We know all about the public's disenchantment with conventional health care. We have seen the disappearance of doctors who make house calls, the appearance of big money medicine, and daily bombardment by drug ads. The average person dislikes this trend. It is therefore a sad irony of human psychology that the public will also say, "But medicine is so much better now. People used to die from that disease." Maybe; but before they didn't die from the medicine.
Naturopathic medicine, while centuries old, is in the process of being remodeled by some into a new product that more resembles allopathic medicine than the natural medicine we all know. One faction of our field has taken it upon themselves to represent this movement as the direction of the profession itself, and not what it truly is — the viewpoint of a minority group.
In the past two decades, naturopaths have been told to adopt new ways of doing things, new products, and new avenues of knowledge. The fact that these new ideas are based on thinking that is suspiciously like conventional medicine has escaped some. For others in our field, it is the same presumption the public makes about high-tech medicine: It's newer, and therefore "better". This discussion will examine this phenomenon, focusing on the major areas in traditional naturopathic practice.
Botanical medicines
There are items in our natural materia medica that we have all used and found to be effective in the majority of
cases—we know them to be effective not because of their historical usage, but because we have put them to the test,
time and time again. Allopaths (green and otherwise) would say that is anecdotal. The implication is that we don’t
really “know” those things are effective, and the things we do know to be effective have been “proven” by studies
that have been published in peer-reviewed journals. All well and good. The double-blind controlled trial is a
good way to find out what is going on. But it is not the only way.
First of all, a “statistically significant” response in the pharmaceutical industry might be as little as fifteen percent. But it has been proven and reviewed by experts. This puts us in the position of approving items that work partially or in only a small number of cases while ignoring those that work consistently with a much better clinical outcome, because they are not “proven” by the current standard.
Secondly, adopting such a hard line regarding our natural materia medica ignores the fact that much of the allopathic materia medica has mechanisms of unknown action. One does not have to read far in the PDR to see passage after passage stating “Mechanism of action: Unknown”. So now we are boasting that we have scientifically chosen the materials we use by the confirmation of their mechanisms of action, while the allopathic medical community has no problem using drugs that they cannot explain.
What we find when we look closely is that the items being subjected to those studies are materials that have been manufactured according to strict standards, often using the “active ingredient” isolated and produced in a “standardized” form to insure uniformity, and which are then found to create a “statistically significant” response in test subjects or the subjects’ follow-up lab work. But is this effective enough? A good example of the pitfalls of this thinking is the wide usage of Hypericum perforatum (St. John’s Wort) for depression. It was concluded from studying this plant that the hypericin in the plant was responsible for the antidepressant effects—the so-called “active ingredient”. Nutraceutical companies boasted of their standardization of their St. John’s Wort extracts to a guaranteed percentage of hypericin. Later, it was found that the hyperforin in the plant, a different constituent, was associated with the antidepressant effects. The latest research into the matter shows that the flavonoid content of the plant may be in fact the most important synergists allowing these phytochemicals to do their work.
If one reads between the lines, the picture becomes very clear: The companies endowing the various naturopathic schools and servicing the natural medicine profession are producing items that are scientifically defensible to the orthodox medical industry, but which may in some cases be less effective than the original substances used for that purpose. A more ominous aspect of this is that fractionated substances, removed from their natural complex state, typically have side effects that the source material does not. This perpetuates the tradition of allopathic pharmacology in which patients will take medicines that will produce side effects for which they will take other medicines, ad infinitum.
Manipulation
Naturopaths have used joint manipulation since almost the inception of the field, and most of our pioneers also
had chiropractic degrees or osteopathic degrees. Benedict Lust’s original school had a chiropractic program as well.
Today, chiropractic is the best-known system using manipulation, and a myriad of specialized technics have emerged,
such as Logan Basic, Gonstead, Palmer Upper Cervical (Toggle) Technic, Sacro-Occipital Technic, Activator, etc.
As with the rush to scientifically “validate” botanical medicine and nutritional therapy, manipulation has been subjected to scrutiny that creates the impression that only the “right” application with the “correct trajectory and line of force” and even the “specific” pounds-per-square inch thrust matched to the degree of subluxation, etc., will be truly effective. This cleverly puts the burden on diagnostic information (more imaging, more assessment of the imaging, etc.), makes specialized training necessary (with the accompanying continuing education, certification, special equipment, etc.), and funneling of the information into a syndrome that can be matched to an ICD code that will make it possible to bill the patient’s insurance effectively. The flaw with this last effect is obvious; valuable information that better delineates the patient’s case (subjective as it may be) is thrown out in favor of data that matches up with the technic the doctor wants to administer. Upper cervical specialists see C1 correlates to everything; activator users find very slight deviations in the spine that require a very slight force to be accurately corrected, etc.
Meanwhile, naturopathic legends such as Frederick Collins (who, in addition to his naturopathic and osteopathic degrees, had trained under both D.D. Palmer and B.J. Palmer for his chiropractic work) took an entirely different approach. He championed his “Universal (or General) Naturopathic Tonic Technique”, a general method that could be applied in very little time and which accomplished a globally mobilizing action on the spinal segments, with resulting lymphatic, vascular, and neurological effects. While immediately reducing any minor restrictions to range of motion, it revealed to the operator the areas for more intensified work; in this way it was diagnostic as well as therapeutic. It is relatively ignored today.
Hydrotherapy
While many and varied technics have been established of applying water to the body in the form of hot and cold packs,
ablutions, spritzes, submersion, and so forth (compiled most comprehensively in Kellogg’s Rational Hydrotherapy), it
remained for naturopath Otis G. Carroll to create “Constitutional Hydrotherapy”. This is a general method that can
be applied, with a few variations, to almost any chronic or acute condition. This is another non-specific therapeutic
modality that is effective, reliable, and will never be subjected to a double-blind crossover trial to “prove” that it works.
Nutritional supplements
Most of us, myself included, became used to prescribing USP vitamins and minerals because that was what the companies
servicing our profession were manufacturing. We felt secure that we were on solid ground because of the wealth of published
scientific studies validating the beneficial effects of nutritional supplementation. No longer would we have to endure
taunts of “food faddist”, “health nut”, and suggestions of being unscientific pretenders by the orthodox medical
community. But what were we doing? Our own profession clearly stated, in the 1947 clarification of naturopathic medicine,
“…Naturopathy does not make use of synthetic or inorganic vitamins or minerals.”
Admittedly, the very few companies making totally natural vitamins had products that came in hard-to-take forms (large and/or many tablets) and were expensive. Because of problems with patient compliance, I overlooked many of these products for years. Fortunately, production methods have improved, prices have come down, and the economic level of the average naturopathic patient has come up. I have for several years used only natural nutritional supplements, and I know there was no suggestive selling going on when patient after patient came back telling me, “I feel much better taking these vitamins than any I ever took before!” I know because I take them, too.
Let Us Face Facts
Here is what the nutraceutical industry, the “green allopathic” NDs, the schools and academies teaching and certifying
specialized methods, and certainly the FDA, don’t want people to know: If a sick person thoroughly cleanses the
colon; does lymphatic, liver, and kidney detoxification; does a fast; regulates the diet; takes some good quality
natural supplements; has some general spinal manipulation and gets a series of massages; does some hydrotherapy
according to the chief complaints and takes a short course of botanical medicines according to the same complaints,
most of the time the sick person will get much better, regardless of the diagnosis.
If further diagnostic or more specialized therapy is needed, the diagnostic testing will be more revealing and the treatment will be more effective than before the initial cleansing. Some abnormal findings that would have been seen on tests at the outset will have cleared and will not have to be addressed. Better for the patient! Therapies that might have been seen as absolutely necessary will be no longer needed. Again, better for the patient!
The only problem with this scenario is that none of these things is better for the industry. An industry that is pushing for more expensive products and more medical interventions on the part of more rigorously trained practitioners. Notice how the word “more” keeps entering into the discussion? The natural medicine monetary system breaks down if old-time naturopaths use cheap, low-tech methods to clear 80-90% of the problems a patient is having.
Admit it, my fellow naturopath. You have used some items in the past that are out of favor today. Did they work? You have read the studies and monographs of current nutraceutical materials that have been touted for different conditions, which have passed muster enough to have the FDA allow a specific health claim on the label. How well do they work? Be honest with yourself. Aren’t you in fact disappointed with the results of using a lot of the so-called “evidence-based” materials? Haven’t you noticed that the standardized extracts of herbs you used in the past, in their easy-to-take capsules and their respectable-looking packaging, don’t really work as powerfully as those tinctures of the whole plant you used to use?
We are now at a point where methods that we once knew to be reliable (upwards of 90% of the time) are being swept away in favor of methods that have been shown “scientifically” to work to a “significant” degree. One needs only look at the orthodox pharmaceutical industry to know how little a drug has to be effective to be approved. Our profession is aligning with the standards of orthodox medicine, and that does not honor us. That should enrage us.
This change in standards is not about doing a better job. It is not about weeding out those methods that have been historically used but are not actually effective. It is about money and power. It is about making sure that the most curative methods are eliminated, and those methods that encourage dependence on the medical system are foremost. It is about getting rid of the practitioners who can take care of the possibly 90% of patients who require a general treatment before needing the expertise of a more highly trained specialist.
Look at it this way. Allopathic medicine has gatekeeper providers, specifically the family practitioners. While the majority of doctors at one time were general practitioners, the age of specialization forced those who later entered the field to “specialize” in the newly-renamed category of “family medicine”. When a patient has a problem that the family practitioner can’t take care of completely, he is referred to a specialist. One can’t just take one’s bowel problem directly to a gastroenterologist. So the gatekeeper makes money and the specialist makes money.
Naturopathic medicine has no such system. Naturopathic practitioners have traditionally fulfilled the role of the general practitioner or family doctor, and the only specializing that has tended to occur has been in the therapeutic realm. Some naturopaths specialize in botanical medicine, some in homeopathy, some in hydrotherapy or manipulation, etc. Centering a practice on a particular type of pathology has been historically foreign to naturopaths.
Certainly, specialists in pathology are starting to appear, but the field is still small enough that this hierarchical system is not developed yet. But it is developing because the newer schools are emphasizing an allopathic approach.
I very much doubt that as naturopathic medicine grows it will establish a gatekeeper provider in the same way. The “green allopathic” type of naturopath wants higher and higher standards of education and certification, and will practice in a more and more narrow fashion (in keeping with scientific reductionist thinking). Who, then, would serve as gatekeepers for these impeccably trained specialists? Logically, it would be lesser-trained naturopaths in general practice. But this is not likely to happen, for two reasons.
First, the “green allopathic” agenda is one that forces a higher standard of certification on everyone, so there will be no “lesser-trained naturopaths”. But if more liberal naturopathic politics come about, the practitioners born for this role are those who graduate from the so-called “non-accredited” schools. If these practitioners cling to only the most basic concepts of natural medicine, use only the most low-tech and simple of therapies, and are willing to bow to a specialist who has greater knowledge in a specific area and training in therapies that are more exacting in execution (injection or intravenous therapies, etc.), what would be the objection?
Only this: The naturopath using the most general approach and the simplest therapies will likely cure eight out of ten patients before they get to the specialist! To these doctors who have invested more years and money and are held accountable to higher standards of certification, this is unthinkable.
Specialists are definitely needed. But we are already starting to think like conventional medicine: You are being negligent if you don’t use the most up-to-date, technologically advanced method. You know all the arguments:
“The newer drugs must be better than the ones we used for that complaint ten years ago.”
“An X-ray may not show anything, so I’ll order an MRI.”
“That textbook was published in the 1970s—we know so much more now.”
Yet, when we read the published cases of naturopaths from decades ago, the results of the treatments they were using are sometimes incredible. We tend, when reading these old accounts, to think, “Well, these weren’t objectively tested and are probably overly dramatic anecdotes.” Or, if we believe the accounts, we may think, “But conditions have changed since then, and illnesses are more complicated today.” Then we head right back to the most current information.
There are those of us, like myself, who took it upon ourselves to investigate those methodologies of old. Anything that stands a chance of being that good, I reasoned, is worth exploring. Luckily, I was able to prod a number of elderly doctors for inside information on these matters. You may have, also. If you didn’t, I am sorry for you, because the preceptor system is virtually dead, and few of us practicing today had any direct contact with those of the generations who were using the most effective methods. The current educational situation discourages preceptors, and in many places one can read the propaganda that undesirable naturopaths are ones who do not attend accredited schools, “…or they learn from other naturopaths.” How this became a badge of ineptitude instead of experience I will leave you to figure out.
The methodologies of those past generations, adapted and chosen in light of modern knowledge, are no step backward. It is in the best interest of the patient to try the simplest and most broadly health-enhancing treatments first, before relying on more intricate diagnostics, more expensive supplements, and more currently acceptable (“defensible”) procedures.
©2007 C.P. Negri, NMD