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From the Townsend Letter for Doctors & Patients
February/March 2003

Opposition to naturopathic licensure harms the public
by Alan R. Gaby, MD

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A recent article in American Medical News (October 28, 2002), a newspaper published by the American Medical Association (AMA), discussed the medical establishment's opposition to the licensing of naturopaths by state medical boards. While the opponents of licensure claim they are simply trying to protect the public from inadequately trained practitioners, it appears that their main goal is to preserve conventional medicine's monopoly status in the lucrative health-care business.

The article quotes the secretary-treasurer of the AMA as saying, "We believe the way to become trained is by education not legislation." That statement wrongly implies that the 11 state legislatures that have passed licensure laws were somehow duped into allowing naturopaths to do what they are not trained to do. As a professor at Bastyr University for nine years, it was my observation that the training naturopaths receive is well-matched to their scope of practice.

The fact is that organized medicine is congenitally opposed to any encroachment on its turf, no matter how much such "encroachments" might increase the availability, or reduce the cost, of health care. In 1990, a US Court of Appeals affirmed a lower-court ruling that the AMA violated anti-trust laws by conducting an illegal boycott of chiropractors. The AMA also has opposed scope-of-practice expansions for nurse practitioners, and has fought proposals that would allow psychologists to prescribe antidepressants or optometrists to prescribe anti-glaucoma medications.
This knee-jerk self-preservationism is evident in the opening sentence of the American Medical News article: "Physicians who beat back scope-of-practice incursions in statehouses across the country are meeting a new foe [naturopaths]." That statement reveals an institution that is bent on using its power and political influence to get what it wants.

The AMA secretary-treasurer acknowledges that naturopaths spend more time with patients than medical doctors do, and suggests that this is one of the chief reasons patients seek "unproven" naturopathic care. While patients certainly prefer a thorough evaluation and carefully explained treatment plan to a hurried visit, the secretary-treasurer insults the American people by suggesting that a longer visit is the main attraction of alternative medicine.

Consider, for example, the child with recurrent otitis media. Conventional medicine typically offers three unappealing treatment choices: 1) put the child on antibiotics every day of his life, 2) put tubes in the ears (at a cost of $3,000) and risk secondary infection, scarring of the eardrums and other complications, or 3) do nothing and hope the condition does not recur. A naturopath, on the other hand, would usually look for hidden food allergies and prescribe a diet that excludes the symptom-evoking foods. Using this approach, recurrences can be greatly reduced or completely eliminated in more than half of cases. Conventional medicine continues to ignore the importance of dietary modification as a treatment for otitis media,1 even though the relationship between allergy and otitis media has repeatedly been demonstrated in peer-reviewed medical journals.2-6

A similar dietary approach has been used successfully by naturopaths, and resisted by conventional doctors, to treat patients with migraines, irritable bowel syndrome, rheumatoid arthritis, asthma, attention deficit-hyperactivity disorder, and other problems. Naturopaths also frequently achieve good results, using diet, nutritional supplements, herbs, and other modalities, with conditions such as fatigue, depression, premenstrual syndrome, insomnia, and fibromyalgia, as well as more serious diseases including Crohn's disease, heart failure, and diabetes.

The medical establishment claims that reliance on alternative practitioners will result in delayed diagnoses and the withholding of "proven" therapies. Naturopaths, however, like nurse practitioners, are trained in the basics of medical diagnosis. Moreover, they are taught to recognize when a referral to, or co-management with, a medical doctor is indicated. Ironically, it is the opposition to naturopathic licensure that is resulting in missed diagnoses (allergic otitis media, for example). Concerning the withholding of "proven" therapies, even a casual perusal of the medical literature would reveal how embarrassingly unproven much of conventional medicine is, and how well researched some alternative treatments are. And while some naturopathic treatments are based on empirical evidence, rather than controlled studies, it is instructive how many conventional doctors have consulted alternative practitioners when they or a family member became ill.
In a 1914 speech, James Bryce remarked that medicine is "the only profession that labors incessantly to destroy the reason for its existence." If the medical profession is to be worthy of that accolade today, it must drop its opposition to the emergence of naturopathic medicine.

Alan R. Gaby, MD

1. Paradise JL. A 15-month-old child with recurrent otitis media. JAMA 2002;288:2589-2598.
2. Nsouli TM, et al. Role of food allergy in serous otitis media. Ann Allergy 1994;73:215-219.
3. Derebery MJ, et al. Allergic eustachian tube dysfunction: diagnosis and treatment. Am J Otol 1997;18:160-165.
4. McMahan JT, et al. Chronic otitis media with effusion and allergy: modified RAST analysis of 119 cases. Otolaryngol Head Neck Surg 1981;89:427-431.
5. Ruokonen J, et al. Elimination diets in the treatment of secretory otitis media. Int J Pediatr Otorhinolaryngol 1982;4:39-46.
6. Viscomi GJ. Allergic secretory otitis media: an approach to management. Laryngoscope 1975;85:751-758.


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