NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
The Value of Naturopathic Medicine in New York:
Cost Effective Primary Care for Disease Prevention and Health Improvement
Executive Summary
This document answers questions about the efficacy, cost-effectiveness, and safety of
naturopathic medicine when it comes to health promotion and disease prevention based on
research from across the country.
Naturopathic medicine is a medical system defined by its philosophy of treating the “cause of
disease” and not just alleviating symptoms. It includes health promotion, disease prevention and
health care education for patient empowerment. Some of the tools Naturopathic Doctors (NDs)
utilize include lab testing (especially looking for unhealthy trends to intervene early), dietary
modifications, nutrients, herbal therapies, supplements and lifestyle changes to support patients
with health.
U.S. Senate Resolution 221 of the 113th Congress states that “naturopathic doctors are skilled in
preventing and treating chronic disease; that naturopathic medicine is a safe, effective, and
affordable means of health care; and that licensure of naturopathic doctors helps address the
shortage of primary care physicians in the United States, while also providing people with more
choice in health care.”
Contents




The Problem: Chronic Disease
Evidence Based Chronic Disease Prevention
Training of Naturopathic Doctors
Cost Effectiveness and Treatment Effectiveness of Naturopathic Care of
Chronic Disease
 Safety of Naturopathic Care
 Patient Satisfaction of Naturopathic Care
NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
THE PROBLEM: Chronic Disease
Chronic Disease is overwhelming the medical system and our
economy.
According to the Center for Disease Control
 Chronic diseases cause 7 in 10 deaths each year in the United States.
 More than 75% of health care costs are due to chronic preventable
conditions.
 About 133 million Americans—nearly 1 in 2 adults—live with at least one
chronic illness.
 Approximately one-fourth of persons living with a chronic illness experience
significant limitations in daily activities.
SOURCE: CDC website. Chronic Disease Prevention: The Burden of Chronic Diseases and Their Risk Factors,
2009.
RTI International, the Agency for Healthcare Research and Quality, and the U.S.
Centers for Disease Control & Prevention in 2009 found:
 Obesity costs the US $147 billion annually.
 Annual medical expenditures attributable to obesity have doubled in less than a
decade.
 58 Million Overweight; 40 Million Obese in the US
 Eight out of 10 over 25 year olds are Overweight
 76% increase in Type II diabetes in adults 30-40 since 1990 and 80% Obesity
Related Diseases
 70% of Cardiovascular disease related to obesity
 42% breast and colon cancer diagnosed among obese individuals
 30% of gall bladder surgery related to obesity
 26% of high blood pressure
According to the New York State Department of Health:
 “Chronic diseases affect the lives of six million New Yorkers, and account for
73% of deaths in New York State annually.”
 “Of the 157,000 deaths in New York State in 2002, 114,000 were attributable to
the top five chronic diseases. The proportion of deaths due to chronic disease in
New York is somewhat higher than that of the United States, primarily because of
higher deaths from diseases of the heart.”
 “Although common and costly, many chronic diseases are also preventable. Many
chronic diseases are linked to lifestyle choices that are within your own hands to
change. Eating nutritious foods, becoming more physically active and avoiding
tobacco can help keep you from developing many of these diseases and
conditions.
NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
New York State Department of Health continued
 Based on a study of Behavioral Risk Factor Surveillance System (BRFSS) data,
6.6% of all adults (approximately 950,000) in New York State are estimated to
have diagnosed diabetes. An estimated additional 450,000 adults have diabetes
but remain undiagnosed. This represents a 50% increase since 1993”
EVIDENCE BASED CHRONIC DISEASE PREVENTION
According to the New York State Department of Health Division of Chronic
Disease, it’s top priorities are:
 “Health system interventions to improve the effective delivery and use of
clinical and other preventive services in order to prevent disease, detect
diseases early, and reduce or eliminate risk factors and mitigate or manage
complications due to chronic diseases.”
 “Strategies to improve community-clinical linkages ensuring that
communities support and clinics refer patients to programs that improve
management of chronic conditions. Such interventions ensure that those with
or at high risk for chronic diseases have access to quality community
resources to best manage their conditions or disease risk.”
The World Health Organization has estimated that if the major risk factors of
chronic disease were eliminated, at least 80 percent of all heart disease, stroke and
type-2 diabetes would be prevented and more than 40 percent of cancer.
Although the evidence is well known that chronic disease is preventable and
reversible the MD (allopathic) dominated healthcare system to this day does not
integrate it into treatment as the prevalence of chronic disease shows.
As far back as 1998 JAMA, the Journal of the American Medical Association
reported:
 “Lifestyle change is the only intervention proven to reverse coronary
artery disease.” (Ornish et al., JAMA, 1998)
 “One year of lifestyle intervention for patients with coronary artery
disease not only improved all health outcomes and reduced the need for
surgery but also cost significantly less then conventional treatment ($7,000
vs $31,000 –$46,000). “(Ornish et al., JAMA, 1998)
NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
According the New England Journal of Medicine in 2002

“58% of Type 2 diabetes is preventable by lifestyle modification (Diabetes
Prevention Program)
A study done by the Department of Health in the State of Washington found:





Non-complimentary medical providers were not recommending lifestyle
changes despite the evidence.
Only 16
% of adult respondents said they were advised by their doctor, nurse, or
other health professional to eat fewer high fat or high cholesterol foods
Only 20% were advised to eat more fruits and vegetables
Only 23% were advised to be more physically active
(SOURCE: The Burden of Heart Disease and Stroke in Washington State 2004; WA State Dept. of
Health)
Primary Care should be Preventive Medicine
 “Naturopathic doctors are trained specifically in the prevention and early
intervention of chronic conditions thus reducing premiums for those
employees utilizing naturopathic medicine.”
SOURCE: Am J Health Promot. 2000 Sep-Oct;15(1):45-52.The relationship between modifiable
health risks and group-level health care expenditures. Health Enhancement Research Organization
(HERO) Research Committee. Anderson DR, Whitmer RW, Goetzel RZ, Ozminkowski RJ, Dunn RL,
Wasserman J, Serxner S; Health Enhancement Research Organization (HERO) Research
Committee.

Naturopathic doctors are experts in guideline-directed, evidence-based
lifestyle modification for diabetes. Four studies to date have demonstrated
improvements in blood sugar control among patients working with NDs.
Additional benefits of the treatment included weight-loss, lower blood
pressure, and less depression.
SOURCE: Bradley RD, Oberg EB. Naturopathic Medicine and Diabetes: a Retrospective from an
Academic Clinic. Alternative Medicine Review 2006
NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
A 2013 study reported in the Canadian Medical Association Journal showed:
 One year of care under the supervision of a naturopathic doctor resulted in
a 3.07% reduction in 10-year CVD event risk compared to patients
receiving only conventional care.
 The same study found that after one year, naturopathic patients were
16.9% less likely to have developed metabolic syndrome than
conventional care patients.
SOURCE: Seely, Dugald, et al. "Naturopathic medicine for the prevention of cardiovascular disease:
a randomized clinical trial." Canadian Medical Association Journal 185.9(2013): E409-E416.
NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
TRAINING
Naturopathic Doctors are Highly Trained World-class Wellness Experts
CURRICULUM
Comparison of academic curriculum hours for US Naturopathic (ND), Allopathic (MD)
and Osteopathic Schools
Profession
Naturopathic
Allopathic
Osteopathic
Anatomy
Physiology
Biochemistry
Pharmacology
Pathology
Microbio/Immun.
350
250
125
100
125
175
380
125
109
114
166
185
362
126
103
108
152
125
Total
1125
1079
976
Source: Jensen CB. Common paths in medical education: the training of allopaths, osteopaths and naturopaths.
Alternative Complement Therapies. 1997;3:276-80
There are 6 Naturopathic Medical Schools in the United States located in: Portland
OR, Scottsdale AZ, San Diego CA, Seattle WA, Bridgeport CT and Lombard IL.
Programs include:
 Minimum pre-requisites are 3 years of pre-medical sciences at a university
including: biology, biochemistry, chemistry, organic chemistry, introductory
psychology and humanities.
 Classroom Training: 4-year-full time program in an accredited school of
Naturopathic Medicine that includes more than 4,500 hours of in-class training
 Clinical Experience - All students must complete 1,500 hours of clinical
requirements and demonstrate proficiency in all aspects of Naturopathic Medicine
prior to graduation.
ACCREDITATION
Naturopathic Medical Education (CNME) [www.cnme.org] is recognized by the U.S.
Department of Education as the profession’s programmatic accrediting agency.
NATIONAL BOARD EXAMS
Graduates from CNME accredited programs are qualified to sit for professional
proficiency exams administered by the North American Board of Naturopathic Medical
Examiners (NABNE) [www.nabne.org] and written by the Naturopathic Physicians
Licensing Examination (NPLEX). Other tests may be required by state regulatory
agencies. Details about these exams can be found at: https://www.nabne.org/home/examoverview/
NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
COST EFFECTIVENESS
Naturopathic Medicine reduces chronic risk factors and saves significant healthcare
costs
848 employees for the Vermont Automobile Dealers Association were examined
and advised by Naturopathic Doctors (NDs) for one year. The organization saved
$1.5 million in direct and indirect medical costs the first year; that is $1800 per
employee.
The drastic reduction in health risk factors has resulted in a decrease in insurance
premiums for each year the program has been in place.
 Direct health care costs were reduced by an estimated $315,817 leading to
a 4.6 to 1 return on investment
 Indirect health care costs were reduced by an estimated $1,143,657
leading to a 16.5 to 1 return on investment
 Combined direct and indirect health care savings lead to overall 21.1 to 1
return on investment ($21.10 saved for every dollar invested)
 Only 0.2% increase in per member claims cost (2005) compared to a
national average of over 7%.
When Chronic disease risk factors are reduced Savings results and Quality of Life
 36% reduction in the incidence of hypertension
 16% reduction in the incidence of high cholesterol
 35% reduction in multiple cardiovascular risks
 17% reduction in smokers
 21% reduction of physically inactive employees
 25% reduction of excessive stress (both work and personal)
SOURCE: Vermont Automobile Dealer’s Association and Green Mountain Wellness Solutions
Studies from Washington State show naturopathic medicine costs insurers and
consumers less than conventional care.1
Patients utilizing naturopathic medicine report much higher patient satisfaction
and health improvement, as compared to conventional care.2
SOURCE: 1 Tais S, Oberg E. (2013) The Economic Evaluation of Complementary and Alternative Medicine.
Natural Medicine Journal.
SOURCE: 2 Stewart, D., Weeks, J., & Bent, S. (2001). Utilization, patient satisfaction, and cost implications of
acupuncture, massage, and naturopathic medicine offered as covered health benefits: a comparison of two
delivery models. Alternative therapies in health and medicine, 7(4), 66.
NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
Naturopathic Medicine for the Prevention of Type 2 Diabetes
 Research shows that naturopathic medicine improves blood glucose control,
patient self-management behaviors, and self-efficacy among patients with
diabetes
SOURCE: Boon, Heather, et al. "Visiting family physicians and naturopathic practitioners. Comparing patientpractitioner interactions." Canadian family physician 49.11 (2003):1481-1487.

Naturopathic doctors address lifestyle modification (dietary recommendations,
exercise prescriptions and stress reduction techniques) with 69-100% of their
diabetic patients.
SOURCE: Bradley R. Adjunctive naturopathic care for type 2 diabetes: patient-reported & clinical outcomes after 1 year.
BMC Complementary & Alternative Medicine 2012, 12:44

Patients under an ND’s care are 17% less likely to develop metabolic syndrome
than those in conventional care.
SOURCE: Bradley R, Shen E, Buckle H, Kaltunas J, Tais S, Standish LJ. Description of clinical risk factor
changes during naturopathic care for type 2 diabetes. J Altern Complement Med 2009;15:633–8.

The Diabetes Prevention Trial demonstrated that the prevention of type 2 diabetes
by diet and lifestyle therapies was more cost effective than pharmaceutical
therapy in high-risk patients. For each quality-adjusted life years (QALY) saved,
a lifestyle modification program costs $8,800 while metformin therapy costs
$29,000. Additionally, the lifestyle modification program was shown to be costeffective in all adults, while metformin was not cost-effective after age 65.
SOURCE: Herman WH et al.; Diabetes Prevention Program Research Group. The cost-effectiveness of lifestyle
modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern
Med. 2005 Mar1; 142(5):323-32.

“CAM (Complimentary Alternative Medicine) users averaged $1,420 less in
annual health care expenditures than nonusers in patients with the heaviest disease
burden.”
SOURCE: Lind BK, Lafferty WE, Tyree WE, Diehr PK. 2010. Comparison of health care expenditures among
insured users and nonusers of complementary and alternative medicine in Washington State: a cost
minimization analysis. Journal of Alternative and Complementary Medicine. 16(4) 411-417

“Changes in lifestyle and stress reduction – a major focus of naturopathic
medicine – could save the US $10 billion annually in reduced coronary
angioplasty procedures and coronary bypass operations alone, and insurance
savings of almost $30,000 per patient.”
SOURCE: Guarneri E, Horrigan BJ, Pechura CM. 2010. The efficacy and cost effectiveness of integrative
medicine: A review of the medical and corporate literature. Bravewell Collaborative Report, June 2010

“Corporate health management programs associated with prevention and wellness
showed a 26% reduction in health care costs and a $5.81-$6 returned for every $1
invested.”
NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
SOURCE: Lafferty WE, Patrick TT, Bellas AS, Watts CA, Lind BK, Sherman KJ, Cherkin DC, Grembowski DE.
2006. Insurance coverage and subsequent utilization of Complementary and Alternative Medicine providers.
American Journal of Managed Care. 12: 397-404.

A Blue Shield of Washington study found that “utilizing NDs as PCPs would
reduce cost for chronic and stress-related illness up to 40% and cut costs of
specialist utilization by 30%.”
SOURCE: Henry. 1995. King County Medical Blue Shield Phase 1 Final Report: Alternative Healthcare Project
Steering Committee. August 5, 1995.

Another comparison revealed a $356 annual health cost savings for each user of
Complementary and Alternative Medicine (CAM) when compared to CAM
nonusers.
SOURCE: Lind BK, Lafferty WE, Tyree WE, Diehr PK. 2010. Comparison of health care expenditures among
insured users and nonusers of complementary and alternative medicine in Washington State: a cost
minimization analysis. Journal of Alternative and Complementary Medicine. 16(4) 411-417

Evidence shows that Naturopathic doctors treated 7 of the top 10 most expensive
health conditions more cost effectively than MDs or other conventional
providers.
SOURCE: Henny, Geoffrey C., Alternative Health Care Consultant, King County Medical Blue Shield (KCMBS),
Phase I Final Report: Alternative Healthcare Project, 1995
Naturopathic Medicine Improves Lower Back Pain and Other Musculoskeletal
Complaints, Getting People Back to Work at Lower Costs
Ineffective pain care cost U.S. employers $297.4 to $335.5 billion in lost
productivity in 2010.
SOURCE: Institute of Medicine of the National Academies Report. Relieving Pain in America: A Blueprint for
Transforming Prevention, Care, Education, and Research, 2011. The National Academies Press, Washington
DC. (page 260). http://books.nap.edu/openbook.php?record_id=13172&page=260
A randomized controlled trial found significant decreases in pain and increases in
range of motion in workers who received naturopathic care versus usual care.
Quality of life also improved (p<0.0001).
SOURCE: Szczurko, Orest, et al. "Naturopathic care for chronic low back pain: a randomized trial." PLoS One
2.9 (2007): e919.
A randomized controlled trial of rotator cuff tendinitis found reduced pain
(p<0.001) and less disability (p=0.0002) among postal workers treated by
naturopathic doctors compared to usual care.16
SOURCE: Naturopathic Treatment of Rotator Cuff Tendinitis Among Canadian Postal Workers: A Randomized
Controlled Trial. Arthritis & Rheumatism (Arthritis Care & Research), Vol. 61, No. 8, August 15, 2009, pp 1037–
1045.
Compared to conventional physiotherapy, naturopathic care was associated with
improvements in symptoms and quality of life, as well as a decrease in costs of
$1,212 per study participant. Workplace absenteeism was also reduced by 6.7
days per year.
NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
SOURCE: Herman PM, Szczurko O, Cooley K, Mills EJ. Cost-effectiveness of naturopathic care for chronic low
back pain.Altern Ther Health Med 2008; 14(2): 32-39.
From the perspective of the employer, the inclusion of naturopathic care in an
essential benefits package could avoid $172 per day of lost productivity at a
cost $154 per absentee day avoided, equal to a return on investment (ROI) of
7.9%.
SOURCE: Herman PM, Szczurko O, Cooley K, Mills EJ. Cost-effectiveness of naturopathic care for chronic low
back pain.Altern Ther Health Med 2008; 14(2): 32-39.
Asthma
 The total cost of asthma hospitalizations in New York State for 2007 was
approximately $535 million, a 70% increase in the cost since 1998 ($315million)
 Increasing evidence supports numerous naturopathic treatments for both the
prevention and treatment of chronic lung conditions, including the use of fish oil
supplements,1, 2 magnesium for acute symptoms,3 and nebulized glutathione.4
SOURCES: 1 Romieu, Isabelle, and Carol Trenga. "Diet and obstructive lung diseases." Epidemiologic reviews
23.2 (2001): 268.
2 Dry, J., and D. Vincent. "Effect of a fish oil diet on asthma: results of a 1-year double-blind study."
International Archives of Allergy and Immunology 95.2-3 (2009): 156-157.
3 Hill, J., et al. "Investigation of the effect of short-term change in dietary magnesium intake in asthma."
European Respiratory Journal 10.10 (1997): 2225-2229.
4 Bishop, Clark, et al. "A pilot study of the effect of inhaled buffered reduced glutathione on the clinical status of
patients with cystic fibrosis." CHEST Journal 127.1 (2005): 308-317.
High Quality Care at Low Cost to Insurance Premiums
Analysis on the impact of Washington State’s 1996 Every Category of Provider
law found that the “impact [of including naturopathic doctors] on premiums was
modest – generally less than 2%.”
SOURCES: Watts CA, Lafferty WE, Baden AC. The effect of mandating complementary and alternative
medicine services on insurance benefits in Washington state. J AlternComplement Med. 2004; 10:1001-1008
After 6 years of insurance coverage of ND Primary Care Providers (PCPs) in WA
state, visits to NDs made up just 1% of all outpatient provider visits but accounted
for only 0.3% of the dollars paid out by insurers.
Lafferty, et al. Insurance Coverage and Subsequent Utilization of Complementary and Alternative Medicine
Providers. Journal of Managed Care. July 2006
Naturopathic doctors delivering the same Medicaid services in Oregon are 57.5%
more cost effective than MD/DO/NP PCPs providing the same services.
SOURCE: The Cost Effectiveness of Naturopathic Delivery of Oregon Medicaid Services Statistics provided by
Leslie Hendrickson, Office of Medical Assistance. Feb 11, 1991
NEW YORK ASSOCIATION OF NATUROPATHIC PHYSICIANS
SAFETY
Malpractice claims against CAM practitioners occur less frequently and typically
involved less severe injury than claims against Conventional Physicians.
SOURCES:
Mark Cohen MH. Malpractice and vicarious liability for providers of complementary & alternative medicine. Benders Health
Care Law Mon. 1996 Jun:3-13.
Mark Studdert DM, Eisenberg DM, Miller FH, Curto DA, Kaptchuk TJ, Brennan TA .Medical malpractice implications of
alternative medicine. JAMA. 1998 Nov 11;280(18):1610-5.
Jury Verdicts Northwest with civil court records in states where 55% of naturopathic
doctors practice, reported that their records show zero cases paid against naturopathic
doctors and only 17 filed in 20 years.
EFFICACY = PATIENT SATISFACTION
According to a study comparing Complimentary Alternative Medicine vs. Allopathic medicine:
 Patient satisfaction with services: (92%) CAM vs. (44%) conventional
 Patients reported conventional care as very (17%) or moderately (27%)
helpful
 Patients reported CAM care as extremely (56%), very (26%) helpful
 Patients reported they would definitely (76%) or probably (13%) return to
the same CAM provider
SOURCE: Stewart D, Weeks J, Bent S. Utilization, patient satisfaction, and cost implications of acupuncture,
massage, and naturopathic medicine offered as covered health benefits: a comparison of two delivery models.
Alternative Therapies in Health & Medicine. 2001;7:66-70
Naturopathic medicine is safe evidence-based medicine focused on the
prevention and recovery from chronic disease with proven cost savings.