Fifteen states and the District of Columbia formally recognize naturopathic practices by licensing naturopaths. While licensing has been in place for almost a century for some states—Connecticut passed its naturopathic licensing law in 1920, for example—it has developed as recently as 2004 in other states like California. In Canada as well, as noted in a 2006 article by Marja Verhoef, Heather Boon, and Donatus Mutasingwa in the journal Social Science and Medicine, the profession of naturopathic medicine is obtaining more formal recognition and government regulation. The issue of licensing has been no small matter for physicians around the continent. As noted by the Massachusetts Medical Society in a 2009 report, “licensure is interpreted by the public as an endorsement of the field.” The inevitable question is, then, should this field be endorsed at all? The opinions are mixed.
The Massachusetts Medical Society has adamantly argued for the past fifteen years that it should not. “Medicine is a science-based practice,” asserts William Ryder, Esq., regulatory and legislative counsel for the Massachusetts Medical Society. “There is very little consistency in the scientific base and belief system of naturopathic medicine.” Calling naturopathic doctors “nice people who are misguided” and the rising popularity of naturopathic medicine as a “disturbing movement,” he worries that allowing licensing and creating a regulatory board will allow the few naturopathic practitioners in the state to set standards that are helpful to them and potentially harmful for patients.
However, Dr. Dohn Krushwitz, a physician and professor at the National College of Naturopathic Medicine, counters that naturopathic medicine is a redeveloping medical field that does include growing research departments within naturopathic medical schools. Even so, he maintains, “Everything can’t be proven by research. Some things may not be research, but they’ve been used for hundreds of years and work fine.” He notes that even in mainstream medical practice there may still be “unscientific prescribing”—giving patients drugs with mechanisms that are not entirely understood.
Krushwitz was also careful to stress the rigorous education received by naturopathic doctors at accredited colleges like the National College of Natural Medicine in Portland, Oregon and Connecticut’s University of Bridgeport. Just like a traditional MD, an ND requires a four-year undergraduate degree for entrance. The four-year graduate program includes many of the same courses as those of traditional medical schools. Diverging from medical school curricula, ND programs include additional courses in nutrition, botanical herbs, and homeopathy while excluding other material, like major surgeries. After graduation, students generally take exams from the national licensing board, and for those who decide to become naturopathic physicians, their practice is limited by state recognition of such licenses.
The issue of licensing is brought up in the form of bills in numerous states every year, sparking recent controversies in several states, including Massachusetts and Colorado. Ryder emphasizes the difficulties of these battles: the legislative process is often about compromise, but when the matter at stake is the safety of patients, it really is a matter of whether or not this medical system works.
Professor Naomi Rogers, a Yale University Associate Professor of the History of Medicine, explained that the debate over medical licensing is not a new controversy. In the 1830s, every state abolished licensing laws. Conversation concerning who should be licensed renewed in the 1870s. While some wanted only orthodox doctors, most people wanted the ability to choose between different medical practitioners. As a result, a lot of laws set up multiple boards during the 1870s and 1880s, and physicians ranged from homeopathic to biomedical to “eclectic” doctors, who practiced a little bit of everything. However, since the medical society was not highly regulated, patients often did not know what kind of doctor they were seeing. Gradually, the system of multi-boards disappeared, and by the 1920s, boards and medical schools were predominantly of the biomedical system that has become mainstream medicine today. Throughout the twentieth century, though, there were always practitioners of alternative medicines that pushed for licensing. In the 1970s, as noted by Hans A. Baer in a 1992 article in the journal Medical Anthropology, naturopathy experienced a particular resurgence as a result of the holistic health movement that emerged in the United States during that time.
The current debates over naturopathic licensing are only the most recent, then, of a long series of battles over who should have the right to be recognized as a medical practitioner and—more significantly—what medical practices and theories are correct. Rogers explains, “The issue about practice is that if you don’t believe the premise, you’re more likely to see what’s wrong with the specifics. The question is what standards do you use to judge.” As naturopathic medicine continues to grow, that is the question that physicians, lawmakers, and patients all struggle to answer.
This article was updated on 9/2/2011.