Although Colorado has a robust system of natural health care practitioners, its Naturopathic Doctors (NDs) are not officially recognized or regulated by the state government. Often, this puts NDs at risk of being criminally prosecuted for using diagnostic tools and treatments for which they have received extensive education and training.
For over a decade, the 150 or so Naturopathic Doctors practicing in Colorado have attempted to become officially regulated and licensed. Two groups have consistently opposed ND licensure: the Medical Doctors (MDs) and the traditional Naturopaths. This article attempts to fairly describe the perspectives of all the stakeholders in this debate.
First, some helpful definitions.
Naturopathic Doctors. These individuals have a bachelor's degree and at least four years post-grad medical education and training from one of seven accredited naturopathic medical schools. They are licensed in 16+ US states and many other countries to diagnose diseases and injuries, and treat or prevent them using a defined set of natural medical tools, drugs, and practices. Generally, they do not prescribe controlled pharmaceuticals, perform invasive surgery, or treat with x-ray therapies. They do have access to medical testing and diagnostic facilities, and often work in tandem with MDs. Their treatments of choice are natural, non-invasive, botanical and nutritive formulations. The oath of a ND starts with "I will do no harm" and his or her practice is focused on supporting the innate ability of the human body to heal itself. To this end, NDs incorporate a holistic approach to diagnosis and treatment by identifying emotional, social, behavioral aspects of a patient's symptoms along with the current and past specific and particular symptoms the patient presents. ND's practicing in states without licensure often depend on their licensure in another state as a proxy for official professional standing.
Traditional Naturopaths. Traditional Naturopaths differ only slightly from Naturopathic Doctors. On the surface, Traditional Naturopaths may have less formal education and training, or may have received their degree from a naturopathic medicine program that is not accepted as an accredited institution. However, Traditional Naturopaths may be equally or more effective as other medical practitioners in identifying and healing many complex and chronic conditions that respond to natural health care treatment modalities. Nevertheless, their lack of formally accepted medical credentials has caused the mainstream medical establishment to marginalize their contributions and denigrate many of their healing modalities. Traditional Naturopaths rarely have legal access to medical testing facilities and may not prescribe controlled drugs.
Medical Doctors. Medical Doctors have completed training similar to Naturopathic Doctors, but have chosen to specialize in medicine that is heavily dependent on invasive practices and potentially dangerous pharmaceutical drug interventions. MDs tend to have a bias toward suppressing symptoms of a condition rather than supporting the structure and function of body to mitigate its underlying causes. An MD's standard of care may also be highly modulated by liability concerns, lack of specific training, or insurance reimbursement requirements. In addition, in conventional medical theory diseases are often compartmentalized into single entities represented by a set of differentiated symptoms. Each "disease" is coded with a number, and a predetermined treatment plan is ordered for the patient -- usually prescription drugs or surgery. The MD's oath of practice avoids stating that he or she will “do no harm”. Instead, the potential harm of a particular drug or treatment is weighed against the potential risks from the condition itself. In spite of these shortcomings, most MDs are the gatekeepers that allow patients to safely access potentially valuable diagnostics, services, and therapies for many conditions.
Osteopaths, Homeopaths, and Chiropractors. These groups of practitioners all have two things in common with Naturopaths. First, the MD's have tried to outlaw their professions to put them out of business for good. Second, their patients sought out their services anyway. Osteopaths are MDs who have also specialized in the physical manipulation of muscle and tissue to aid in relief and healing. Homeopaths use special preparations of diluted medicine designed, much like vaccines, to stimulate the body's awareness of, and restorative response to, a particular health condition. Chiropractors specialize in the manipulation of the position of bones and joints to ensure that blood flow and nerve activity are functioning properly.
Quacks, Charlatans, and Snake Oil Salesmen. You know who they are, and you know they can be found in all professions. The MD who misdiagnoses ailments, mistreats conditions, ignores potential side effects, orders unnecessary and expensive tests, or orders expensive surgery in a facility she owns to pump up its profits. The Chiropractor who claims that all disease is caused by subluxation of nerves in the spine. The Naturopath who delays a cancer treatment in hopes that just a change in diet will be a cure. The important point to be gained here is that when we speak of each of the healing arts professions, we are talking about the well-trained, honorable and responsible practitioners. It is a great mistake to characterize MDs, NDs, Traditional Naturopaths, Osteopaths, Homeopaths, Chiropractors and other health practitioners based on tired anecdotes about occasional bad actors.
Anachronistic Antagonism. Like ranting at an old Pope for once insisting the sun circled the earth, so should we avoid going back in time to dig up a profession's embarrassing theories and practices that were long ago abandoned. Yes, the MD's infected thousands of helpless patients while refusing for thirty years to implement sanitary sterilization practices after the Naturopaths proposed the theory of microbial infection and established sterile practices in naturopathic hospitals and surgeries. And yes, the Naturopaths hoped at the time that all disease could be cured by activating a body's innate ability to recognize the cause of its disease and heal itself. So what? Currently accepted practices and standards are what matter now, and only by thinking clearly about how all of these very different approaches to health care can fit into an affordable and functioning system will we be able to make good policy decisions.
In Colorado, the accredited Naturopathic Doctors are between a rock and hard place. The Rock is the mainstream medical establishment that does not want to acknowledge in any form the value of Naturopathic Medicine. In our dealing with the MDs, we have found that it is not regular doctors but rather the leadership of the Colorado Medical Society (CMS) that is opposed to Naturopathy based on its collective fear that Naturopathic Doctors will harm someone. We emphasize the word "fear" because there is no evidence that this is the case. On the contrary, by providing an advisory committee and Director to oversee the Naturopathic Doctors and formalize their scope of practice and treatment modalities, patient outcomes will improve.
It also appears that as a trade guild, the American Medical Association and CMS are determined to prevent competition from other medical disciplines. One CMS official admitted as much when he stated that many MDs were migrating to "Lifestyle Medicine" which incorporates many of the principles of Naturopathy. The CMS states that it worries about Quacks in Naturopathy but admits its own ranks have similar problems. The CMS refers to homeopathy as promoted by a "sect," and refers to holistic, whole-person healing as if it is comprised of mystic religious practices. Owing to this cloudy thinking, the CMS is extraordinarily reluctant to cede to any other professional group the right to prevent, diagnose and treat diseases and injuries. The result of the MDs' ungrounded fears and the CMS's protectionist policies is a greatly circumscribed scope of practice for NDs as proposed by HB13-1111.
At then there's the Hard Place: the Traditional Naturopaths have negotiated their own language into HB13-1111 to protect their freedom to use natural healing modalities without regulatory oversight. When you compare the scope of practice between unregulated "natural health care healing practices" and "natural medicine" as described in HB13-1111, there is almost no difference in the methods and practices each group is allowed. However, the ability to prevent, diagnose and treat diseases, injuries and conditions of the human body is only given to NDs. Well, kind of. In fact, the haphazard, overlapping, ill-defined and sometimes contradictory language in the bill will be a challenge for the Advisory Committee and its Director to untangle during the rulemaking process.
So, one simple reading of the bill is this: the Naturopathic Doctors gain a limited scope of practice in exchange for the burden of registration, fees, oversight, reporting and compliance measures required by regulation. They will no longer be subject to persecution by the State, they can get professional liability insurance, and they may be eligible to participate in health insurance reimbursement.
At the same time, the scope of practice of the Traditional Naturopaths and natural health care practitioners is not changed in any way from what it is now, and they continue to practice without regulatory oversight.
The one key difference for the Traditional Naturopaths is that there will probably be more focus on their practices from the new Naturopathic Medicine Advisory Committee than there is now by the State Medical Board. The substance of the oversight will not change -- both boards are eligible to hear complaints, make investigations, and stop practitioners from exceeding their legal scope of services -- but the new Advisory Committee is probably more likely to take keener interest in regulating natural health care practices that are part of the ND's specialized training.
Like we said at the start, the NDs find themselves between a rock and hard place. By demanding recognition and legitimacy for their naturopathic medical practice based on accredited degrees and training, they have antagonized both the entrenched medical establishment and the grassroots natural health care providers practicing in the state.
Natural Grocers has attempted to stay above the fray, listen to all sides, and push for coordinated development of a system where everyone has a seat at the table. There are thousands of MDs, hundreds of NDs, and tens of thousands of Natural Health Care practitioners in the state -- so that's a really big table. Currently, a group of Natural Health Care practitioners has introduced a companion bill that clearly outlines the rights and freedoms that Coloradans should enjoy when choosing health care practitioners and treatments. Stay tuned for what happens next....