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With stethoscopes and nature's remedies

Now licensed in California, naturopaths hope to win some respect.

January 17, 2005|Hilary E. MacGregor | Times Staff Writer

In California naturopathic doctors will have some prescription rights. They will be able to prescribe natural and synthetic hormones, epinephrine for severe allergic reactions (anaphylaxis) and barrier contraception.

Carl Hangee-Bauer, a San Francisco-based naturopathic doctor and licensed acupuncturist, describes naturopaths as much like family doctors, though without the medical degrees. Naturopathic doctors will treat a lot of conditions "on a basic level" but refer patients to medical doctors if an illness or treatment gets more complicated, he said.

Naturopathic doctors typically spend 60 to 90 minutes with patients on their first visit, taking a comprehensive history.

"The relationship with the patient is key," said Sally LaMont, a naturopath in San Rafael, Calif., who was active in the effort to get naturopathic doctors licensed in the state. "We sit with someone for an hour and a half, take a thorough history. We talk about their marriage, what the relationship is like, about their spiritual focus."

Such conversations, she said, tend to promote a kind of partnership between patient and doctor "that builds confidence and a willingness to make the kind of changes that promote health and prevent disease."

Adds Pizzorno: "The reason it takes longer is we don't want to just diagnose the disease. We look at why are they sick and what is necessary to make them healthy. It takes a lot of work, a lot more commitment from the patient. You can't expect a magic pill. We expect them to eat better, get more exercise and get more sleep."

It's too early to know whether the licensing of naturopaths will prompt more Californians to seek their services. Washington, which has licensed naturopaths since 1987, has more than 600 practitioners who are used as both complementary and primary care doctors. By that state's law, insurance is required to cover visits to naturopathic physicians.

As the profession has grown, it has begun to work more closely with mainstream medicine; in Washington there are now hundreds of integrative clinics -- where a naturopathic physician, an M.D., and practitioners from other healing arts work together in a single practice, sharing care for patients.

"The great thing about this licensing is it brings the naturopathic practice into the medical community and into the public domain in a way that it hasn't been before," said Dr. Mary Hardy, medical director of the Integrative Medicine Program at Cedars-Sinai Medical Center in Los Angeles.

Doctors like Soram Khalsa, an internist at Cedars-Sinai who uses herbs, vitamins and acupuncture along with conventional medicine, say many patients are hungry for more natural treatments. His own practice, he says, for years has had a long waiting list of patients who want integrated care.

"People are realizing that Western medicine has many answers, but not all the answers," Khalsa said. "Especially in the last three months, with the increasing number of stories in the news about Vioxx, Celebrex and statin drugs, and concerns about their safety. I have patients who come in and say, 'Do you have anything I can use to replace these?' Of course we do."

Khalsa says naturopaths can provide reliable information to patients about herbs and supplements -- an alternative to relying on a sales clerk at the local health food store. "Now we will have physicians trained in this, who know what they are talking about," Khalsa said.

Dr. Ken Pelletier, professor of medicine at the University of Arizona School of Medicine and the University of Maryland School of Medicine, says patients can benefit from more cooperation between naturopaths and medical doctors, as well as more research into the benefits of natural medicine. It's not enough for naturopaths to simply refer patients to medical doctors when "they hit a medical problem outside their scope of practice," said Pelletier, former head of the alternative medicine program at Stanford University. Rather, the two professions need to work together, "in the same offices, around the same patients, sharing patients, sharing charts."

Some conventional doctors still consider the naturopathic profession and many of its therapies to be scientifically unsound. The California Medical Assn. opposed licensing the profession. "We are not taking a reactionary position," said Dr. Jack Lewin, a family physician and chief executive of the CMA, adding that there are some good things that naturopaths do that patients appear to appreciate. "But we are concerned that the consistency and quality of training for naturopaths varies considerably."

Physicians get four years minimum of medical school, then do three or four years of residency. (Naturopaths do not generally do a residency.) "We don't think that is too much training or that you can shorten that and still be a capable physician," Lewin said. "We are concerned that naturopaths' training is not as extensive."

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