NATUROPATHY

Scope of practice

In the United States both naturopathic physicians and traditional naturopaths use the degree designation of N.D. (doctor of naturopathic medicine), leading to considerable confusion about the scope of practice, education and training of a naturopathic practitioner (in the United Kingdom, N.D. stands for Diploma in Naturopathy). There is great contention between the two factions, as their political agendas are in opposition to each other: Naturopathic physicians, whose national professional organization is the American Association of Naturopathic Physicians, strive to recover licensure in all 50 states, whereas traditional naturopaths, whose professional organization is the American Naturopathic Medical Association, oppose licensure and often block licensing attempts. Negotiation is currently in progress between naturopathic physicians and traditional naturopaths to come to a resolution to this problem and agree to use different degree titles and designations, but so far this has not been a successful endeavour.

Science and naturopathy

There is widespread support for the application of an evidence based medicine framework to assess health outcomes and that systematic reviews with strict protocols are essential. Organisations such as the Cochrane Collaboration and Bandolier publish such reviews.

There are reports of evidence based medicine trials published for naturopath.

Some modalities used in naturopathy are widely regarded as pseudoscience. Medical doctors often cite the large differences between naturopathic practitioners and the lack of scientific documentation of the safety and efficacy of their practices in order to justify limiting naturopathic scope. Advocates claim that naturopathic practitioners find it difficult to obtain financing for research due to the lack of prior research in many areas. Proponents state that this is slowly changing as naturopathic physicians develop research programs to help build up a foundation for evidence based treatment.

Conventional medicine is required to undergo rigorous testing; drug trials often last for a decade. A criticism of alternative therapies is that they are not subject to detailed safety assessment. Restrospective analysis of various herbal agents have found many to be of little therapeutic value and others to be harmful. This can be tied to the fact that 'natural' does not necessarily correspond to being beneficial or even benign. Also of concern is the ambiguity of the word "natural" and poor agreement as to its meaning.

While the above addresses a primary challenge to the validation process for "natural" remedies, perhaps of greater concern amongst critics is the lack of regulation of manufacturer claims in advertising. Common labeling practices suggest that herbal extracts are devoid of "drugs" or "chemicals". Claims of this type are patently false as every component of any plant extract is a chemical by definition. Likewise, claims as to the relative absence of toxicity in herbal extracts, when compared to conventional pharmaceutical preparations, are tainted by incongruent regulations for reporting of side effects. The manufacturers of conventional pharmaceutical agents are legally bound to record and report any perceived negative experiences during large scale clinical trials, though there may be no actual link between the tested drug and the perceived side effect. To wit, it is often the case that drugs are labelled with side effects such as headache, constipation, diarrhea, or sleep disturbance. These "side effects" are required to be listed even if they are found with no more regularity than they are in a placebo control group or within the general populace for that matter. Conversely, herbal manufacturers are not required to carry out such clinical studies nor to report any known adverse effects, even if said effects have been directly linked to injestion of the herbal preparation in question. While these advertising techniques do not negate the potential for some beneficial uses of various herbal agents, and they do not necessarily reflect upon the validity of naturopathic medicine as a field of study, critics suggest that they do serve to beguile the public through the employment of nothing more than legally permissible semantics and selective reporting.

Naturopathic modalities may be controversial (eg homeopathy), or have proven effectiveness only for very specific conditions (eg acupuncture, aromatherapy) Some naturopaths may use these modalities as panaceas or to improve the patient's quality of life.