Navigating the realm of alternative medical professionals can be a challenge. There is an abundance of varying medical specialties, legitimate and otherwise, that thicken the mud known as the alternative medical system. Although specialization and uniqueness may improve a patient’s quality of care, most patients don’t even know where to go when seeking a specific type of treatment. And often when they go looking, they are met with confusion, skepticism or a myriad of sales pitches that lead them down a dark path of expensive care.
In an attempt to help you navigate this medical maze, let's start by comparing Allopathic (or conventional) Medicine with Naturopathic (or natural) Medicine, considered to be the two primary systems of complete medical care in North America. Note that this is a condensed summary and not intended to provide a detailed perspective of either profession.
Medical Doctor / Allopath / Functional Medicine
A medical doctor is trained in a type of medicine called Allopathy or Allopathic Medicine. Ironically, this term was coined by the founder of Homeopathy, and means to treat with a substance that opposes the body’s own mechanisms. Now widely accepted as a description, allopathy is considered the primary system of medicine in most countries. Its methods of treatment are pharmaceutical drugs and surgery - both of which oppose natural forces, whether they be of the body or a pathogen (harmful microbe). Are you complaining if it’s the latter? Likely not.
Functional Medicine is a term coined relatively recently to describe medical doctors (or alternative practitioners) that practice a more holistic style of medicine. The esteemed Cleveland Clinic recently opened its Center for Functional Medicine, and it describes functional medicine as:
“a personalized, systems-oriented model that empowers patients and practitioners to achieve the highest expression of health by working in collaboration to address the
underlying causes of disease”.
In essence, functional medicine aims to determine the root cause of ilness and resolve it.
Most medical doctors must complete a minimum of three or four years of premedical (undergraduate) studies; followed by three or four years of medical school; followed by a minimum of one and up to five years of residency, depending on specialty. There are variations of this schedule, including a condensed version in Australia and far shorter versions in some countries, but most systems are similar. Qualifications, however, are not always considerd the same, and most doctors trained in developing countries will not be considered equal in developed countries (a significant ongoing political issue). When I shadowed a doctor in Kenya for three months, he explained to me that his medical training would be considered equivalent to paramedic training in Canada. I was shocked considering the medical knowledge he had, but I suppose that comes with seeing upwards of 50 patients per day in a rural Kenyan clinic.
In Canada, the medical profession is represented nationally by the Canadian Medical Association, and provincially by associations (advocacy) and colleges (regulatory). Each province has its own medical act, which governs the standards of medical practice, and the provincial colleges uphold these standards. The associations do not act in a regulatory capacity, but rather serve to support and advocate for its members. In Ontario, for example, you have the College of Physicians and Surgeons of Ontario and the Ontario Medical Association.
Internationally, there is the World Medical Association, which does not govern the profession, but acts as a community for medical doctors around the world.
It’s interesting to see the recent surge of the terms “integrative” and “functional” in the allopathic medical community. This is likely in response to the public’s demand for a more comprehensive medical system than what currently exists. Ironically, when you peel back the layers, functional medicine is practiced by most competent medical practitioners. Its purpose is to analyze the problem and determine the solution to that problem rather than palliating whatever symptoms that problem is causing. It’s a long-term solution rather than a short-term fix, and the public is slowly waking up to the fact that short-term fixes have detrimental effects in the long-term - hence the demand for a more comprehensive system.
Based on this description, a good doctor will practice Functional Medicine.
Naturopathic Doctor / Naturopath / Nature Doctor
Naturopathy or Naturopathic Medicine is a relatively newly formalized system of medicine, amalgamating several older systems of medicine. Originally organized into an official profession by a medical doctor named Benedict Lust in the early 20th century, naturopathy is a combination of traditional European nature cure (food, air, water, plants, exercise), homeopathy, physical medicine and (most recently) Traditional Chinese Medicine. The term naturopathy literally means “nature pathology”, its creation based on the popular term Homeopathy, but inaccurately translated. In contrast, homeopathy means "similar pathology", with its intention to mean "like cures like". Unfortunately, at the time naturopathy was coined, the term stuck and has been used ever since. A more appropriate title would have been Nature Cure or Natural Medicine.
The history of Naturopathy is plagued with controversy due in part to the medical profession’s attack on it (Flexner Report) in the early 20th century, and in part because its practitioners tended to be inconsistent in practice, exposing it to attacks of skepticism. The scope of naturopathic medicine also includes the modalities of homeopathy and Chinese medicine, which until recently have been considered illegitimate by the science-based medical communiy. There is still significant controversy surrounding homeopathy, which is based on a system of using minute diluted doses of substances (sometimes beyond conventional measure) to induce a systemic reaction in the person taking it. Based on a concept that "like cures like", the substances chosen are those than would cause the symptoms the patient is experiencing if taken in larger doses. Modern research is not generally applicable to this system, so it has been ridiculed and cast aside, despite its widespread use in the rest of the world. For more information on homeopathy, the National Centre for Complimentary and Alternative Health provides a good summary.
Regardless of the reasons, by the 1950s, naturopathic medicine had been nearly eradicated from the Western medical landscape. Today, it exists as an organized profession in several North American, Australian and European jurisdictions as a primary system of medicine that incorporates all the systems above with an evidence-based approach. In essence, Naturopathic Medicine is Functional Medicine. A naturopathic doctor will take a detailed case history; perform appropriate physical exams; conduct relevant lab work; make a diagnosis; and prescribe a treatment, which may include acupuncture, herbs, homeopathic remedies, nutritional supplements or dietary changes, general lifestyle changes, spinal manipulation or hydrotherapy protocols. For more information on specific naturopathic treatments, click here.
This is the basic foundation of naturopathic practice, which at this time is regulated in 19 American states, 5 Canadian provinces, Australia, England, and in varying terms across Western Europe, as well as parts of Asia Africa. Most Canadian provinces and territories now have title protection and some form of regulatory policies in place, meaning that complete Canadian regulation is imminent.
Note that there are several variations of the term naturopath, naturopathy or naturopathic doctor that could be misinterpreted. In most juristictions, these titles are protected. If a practitioner is using a similar term like “Natural Health Practitioner” or “Natural Holistic Practitioner”, it is likely that they are not a legitimate medical practitioner. For example, this college offers a diploma program to become a Natural Health Practitioner. It is a distance program and by no means adheres to the rigorous medical training that naturopathic doctors receive. Unfotunately, the naturopathic profession does not currently have the clout to have such programs re-named, so there will continue to be some degree of confusion as to academic merit.
Most naturopathic doctors complete a similar degree of training as medical doctors: three or four years of undergraduate studies; followed by three years of naturopathic medical training; followed by one year of clinical internship, followed by an optional two-year residency. Most naturopathic doctors will not complete the optional residency, so the average graduate will have a minimum seven years of post-secondary education and one year of clinical internship.
In North America, naturopathic students are required to complete rigorous testing similar to allopathic medical students. This testing is called Naturopathic Physicians Licencing Exam (NPLEx) and is governed by an international body called the North American Board of Naturopathic Examiners (NABNE). NABNE is a non-profit organization that serves as the intermediary between the naturopathic academic bodies and regulatory authorities.
In Canada, naturopaths are licensed in British Columbia, Alberta, Manitoba and Ontario, meaning they can convey a medical diagnosis. In some cases, they are even permitted to prescribe pharmaceutical agents and perform minor surgery, both of which all naturopathic students learn in their studies.
Similar to the medical profession, each province regulates naturopathic medicine differently. As a result, there are provincial associations (advocacy) and colleges (regulatory) in every province where the profession is regulated. Nationally, the profession is represented by the Canadian Association of Naturopathic Doctors.
Internationally, the profession’s representation is still a bit murky as the profession works to establish international standards. Recently, the World Naturopathic Federation was formed in an effort to unite NDs internationally. The inaugural WNF meeting will take place in June 2015, at which time a formal board will be established.
The Naturopathic Medical profession has had an interesting history. Originally intended to unite natural practitioners using less invasive medical techniques, it quickly attracted negative attention for being radically opposing to the allopathic medical system. With the advent of antibiotics and modern medical advances in the early 20th century, the public’s perspective of nature-based medicine shifted and faith was placed in the hands of those performing medical miracles of the time. There’s no doubt that those miracles were legitimate (eg. life-saving vaccines; open heart surgery; modern genome mapping). However, as we have witnessed this past century, when allopathic medicine was put to the test of time, it lacked severely in addressing long-term or chronic conditions. Palliating symptoms provides fantastic short-term gains, but yields long-term problems. As discussed above, the public is now seeking “alternative” solutions to addressing chronic illness, which is why we see a resurgence of not only the naturopathic profession, which represents a return to an old way of medicine, but the advent of integrative/functional medicine.
This bodes well for a fledgling profession like naturopathic medicine, but what I predict will eventually happen (and what we’re already seeing in British Columbia, Arizona, Europe and China) is that naturopathic medicine and allopathic medicine will amalgamate into a more holistic system, likely dubbed functional or something similar.
What I continue to find curious is the criticism directed toward naturopathic doctors from the medical profession and conservative medical critics. I can only assume this criticism originates from a place of fear and lack of understanding, especially considering institutions like the Cleveland Clinic are now embracing naturopathic (guised under the term functional) approaches to medical care with open arms.