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Foundations of Naturopathic Medicine Project to Cast Light on the Nature of Integrative Medicine PDF Print E-mail
Written by John Weeks   

Foundations of Naturopathic Medicine Project to Cast Light on the Basis of Integrative Medicine and Integrated Health Care

Summary:  The past 20 years of the dynamic renewal of naturopathic medicine as a discipline have created a new set of pressures and opportunities for the profession. A multi-faceted Foundations of Naturopathic Medicine (FNM) Project has recently emerged, under the leadership of Pamela Snider, ND, and with participation of all of the profession's leading agencies. The focal product of the FNM Project will be the first textbook of naturopathic medicine in more than a half century, to be published by Elsevier Publications. But the two dozen editors and over 100 authors see that what is at stake here is more fundamental than a typical textbook. Through a series of retreats and written products, the FNM Project has a goal of "codifying (naturopathic) knowledge." The project may cast interesting light on the parallel emergence of integrative medicine.
Send your comments to johnweeks@theintegratorb log.com
for publication in a future Your Comments forum.

1.    A Context: Naturopathy, Osteopathy, Pacts for Power and the Need for Self-Examination

From 1983-1993, while working closely with the leadership of the modern naturopathic medical profession, I frequently heard that profession's leaders speak of the example, to be avoided, of what the osteopaths did.

   
 
I frequently heard the
naturopathic profession's
leaders speak of the
example, to be avoided, of
what the osteopaths did.



In this telling, the osteopathic profession, born within a decade of the birth of naturopathy roughly 100 years ago, made a classic "pact with the devil" in the 1960s. That is, the osteopaths ended their battle with the conventional medical (MD) profession by agreeing to have their graduates take conventional medical boards before entering practice.

By doing so, osteopaths gained access to power and respect inside the emerging US healthcare system. But in the meantime, the osteopathic profession let go of a good deal of its soul and practice philosophy as a natural healthcare discipline. A 1995 editorial in the New England Journal of Medicine noted that only 6.2% of osteopaths were then using manipulation.

This danger - what the osteopaths did - looms for the naturopathic profession in 2007 for many reasons.
The profession has more than doubled in size in the last half decade. In the 14 states in which naturopathic doctors are licensed, they are direct-access, general practitioners with significant and expanding pharmaceutical prescribing rights. Most in the profession promote the recognition of NDs as primary care providers (PCPs). Many payors and government agencies recognize them as such. And, of course, the PCP model in the dominant school of medicine makes primary care practice and prescription of pharmaceutical drugs nearly synonymous. Inclusion in the system promotes a conventionally-oriented practice.

   
 
There are many pressures

on the naturopathic doctors
to make minor and major
adjustments to both clinical
practice and philosophy
which might gain both
protection and inclusion.


 
Now toss into this already potent mix the economic pressure on a typical graduate of ND school. Many have student loan debts of over $100,000. Yet new NDs enter a work force in which most insurers do not cover naturopathic services. Few public or private salaried jobs in hospitals or community clinics are available to them. At the same time, the evolution of "integrative medicine" in the conventional medical profession presents what some NDs view as a troubling competition. The MDs haven't the depth of training in natural medicine but may be viewed as a more accepted look-alike to the consumer. Adding a potent unpleasantness to the mix, the American Medical Association has directly aligned their Scope of Practice Partnership against licensing NDs as practitioners of medicine.

To be clear, I have not heard anyone in the naturopathic leadership call upon their profession to do what the osteopaths did. But t
here are many pressures on the naturopathic doctors to make minor and major adjustments to both clinical practice and philosophy which might gain both protection and inclusion.

Into this dynamic context was recently born a unique, multi-year, multi-faceted initiative entitled the Foundations of Naturopathic Medicine Project.


2.   Origins: From Elsevier Book to Expansive Profession-Wide Project


A half-decade ago, Marc Micozzi, MD, PhD, began laying groundwork for an additional volume in a series of books on complementary, integrative and alternative medicine topics. He was overseeing the multi-volume project for Elsevier Publications. Micozzi contacted Pamela Snider, ND, to write a 300 page book on naturopathic medicine.

Image Snider had been a long-time national leader for her profession and in the broader integrative health care arena. Her resume included co-chairing a 1987-1989 profession-wide process which led to the drafting of a widely-cited, principles-based, definition of naturopathic medicine. From 1994-2003, Snider served in policy leadership as associate dean of naturopathic medicine for Bastyr University. She was intimately involved in the drafting of the enabling legislation for the National Center for Complementary and Alternative Medicine and was appointed to a Medicare Coverage Advisory Committee panel on preventive services. As an organizer, Snider later co-founded the National Education Dialogue to Advance Integrated Healthcare and served as the founding executive director of the Academic Consortium for Complementary and Alternative Health Care.

Elsevier may not have foreseen all that his invitation to Snider would eventually entail. Snider believed that the book needed to be an edited volume, allowing diverse voices. She also saw the Elsevier book as an opportunity for the profession to create the
first textbook of naturopathic medicine in at least a half century. To create the book would require a profession-wide exploration of philosophy, principles and their applications in clinical practices.

Snider organized a group of senior editors:
Jared Zeff, ND, her co-chair in the definitions work 20 years ago; Joe Pizzorno, ND, founding president of Bastyr; James Sensenig, ND, the founder of the American Association of Naturopathic Physicians; and three international leaders Stephen Myers, PhD, BMed, ND (Australia), Roger Newman Turner, ND, DO (United Kingdom) and Don Warren, ND, DHANP (Canada).

Pamela Snider, ND, executive editor, Foundations of Naturopathic Medicine Project, National College of Natural Medicine
Pamela Snider, ND. at the retreat. Photo credit Sarah Spring, NCNM
The group began to understand that what was needed was a deep, formal, profession-wide engagement. An editorial structure was created which included a group of associate editors and section leads for various content topics. These began overseeing inputs from over 100 authors. The profession's leading organizations - for accreditation, testing, professional advancement, student activity and education - all established formal liaisons to the project.
William Keppler, PhD, past president of Portland, Oregon-based National College of Natural Medicine (NCNM) and his successor, David Schleich, PhD, extended an offer for the FNM Project to be housed at NCNM. To knit the FNM work together and sustaining it over time, Snider, Schleich and her associates created an infrastructure of multi-year corporate sponsorships. Micozzi remains involved as a medical reviewer.

   
 
 Core Product:

"A textbook on the philosophy,
theory, and principles of
naturopathic medicine (which is)
intended to provide an updated
and comprehensive account
of the profession, its principles,
and its applications."


The Elsevier book proposal to Snider slowly morphed into a multi-year project. The core product was recently described in a publication of the American Botanical Council (ABC) as a "key initiative that can support the growth of the naturopathic medical field." ABC spoke of "a textbook on the philosophy, theory, and principles of naturopathic medicine (which is) intended to provide an updated and comprehensive account of the profession, its principles, and its applications."

But the FNM Project's dimensions are larger.
The editors and writers began working in teams in specific areas with knowledge that a series of retreats would shape not only the textbook, scheduled for late 2009 publication. The gatherings would also shape ongoing work and additional publications. The goal, emblazoned on the FNM Project written materials, is simple:

"Codifying our knowledge. It's time."

3.   A Meeting: The First FNM International Editors Retreat

On April 1-5, 2007, FNM Project held its first annual editor's retreat at Skamania Lodge on the Columbia River in Southwestern Washington. The breadth of professional inclusion was evident in the participation. In attendance were 35-45 professionals representing naturopathic organizations and all 7 North American naturopathic medical colleges, plus some invited guests and presenters.

National College of Natural Medicine, home of the Foundations of Naturopathic Medicine Project, David Schleich, PhD
Home of the FNP Project
I had the opportunity to experience two days of the retreat. The precise contents of the meeting are presently embargoed from publication. Yet the general themes engaged suggest both the depth and the connectivity which the editors are attempting to achieve. Work focused on editors sharing drafts of their sections. But to kick-off the discussion, the group spent the better part of a day exploring modern understanding of the Vis medicatrix naturae (the healing power of nature), the core principle around which the profession is organized.

Outside experts were used to stimulate discussion. Among these were: Wayne Jonas, MD, the director of the Samueli Institute whose current work focuses on practical integration of healing healthcare practices; Iris Bell, MD, an international leader in whole systems thinking and complexity theory as applied to medical practice; Christa Louise, PhD, whose professional work has included applying complexity theory to naturopathic practice; Chris Grontkowski, PhD, an academic with expertise in the philosophy of science; and Mary Koithan, RN, PhD, an expert on formation of theory in health professions and nursing practice.

After the retreat, Warren, who also serves as agency liaisons to the FNM project for the Council on Naturopathic Medical Education, reported to his organization: "I have no doubt that the beneficial outcomes of this retreat will ripple across the profession in the months to come and will influence in a most positive way the next generation of naturopathic doctors." Among the potential projects under discussion is an international clinical integration symposium in 2010. Leaders of the naturopathic profession are also exploring whether to embrace the FNM project in a way which would allow the gathered philosophical, educational, clinical, intellectual and professional energy as an ongoing part of the profession's organizational infrastructure.

Vis medicatrix naturae explored at the Foundations of Naturopathic Medicine Project retreat with panelists Wayne Jonas, MD, Samueli Institute director, Iris Bell, MD, Univresity of Arizona Program in Integrative Medicine, James Sensenig, ND, founder of the AANP American Association of Naturopathic Physicians, Jared Zeff, ND, nature cure expert, and Stephen Myers, Australian naturopath and medical doctor research and Leanna Standish, PhD, ND, LAc, Bastyr University
FNM Project panel on the Vis Medicatrix Naturae: (l to r) Myers, Leanna Standish, PhD, ND, LAc, Bell, Jonas, Sensenig and Zeff. Photo credit, Sarah Spring, NCNM



Disclosure: Snider, an Integrator advisor, has been a close collaborator on many projects. The Integrator is pleased to serve as an in-kind contributor to the FNM Project.

Comment: In the course of exploring this article, Snider shared a quote from Edmund Pellegrino, MD which she says captures the organizing energy behind the FNM Project.
“What physicians think medicine is profoundly shapes what they do, how they behave in doing it, and the reasons they use to justify that behavior….whether conscious of it or not, every physician has an answer to what he [she] thinks medicine is, with real consequences for all whom he [she] he attends….the outcome is hardly trivial…It dictates, after all, how we approach patients, [and] how we make clinical judgments.” (1)
Credit Snider, NCNM and the team she has organized for understanding that deliberate consciousness of philosophy is a necessary countervailing force to the frequently unconscious influences of the marketplace. Healthcare disciplines of all kinds blithely intone their sacred relationship with patients and healing. Meantime, they allow their fundamental shape to be determined by coding, coverage and self-aggrandizement. A continuous engagement with philosophy and principles may help in antidoting the worst of the abuses of the marketplace that quietly creep in. And this includes the abdication of philosophical alignment which describes what the osteopaths did.

   

The broader integrative
medicine discussion has
always been characterized
by deep questions about
philosophical alignment.

Might the products
of the FNM Project help
guide others who claim
to be engaged in
substantially changing
health care as we know it?


 
The more interesting potential for the FNM Project is whether it can influence not just the practices in 7 schools and a small profession with 4500 practitioners. In fact, the broader integrative medicine discussion has always been characteized by deep questions about philosophical alignment. In 1995, clinician-educator Robert Duggan, a co-founder of Tai Sophia Institute, kicked off discussion of the long-term impact on "integration" in a seminal piece in Alternative Therapies in Health and Medicine (2). Duggan asked if such integration would merely be grafting a few therapies onto a broken system? Or have we engaged a larger challenge of transforming the focus and intent of that system?

The FNM Project is clearly focusing on the accountability and soul in the single profession of naturopathic medicine.
Yet might the products of this process help guide others who claim similarly to be engaged in substantially changing health care as we know it? Both the Bravewell Collaborative of philanthropists and the Consortium of Academic Health Centers for Integrative Medicine claim that their goals are to transform medicine.

Will this FNM Project, engaged by the physician-level practitioners with the broadest, federally-recognized education in natural medicine, help carve a sustainable path which honors principle and philosophy? Might it model directions for natural health care and for integrative medicine which affirm principles and defend against the loss of soul which typically accompanies uptake into the dominant, broken system? Or will our children one day look back and say: Oh, they did kind do of like what the osteopaths did.

1. Pellegrino E.  Medicine, Science, Art: An Old Controversy Revisited.  Man and Medicine.  1979; 4.1: 43-52.
2. Duggan R. Complementary Medicine: Transforming Influence or Footnote to History? Alternative Therapies, May 1995,


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