Should Naturopaths Be Licensed

The debate continues across the country, including recently Colorado, where an unlicensed "naturopath" treated a pediatric cancer patient by injecting him with hydrogen peroxide.

According to "RX for confusion: Colorado's lack of regulation leaves alternative doctors on risky ground" by Dan Wilcock in the Colorado State Independent (,
the child died nine days later and the practitioner was arrested on a variety of criminal charges, including reckless manslaughter, multiple assaults, fraud, theft, practicing medicine without a license, and possession of controlled substances.

The article highlights the debate among these different groups: (1) naturopathic physicians who graduate from one of the three nationally accredited four-year residential colleges (or from a fourth college currently a candidate for accreditation), whose curriculum includes a foundation of conventional, science-based medical training, and who receive licensure in over a dozen states. Such naturopathic physicians (or naturopathic doctors, ND's), typically favor regulation (licensure) as a means of quality assurance and legitimacy/credibility. (2) non-licensed practitioners, including 'lay naturopaths' who lack such training; the practitioner who treated the child in this case titled himself an "N.M.D.," or naturopathic medical doctor, although his credentials were from a correspondence course. (3) conventional MD's, some of whom oppose licensing for naturopathic physicians.

The debate is complex, as there is a lot of confusion about the pros and cons of regulation, and the level of training received by naturopathic doctors who graduate from appropriately accredited institutions as opposed to those who have mail-order degrees and may be engaging in dangerous if not criminal conduct. I've canvassed some of this complexity in "Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives" and in Eisenberg DM, Cohen MH, Hrbek A, Grayzel J, van Rompay MI, Cooper, RA. Credentialing complementary and alternative medical providers. Ann Intern Med; 2002;137:965-973. In general, I've argued that we've gone too far in the direction of medical paternalism and ought to swing the balance more toward respecting patient autonomy and medical pluralism; the times seemed to have tilted in favor of this argument over the past decade, as many regulatory developments suggest. But I am not in favor of the kind of unbridled "medical freedom" advocated by some within group (2) (interestingly, I've been in hearings where representatives of these groups nonetheless quoted my own books as authority). The newer legislation in CA, RI, and MN, for example, has some public safeguards (such as disclosures regarding training and competence) that allegedly were not fulfilled by the practitioner in the above case.

I was interviewed for the above article and quoted as follows:

"It's all about balancing," he says. "A person has the right to say what will happen with his own body." This quote should have been put in context. It is an axiom of informed consent that a person has the right to say what shall be done with his or her body. Ethically, this is a powerful statement about the value of patient autonomy. It does not say that untrained or poorly practitioners should be allowed to mislead and endanger the public. The balance to be drawn is one between autonomy and paternalism.

The quote continues: "Naturopaths who have gone through rigorous training but operate in unlicensed states "are at risk," he notes. "They operate in a grey zone." As the article points out, this is legal risk faced by properly trained ND's in states that do not license them.

The quote continues: But the antagonism that currently bristles between naturopaths and M.D.s in Colorado may give way to new cooperative relationships, he says. "Cross-referral is probably the wave of the future," he says.

That would be cross-referral between licensed, duly trained, competent practitioners. It isn't always easy to put complex ideas into sound bites, particularly in such a controversial arena. And when interviewed, I was not asked to comment on this particular case--nor was I aware the case formed the backbone of the current controversy. It's hard to put the genie back in the box once the sound bites are out, but I suppose that's part of understanding the pitfalls that parallel the public service of speaking with reporters.