A Brief Description of Naturopathic Medicine:
Naturopathic medicine bridges the gap between natural and conventional medicine. It is a distinct and comprehensive form of medicine that blends centuries-old, natural, non-toxic therapies with current advances in the study of health and human systems. Naturopathic medicine covers all aspects of family health from prenatal to geriatric care, with a special focus on whole-patient wellness.
Philosophy and Treatment Methods
Naturopathic physicians (ND) are trained as integrative doctors, emphasizing the use of natural therapies in the treatment and prevention of acute and chronic illnesses. Naturopathic practice is predicated upon the assumption that the human body is inherently capable of healing itself. In practice, NDs perform physical examinations, take thorough health histories, make nutritional and dietary assessments, and order lab tests. NDs may also order diagnostic tests and imaging procedures such as x-rays, ultrasounds, and anything else a general practitioner would require to access health and determine appropriate treatment methods for a patient. Referrals are made to specialists or other healthcare providers for additional testing or treatment when necessary.
Education
Naturopathic physicians attend four-year; graduate level, in-residency programs at institutions recognized by the U.S. Department of Education. There are currently four such schools in the United States. Naturopathic medical schools provide the same foundational coursework as conventional medical schools. In fact, ND programs often provide more pharmacology and physiology than mainstream MD schools do. In addition, ND programs provide extensive education unique to their treatment approach, emphasizing disease prevention and wellness
While this list is by no means comprehensive, naturopathic physicians are trained in the following: clinical nutrition, botanical medicine, pharmacology, parenteral/intravenous therapies, homeopathic medicine, physical medicine, lifestyle counseling and stress management, natural childbirth, minor office procedures and monitoring nutrient/drug/herb interactions. In fact, NDs are the only healthcare professionals formally trained to monitor and manage nutrient/drug/herb interactions.
The Board of Naturopathic Medicine's formulary adoption:
The formulary adopted by the Board of Naturopathic Medicine on 1/1/10 reflects one adopted by the California Bureau of Naturopathic Medicine in 2007. That formulary was developed over a two year period by a panel of two naturopathic doctors, two allopathic/medical doctors and two pharmacists. Similar and broader formularies were adopted many years ago in other western states, such as Washington, Oregon, Arizona, Utah and Montana. It is a formulary that reflects the fact that naturopathic doctors provide primary care, and need to have access to medications which are commonly used in such care. The Hawaii naturopathic formulary does not include any controlled substances, or any medications which are generally prescribed by specialists, such as oncologists, neurologists, and cardiologists.
In preparation for the California Bureau's report, the Bureau contacted the licensing agencies for each of the states that allow NDs to prescribe. None of the states reported any patient harm or disciplinary action due to ND prescribing. In addition, the states were not aware of any civil actions against NDs for prescribing.
The California Bureau also contacted NCMIC Insurance Company. NCMIC insures NDs in all of the licensing states and also insures the naturopathic medical schools. In a letter to the Bureau 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 a licensed ND. JVN covers both Oregon and Washington, the two states with the greatest number of NDs and that have been licensing NDs for a considerable length of time (since 1919 and 1927, respectively). JVN responded "Upon reviewing cases contained in Jury Verdicts Northwest's database we found no cases against naturopaths for prescription negligence, or for that matter our database contained no cases against naturopaths at all."
Naturopathic Medical School Pharmacological Education
Interventions by naturopathic physicians include the use of pharmaceuticals when appropriate. Naturopathic medical students are required to learn about all classes of pharmaceutical agents, regardless of their ability to prescribe them under various state laws. A typical program includes 72 hours of classroom education which includes the principles of pharmacodynamics, side effects, and therapeutic uses of legend, or prescription, drugs. This does not include many other hours in courses such as gynecology, urology, cardiology, dermatology, etc. where prescription medications are discussed. It also does not include the minimum 1200 hours of clinical training where prescription medications are prescribed, administered, and managed as part of comprehensive treatment plans. This compares favorably with the didactic education for other medical professionals with legend drug prescribing rights.
Pharmacology is also an integral part of the Naturopathic Physicians Licensing Examination (NPLEX). NPLEX consists of extensive clinical case summaries for which the candidate must answer a series of questions relevant to diagnosis and treatment for each case.
Naturopathic students are exposed routinely in their clinical training to the appropriate selection, prescription, and management of prescriptive drug use, with clinical rotations providing practical management experience. They are also exposed to a wide variety of patient populations, and while it is true that many patients select naturopathic care based on their desire to avoid or reduce use of legend drugs with perceived side effects, a drug may be the best choice for their care at certain times. Naturopathic physicians are trained to recognize the indications, efficacy and potential side effects of all drugs a patient is on whether they can prescribe them or not, since many patients come in already taking medications. In all teaching clinics, assessment of the patient history includes an evaluation of their current pharmacological treatments.
Parenteral therapies:
Naturopathic doctors licensed here in Hawaii and nationwide have been administering natural substances including vitamins, minerals and amino acids subcutaneously, intramuscularly and intravenously (i.e., parenterally) for over twenty years. The naturopathic governing statute, HRS 455 prior to 2009 stated naturopathic doctors may use the ".natural methods or modalities, together with natural or homeopathic medicines, natural foods, and herbs, and nature's remedies of the type taught in education and training at naturopathic medical colleges." Because injection routes are taught in naturopathic medical colleges, doctors had chosen in the past to safely utilize these effective methods.
The naturopathic governing board issued an opinion in 1984 that the injection of vitamins was within the scope of practice of naturopathic physicians. There has not been one case of misuse or harm caused by these methods reported to the state licensing board or the state member society. In addition, naturopathic malpractice insurance companies insure practitioners using these techniques. The largest insurance companies offering malpractice insurance have not received one malpractice claim throughout the nation against a naturopathic physician for the misuse of injection methods.
There were no complaints brought to the Board of Naturopathic Examiners in regard to the use of these injectable natural medicines by naturopathic physicians during this time. In 2006, the legislature approved HB1155 which clarified that naturopathic physicians have the authority to administer natural medicines by injection, although the bill was vetoed by the Governor.
Vitamin, mineral, and amino acid injections are very beneficial for a variety of health conditions, including immune enhancement, correcting nutrient deficiencies, and eliminating toxic substances such as heavy metals (lead, mercury, etc.). Naturopathic physicians provide a valuable service to public health and safety by offering this treatment.
