If we are somehow going to build better, more effective health care systems, we need to recognize a fundamental truth: there are many different types of health care practitioners, all of whom have dedicated their lives to preventing suffering and helping those who are suffering.
To be sure, we differ in our training and the skill sets we bring to the health care equation, but let us acknowledge that no one health care profession has all the answers. No one profession should have the right to stand in the way of the legitimate development of another profession that essentially has the same goal of preventing illness and helping to heal the sick.
There is plenty of suffering in this world, plenty of people who are underserved, and plenty of need for all of us.
Battles between medical professions over scope of practice are very common and highly destructive. Though the arguments are usually couched in the language of “protecting the public,” all too often, it is the public that suffers—from lack of access, from fragmented and non-coordinated care.
Last year the Hawaii State Legislature nearly unanimously passed a law that gave the Board of Naturopathic Medicine independent authority to determine what legend drugs naturopathic physicians (NDs) should and should not prescribe. The law also enabled the Naturopathic Board to establish practice standards and certification requirements in parenteral therapy and minor surgery.
The state’s naturopathic formulary became effective January 1, 2010. No sooner than it had, the Hawaii Medical Association forwarded several bills that would repeal these very advances. As I write, one of these bills is having its first hearing in the Senate Health Committee.
The 2009 legislation was a modernization act that brought the scope of naturopathic medicine up to par with how modern naturopathy is taught in naturopathic medical schools and how it is practiced in most all the states which license NDs. Pharmacology has always been part of the required curriculum of accredited naturopathic medical programs, and part of the Naturopathic Physician’s Licensing Examination (NPLEX).
Although our emphasis is clearly on natural medicine, not pharmaceutical prescription, NDs are increasingly serving as primary care doctors, and given the current primary care shortage in many parts of the country, their services are much needed. It is only reasonable that prescriptive authority be part of naturopathic practice when drugs are needed.
The US Department of Labor approved an updated definition of “Naturopathic Physician” in 2009, to include “natural medicines, prescription or legend drugs, foods, herbs, or other natural remedies.”
The old guard of conventional medicine has imprisoned health care in the American Medical Association (AMA) and state medical associations, where it is jealously guarded, isolated, and rendered sterile, its vital covenant with the public arrogantly broken. In the small minds of the zealots, any advance by other health professionals is a sure sign of compromise and failure.
In their attempt to limit naturopathic scope of practice, the AMA and HMA borrow and distort the tired arguments made by unlicensable “mail-order naturopaths” (ie, people who do not attend 4-year naturopathic schools but claim a right to practice based on correspondence course degrees). This argument claims that licensed NDs are not “true naturopaths,” since they sometimes prescribe drugs, do minor surgery, and seek to prevent those who are not licensed from practicing.
The AMA and HMA refuse to recognize the high standards of education and training of NDs, or the safety and ethical records of NDs in states with licensure—performance records that are typically better than those of MDs and DOs in these states. In 2006, the California Bureau of Naturopathic Medicine contacted the licensing agencies in states that allow NDs to prescribe. None of the states reported any patient harm or disciplinary action due to ND prescribing, nor were there any civil actions against NDs for prescribing.
The Bureau also contacted the NCMIC Insurance Company, which insures NDs in all licensing states, as well as all the naturopathic medical schools. In a letter dated June 7, 2006, NCMIC stated: “In the five years that NCMIC has been insuring Naturopathic Physicians and the colleges, we have never opened a claim against a Naturopathic Physician involving prescription medications.”
Additionally, the Bureau contacted Jury Verdicts Northwest (JVN) to see if there were any civil actions filed against licensed NDs. JVN covers both Oregon and Washington, the two states with the greatest number of NDs and the longest histories of licensure (since 1919 and 1927, respectively). JVN found no cases against NDs for prescription negligence, and added that, “for that matter our database contained no cases against naturopaths at all.”
And it is time to recognize the primacy of patient-centered health care, and the role of naturopathic medicine— with its longstanding humanistic tradition and its recognition of the role of nature in healing—in providing it.
Each healthcare profession should have the responsibility of regulating itself so that its members meet high standards of education, training, safety, ethics and accountability. No healthcare profession should be in the business of trying to tell another what it can and can not do.
We live in a medical world long dominated by specialty-centric conventional paradigms, and in which egotism on all sides continues to overtake reason and good sense. In many ways the controversy over naturopathic medicine and its scope of practice reflects the world’s escalating friction between modernity and traditionalism, and its simultaneous struggle for and rejection of integration. But that is the human condition and it’s what we have to work with. That work is possible, and it is the very stuff of healing. So on with it!
Michael Traub, ND, past-president of the American Association of Naturopathic Physicians, is Chairman of the Hawaii Board of Naturopathic Medicine. He practices in Kailua-Kona, Hawaii.
