M.D. or N.D.?
Licensing Naturopathic Doctors could give New Yorkers a new health
care choice
Four years ago, doctors told Diane Paradise that her cancer had
returned. This time, though, she couldn't bear the thought of
fighting the disease a second time. She refused treatment. "I
told my friends and family that I was going to love life and enjoy
it to the fullest, and whatever happened happened," she said.
What happened was that she discovered an alternative form of therapy
that she believes saved her life. Today, says the 35-year-old
two-time cancer survivor, her quality of life is "pretty
darn good."
When Paradise was diagnosed with lymphocyte-predominant Hodgkin's
Disease at 25, she went through chemotherapy and radiation. The
treatment sent her cancer into remission. But the regimen was
so painful she vowed never to go through it again.
"The pain was so intense that I couldn't possibly sleep,"
said the Rochester native. "I felt like my nerve endings
were at my skin at every inch of my body. No one could reach over
and touch me; it hurt. It hurt to wear clothes, it hurt to lie
in bed."
But as bad as the ordeal was, the treatment worked. She went into
remission for five years, and the doctors told her she was essentially
cured. Then year six came, and her cancer returned. This time,
determined not to go through the agony of radiation and chemo
again, she refused conventional treatment.
She went away on vacation in September 2001, and, as it changed
the course of so many lives, 9/11 changed Diane Paradise's life
as well.
"September 11 changed everything, because I realized that
a whole lot of people died that day who had absolutely no choice,
and I had a choice and I was choosing to die, and there had to
be a better way," she said.
Her better way came in the form of naturopathic medicine. She
flew to an alternative cancer treatment center in Arizona and
four years later tells about the "total mind-body-spirit
approach" that saved her life.
She received 50,000 to 100,000 milligrams of Vitamin C intravenously
and also was given 60 to 80 different vitamins and supplements
designed to boost her immune system. She sold everything she owned
and left her family and friends to fly across the country to do
it. She's still thousands of dollars in debt, but, as she puts
it, "I'm alive."
Another treatment option
This isn't about testimonials, magic potions and promises of money-back
guarantees on infomercials. For Paradise, her treatment is all
about having an option for when conventional medicine either fails
or you simply choose not to use it. Fourteen states and Washington,
D.C., recognize naturopathic medicine as a legitimate treatment.
New York could be the 15th state to do so.
A bill is in the Higher Education Committee of the State Senate
and Assembly that, if passed, would license accredited naturopathic
doctors and establish a state board for naturopathic medicine.
Sponsored by Sen. Dale Volker and Assemblyman Sam Hoyt, the bill
is supported by the New York Association of Naturopathic Physicians
(NYANP). Naturopathic doctors are already licensed in Alaska,
Arizona, California, Connecticut, Hawaii, Kansas, Maine, Montana,
New Hampshire, Oregon, Utah, Vermont, Washington, Washington,
D.C., and, as of this month, Idaho. They are licensed in Ontario
as well.
What on Earth is a naturopathic doctor? "I am a general practice
physician," said Dr. Maria Herod, the only naturopathic doctor
in Buffalo who holds a doctorate from a federally accredited naturopathic
medical school.
"Everything you go to your doctor for, you can go to a naturopath
for. If we had a license (in New York State), we could be your
general practice physicians specializing in natural medicine."
Which leads to the next question: What's natural medicine? Basically,
naturopathic doctors use a variety of natural and noninvasive
therapies, including clinical nutrition, herbal medicine, homeopathy,
physical medicine, counseling and hydrotherapy. If you're picturing
a hike in the woods to visit a holistic "doctor" in
Birkenstocks who recites Thoreau while tilling his organic garden,
you're not alone.
"My degree -- because it says "nature' -- doesn't sound
like a professional doctor," said Herod. "I have to
pass board exams just like a regular M.D. I have to do clinical
rotations, attend a post-graduate four-year naturopathic medical
college. I'm a licensable physician."
But without a license in New York State, accredited naturopaths
cannot run lab tests, give a patient an actual title for a disease,
prescribe medication or perform minor surgery. However, if a patient
has a diagnosis, a naturopath can work with that diagnosis, using
lifestyle, nutrition and herbal treatment methods.
"If I believe or suspect a diagnosis, I can refer a patient
back to their primary (physician) with a list of points and explain
why I think they have something and the tests that need to be
run," said Dr. Raffaella Marcantonio, a naturopath in Tonawanda.
"Sometimes the doctor will go for it and sometimes he won't.
It depends on the patient and it depends on his interaction with
the doctor."
Marcantonio also will refer patients to specialists if the doctor
isn't cooperative. "It's teaching the patient to be an advocate
for themselves," she said.
Currently, anyone in New York State can call himself a naturopathic
doctor. You can buy a degree online or you can attend a six-month
correspondence school. The public has no way of knowing who holds
a doctorate from one of the five federally accredited naturopathic
medical colleges and who doesn't. Naturopathic physicians argue
that their training is very similar to that of an M.D. and that
they are fully qualified to diagnose and treat disease like a
general practice physician.
"We have to have a bachelor's degree going in (to an accredited
naturopathic medical college) with a pre-med track. Same requirements
as a medical school," said Marcantonio. In Oregon, Marcantonio
is a primary care physician, and she must fulfill all the requirements
to maintain her licensure on a yearly basis.
"New York State doesn't license me, so I'm here" working
to get the state to grant licenses to naturopaths, Marcantonio
said. "I hold my license in Oregon as a way to set and maintain
a standard. Every year, I'm required to have (25 hours of) continuing
education from that state, of which six of those hours are in
pharmacology. These are the same standards that a medical professional
has."
A difference of philosophy
The differences between an M.D. and an N.D. lie in their scope
and philosophy of training. Instead of focusing on the treatment
of a specific set of symptoms, naturopathic doctors treat the
whole person and seek to identify and remove the underlying causes
of illness.
"Going to a naturopath is a whole new experience for people,"
said Marcantonio. "You come in for headaches, but I'm not
just asking you about your headaches. I'm asking you about every
part of your body. You want to find out, where is it all coming
from? What other factors can be contributing to my headaches,
instead of just prescribing aspirin or some other migraine medication."
One man with a terrible ear infection who had a horrible ringing
in his ear went to Herod because he's severely allergic to antibiotics.
"Doctors usually don't have alternatives," she said.
"We habitually overuse antibiotics, and we're becoming resistant
to them."
If you're not going to get a pill, count on making a commitment
to a complete lifestyle change when you visit a naturopathic doctor.
"The basic naturopathic approach is to clean up your diet,
live a cleaner lifestyle, watch the medications and look for food
triggers -- that's the gamut that everybody goes through with
naturopathic because it works," said Herod, who stressed
that naturopaths receive extensive nutrition training. "A
lot of people are getting wiser to the fact that our food supply
is a disaster, between the corn syrup, artificial sweeteners,
the antibodies and the hormones in meats."
The medical community may say that they know how important a lifestyle
change is in the treatment of chronic disease, but the problem
is that they don't teach it to their patients, argued Marcantonio,
the Tonawanda naturopath.
"My mother is a cancer survivor," she said. "I
know what they told her. They said, "Eat anything you want.
It's important that you keep your weight up. Go ahead, drink milkshakes
and eat chicken wings.' Now would I tell a patient who's a cancer
patient that? Absolutely not."
Assemblyman Hoyt believes that naturopathic doctors must be licensed
in New York State to protect an increasing number of people who
are turning to alternative therapies.
"This legislation would guarantee (naturopathic doctors)
are properly trained in accredited institutions, that they have
clinical experience and they have an understanding of drug interactions
between traditional medicine and natural medicine," he said.
"I'm confident that by next year, we're going to see this
bill get passed by both houses and get it signed into law."
A 2004 nationwide government survey conducted by the National
Center for Complementary and Alternative Medicine and the National
Center for Health Statistics found that 36 percent of U.S. adults
use some form of complementary and alternative medicine. Moreover,
in a 2000 survey of all 453 patients at the University of Texas
M.D. Anderson Cancer Center, 69 percent had used at least one
complementary and alternative therapy, and 65 percent did not
inform their oncologists.
Without access to trained specialists in natural medicine, people
are going online, listening to the advice of well-meaning friends
and relatives and self-medicating. Obviously, it's wonderful that
patients are taking an active role in their health care, but not
if they're acting without the direction of a trained physician.
"Physicians don't have the time to ask the follow-up questions
they should be asking and give the advice and guidance they should
be giving," said Sanford Levy, M.D., of Buffalo Medical Group.
"Our health care system is based on shorter visits being
better financially. Physicians constantly feel like they're racing
against the clock."
Levy added that even though many doctors are aware that patients
are using alternative therapies, they don't ask for reasons other
than a lack of time. "The attitude is, "Why ask? I'm
not going to know what to do with the information if I get it,'
" he said. For Levy, patients are best served if conventional
and unconventional practitioners are working together.
"It doesn't take a rocket scientist to know the side effects
of Saint Johns Wart and the interactions with prescription drugs,"
said Richard M. Peer, M.D., a member of Buffalo Medical Group
and president-elect of the Medical Society of the State of New
York. "I don't have a problem with an internist or a family
practitioner who has an interest in alternative medicine attracting
a clientele of patients who would prefer to not be treated with
drugs but rather take a more naturopathic approach. But why does
New York State need to legitimize another medical profession?"
It's clear, however, that Peer doesn't regard naturopaths as "real"
doctors. He likened them to the folks in the old West who "went
around selling these potion things that cure all that ails you
from your cough to your constipation and your diarrhea all in
the same bottle. That's naturopathic medicine."
Ideal is to work together
"There are benefits to all types of medicine," said
Donielle Wilson, N.D. and president of the NYANP. "We're
not trying to be medical doctors, and we're not trying to put
(them) out of business. We're trying to provide the best care
for patients, and we feel the best care comes from integrative
care where medical doctors and naturopathic doctors are working
together."
"The medical society isn't excited about this legislation
because they tend to want to protect their own turf," Hoyt
said. "I think the younger docs might have a greater appreciation
of the value of naturopathic medicine and will be more open-minded
about the integrative work between medical doctors and naturopathic
doctors."
"Part of our oath as doctor is teacher," said Herod.
"We teach patients preventative medicine and how to take
responsibility for their health care."
The World Health Organization estimates that 65 to 80 percent
of the world's people rely on what we call "alternative"
medicine as their primary form of health care. Perhaps it's time
New York State considers the possibility.
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