Allopaths, Naturopaths, Osteopaths…, Oh My! NUTR 547 - Nutrition Update Summer 2006 David L. Gee, PhD Central Washington University Naturopathic Medicine Two views of naturopathy • Bastyr University (web page, 2006) • “Naturopathic medicine is a distinct profession of primary health care, emphasizing prevention, treatment and the promotion of optimal health through the use of therapeutic methods and modalities, which encourage the selfhealing process…” Bastyr University (web page, 2006) “The scope of practice includes all aspects of family and primary care, from pediatrics to geriatrics, and all natural medicine modalities.” Two views of naturopathy • Quackwatch.org – A Close Look at Naturopathy, S Barrett, MD • Naturopathy, sometimes referred to as "natural medicine," is a largely pseudoscientific approach • a close look will show that naturopathy's philosophy is simplistic and that its practices are riddled with quackery. Quackwatch.org A Close Look at Naturopathy, S Barrett, MD • 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. Definition of naturopathy: Practices to improve health and treat disease by assisting the body’s natural healing process • • • • • herbology homeopathy massage hydrotherapy Chinese medicine • • • • • Ayurvedic medicine accupuncture pharmacology minor surgery obstetrics History of Naturopathy • Earliest medical therapy used naturopathic methods – Hippocrates: • “nature is the healer of all diseases” – Greek root of ‘physician’ is ‘nature’ • American use of naturopathy – very popular until 1920’s • advent of modern medicines (antibiotics, corticosteroids, vaccines) The Principles of Naturopathic Medicine Amer. Assoc. of Naturopathic Physicians Physician’s Oath • Do no harm – symptoms of disease part of healing; avoid suppression of symptoms • Act in the cooperation with the healing powers of nature – physician facilitates this natural process • Address the fundamental causes of disease – physician identifies and treat root causes • physical, mental, spiritual, emotional The Principles of Naturopathic Medicine Amer. Assoc. of Naturopathic Physicians Physician’s Oath • Heal the whole person through individualized treatment – health goes beyond treating the symptoms • Teach the principles of healthy living and preventive medicine. – Building health, not fighting illness Naturopathy vs Naturopathic Medicine: Controversy within CAM • Naturopathic physicians – formalized course of study • • • • 4 year graduate course of study professional board exams may prescribe some drugs, minor surgery, obstetrics ND degree • American Association of Naturopathic Physicians (AANP) – promote state licensure – values standardization & improvement of practice (research) Naturopathy vs Naturopathic Medicine: Controversy within CAM • Traditional Naturopaths – holistic approach to health – drugs, surgery, and other invasive techniques outside scope of traditional naturopathy – training from correspondence school or from practitioners • no programs accredited by US Dept. Ed. • some grants ND Legal Status of Naturopathic Medicine • 13 states with licensure (WA) – Scope of practice prohibits major surgery and prescribing controlled substances • 1 state with registration • 2 states with legal basis for practice • 2 states prohibit practice (SC, TN) Legal Status of Naturopathic Medicine • American Association of Naturopathic Physicians – represents NDs – goal: have licensure in 50 state • American Naturopathic Medical Association – represents traditional naturopaths – Opposes licensure Medicare/Medicaid/Insurance and Naturopathic Medicine • Currently not covered by Medicare – 2003 two ND (from Bastyr) appointed to US Medicare Advisory Committee • In Washington state, an "every category of provider" law requires private insurers to reimburse naturopaths. Quackwatch National Council Against Health Fraud Concerns about Naturopathic Medicine • Allopathic medicine – Based on measurable causative factors – Treatment proven using scientific methods • Naturopathic medicine – – – – Based on ‘glib generalities’ Simplistic theories May contradict science based knowledge Assumes safety Cited examples of Naturopathic Quackery K. Atwood, Medscape General Medicine, 2003 http://www.medscape.com/viewarticle/465994_1 • The repudiation of standard treatments of asthma, offering instead, for example, a hydrogen peroxide bath to "bring extra oxygen to the entire surface of the skin, thus making the lungs somewhat less oxygen hungry" or "gems and minerals ... worn as jewelry, or placed around the home in special places." • This quotation is from "Articles written by Naturopathic Physicians for the general public" (on the AANP Web site). The author is listed as a "senior editor of the Journal of Naturopathic Medicine, the official publication of the AANP." Cited examples of Naturopathic Quackery • The insertion of endonasal balloons, followed by their inflation in the nasopharynx, to "release tensions stored in the connective tissue and return the body to its original design," thus curing learning disorders and a host of other problems. Cited examples of Naturopathic Quackery • Treatment of the acute stroke patient for at least 20 minutes with an "ice-cold compress ... over the carotid arteries under the jaw bone on the neck" (which "may even abort the stroke") and subtle energy medicine. • The author of these recommendations is listed as a "senior editor of the Journal of Naturopathic Medicine, the official publication of the American Association of Naturopathic Physicians." Osteopathic Medicine Osteopathic Medicine: Features • Whole person approach – not only treating specific symptoms • Focus: preventive health care • Extra training: musculoskeletal system – 2/3 rd of total body mass • Osteopathic manipulative treatment (OMT) – use hands to diagnose and encourage body’s natural tendency to heal itself Osteopathic Medicine: Scope of Practice & Current Status • Doctor of Osteopathic Medicine (DO) – fully trained and licensed to prescribe medication and perform surgery • Separate but equal branches of medicine – DO’s full active members of AMA • 65% of DO’s in primary care – family practice, pediatrics, internal medicine, OB/GYN Osteopathic Medicine: A brief history • Late 19th Century – Andrew T. Still, MD, OD • over prescription of medications • origins of disease in dysfunctional musculoskeletal system • ‘rational medical therapy’ includes manipulation and limited use of medications • ‘osteo’ - ‘pathos’ Osteopathic Medicine: A brief history • Early 20th century – DO’s adopt use of medicines and surgery – Chiropractors limit to manipulation • 1960’s AMA lobbies to end practice of osteopathy in CA – referendum passed to end osteopathy – OD’s become MD’s – College of Osteopathic Physicians & Surgeons absorbed in UC system (Irvine) Osteopathic Medicine: A brief history • 1974 – CA Supreme Court overrules referendum • Professional equivalency for OD’s – 1960 incorporation of OD’s into MD’s – US Army allows OD’s as physicians Comparative training for MD’s, DO’s & ND’s Pre-requisites MD’s DO’s ND’s 4 yr degree expected 4 yr degree expected 4 yr degree expected 2 yrs of chemistry 1 yr of biology 1 yr of biology 4 courses in chemistry 1 yr of biology 1 yr of physics 1 yr of physics 1 course in physics 2 yrs of chemistry 1 course in math MCAT required MCAT required V:10.5, PS: 10.6, BS: 11 avg GPA 3.69 V: 8.0, PS: 7.7, BS: 8.3 Avg GPA 3.38, 3.25 Comparative training for MD’s, DO’s & ND’s Medical Schools MD’s DO’s ND’s # medical schools 125 22 4 Accreditation Yes Yes Yes Liason Committee on Medical Education American Osteopathic Association Council on Naturopathic Medical Education 2001-2003 Curriculum • Kirksville College of Osteopathic Medicine – http://www.kcom.edu/ • Bastyr University – http://www.bastyr.edu/academic/naturopath/curriculum.asp?track=4 • UW School of Medicine – http://apps.medical.washington.edu/somoc/index.asp Comparative training for MD’s, DO’s & ND’s Post-Graduate Education • MD’s – – – – Residency Program (3-7 yrs, depending on specialty) Fellowships (1-3 yrs, subspecializations, optional) License to practice (examination) Board Certification (optional) • DO’s – Internship (1 year) – Residency (2-6 years, optional) • ND’s – Residency Program (Bastyr 2 yr, optional) Conclusions: • Who should patients turn to for nutrition information and counseling? – MD’s, DO’s, or ND’s?? • How about RD’s !!