The Comeback Cure: Colorado Seeing Naturopathic Medicine Revival in 2014

Naturopathic medicine is not new -- far from it. "We've been around since the 1800s," says the Boulder Naturopathic Clinic's Dr. Denise Clark, a powerful voice behind the local movement to regulate NDs in Colorado.

A century ago, Clark explains, thousands of folks practiced naturopathy. They did simple things with herbs, diet, nutrition, sunlight and hot-cold therapy and subsequently saw remarkable results -- in part because they sought to "unravel the source of the problem," as Clark puts it.  

 

When it comes to naturopathic medicine, Clark and her cohorts have ample one-on-one time with patients and are interested in gathering a whole health history. "Diet, lifestyle, stress and how you manage it -- I'm looking at the underlying cause of illness," says Clark, who never treats symptoms alone. 

 

The naturopathic approach combines traditional lab testing with other types of analysis such as allergy and toxicity testing. For those who have grown weary of the often-reactive treatment typically offered by Western medical doctors, Clark's mode may be exactly what the doctor ordered. 

 

Despite favorable outcomes, the once-vibrant practice of naturopathic medicine saw a sharp decline in the 1940s and '50s as medical doctors organized and the general American public became enamored with a more technical form of medicine. Naturopathic schools began closing, and the profession became all but obscure. 

 

By the 1970s, skeptics were questing conventional medicine, contemplating its limitations and doubting supposed miracle drugs. Thus began a small but passionate move back toward alternative practices, including naturopathy.  

 

Naturopathic schools reopened, starting with the National College of Natural Medicine in Portland, Oregon, which remains the oldest naturopathic school in the country. Today, there are four accredited four-year naturopathic medical programs in the United States, with a fifth school pending accreditation. Canada also has one accredited naturopathic program.

 

ND hopefuls, much like aspiring MDs, must hold a bachelor's degree and have several basic science requirements under their belts before being admitted into an accredited program. The first half of their graduate career is spent in the classroom, covering everything from pharmacology to nutrition, manual therapy and herbal medicine. 

 

After classroom requirements are met, students must pass an eight-hour board examination in order to proceed to the next stage: two years of clinic classes, where they'll learn from MDs how to order lab tests, analyze blood, urine, and stool, and diagnose diseases, among other things. 

 

And while graduated NDs are highly trained practitioners, up until now the scope of naturopathic practice has been dicey in Colorado. Prior to the passage of the Naturopathic Doctor Act, says Dr. Caitlin O'Connor of All Families Natural Health in Denver, "Anybody could call themselves an ND, regardless of whether they'd actually gone to an accredited school and passed postdoctoral board examination requirements." Regulations, explains Clark, are important because they ensure public safety while defining what, exactly, NDs are allowed to do. 

 

 

There are about 150 to 200 naturopathic doctors in Colorado, estimates Clark, who serves as President of the Colorado Association of Naturopathic Doctors, a nonprofit, professional association aiming to uplift the profession by ensuring members meet established standards for education and practice. Currently, the organization has about 60 members, though Clark is hopeful new legislation will drive up membership.

 

The new legislation she's referring to is House Bill 13-1111, signed into law by Gov. John Hickenlooper on June 5, 2013 with the purpose of regulating all naturopathic doctors practicing in Colorado. This Naturopathic Doctor Act went into effect last August. By April 1, 2014, naturopathic doctors will be able to register to practice naturopathic medicine in Colorado, and, by June 1, it'll be illegal for an unregistered person to practice naturopathic medicine in the state. 

 

This makes us the 17th state to regulate NDs, with about a dozen others likely to follow suit, Clark says. According to Clark, Arizona has one of the most robust scopes of naturopathic practice. There, NDs can diagnose and treat medical conditions, perform physical exams, and order laboratory testing for patients. As a result, many consumers chose NDs as their primary care providers -- which, by the way, isn't such bad news for medical doctors. 

 

According to Clark, the Naturopathic Doctor Act had strong support from the state legislature, the Governor, and, also, a large group of medical doctors, many of who testified in support of the bill during the legislative process. 

 

"Look back 30 years, and NDs and MDs wouldn't sit in same room together," says O'Connor. But today many MDs recognize that NDs play an important role in general healthcare. NDs also bring MDs work since a good chunk of naturopathy must be outsourced pursuant to state laws.  

 

NDs, for example, cannot currently prescribe prescription medicine in Colorado (they're limited to herbal remedies) and thus they must collaborate with MDs in order to treat patients with pharmaceuticals. They can't treat children under two years old either, which Clark says in incredibly limiting and hopefully won't always be the case.   

 

Thanks to the Naturopathic Doctor Act, though, it's now legal for NDs to treat and diagnose most patients, much like a family practitioner would. "We'll be able to order labs and imaging from conventional laboratories, and we'll be able to do physical exams, including pap smears, as well as some minor office procedures like suturing for lacerations," says Clark.

 

 

But, while Clark calls this "a pretty historic year," the work isn't over just yet. If choice in healthcare is a goal, then another important step, of course, will be getting insurance companies on board wholeheartedly -- and that's something Clark has been working toward. 

 

Some insurance companies already cover naturopathic care, though NDs are always considered out-of-network providers, Clark says. "Some insurance companies will reimburse for part of an office visit, and labs are usually covered." 

 

Section 2706 of the Affordable Care Act states that, "A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any healthcare provider who is acting within the scope of that provider's license or certification under applicable State law." 

 

Clark and her organization requested clarification from federal regulators on whether, once naturopathic doctors are regulated in Colorado, their services will be entitled to widespread insurance coverage under that section -- which, ultimately, is something the federal government says individual states must determine. It follows that recently Clark met with Colorado's Insurance Commissioner, who ultimately sent her full circle, telling her to talk to individual insurance companies. 

 

"We try not to be too heavy-handed with insurance companies," says Colorado Department of Regulatory Agencies communications manager Vincent Plymell, who confirms that, "So long as the service is a covered benefit and it falls within the scope of the naturopathic doctor's license, NDs can be reimbursed for it. 

 

"As with any doctor," Plymell continues, "it will matter whether they are contracted or within the network of a particular health insurance plan." The Division of Professions and Occupations, which is the state agency that will license NDs, is currently working on issues surrounding regulation. 

 

There's good reason for insurance companies to cover naturopathic care. "There have been really great studies in other states that show NDs actually save insurance companies money by preventing surgery," says O'Connor. 

 

According to Sen. Linda Newell (D-Littleton), who sponsored the bill in the Colorado Senate, "Naturopathic doctors are going to be a key component in healthcare, saving the state millions of dollars through their focus on disease prevention and natural treatment, such as nutrition, lifestyle counseling and botanical medicine." 

 

With growing public demand for greater choice and increased access to natural approaches to healthcare, naturopathic medicine might just be poised to reemerge as a clinical option -- and a fiscal cure.