Understanding the Regulation of Naturopathic Doctors in the United States

Being relatively new to blogging, I’ve noticed a trend of criticism against naturopathic doctors as being “self-regulated” most recently in regards to the tragic and preventable death of Ezekial Stephan in Alberta. Self-regulation implies that naturopathic doctors are regulated by only their peers and in a way, act as their own judge, jury and executioner. This topic of regulation is important to me as I believe the reliable and honest regulation of all professions, including the practice of naturopathic medicine, is crucial to ensure consistent and high standards of health care. It is the purview of a regulatory board to understand (and promulgate) standards for professional competency, investigate complaints and impose disciplinary actions when necessary. So how (and who) regulates naturopathic doctors in the United States?

In California, the regulating board for NDs, the Naturopathic Medicine Committee (NMC), includes naturopathic doctors, public members and medical doctors. The Committee is also housed under the Osteopathic Medical Board of California (OMBC). Here are the current members of the NMC (although the website has not been updated with the latest appointments):

  • David Fields, ND
  • Tara Levy, ND
  • Greta D’Amico, ND
  • Dara Thompson, ND
  • Michael Hirt, MD (medical degree from Harvard University)
  • Myles Spar, MD, MPH (medical degree from the University of Michigan)
  • Gregory Weisswasser, ND (former member of the OMBC)
  • Thyonne Gordon, Ph.D (public member)
  • Alexander Kim (public member, formerly served on the California Optometry Board)

In addition, the executive officer of the NMC, Rebecca Mitchell is not an ND and has previously served as the Executive Analyst of the OMBC from 2006-2012. As you can see, NDs in California are not “the sole regulators of naturopathic medicine.” How does this compare to the Medical Board of California (MBC)? The MBC consists of medical doctors and public members. They don’t even have an osteopathic physician on their board. But really, what do you expect? Would (or should) medical doctors want (or need) to be regulated by other medical professionals? No one is accusing medical doctors of being the sole regulators of their profession; however last week skeptic blogger David Gorski, MD candidly points out that most state medical boards are “toothless” particularly in regards to the anticipated response of the MBC in cracking down on medical doctors making money off (illegally and unethically) signing immunization medical exemptions for conditions like eczema and celiac disease.

Medical board criticism

What could be more frustrating (and dangerous) than a toothless regulatory board? We will discuss SB277 and immunization waivers in another post, but for now let’s get back to state regulatory boards. What’s happening in other states? Each state is different but from what I’ve seen, every state that licenses naturopathic doctors has a regulatory board consisting of naturopathic doctors and public members, appointed by their respective governor. Let’s take a look at my neighboring states…

Washington’s regulatory board is called the Board of Naturopathy; its board has 5 ND members and 2 public members, all appointed by the governor. Their website explains that the board’s responsibilities include investigating complaints against naturopathic physicians and serving on disciplinary hearing panels.

The same holds true in Oregon, where the Board of Naturopathic Medicine, consist of 5 NDs and 2 public members, all appointed by the governor. The chair of their board is Dwight Adkins, one of their public members.

Lastly, Arizona’s regulatory board, the Naturopathic Physicians Medical Board, consists of 4 NDs and 3 public members, with the caveat that the 3 public members are not allowed to have ever been under the care of a naturopathic doctor. The board members are all appointed by the governor.

It is clear to me that NDs are not the sole regulators of their professions. All of the boards I mentioned include at least 2 public members. The regulation of the naturopathic medical profession is consistent with osteopathic and medical regulatory boards that are comprised of members of their own profession plus public members. The only unusual observation is that California’s regulatory board includes 2 medical doctors. Does it make any sense to have medical professions regulated by other professions? I don’t think so and I believe what happened to acupuncturists in Oregon demonstrates what could go wrong when we open up regulatory boards to other professions. Oregon’s acupuncturists are now regulated by MDs and DOs under the Oregon Medical Board. Did that result in cracking down on “quackery” or protecting the public from acupuncture? No! Instead it resulted in the OMB allowing MDs and DOs in Oregon to practice acupuncture with minimal training. In fact Marilyn Walkey, MD, LAc who practices in Oregon and had completed a traditional 4 year acupuncture program writes about how unfair it is that other MDs and DOs can now practice acupuncture with virtually no training (or specifically by watching videos created by MDs without a need for any hands-on training in needling). She even goes as far as saying that “[The new regulation] assumes that MDs have some sort of magical ability to discern our medicine with no training whatsoever.”

Well what about the accrediting body for naturopathic medical schools? The Council on Naturopathic Medical Education (CNME), is overseen primarily by naturopathic doctors. As it happens, CNME’s board includes public members and both the Executive Director and President emeritus are not NDs. The accrediting bodies for conventional medical schools and osteopathic medical schools, the Liaison Committee on Medical Education (LCME) and the Commission on Osteopathic College Accreditation (COCA), have boards that are made up entirely of their own doctors and students. In addition, they are both wholly or partly run by their trade associations, the American Medical Association (AMA) and the American Osteopathic Association (AOA). This is not considered inappropriate. The national naturopathic association, the American Association of Naturopathic Physicians (AANP) has no direct involvement with CNME. CNME is a member of the same association of accrediting agencies as LCME and COCA, the Association of Specialized and Professional Accreditors (ASPA).

Finally before I close, I want to explain what happens when a complaint is filed against a naturopathic doctor in California. To do so, here’s a quote from Rebecca Mitchell, the Executive Offer of the NMC:

The complaint is sent to an expert reviewer (peer review, which is exactly what the MD/DOs and all other healing arts boards do), who is only allowed to determine if there was a deviation from the standard of practice.  At the same time that the review takes place, the case is sent to the Dept. of Consumer Affairs, Division of Investigation and a sworn peace officer (not a licensed peer) conducts an investigation of the accusations.  The Expert Reviewer will submit their review to the investigator.  If there is merit to the complaint that there was a deviation from the standard of practice/violation of statute, DOI will then forward the case to the NMC and we will forward to the Attorney General for administrative accusations and/or the District Attorney for criminal prosecution. The hearings are heard in front of an Administrative Law Judge (ALJ) and the Committee, (remember that almost half of the committee members are non-NDs).  The ALJ will make a decision and then the Committee as a whole must vote to adopt or not. This is all done in a public meeting.

To summarize, the regulation of naturopathic doctors is similar to the regulation of other medical professions and state regulatory boards include public members. There is some inconsistency with the nuances of each state regulatory boards, but I can only hope that naturopathic regulatory boards across the country have the same commitment as the NMC to the promotion of public health and to protect the public from improper and unprofessional care.

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