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99
Naturopathic
Medical
Education:
Where
Conventional,
Complementary,
and
Alternative
Medicine
Meet
Douglas
Poorman,
PhD
Linda
Kim,
ND
Paul
Mittman,
ND,
DHANP
Background
on
the
philosophy
of naturopathic
medicine
and
the
six
principles
basic
to
its
practice
are
presented.
Naturopathic
medical
education
is
discussed
with
examples
of
the
didactic
and
clinical
curriculum
at
Southwest
College
of
Naturo-
pathic
Medicine
and
Health
Sciences,
located
in
Tempe,
Arizona.
The
range
of
therapeutic
modalities
included
in
naturopathic
medicine
and
integrative
clinical
training
are
discussed.
Complementary
Health
Practice
Review,
Vol.
7,
No
2,
Winter
2001
Naturopathic
medicine
marries
ancient
curative
remedies
with
modern
medical
tech-
nology ;
intuitive
healing
processes
with
clinical
investigative
skills;
and
natural
medicinal
powers
with
pharmaceutical
capacity.
Above
all
else,
naturopathic
medicine
embraces
preventive
care.
The
prevalence
and
expenditures
associated
with
integrative
medical
therapies
increased
substantially
from
1990
to
1997
when
the
number
of
U.S.
adults
utilizing
alternative
therapies
increased
from
60
million
to
83
million
people
(Eisenberg
et
al.,
1998).
Likewise,
attendance
at
naturopathic
medical
schools
educat-
ing
primary
care
practitioners
in
alternative
medicine
has
increased
during
this
period.
Naturopathic
Doctors
(NDs)
graduate
from
a
four-year
in-residence,
naturopathic
medical
program
that
integrates
conventional
and
natural
medicine
in
both
classroom
and
clinical
training.
The
first
two
years
focus
on
Basic
Sciences
including
Gross
Anatomy
with
Dissection,
Histology,
Embryology,
Neuroanatomy,
Physiology,
Microbiology,
Pathology
and
Pharmacology
and
pre-clinical
medicine
such
as
physical,
laboratory,
and
clinical
assessment.
Students’
third
and
fourth
years
emphasize
therapeutics,
including
tracks
in
Homeopathy,
Botanical
Medicine,
Acupuncture,
Physical
Medicine,
Counsel-
ing,
Nutrition,
Pharmacology
and
Minor
Surgery.
During
these
last
two
years,
students
engage
in
clinical
training
under
the
supervision
of
NDs,
MDs,
and
DOs.
The
Council
on
Naturopathic
Medical
Education
(CNME)
is
the
accrediting
body
that
oversees
medical
education.
The
Council
is
comprised
of
institutional
members
representing
each
medical
college,
professional
members
who
are
actively
engaged
in
private
practice,
and
public
members
with
various
backgrounds
and
careers,
including
higher
education.
Meeting
semi-annually
to
monitor
the
quality
of
educational
experi-
ence
at
each
of
the
colleges,
the
CNME
places
emphasis
on
educational
excellence,
ethical
practice
and
each
institution’s
attention
to
community
service.
©
2001
Springer
Publishing
Company
100
There
are
five
naturopathic
medical
schools
in
North
America-Bastyr
University
in
Seattle,
Washington;
Canadian
College
in
Toronto,
Ontario,
Canada;
National
College
of
Naturopathic
Medicine
in
Portland,
Oregon;
Southwest
College
of
Naturopathic
Medi-
cine
and
Health
Sciences
in
Tempe,
Arizona;
and
the
University
of
Bridgeport
in
Bridgeport,
Connecticut.
Their
curricula
include
a
range
of
2,580
to
3,270
hours
of
didactic
instruction
and
between
1,200
to
1,500
hours
of
clinical
education.
Academic
backgrounds
of
faculty
include
those
having
a ND,
MD,
DO, DC,
PhD,
MS,
MPH,
and
other
specialized
degrees
and
professional
backgrounds.
Student
enrollments
in
the
naturopathic
medical
programs
range
between
260
and
540.
Students
attending
colleges
in
the
United
States
are
eligible
to
participate
in
federally
funded
student
financial
aid
programs
and
receive
subsidized
and
unsubsidized
Stafford
loans.
Graduates
take
national
board examinations
in
both
basic
and
clinical
sciences
to
become
licensed
as
general
practice
naturopathic
doctors
within
licensed
states
or
as
individual
jurisdictions
allow.
While
residencies
are
not
yet
required
for
licensure,
naturopathic
medical
schools
offer
one-
and
two-year
residency
programs.
Southwest
College
of
Naturopathic
Medicine
(SCNM)
places
particular
attention
on
providing
students
with
career
opportunities.
This
is
accomplished
through
many
clinical
settings
including
collaborations
with,
among
others:
Maricopa
Integrative
Health
Systems;
Springdale
Village
&
Springdale
West
Nursing
Homes;
Banner
Health,
Inc;
and
Valley
Lutheran
Hospitals.
The
Southwest
College
Doctor
of
Naturopathic
Medicine
is
a
four-year,
post-
baccalaureate
medical
degree
program
that
is
completed
in
16
academic
quarters,
during
four-years
of
year-round
attendance.
Upon
completion
of
the
graduation
re-
quirements,
the
student
is
awarded
a
Doctor
of
Naturopathic
Medicine
degree
(ND).
Students
are
educated
to
become
primary
care
physicians
with
a
specialized
focus
on
preventive
medicine
and
natural
therapeutics.
Student
research
projects
are
a
culmination
of
a
series
of
required
medical
research
classes
at
SCNM.
Students
practice
the
skills
of
evaluation
and
using
information
provided
by
medical
research.
Students
also
have
the
opportunity
to
further
their
skills
in
research
through
the
activities
of
the
Southwest
College
Research
Institute
(SCRI).
The
research
curriculum
is
offered
in
four
courses
in
40
didactic
hours.
The
courses
cover
introductory
biostatitics,
research
design
and
methods,
Institutional
Review
Board
and
Scientific
Merit
applications,
FDA
methodology,
literature
search
and
review,
and
scientific
writing.
Student
research
projects
began
with
the
first
graduating
class
at
SCNM
in
1996.
The
projects
are
predominately
pilot
CAM
clinical
trials
with
human
subjects,
and
are
usually
conducted
by
teams
of
four
to
six
students
per
project.
The
students
must
complete
their
project
by
their
fourth
year,
and
present
the
results
at
a
college
Senior
Research
Presentation
with
invited
guests
from
the
community.
The
presentations
are
conducted
twice
a
year,
January
and
July.
Student
Research
Projects
have
a
faculty
adviser
from
SCNM
or
from
other
licensed
professionals
from
the
local
community.
Student
Research
Projects
are
supported
by
SCNM
(facility
use,
supplies,
faculty
advisers,
SCRI
contribution),
and
when
Student
Research
Projects
are
funded
by
outside
sources,
these
are
primarily
nutraceutical
and
diagnostic
laboratory
compa-
nies.
One
of
SCNM’s
student
research
projects
resulted
in
an
academic
publication,
The
Effect
of
Homeopathic
Coca
on
High
Altitude
Mountain
Sickness,
2000:
Mt.
Everest
Base
Camp
(Shackelton,
Tondora,
Whiting,
&
Whitney,
2000).
101
PHILOSOPHY
OF
NATUROPATHIC
MEDICINE
Naturopathic
medicine
is
a
distinct
medical
approach
to
health
care:
an
art,
science,
and
practice
of
diagnosing
and
treating
people,
maintaining
health,
and
preventing
disease.
Naturopathic
physicians
(NDs)
seek
to
restore
and
maintain
optimal
health
as
they
practice
independently
and/or
with
provider
groups.
Many
also
become
educators,
authors,
and
researchers
who
play
vital
roles
in
community
health,
awareness
and
education.
Patients
are
treated
as
unique
human
beings,
enabling
them
to
take
responsibility
for
their
own
health.
Naturopathic
physicians
are
partners
in
their
patients’
healthcare
providing
evaluations
and
recommendations
for
patients
who
are
committed
to
becoming
healthier
(Lindlahr,
1975).
They
educate
their
patients
to
optimize
their
lifestyles,
enhance
their
immune
function
and
learn
how
to
take
preventive
measures
to
decrease
illness.
As
primary
care
practitioners,
naturopathic
physicians
are
trained
as
specialists
in
preventive
medicine
and
natural
therapeutics.
As
in
other
medical
schools,
a
solid
foundation
is
needed
for
diagnosis
and
treatment.
To
build
this
foundation,
the
curriculum
includes
conventional
medical
sciences,
laboratory
testing
and
physical
examination
procedures
as
listed in
Figure
1.
Naturopathic
physicians
evaluate
physical
structure,
nutrition,
digestion,
and
many
other
health
parameters.
NDs
combine
and
individualize
a
wide
variety
of
therapies
based
on
a
philosophy
which
acknowledges
and
encourages
patients
to
actively
participate
in
their
health
care.
They
practice
medicine
that
includes
the
best
aspects
of
many
healing
traditions
from
diverse
cultures.
Effectively
treating
all
age
groups
in
a
wide
array
of
both
acute
and
chronic
health
problems,
naturopathic
physicians
are
trained
to
use
drugs
when
necessary,
naturopathic
therapies,
usually
alone
or
in
combination
with
low
doses
of
synthetic
drugs,
to
provide
the
needed
results.
The
last
decade
has
seen
a
dramatic
increase
in
the
collaboration
in
patient
care
between
naturopathic
physicians
(ND),
allopathic
physicians
(MD),
and
osteopathic
physi-
cians
(DO).
Southwest
College
has
educational
affiliations
with
three
hospitals,
including
the
County
hospital,
numerous
community
medical
centers
and
over
100
area
physicians.
The
educational
process
is
a
two-way
street
with
Southwest
College
students
obviously
benefiting
from
their
clinical
work
in
diverse
settings.
Southwest
College
of
Naturopathic
Medicine
fosters
opportunities
for
area
physicians
to
learn
more
about
and
incorporate
natural
medicine
into
their
own
practices.
In
the
past
two
years,
naturopathic
physicians
have
started
being
credentialed
in
many
of
these
same
clinics.
Using
a
holistic
approach
to
care
for
their
patients,
naturopathic
physicians
cooperate
and
participate
with
other
health
care
providers,
referring
patients
to,
and
accepting
patients
from,
other
practitioners.
PRINCIPLES
OF
NATUROPATHIC
MEDICINE
Naturopathic
physicians
are
guided
by
six
principles:
1.
First
Do No
Harm;
2.
The
Healing
Power
of
Nature;
3.
Find
the
Cause;
4.
Treat
the
Whole
Person;
5.
Preventive
Medicine;
and
6.
Doctor
as
Teacher.
This
set
of
principles,
emphasized
throughout
a
naturopathic
physician’s
training,
outlines
the
philosophy
guiding
the
naturopathic
approach
to
health
and
healing
and
forms
the
foundation
of
this
distinct
health
care
practice.
102
Figure
1.
Basic
science
and
clinical
courses
taught
at
Southwest
College
of
Naturo-
pathic
Medicine.
First
Do
No
Harm
(Primum
Non
Nocere)
Illness
is
a
purposeful
process
of
the
organism.
The
process
of
healing
includes
the
generation
of
symptoms
that
are,
in
fact,
expressions
of
the
life
force
attempting
to
heal
itself.
Therapeutic
actions
should
be
complementary
to
and
synergistic
with
this
healing
process.
The
physician’s
actions
can
support
or
antagonize
the
actions
of
the
vis
medicatrix
naturae,
the
healing
power
of
nature.
Therefore,
methods
designed
to
suppress
symptoms
without
removing
underlying
causes
are
considered
harmful
and
are
avoided
or
minimized.
Naturopathic
physicians
prefer
non-invasive
treatments,
which
minimize
the
risks
of
harmful
side
effects.
They
are
trained
to
know
which
patients
they
can
treat
safely,
and
which
ones
they
need
to
refer
to
other
health
care
practitioners.
To
avoid
harming
the
patient,
naturopathic
physicians
utilize
methods
and
medicinal
substances
that
minimize
the
risk
of
harmful
effects,
and
apply
the
least
possible
force
or
intervention
necessary
to
diagnose
illness
and
restore
health.
Whenever
possible,
the
suppression
of
symptoms
is
avoided
as
suppression
generally
interferes
with
the
healing
process.
Naturopathic
physicians
respect
and
work
with
the
vis
medicatrix
naturae
in
diagnosis,
treatment
and
counseling.
If
this
self-healing
process
is
not
respected,
the
patient
may
be
harmed.
The
Healing
Power
of
Nature
(Vis
Medicatrix
Naturae)
The
body
has
the
inherent
ability
to
establish,
maintain,
and
restore
health.
The
healing
process
is
ordered
and
intelligent;
nature
heals
through
the
response
of
the
life
force.
To
heal,
nature
acts
powerfully
through
the
healing
mechanisms
of
the
body
and
mind
to
maintain
and
restore
health.
Naturopathic
medicine
recognizes
this
healing
process.
Naturopathic
physicians
work
to
restore
and
support
these inherent
healing
systems
when
they
have
broken
down,
by
using
methods,
medicines,
and
techniques
that
are
in
harmony
with
natural
processes.
The
naturopathic
physician’s
role
is
to
facilitate
and
augment
this
process,
to
act
to
identify
and
remove
obstacles
to
health
and
recovery,
and
to
support
the
creation
of
a
healthy
internal
and
external
environment.
Identify
and
Treat
the
Cause
(Tolle
Causam)
Illness
does
not
occur
without
cause.
Underlying
causes
of
disease
must
be
discovered
and
removed
or
treated
before
a
person
can
recover
completely
from
illness.
Symptoms
are
expressions
of
the
body’s
attempt
to
heal,
but
are
not
the
cause
of
disease.
Symptoms,
therefore,
should
not
be
suppressed
by
treatment.
Causes
may
occur
on
many
levels
including
physical,
mental,
emotional,
and
spiritual.
The
physician
must
evaluate
fundamental
underlying
causes
on
all
levels,
directing
treatment
at
root
causes
rather
than
at
symptomatic
expression.
The
naturopathic
physician
seeks
to treat
the
causes
of
disease,
rather
than
to
merely
eliminate
or
suppress
symptoms.
103
Treat
the
Whole
Person
(The
Multifactorial
Nature
of Health
and
Disease)
Because
health
and
disease
are
conditions
of
the
whole
organism-a
whole
involving
a
complex
interaction
of
physical,
spiritual,
mental,
emotional,
genetic,
environmental,
social,
and
other
factors-naturopathic
physicians
treat
the
whole
person
by
taking
all
of
these
factors
into
account.
The
harmonious
functioning
of
all
aspects
of
the
individual
is
essential
to
recovery
from
and
prevention
of
disease,
and
requires
a
personalized
and
comprehensive
approach
to
diagnosis
and
treatment.
Since
total
health
also
includes
spiritual
health,
naturopathic
physicians
encourage
individ-
uals
to
pursue
their
personal
spiritual
development.
The
multifactorial
nature
of
health
and
disease
requires
a
personalized
and
comprehensive
approach
to
diagnosis
and
treatment.
Naturopathic
physicians
take
all
of
these
factors
into
account
as
they
treat
the
whole
person.
Prevention
(Prevention
is
the
Best
&dquo;Cure&dquo;)
The
ultimate
goal
of
any
health
care
system
should
be
prevention.
This
is
accomplished
through
education
and
promotion
of
life-habits that
create
good
health.
Assessing
risk
factors,
lifestyle,
and
hereditary
susceptibility
to
disease,
the
naturo-
pathic
physician
makes
appropriate
interventions
to
avoid
further
harm
and
risk
to
the
patient.
The
emphasis
is
on
building
health
rather
than
on
fighting
disease.
Naturopathic
medicine
asserts
that
one
cannot
be
healthy
in
an
unhealthy
environment.
Based
on
this
premise,
naturopathic
physicians
work
toward
the
creation
of
a
world
in
which
humanity
may
thrive.
Naturopathic
medical
schools
emphasize
the
study
of
health
as
well
as
disease.
The
prevention
of
disease
and
the
attainment
of
optimal
patient
health
are
primary
objec-
tives
of
naturopathic
medicine.
In
practice,
these
objectives
are
accomplished
through
education
and
the
promotion
of
healthy
ways
of
living,
and
appropriate
interventions
are
introduced
to
avoid
further
and
possible
future
harm
and
risk
to
the
patient.
The
Physician
As
Teacher
(Docere)
The
original
meaning
of
the
word
&dquo;doctor&dquo;
is
teacher.
A
principal
objective
of
naturopathic
medicine
is
to
educate
the
patient
and
emphasize
self-responsibility
for
health.
Beyond
an
accurate
diagnosis
and
appropriate
prescription,
the
physician
must
work
to
create
a
healthy,
sensitive
interpersonal
relationship
with
each
patient.
A
physician’s
major
role
is
to
educate
and
encourage
patients
to
take
responsibility
for
health.
The
physician
is
a
catalyst
for
healthful
change,
which
empowers
and
motivates
patients
to
assume
responsibility.
Naturopathic
physicians
also
recognize
and
employ
the
therapeutic
potential
of
the
doctor-patient
relationship.
It
is
the
patient,
not
the
doctor,
who
ultimately
creates/
accomplishes
healing.
The
physician
must
strive
to
inspire
hope
as
well
as
understand-
ing.
The
physician
must
also
make
a
commitment
to
his/her
personal
and
spiritual
development
in
order
to
be
a
good
teacher.
NATUROPATHIC
MEDICAL
EDUCATION
With
admissions
requirements
comparable
to
conventional
medical
schools,
applicants
for
admission
to
Southwest
College
of
Naturopathic
Medicine
and
Health
Sciences
must
take
prerequisite
courses
such
as
biology,
inorganic
and
organic
chemistry,
104
English,
psychology,
and
humanities.
The
degree
of
Doctor
of Naturopathic
Medicine
requires
four
years
of
graduate
level
study
in
the
medical
sciences
at
Southwest
College
of
Naturopathic
Medicine
and
Health
Sciences.
Throughout
the
four
years,
there
is
extensive
training
in
naturopathic
therapeutics,
including
botanical
medicine,
homeopathy,
nutrition,
acupuncture,
hydrotherapy,
and
mind-body
medicine.
A
listing
of
therapeutic
courses
with
number
of
hours
in
the
curriculum
is
included
in
Figure
2.
Clinical
Nutrition
The
Hippocratic
concept
that
&dquo;food
is
the
best
medicine&dquo;
is
a
cornerstone
of
naturopathic
practice.
Many
medical
conditions
can
be
treated
more
effectively,
having
fewer
complications
and
side
effects,
with
foods
and
nutritional
supplements.
Naturopathic
physicians
use
dietetics,
natural
hygiene,
fasting,
and
nutritional
sup-
plementation
in
practice.
The
discovery
of
vitamins,
minerals
and
deficiency
diseases
in
the
early
part
of
the
20th
century
began
to
provide
a
scientific
understanding
of
clinical
nutrition.
The
realization
that
enzyme
systems
were
dependent
on
essential
nutrients
provided
the
naturopathic
profession
with
great
insights
into
the
importance
of
an
organically
grown,
whole
foods
diet
for
heat.
Nutritional
biochemist
Roger
Williams
formulated
the
concept
of
biochemical
individuality.
In
1955,
he
further
developed
insights
into
the
unique
nutritional
needs
of
each
individual,
how
to
correct
in-born
errors
of
metabolism,
and
even
how
to
treat
specific
diseases
through
the
use
of
nutrient-rich
foods
or
large
dosages
of
specific
nutrients
(Williams
&
Dans,
1986).
Linus
Pauling,
two-time
Nobel
Prize
winner,
coined
the
concept
of
orthomolecular
medicine,
and
provided
further
theoretical
substantiation
for the
use
of
nutrients
as
therapeutic
agents
(Pauling,
1968).
Naturopathic
physicians
sometimes
use
nutritional
supplements
as
part
of
a
patient’s
s
treatment.
The
dietary
approach
to
prevention
and
treatment
of
chronic
degenerative
disease,
championed
for
more
than
a
century
by
naturopathic
physicians,
has
recently
gained
the
attention
of
conventional
medicine.
Each
of
the
seven
dietary
guidelines
in
the
1988
U.S.
Surgeon
General’s
report
on
nutrition
and
health
is
a
traditional
part
of
naturopathic
practice.
More
than
40
scientific
journals
worldwide
are
devoted
to
Figure
2.
Therapeutic
courses
at
Southwest
College
of
Naturopathic
Medicine.
105
clinical
nutrition,
and
articles
on
the
therapeutic
use
of
diet
or
supplements
also
appear
regularly
in
conventional
medical
journals.
However,
naturopathic
physicians
are
the
only
health
care
professionals
that
meet
and
exceed
the
recommendations
of
former
U.S.
Surgeon
General
Koop
for
education
in
nutrition.
Recently,
the
American
Cancer
Society
has
established
nutrition
and
physical
activity
guidelines
for
the
prevention
of
cancer
(Brown,
Byers,
Thompson,
Eldridge,
Doyle,
&
Williams,
2001).
Botanical
Medicine
Many
plant
substances
are
powerful
medicines.
Where
single
chemically
derived
drugs
may
only
address
a
single
problem,
botanical
medicines
are
able
to
address
a
variety
of
problems
simultaneously.
Their
organic
nature
makes
botanicals
compatible
with
the
body’s
own
chemistry;
hence,
they
can
be
gently
effective
with
few
toxic
side
effects.
Naturopathic
physicians
use
plant
material
for
food,
medicine
and
health
promotion.
Formal
training
includes
plant
identification,
preparation,
storage,
therapeutic
indica-
tions,
contraindications,
and
dosing.
There
is
extensive
contemporary
medical
litera-
ture
on
medicinal
and
healing
plants.
Nothing
in
naturopathic
licensing
laws
prevents
the
use
of
plant
medicines
by
any
individual
or
group.
Most
European
countries
recognize
the
effectiveness
of
medicinal
plants,
include
them
in
their official
pharmacopoeias
and
regulate
them
as
drugs
or
over-the-counter
remedies.
At
least
fourteen
scientific
journals
worldwide
are
devoted
to
the
study
of
botanical
medicine.
Naturopathic
Formulary
Naturopathic
formulary
is
usually
a
part
of
rules
and
regulations
rather
than
law
that
list
those
prescriptive
substances
which
naturopathic
physicians
use
in
practice.
Much
of
the
prescriptive
pharmacy
is
based
on
naturally
derived
substances.
Further,
giving
naturopathic
physicians
prescriptive
rights
saves
the
state
constituents’
money
and
time
by
not
requiring
a
visit
to
another
physician
when
a
simple
prescription
is
indicated.
Creating
a
naturopathic
formulary
helps
clarify
to
legislators,
pharmacists,
naturopath-
ic
physicians
and
other
practitioners
the
legal
scope
of
naturopathic
prescribing.
The
list
is
composed
of
those
substances
that
are
in
the
traditional
pharmacopoeia
of
naturopath-
ic
medicine.
The
curriculum
of
naturopathic
medical
schools
includes
extensive
training
in
clinical
pharmacology.
Courses
cover
the
use
of
legend
drugs
as
well
as
nonprescription
agents,
botanicals,
antibiotics,
hormones,
vitamins
and
minerals.
Homeopathic
Medicine
Homeopathy
is
a
system
of
medicine
more
than
200
years
old.
It is
based
on
the
principle
of
&dquo;like
cures
like,&dquo;
working
on
a
subtle
yet
powerful
electromagnetic
level
to
gently
strengthen
the
body’s
healing
and
immune
response
(Wood,
1992).
Homeopathic
therapeutics
use
medicines
made
from
natural
substances
which
stimulate
the
body’s
s
immune
and
defense
system
to
initiate
the
healing
process.
A
recent
review
article
in
the
British
Medical
Journal
performed
a
meta-analysis
of
107
controlled
clinical
trials
of
homeopathic
substances,
and
found
positive
evidence
supporting
their
effectiveness
(Linde
et
al.,
1997).
Various
other
in-vitro
or
animal
studies
have
also
demonstrated
the
effectiveness
of
homeopathic
preparations.
106
There
are
more
than
100
homeopathic
medical
colleges
worldwide.
Naturopathic
medical
schools
teach
homeopathic
therapeutics
as
a
standard
part
of
the
curriculum.
Naturopathic
schools
in
the
U.S.
offer
training
in
homeopathy
at
the
same
high
standard
of
Canadian
or
European
schools.
Physical
Medicine
Manipulative
therapy
is
a
large,
international,
interdisciplinary
science
practiced
by
a
multitude
of
professions.
The
value
of
such
treatments
is
recognized
in
other
licensed
professions
such
as
physical
therapy,
osteopathy,
chiropractic,
and
massage
therapy.
The
chiropractic
system
of
spinal
adjustment
is
only
one
of
many
systems
of
spinal
manipu-
lation,
as
is
Naturopathic
Manipulative
Therapy
(NMT).
Some
systems
of
medicine
want
to
co-opt
manipulative
therapy
for
their
exclusive
use.
Naturopathic
Medicine
has
its
own
methods
of
therapeutic
manipulation
of
muscles,
bones,
and
spine.
NDs
also
use
ultrasound,
diathermy,
exercise,
massage,
water,
heat
and
cold,
air,
and
gentle
electrical
pulses.
Naturopathic
manipulation
of
the
muscles,
bones
and
soft
tissues
are
collectively
known
as
Naturopathic
Manip-
ulative
Therapy
(NMT).
Physical
medicine
also
includes
exercise
therapy,
physio-
therapy
using
heat
and
cold,
electrical
pulsation,
ultrasound,
diathermy
and
hydrotherapy.
Such
techniques
are
regularly
evaluated
in
journals
such
as
the
Journal
of Manipulative
and
Physiological
Therapies.
Naturopathic
Manipulative
Therapy
is
performed
and
prescribed
as a
&dquo;therapy.&dquo;
That
is,
it
is
used
for
a
specified
therapeutic
effect
and
is
not
conceived
of
as
the
final
act
of
anatomical
approxima-
tion
of
a
displaced
bone.
Rather,
it
is
conceived
of
as a
dynamic
process
having
specific
therapeutic
benefits.
Naturopathic
Manipulative
Therapy
has
been
an
integral
part
of
the
practice
of
naturopathic
medicine
since
the
founding
of
the
naturopathic
profession
and
throughout
its
existence.
It
is
part
of
every
current
naturopathic
licensing
law.
The
training
of
naturopathic
physicians
in
NMT
and
related
fields
is
extensive.
Students
receive
approximately
348
hours
of
instruction
in
NMT.
Of
these,
132
hours
are
devoted
strictly
to
the
hands-on
learning
of
technique.
In
addition,
elective
course
work
is
available
for
students
wishing
greater
expertise
in
this
area.
Hydrotherapy
Hydrotherapy
is
the
use
of
hot
and
cold
water
for
the
maintenance
of
health
and
treatment
of
disease.
These
are
therapies
that
stimulate
circulation
and
healing,
often
with
the
only
other
effect
of
cleanliness.
Naturopathic
medicine
is
partly
rooted
in
the
European
hydrotherapy
movement,
centuries
old
and
still
thriving.
The
best
known
American
hydropath
was
John
Harvey
Kellogg,
MD,
who
ap-
proached
hydrotherapy
scientifically
and
performed
many
experiments
to
determine
the
physiological
effects
of
hot
and
cold
water.
Rational
Hydrotherapy
(Kellogg,
1902)
is
considered
one
of
the
definitive
texts
on
the
therapeutic
effects
of
water.
It
also
has
an
extensive
discussion
of
the
actual
techniques.
The
value
of
water
treatments,
fasting
and
rest
in
treatment
for
chronic
disease
is
recognized
throughout
the
developed
countries
in
Europe.
About
half
a
million
French
citizens
each
year
receive
insurance
reimbursement
for
medically
prescribed
spa
therapy.
107
Acupuncture
and
Traditional
Chinese
Medicine
Acupuncture
and
Traditional
Chinese
Medicine
(TCM)
are
complementary
healing
philosophies
to
naturopathic
medicine.
Meridian
theory
offers
an
important
understand-
ing
of
the
unity
of
the
body
and
mind,
and
adds
to
the
Western
understanding
of
physiology.
Acupuncture
provides
a
method
of
treatment,
which
can
unify
and
harmonize
the
imbalances
present
in
disease
conditions,
which,
if
untreated,
can
result
in
illness.
The
eclectic
base
of
the
modern
naturopathic
practices
offers
simple,
effective
acupuncture
treatments
for
a
wide
variety
of
health
problems.
All
NDs
are
trained
with
entry-level
acupuncture
competency
and
many
continue
studies
that
certify
them
as
specialists.
An
individual
naturopathic
physician
may or
may
not
have
the
same
in-depth
training
as
an
acupuncturist,
who
is
a
specialist
to
whom
referrals
are
made.
Every
ND
receives
appropriate
training
to
utilize
acupuncture
in
an
eclectic
practice.
To
specialize
in
acupuncture,
training
is
similar
to
any
other
acupuncturists
at
the
level
required
for
certification
by
the
National
Commission
on
the
Certification
of
Acupuncturists.
All
naturopathic
physicians
are
trained
at
an
introductory
level
in
the
basics
of
Traditional
Chinese
Medicine,
and
about
one
in five
receives
further
training
and
specializes
in
it.
Traditional
Chinese
Medicine
has
been
developed
continuously
for
more
than
three
thousand
years
in
Asia
and
coexists
along
with
conventional
medicine
today
in
China
and
Japan
as
a
primary
form
of
medicine.
Dozens
of
peer-reviewed
journals
are
devoted
to
the
scientific
evaluation
of
Oriental
methods,
including
both
acupuncture
and
botanical
medicine.
Mind-Body
Medicine
Mental
attitudes
and
emotional
states
may
influence,
or
even
cause,
physical
illness.
Counseling,
nutritional
balancing,
stress
management,
hypnotherapy,
biofeedback,
and
other
therapies
are
used
to
help
patients
heal
on
the
psychological
level.
The
ND
must
be
able
to
talk
with
patients
in
a
constructive
way
about
lifestyle,
stresses,
and
habits.
As
a
rule,
naturopathic
physicians
spend
one-half
to
one
and
a
half
hours
with
a
patient
on
the
first
visit.
They
gather
a
medical
history,
as
well
as
a
family
history.
They
get
data
on
lifestyle
and
stress,
means
of
relaxation,
diet,
and
exercise.
They
ask
the
patient
when
each
symptom
began
and
what
was
happening
in
his
or
her
life
at
the
time.
They
try
to
uncover
the
cause
or
causes
of
the
symptoms
or
imbalance
and
to
discover
the
blocks
that
keep
the
patient
from
necessary
change.
Again,
nothing
in
any
naturopathic
licensing
bill
interferes
with
the
scope
of
any
other
practitioner.
Naturopathic
physicians
are
trained
in
various
psychological
techniques,
including
basic
counseling,
stress
management,
hypnotherapy,
biofeedback,
and
methods
of
lifestyle
modification.
A
large
body
of
scientific
literature
points
to
the
importance
of
treatment
for
psychological
and
somatic
factors
and
coping
mechanisms
in
many
illnesses
and
complaints.
INTEGRATIVE
CLINICAL
EDUCATION
The
Southwest
College
clinical
education
provides
students
with
an
integrative
ap-
proach
to
the
delivery
of
health
care
while
encompassing
natural
therapy
philosophies
and
emphasizing
the
practical
information
necessary
to
establish
a
successful
practice.
108
ND
students
gain
experience
in
private
practice
offices
and
in
local
health
care
and
hospital
settings
under
the
supervision
of
naturopathic,
allopathic,
or
osteopathic
licensed
physicians.
Clinical
training
is
designed
to
provide
the
entry-level
skills
necessary
to
become
a
successful
practitioner.
Along
with
providing
experiences
to
establish
confidence
as
a
practitioner
and
to
foster
understanding
of
the
role
of
naturopathic
medicine
within
the
health
care
system,
students
are:
· Provided
with
many
opportunities
to
observe
excellent
role
models.
· Involved
in
observing
diverse
patient
populations
in
a
variety
of
clinical
environments.
· Focused
on
effective
communication,
diagnostic,
and
therapeutic
tools.
· Immersed
in
a
Clinical
Competency
Program,
where,
at
their
own
pace,
they
gain
the
skills
and
knowledge
to
become
successful
practitioners.
CONCLUSIONS
Naturopathic
medical
schools
go
beyond
offering
electives
in
complementary
and
alternative
medicine.
They
are
the
only
medical
schools
in
the
United
States
that
integrate
basic
sciences,
conventional
diagnostic
medicine,
pharmacology
and
com-
plementary
and
alternative
medicine.
They
also
have
the
advantage
of
educating
students
using
these
modalities
in
direct
patient
care.
The
ultimate
strength
of
this
program
is
that
the
philosophy
and
principles
of
natural
medicine,
introduced
in
the
first
week
of
school,
are
imbedded
and
interwoven
throughout
the
entire
fabric
of
the
program.
The
challenges
in
naturopathic
medicine
are
primarily
in
two
areas.
First,
because
naturopathic
medical
schools
do
not
receive
government
or
state
subsidies,
the
funding
base
for
them
is
significantly
smaller
than
for
their
allopathic
and
osteopathic
counter-
parts
resulting
in
smaller
libraries,
laboratories,
and
clinical
facilities.
Second,
the
clinical
training
focuses
primarily
on
outpatient
care
and
needs
to
incorporate
training
in
hospital
settings
and
emergency
care.
Because
naturopathic
residencies
do
not
receive
funding
from
the
Federal
Government,
they
are
few
in
number
resulting
in
less
than
10%
of
naturopathic
physicians
having
residency
opportunities.
Naturopathic
medicine
and
its
training
institutions
work
hard