Naturopathic Medical Education: Contrary Imperatives
David J. Schleich, PhD
What distinguishes the medicine of the past twenty-five years is not that its practitioners are equipped with an arsenal of antibiotics and antiseptics, but that they are furnished with a comprehensive and unprecedented understanding of what the healthy body is and how it survives and protects itself. – Jonathan Miller, 1978
“But it’s no use now,” thought poor Alice, “to pretend to be two people! Why, there’s hardly enough of me left to make one respectable person!” – Lewis Carroll, Alice’s Adventures in Wonderland, p.6
“It’s no use going back to yesterday, because I was a different person then.” – Lewis Carroll, Alice’s Adventures in Wonderland, p.125
There is a conversation occurring from time to time within the AANMC (Association of Accredited Naturopathic Medical Colleges) about the advisability of locating naturopathic medical education within the public research universities and schools model. Accompanying that debate is often a rigorous discussion about the potential of the incorporation of evidence-based medicine (EBM) into any higher-education model we go for in naturopathic medical education to co-opt and dilute the medicine. There are some naturopathic leaders who contend that we are losing our roots and our philosophy. There are others who, like Alice, suggest that we are either different now or we are not. And, there are still others who maintain that we are either what we were along with what we are becoming, or we are not.
Whatever the nooks and crannies of the discussion, though, the original and abiding intention to join the postsecondary “first-professional degree” niche comes from our knowing that the numerous proprietary schools that initially dominated the North American medical education (allopathic and naturopathic) landscape in the 19th and early 20th centuries didn’t make it through Flexner and those private, for-profit entities that endured but which remain marginalized at the periphery. The Council on Naturopathic Medical Education (CNME) network of programs has a foothold, despite detractors and the vagaries of the postsecondary and postgraduate terrain at the end of the second decade of a new century.
Actually, by the middle of the 20th century the proprietary school in Canada and the United States virtually disappeared as a serious framework for institutionalizing naturopathic medical education (Baer, 2001). In CAM, Natural Medicine, Integrative Medicine, or Holistic Medicine – to iterate some of the framework language – the non-profit, private-sector model dominates in the CNME-accredited naturopathic niche. In the larger kaleidoscope of proprietary schools presenting programs in these fields, there is a will to provide medical training of high caliber and to sustain standards and clinical rigor that can permit inclusion within the first-professional degree category of the US Department of Education’s Integrated Postsecondary Education Data System (IPEDS).
Two decades back it was clear that applications by proprietary, non-compliant schools or programs touting “naturopathy” as their discipline were eschewed routinely. Some of us will recall that the First University of Naturopathic Medicine (FUNM) in the state of Alabama was denied a license to operate by the state principally because an accrediting committee concluded that the university as a private, for-profit institution “did not meet the minimum standards of a post-secondary professional school.” (Dr Peter Martin, then Dean of the faculty of naturopathic medicine, Bridgeport University, October 24, 2002)
A few similarly structured proprietary schools of naturopathy, homeopathy, herbalism, and so on, which had been so prolific during the early part of the 20th century, still existed by the end of the last century, but in a much changed form. However, those of their graduates who were either not grandfathered or who did not have the umbrella of a different modality (eg, acupuncture) were eventually not able to practice naturopathic medicine in the growing number of regulated states and provinces. A tension grew during this period, then, between naturopathic practitioners from accredited schools and graduates from proprietary diploma schools. Early suggestions about rationalizing the 2 main groups did not succeed, and to this day the contrary imperatives of the CMNE and the ANMA (American Naturopathic Medical Association) persist, although less sharply.
The Risk of Marginalizing the Profession
Graduates from schools not aligned with a serious commitment to joining the higher-education sector had, in the opinion of the mainstream medical profession, long been a source of “coarse and common elements” (Starr, 1982, p.115). As far as the American Medical Association was concerned, such schools and their graduates had to be “sloughed off.” (Starr, 1982, p.116) The cumulative effect of all these developments has been described by naturopathic leaders as contributing to the “marginalization” of the profession. (Cody, 1985; Pizzorno, 1987)
There has arisen over the years, then, confusion among the public, elected officials, government policymakers, professional healthcare providers other than the natural medicine community, higher education administrators, and academics about what naturopathic medicine is, and more particularly about its academic and clinical validity. This has made it difficult for those policy-makers and lawmakers to determine where naturopathic medicine fits into the primary healthcare landscape. To the rescue, though, came the work of naturopathic leaders in the first decade of our current century to reclassify naturopathic medical schools as first-professional degree institutions – namely, the American programs and CCNM in Toronto.
A number of years back and in the context of his membership on the Technical Review Panel for IPEDS, William Keppler, PhD, former president of NCNM, called attention in committee hearings in Washington to Dr Edward Delaney’s admonition about the confusion that has accompanied the expanding of educational requirements in the allied health fields. At the time, a very prescient Dr Keppler reinforced for us why this beacon for the naturopathic profession in the primary healthcare landscape must be understood. He laid out the recent history, players, and their roles in higher education classification. This reconceptualization process endorsed by the panelists at those meetings in the early 2000s was a powerful window for the profession while a level playing field is created.
A Scholarly Literature That Helps
As well, there is a helpful, emerging literature we can count on to guide us (Aakster, 1986; Bloomfield, 1983; British Medical Association, 1986; Frank, 1981; Rosengren, 1980; van Dam, 1986; Wiesner, 1989). For several decades now these scholars of higher education and public policy related to professional formation have been charting a pioneering course through such confusion. In the background or perhaps in parallel, there is a tradition of radical and progressive inquiry that takes aim at a so-called medical industrial complex characterized by the elitism of the allopathic medical profession, as well as a well-established link between it and the pharmaceutical and medical equipment and supplies industries. Sociologists have written extensively about the hierarchies that exist among medical professionals. As we propel our schools more and more into the higher education niche, it would do us well to become increasingly familiar, as institutions, with the ideas and conclusions emerging from that scholarship.
Doyal (1979) and Navarro (1976), for example, using political economy as a framework, have written about the social context in which medicine operates. Ehrenreich (1978), Illich (1977), and McKeown (1979) have contributed to a dialogue about the failure of allopathic medicine to deal with numerous health concerns. These sociological backdrops help in an understanding of the nature and impact of the marginalization of the non-allopathic medical traditions. Ruzek (1989), in this regard, considers some of these social aspects of primary medical care. Shroff calls attention to the “risks of many technical diagnostic and therapeutic procedures” (1996), when compared with holistic medicine where the practitioner validates client feelings (Flood, 1995).
In general, the relationship of the various specialist qualifications and modalities of the naturopathic doctor to those of the more universally known medical doctor or osteopathic doctor are not only confusing to the populations cited above, but have also been persistently argued about. Along this continuum of controversy there are potentially alarming revelations about the testing of pharmaceuticals in third-world countries that has been going on for decades (Lexchin, 1984), or substantial explanations about why North America, in particular, “is the international aberration in terms of the non-Native culture’s relationship to holistic medicine” (Shroff, 1996, p.35). At another point in that continuum, Boon (1996) summarizes the aim and treatment modalities of the naturopathic doctor, explaining in considerable detail how the ND is trained to integrate these therapeutic approaches.
However, there is little written about the intersection of these 2 professional groups, and even less that compares their respective medical educations. What the literature reveals is that the naturopathic group, as a key player in the natural medicine or the CAM field, has been marginalized, that is, less known, less understood, and less accepted, particularly in North America.
Gort (1986) was talking about these issues a generation back. He prefers to use the terms conventional and unconventional to establish the distinctions between mainstream allopathic medicine and naturopathic medicine. Notwithstanding recent initiatives by the World Naturopathic Federation (WNF), the therapies and modalities of the complementary, alternative, traditional, unconventional practitioners, in any case, are still not yet officially recognized by the dominant political system (Ministry of Health and Environmental Protection, The Netherlands, 1981). Despite this political dichotomy, patients in Canada and the United States increasingly access both medical doctors and naturopathic doctors, and in this sense the latter do indeed provide a valid, primary care health service. It is not surprising, then, that public health officials, government higher education authorities, and the public itself are increasingly interested in the nature, credibility, and history of the education and training foundations of these medical groups.
Influencing public policy and the formation of regulatory environments – which in turn affects the agenda of the naturopathic medical education institutions in the United States and Canada – has been the cumulative impact of this marginalizing of the naturopathic profession, even though naturopathic practitioners have existed in those countries since the early part of the 20th century and have roots linked to German nature-cure and water-cure systems and professions. Skilled German nature-cure doctors brought the discipline to America at the end of the 19th century. The professional status of naturopathic practitioners, however, was from the outset peripheral to the mainstream medical professions, the so-called dominative medical system (Baer, 1991) that considered itself the final authority on primary health care. The educational institutions supporting the NDs, DOs, homeopaths, and DCs in Canada and the United States have been correspondingly marginalized in a variety of ways regardless of the unrelenting efforts of naturopathic physicians such as John Bastyr, Joseph Boucher, Gordon Smith, John Cosgrove, James Sensenig, Joe Pizzorno, and Donald Warren.
The Way Forward
The way forward is to embrace a location within the public and higher education sectors for naturopathic programs. This is tricky terrain. Public higher education settings are massive elephants sitting on the same bench as our tiny naturopathic network. Like the allopathic industry, these folks shift a little on that bench and risk squashing us, albeit unintentionally in some cases. Negotiating a place in higher education and public health care policy for naturopathic medicine risks our being assimilated (as have been the osteopaths in America and Canada, for example). A place in that mainstream domain is also replete with health policy concerns. Even so, the time has come for a more focused conversation, analytic and strategic at the same time, on the work nearest to grow the profession.
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David J. Schleich, PhD, is President Emeritus of the National University of Natural Medicine (NUNM), where he served from 2007 to 2019; former president of Truestar Health; and former CEO and president of CCNM (1996 to 2003). 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).