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.
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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).
