This is actually a trick question. "Yes" would mark me as an "advocate" of naturopathic licensure, which particularly a few years back would have been a signal to those supposed 'quackbusters' out there for open season. "No" would then create enemies on the other side of the fence. I am mindful of some Biblical quote about being spit out of God's mouth if one is lukewarm and sits on the fence; at the same time, of the Dalai Lama-ish admonition against falling into one polarity or another, since that perpetuates duality, and we truly live the union of the opposites.

The Mind-Body-Spirit Journal argues:

"The medically trained faction should not be afraid to adopt a new, distinct and more descriptive "brand" as it marches forward with its decade-and-a-half-long charge to get its doctors licensed to practice as family doctors in every state.

"They have much more to offer the public than typical naturopathic doctors.

"In fact, because they are trained in basic scientific medicine as well as some aspects of Oriental medicine (including acupuncture), and in an osteopathic/chiropractic-like form of physical "adjustment," and, like all naturopaths, in homeopathy and herbalism and nutrition, they have even more to offer the public than does the typical family physician. Because the medically trained naturopaths practice integrative medicine -- which is gaining wide public recognition and favor."

And yes, this is the argument made by naturopathic physicians trained in 4-year naturopathic colleges: that they are the lawful heirs to the integrative medicine title (if, in fact, they will claim the title "medicine" as in "naturopathic medicine;" there is a lot of debate, canvassed in Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives, about what "medicine" means, or should mean -- both pragmatically, and from a legal standpoint (i.e., as defined over many state statues)).

The Journal continues:

"If they adopt as exclusive titles, Naturopathic Physician and Naturopathic Medical Doctor, as they have in some states, can they develop a powerful, highly differentiated brand? Is that distinct enough from "naturopathic doctor" for them to easily communicate or "sell" how different and more qualified they are?

"....I think not. While NP and NMD are a step in the right direction, they aren't different enough from "naturopathic doctor" to really carry the powerful marketing message that they could automatically convey and that the AANP/CNME physicians need to convey.

"Idaho is a model. Idaho basically got it right last year. Idaho adopted a complex act that sets up a two-tier system and gives the medically trained naturopaths a distinct title (although maybe not distinct enough) and allows them to practice to the full extent of their training as family physicians. Or, at least, has the potential to do that. (I'm not sure how the AANP docs will work out hospital privileges -- that may be their next frontier.) The Idaho law reserves the title "naturopathic doctor" for trained, traditional naturopaths, the non-medical bunch, who essentially offer homeopathy and herbalism and nutritional, wellness and lifestyle counseling."

From the perspective of clearing up consumer confusion, this is helpful: letting the public know that naturopathic physicians who have graduated from the accredited 4-year program have different training than those who are lay practitioners. I'm a big believer in disclosure that is sufficient to help make caveat emptor work.

As to whether one bunch is "medical" and "scientific" or not, that is the subject of great debate. Unfortunately, naturopathic practices do not have the same track record of research as many conventional therapies (though that too may be debatable and I'm sure the AANP will try to correct or refine the statement; I'm referring to naturopathic practices overall and not just studies of single dietary supplements).

There is another issue, which is the question of regulating folk medicine (or not) and its availability to the public.

Quoth the Journal:

"When they do this, they ignore the numbers and they ignore the fact that some great schools in the United States, Australia, New Zealand (and throughout Great Britain), in India and elsewhere teach a different (more 'folky') form of naturopathy than the scientific, medical form that the AANP/CNME has evolved. They ignore that the form most-frequently taught and practiced is much closer to that which was promulgated by the discipline's founder, Benedict Lust -- who very vocally insisted that naturopathy was not the practice of medicine, but an alternative and a synthesis of timeless natural healing and self-healing techniques and approaches available to all."

True enough - and the question is whether licensure, permissive certification, or mere registration (as in states that allow non-licensed CAM practitioners to offer legal services) provides the better model of regulation for those lay providers who wish to ply their naturopathic theories without any real understanding of biology and chemistry.

According to the Journal:

"Licensing -- under a distinct title (and from a marketing-communication standpoint, getting the terms "integrative" and "medicine" or "medical" into that title would incredibly enhance its "selling power" and the amount of respect it would command) -- is essential for the medically trained faction....Let's declare peace. Let's constructively educate the public about the two classes of naturopaths, about the high qualifications and broad offerings of those who practice naturopathic integrative medicine, and about the basic, simple, helpful philosophy of life balance that is called 'naturopathy.' .... And quit trashing the majority of naturopaths, dismissing them fakes and as unqualified and as "mail-order doctors" or "diploma-mill doctors" -- the latter of which indeed has been true in a very small number of cases and which a Health-Freedom Act would immediately resolve by statutorily requiring full, accurate, verifiable written disclosure of a non-licensed practitioner's training."

Well, turf battles do persist, whether among conventional health care providers or alternative and complementary ones, and the question remains how best to protect the public while ensuring public access to a broad range of therapies. Ethically, this is a clash between medical paternalism and patient autonomy, with the notion of "health care freedom" enshrining the latter. The battles are fought in state legislatures deciding whether and/or how to deal with unlicensed health care providers, naturopathic practitioners seeking licensure, issues of provider training and discipline, and other matters.

It is important for practitioners of all kinds to be aware of relevant state laws, administrative (board) regulations, and cases, as issues such as licensure (and credentialing) do interact with questions of negligence (malpractice), discipline, and other aspects of health law that also work to help safeguard the public's interest in accessing safe and effective health care services.