Every time I am asked about naturopathic (ND or NMD) doctors and whether my patients should seek one out, I say “it depends”. I have collaborated with naturopaths and like anything else in life, some are better than others and some are better trained than others. So, how is the public supposed to choose?
Is the fact that someone had an N in front of the MD (NMD) mean they are “better” in some way, above and beyond a “regular” or allopathic MD? Is it at all related? Is the training even similar enough to compare the two? What is the real objective story about the role of the ND or NMD naturopath in cancer care? Well, here is my view on this issue, trying to steer clear of the “politics” between naturopathy, especially naturopathic oncology, and the mainstream allopathic perspective. I will also consider MD and DO programs as pretty equivalent.
While Traditional Chinese Medicine, Ayurvedic Medicine, as examples, are ancient, the concept of “Naturopathic Physician” is a relatively modern construct, at least as far as formal training and certification goes. Modern mainstream “Western” medicine is also relatively young as far as training and certification goes, but it is at least a couple of centuries old compared to naturopathy. The concept was originated around 1900, but the real thrust in training and certification in this area really began in the 1970’s. To be fair, naturopathy uses many concepts from Chinese, Ayurvedic and other ancient disciplines. But we are talking about training here and how to determine who is qualified to help you as you try to regain and maintain health.
I won’t repeat or rewrite an already decent historical account of Naturopathy that you can read on Wikipedia. It may not be the most authoritative piece, but it gives you a very good overview. In my view, the problem is that the field is quite diverse in opinion amongst its practitioners. Some are focused on “Alternative Medicine” as a treatment for many conditions, even to the point of vilifying all of allopathic mainstream Western medicine, while others are quite a bit more moderate in opinion and are simply seeking to provide the best vitalism based natural support and preventative care possible. So, here is a good example of “it depends”. In my view, there is good and benefit that can be derived from all types of medical practice. The more you are looking at TREATING life-threatening disease, the more a polarizing and inadequate scientific base for treatment becomes inappropriate.
Let’s look at the current training. If you go to a website of an accredited and respected school like Bastyr University, you will find a curriculum listing which looks similar to that provided by a traditional Western medical school. In fact the Association of Accredited Naturopathic Medical Colleges (AANMC) offers a comparison year by year between MD and ND programs. The requirements to get in to a naturopathic school are becoming more and more rigorous, so bright minds are entering the field. I have attended chiropractic school in the past, but have not taken classes in a naturopathic school. So, if one assumes that the rigor of the classes is the same, an ND graduate is similar to an MD graduate in terms of basic science training, allowing for the differences in philosophy between the two types of schools. Keep in mind however that graduation from an MD or an ND school with this type of generally comparable curriculum means that you have earned your training wheels. That’s it. You are nowhere near qualified to take care of sick people. You MAY be qualified to help prevent disease, but not treating it. This is especially true of life threatening disease like cancer.
So, what’s next? After an MD program all it takes to be licensed is a year of internship in most states. This is BARELY adequate to prescribe or treat ANYTHING. Most MD and DO graduates go on to take at least a three year residency, and those who go on to practice oncology usually take a three to five year residency, depending upon the ultimate goal of medical or surgical or radiation oncology. Then there is a three to four year fellowship training program, and some go beyond this. So, for bona-fide MD or DO oncologists AFTER four years of medical school we are talking about six to nine years of training which involves taking care of real patients. There are some opportunities for naturopathic school graduates to get an additional one or two years of “residency” at a limited number of institutions. However, you should be seeing quite a difference in the experience achieved by the end of MD vs. ND training. Learning beyond the framework of a residency or fellowship (i.e. self study or 18th century-like apprentice work) is very hard to quantify, with some doctors remaining perennial students of their field and others slacking off to the extent possible in this day of constant re-certification requirements. So, simply adding up the hours devoted to care of patients is woefully inadequate because it is not standardizable and verifiable in many cases. Yet, this approach is used in the board certification process of ND oncologists.
So what is the bottom line? There is no question that MD and DO physicians who choose to pursue oncology as a field are much more robustly trained. This does not mean that ND oncologists have no role. They most certainly do, after verification of their training credentials. If there is a FABNO certification involved, you can be pretty much assured that they are the most highly trained naturopathic oncologists available. Is this enough to manage all of the oncologic needs of a patient? In my opinion, taking into account the differences in total training, the answer is NO. However, as part of a well functioning team, along with a allopathic oncologist, the knowledge base of a certified naturopath in an integrative oncology program can be invaluable. One word of warning though. Not all naturopaths graduate from an accredited or good school and are not eligible for certification.
The following video from the Cancer Treatment Centers of America, presented by a Naturopathic Physician who is FABNO certified gives a good overview of what a team approach to Integrative Oncology might look like.
What about MD and DO doctors? Are they all qualified to be an “Integrative Oncologist” just because they have an MD or DO degree? The answer is a resounding NO. An MD or DO is only qualified to be an Integrative Oncologist if they have completed oncology fellowship training and are board eligible. But this is not enough. They must also have some training and certification in Integrative Medicine. The American Board of Integrative and Holistic Medicine spells out what is required today and into the future.
Let’s cover practitioners of acupuncture and herbalism. So far we have covered programs who graduate doctors that have some similar training, at least a significant part of the way. The EXTENT of training is radically different and that should be clear by now. There are also practitioners who are called “doctor of oriental medicine”, and the degrees granted have varied a lot over the years and differ by state. They also differ by how long ago they were conferred, since regulatory bodies to control what is actually taught in such schools varied, and still varies, tremendously. So, one may see OMD, DOM, L.Ac, DAOM, Dip.Ac, Dip.OM, and so on. As far as acupuncture is concerned, this line of training is probably as in-depth as it gets. As far as covering the totality of ancient Chinese herbal background, although curricula vary by school, this may or may not be the most in-depth training. But the bottom line is, how well trained, beyond acupuncture, are such practitioners in treating or advising cancer patients? Even with a lot of self-study it is unimaginable, based on the described training, that such practitioners could safely treat or advise cancer patients independently. They can certainly become valued members of an oncology team, but to use “doctor” in such cases to imply ability to independently treat or advise patients is, in my opinion, a very dangerous misnomer.
What about other practitioners and doctors like PhD doctors, chiropractors or nutritionists or nurses? Are they qualified to say they are an Integrative Oncologist? The training background here is EXTREMELY variable but suffice it to say that none have the same oncology training background as a board certified or eligible oncologist. The expertise they bring to helping you in beating cancer and optimizing health and quality of life may be VERY valuable, but only if there is an ongoing dialog with an oncologist. This is hard to achieve anywhere other than at centers which have an integrative program, but possible. Just ensure there is two way communication going on before assuming that all of the mainstream and natural support you are receiving is safe, effective and compatible.
One final note. No reasonable well trained science based physician would ever recommend that you ignore standard oncologic medical care in favor of an “alternative” approach. This is especially true at the beginning of care. In the case of recurrence, resistance to therapy and the like, some patients elect to stop standard therapy because it does not appear to be helping them and the treatment side effects are becoming worse than the disease itself. In these situations certainly choices may include whatever it takes to help improve quality of life, and if unproven anti-cancer “alternative” therapy is added it should at least be determined to be safe based on available science. Again, work with an MD/DO oncologist at all times to get input about the plausibility, efficacy and safety of therapies.