Important Factors in Naturopathic Professional Formation (Part 3 in a Series)

David Schleich

Professional formation occurs across a broad front and includes clinical players, politicians, academics, and policy wonks. The naturopathic profession is in midleap, from a marginalized group to a social location smack dab in the middle of the primary health care landscape. There is no shortcut.

Part of the reality of the current stage of professional formation processes for naturopathic doctors is that much of the scholarly inquiry in this field has been aimed at the mainstream allopathic and allied health professions. For example, in Canada “nurse practitioners” are discussed as an emerging primary care group in terms of medical doctors, rather than as a distinct professional group. One finds literature describing what nurse practitioners can and can’t do in terms of what medical doctors will permit. In this way, scholars and clinicians alike have persisted for a long time in understanding the emergence of particular professional groups in terms of the dominant biomedical group, the medical doctors.

For example, Kaptchuk and Eisenberg have noted, “the historical magnitude of alternative medicine has rarely been studied with anything resembling modern survey methods or with the intensity of recent efforts” (2001). As well, and at about the time that defining institutions such as the Council on Naturopathic Medicine Education (CNME) and the American Association of Naturopathic Physicians (AANP) were being reestablished, Twaddle and Hessler were already saying that “naturopaths have not yet received the attention of sociological research” (1976, p. 191).

Much of the available literature, then, has tended to focus on mainstream health care professions and has not considered the naturopathic profession very thoroughly up until now. For example, medical sociologists (Jarvis, 1958; Inglis, 1965; Lucas, 1966; Wardwell, 1980; Coburn and Biggs, 1987; Whorton, 1985) and medical anthropologists (Kleinman, 1973; Cobb, 1977; Gevitz, 1988; Baer, 2001; Boozang, 1998; McCracken, 1999) have long been contributing to a growing body of scholarship about the formation of and public demand for complementary and alternative medicine (CAM), often used in conjunction with biomedical care (Eisenberg et al., 1993, 1998). And, as landmark events such as the Naturopathic Foundations Project and the growth in regulatory jurisdictions in the United States and Canada accumulate, the naturopathic profession is finding itself under more and more scrutiny. In fact, despite this hegemony of biomedicine in North America (Baer, 1992, 2001), among scholars of higher education interested in the formation of professional groups such as naturopathic doctors or chiropractors, there has been a sporadic but growing interest in studying the location and role of the graduate medical education institutions and systems preparing these alternative and complementary practitioners for entry to practice (Boon, 1996; Baer, 1992, 2001).

Indeed, within a rich history of medical pluralism in North America, particularly in the United States, medical historians, medical anthropologists, and social scientists have occasionally written about professional formation or about the alternative and complementary treatment modalities and therapies of such professions (Roth, 1976; Maretzki and Seidler, 1985; Gort and Coburn, 1988; Baer, 1992, 2001; Boon, 1996). This attention, albeit quite uneven, has resulted as much from the small numbers in professions such as naturopathic medicine as it has from the so-called marginalization within regulated state or provincial frameworks of those professions in North America by the dominant, biomedical, science-based allopathic profession, as discussed by scholars such as Wardwell (1951) and Roth (1976). The allopathic monopoly, which has perpetuated this scholarly imbalance, itself emerged, according to an early president of the Institute of Homeopathy, in the beginning decades of the 20th century as a result of the “assault on traditional medicine” by the American Medical Association, long “bent on throttling everything which stands in its way for obtaining medical supremacy” (Wilcox, JAOA, 1914, p. 650).

A factor contributing to this small body of scholarship about naturopathic medical education has been the particular framework in which non-mainstream professional health care practitioners, because of public policy and legislation governing higher education, have had to support their educational needs in North America. Essentially, their activities were on such a small scale and located so far away from the mainstream activities of higher education in the states and provinces where efforts to establish colleges were undertaken, that students and scholars of higher education were rarely attracted until recently to their issues and development.

However, when the higher education scholar’s attention eventually did land on the naturopathic physicians or the chiropractors (Hildreth, 1942; Homola, 1963; Kelner et al., 1980; Hiatt, 1984), it became quickly apparent that there were topics of considerable interest and value to investigate, such as professional formation, values, and political strategy (Cody, 1985; Gort, 1986; Baer, 1987, 1992, 2001, 2004; Gevitz, 1988; Boon, 1996). These early investigators wanted to explore more fully, most often from a sociological or anthropological perspective, the formation of the naturopathic profession among others of a growing taxonomy of professionalized, partially professionalized, and unorganized medical systems, and were not particularly concerned with the location of naturopathic medical training within higher education in the province. It appears that naturopathic medical education had been on the periphery of professional training at the same time as its leaders had long been seeking a location institutionally for naturopathic students within the professional preparation sector of higher education.

As well, the data suggest that the presence of chiropractic in the evolution of naturopathic medicine has also significantly influenced its institutional development. Reed explains that naturopathic medicine “attained importance contemporaneously with the development of ‘mixing’ in chiropractic” (Reed, 1932, p. 63). Mixing is a term well known to the naturopathic profession, and which defines the blending of naturopathic techniques with chiropractic ones to give the doctor of chiropractic an enhanced repertoire of techniques. Thus, the institutionalizing of naturopathic medical education reflected a strong chiropractic influence over the course of several decades up to midcentury. Indeed, there is a recurrent discussion in the literature about the role of chiropractic in the formation of naturopathic medicine (Gort and Coburn, 1988). References to the educational foundations of CAM professions other than chiropractic do appear, but with a certain surprising paucity given the momentum of interest in medical pluralism and the dominance of the biomedical model especially in North America and Europe.

References

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Baer HA: Biomedicine and Alternative Healing Systems in America: Issues of Class, Race, Ethnicity and Gender, Madison, 2001, University of Wisconsin Press.

Baer HA: Divergence and convergence in two systems of manual medicine: osteopathy and chiropractic in the United States, Medical Anthropology Quarterly 4:176 -93, 1987.

Baer HA: The potential rejuvenation of American naturopathy as a consequence of the holistic health movement, Medical Anthropology 13:369-83, 1992.

Baer HA: Toward an Integrative Medicine: Merging Alternative Therapies with Biomedicine, Walnut Creek, CA, 2004, Alta Mira Press.

Boon H: Canadian Naturopathic Practitioners: The Effects of Holistic and Scientific World Views on Their Socialization Experiences and Practice Patterns. PhD Thesis, University of Toronto, 1996.

Boon H: The Future of Naturopathic Medical Education. Primary Care Integrative Natural Medicine: The Healing Power of Nature. Doctoral dissertation, Graduate Department of Pharmacy, University of Toronto, 1996.

Boozang KM: Western medicine opens the door to alternative medicine, American Journal of Law and Medicine 24(2-3):185-213, 1988.

Cobb AK: Pluralistic legitimization of an alternative therapy system: the case of chiropractic, Medical Anthropology Quarterly 4:1-23, 1977.

Cobb AK: Pluralistic legitimization of an alternative therapy system: the case of chiropractic, Medical Anthropology Quarterly 4:1-23, 1977.

Coburn D, Biggs, CL: Legitimization or medicalization? The case of chiropractic in Canada. In Coburn D et al. (eds): Health & Canadian Society: Sociological Perspectives, Toronto, 1987, Fitzhenry & Whiteside, pp 366-84.

Cody G: History of naturopathic medicine. In Pizzorno JE, Murray MT (eds): Textbook of Natural Medicine, Seattle, 1985, John Bastyr College Publications.

Eisenberg D: Herbal and magical medicine: traditional healing today—a book review, N Engl J Med 328(3):215-16, 1993.

Eisenberg DM et al: Trends in alternative medicine use in the United States, 1990-1997, JAMA 280(18):1569-75, 1998.

Gevitz N: The DO’s: Osteopathic Medicine in America, Baltimore, 1982, Johns Hopkins University Press.

Gort E: A Social History of Naturopathy in Ontario: The Formation of an Occupation. M.Sc. Thesis, Division of Community Health, University of Toronto, 1986.

Gort EH, Coburn D: Naturopathy in Canada: changing relationships to medicine, chiropractic and the state, Social Science and Medicine 26(10):1061-72, 1988.

Hiatt SR: A survey of attitudes and knowledge of chiropractors, ACA Journal of Chiropractic22(12):25-30, 1985.

Hildreth A: The Lengthening Shadow of Andrew Taylor Still, Kirksville, MO, 1942, Journal Printing.

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Maretzki TW, Seidler E: Biomedicine and naturopathic healing in West Germany: a historical and ethnomedical view of a stormy relation, Culture, Medicine and Psychiatry 9:383-421, 1985.

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Wardwell WI: Social Strain and Social Adjustment in the Marginal Role of the Chiropractor. PhD Dissertation, Harvard University, 1951.

Wardwell WI: The present and future role of the chiropractor. In Haldeman S (ed): Modern Developments in the Principles and Developments of Chiropractic, New York, 1980, Appleton-Century-Crofts, pp 25-51.

Whorton J: The first holistic revolution: alternative medicine in the nineteenth century. In Stalker D, Glymour C (eds): Examining Holistic Medicine, Buffalo, NY, 1985, Prometheus.

Wilcox, D: Medical organizations in annual session: the AMA meeting, Journal of American Osteopathic Associations 13:650, 1914.


David_Schleich_Headshot-248x300

David Schleich, president of Truestar Health, is the former CEO and president of Canada’s accredited Canadian College of Naturopathic Medicine, where he served from 1996 to 2003. His previous posts have included appointments as vice president academic of Niagara College, and administrative and teaching positions at St. Lawrence College, Swinburne University (Australia), and the University of Alberta. His academic credentials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s University (BEd), and the University of Toronto (PhD).

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