Naturopathic Medicine Unlike oriental medicine or homeopathy, naturopathy does not have a long history of traditional use, nor is it based in a comprehensive system. Naturopathy views disease as a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including diet and clinical nutrition; homeopathy; acupuncture; herbal medicine; hydrotherapy (the use of water in a range of temperatures and methods of applications); spinal and soft-tissue manipulation; physical therapies involving electric currents, ultrasonography, and light therapy; therapeutic counseling; and pharmacology.
There is no national licensure for naturopathy, and licensure at the state level is inconsistent. Only 15 states have licensing laws, and those laws differ considerably. Seven 4-year naturopathic medical schools are accredited by the Council on Naturopathic Medical Education (20). This training focuses on outpatient medicine and does not require a residency. Although the 4-year programs are rigorous, it is possible to get a naturopathic degree online.
The Placebo Effect The role of the placebo effect in various CAM approaches needs to be further elucidated with rigorous scientific research. Just as with conventional medicine, the effects of certain approaches are more likely than others to be associated with a placebo response. After exposure to a stimulus believed by both the patient and the practitioner to be an active intervention, the body responds physiologically in an equivalent manner. Approximately one-third of patients in placebo-controlled trials of conventional methods experience a placebo response. It would be of great value to medicine if the placebo response were better understood and could be activated more reliably in patients. There is no evidence that the placebo response is more active in CAM than in conventional approaches.
Quality Control Quality control issues in CAM are very challenging for several reasons. First, the market demand is huge and is far ahead of the health care system’s ability to address issues of regulation, education, or research. Because CAM, by definition, is inclusive of everything that conventional medicine is not, issues of quality control are extremely difficult. The Federation of State Medical Boards developed the “Model Guidelines for the Use of Complementary and Alternative Therapies in Medical Practice,” approved by the House Delegates of the Federation of State Medical Boards of the United States, Inc., as policy in April 2002 (21). The intention of this initiative was to provide guidelines that are clinically responsible, ethically appropriate, and consistent with what state medical boards consider to be within the boundaries of professional practice and accepted standard of care.
Potential Misuse In addition to physical risks, patients and physicians alike should be aware of other areas of potential misuse. Two areas are of particular concern. First, given that the dollars being spent out of pocket are so significant, there are some products and some providers whose primary motivation is monetary. Patients can spend significant dollars based on false promises or claims. Second, patients can postpone effective therapy or treatment by turning to CAM modalities exclusive of conventional approaches. This time can be significant in the treatment of many patients’ diseases. Factors that should increase suspicion for potential misuse are listed in Table 13.6.
The Potential Benefits: Therapeutic Opportunities
Given all of the risks and uncertainties, it is appropriate to ask the question: Why should physicians educate themselves regarding CAM? The most basic answer is commitment to the best practice of medicine. If patients are using therapies that are potentially dangerous in their action or in their interaction, physicians should be aware of this possibility and counsel them accordingly. Physicians have a commitment to offer their patients the best treatment options, regardless of their system of origin. If there are CAM therapies that can benefit patients, the physician should be knowledgeable about them and be willing to discuss them with patients.
In addition to this most fundamental of reasons, there are additional therapeutic opportunities offered by CAM, as shown by the following examples:
Table 13.6 Factors that Should Increase Suspicion for Potential Misuse 1.