Unifying Principles of Naturopathic Medicine Origins and Definitions

Naturopathy was founded in the United States in 1901 by Benedict Lust, MD^1–9 who collaborated with other leaders to build the profession.⁹ Naturopathy emerged, grew, formed, fragmented, and declined under internal debate and external political pressure; rising again in the 1970’s. It grew from Naturopathy into Naturopathic medicine starting in the 1960’s, expanding from 1 college,^6-8 21 licensed states, 3 licensed provinces and approximately 200 licensed Naturopathic physicians in North America^1,2,3 to 7 colleges, 22 licensed and regulated states, 3 regulated territories and districts, and 5 licensed and regulated Canadian provinces in the US and Canada; becoming an estimated 8000 licensed ND’s in North America by 2019.^10,11,12 and approximately 100 000 naturopaths worldwide in the process of professionalizing.¹³

After the profession’s decline in the 1950s and 1960s, during the profession’s rebirth in the 1970’s, the re-emerging profession became more grounded in medical sciences. Its regrowth was fueled by a young generation with relatively few veteran teachers due to a missing generation. Much of the wealth of early generation naturopathic scholarship and clinical experience had not traversed the profession’s near demise, trickling into the classrooms of the 1970’s and 1980’s. Clinical mentorship and classroom teaching by this era’s senior physicians and clinicians was influential. The profession’s roots were neglected out of ignorance, for the most part, along with perhaps, a youthful arrogance.

By the early 1980s, it was apparent that attempts to regenerate the progress made by Lust, Lindlahr and Carroll would require the creation of a unified professional organization and all which that entailed: more schools, accreditation for schools, national standards in education and licensure, clinical research, increased federal and state legislation, and the articulation of a coherent definition of the profession for legislative purposes, as well as for its own internal development. These accomplishments would be necessary to be able to demonstrate the uniqueness and validity of the profession, guide its educational process, and justify its status as a separate and distinct medical profession.^1,2,3,9

In 1986, the newly formed (1985) American Association of Naturopathic Physicians (AANP) began this task of developing a unified professional organization under the leadership of James Sensenig, ND (president) and Cathy Rogers, ND (vice president). Four tasks were developed and committees with specific chairs were delegated: (1) Accreditation of Naturopathic schools through governmental accreditation bodies (Joseph Pizzorno, ND), (2) Standard independent national licensure examination (Ed Smith, ND), (3) A peer-reviewed scientific journal (Peter D’ Adamo, ND). The fourth was the Select Committee on the Definition of Naturopathic Medicine, appointed to develop a new unifying definition of naturopathic medicine, co-chaired by Pamela Snider, ND and Jared Zeff, ND with committee members Bruce Milliman, ND, K. Wilson, ND, William Wulsin, ND, and Peter Glidden, ND. The Select Committee on the Definition of Naturopathic Medicine succeeded in its 3-year effort, culminating in the unanimous adoption by AANP’s House of Delegates (HOD) of a comprehensive, consensus definition of naturopathic medicine in 1989 at the annual AANP convention held at Rippling River, OR.^{1,2,3,14,15,16}

From 1987-1989 The Select Committee led the US profession in an iterative, progressive process of inclusive, profession wide input, review, classification of agreements and disagreements, negotiation, revision, publication of serial drafts and repeated review. The first point of unanimous consensus was to define the profession by its principles, not by its modalities. The Committee sought a defining statement which represented the profession’s highest water mark, the best of its common thinking and aspirations vs. a mediocre and less controversial statement. Conflicts were acknowledged, publicized in open meetings and elsewhere, then negotiated. Superlative common language was sought as opposed to settling on low common denominators in language. Robust arguments and passionate discussions were encouraged rather than suppressed; all with the aim of agreement and codifying the best possible statement, which was achieved. Group meetings were held at conventions, schools and elsewhere; thousands of written inputs and telephone calls were invited, received and organized, shaping the evolving draft sand interim reports. 16,17,18,19 Naturopathy’s historical principles and scope of practice were researched; there was no record of a national unifying definition within a governing body, formally representing the profession through a stakeholder vote. Lusts journals including the Naturopath and Herald of Health and other individual writings provided fertile contributions for discussion. Canadian engagement was welcome, robust and influential.^16-19

An important part of the process was that all conflicts were negotiated in open meetings. The final meeting held to complete the Definition Position Paper addressed two conflicts about specific language. These conflicts were delegated by the co-chairs to an external mediator, who facilitated the profession’s organizational and committee leaders in coming to final consensus, resolving these remaining and potentially divisive polarities concerning language. A fundamental and unique aspect of this Definition was its basis in definitive principles, rather than in therapeutic modalities as the defining characteristics of the profession. Until this point the only extant national definition available was through the US Department of Labor and Industries—a modality-based statement.²⁰

When AANP’s House of Delegates (HOD) passed the Resolution formally adopting the Definition of Naturopathic Medicine Position Paper the HOD asserted and ratified that these principles would continue to evolve with the progress of knowledge, and should be formally reexamined by the profession as needed, perhaps every 5 years.^14-19 From 1996 - 2000 four additional principles were proposed to the HOD for consideration. None were adopted, however they are valued and used in teaching.

Principle Proposed	College	Proposed By
Wellness 1996	Bastyr (adopted)	Maureen O’ Keefe, PhD
Salus 1999	SCNM	Mona Morstein, ND
Least Force 2001	Bastyr	Bruce Milliman, ND
Relieve Suffering 2001	Bastyr, NUNM	Jared Zeff, ND, LAc

AANP’s House of Delegates formally reaffirmed the 5-page Definition of Naturopathic Medicine Position Paper and Principles in 2000 and 2011 by House vote, adding one phrase: “prescription medication,” to the Practice section. The Position Paper was formally reviewed in 2005, 2006, 2007, 2008, and 2009 by HOD’s Position Paper Review Committee with no changes recommended.¹⁵

The following are the definitions of the unifying Principles of Naturopathic Medicine.¹⁵

Principles

The Healing Power of Nature (Vis Medicatrix Naturae)

The healing power of nature is the inherent self-organizing and healing process of living systems which establishes, maintains and restores health. Naturopathic medicine recognizes this healing process to be ordered and intelligent. It is the naturopathic physician’s role to support, facilitate and augment this process by identifying and removing obstacles to health and recovery, and by supporting the creation of a healthy internal and external environment.

Identify and Treat the Causes (Tolle Causam)

Illness does not occur without cause. Causes may originate in many areas. Underlying causes of illness and disease must be identified and removed before complete recovery can occur. Symptoms can be expressions of the body’s attempt to defend itself, to adapt and recover, to heal itself, or may be results of the causes of disease. The naturopathic physician seeks to treat the causes of disease, rather than to merely eliminate or suppress symptoms.

First Do No Harm (Primum Non Nocere)

Naturopathic physicians follow three precepts to avoid harming the patient:

• Naturopathic physicians utilize methods and medicinal substances which minimize the risk of harmful effects, and apply the least possible force or intervention necessary to diagnose illness and restore health.

• Whenever possible the suppression of symptoms is avoided as suppression generally interferes with the healing process.

• Naturopathic physicians respect and work with the vis medicatrix naturae in diagnosis, treatment and counseling, for if this self -healing process is not respected the patient may be harmed.

Doctor As Teacher (Docere)

The original meaning of the word “doctor” is teacher. A principal objective of naturopathic medicine is to educate the patient and emphasize self-responsibility for health. Naturopathic physicians also recognize and employ the therapeutic potential of the doctor-patient relationship.

Treat the Whole Person (Tolle Totum)

Health and disease result from a complex of physical, mental, emotional, genetic, environmental, social and other factors. Since total health also includes spiritual health, naturopathic physicians encourage individuals to pursue their personal spiritual development. Naturopathic medicine recognizes the harmonious functioning of all aspects of the individual as being essential to health. The multifactorial nature of health and disease requires a personalized and comprehensive approach to diagnosis and treatment. Naturopathic physicians treat the whole person taking all of these factors into account.

Prevention (Preventare)

Naturopathic medical colleges emphasize the study of health as well as disease. The prevention of disease and the attainment of optimal health in patients are primary objectives of naturopathic medicine. In practice, these objectives are accomplished through education and the promotion of healthy ways of living. Naturopathic physicians assess risk factors, heredity and susceptibility to disease, and make appropriate interventions in partnership with their patients to prevent illness. Naturopathic medicine asserts that one cannot be healthy in an unhealthy environment and is committed to the creation of a world in which humanity may thrive.¹⁵

World Naturopathic Federation Report. Pg. 11-12. June 2015. Lloyd et al.¹³

According to a World Naturopathic Federation (WNF) Report in 2015 “as shown in the chart, the naturopathic principles codified in 1989 are very consistent across all countries that practice naturopathy / naturopathic medicine.”¹³

The WNF’s report on Naturopathic Principles summarized data from the WNF’s 42 country survey, with the following statement: “In 1986 the American Association of Naturopathic Physicians (AANP) formed a committee that consisted of naturopathic doctors Pamela Snider, Jared Zeff and others. These practitioners spent over three years reviewing the historic data and documents and interviewing over 1000 people. In 1989, a definition of naturopathic medicine and the description of the six naturopathic principles was formally codified and accepted by the two North American national naturopathic associations (American Association of Naturopathic Physicians (AANP) and the Canadian Association of Naturopathic Doctors (CAND). As shown in Chart 3, the naturopathic principles codified in 1989 are very consistent across all countries that practice naturopathy / naturopathic medicine.”¹³

The WNF’s survey report of an average 94.16 % concurrence with the language in the original 1989 AANP Definition of Naturopathic Medicine Position Paper’s six Principles statements in 42 countries was an indicator of an underlying global sense of professional unity of identity, despite the profession’s ongoing debates. The authors believe that it is the investment in transparency, inclusivity and the “long time listening” within the profession which surfaced the deepest patterns of the profession’s agreement. Ensuring a forum for negotiating what appeared at times to be intractable conflicts and, in every case, led to a positive outcome in language, birthed a well crafted unifying and timeless statement. In that sense, they were not authors of the document but midwives of a process of re-establishing the profession’s identity through its principles, as a platform for rebuilding all aspects of Naturopathic medicine. The authors acknowledge and thank the thousands of voices in North America and around the world who find resonance woven through diversity. Though timeless, these principles must continue to be allowed to evolve with the progress of our knowledge and our understanding.