Letter: Naturopathic Med Has Standarized Licensure Exams


Professional Agendas and Mechanisms for Standardized Licensure Exams Do Exist in Teaching Naturopathic Medicine

Posted 03/24/2004

Thomas C. Shepherd, DHA

Medscape published a paper[1] that claimed to be a critical appraisal of the profession of naturopathic medicine. We believe, however, it's a biased and wholly inaccurate picture of the principles and practice of naturopathy.

The article uses a 1968 HEW report to argue that naturopathic physicians (NDs) do not practice science-based medicine. But, in 1968, there were no accredited schools teaching naturopathic medicine. There was no agreement on a professional agenda, and no mechanism for standardized licensure examination.

Today, through the work of many committed physicians, all of these things do exist. To cite a 1968 paper as evidence against the current practice of naturopathy would be akin to using Civil War-era literature to evaluate modern surgery techniques.

An examination of the curriculum at Bastyr and other accredited ND schools will show that the profession uses science-based Western methods of diagnosis as a basis for application of complementary and alternative methods (CAM) of treatment.

The ND of today is trained in the evidence-based use of therapeutic nutrition, botanical medicine, physical modalities, and lifestyle counseling as adjuncts to conventional medical treatments for disease prevention and management.

Published data exist to support the use of these therapeutic modalities in many common disease states, including atherosclerosis,[2] hypertension,[3] diabetes,[4] and migraine.[5]

The paper goes on to claim that NDs are so convinced of their success that they do not need to validate their claims. Again, this is demonstrably untrue.

In fact, the interest in research and establishing the efficacy of our medicine is a top priority. Bastyr University, for instance, has received millions over the past few years from NIH for CAM research and is leading an NIH-funded effort to establish research priorities for ND and conventional schools.

A recent clinical trial involving the Bastyr Research Department was recently published in JAMA.[6]

The distinction between licensed naturopaths and correspondence school-trained practitioners is much greater than Dr. Atwood would suggest, and an important argument in favor of NPLEX-based licensure.

As can be seen on the examination Web site, the standardized NPLEX licensure examination requires each licensee to demonstrate proficiency in basic sciences (such as pathology and biochemistry) as well as clinical medicine.[7]

As Dr. Atwood points out, the Achilles heel of the naturopathic profession is the widespread lack of formal residency training. To date, less than 20% of Bastyr University graduates have access to this level of training.

The appointing of naturopathic physicians to the Medicare Coverage Advisory Committee will, we hope, be a first step toward rectifying this situation.

The millions of Americans who embrace a wide array of nonconventional treatments and the thousands of MDs who have discovered effective therapies outside their training are not stupid or ill informed.

They have simply learned that science-based CAM training and modalities have much to offer those who want to stay healthy and those who want to improve their health.

Thomas C. Shepherd, DHA, President, Bastyr University, Kenmore, Washington


1. Atwood KC. Naturopathy: a critical appraisal. Medscape General Medicine. Available at: http://www.medscape.com/viewarticle/465994. Accessed March 5, 2004.

2. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336:129-133. Abstract

3. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344:3-10. Abstract

4. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. Abstract

5. Buck AC, Cox R, Rees RW, et al. Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, cernilton. A double-blind, placebo-controlled study. Br J Urol. 1990;66:398-404. Abstract

6. Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA. 2003;290:2824-2830. Abstract

7. Contents of the NPLEX examination are available at: http://www.nabne.org/html/pdf/CLAPPL.pdf. Accessed March 5, 2004.

Medscape General Medicine 6(1), 2004

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