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HEW Report on Naturopathy (1968)

In December 1968, the Department of Health, Education, and Welfare (HEW) recommended that naturopathic coverage not be added to Medicare. The HEW report -- called "Independent Practitioners under Medicare" -- contained over 300 pages and covered several professions. This page contains the passages relevant to naturopathy. Although some aspects of naturopathic education have improved in recent years, the report's observations are still significant.


Present Medicare Coverage

Although naturopathic services are not excluded by name from Medicare coverage, in effect, they are not covered. The definition of a physician under Medicare does not include naturopathic physicians, thus excluding all services of naturopaths in independent practice. Moreover, because Medicare-approved hospitals and other providers normally do not provide naturopathic services, it is unlikely that naturopaths would be employed by any approved provider. Hence, services of naturopaths are excluded from coverage as "other therapeutic services," which are reimbursable to providers.

Requested Change in Coverage

The National Association of Naturopathic Physicians has requested coverage for the services of naturopathic physicians under Part B of the Supplementary Medical Insurance Program (see Association Statement, Appendix B), as independent practitioners serving as "points of entry" similar to doctors of medicine and osteopathy, but subject to restrictions in treatment at specified in State licensure laws.

Professional Organization

In 1956, the National Association of Naturopathic Physicians was formed from the merger of the American Naturopathic Association and the American Association of Naturopathic Physicians. This is now the only naturopathy organization in the United States. It has 168 members located in the following States: Washington (26), Idaho (26), Connecticut (24), Oregon (20), California (17), Kansas (16), and New York (7). The membership is composed of naturopaths, naturopath-chiropractors, and chiropractors [1].

The definition of naturopathy adopted by the National Association of Naturopathic Physicians is as follows:

Naturopathy (naturopathic medicine)-- A system of treatment of human disease which emphasizes assisting nature, It embraces minor surgery and the use of naturopathic agents, forces, processes, and products, and introduces them to the human body by any means that will produce health-yielding results [2].

Concepts and Philosophy of Naturopathy

Benedict Lust, N.D., D.O., D.C., M.D., who was born and educated in Germany, introduced naturopathic healing to the United States in 1892 with the establishment of the Yungborn Health Institute in New Jersey. Other pioneers in the development of naturopathy in the United States include Kellogg, the founder of the Battle Creek Sanitarium, and Hahnemann, the founder of homeopathy [3]. However, the historical roots of naturopathy date back to the early Egyptians, who used massage and manipulation of the body, and to the use of steam and vapor baths in Europe during the Middle Ages.

The naturopathic approach to health and disease is reflected in its philosophy which is explained in the textbook, Basic Naturopathy (submitted to this study by the NANP), as follows: Naturopaths hold that there is a vital force ". . . which is the maintainer and healer of the body" [4] and that all ". . . vital actions are correlated by the nervous system." [5] When the vital force is depressed, "enervation" exists. Disease is explained as follows:

The primary cause of disease is reaction to unnatural environment . . . When the body is weighted down by toxins in excess of the amount with which the vital force is able to cope, then enervation... supervenes and there is a lag in the body's power to expel the "ashes" of metabolism... Enervation leads to the secondary cause of so-called disease -- toxemia. Toxemia is the state of auto-intoxication resulting from the accumulation ot poisons in the body - poisons taken in from without in the form of incorrect food, impure water, vitiated air, etc., and which are not thrown off by the body because of its enervated state, and in addition thereto the poisons formed within the body itself by the processes of metabolism. . . The presence of these poisons within the blood stream and tissues causes the vital force to make efforts to eradicate toxemia, and these efforts are what is called "diseased crises." . . . Disease, therefore, is not a hostile entity to be attacked, but is rather a manifestation of vital force in its efforts to continue to live and to remove anti-vital conditions caused by man's deliberate, or ignorant, breaking of the laws of health and life ... Disease, then, is the result of stagnation and accumulation of filth in the blood stream and in the tissues." [6]

In keeping with this philosophy, Basic Naturopathy presents the following views concerning parasitic diseases:

. . . bacteria are not the unmitigated evil they are pictured to be; like everything else in Nature, they serve a useful purpose. They are scavengers which consume and remove waste and morbid matter. ... So long as we are foolish enough to burden our system with all sorts of morbid matter to such an extent that our organs of elimination cannot take care of It, Nature must provide some other radical forms of housecleaning such as fever, inflammations, catarrhal conditions, bacterial disease, etc., otherwise we would perish in our own impurities and often do. It is not necessary to kill these useful little scavengers; their activity ceases and they become innocuous when they have consumed the morbid matter upon which they live . . . Although not considered a primary cause of disease by Naturopathic physicians, germs are regarded as the exciting cause where ever the proper soil for their growth and development exists. [7]

In addition to the above conditions, the National Association of Naturopathic Physicians points out that the naturopathic approach to healing also places priority on "maladjustment of muscles, ligaments, bones, and neurotrophic disturbances" [8] and "consideration of hereditary influences" [9] as basic causes of disease.

Chiropractic and naturopathic philosophy are very similar, in that practitioner groups believe in the concept of a vital force that Is transmitted through nerves and is capable of effecting the cure of disease. Both believe that maladjustment of bones causes Ill health. This similarity is not mere coincidence since the disciplines have had a close relationship since their inception in the late nineteenth century.

According to the president of NANP, until 1953 many of the schools In the United States which taught naturopathy were schools of chiropractic [10]. It is believed that many chiropractors are also naturopaths. The most widely used chiropractic textbook was written by a naturopath-chiropractor.

In 1932, Louis Reed, Ph.D., in his book, The Healing Cults. made the following statement about naturopaths:

Chief among the naturopathic therapeutic agents is the chiropractic treatment. Indeed, the relationships between. naturopathy and chiropractic are most close. Many -- if not all -- the naturopathic schools teach chiropractic and give their graduates the D.C. (Doctor of Chiropractic) as well as the N.D. (Doctor of Naturopathy) diploma. So far as their actual practices and activities go, it is difficult to distinguish the naturopaths from the chiropractic "mixers." As a matter of fact, they are often one and the same. Many naturopaths are former chiropractors -- chiropractors who began using so many other healing methods that they ceased to call themselves chiropractors. [11]

Naturopathic Practice

The naturopathic philosophy and approach to disease are all-encompassing and naturopaths treat most Illnesses. The practice of naturopathy is considered to be a part of the practice of medicine [12] by the NANP. The scope of naturopathic practice is described by the NANP as follows:

Naturopaths can and do diagnose, apply naturopathic therapy to, and thereby treat, acute infectious disease and abnormalities of the digestive system, the respiratory system, the cardiovascular system, the urinary system, the hemopoetic system, the nervous system and the endocrine system. [13]

Although naturopathic physicians treat patients of all ages, according to the NANP they treat a high proportion of geriatric patients.

Naturopaths, in the main serve geriatric patients... Naturopaths rights extend prenatal care (and subsequent obstetrics), through the detection and reporting of contagion to signing birth and death certificates. [14]

Almost all naturopaths are in solo practice; 90 percent are in general practice, and the remaining 10 percent specialize in pediatrics, obstetrics, gynecology, proctology, dermatology or chiropractic. [15]

The HANP describes the naturopathic approach to diagnosis as follows:

The personal interview is the naturopathic physician's first phase of diagnosis -- observation, visual detection of obvious abnormalities of a physical or psychological character, aural detection of physiological (speech) or psychological abnormalities, etc. [16]

Initial physical examinations, for new patients, are comprehensive, regardless of the nature of the patient's complaint -- to establish history and ascertain with some exactitude the current status of the patient's body. Manual and visual examinations of the body -- its limbs, muscles, orifices is routine. [17]

All of the bodies' tissues, fluids and excretions are subject to examination during the course of laboratory testing as part of naturopathic diagnosis; urine, sputum, feces, epidermal abnormalities, gastric fluids, etc. [18]

Blood testing, aside from its role as part of any general physical examination, is also conducted by the naturopath for the specific purpose of detecting venereal disease or as a concomitant to pre- and post-natal care and the prophylaxis of or informational reporting on new-born infants. Serology is an essential part of naturopaths geriatric and gerontological practice. [19]

The diagnostic aids used by naturopaths "includes, every accepted diagnostic instrument: sphygmomanometer; stethoscope; electrocardiograph; endocardiograph; thermometer; speculums; proctoscope; sigmoidoscopes; instruments for testing, reflexes, aural receptivity, and for testing pressure of eyeball; scales, X-ray; fluoroscopes . . . the gamut of modern medicine's diagnostic equipment." [20]

Some naturopaths undertake "iridiagnosis" as part of their diagnostic evaluations. It is based on the belief that bodily departures from the normal cause observable markings in the eyes of the patient. By study of these markings, according to Basic Naturopathy, [21] the naturopath can learn a complete history of past illnesses, as well as previous treatment. For example, drugs taken by the patient are said to cause appearance of certain markings and colors at a later time. The author cites as evidence of lack of validity of conventional medical treatment: ". . . such unnatural treatment always leaves more signs and markings in the iris than were there before the treatment. Under naturopathic treatment the disease signs lessen or completely disappear."

For iridiagnosis, the eyes, starting from the pupil, are divided into the stomach ring, the intestine ring, the nerve rings, circulatory system and brain, and skin or scurf rings. The sympathetic ring is further divided into areas associated with body organs or functions. Examples of signs and interpretation are: (1) a jagged white line in the sympathetic ring, pointing to a specific area associated with an organ, Indicates hypertrophy or atrophy in that organ; (2) fine black lines forming a circle in the stomach area indicate that patient has had morphine; (3) a white triangle in the appropriate area of the eye Indicates a true appendicitis, while a white line only indicates a pseudo-appendicitis and a black speck indicates an appendectomy; (4) a straw-colored stomach ring is interpreted to mean acidity or hyperacidity of the stomach.

In interpreting the signs, the author warns that ''the diagnostician must use judgment, and take Into consideration all organic and functional diseases of the organ indicated which could be located in that organ." Ability to perform irldiagnosis, the author states, requires long and arduous study and practice, which may account for the fact that it is not a too popular method of diagnosis." [22]

The naturopathic approach to treatment is described by the NANP as follows:

The techniques applicable to naturopathic treatment of disease and illness are the same techniques applicable to treatment by an allopath, with greater emphasis upon hydrotherapy, massage, manipulation, or electrotherapy in necessary instances, and with greater utilization of medications in their natural or botanical form than in their chemically-created or derived form. [23]

Naturopathy does, in general, rely less heavily on radical alteration of bodily functions and chemistry than do other healing arts. Naturopathy's primary stresses include light therapy ... ; electrotherapy... ; vibrotherapy ... ; remedial exercises...; manipulations ... ; vasomotor control; mechanical therapy... ; chemotherapy; biochemic therapy ... phytotherapy -- using naturopathic botanicals, herbal, and vegetable materials as listed in "Naturae Medicina"; the use of tissue minerals and cell salts...; vapotherapy; colon therapy -- irrigating agents and other products for the treatment pathoses of this region; autotherapies; climatotherapy.

Emphasis is placed upon nutritional advice and elimination of waste. The following treatment methods are cited as examples:

Treatment of Retention: Open the pores of the skin, increase respiration, increase excretion of the kidneys, supply adequate ingestion of proper minerals, particularly. Withhold food during the acute stages. [25]

Treatment of Invasion: Open the pores of the skin, general tonic treatment to control and only to keep the symptoms within safe limits. Congenial germicides may be used. [26]

Treatment for Enervation: General tonic treatments to maintain adequate circulation, adequate nutrition . . . Usually this will require some of the mineral phosphates and quite often vitamins in large doses. Secure emotional rest. Stimulate the skin and other emunctories. [27]

The naturopath attempts to prevent morbid matter or toxins from accumulating by prescribing pure, natural foods. Eating flesh and drinking coffee or tea, the "multiple barreled poison," are discouraged. [28] Naturopaths believe the extensive ". . . use of flesh meats may lead to auto-intoxication, a resultant of decomposition or decay of undigested remnants and cause intestinal catarrh, ulceration, biliousness, appendicitis, and many other diseases." [29]

It is apparent that naturopaths' approach to health and disease is very different than that of medicine and osteopathy. For example, the conflict with other concepts of health and disease is illustrated by the following quotations from Basic Naturopathy:

If symptoms are the showing. of an effort to get well or to adapt, does it seem reasonable to suppress, or abort, or to stop the symptom? Would It not be more logical if we were to slightly increase the symptom. to speed up the process of repair or cure? [30]

Every doctor should know that the only way to cure an ulcer is to change the "cold" condition into a "hot" condition. Irritate it, to cause an acute active reaction that will cure. The same basic principles apply to acute and chronic disease as relatively to the boil and ulcer. [31]

A good case of smallpox may rid the system of more scrofulous, tubercular, syphilitic and other poisons than could otherwise be eliminated in a lifetime. Therefore, smallpox is certainly to be preferred to vaccination. The one means elimination of chronic disease, the other the making of it. [32]

The assertion that Naturopaths could cure cancer by natural methods of treatment, was scouted and ridiculed. Many a poor sufferer has missed his chance of recovery because he believed that his only possible salvation lay in a surgical operation. [33]

Naturopaths do not believe in artificial immunization . . . [34]

Manpower

According to State Licensing of Health Occupations, in 1965 there were 351 naturopathic licenses in effect in Arizona. Connecticut, Hawaii, Oregon, Utah and the District, of Columbia. Also in 1965, 202 licenses were renewed in Florida and California. [35]

In addition to these 553 naturopaths, the NANP believes there may be 400 to 700 more naturopaths in the licensed and regulated States and 3,000 to 4,000 practitioners in States where naturopathic practice is regulated under the old common law. [36]

The exact number of naturopath-chiropractors is unknown. However, the president of the NANP believes there are about 3000 to 4000 naturopath-chiropractors practicing naturopathy. [37] If this is true, most naturopaths are also chiropractors, since according, to estimates of State licenses and the NANP there are only about 500-1000 persons with only the ND degree.

Education and Research

The National College of Naturopathic Medicine (NCNM), located in Seattle, Washington, is the only naturopathic college in the United States. The Office of Education has not designated any accrediting body for naturopathic schools. The NANP says that it accredits the one existing college. [38]

The catalog of the National College lists 40 faculty; most hold volunteer appointments. Thirty-one have the ND degree (Doctor of Naturopathy), five have a bachelor's degree, and one is a registered nurse. The president of the college has a bachelor's, master's and Th.D. degree. [39]

The NCNM offers a four year (4706 hours) course which leads to the ND degree. The first two years are concerned with the basic sciences and the last two years with outpatient clinical work. The curriculum includes psychiatry, ophthalmology. neurology, gynecology, obstetrics (in which the student has to assist in 2 or more deliveries), orthopedics, otolaryngology, minor surgery, pediatrics, urology, proctology, geriatrics and endocrinology. The 1968 catalog also lists human dissection, although this is apparently not included in the curriculum now, since there is no laboratory for this procedure. [40]

Most of the outpatient clinical experience is obtained in the office of a private practitioner. There is no inpatient training. [41]

The school makes extensive use of standard medical texts, especially in teaching the basic sciences. . According to the president of the NANP. the two books written by the profession and used at the school are Basic Naturopathy, by Harvey Spitler,, N.D., M.D., Ph.D.. and Naturae Medicaine and Naturopathic Dispensatory, by A. W. Kuts Cheraux, B.S., M.D., N.D. [42]

The library and laboratory are described as follows:

The NCNIM maintains a 5000 volume library, most of its works dealing with natural drugs -- older books whose content remains unchanged by any but radical research innovations of the relatively static character of Naturopathic publishing, the library remains valid and is more adequate than the sheer number of volumes would imply. [43]

The College contains one laboratory, operated in conjunction with its clinic . . . this laboratory is equipped and utilized for conducting clinical testing, but is too small for extensive research. [44]

The NCNM requires a high school diploma and two years of college for admission. Students have included midwives and chiropractors. [44] Since 1960, sixteen students have graduated, and in 1968 seven students were enrolled and three students were graduated. [46] No organized research is carried on by the college or by the profession. [47]

Current Status of Naturopathy

By the late 1950's, naturopathy as an entity was dropped from the curriculum of all but one chiropractic school and that one was closed in 1961. However, certain naturopathy courses continued to be taught at the other chiropractic schools. [48] The number of naturopaths therefore is rapidly declining because of the limited number of graduates from the only school of naturopathy.

In 1964, the Canadian Royal Commission on Health Services undertook a study of naturopaths. As part of this study a research team headed by Donald Mills [49], sent a detailed questionnaire to all naturopaths, chiropractors and osteopaths in Canada. The recommendation of the Royal Commission concerning naturopathy which was in part based on the Mills report was as follows:

Their number is not growing and they are not scientifically oriented to the extent that they should be included as providers of services to be paid for under the comprehensive health services recommended. [50]

Licensure

A naturopathic license can be obtained in at least five States and the District of Columbia [51] Florida has a licensure act for naturopaths, but in 1959 the Board of Naturopathic Examiners was abolished after a thorough investigation and no new licenses are being issued. [52] In addition, Georgia, California, Pennsylvania, South Carolina, and Texas once had licensure laws but repealed them; and Tennessee in 1943 passed a licensure law but repealed it in 1947 and made it a misdemeanor to practice naturopathy in that State. [53] A few States license naturopaths under a general medical practice act or as "drugless healers," or in the case of Idaho, under State Supreme Court ruling. The State licensing laws place no specific restriction on diagnostic methods as long as drugs or major surgery are not used. The use of certain treatment methods is specifically forbidden in various States, e.g., the administration of drugs is specifically prohibited in six jurisdictions; surgery in three Status; radium treatment in one State; and massage in one State. One State law specifically permits naturopaths to sign birth and death certificates.

The District of Columbia and all the States that license naturopaths require a written examination for licensure. Three States and the District of Columbia require two years of college, one State requires one year of college, and one State requires a high school diploma for licensure. All five States and the District of Columbia require a basic science certificate. [54]

In summary, it is apparent that the State licensing laws generally place no restrictions on the scope of naturopathic practice since they do not infringe upon the naturopathic philosophy or approach to health and disease. Naturopaths have no desire to administer drugs are not "natural" or to perform major surgery, yet these are the major prohibitions of the licensure laws.

Conclusions

Naturopathic theory and practice are not based on the body of basic knowledge related to health, disease, and health care which has been widely accepted by the scientific community. Moreover, Irrespective of its theory, the scope and quality of naturopathic education do not prepare the practitioner to make an adequate diagnosis and provide appropriate treatment.

Recommendation

It is recommended that no changes be made. In coverage in relation to the services of naturopaths.

References

  1. National Association of Naturopathic Physicians. Outline for Study of Services of Practitioners Performing Health Services in Independent Practice. (Report submitted to the Public Health Service by J. W. Noble, President, National Association of Naturopathic Physicians, August 1, 1968), pp. 3-4. (Mimeograph)
  2. Ibid., p. 11.
  3. Ibid., p. 13.
  4. Ibid., p. 191.
  5. Ibid.
  6. Ibid., pp. 191-193.
  7. Ibid., pp. 223-224; 261.
  8. Ibid., p. 13.
  9. Ibid.
  10. National Association of Naturopathic Physicians, Transcript of Proceedings, Independent Practitioner Study, Ad Hoc Consultant Group, USPHS, Session on Naturopathy, Friday, 22 November 1968, p. 7.
  11. Louis Reed, The Healing Cults (Chicago: The University of Chicago Press, 1932), p. 62.
  12. See page 24, footnote 10 above.
  13. See page 21, footnote 1 above.
  14. Ibid.
  15. Ibid.
  16. Ibid., p. 15.
  17. Ibid.
  18. Ibid., p. 16.
  19. Ibid.
  20. Ibid., p. 16.
  21. Harry Riley Spitler, Basic Naturopathy: a textbook (n.p.: American Naturopathic Association, Inc., 1948), pp. 240-249. This book was submitted to The U. S. Public Health Service as a part of the report from the National Association of Naturopathic Physicians.
  22. Ibid.
  23. See page 17, footnote 1 above.
  24. See page 17, footnote 1 above.
  25. See pages 255-256, footnote 21 above.
  26. Ibid.
  27. Ibid.
  28. Ibid., p. 165.
  29. Ibid., p. 286.
  30. Ibid., p. 47.
  31. Ibid., p. 41.
  32. Ibid., p. 214.
  33. Ibid., p. 224.
  34. Ibid., p. 271.
  35. Ibid., pp. 62-63.
  36. Letter of February 19, 1968 from J.W. Noble, President of The National Association of Naturopathic Physicians, to the Secretary of the Department of Health, Education, and Welfare.
  37. See page 6, footnote 10 above.
  38. U. S. Department of Health, Education, and Welfare, Office of Education, Telephone conversation with U. S. Public Health Service Staff.
  39. National College of Naturopathic Medicine, Calendar 1965-66, 1967-68.
  40. Ibid., p. 20.
  41. See page 27, footnote 1 above.
  42. See Footnote 21; and A. W. Kuts Cheraux, Naturae Medicina and Naturopathic Dispensatory (Des Moines, Iowa: American Naturopathic Physicians and Surgeons Association 1953). (Submitted to The U. S. Public Health Service by The National Association of Naturopathic Physicians).
  43. See page 27, footnote 1 above.
  44. Ibid.
  45. See page 26, footnote 1 above.
  46. See page 30, footnote 1 above.
  47. See page 7, footnote 1 above.
  48. See page 7, footnote 10 above.
  49. Donald Mills, Chiropractors, Osteopaths and Naturopaths in Canada, (Ottawa: Queen's Printer and Controller of Stationery, 1966).
  50. Royal Commission on Health Services, Vol. II (Ottawa: Queen's Printer and Controller of Stationery, 1965), p. 80.
  51. U. S. Department of Health, Education, and Welfare, U. S. Public Health Service, National Center for Health Statistics, State Licensing of Health Occupations, Public Health Service Publication Number 1758 (Washington, D.C.: Government Printing Office, 1967), pp. 61-63.
  52. P. W. Sapp, Report on Naturopathy in Florida to the Honorable Lerox Collins, Governor, Vol. I and II (Florida State Board of Health, January 1957).
  53. Ibid.
  54. See pages 61-63, footnote 51 above.

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This page was revised on August 30, 1999.