B

OSTON — Naturopaths, who practice an alternative medicine heavy on herbal supplements, are making a big push to gain more authority and stature across the United States, including the right to do more hands-on patient care and to be reimbursed by Medicare.

That’s raising concern among critics who see naturopaths as quacks — and who warn that offering them state licenses, insurance reimbursements, and other recognition only legitimizes their pseudoscience.

“You don’t want to regulate the snake-oil salesmen,” said Steven Salzberg, a computational biologist at Johns Hopkins who has been a vocal critic of naturopaths. “They don’t offer something that works to begin with.”

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Naturopaths’ lobbying and public relations drives are funded in part by vitamin companies, which have a vested interest in seeing the profession expand, since many naturopaths promote dietary supplements, herbal remedies, and vitamin infusions for healing.

Next Monday, more than 100 aspiring and practicing naturopaths plan to storm Capitol Hill to rally support for a federal pilot program that would allow them to be reimbursed by Medicare for some patients. Naturopaths are also lobbying for expanded authority to diagnose and treat patients in a handful of states, including Massachusetts and Michigan.

The campaign comes at a tricky time: A Canadian couple last month was found guilty of “failing to provide the necessaries of life” after their son died after they took him to a naturopath instead of getting his meningitis treated with antibiotics. The naturopath is under investigation by a professional board.

But in the US, the American Association of Naturopathic Physicians is optimistic that the public is ready to embrace its approach.

The AANP plans to host its first big consumer health fairs this summer, in D.C. and Utah, complete with cooking demonstrations and yoga for the whole family. And the group recently hired two new staffers to lead a more aggressive PR strategy, including a former TV journalist.

“There’s a lot of excitement with the increase in consumer demand for natural remedies,” said Ryan Cliche, executive director of the AANP.

The group’s goal: Pushing all 50 states to license naturopaths by 2025.

That would be a big jump. Today, just 17 states, Washington D.C., Puerto Rico, and the Virgin Islands have systems in place to license naturopaths after they pass an exam covering a wide variety of topics, from genetics and pathology to homeopathy, botanical medicine, and nutrition.

The roughly 4,400 licensed naturopaths in the US are typically allowed to perform some medical tests, make diagnoses, and prescribe certain medications, though the exact rules vary by state. In states without licensure, they’re usually limited to doling out advice about healthy lifestyles.

Essential oils, alcohol for disinfecting acupuncture points, and other acupuncture supplies. Chantal Heijnen for STAT

Practitioners say expanding licensing would protect patient safety by weeding out bad actors who can’t meet state standards. Many naturopaths also argue that they don’t aim to replace, but to complement, traditional medicine.

Robert Kachko, a licensed naturopath in Connecticut who also practices acupuncture in New York, says he makes referrals to medical doctors at least weekly. He maintains dialogues with his patients’ primary care physicians. And when parents come in with questions about vaccinating their children — something many naturopaths recommend against — he refers them to a pediatrician.

“We’ll be the first doctors out there, especially in states where we’re licensed, to tell people there’s a time and a place for all kinds of approaches,” Kachko said.

A state-by-state look at legislation on naturopathy

Naturopaths are licensed to practice in states shaded dark. They can only dole out advice about diet and lifestyle in states shaded light. Red stripes signify states in which "key legislation" is pending, according to the American Association of Naturopathic Physicians.

Natalia Bronshtein/STAT Source: American Association of Naturopathic Physicians

Training in the discredited field of homeopathy

Naturopaths are trained at a handful of schools across the country. They take courses with titles like “Gross Human Anatomy” and “Fundamentals of Radiology and Diagnostic Imaging,” which sound a lot like something you’d see at a conventional medical school. But critics say the classes are far less rigorous and they’re often taught by professors who lack any relevant credentials.

“I spent three times as much time learning how to give a patient sugar than learning how to prescribe a pill,” said Britt Marie Hermes, who trained as a naturopath, became disenchanted with the profession, and is now pursuing a master’s degree in biomedical research.

Students also take classes like “Homeopathy” that wouldn’t pass muster among MDs. Homeopathy relies on the allegedly curative power of miniscule, highly diluted doses of natural substances — for instance, an allergy treatment might be made from a lot of water and a tiny dose of pollen.

A recent review of 176 studies that examined more than 60 diseases and illnesses found no health condition for which homeopathy was any better than a placebo. (Of course, the placebo effect can be a potent force in reducing pain and boosting energy, which could help explain the enduring consumer interest in naturopathic treatments.)

Naturopaths often vouch for other unproven approaches, too, like detoxes, intravenous vitamin infusions, and the “blood type workout,” which advocates tailoring an exercise plan to your blood type.

Many distrust conventional products that have been proven safe. The actress Gwyneth Paltrow’s lifestyle publication Goop, for instance, has featured Q&As with a naturopath cautioning against possible toxicity in tampons and lubricants.

But the biggest problem, critics say, is that patients who seek out naturopaths sometimes forgo conventional medicine — and naturopaths don’t always object.

A study published last week found that breast cancer patients who followed alternative medicine practices that are the central tenets of naturopathy were 84 percent less likely than their peers to have received the chemotherapy that’s the standard of care for their type of cancer.

And a study of insurance claims in Washington state from 2000 to 2003 found that children were significantly less likely to receive four recommended vaccines if they saw a naturopath.

Cliche said the AANP’s governing body is discussing its stance on vaccinations.

Kachko performs acupuncture on a patient in his office in Manhattan. New York law limits him to doling out diet and lifestyle advice as a naturopath. Chantal Heijnen for STAT

The vitamin industry gets behind naturopaths

The makers and sellers of herbs and supplements have a big stake in the expansion of naturopathy — and they’re putting money behind it. “Corporate partners,” many of them dietary supplement makers, have collectively contributed more than $270,000 to fund the AANP’s work this year.

One of the AANP’s top contributors: Emerson Ecologics, which distributes nutritional supplements and vitamins and gave $50,000 to the group.

Emerson’s ties to naturopath advocacy run deep. The New Hampshire-based company employs AANP President Jaclyn Chasse as an executive overseeing scientific and regulatory affairs. (Emerson and Chasse didn’t return requests for comment.)

The AANP trains its board members about conflicts of interest and requires them to recuse themselves from conversations or votes that might pose a conflict. The group “takes this very seriously,” Cliche said. The Consumer Healthcare Products Association, which represents the makers of dietary supplements, declined to comment on the funding.

Last year, Emerson gave $10,000 to the professional group for naturopaths in Michigan. Those funds went to pay a lobbyist and and run a public relations campaign to advance the group’s push for licensure in the state, according to Abigail Ellsworth, the group’s president.

The funds, Ellsworth said, “indirectly” helped the group achieve a victory last month: favorable passage by a key House committee of a bill that would give licensed naturopaths the ability to conduct physicals and do blood work and imaging. Ellsworth is hoping for a vote in the full House before the legislature breaks for the summer.

Lobbying for a license

It’s unclear how receptive state lawmakers will be to these efforts. Recent pushes by naturopaths to expand the scope of their practice have been beaten back in North Dakota and Colorado. In other states, licensing bills have been introduced and reintroduced for years without ever passing. They’re typically opposed by medical groups who worry that licensure would lend legitimacy to treatments that are not based in science.

“Let’s not legitimize a combination of the worst methods of the 19th century and New Age healing,” the Massachusetts Medical Society said last fall in testifying against two naturopath licensing bills pending at the time.

But naturopaths are optimistic anyway.

Here in Massachusetts, the licensing legislation— which would allow naturopaths to diagnose and treat patients — is still very much alive. It’s now pending as a single bill in the state Senate.

The state naturopath association retains a professional lobbyist. But on a sunny day last week, it was Amy Rothenberg, the group’s warm and friendly president, who showed up at the State House without any appointments to dart in and out of offices of state senators, trying to grab a few minutes with aides.

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“I feel like it’s our time. The culture has shifted. We’re lagging behind the other New England states,” she implored one aide who nodded politely as she made her case.

Rothenberg tried out a handful of arguments on each aide she met: The state loses tax revenue when Massachusetts-based naturopaths like her must practice in neighboring states where they can get licenses. Patients are at risk when anyone — even a Senate aide— can hang up a shingle and call themselves a naturopath with no regulatory oversight.

She even nodded toward the opioid crisis that is ravaging communities in the state. “There are a lot of things we can do shy of prescribing opiates,” she assured one aide.

The aides seemed to really start listening, though, when Rothenberg shared a personal story: Her own experience a few years ago as a patient being treated for breast and ovarian cancer.

She didn’t hesitate to get surgery, chemotherapy, and radiation at Massachusetts General Hospital. But she also sought care from a naturopath in New Hampshire, driving six hours round trip for her weekly appointments, where she got intravenous vitamin infusions, breathed pure oxygen in a pressurized chamber, and got recommendations for plant-based remedies like bromelain, an enzyme derived from pineapples. Six months after finishing chemotherapy, she felt so good she completed a triathlon.

“I’m a perfect example,” she told one aide, “of somebody who would love access in the state.”

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  • what your thinking of is the Edge and Lita live sex celebration and Ric Flair was the one who broke it

  • What a beautifully uninformed and misleading piece of “writing”. I was really
    hoping for better journalism, but that’s too much to ask from…what’s this site again?
    Oh, you should look into the international medical graduate (IMG) bridge program in Toronto, and how so many MDs are flocking into it. I’d also suggest looking into some of the actual regulations in place if you really care about providing balanced information. And c’mon, we know homeopathy is as good as placebo, but that argument is old and boring. Move on! Bottom line, in regulated jurisdictions, morbidity is reduced and quality of life actually improves with naturopathic care. Look for the studies, and if you want to really have a debate, then let’s focus on what matters, not the name calling (i.e. quacks…snakw oil? So lame!). Regulation is in place to protect the public; it would be irresponsible not to.

  • Wow. The supplement industry donated $270 000 to the AANP. What a vast number!!!

    It almost makes the 185,490,520 spent by the Pharmaceutical cartel, or the 182,440,000 spent by the American Medical Association, or the 162,550,000 by the American Hospital Association seem quaint by comparisson.

    Source http://maplight.org/us-congress/lobbying

  • I hope that part of the licensing, requires the coordination care with physicians and traditional care provided to patients. It is imperative, that patients let all care givers know what traditional and non-traditional therapies they are taking. When I was in hospital pharmacy practice, we ran into a number of issues where oncology patients weren’t telling their oncologists they were taking other treatments, had an HIV patient importing a drug from Japan we had to identify, ran into an issue where two patients had unexpected bleeding during surgery (Action plan was to add alternative/nutraceuticals as part of patient interviews for surgery and admission to the hospital) and was asked by Physician Attendings to identify what the patients were taken, with no identification on the tablets (can’t use DrugDex), etc. I believe, that if everyone communicates better, we will make patient care better and avoid adverse events that have occurred (the one’s we know of).

  • I agree that there are a handful of mainstream medicines that really work – antibiotics are one of them. But for most other medicines, meta analyses have shown that active drugs and placebos have similar effect sizes (see: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0062599).
    Also, when considering the terrible side effects (and long term adverse effects) of things like psychiatric drugs that are prescribed today (these are medicines that drug companies come up with using a hit-or-miss approach), it would be definitely better off for a person to take a non-harmful product (that would help them as well – through “placebo effects”). So, if an alternative product is nontoxic, it should be allowed.

  • I think they should be allowed, at least in a smaller scale at the beginning. The reason I say this is because even when considering western medicine, meta analyses have shown that active drugs and placebos have similar effect sizes, questioning the actual effectiveness of most modern drugs – see:
    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0062599
    Also, expectations of a patient can play a very big role in their healing (check out the documentary “Brain Magic: The Power of Placebo” in ‘nature of things’). Therefore, if natural healing products were restricted, some people who swear by natural remedies would miss out on their healing. Additionally, when considering the terrible side effects (and long term adverse effects) of things like psychiatric drugs that are prescribed today (these are medicines that drug companies come up with using a hit-or-miss approach with only profits in mind), it would be definitely better off for a person to take a non-harmful product. Therefore, if a product is nontoxic, it should be allowed.
    Also, things like yoga and mindfulness should be definitely included considering that the evidence is overwhelming for their effectiveness – with these practices, even the structure and function of the brain known to change in positive ways.
    By the way, it should be noted that the recent review (of 176 studies) mentioned in this article is not a peer-reviewed journal article.

    • So you are in favor of allowing naturopathy because their treatment basically amounts to a placebo effect? That’s very dangerous.

      First of all, naturopaths will not admit that their treatment is ineffective. They will spin all sorts of stories and make all sorts of claims about efficacy. They are not burdened by the need for evidence. These people are marketers and evangelicals.

      They also use scare tactics and conspiratorial thinking to discourage patients from conventional medical care. “Doctors don’t want you to know this because then they couldn’t make money…” etc.

      Second, you assume that the treatments do no harm. This is absolutely not true. Look at the adverse effects of vitamin megadoses that naturopaths favor. Also think of how dangerous it is to have an overconfident and underqualified practitioner testing for and attempting to treat real diseases. At the very least it wastes the limited resources of vulnerable sick people.

      Naturopaths are grasping for legitimacy. Give them an inch and they will take a mile. They even risk infecting proper medical practice with their logical fallacies.

    • Catherine: These drugs should be allowed as long as they pose no harm. To get an idea of the terrible long-term adverse effects of conventional psychiatric drugs, check out the report titled “The Case Against Antipsychotics: A Review of Their Long-term Effects” (it is available online). To get a drug approved, I have heard that pharmaceutical companies need to present only two positive trials – therefore, what the drug companies do is to conduct many many trials and present two trials that just happened to show results in a favorable direction for that drug.
      By the way, it should be noted that the review (of 176 studies) mentioned in this article is not a peer-reviewed journal article, so we do not know if any biases played a role in compiling it. I have checked academic databases and there appears to be studies that have found positive results for homeopathy. Perhaps science has not yet figured out how homeopathy, etc., works – science cannot simply assume that it knows all the answers and understands everything.

  • Supplements, complementary and alternative medicine. Or simply SCAM.
    The legitimizing of non-scientific medicine in this country is a disgrace and dangerous. What’s the harm? Search that phrase and find a website dedicated to documenting the harm from non and pseudo-scientific medicine.

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