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ACAM only accepts membership application from Naturopathic physisicans who hold a degree from one of the following accredited Naturopathic Medicine Colleges:
Additionally, ND members of ACAM must show proof of licensure in the state of their practice. About Naturopathic physiciansNaturopathic physicians in the United States are independent providers with training in conventional medical sciences, diagnosis and treatment, and natural therapeutics with licenses or registration granted by an individual state Naturopathic Board of Medical Examiners. They graduate from four-year nationally accredited naturopathic medical graduate schools. Naturopathic physicians training with respect to modalities is different, with a focus on nutrition, botanical medicine, homeopathy, hydrotherapy, physical manipulation, pharmacology, and minor surgery. Some naturopathic physicians have additional training in the following: natural childbirth, acupuncture, and Chinese medicine. These subspecialties often involve additional years of study. Naturopathic physicians are required to attend continuing education yearly in order to maintain and renew their license. Naturopathic physicians are licensed to diagnose and treat disease in Alaska, Arizona, California, Connecticut, District of Columbia, Hawaii, Idaho, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, Washington, US Territories: Puerto Rico and Virgin Islands. Naturopathic Physicians are working in cooperation with both conventional and alternative practitioners to provide patients with complete medical care. Naturopathic physicians can bridge disparate fields with their training in both conventional and non-conventional treatment. Naturopathic physicians are able to identify and prescribe appropriate treatment including referral to conventional medical doctors. For licensure as a naturopathic physician in one of those licensing U.S. states or Canadian provinces, candidates must have a Doctor of Naturopathic Medicine (abbreviated as N.D. or less commonly N.M.D.) / Doctor of Naturopathy (abbreviated as N.D.) from an accredited institution in the U.S. or Canada and pass licensing board examinations. The abbreviation N.D. can also denote the professional title and status Naturopathic Doctor that is conferred by the licensing body in the state or province. In contrast, the "degree" Doctor of Natural Medicine (abbreviated D.N.M.) does not qualify for licensure as a naturopathic physician and carries no regulatory status in the U.S or Canada. The Principles of Naturopathic MedicineNaturopathy is based on six tenets or principles [2][3]:
"The healing power of nature"The healing power of nature (vis medicatrix naturae), has two aspects: first that the body has the ability to heal itself and it is the naturopathic doctor's role to facilitate this natural process, and second that nature heals. Following this principle includes getting enough sleep, exercising, feeding the body nutritional food and, if needed, additional earth food, such as herbs, or algae, which is a living organism. It is asserted, yet strongly refuted by critics, that plants can gently move the body into health without side effects posed by some synthetic chemicals in modern pharmaceuticals. "Identify and treat the cause"The underlying root causes of disease must be removed for complete healing to take place (tolle causam). These root causes can exist at many levels: physical, mental, emotional, and spiritual. It is the naturopathic doctor's ostensible role to identify this root cause, in addition to alleviate suffering by treating symptoms. "First do no harm"The process of healing includes the manifestations of symptoms, so that any therapy that interferes with this natural healing process by masking symptoms is considered suppressive and should be avoided (primum non nocere). The natural life force of the individual should be supported to facilitate healing. "Treat the whole person"A core tenet of naturopathy is the belief that health must go beyond treatment of immediate symptoms (as with medicine), and instead treat the entire person's well being. That means treating the entire body, as well as the spirit/soul and mind. This approach is usually called the wholistic or holistic method. "The physician as teacher"It is the role of the naturopath to educate an individual in their practices and encourage that individual to "take responsibility for their own health" (docere). This cooperative relationship between doctor and patient is essential to healing. "Prevention"The ultimate goal of the naturopathic physician is prevention. The emphasis is on building health, not fighting illness. This is done by fostering healthy lifestyles, healthy beliefs, and healthy relationships. RegulationIn some countries naturopathy is unregulated and the term "naturopath" is not clearly defined. This may lead to difficulty in ensuring that a practitioner is trained to a particular standard or has adequate liability insurance. Regulation in AustraliaThere is currently no state licensure in Australia, rather the industry is self regulated. There is no protection of title, meaning that technically anyone can practise as a naturopath. The only way to obtain insurance for professional indemnity or public liability is by joining a professional association, which can only be achieved having completed an accredited course and gaining professional certification. It is generally thought that with registration, a minimum four-year degree with a minimum 400 hours of supervised clinic practice will be required for practice. Currently only two institutions fulfil these requirements, the Australian College of Natural Medicine and Southern Cross University. Professional naturopathic associations in Australia include:
There is currently debate in the industry over whether compulsory registration should be introduced for naturopaths, as with physiotherapy, osteopathy and chiropractic. ATMS is opposed on the grounds that naturopathic treatment is potentially dangerous, and that registration would therefore instigate a significant rise in insurance premiums. NHAA is pro-registration on the grounds that herbalists and naturopaths will never be taken seriously by the medical profession while unregistered. ANPA is also pro-registration, arguing that only registration of the profession will advance naturopathy as an integral part of healthcare in Australia. Regulation in North AmericaJurisdictions that currently regulate naturopathic medicine include:
Regulation in the United KingdomIn the United Kingdom, naturopathy as a profession is very closely aligned with osteopathy. There is no government sponsored regulation of the profession, the largest body, The General Council & Register of Naturopaths recognises three courses in the UK, two being taught at osteopathic schools: the British College of Osteopathic Medicine; The College of Osteopaths Educational Trust; and one at the University of Westminster School of Integrated Health under the auspices of the B.Sc Health Science (Naturopathy) course. Members of this register will either have completed a three or four year full time degree level course or possibly be a healthcare professional (Medical Doctor, Osteopath, Chiropractor, Nurse) who has completed a two year post-graduate Naturopathic Diploma, the N.D. As the naturopathic profession has developed along different lines in the UK, naturopaths do not perform minor surgery or have prescribing rights. Scope of practiceIn the United States both naturopathic physicians and traditional naturopaths use the degree designation of N.D. (doctor of naturopathic medicine), leading to considerable confusion about the scope of practice, education and training of a naturopathic practitioner (in the United Kingdom, N.D. stands for Diploma in Naturopathy). There is great contention between the two factions, as their political agendas are in opposition to each other: Naturopathic physicians, whose national professional organization is the American Association of Naturopathic Physicians, strive to recover licensure in all 50 states, whereas traditional naturopaths, whose professional organization is the American Naturopathic Medical Association, oppose licensure and often block licensing attempts. Negotiation is currently in progress between naturopathic physicians and traditional naturopaths to come to a resolution to this problem and agree to use different degree titles and designations, but so far this has not been a successful endeavour. Science and naturopathyThere is widespread support for the application of an evidence based medicine framework to assess health outcomes and that systematic reviews with strict protocols are essential. Organisations such as the Cochrane Collaboration and Bandolier publish such reviews. There are reports of evidence based medicine trials published for naturopathy[4]. Some modalities used in naturopathy are widely regarded as pseudoscience. Medical doctors often cite the large differences between naturopathic practitioners and the lack of scientific documentation of the safety and efficacy of their practices in order to justify limiting naturopathic scope. Advocates claim that naturopathic practitioners find it difficult to obtain financing for research due to the lack of prior research in many areas. Proponents state that this is slowly changing as naturopathic physicians develop research programs to help build up a foundation for evidence based treatment. Conventional medicine is required to undergo rigorous testing; drug trials often last for a decade. A criticism of alternative therapies is that they are not subject to detailed safety assessment. Restrospective analysis of various herbal agents have found many to be of little therapeutic value and others to be harmful. This can be tied to the fact that 'natural' does not necessarily correspond to being beneficial or even benign. Also of concern is the ambiguity of the word "natural" and poor agreement as to its meaning. While the above addresses a primary challenge to the validation process for "natural" remedies, perhaps of greater concern amongst critics is the lack of regulation of manufacturer claims in advertising. Common labeling practices suggest that herbal extracts are devoid of "drugs" or "chemicals". Claims of this type are patently false as every component of any plant extract is a chemical by definition. Likewise, claims as to the relative absence of toxicity in herbal extracts, when compared to conventional pharmaceutical preparations, are tainted by incongruent regulations for reporting of side effects. The manufacturers of conventional pharmaceutical agents are legally bound to record and report any perceived negative experiences during large scale clinical trials, though there may be no actual link between the tested drug and the perceived side effect. To wit, it is often the case that drugs are labelled with side effects such as headache, constipation, diarrhea, or sleep disturbance. These "side effects" are required to be listed even if they are found with no more regularity than they are in a placebo control group or within the general populace for that matter. Conversely, herbal manufacturers are not required to carry out such clinical studies nor to report any known adverse effects, even if said effects have been directly linked to injestion of the herbal preparation in question. While these advertising techniques do not negate the potential for some beneficial uses of various herbal agents, and they do not necessarily reflect upon the validity of naturopathic medicine as a field of study, critics suggest that they do serve to beguile the public through the employment of nothing more than legally permissible semantics and selective reporting. Naturopathic modalities may be controversial (eg homeopathy), or have proven effectiveness only for very specific conditions (eg acupuncture, aromatherapy) Some naturopaths may use these modalities as panaceas or to improve the patient's quality of life.
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