What is a Naturopathic Physician?
© Andrew L. Rubman, ND
The modern naturopathic physician is the best-trained arbiter of wellness. Educated with the same rigor as the graduate of ivy-league medical schools, the licensed ND blends the vitalistic philosophies of the founders of scientific reductionism with a working knowledge of the naturalistic therapies that have endured the millennia.
Where the Allopath strives to master the manipulation of pathology in the pursuit of disease ablation and suppression, the Naturopath endeavors to augment physiology and enhance wellness, decreasing the opportunity for illness.
As there are areas of naturopathic medicine that address acute or heroic medical care and areas of allopathic medicine that ostensibly focus on prophylaxis, the above definitions are not meant to be absolute, only fundamental. Because of these areas of overlap there are naturopathic principles and therapies that complement or function alternatively to allopathic interventions, as there are allopathic notions and ministrations that offer alternatives and complements to naturopathic care. Casting trivialized ‘naturally–oriented therapeutics’ as ‘complementary and alternative’ is myopic and pejorative.
Applying the assessments and treatment skills of naturopathic physicians as ‘come-ons’ in the disease-oriented or condition-specific model of healthcare does little more than palliate. What I wish to assert is that the emerging model of “The New Medicine” needs to have naturopathic physicians functioning as equals with their MD allopathic allies; and that NDs need to be the primary care physicians and initial arbiters of the healthcare model of the future. Why would the government and medical and insurance industries embrace not only the equal inclusion of NDs into the model, but the almost topsy-turvy approach of having patients see NDs first?
The answer is first and foremost one of capital. Money is being spent not on procedures that will enhance health, but on heroic medicine, suppressive pharmacy, and complex ablative surgeries. An approach to contain underwritten medical spending among the citizenry relying predominantly on disease mitigation to promote wellness is specious. A true national wellness initiative based on the objective oversight by naturopathic physicians of the extant medical industry, particularly its physicians and pharmaceutical houses, is well overdue. The cost containment and improved outcomes resulting from this action will be obvious in short order.
What a naturopathic physician is can be partially arrived at by appreciating their role in the gestalt of modern medical care. A look at the historical basis of viewing human function can yield a more complete understanding of this role. The earliest healers based their philosophies and practice on the observation of nature and the degree to which an individual behaved in concordance with the natural dictums. It was only when nature began to be perceived as responding vindictively to man’s largess that treating antithetically to normal function became therapeutic. Thus helping to purge the ‘pernicious influence’ through poisoning with arsenic or mercury, or externalizing the ill through trephoning or bloodletting, came into vogue. Although the modern ND may incorporate surgeries and drug therapy into a regime when absolutely necessary, their ‘stock-in-trade’ practice does not depend on these punitive and often expensive approaches.
True patient-centered care positions education as a part of every office visit, not an afterthought for an optional class taught by a subordinate. Today’s ND spends considerable time helping the patient use their diet, lifestyle choices, routine supplementation, and assessment of normal function as a means to promote better health.
To do so for the individual and their family means to assist them in becoming better medical consumers. Staying healthier and requiring fewer medical interventions decreases the public burden that healthcare has become. The present high-tech disease management system is great for what it does; it is just over-utilized. Objective oversight arrived at solely by those who would profit from increased public spending is an arcane notion perpetuated through the indefensible construct of monofocal ‘scientific medicine’. Although modern medicine has features, which are loosely scientifically defensible, it has been, and remains, primarily an art.
By teaching wellness strategies, the modern ND can not only improve the general level of health of the typical American, but also decrease sickouts, downtime, and absenteeism. It is unfortunate that far from being the prime concern of governmental agencies and legislative bodies, wellness education seems to, until recently, been the province of the health food shopkeeper and self-taught naturalist. We do owe a debt of thanks to these folks fanning the embers of self-empowerment, but we shouldn’t look to them to function as physicians. As odd as it may seem, the public is presently threatened not only by MDs ‘going holistic’ and practicing beyond their formal training, but by lay individuals becoming self pronounced ‘nature doctors’. Thus it is incumbent upon government and media to inform and protect the populace from those whose reach exceeds their grasp.
Although it is true that the human condition is flawed and thus vulnerable to external and internal malfeasance, we manage to survive and thrive progressively longer for the most part. While we have succeeded in identifying and in some cases eliminating microorganisms probably causative of certain diseases, our greatest victories over mortality and morbidity have resulted from improvements in sanitation and life-style. If it is truly the wish of our medical establishment to promote a healthier population and decrease medical spending, we must draw from the skills of the naturopathic physician to help revise incorrect thinking. Most chronic diseases do not have single discrete causes. They arise as the result of years of misguided activity, primarily eating and drinking. If the knowledge base of naturopathic physicians regarding the biochemical impact of dietary modulation alone were given the same emphasis in the media as pharmaceutical advertisement, disease-care costs would drop precipitously.
Now that the sales of natural medications has become big business, even bigger than elective surgery, naturopathic physicians' input can be brought to bear to oversee not only proper ‘good manufacturing practices’ but also proper prescription. While it is true that MDs have no training in the field of natural prescription, this does not mean that the notion should be trivialized. Any substance, offered by an expert with the intention of modifying physiology or pathology, becomes prescribed. There are valuable materials that can not only promote health but also in some cases modify disease more cost-effectively and with fewer side effects than conventional pharmaceuticals. Again the ideal scenario is to have the influences of naturopathic physicians and allopathic physicians co-mingled.
Thus what a naturopathic physician is can also be determined by observing in what function they can best serve their patient base. Personally speaking, over my 25 years of clinical practice, besides functioning as the primary care provider that I was trained to be, I have found myself cast as: allopathic foil, student of colonic microflora, ‘whole life’ lecturer, home birth obstetrician, surgical assistant, consultant to State and Federal entities, hospice functionary, and Shamanic aspirant. I can identify aspects of all of these disparate functions in the four years of post-graduate naturopathic medical schooling that I received often complemented by shared experience of students and faculty in the program.
In summary, a naturopathic physician is dissimilar from other licensable medical physicians in many respects and similar in others. Although formal training in the classic basic and clinical medical sciences and supervised clinical internship is analogous in content and rigor to that of the Nation’s best allopathic medical schools, the philosophical perspective offered may be quite antithetical. Much if not more of what the graduate physician becomes is shaped by interaction with fellow students and instructors and their rich and diverse background as by formal course content. Our scope of practice encompasses almost all of the legitimate “holistic therapies” which are in vogue today and we are formally trained in these disciplines in medical school.
Perhaps most importantly, the practicing naturopathic physician grows to meet the expectations and the demands of the population that they treat, often with more breadth of life experience than their allopathic counterpart. These are some of the factors that make us effective, irreplaceable and to some threatening. If the true voice of the naturopathic physician could be spoken for, it would be that of the American people wishing for empowerment and objectified self-determination.