Doctors with an alternative agenda
Encouraged by Americans’ growing fondness for alternative health therapies, naturopathic doctors in California are asking the state to allow them to diagnose conditions, perform minor surgery, order prescription drugs and deliver babies.
Their efforts got a boost recently when the California Senate passed a bill, SB 907, that would license naturopathic doctors and allow them to legally offer a range of medical services that they are now prohibited from performing. The state Assembly is scheduled to consider the bill next month.
Supporters of SB 907 say that licensing naturopathic doctors would benefit consumers because they are going to seek out these complementary and alternative services anyway. Naturopathic doctors must undergo four years of graduate-level training at accredited naturopathic colleges and take national licensing exams. Licensing by the state would help consumers distinguish these more highly trained doctors from people who call themselves naturopaths but are self-taught or receive mail-order diplomas.
“What licensure would do is elevate us to a place where consumers could actually choose [naturopathic doctors] as their primary-care provider and have an opportunity for insurance reimbursement,” says Holly Lucille, a naturopathic doctor in Los Angeles who is president of the California Assn. of Naturopathic Physicians.
Naturopathic medicine is based on the belief that the body has a natural ability to heal itself. Practitioners use diet, nutrition, vitamins and herbs, acupuncture, fasting, homeopathy and psychology to treat minor or chronic ailments. Naturopathic doctors can obtain degrees from one of a handful of accredited colleges, and their training includes many aspects of conventional health care that focus on wellness and prevention, Lucille says.
The California Medical Assn., an influential group representing the state’s medical doctors, opposes the bill because it would allow naturopathic doctors to be primary-care providers. Naturopathic physicians are unqualified to perform many of the functions of a traditional primary-care doctor, CMA officials contend. The bill “allows them to call themselves physicians, prescribe medications, perform minor surgical procedures” and deliver babies, says Bryce Docherty, the CMA’s associate director for government relations. The CMA wants to strike those four provisions from the legislation.
“We’d like them to adhere to what they do, such as prescribe the botanicals,” says Docherty. “Anything above and beyond that needs to be restricted.”
Twelve states already license naturopathic doctors; other states, including New York and North Carolina, are considering licensure legislation.
Lawmakers in many states are open to licensing because surveys show that alternative health therapies are popular with the public, says Karen Howard, executive director of the American Assn. of Naturopathic Physicians in Washington, D.C. Studies show that as many as 43% of all Americans have used some form of alternative medicine.
Dr. Andrew Weil, the well-known alternative-medicine guru, believes that licensure is a good step because it would help the public distinguish doctors with comprehensive training from those masquerading as naturopathic physicians -- some of whom may have only a mail-order degree.
“Well-trained naturopaths complement medical doctors,” said Weil, who directs an integrative medicine program at the University of Arizona that uses both medical and naturopathic doctors. “They are very well trained in areas of medicine that medical doctors are not, such as nutrition and mind-body medicine. And they may have lower-cost methods of dealing with common conditions.”
Howard says naturopathic doctors in states such as California aren’t allowed to use their full range of skills. In California, for example, naturopaths cannot diagnose conditions or offer medical treatments. “We end up working as holistic health counselors that provide guidance,” Lucille says. “We are practicing well below our scope of training.”
Under the proposed law, naturopaths could prescribe some medications (such as antibiotics and cholesterol medications), suture wounds, remove moles for biopsy, order lab tests and X-rays and deliver babies.
Naturopathic doctors in other states also have sought an expansion of services under licensing but have largely failed in that effort. Lucille acknowledged that her group is trying to reach a compromise with the CMA that would remove some key obstacles to passage of the bill.
Docherty says the CMA might support an expanded role for naturopathic doctors, such as allowing them to deliver babies, as long as strict guidelines are met. “I can envision a time when they would play a role -- a complementary role,” says Docherty.
“That’s what we’re trying to achieve: a scenario where naturopaths, primary-care providers and specialists are all working together.”
