How to Choose the Right Naturopathic Doctor

Just like with any other kind of profession, naturopathic doctors come in all shapes and sizes. Even though they share a common core of naturopathic principles, the scope of training and practice, as well as how they apply those naturopathic principles in real life, can vary widely from one naturopathic doctor to another. Here are some tips to help you make the right choice of naturopathic doctor for your individual needs.

Two Tiers of Naturopathic Training

When it comes to choosing the right naturopathic doctor, it is essential for potential patients to understand that there are two tiers of training in the field of naturopathy. Depending on your preferences and who is available in your area, you may decide to choose one over another. Knowing the difference between the two tiers of naturopathic doctors will help make that choice easier.

Naturopathic physicians graduate from full-time four-year naturopathic medical schools accredited by the Council for Naturopathic Medical Education, engage in clinical training under the supervision of other licensed naturopathic physicians, pass naturopathic board exams, and obtain naturopathic medicine licenses in states where they are offered.

Naturopathic physicians learn all of the same basic sciences as medical doctors- using the very same textbooks- and are also trained in diagnostic lab testing and imaging, as well as pharmacology and minor surgery. Like conventional medical doctors, naturopathic doctors learn clinical nutrition however their training in diet and nutrition is typically more extensive. On the other hand, MDs typically learn more about pharmacology and many of them go on to receive additional training in advanced surgical techniques.

For more details regarding the similarities between naturopathic and conventional medical school, please see: What Do Naturopaths Learn in Medical School?

Upon this foundation of basic medical sciences, naturopathic physicians also learn about natural remedies like herbs and dietary supplements. Some naturopathic doctors also learn Traditional Chinese Medicine and acupuncture.

Medical doctors who include natural remedies in their toolbag are known as integrative medicine or functional medicine practitioners, and may practice very similarly to a doctor trained in naturopathic medicine. On the other hand, where they are licensed to do so, naturopathic physicians will also write prescriptions for medications and refer for surgery when they feel it is appropriate.

Naturopathic practitioners or traditional naturopaths may have attended state chartered or proprietary schools, with varying curricula and graduation requirements. Sometimes these naturopathic doctors receive diplomas from distance learning programs conducted solely through mail and over the Internet.

Traditional naturopaths are not eligible to receive medical licenses in any state, however they also do not seek medical licenses or to practice medicine. Some of them may eschew science-based medicine entirely and rely only upon holistic or alternative remedies like homeopathy and flower essences. They may also be knowledgeable about traditional herbalism, nutrition, and dietary supplements, however there is not necessarily the same kind of standardization of training that a naturopathic physician receives. Nevertheless, based upon your preferences and beliefs, this might be just the type of practitioner you are looking for.

Ultimately, when choosing a doctor of any kind, it is often helpful to dig a little deeper into their training, credentials, and experience in order to assess how well of a fit they may be for your particular situation.

Different Focuses of Naturopathic Practice

Similarly to how medical doctors might specialize in one particular area of medicine, such as gastroenterology or general surgery, naturopathic physicians may choose to focus their practice in a specific area of health. In states where medical licensing is available, you are more likely to find naturopathic physicians practicing as primary care doctors. In other states, naturopathic physicians tend to position themselves more as consultants in natural health and co-manage the care of their patients with conventional medicine doctors.

While there are few formal residency programs for naturopathic physicians to participate in, there are additional specialty trainings and certifications available for specific areas such as oncology (cancer treatment), pediatrics, and environmental medicine.

Beyond this, different naturopathic physicians may choose to focus on one or two treatment modalities to the exclusion of all others. For example, one naturopath might focus on science-based modalities like botanical medicines and dietary supplements while another might use bodywork and energy medicine modalities. When considering different naturopathic practitioners it is important to ask if they have any particular areas of focus or preferred modalities, as these may vary greatly from one doctor to another.

Utilization of Science-Based Medicine

While there is little doubt that scientific investigation has forwarded the medical profession by leaps and bounds, there are many phenomena in the world that don't lend themselves well to scientific inquiry. In medicine, the gold-standard for research is a double-blind placebo-controlled study. However these are not only difficult to perform well for certain modalities (for example acupuncture) but they are also time consuming and expensive.

Due to a combination of historical trends, politics, economics, and intellectual property laws, most of medical research is focused on drugs and surgical procedures. For this reason, it should come as no surprise that the preponderance of "Grade A" scientific research available on the treatment of any given disease is going to be heavily in favor of drugs or surgery. However, this is not to say that research for other treatment modalities doesn't exist, or that drugs and/or surgery are automatically the best option in all cases. In addition, just because "Grade A" double-blind placebo-controlled studies exist for a given treatment, doesn't guarantee that the particular treatment is the most safe or effective. It is sometimes the case that treatments that were once vetted by science to be safe and effective are later abandoned after new information or post-market research becomes available.

A considerable amount of scientific research looks at the effects of nutrition and exercise on health. We all know that nutrition and exercise are important determinants of health, if not the primary determinants. However, the quality of research in these areas is generally much lower than that for pharmaceutical drugs because it is very difficult to double-blind and placebo-control diet and exercise behaviors. When scientifically investigating a drug, this is relatively simple: Either you are taking the drug or you are taking a placebo. However there is no way to get somebody to think they are doing high-intensity interval training or eating broccoli when they are not. Similarly, it is nearly impossible to isolate one specific food or exercise for a research study since we are eating and moving about all the time.

The scientific research of medicinal herbs and dietary supplements faces different challenges. While it is relatively easy to double-blind and placebo-control these therapies, there are often vast differences between the quality and types of natural agents available. For example, the chemical constituents of a medicinal herb can vary greatly depending upon where it was grown or the time of year that it was harvested. One way to deal with this issue is to standardize the herbs for a specific quantity of a single chemical constituent. However this is also problematic because the health benefits might very well be due to a number of different chemicals working together. Despite these challenges, the body of scientific research supporting the use of medicinal herbs continues to grow at a rapid pace.

In the case of non-quantifiable influences on health, such as faith and spirituality, attitude and psychology, therapeutic touch and "quantum" or subtle energies, bodywork and breathwork, or other holistic modalities, the scientific research for these is almost nonexistent. This should be no surprise because we cannot measure and compare things that are nonphysical or entirely subjective. It just simply cannot be done. However- just because we cannot scientifically investigate a holistic healing modality does not necessarily mean that it is wrong or that it is not effective. It just means that we will most likely never be able to prove that it is effective.

Where some holistic health practitioners get into trouble is when they present a healing modality that is fundamentally non-scientific as being science-based. This in an unethical practice known as pseudoscience which unfortunately seems to be increasing in recent times. The main thing to remember about pseudoscience is that just because something sounds scientific doesn't mean it is scientific. Perhaps more important is to realize that having a scientific degree or medical license does not make a practitioner immune to pseudoscience. While pseudoscientific beliefs and practices are more commonly found among lay practitioners, many of them are also practiced by naturopathic physicians and medical doctors.

Again, it is important to remember that it isn't inherently wrong or foolish to offer certain holistic therapies- indeed many of them can be quite effective- the problem arises when a practitioner presents tham as being science-based when they are not. What scientific investigation offers us is the ability to reliably predict whether a given therapy has a chance of being effective, and what that chance might be. With non-scientific holistic practices, we cannot make those kinds of assessments. In particular, we cannot assess to what degree a holistic healing modality is effective due to the modality itself, or due to a patient's belief that it will work. This phenemonon is called the placebo effect, and is why we can reasonably expect that health insurance companies will never cover holistic healing modalities.

On the other hand, even science-based medicine practitioners must always be vigilant about the ethical implications of medical research being conducted by organizations that have a strong bias and/or financial interest in a particular outcome. Unfortunately, fraud and deceit in medical research appears to be on the rise. A 2012 study published in the Proceedings of the National Academy of Sciences found that the proportion of scientific research retracted due to fraud has increased tenfold since 1975 and that more than two-thirds of retracted studies are due to scientific misconduct. The takeaway from this is that we cannot simply hang our hats on "trusting in science" because science is conducted by human beings with a wide array of biases, ethical standards, and ulterior motives.

Summary

When choosing the right naturopathic doctor, there are three main factors to keep in mind:

  1. Which of the two tiers of training the naturopathic doctor receives.
  2. If there is a specific focus of their naturopathic practice.
  3. The level of utilization of science-based vs. nonscientific modalities.

These three factors should help you to choose the right naturopathic doctor for your particular needs. When in doubt, remember to ask questions and never be afraid to switch naturopaths if you feel that another one might be a better fit for you.