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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.
To be clear, I have not heard anyone in the naturopathic leadership call upon their profession to do what the osteopaths did. But 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. 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. ![]() 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. at the retreat. Photo credit Sarah Spring, NCNM
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."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. ![]() Home of the FNP Project 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. ![]() 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 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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