Provide Licensure for Naturopathic Physicians

Provide Licensure for Naturopathic Physicians

in the State of Iowa.

This document provides background information and support for the passage of HB602/SF281, a bill which will create licensure for Naturopathic Physicians (ND) in the state of Iowa and establish a board of examiners to regulate licensed NDs.

What is 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 (see Appendix A: Naturopathic Practice and Principles). 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. Licensed NDs are currently working alongside medical doctors (MD), osteopathic doctors (DO) and chiropractic doctors (DC) in progressive states to provide integrative solutions(see Appendix B: Licensed States).

Education

Naturopathic physicians attend four-year, graduate level, in-residency programs at institutions recognized by the US 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. (Appendix C: Princeton Review Excerpt) In addition, ND programs provide extensive education unique to their treatment approach, emphasizing disease prevention and wellness.(Appendix D: School Curriculum from NCNM)

While this list is by no means comprehensive, naturopathic physicians are trained in the following: clinical nutrition, botanical medicine, homeopathic medicine, physical medicine, Chinese medicine, lifestyle counseling and stress management, natural childbirth, minor office procedures and monitoring nutrient/drug/herb interactions (see Appendix E: Naturopathic Modalities). In fact, NDs are the only healthcare professionals formally trained to monitor and manage nutrient/drug/herb interactions.

How will licensure benefit Iowans?

Iowans will have access to what health consumers demand

36%[1] -68%[2] of Americans are using some form of naturopathic modalities as part of their healthcare. Despite this widespread consumer preference, Iowans have no choice but to obtain health care from practitioners who lack the training to provide this care. MDs and DOs do not receive any formalized training in alternative and natural medicine, and Chiropractors lack sufficient training in herb/nutrient/pharmaceutical interactions. These medical providers are not able to fill the gap between consumer demand and available treatment methods. This bill will provide Iowans with safe, reliable access to integrative care.

Naturopathic physicians are trained to integrate natural and conventional medicine

Naturopathic physicians complement and enrich other medical models and treatment modalities. NDs can work with other practitionersto facilitate referrals that expedite the patient’s health and well-being. In licensed states, NDs, MDs, DOs and DCs work together to provide better, more comprehensive health care. Licensure is needed to create an effective referral environment essential for patient safety and responsible health care.

Iowans will be protected from diploma mill graduates

Despite USDepartment of Education recognition of naturopathic medical education, diploma mills that offer “naturopathic” degrees still exist. Without licensure, it is difficult for health consumers to discern the difference between natural health consultants and naturopathic primary care physicians. State licensure is the only way to protect the public by providing a board to verify the credentials of their naturopathic physicians. Licensure separates life-experience and self study from formal medical training. Additionally, as surrounding states pass licensure laws, Iowa is likely to see an influx of diploma mill doctors implying physician level training, unless Iowans enact licensure first.

Naturopathic Medicine lowers health care costs for Iowans and Iowa businesses

In a recent study conducted by Green Mountain Wellness Solutions for the Vermont Automobile Dealers Association in 2005-2006, 848 employees were examined and advised by naturopathic physicians for one year. The organization saved $1.5 million in direct and indirect medical costs the first year. Further, the drastic reduction in health risk factors has resulted in a decrease in insurance premiums for each year the program has been in place. (See appendix F: VADA Wellness Program). Licensure of naturopathic physicians will lower health care costs for Iowans.

Naturopathic medicine is extremely safe

Naturopathic Physicians have a phenomenal safety record. In states that license and insure NDs, coverage costs, reports and claims are significantly lower than those found in conventional medicine (see Appendix G: ND Prescription Safety Record). This bill provides access to safe, effective holistic medicine.

How will not passing licensure hurt Iowans?

Iowans who want natural and integrative health care will have to leave the state

With neighboring states currently reviewing licensure, Iowans may soon be taking their health care dollars across Iowa’s state lines. The University of Iowa Research Department is already contacting Naturopathic Clinics outside of the state for inclusion in NIH grant proposals.

Iowa can expect an influx of diploma mill graduates

The only way to prevent diploma mill graduates from representing themselves as doctors and physicians is to provide licensure to those that uphold the national standards proven safe and effective for primary, natural health care. Minnesota and Illinois currently have bills for licensure and Wisconsin is planning to enter a licensure bill in 2008. When these states pass licensure, Iowa can expect an influx of diploma mill graduates presenting themselves as formally trained health professionals.Without responsible oversight there sill be lower health care standards and public confusion.

Medical costs will continue to rise while Iowan’s health declines

Diabetes, heart disease and cancer are all considered preventable conditions yet the current health care system has shown little efficacy in preventative medicine.[3][4][5][6][7]Naturopathic Medicine has proven itself to be significantly more effective in improving health and reducing health care costs.[8] Health is a right that all Iowans deserve access to. Naturopathic physicians are the only natural medicine professionals trained and willing to work with other branches of medicine to offer the best and safest health care.

Who is likely to oppose this bill?

IOWA MEDICAL SOCIETY

Some are afraid they will lose patients.

However, this is simply not true. The increasing shortage of physicians currently leaves nearly one in five Americans (56 million individuals) with inadequate or no access to primary health care. The chart below shows the current medically underserved areas of Iowa. This isn’t a new problem; MD enrollment has dropped every year since 1980[9]. Perhaps more importantly, according to Managed Care Magazine, “the number of conventional primary care residencies fell by more than 100 this year (2007). And just 7.8% of medical students …selected primary care residencies, down from 8.1% in 2006.” Conventional medicine can not fix the shortage of primary care doctors.

NDs are primary care physicians who have proven effective for underserved and rural areas.In more affluent areas, the people whoseek health care from NDs are either not interested in conventional care or conventional medicine is not able to serve their needs. MDs and DOs are not trained to do what NDs do, and therefore are rarely in direct competition for the same patients.

Some will say NDs don’t have sufficient education.

Naturopathic physicians are already licensed as primary care physicians in nearly 1/3 of the states. Naturopathic physicians have a outstanding safety record. Naturopathic physicians have an outstanding record for improving health and reducing disease risk factors in their patient population. All naturopathic medical schools have four year, post graduate, in-residency programs recognized by the US Department of Education. (See appendix H: Schools, Accreditation and Board Examinations and Appendix I: Medical College Comparisons)

Some will try to confuse the issue by linking diploma mill graduates with licensed naturopathic physicians

The truth is that naturopathic physicians receive exemplary education and have the health results and safety records to prove it. Many states have had naturopathic licensure since the early 1920’s.When both conventional and naturopathic forms of health care become available, there is a significant benefit to the public in accessibility, prevention and reduced health care costs.

(See appendix J: History of Naturopathic Medicine)

IOWA CHIROPRACTIC SOCIETY

Some are afraid they will lose patients

This couldn’t be further from the truth. Since NDs bridge the gap between natural and conventional medicine. This increased awareness creates a higher level of comfort in all forms of health care, including chiropractics. Chiropractic doctors actually see more patients in states where naturopathic medicine is licensed. Naturopathic physicians are trained in naturopathic manipulation, not in chiropractics and not in osteopathic manipulation. Although NDs do learn chiropractic theory, this is to educate patients on the benefits of chiropractic treatment and will generate referrals to optimize patient care. The following charts show an increase in the number of chiropractors per area with chiropractic mean salary remaining the same. This shows that the increase in the number of chiropractors can only be explained by an increase in the patient base. Showing clearly that chiropractic medicine is helped, not hindered, by naturopathic state licensure. Chart sources: Federation of Chiropractic Licensing BoardsChiropractic Economics.

HEALTH FREEDOM ORGANIZATIONS

Some will say we are restricting access to natural health therapies and natural products.

We have absolutely no interest in restricting access to any of the modalities within naturopathic medicine. This has not occurred in any state where naturopathic physicians have been licensed. This bill provides that only those who have a 4 year, post graduate, in-residency education can present themselves as physicians, and only NDs can use the word naturopath which has implied physician training since we first gained licensure in several states almost 100 years ago. There is no wording in the bill that would prevent others from performing their trade. Iowa will simply prevent the terms Naturopathic Doctor, Naturopathic Physician, Naturopath and any variation from being used by graduates of diploma mills and self study courses. This bill does not restrict the use, education pertaining to or sale of homeopathic remedies, supplements, foods, or any other natural health modality generally proven save and currently allowed under Iowa safe practices acts. This bill regulates naturopathic physicians and allows them to diagnose and treat disease within their scope of practice.

Some will say that natural medicine does not require licensure.

Nearly one third of the country already has licensed naturopathic doctors as primary care physicians. For public welfare, diagnosing and treating disease absolutely requires a license. Additionally, licensing naturopathic physicians in Iowa will not change other therapists’ practices, methods, business or abilities in anyway. For instance, health food stores can do as they have been doing, natural health practitioners can continue as they have been doing and massage therapist’s careers will be completely unaffected by this bill. However Iowans will be protected from unqualified individuals masquerading as physicians. Naturopathic physicians seek legislated oversight to guide safe practice. Additionally, it is imperative that the public can have peace of mind knowing that their naturopathic doctor has met established educational and licensure requirements.

This bill is not about MDs

This bill is not about DCs

This bill is not about health freedom groups

THIS BILL IS ABOUT IOWANS HAVING ACCESS TO SUFFICIENT, SAFE AND COMPREHENSIVE HEALTH CARE OPTIONS.

Appendices

Appendix A: Naturopathic Medicine and its Six Principles

Naturopathic medicine is a primary health care profession emphasizing:

• Prevention and treatment of disease
• Maintenance of optimal health
• Promotion of the individual's inherent self-healing process

Naturopathic medicine uses holistic diagnosis with the following therapies:

1

• Clinical nutrition
• Botanical medicine
• Homeopathic medicine
• Physical medicine
• Lifestyle counseling
• Pharmaceutical medicine
• Minor surgery

1

All licensed naturopathic physicians have Doctorate of Naturopathic Medicine degrees from federally recognized medical schools. Their education includes:

• The same premedical undergraduate coursework required by other schools of medicine
• Graduation from a four-year, federally recognized, naturopathic medical school
• Two full years of supervised clinical internship
• Optional residency programs
• The same foundational and clinical sciences as other medical students, and in addition, a full spectrum of natural medicines and therapies.

As primary care providers, naturopathic physicians diagnose and treat using:

• Standard medical diagnostic techniques such as extensive health history, physical examination, blood tests, radiology, and other standard laboratory procedures. They use holistic interpretation in order to find the underlying cause of the disease process. Following diagnosis, NDs use natural medicines and therapies as the first line of treatment, use of drugs and surgery.

The Six Principles of Naturopathic Medicine

1) The Healing Power of Nature: vis medicatrix naturae

Naturopathic medicine recognizes an inherent healing process in the person that is ordered and intelligent. The body is capable of healing itself. The role of the naturopathic doctor is to identify and remove obstacles to healing and recovery and to facilitate and augment this inherent natural tendency of the body.

2) Identify and Treat the Cause: tolle causam

Naturopathic doctors seek to identify and remove the underlying causes of illness, not merely eliminate or suppress symptoms.

3) First Do No Harm: primum no nocere

Naturopathic doctors follow three guidelines to avoid harming patients: 1) Utilize methods and medicinal substances that minimize risks of side effects, using the least force needed to diagnose and treat. 2) Avoid, when possible, the harmful suppression of symptoms. 3) Acknowledge and work with the individual's self-healing process.

4) Doctor as Teacher: docere

Naturopathic doctors recall that the origin of the word "doctor" is the Latin word, "to teach." A fundamental emphasis in naturopathic medicine is patient education.

5) Treat the Whole Person: -- in perturbato animo sicut in corpore sanitas esse non potest

Naturopathic doctors attempt to take into consideration all the factors that make up patients' lives and affect their health and well-being.

6) Prevention: principiis obsta: sero medicina curatur

Naturopathic medicine emphasizes the prevention of disease, assesses risk factors, and makes appropriate interventions with patients to prevent illness.

Appendix B: Licensed States

Currently, 14 states, the District of Columbia, and the US territories of Puerto Rico and the U.S. Virgin Islands have licensing laws for naturopathic doctors. The Alliance for State Licensing (Alliance) is a group of representatives from various state naturopathic associations that align with each other to share information, support, and experience in their quest for licensure, under the auspices of the American Association of Naturopathic Physicians. According to the Alliance, the states of Colorado, Florida, Illinois, Iowa, Massachusetts, Minnesota, New Mexico, New York, North Carolina and Virginia have introduced legislation during the last year or will be introducing legislation next year. The states of Maryland, Michigan, Nevada, Ohio, Pennsylvania, Texas, and Wisconsin are moving towards legislation in the near future.[10]

Year of Licensure Enactment and Number of Active NDs[11]

Licensed State / ND Licensure
Enacted / Number of
Active NDs
Alaska / 1986 / 40
Arizona / 1935 / 375
Connecticut / 1920 / 210
Hawaii / 1925 / 85
Kansas / 2003 / 11
Maine / 1995 / 27
Montana / 1991 / 67
New Hampshire / 1994 / 57
Oregon / 1927 / 715
Utah / 1997 / 18
Vermont / 1995 / 117
Washington / 1919 / 802

Appendix C: Excerpted from The Princeton Review’s

“Best 168 Medical Schools”

October 30, 2006

The Princeton Review has just published and released their new edition of “Best 168 Medical Schools, 2007 Edition” (October 2006). The book includes medical school applicant information and advice, as well as a chapter which profiles each of the six naturopathic medical schools. One excerpt comparing and contrasting the three major medical fields’ states:

“Naturopathic physicians (NDs) take a holistic approach to healing, and aim to cure disease by taking advantage of the body’s self-regenerative powers and harnessing the restorative power of nature. Like osteopaths, naturopathic physicians endeavor to treat the whole person by taking into account the emotional, genetic, and environmental factors that have influenced their state of health. Unlike osteopaths, however, naturopathic physicians emphasize natural remedies. NDs also differ from allopaths (MDs); rather than limiting their treatment to synthetic drugs and invasive procedures, NDs predominantly utilize natural medicines and procedures. Naturopathic physicians work to identify and eliminate the cause of disease, and are guided by six basic principles: