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,
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
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
2. Nsouli TM, et al. Role of food allergy in serous otitis media. Ann
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.