Holistic Part 2

A SCIENTIFIC LOOK AT ALTERNATIVE MEDICINE

Homeopathy, Naturopathy, Energy Medicine, and Other "Holistic" Approaches

Part 2: Naturopathy

Thomas J. Wheeler, Ph.D.

Associate Professor (retired), Department of Biochemistry and Molecular Biology,

University of Louisville School of Medicine, Louisville KY

thomas.wheeler@louisville.edu

Revised 2020

This original version of this material was a part of a handout for an elective course given to medical students at the University of Louisville.

DISCLAIMER: The material presented here is not medical advice. It represents the author's summary of scientific evidence concerning various topics. For medical advice, see your physician.

A pdf file containing all parts and references can be downloaded from ARTICLES or HOLISTIC.

CONTENTS OF PART 2

Naturopathy: Background Research

Principles Scientific critique

Practice and scope Adverse effects

Regulation Other points

Research References

NATUROPATHY: BACKGROUND

Naturopathy is a system of healing with "natural" means such as diet and lifestyle. It may include vitamins, herbs, exercise, massage, etc., and incorporate alternative approaches such as iridology, acupuncture, hair analysis, and homeopathy. Naturopaths may oppose use of drugs and advocate natural childbirth outside of the hospital. "Naturopathy did not spring from a unified doctrine and lacks coherence in both theory and practice. It is characterized by a miscellany of vitalistic approaches..." (Raso 1994. “Alternative” Healthcare: A Comprehensive Guide).

"Vitalism is 'a doctrine that the functions of a living organism are due to a vital principle distinct from physicochemical forces' [Webster's New Collegiate Dictionary] which denotes a paranormal 'Life Force.' Vitalists are generally not only nonscientific, but antiscientific because they abhor the reductionism (v. holism), materialism (v. etherealism) and mechanistic (v. mystical) causal processes of science. Its belief in Vitalism (Vis Medicatrix Naturae) can be seen in its over-riding tendency to overstate the body's self-healing power, and the beneficence of 'natural' remedies (eg, whole herbs alleged to be superior to drugs extracted from them)" (Jarvis 1997. NCAHF Fact Sheet on Naturopathy. National Council Against Health Fraud).

"Sebastian Kneipp, born in Stephansried, Germany, in 1821...was a pioneer of the European nature cure movement, which inspired naturopathy in the United States and provided the foundations for modern naturopathic medicine...Even after his death in 1897, his holistic approach to health and healing continued to thrive. Organized in various confederations, associations, and institutions across 40 countries under the umbrella of Kneipp Worldwide, the Kneipp movement, with its 170,000 members...constitutes one of the largest noncommercial global health promotion organizations. Perhaps the most visible legacy of Kneipp's philosophy in the 21st century is the continued practice of offering his holistic therapy concept (known as Kneipp Kur) in hundreds of accredited Kneipp spas and health resorts across Europe. In Germany, for example, the 'Kneipp Cure' was recognized in 1953 as a legitimate form of rehabilitation therapy reimbursable through the country's public health insurance fund and has remained so, albeit to a lesser extent, to this day" (Locher and Pflorr 2014. J Altern Complement Med. 20(7):521-6).

"Naturopathy was named and popularized in the United States by Benedict Lust, who was born in Germany in the late 1800s. When Lust became seriously ill with what he believed was tuberculosis, he was treated by a priest and healer in Germany named Sebastian Kneipp. Kneipp’s treatment was based on various healing approaches and philosophies that were popular in Europe, including:

Hydrotherapy (water treatments).
The 'nature cure' movement, which focused on restoring health through a return to nature. This movement advocated therapies such as gentle exercise, herbal medications, wholesome dietary approaches, and exposure to sun and air.

"Lust found his health much improved from Kneipp’s treatment, and when he immigrated to the United States at the turn of the 20th century, he was dedicated to popularizing it. He gave it the name naturopathy, led the way in developing it as a medical system in the United States, and founded the first naturopathic college and professional association. In naturopathy’s early years, other therapies were added to its practice - for example, homeopathy and manipulation (a hands-on therapy).

"Naturopathy’s popularity reached its peak in the United States in the 1920s and 1930s. However, its use began to decline when drugs (such as antibiotics) and other developments in conventional medicine moved to the forefront of health care. Naturopathy began to reemerge in the 1970s, with increased consumer interest in 'holistic' health approaches and the founding of new naturopathic medical colleges" (National Center for Complementary and Alternative Medicine 2007. An introduction to naturopathy). The number of licensed NDs in the US and Canada nearly doubled from 2001 to 2006.

"Possibly more than any other CAM system, naturopathic medicine has a whole-person focus that supports both the development of a knowledge base and the embodiment of behavioral patterns that promote and sustain a patient's optimal health and well-being (not just the absence of symptoms) over a lifetime" (Sutherland 2011. J Altern Complement Med. 17(11):981-2).

There are currently six U.S. and two Canadian colleges or universities offering naturopathic training; the most prominent is Bastyr University in Seattle. These offer the N.D. degree. In 2019 the University of Bridgeport announced that it was phasing out its naturopathy program.

"A review of the curricula of accredited naturopathic schools shows that their courses of study include a mixture of medical discards (eg, colonics, water therapies, herbalism), pseudosciences (eg, acutherapy, homeopathy, gravity guidance, hair analysis for nutritional assessment, cleansing - at least one college offers preceptorships at Mexico border clinics which traffic in cancer quackery), and modalities expropriated from biomedicine (eg, nutritional counseling, hypnosis, natural childbirth, psychological counseling). An important difference is that at medical schools these topics are likely taught by more a [sic] qualified faculty, and applied with greater restraint by better trained and more rational practitioners. Much financial support for naturopathic education comes from the health foods industry, herbal trade associations, homeopathic suppliers, and other's [sic] who disdain consumer protection law and science" (Jarvis 1997. Op. cit.).

Gorski (2016 May 16. Science-Based Medicine blog) wrote, "Within naturopathy, there are two types of practitioners, traditional naturopaths and 'naturopathic physicians.' In reality, from my perspective there is little difference between the two, other than that 'naturopathic physicians' have graduated from 'accredited' schools of naturopathic medicine and hold the 'ND' degree...Both naturopaths and NDs embrace a wide variety of quackery, which they mix with some sensible lifestyle and diet advice, which is 'rebranded' as somehow being unique to naturopathy."

Naturopathy is not covered by Medicare or most insurance plans. Four states require insurance to cover.

Naturopathic medicine "is typically practiced within a fee-for-service health care delivery model. A survey of U.S. NDs revealed that the average fees range from $100 to $200 per office visit" (Tippens et al. 2012. Med Anthropol Q. 26(2):257-70).

PRINCIPLES

Naturopathy is based on the idea that diseases are caused by toxins that can be eliminated by natural methods. "Most naturopaths believe that virtually all diseases are within their scope of practice" (Raso 1994. Op. cit.). Naturopathy has roots in the 19th century hydropathy (water-cure) movement, as well as in Naturophilosophie, a romantic movement.

"The practice of NM is guided by six philosophical principles. These principles include honoring the healing power of nature (vis medicatrix naturae), identification and treatment of underlying causes (tolle causam), the promise to first do no harm (primum non nocere), doctor as teacher (docere), treatment of the whole person, and emphasis on prevention and wellness" (Tippens et al. 2012. Op. cit.).

"When discussing determinants of health, naturopaths consider inborn factors (genetic makeup, maternal exposure–nutrition, and constitution); lifestyle factors; exposure to nature (fresh air, clean water, light); diet, nutrition, and digestion; social factors (culture, loving and being loved, meaningful work, community); and physical, psychological, and emotional stress" (ibid.).

PRACTICE AND SCOPE

"Naturopathy is most accurately viewed as a 'whole system' medical practice, representing not a distinct modality, but rather a paradigm guiding the selection and prescription of relatively complex, individualized, multimodality treatment regimens" (Elder 2013. Perm J. 17(4):80-3).

"Naturopathy is eclectic (practitioners select whatever he/she personally likes from a cacophony of philosophically-based procedures), and empirical (practiced by subjective clinical experiences)" (Jarvis 1997. Op. cit.).

Atwood (2001. Naturopathy: a monograph) wrote: "If there is a modus operandi that seems to characterize the field of naturopathy, it is the ease with which it embraces virtually any unlikely pseudoscientific health claim, no matter how preposterous, while denigrating scientific medicine."

Boon et al. (BMC Complement Altern Med. 2004 Oct 20;4:14) surveyed practice patterns in Washington and Connecticut. “Almost 75% of all naturopathic visits were for chronic complaints, most frequently fatigue, headache, and back symptoms...The most commonly prescribed naturopathic therapeutics were: botanical medicines (51% of visits in Connecticut, 43% in Washington), vitamins (41% and 43%), minerals (35% and 39%), homeopathy (29% and 19%) and allergy treatments (11% and 13%).” 75% of visits were by women.

A survey of NDs in the U.S. (Allen et al. 2011. J Altern Complement Med. 17(12):1175-80) found that 92% employed detoxification therapies. "Over 75% of respondents utilized detoxification therapies primarily to treat patients for environmental exposures, general cleansing/preventive medicine, gastrointestinal disorders, and autoimmune disease. Regarding methods used, >75% reported using dietary measures, reducing environmental exposures, and using botanicals as detoxification therapies." Dietary measures included "'cleansing foods,' increased fruit/vegetable intake, vitamin/mineral supplementation, organic foods, elimination diet, probiotics, and stool bulking agents/fiber...and liver, gallbladder, or lymphotrophic botanicals, such as cholegogues (herbs that promote the excretion of bile), and lymphogogues (herbs that promote lymphatic flow...)."

"Attention to the individual needs of the patient can be reflected in the way NDs engage their patients as active participants in the healing process...Emphasis on the individual is also reflected in the amount of time NDs take to 'hear the story' and to understand multiple dimensions of a person's health-related concerns. Through this relationship, shared decision making is prioritized, and patients are empowered and motivated to make educated decisions about their own health...NDs focus on individual behavior change through the clinical delivery of health education and health promotion counseling...The emphasis on prevention and health promotion cultivates a proactive worldview and empowers patients to engage in self-care" (Tippens et al. 2012. Op. cit.).

"Observational studies of naturopathic practice have found that health promotion counseling on diet, physical activity, and stress management is incorporated into almost every clinical encounter (80%-100%) and is reinforced over successive patient visits" (Wardle and Oberg 2011. J Altern Complement Med. 17(11):1079-84).

Naturopaths "seem to promote eating patterns that may appear faddish to the internist. For example, patients who visit naturopaths are almost universally advised to discontinue consumption of wheat and dairy products" (Elder 2013. Op. cit.).

"NDs, as best I can tell, are prolific in their testing of every bodily fluid and structure they can access...Hair, blood, urine, saliva & stool all get sent to ’specialty’ labs and, not unsurprisingly, they find abnormalities that need treating" (Crislip 2017 Apr 14. Science-Base Medicine blog).

In recent years naturopaths have begun operating stem cell clinics, an area where there is rampant abuse and few if any treatments have been shown to be safe and effective.

Naturopaths have created a specialty of naturopathic oncology, participating in the care of cancer patients in integrated medical centers.

In August, 2019, "A Naturopathic Clinic in Washington has signed what is believed to be the first ever contract with a benefits administrator of the Veterans Health Administration (VHA) to provide services to veterans. This marks the first time that a federal payor has recognized naturopathic doctors (NDs) as an eligible provider type, although naturopathic doctors have been providing medical care to vets paying out of pocket for decades" (PRWeb 2019 Aug 14. Veterans granted access to naturopathic physician care).

REGULATION

Naturopathy is licensed or regulated in 22 states, two territories, and the District of Columbia as of 2019. There were estimated to be about 10,000 naturopaths (this total probably includes other health professionals who use some naturopathic approaches); 4000-5000 graduates of naturopathic colleges; and 6000 licensed practitioners in U.S. as of 2017. Professional associations: American Association of Naturopathic Physicians; American Naturopathic Medical Association.

"Because health care is constitutionally governed at the state level, the scope of naturopathic practice varies by state but typically includes the ability to prescribe medications, perform minor surgery, and other elements commensurate with primary care responsibilities and practices required for acute care in medicine. Additionally, NDs' scope emphasizes prevention and chronic disease management using elements that are less emphasized in biomedicine such as nutritional and behavioral counseling" (Tippens et al. 2012. Op. cit.).

"Naturopaths want to have it both ways. They like to portray themselves as purveyors of 'natural' treatments that 'stimulate the body's self-healing ability' and as experts at prevention and management of chronic diseases. But what they really want is exactly the same broad-scope privileges as MDs and DOs, from pre-natal care right down to pulling the plug on the terminally ill" (Bellamy 2017 Jun 8. Science-Based Medicine blog).

An article by Robbins noted that "The makers and sellers of herbs and supplements have a big stake in the expansion of naturopathy - and they're putting money behind it" (2016 May 17. Naturopaths, often derided as quacks, push to go mainstream - with help from vitamin companies. STAT).

In Colorado, registered naturopaths may refer to themselves as "doctor" but not "physician."

In 2018 a judge in the province of New Brunswick ruled that "naturopaths cannot claim that they are 'medically trained' or that they offer 'family practice'" (Gavura 2018 Dec 27. Science-Based Medicine blog).

"It is interesting that state legislatures continue to include homeopathy as a staple in naturopathic licensing bills even after the FDA has put everyone on notice that no homeopathic remedy has been approved by the FDA, as required by federal law, thus making all of them 'subject to FDA enforcement action at any time'...In other words, state legislatures are attempting to authorize the prescription and sale of illegal drugs" (Bellamy 2018 Dec 6. Science-Based Medicine blog).

In 2019, the "FDA issued a proposed rule rejecting eleven substances nominated by the American Association of Naturopathic Physicians (AANP) and like-minded organizations for use in drug compounding, including curcumin and cesium chloride" (Bellamy 2019 Sep 26. Science-Based Medicine blog).

RESEARCH

Beyerstein and Downey (2000. In Sampson and Vaughn, editors, Science Meets Alternative Medicine) noted that their “bibliographic searches failed to discover any properly controlled clinical trials that supported claims of the profession, except in a few limited areas where naturopaths’ advice concurs with that of orthodox medical science. Where naturopathy and biomedicine disagree, the evidence is uniformly to the detriment of the former.”

Many studies of naturopathy are outcome studies, where patients receiving naturopathic care are compared to those receiving conventional medical care.

SCIENTIFIC CRITIQUE

Naturopathy employs numerous approaches from different areas of alternative medicine. Scientific critiques of these methods are provided elsewhere in the corresponding articles on these areas. This section deals with critiques specifically related to the overall practice of naturopathy.

In the article "Why naturopaths should not be licensed," Atwood (2001. Quackwatch) listed some of the reasons that the Massachusetts Medical Society gave for opposing licensure. Among them were:

Naturopathy is both potentially and actually injurious when practiced according to the accepted standards of the profession. This injury is likely to be due to the failure of the naturopathic practitioner to recommend appropriate medical treatment.
Unscientific naturopathic beliefs pose irrational challenges to proven public health measures, most notably childhood immunizations.
Irrational, unscientific beliefs and practices abound in naturopathy, likening it more to a cult than to a valid form of health care. These beliefs and practices are not merely at the fringes but are the standards of the field. They are advocated by the leaders themselves.
Naturopathic practitioners are incapable of self-regulation commensurate with public safety. No study has demonstrated that naturopaths who attend full-time schools are any less dangerous than those who have mail-order degrees.
Naturopaths prescribe numerous 'natural medicines' with a standard for safety and efficacy that is unacceptably low, as evidenced by the leading textbook in the field.
The scientific pretensions of naturopathy and naturopathic training programs are baseless. There is ample evidence that the basic science courses do not teach students to think critically. Research performed at naturopathic colleges is lacking in scientific rigor and has not investigated common naturopathic claims. The libraries at naturopathic colleges are filled with books and journals that promote trendy but implausible notions regarding health care...
Naturopathy involves many nonsensical diagnostic practices that mainstream medicine considers quackery but naturopaths consider standard.
There are ubiquitous claims of dubious clinical "syndromes," among which are multiple "food allergies," "toxemia," and chronic yeast infections, which cast further doubt on the science and ethics of naturopathic practice.
The duration and setting of naturopathic clinical training, even overlooking its content, is inadequate for producing competent primary care physicians. This is clear from a comparison of the training of medical doctors to that of naturopaths. Just as a newly graduated medical doctor, no matter how well-intentioned, would not be allowed to assume the role of a primary care physician, neither should this be allowed for a naturopath whose training is clearly inferior.

Britt Hermes, who graduated from Bastyr University and who now publishes the blog Naturopathic Diaries, has been highly critical of naturopathic training and practice. Among her points:

"NPLEX, the naturopathic licensing exams administered by the North American Board of Naturopathic Examiners (NABNE), is written entirely by naturopaths and does not have the same level of transparency as the USMLE or COMPLEX-USA, which undergo an external audit process to maintain common standards, evidence-based rigor, and high-quality assessment" (Hermes 2015 Mar 13. Science-Based Medicine blog).
Hours of coursework are misleading "because dubious coursework is inappropriately lumped into other legitimate categories" (ibid.).
Clinical hours are inflated because they count time when students are merely observing as "direct patient contact." Moreover, many of these hours can be in homeopathic training.
"My clinical training included such a small amount of pharmacological experience that it hardly seems worth mentioning. I spent far more time learning how to write a prescription for botanical medicines than how to prescribe appropriate pharmaceutical medications" (ibid.).
Students often do not have direct contact with patients suffering the various conditions that they supposedly are trained to treat.
Similarly, there was a lack of actual patients on which to practice various types of examinations, with students often practicing on each other.

"In short, naturopathic clinical training is not on par with medical or osteopathic doctors and is in fact far less, in terms of quantity and quality - and also less than nurse practitioners and physician’s assistants. Of the hours that Bastyr provided to me and my classmates in purported primary care training (748 hours), one quarter of this time was spent in case preview and review. The remaining 75% (561 hours) contained dubious diagnostics and experimental treatments that were so embedded within a pseudo-scientific and pseudo-medical practice that the student clinician loses the ability to assess what is truth and what is make-believe" (ibid.).

In another article, Hermes (2016 Apr 14. Naturopathic Diaries blog) noted that " it is entirely possible that a naturopathic student could graduate without seeing any pediatric patients...a pediatrician gets a combined 20,000 hours of training in medical school and residency; a licensed naturopath has the option of doing a naturopathic residency for 1,300 hours after having done 30 to 40 hours of lecture hours in pediatrics. That difference speaks for itself...My class notes contain clinical pearls on using homeopathic remedies to treat febrile seizures, ear infections, burns, and snake bites." Hermes (2015 Mar 13. Science-Based Medicine blog) has also pointed out that "There are no naturopathic standards of care."

Crislip (2017 May 12. Science-Based Medicine blog) pointed out that "it is residency where physicians really learn clinical medicine. There has never been an MD/DO medical student, freshly graduated, who is even remotely able to care for patients on their own, and that is with three times the clinical experience that an ND receives. A lack of experience defines NDs, who go from ND school straight to practice." Naturopathic residencies are uncommon because they are not required by most states.

"Over time...electives in homeopathy were introduced into the curriculum of naturopathic medical programs, and by 1978, the leading North American institution required a 40-hour minimum in homeopathy...that curriculum commitment has ballooned to 140 hours. Information concerning mandatory clock hours provide little specificity concerning the precise details of the homeopathic instruction; however, because it was decided that naturopathic national board exams will test basic knowledge of dozens of common homeopathic remedies, instruction radiates around the nucleus of remedies as a form of biomedicine (as if on par with the differences between fluoxetine and sertraline), and encourages rote memorization. This approach also discourages the application of critical appraisal pertaining to these common remedies and homeopathy as a theoretical system..." (Nelson et al. 2019. J Evid Based Integr Med. 24:2515690X18823696).

"Last year, the North American Board of Naturopathic Examiners (NABNE), which administers the NPLEX exam, admitted that naturopathic education and training was insufficient for prescribing privileges, claims to the contrary made by the American Association of Naturopathic Physicians notwithstanding. The NPLEX, according to the NABNE, tested only a naturopath’s knowledge of drugs commonly prescribed by other practitioners, not whether the naturopath herself could safely and effectively prescribe drugs" (Bellamy 2017 Apr 13. Science-Based Medicine blog).

Hall (2018 Aug 14. Science-Based Medicine blog) reviewed Textbook of Natural Medicine, the leading textbook in naturopathy. "It is hard for me to fathom how such a textbook could exist in the 21st century and how anyone could characterize it as scientific. Despite the plentiful citations, the content is a bizarre, uneven potpourri of good science, bad science, pseudoscience, vitalism, philosophy, ancient history, superstition, gullibility, misrepresentations, metaphysics, religion, hearsay, opinion, and anecdotes...Right alongside good conventional evidence-based medical information and advice, it recommends using treatments that are purely speculative and even treatments have been proven not to work... the things that NDs do that are good are no different from what good MDs do; and the things they do that are different are not good."

"Particularly popular among naturopaths is a belief that disease is caused by 'toxins.' These toxins are seldom validated by science. In many cases, they aren’t even identified. Yet, 'detoxification' is a major theme in naturopathic treatments, with unscientific and sometimes dangerous treatments, such as chelation therapy (to 'detoxify' heavy metal overload) and colon cleanses, including the infamous coffee enemas, being advocated to help patients 'detoxify'" (Gorski 2016 May 19. Respectful Insolence blog).

"Naturopaths contend that theirs is 'natural medicine' that is much less toxic and causes many fewer side effects; sometimes it’s claimed that there will be no side effects. Yet their treatment regimens are often quite onerous. For example, read the description of this woman’s regimen, which got to the point where she had to get up earlier every morning just to 'go through all my stuff.' She spent thousands on 'myriad pills, drops, powders and ointments the naturopath advised her to take.' Then consider other alternative cancer treatments favored by naturopaths, like the Gerson protocol, which requires drinking thirteen organic juices (which have to be prepared fresh hourly) and well over a hundred supplement pills per day, as well as a basic organic whole food plant-based diet plus five coffee enemas per day" (Gorski 2017 Sep 5. Respectful Insolence blog).

"The sale of dietary supplements out of naturopathic clinics is a mainstay of naturopathic practice. Most naturopaths sell dietary supplements directly to their patients for a large profit margin after prescribing them for health benefits. This is a glaring conflict of interest" (Hermes 2016 May 21. Naturopathic Diaries blog).

"One reason naturopaths (NDs) are held in low regard is their historical opposition to immunization. Some naturopaths now claim that this opposition does not reflect the current view of NDs trained in accredited schools. However, a close look indicates that opposition is still widespread and that anti-vaccination views are deeply rooted within the educational system" (Barrett 2019 May 31. Naturopathic opposition to immunization. Quackwatch). Recent surveys have shown that very few naturopaths support the recommended CDC vaccination schedule. However, "In 2016, the Naturopathic Academy of Primary Care Physicians (NAPCP) published a position paper on immunizations that is 100% in line with the scientific community and includes giving a copy of the CDC schedule for patients or parents to sign" (ibid).

ADVERSE EFFECTS

A danger in naturopathic practice relates to the "belief in the so-called healing crisis which holds that adverse reactions associated with their practices (herbal remedies, fasting, colonics, etc.) are due to 'toxins' being expelled; and, that the worse are these adverse symptoms the worse would have been the future diseases being prevented. This false belief allows a naturopath to assert that the patient is 'getting better' if they feel good, bad, or indifferent" (Jarvis 1997. Op. cit.). Thus, potentially dangerous conditions may remain untreated by effective medical procedures.

In 2017, a 30-year old woman died after receiving intravenous turmeric from a naturopath. The "death should not be seen as an isolated incident at the hands of a rogue practitioner. Naturopathic doctors across California advertise intravenous therapies with dangerous substances, including hydrogen peroxide, ultraviolet light and ozone gas" (Hermes 2017 Mar 27. Naturopathic doctors look bad after California woman dies from turmeric injection. Forbes). Contrary to the idea that licensure would protect the public, the naturopath in this case was licensed, and indeed was a graduate of the leading naturopathic institution, Bastyr University. Bellamy (2017 Apr 13. Science-Based Medicine blog) pointed out that "This tragedy is the direct result of...the California legislature having foolishly decided, in 2013, to add IV administration to the naturopathic scope of practice."

Hermes (2016 Oct 13. Naturopathic Medicine Week and the problem of endemic quackery, like ozone therapy. Forbes) noted that ozone therapy, a discredited and potentially dangerous therapy, is practiced by many naturopaths and is even taught at some naturopathic schools.

Gorski (2017 Sep 4. Science-Based Medicine blog) wrote: "...despite what 'NDs' claim, there really isn’t any substantive difference that I’ve ever been able to find in the level of quackery practiced by NDs or non-ND naturopaths. Basically, licensed naturopaths are no safer than any other naturopath."

In 2017, a woman in labor was treated with homeopathic remedies for nine hours by the naturopath administering a birthing center, even though there were signs the baby was distressed (it later died). The naturopath "was absolved of any liability for the baby’s death. The naturopathic board ruled that she had acted like any licensed naturopath in her position could be expected to act" (Hermes 2017 Dec 28. Naturopathic Diaries blog).

OTHER POINTS

"A common dilemma arises when the patient has insurance coverage for tests if ordered by allopathic, but not naturopathic, physicians. To avoid out-of-pocket expenses, such patients frequently contact their internist requesting that s/he order tests recommended by a naturopath. Yet because of differentials in paradigm and/or clinical experience, naturopaths commonly order laboratory tests that are either unrecognizable or seem inappropriate to internists. The most frequent example relates to evaluation and management of thyroid disorders. Naturopathic physicians will commonly recommend multiple hormone studies, including T3 and T4 levels, in settings where, from a primary care internal medicine perspective, the sensitive thyroid stimulating hormone (TSH) test is the only appropriate test" (Elder 2013. Op. cit.).

"Natural Hygiene, a Spartan form of naturopathy, is a comprehensive philosophy of health and 'natural living' whose ideal diet consists exclusively of vegetables, fruits, nuts, and seeds - all uncooked and minimally processed" (Raso 1994. Op. cit.). It was popularized by Harvey and Marilyn Diamond (Fit for Life and Living Health) and the American Natural Hygiene Society. Natural Hygiene rejects medications, blood transfusion, radiation, and dietary supplements.

REFERENCES

Naturopathy - overview

Fleming SA, Gutknecht NC. 2010. Naturopathy and the primary care practice. Prim Care. 37(1):119-36

National Center for Complementary and Integrative Health. 2017. Naturopathy

Locher C, Pforr C. 2014. The legacy of Sebastian Kneipp: Linking wellness, naturopathic, and allopathic medicine. J Altern Complement Med. 20(7):521-6 [abstract]

Naturopathy - practice and scope

Barrett S. 2013. A close look at naturopathy. Naturowatch

Boon HS, Cherkin DC, Erro J, Sherman KJ, Milliman B, et al. 2004. Practice patterns of naturopathic physicians: Results from a random survey of licensed practitioners in two US states. BMC Complement. Altern Med. 4:14

Allen J, Montalto M, Lovejoy J, Weber W. 2011. Detoxification in naturopathic medicine: a survey. J Altern Complement Med. 17(12):1175-80

Tippens KM, Oberg E, Bradley R. 2012. A dialogue between naturopathy and critical medical anthropology: toward a broadened conception of holistic health. Med Anthropol Q. 26(2):257-70 [first page]

Hermes B. 2016 Apr 14. Naturopathic pediatrics is not safe. Naturopathic Diaries

Gorski D. 2016 June 1. The quackery that is "naturopathic oncology." Respectful Insolence

Novella S. 2016 Sep 6. Naturopathic cancer quackery. Science-Based Medicine

Gorski D. 2017 Jun 26. You can't have naturopathy without antivax. Respectful Insolence

Gorski D. 2017 Sep 4. Naturopaths are fake doctors cosplaying real doctors (even the ones running dubious stem cell clinics). Science-Based Medicine

Gorski D. 2017 Dec 12. The quackery of "naturopathic oncology" is metastasizing. Respectful Insolence

Gorski D. 2018 Feb 2. More naturopathic propaganda claiming lifestyle interventions as their own and adding quackery. Respectful Insolence

Hall H. 2018 Jul 3. How naturopaths treat heart disease. Science-Based Medicine

Barrett S. 2019. Naturopathic opposition to immunization. Quackwatch

Gorski D. 2019 Mar 18. The Oncology Association of Naturopathic Physicians publishes Principles of Care Guidelines. Not surprisingly, they aren’t science-based. Science-Based Medicine

Hall H. 2019 Sep 24. Naturopathy in the VA. Science-Based Medicine

Gorski D. 2019 Oct 7. A horrifying survey of “pediatric naturopathic oncology” practice. Science-Based Medicine

Ernst E. 2019 Oct 10. Naturopathy for children with cancer? Edzard Ernst

Naturopathy - regulation

Relman AS. 2002. Licensure of Naturopathic Physicians. Quackwatch [“A Statement Approved by the Board of Registration in Medicine of the Commonwealth of Massachusetts,” arguing that naturopaths are not qualified to be independent primary care physicians]

Atwood KC. 2001. Why naturopaths should not be licensed. Quackwatch

Gorski D. 2016 May 19. Naturopaths and supplement manufacturers: In bed together to promote naturopathic licensure. Respectful Insolence

Gorski D. 2017 Mar 22. Naturopaths cynically use the murder of a quack to promote naturopathic licensure. Respectful Insolence

Bellamy J. 2017 Jun 8. What naturopaths really want. Science-Based Medicine

Bellamy J. 2017 Jul 20. Naturopathic conquest of New England nears completion. Science-Based Medicine

Bellamy J. 2017 Dec 21. Legislative alchemy 2017: Naturopathy. Science-Based Medicine

Bellamy J. 2018 Dec 6. Legislative alchemy 2018: Naturopathic licensing and practice expansion shutout? Science-Based Medicine

Bellamy J. 2020 Jan 16. Legislative alchemy 2019: Naturopaths gain licensure in two states, try for authority to grant vaccination medical exemptions. Science-Based Medicine

Naturopathy - scientific critiques

Barrett S. Naturowatch

Hermes BM. Naturopathic Diaries

Relman AS. 2001. Textbook of Natural Medicine. Quackwatch [critique of a widely-used naturopathic text]

Beyerstein BL, Downie S. 2004. Naturopathy: A critical analysis. Naturowatch

Bellamy J. 2015 Mar 5. “Naturopathic Diaries: Confessions of a Former Naturopath.” Science-Based Medicine

Lipson P. 2016 May 12. Naturopaths: Fake doctors in white coats. Forbes

Hermes B. 2016 May 21. Fact-checking naturopathic talking points at DCFLI. Naturopathic Diaries

Bellamy J. 2016 Sep 15. NCCIH funds sauna “detoxification” study at naturopathic school. Science-Based Medicine

Hermes BM. 2016 Oct 13. Naturopathic Medicine Week and the problem of endemic quackery, like ozone therapy. Forbes

Thielking M. 2016 Oct 20. "Essentially witchcraft": A former naturopath takes on her colleagues. STAT

Crislip M. 2017 Apr 14. Naturopathic experiences: Remembrance of things past. Science-Based Medicine

Crislip M. 2017 May 12. Naturopathic edumacation: A FAQ. Science-Based Medicine

Interlandi J. 2018 Feb 1. How "natural" doctors can hurt you. Consumer Reports

Roos D. 2018 Feb 15. A former naturopath blows the whistle on the industry. Howstuffworks

Hall H. 2018 Aug 14. Naturopathy textbook. Science-Based Medicine

Naturopathy - adverse effects

Gorski D. 2017 Mar 23. An as yet unidentified “holistic” practitioner negligently kills a young woman with IV turmeric (yes, intravenous). Respectful Insolence

Gorski D. 2017 Apr 11. Death by intravenous “turmeric”: Why licensed naturopaths are no safer than any other naturopath. Respectful Insolence

Gorski D. 2017 Aug 7. Naturopathy and dubious compounding pharmacies: A deadly combination. Science-Based Medicine

Hermes B. 2017 Dec 28. A naturopath-midwife, homeopathy, and a dead newborn. Naturopathic Diaries

Bellamy J. 2019 Sep 26. FDA proposes ban on curcumin and other naturopathic favorites in compounded drugs. Science-Based Medicine

MAIN PAGE HOLISTIC

OTHER PARTS:

Part 1: Homeopathy Holistic Part 1

Part 3: Other "holistic" approaches: aromatherapy, bodywork, iridology, reflexology, and others Holistic Part 3

Part 4: Energy medicine and "New Age" healing Holistic Part 4