With stethoscopes and nature’s remedies

When George Taraviras sprained his thumb six years ago, the primary care physician he picked from his health plan’s booklet turned out to be a naturopathic doctor. W. Bruce Milliman treated Taraviras’ thumb that day, and during a thorough exam found Taraviras had high blood pressure, high cholesterol and Type II diabetes. Milliman put Taraviras on garlic tablets, vitamins and minerals. He encouraged Taraviras to watch his diet and exercise more.

“Triglycerides, cholesterol, my blood sugar, he helped me get all those in line without any drugs,” said Taraviras, 40, a private investigator in Seattle.

Under Milliman’s care, Taraviras has drunk astragalus tea to help his body fight a cold, let an unsightly rash run its course rather than take steroids and had an injured ankle checked for a possible break with a tuning fork -- a device once commonly used by orthopedists to check for bone fractures. He hasn’t felt the need to see a traditional medical doctor, and he likes the fact that he’s been able to largely avoid prescription drugs -- and their potential side effects -- for his various ailments.

“When I see these news articles, about the side effects that the medical establishment considers acceptable,” said Taraviras, “and I know that I can lower my cholesterol, my blood pressure, and I can do it all without drugs, with a knowledgeable naturopath, I don’t understand why you would do anything else.”

For most Californians, going to a naturopathic doctor was not an option -- until now. On Friday, California licensed naturopathic doctors for the first time, becoming the 13th state to do so. New York, Massachusetts and Florida are considering similar licensure.

Because of its population, influence and openness to alternative therapies, the naturopathic profession considers California’s action an important step to legitimizing this little-known field.

Most Californians have only a vague notion of what naturopathy is. For those unfamiliar with the field, the word naturopath itself might conjure images of an herb-dispensing, Birkenstock-wearing hippie type with minimal medical training.

So what is the difference between an N.D. (Naturopathic Doctor) and an M.D. (Medical Doctor)?

Naturopathic medicine grew out of the 19th century European natural healing movement, which involved treatments at natural mineral springs and spas. The field gets its name from Dr. Benedict Lust, who claims to have cured himself of tuberculosis with hydrotherapy and who brought his practice to the United States from Germany around 1900. He opened the first school of naturopathic medicine in New York City. At the time naturopathy included fasting and folk remedies, standing in cold waterfalls, running barefoot through the snow and eating whole grain bread. Naturopathic medicine became highly popular in the 1920s, and was licensed in many states, but the profession fell out of favor in the ‘40s and ‘50s, as Americans came to rely more on conventional medicine and pharmaceuticals.

Among the founding principles of naturopathy are a belief in the healing power of nature, the idea that the “whole person” should be treated, and that prevention of disease is as important as the cure.

To obtain a license in California, doctors will have to attend one of four accredited naturopathic colleges in the United States (there are also two in Canada) and take a standardized national board exam. The four-year postgraduate program includes two years of instruction that is similar to medical school, including classes in anatomy, physiology, pathology and immunology.

During the students’ third and fourth years of training, the teaching begins to diverge. Students learn about vitamins, herbs, nutritional supplements and lifestyle modification. They take basic classes in Ayurveda -- the ancient medical system from India; homeopathy -- a system for treating illness based on administering minute, highly diluted doses of natural substances to stimulate the body’s self-healing mechanisms; acupuncture; exercise therapy and counseling. Many go on to specialize in one of these areas.

“Conventional medicine tends to focus on a specialization in diseases,” said Joseph Pizzorno, a naturopathic doctor and president emeritus of Bastyr University, a Seattle college with programs in naturopathic medicine, acupuncture and other natural health sciences. “We tend to focus on therapeutic approaches. One person might choose to become really good at homeopathy or nutrition; another, like myself, might be more interested in nutrition and herbs.”

The biggest difference between a visit to a naturopathic doctor and a medical doctor is the amount of time spent with the patient and an emphasis on treating the root of the medical problem rather than the symptoms. Naturopaths also are trained to try less invasive, less toxic therapies first.

In California naturopathic doctors will have some prescription rights. They will be able to prescribe natural and synthetic hormones, epinephrine for severe allergic reactions (anaphylaxis) and barrier contraception.

Carl Hangee-Bauer, a San Francisco-based naturopathic doctor and licensed acupuncturist, describes naturopaths as much like family doctors, though without the medical degrees. Naturopathic doctors will treat a lot of conditions “on a basic level” but refer patients to medical doctors if an illness or treatment gets more complicated, he said.

Naturopathic doctors typically spend 60 to 90 minutes with patients on their first visit, taking a comprehensive history.

“The relationship with the patient is key,” said Sally LaMont, a naturopath in San Rafael, Calif., who was active in the effort to get naturopathic doctors licensed in the state. “We sit with someone for an hour and a half, take a thorough history. We talk about their marriage, what the relationship is like, about their spiritual focus.”

Such conversations, she said, tend to promote a kind of partnership between patient and doctor “that builds confidence and a willingness to make the kind of changes that promote health and prevent disease.”

Adds Pizzorno: “The reason it takes longer is we don’t want to just diagnose the disease. We look at why are they sick and what is necessary to make them healthy. It takes a lot of work, a lot more commitment from the patient. You can’t expect a magic pill. We expect them to eat better, get more exercise and get more sleep.”

It’s too early to know whether the licensing of naturopaths will prompt more Californians to seek their services. Washington, which has licensed naturopaths since 1987, has more than 600 practitioners who are used as both complementary and primary care doctors. By that state’s law, insurance is required to cover visits to naturopathic physicians.

As the profession has grown, it has begun to work more closely with mainstream medicine; in Washington there are now hundreds of integrative clinics -- where a naturopathic physician, an M.D., and practitioners from other healing arts work together in a single practice, sharing care for patients.

“The great thing about this licensing is it brings the naturopathic practice into the medical community and into the public domain in a way that it hasn’t been before,” said Dr. Mary Hardy, medical director of the Integrative Medicine Program at Cedars-Sinai Medical Center in Los Angeles.

Doctors like Soram Khalsa, an internist at Cedars-Sinai who uses herbs, vitamins and acupuncture along with conventional medicine, say many patients are hungry for more natural treatments. His own practice, he says, for years has had a long waiting list of patients who want integrated care.

“People are realizing that Western medicine has many answers, but not all the answers,” Khalsa said. “Especially in the last three months, with the increasing number of stories in the news about Vioxx, Celebrex and statin drugs, and concerns about their safety. I have patients who come in and say, ‘Do you have anything I can use to replace these?’ Of course we do.”

Khalsa says naturopaths can provide reliable information to patients about herbs and supplements -- an alternative to relying on a sales clerk at the local health food store. “Now we will have physicians trained in this, who know what they are talking about,” Khalsa said.

Dr. Ken Pelletier, professor of medicine at the University of Arizona School of Medicine and the University of Maryland School of Medicine, says patients can benefit from more cooperation between naturopaths and medical doctors, as well as more research into the benefits of natural medicine. It’s not enough for naturopaths to simply refer patients to medical doctors when “they hit a medical problem outside their scope of practice,” said Pelletier, former head of the alternative medicine program at Stanford University. Rather, the two professions need to work together, “in the same offices, around the same patients, sharing patients, sharing charts.”

Some conventional doctors still consider the naturopathic profession and many of its therapies to be scientifically unsound. The California Medical Assn. opposed licensing the profession. “We are not taking a reactionary position,” said Dr. Jack Lewin, a family physician and chief executive of the CMA, adding that there are some good things that naturopaths do that patients appear to appreciate. “But we are concerned that the consistency and quality of training for naturopaths varies considerably.”

Physicians get four years minimum of medical school, then do three or four years of residency. (Naturopaths do not generally do a residency.) “We don’t think that is too much training or that you can shorten that and still be a capable physician,” Lewin said. “We are concerned that naturopaths’ training is not as extensive.”

Finally, the CMA does not believe that naturopathic doctors should be able to perform minor surgeries, deliver babies or prescribe drugs. (Though naturopathic doctors will have very limited prescription privileges under California law and will not be able to perform surgeries or deliver babies, they are permitted to do so in some other states.) “There was a concern that this was simply a first step toward getting other privileges,” Lewin said.

While there have been studies of certain treatments, such as acupuncture, and the effectiveness of certain herbs, there have been few studies on the efficacy of naturopathic medicine as a healing system. Experts hope that the licensing of naturopaths in California will bring more research.

But for those who have chosen to use naturopathic doctors, no further tests are needed. The proof has come with personal experience. Mara Elizondo, 46, first started seeing Hangee-Bauer about five years ago for an array of symptoms. “I had problems with my gall bladder, uterine fibroids, chronic headaches, neck and shoulder pain,” she recalled. “I had been to regular doctors over the years and felt I needed someone who would look at the whole picture.”

Hangee-Bauer has treated Elizondo’s head and neck pain with supplements and acupuncture, and her gall bladder by giving her Chinese herbs and helping to restrict her intake of cheese and other dietary fat. She underwent surgery for her fibroids, but Hangee-Bauer worked with her on strategies to prevent recurrence.

Most important, she says, is that Hangee-Bauer has taught her how to take more responsibility for her health. “I could have gone years ago and had my gall bladder removed,” Elizondo said. “But I don’t need to have my gall bladder out. I need to take care of myself.”

Because insurance does not cover her visits to the naturopath, she cannot afford to see him as often as she would like. For now, visits to naturopathic doctors in California will not be covered by health insurance. Blue Cross of California said the company had “no plans at this time” to cover such visits, according to spokesman Michael Chee, and Blue Shield of California “just doesn’t have enough information at this time to make a comment,” said spokeswoman Elise Anderson.

That doesn’t deter the hopes of naturopathic doctors who believe many in their profession will flock to California from nearby states to fill consumer demand.

“The amazing thing about this form of medicine,” said Pizzorno, “is despite all the obstacles, paying out of pocket, so much negative media, this medicine stays alive in the culture, because it helps people.”