Understanding Naturopathic Medicine in the healthcare system

Understanding Naturopathic Medicine in the healthcare system
Dr. Raphael Nyarkotey OBU and Lawrencia AGGREY-BLUWEY

The Practice of Naturopathy has many faces. Naturopathy is part of alternative medicine system group. However, it is a distinct system of medical practice on its own. Basically, Naturopathy is the general practice of natural medicines with emphasis based on modern scientific approaches.

Legal definition

The Dictionary of Occupational Titles published in 1931, provided the legislative definition of naturopathy to carve out a scope of practice in the US:

“Doctor, Naturopathic (medical services) 079.101-014 A Naturopathic physician, diagnoses, treats and cares for patients, using a system of practice which bases treatment of physiological functions and abnormal conditions on natural laws governing the human body: utilizes physiological, psychological and mechanical methods, such as air, water, light, heat, earth, phototherapy, food and herb therapy, psychotherapy, electrotherapy, physiotherapy, minor and orificial surgery, mechano-therapy, natural processed foods and herbs and nature’s remedies. Excludes major surgery, therapeutic use of x-ray and radium and use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and are physiologically compatible to body processes for maintenance and life”.

Hence, for legislative purposes to provide licensure, Naturopathic Medicine was defined by the individual state licensing statutes, which provides a legal scope-of-practice definition, often conflicting with each other, reflecting different standards of practice in different places. Legislative definition limits what practitioners could do legally, not what they were doing previously.

Naturopathy in Healthcare

Naturopathic Medical Students at Nyarkotey College of Holistic Medicine

The Naturopathic Medical profession is poised to play a greater role in healthcare across Ghana; its unique set of principles and heterogeneous scope of practice equip its practitioners to lead roles in complementary and interdisciplinary care. There has to be uniformity in training competencies of naturopathic doctors in Ghana. Hence, demonstration of graduate proficiency in the core competencies of naturopathic programs is essential.

As a result, it is important to define what constitutes the profession of naturopathy.   A good definition describes the meaning of a word so that it expresses the essential nature of the thing; a good definition gives a clear outline of the subject in question, marking its border so it stands out and is distinguishable from other similar things. A definition defines; it draws a line around the thing.

Definition based on Medical Terminology

We can take clues from the definition of Naturopathy, by looking at the meaning of the root words of the subject.  “naturo,” from the Latin word natura, to which the Greek suffix “-pathy” is tagged on. The suffix “-pathy” derives from pathos, meaning “suffering or disease.” The same suffix is used in loads of terms such as myopathy (muscle disease), neuropathy (nerve disease), or even sympathy (suffering together) according to the medicinenet.com

Thus, naturopathy might have two possible meanings. First it might mean, “nature-disease” or “suffering nature.” If so, then climate change or drought might be examples of naturopathy. Or perhaps naturopathy could mean “suffering caused by nature,” perhaps an example would be perennial flooding in Ghana.  The roots of the word “naturopathy” also seem insufficient to define naturopathic medicine.

Renowned associations definition

The World Naturopathic Federation (WNF), Canada, which is the umbrella body of naturopathy globally defined Naturopathy as: “A system of healthcare with a deep history of traditional philosophies and practices, medically trained practitioners and a breadth of natural treatment options to serve patients”.

The American Association of Naturopathic Physicians (AANP) also defines Naturopathy as: “a distinct primary health care profession, emphasizing prevention, treatment, and optimal health through the use of therapeutic methods and substances that encourage the individuals’ inherent self-healing process. The practice of naturopathic medicine includes modern and traditional, scientific, and empirical methods”. This definition on the other hand appears as a single self-healing process common to the profession.  There are proponents who feel that this definition is rather unclear. So does the word distinct. Hence, a good definition should distinguish between primary health care professions and educate the public on how Naturopathic Medicine is distinct.

The Canadian Association of Naturopathic Doctors (CAND) defines Naturopathy as: “a distinct primary health care system that blends modern scientific knowledge with traditional and natural forms of medicine. The naturopathic philosophy is to stimulate the healing power of the body and treat the underlying cause of disease. Symptoms of disease are seen as warning signals of improper functioning of the body, and unfavorable lifestyle habits. Naturopathic medicine emphasizes disease as a process rather than as an entity”.

Forefather’s Definition

Benedict Lust, (1905) further attempted to bring some clarity into the definition of Naturopathy. He also distinguishes the profession by saying it is distinct but added osteopathy and chiropractic under the general umbrella of Naturopathy: “Naturopathy is a distinct school of healing, employing the beneficent agency of Nature’s forces of water, air, sunlight, earth power, electricity, magnetism, exercise, rest, proper diet, various kinds of mechanical treatment such as massage, Osteopathy and chiropractic, and mental and moral science.”

Modern Day Naturopathic Scholars definition

For Schor, (2019), a noted Naturopathic Doctor, a good definition of Naturopathy should include some metrics. He included: emerging, evolving, and rational. He notes: “Emerging means we are still new in the medical field and going through developmental stages. Evolving means we are still changing and adjusting to our place in medicine. Rational is a term that goes back to the Hippocratic era. Hippocrates is credited with turning away from divine notions of medicine and using observation of the body as a basis for medical knowledge.

Prayers and sacrifices to the gods did not hold a central place in his theories, but changes in diet, beneficial drugs, and keeping the body “in balance” were the key. We might call it ‘fact-based medicine.’ This was termed “rational medicine,” and most of us would rather be thought of as rational than its opposite, irrational. These days it may be called evidence-based medicine. Rational, though, is a more Hippocratic term”.

Hence, he finally defines Naturopathy as: “An emerging and evolving school of rational medicine, that encourages use of natural substances, and/or exposure to nature and its elements, as catalysts to restore homeostasis through triggering adaptive or hormetic responses. Other strategies employed for improving health include lowering toxic burden, providing nourishment in cases of deficiency, or stimulating a healing response. Therapies are viewed as existing on a spectrum of force or potential for harm and are selected conservatively, referentially selecting the least invasive, safest options. Knowledge and discoveries from modern science are translated into ‘greener’ approaches to treatment.”

Hence, Obu, (2021) also define Naturopathy as: “A modern approach to healthcare which embraces scientific methods in treatment delivery with the emphasis on using natural remedies to aid the body to heal itself.   However, Naturopathy is not superior to conventional medicine and the practitioner needs to recognize this assertion and refer when necessary to improve the quality of life of the patient in Ghana”.

For Aggrey-Bluwey, (2021) in the book, The Law and Naturopathic Medicine Practice in Ghana, “Naturopathic Medicine, especially in the formal context of Clinical Medicine, is still an emerging disciple in Ghana and sub-Sahara Africa as a whole.”

Obu, (2021) is further of the view that Practitioners must also recognize that: “Medicine is not competition and collaboration is key for effective delivery”.

Definition based on Naturopathic Principles

In the modern era, Naturopathy is defined based on its principles, therapeutic order and theories. The credit goes to Drs. Pam Snider and Jared Zeff for the great work in developing the Naturopathic Principles. This notwithstanding, some of the credit for this switch in focus from definition to principles should also go to Roger Fisher and William Ury. They wrote a book called Getting to Yes that was published in 1981. However, some scholars hold that view that, these Naturopathic principles originated with medical doctors and do not specifically describe naturopathic medicine. For example, the phrases Tolle causam or Vis medicatrix Naturae: these are concepts to which we gladly pledge our allegiance and that have a history in medicine that long predates the nature cure movement. Samuel Hahnemann took a different ideas in The Organon (Neuburger, 1934).

In Hahnemann’s view, finding the cause of disease was a waste of time: “As it is not perceptible and not discoverable. For as far the greatest number of diseases are of dynamic (spiritual) origin and dynamic (spiritual) nature, their cause is therefore not perceptible to the senses…”

“Tolle causam” for instance, could today be regarded as a motto for a number of medical and scientific specialties; for example, epidemiologists and geneticists and could easily be used as a slogan for the Center for Disease Control (CDC). Hence, it appears the fact that it is used in the Naturopathic profession does not separate Naturopathy school of medicine from Mainstream philosophies.

Also, the term “primum non nocere” does not solely belong to the profession of Naturopathy as we thought.  Hence, modern Medical Practitioners, Naturopathic Doctors included, attempt to follow this Hippocratic order; meaning that the Naturopathic Profession is not unique. Just that this primum thing is not a Hippocratic order.  The oath has slowly evolved and changed over time according to Schubert and Scholl, (2005).

The principle of “docere” can also not be claimed as a naturopathic idea. The fact is that, all physicians use this principle, including those engaged in the healing arts, who have long been referred to as Doctors. The Hippocratic oath rather emphasis that Doctors need to be teachers and pass on their art (McLeod ME, 2001).  In Naturopathy, we are to teach our patients. Interestingly, the docere idea has been extended, in allopathic medicine, to further include ‘truth telling’ or informed consent ( Byk 2007).

So from the foregoing analysis, Naturopathic Profession cannot claim sole ownership of these principles but have a different emphasis on these principles, as neither of these phrases, tolle causam, primum non-nocere, nor docere defines naturopathy as distinct from Mainstream Medicine.

Scope of Practice

In some jurisdictions, Naturopathy is regulated as medical system on its own. For instance, in the State of Oregon, Naturopathic students are trained in a wide range of areas within a Tier-4 Patient Centered Primary Care Medical Home, as well as community-based “safety net” clinics that allow them to enhance their primary care skillset:

  1. Conducting a holistic medical interview.
  2. Performing physical examinations and preventive screening examinations and tests.
  • Utilizing a broad set of natural medicine therapies.
  1. Providing parenteral (intravenous and intramuscular) nutrient therapy.
  2. Administering immunizations.
  3. Prescribing or modifying prescriptions of pharmaceutical drugs.
  • Utilizing a regional/national electronic health record (EpicCare) for patient recordkeeping.
  • Performing minor surgery.
  1. Referring to medical specialists.
  2. Collaborating in healthcare teams.

In conclusion with the concept of definition, there’s a famous line attributed to US Supreme Court Justice Potter Stewart. In a court opinion he wrote in 1964, in a case Jacobllis v. Ohio, (1964) that attempted to define “hard-core” pornography, Justice Stewart wrote: “… I know it when I see it…” We can therefore akin Naturopathy, similar to pornography: “We know it when we see it.’”

Types of Naturopathy

First, there are those who practice “Radio Naturopathy” in Ghana which was coined by Prof. Raphael Nyarkotey Obu. He explains that, these people collect materials from any websites, read from books, sit on radio and Televisions and educate the public on natural medicine. They are not true Naturopaths or Naturopathic doctors.

Secondly, there are the Northwestern schools which are not truly Naturopathic, but integrated medical, and are sometimes known within the profession as ‘M.D. Wannabees’.  ‘Wannabee’ is a person who tries to be like someone else or to fit in with a particular group of people. Today, we have them in Ghana. There are Medical Doctors who are into the natural medicine business in the form of network marketing. They have no naturopathic education, yet they practice as integrative practitioners. This phenomenon, known as crosspathy practice, is a crime in medicine.

Third, there are the unaccredited Correspondence schools, who, until recently, were teaching a limited curriculum of true Naturopathy.  They focused more on being nutritional consultants with a few other modalities such as homeopathy, iridology, colon hydrotherapy and herbalism thrown in. In Ghana, we have colon hydrotherapists, nutritional consultants or iridologists who utilize the title Naturopathic Doctor as well. They are still not true Naturopaths.

Fourth, this is real naturopathy. Their position is cemented on traditionally accurate Naturopathic Medicine. They are not Allopathic or Integrated Medicalists as the Northwestern schools. Nor are they Minimalists, such as the Correspondence unaccredited schools. Rather, they stand for true Naturopathy, also known as Naturopathic Medicine, which means the full scope of practice as passed by Act of Congress in the US and embodied in the Dictionary of Occupational Titles and its successor. The Dictionary of Occupational Titles or D-O-T (DOT) refers to a publication produced by the United States Department of Labor which helped employers, government officials, and workforce development professionals to define over 13,000 different types of work, from 1938 to the late 1990s according to the Wikipedia.  According to the Dictionary of Occupational Titles or D-O-T (DOT), the Title(S): Doctor, Naturopathic (medicalser) means:

“Diagnoses, treats, and cares for patients, using system of practice that bases treatment of physiological functions and abnormal conditions on natural laws governing human body: Utilizes physiological, psychological, and mechanical methods, such as air, water, light, heat, earth, phytotherapy, food and herb therapy, psychotherapy, electrotherapy, physiotherapy, minor and orificial surgery, mechanotherapy, naturopathic corrections and manipulation, and natural methods or modalities, together with natural medicines, natural processed foods, and herbs and nature’s remedies. Excludes major surgery, therapeutic use of x ray and radium, and use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and are physiologically compatible to body processes for maintenance of life.”

They teach Naturopathy defined as stated and as it existed in its peak of the 1920’s, 1930’s and 1940’s, when it was free to exist as a self-defined system of medicine, combined with the best of modern technology and science. It is integrated Naturopathic Medicine because they teach the integration of the various naturopathic modalities into Naturopathic practice. However, it is not allopathic or integrated medicalism. This is True or Modern Naturopathy. Proponents are not anti -science and do not compete with Mainstream Medicine.  They exist on their own as Naturopathic Medicine, a distinct system of Medical Practice.

>>>Prof. Raphael Nyarkotey Obu is the president of Nyarkotey college of Holistic Medicine and a  final year  LLB Law student.   Lawrencia Aggrey-Bluwey  is an Assistant Lecturer with the Department of Health Administration and Education, University of Education, Winneba, and is currently a PhD student in Health Policy and Management at the University of Ghana Business School.

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