Naturopaths seek licensing in New York
10/07/2006

Martha Morrison never suspected a sandwich could cause her pain.

After a diagnosis of rheumatoid arthritis in 2003, Morrison decided to see if there was an alternative treatment to the medications her doctors prescribed to treat her symptoms.

She began working with naturopathic practitioner Tom Francescott, who started by trying to determine if food allergies could be causing the inflammation in her body.

As part of the process, Francescott had Morrison eliminate foods from her diet that are often associated with arthritic pain. For one month, she didn't eat anything containing wheat.

The day she reintroduced wheat back into her diet, a sandwich on wheat bread gave her an almost immediate answer.

"That day I was going to walk home from work," said Morrison, who lives in the City of Poughkeepsie and works at Vassar College. "I couldn't even stand up to walk ... it was really obvious. I had to ask for a ride home. I hurt everywhere."

Francescott, who holds a doctorate of naturopathic medicine, said they found that by avoiding certain foods, including wheat and vegetables such as peppers, tomatoes and potatoes, Morrison can live symptom-free without taking medication.

Nutrition is a large part of a naturopath's philosophy in treating patients.

"Naturopaths would look at her diet," said Francescott about Morrison. "Medical doctors would not necessarily look at diet at all nor does he or she think necessarily that it could contribute to her symptoms."

According to the National Center for Complementary and Alternative Medicine, 36 percent of U.S. adults aged 18 years and older use some form of complementary and alternative medicine. This is defined as a group of diverse medical and health-care systems, practices and products that are not presently considered to be part of conventional medicine. Naturopathy is included.

Naturopaths use a holistic approach to medicine, focusing not only on the patient's body but their mind and spirit as well. Some medical professionals feel that with proper training and some limitations, naturopathy, which has been around for more than a hundred years, can complement traditional medicine. Naturopaths see the scope of their work as going much further.

Francescott, who has a practice in Rhinebeck, explained that naturopaths who graduate from one of the four accredited colleges in the United States receive training very similar to medical doctors but with a different philosophy.

"Our philosophy is that we believe the body can heal itself, and we look at the symptoms as linked to some other cause," he said.

Licensing at issue in N.Y.

Like traditional medical doctors, naturopaths aim to treat health problems, and in some states can perform physical exams, diagnose problems, order lab tests and prescribe some drugs.

But naturopaths take a different approach than other practitioners may. They use nutrition, botanical medicine, traditional Chinese medicine, homeopathy, and some become licensed acupuncturists as well. Understanding the role stress can play in a person's health, they are also trained to do different types of counseling.

Currently 14 states, the District of Columbia and the U.S. territories of Puerto Rico and the Virgin Islands have licensing laws for naturopaths. However, there is no licensing in New York state. Recent legislation would have created licensure for naturopaths in New York. It did not pass the Senate or the Assembly and will have to be re-introduced next year.

There are approximately 100 license-eligible naturopaths in New York state, according to Sam Schikowitz, a member of the New York Association of Naturopathic Physicians.

One of the reasons some naturopaths are pushing for licensure is it would define educational standards, allowing naturopathic doctors to provide the services they feel they are trained to provide after completing a four-year, residential doctorate program at a naturopathic medical school.

Focus on preventing illness

Schikowitz, a naturopath with an office in New Paltz who is also a licensed naturopathic doctor in Connecticut, said while there are not many residency opportunities for naturopathic students, they do have internships and other clinical experiences.

"During the third year, we follow a doctor around and then in the fourth year, we act as the primary clinician under the supervision of a naturopathic doctor," he said.

Since the 1990s, naturopathic medicine has taken off in the United States, said naturopath Jana Nalbandia, chairwoman of the clinical sciences division of the School of Natural Medicine at Washington State's Bastyr University, with some medical doctors even jumping on board.

"The popularity of alternative medicine, nutrition, yoga, acupuncture, all of them have taken off," she said. "Some of it can be explained by some sort of dissatisfaction with the medical community ... they're stellar in acute medicine but they don't work as well with the chronic. They're not good with preventative (medicine), actually prevention through lifestyle choices and changes."

Dr. Ravinder Mamtani, a physician in Fishkill and director of acupuncture and complementary medicine education programs at New York Medical College, said patient surveys have indicated 50 percent to 55 percent of patients are using complementary therapies and/or seeing a practitioner who practices many of these treatments.

Mamtani warns it is important for patients to understand the benefits, along with the risks and limitations of any treatment — both complementary and conventional. Whatever treatments practitioners offer to their patients should be based on evidence.

"I think that the evidence is not just looking at a randomly controlled trial, like most physicians would do, there is the effectiveness of treatments, there is safety, and I think we should also consider treatments that are based on patients' preference and their values," he said.

There is some concern within the medical community about the scope of naturopathic practices. Gail Myers, senior associate director for legislative and political affairs for the Medical Society of the State of New York, said they do not feel the education naturopaths say they receive gives them sufficient training to diagnose and treat injuries.

"Naturopaths as they are assisting patients in making choices about how to attain a well lifestyle, that is a beautiful thing," Myers said. "We don't think they should be forming diagnosis. We don't think they should be treating injuries. They can work in collaboration with a physician."

One area naturopaths fall short, Myers said, is with a residency, which allows physicians to rotate through every part of the health-care consortium. Through a residency, physicians see patients at the end of a disease and try to understand how it could have been prevented. Naturopaths do not get the experience of being able to treat and diagnose health conditions at the acute side, she said.

Francescott started his local practice three years ago and has also recently opened a store in Rhinebeck, Dr. Tom's Tonics, which carries natural remedies, natural products and supplements.

Being able to spend time with their patients is one of the things naturopaths feel is an important part of their practice. A typical first appointment with Francescott lasts about two hours and includes a 10-page intake form.

Much of the time is spent talking with Francescott, who said patients feel empowered once they have the ability and tools to know how to help their body and help them feel better. "I'm very thorough, but I listen for a long time," he said. "Basically, they feel heard. They are seeking someone who looks at the root of the problem."

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