Proposal to the American Association of Naturopathic Physicians
Naturopathic Greetings,
The American Naturopathic Research Institute-Naturopathic Oncology Research Institute (ANRI-NORI) began 3 years ago and earlier this year committed to the undertaking of drafting this potentially contentious AANP proposal regarding the growing tension of specialty organizations as well as the multitude of opinions on this topic.
1. Basic Origin:
This project began years ago and became, and is, quite an involved issue and slightly contentious with the best of intentions on all sides.
ANRI-NORI was founded in Arizona over 3 years ago by naturopathic physicians Dr. Kenneth Proefrock and Dr. Colleen Huber, both nationally and internationally published writers and speakers in oncology and other fields of medicine. Their objective was to unify naturopathic physicians who had similar concerns over the possible restrictions of choice that may come with a focus on evidence-based medicine and the codification of certain specialties that may result. Although ANRI-NORI meetings also entail IRB proposals, in accordance with FDA guidelines and the Code of Federal Regulations, and physician case studies, eventually the membership and discussions grew at the same time as elsewhere new specialty naturopathic organizations (pediatrics, environmental medicine, endocrinology, etc.) were formed and announced.
As a way for these concerns to be officially heard, a proposal to the AANP was decided upon as a proper way to address this complex issue. After the initial draft was completed and approved by all ANRI-NORI members, it was sent to various nationwide physicians outside of ANRI-NORI for further approval and consideration. More seasoned naturopathic physicians were also contacted since they have had the greatest perspective of changes within the profession. We received an overwhelming response. Most approved and supported the idea, and especially the intent of the Proposal. Others sent long letters outlining their concerns and personal experiences for us to consider. Many helped with the drafting and legal construction. At the bottom we included the names of those who have read, contributed and publicly endorsed the Proposal and its principles to date. Please note that not all physicians who approved this measure are listed; many preferred to be anonymous at this time while others are current members of naturopathic boards (ex. AANP) that may create a conflict of interest.
2. Concerns:
It must be emphatically stated that the intention of this document is NOT to dissuade specialty training; only that specialty groups should not have a political or controlling interest over other naturopathic physicians or his/her practice.
After confirming that specialty groups are private and not public governing bodies, there were specific concerns that were consistently brought up.
The following are a few that initiated this Proposal.
Here are some specifics:
– Can a specialty organization be a ‘board,’ as they are often referred to, since they have no jurisdiction.
– Can an accredited medical school mandate the teachings specifically from a specialty group?
– Can/will physicians be mandated to have certain specialty group training or ‘certification’ in order to practice a field of medicine? Some physicians and recent graduates claim that they were led to believe that this mandate exists currently. (This claim has not been substantiated.) Although this premise is not true, it was still a serious concern from many interviewed.
– Will specialty organization certification be necessary to be included as a speaker at further ND conferences, including the AANP?
– If specialty group training and membership becomes mandatory, how will this affect local state and national associations?
– Specific concerns to certain physicians were also discussed. For example, publishers (2 on record) of ND material now refuse to publish any article relating to a specific specialty from any doctor. This is apparently due to serious chastising from a specialty group regarding publishing ‘un-approved’ treatments or by ‘unqualified’ naturopaths.
– If a physician is called to defend his treatment actions before a state licensing board, will a specialty organization’s guidelines be the automatic point of reference that he/she must defend from? From a licensing board’s perspective, this seems very logical and customary, however it is daunting if the physician has a defensible yet different point of view (for example, re: vaccinations).
– Will there develop inconsistencies and prejudices amongst the different specialty organizations? For example, if the OncANP deems it appropriate to only treat with the evidence-based therapies that they have chosen to acknowledge, then will the homeopathy specialty organization be held to the same strict standard? And if not, then is this inconsistent and perhaps discriminatory between the practicing physicians?
– At the core of this Proposal became this distilled debate: If Treatment ‘A’ has been favored by a specialty organization over Treatment ‘B’, then does the naturopathic physician, or more profoundly their informed and consenting patient, have a choice and a right to choose Treatment ‘B’?
3. The Solution:
How does our complex profession answer these concerns while still supporting the scientific and technical growth of our profession?
After long discussions of the concerns mentioned above, a unified simple solution was determined: diversity and competition.
Every concern mentioned will be resolved as long as the AANP acknowledged diverse specialty organizations that may have competing ideas.
– Diverse yet recognized organizations will remind all physicians that their views, as currently relevant as they may be, are still ‘one voice in a chorus of opinions.’
– Differing organizations will allow a physician reprimanded by their state board to draw from an alternative popular opinion to buttress their treatment philosophy.
– Competition will allow our profession to grow more rapidly when one specialty group is attempting to outperform their competitor in evidence-based medicine, outcome results, and ultimately public recognition.
– Diversity allows the AANP to become more inclusive in their national recruitment and growth.
Example: Consider if one pediatric organization supports vaccination via evidence-based science. If a naturopathic physician is challenged by their State License Board, they could still be supported by a competing pediatric organization that vaccinations are a concern. Of course, a significant issue with this model is whether the patient had adequate informed consent on both sides. This latter issue is also addressed within this proposal.
4. Oxymoron?
To give respect to the elder naturopathic physicians interviewed for this proposal, it is a very fair argument that a ‘specialist-holistic doctor’ is a contradiction. This issue is a deep concern regarding the future evolution and soul of our profession, especially for those respected ‘old-school’ naturopaths who bequeathed to us our current ND licensure. However, this legitimate philosophical debate is NOT the intention for this Proposal, although it may be answered through the debate on this Proposal.
5. Contacts:
When ANRI-NORI undertook this draft, they were clear that it was to be from the profession and not one doctor or one organization. As the growing list of signatories at the last page suggests, we have hopefully achieved this goal. This list has grown beyond the initial AANP Proposal submission and the updated list is available upon request.
6. Collateral Issues and Definitions:
Although this Proposal is specifically about specialty organizations eclipsing basic naturopathy, it became immediately clear that this topic was complicated because at its’ core were larger issues of medical freedom and patient rights. Therefore, these issues were integral in forming this Proposal and the results are included as a coda at the end of the Proposal under the section of Definitions. Examples discussed included ‘Standards of Care,’ ‘Proper Informed Consent,’ ‘Medical Ethics,’ and ‘Patient Rights.’
7. Conclusion:
-It should be restated that there is no animosity toward specialty organizations from ANRI-NORI or those that endorsed this project. Specialty groups are a natural extension of our growing profession. However, the concern over what the influence of an opinionated group has over the naturopathic body at large has reached a drumhead, and hence the initiation of this much-needed debate resulting in this Proposal.
-ANRI-NORI hopes this introductory letter is sufficient in explaining the intentions and the positive outlook for all naturopaths that this Proposal embraces. ANRI-NORI understands that this Proposal, once opened to debate, will be subject to many opinions and comments. Our goal, however, was to offer this organization this constructive Proposal with as much polish and insight (both legislative and philosophical) and national endorsement as possible going into this official unveiling. However, if there is anyting else ANRI-NORI can do in answering questions about this document (re: its wording, intentions, the Signatories) or to edit the language, then please feel free to contact ANRI-NORI at any time.
On behalf of ANRI-NORI, we thank each of you for your time and insight regarding this Proposal.
NATUROPATHIC SPECIALTY MEDICAL ORGANIZATIONS:
A Unified Proposal for Adaptation into the AANP National By-Laws for their Defined Purpose, Principles, and Restrictions
Purpose and Opinion:
Specialty Medical Organizations (SMO) are an integral part of the Naturopathic Profession. They are a natural and welcome extension to a medical profession that is growing in the number of practitioners, the scope of practice, in public awareness, and in the new medical ideas that each of these eventually create.
Specialty Medical Organizations should be encouraged by the naturopathic profession at large to become bastions of organized practitioners of specific skill sets and talents that can bolster and refine relative treatments, techniques, promote research and the medical arts held within.
The naturopathic community is experiencing a professional ‘quickening’. This very young profession is still defining itself through experiences of severe limitations in State licensure, numerous variances in medical scope, and by the large array of modalities, principles, medical philosophies, and opinions the naturopathic profession has been bequeathed.
A palpable concern has therefore evolved that the sudden evolution of Specialty Medical Organizations, with proper intentions, may limit the medical expression, modalities, and professional creativity before the naturopathic profession has defined itself nationally as a whole. This proposal for adoption into the AANP was formed to address these concerns so the naturopathic profession can both forge into our future while still allowing the foundation to evolve.
Proposed Position Statement Part I:
Accepted Professional Structure for Specialty Medical Organizations:
Specialty Medical Organizations shall be governed by their individual members and be encouraged to become a free market of shared ideas, beliefs, and success rates.
Specialty Medical Organizations shall be independent and privateentities recognized by the AANP and shall not be regulated by any other specialty medical organizations, accredited naturopathic medical schools, or by any other professional association. Specialty Medical Organizations should not be regulated by individual State Boards of Medical Examiners, but individual physician members of Specialty Medical Organizations are subject to each individual state licensing laws.
Specialty Medical Organizations shall not regulate each other. There shall not be any limit or quota upon the number of Specialty Medical Organizations active at one time. There shall not be any restrictions preventing a similar, secondary, or competing specialty medical organization, even within the same specialty, as long as the members are in good standing with their state of license and operate under the common naturopathic scope of practice.
Specialty Medical Organizations may offer its members board certification through examination. Successful candidates shall then be allowed to advertise their declared specialty and Specialty Medical Organization affiliation to the public and profession.
Proposed Position Statement Part II:
Principles and Code of Conduct for Specialty Medical Organizations:
Specialty Medical Organizations shall:
– Promote patient choice, not restrictions.
– Provide medical options, not limitations.
– Work to expand ND scope of practice; not limit it.
– Provide education, not regulations.
– Exist as private nurturing organizations, not public governing bodies.
– Lead by example, not by force.
Proposed Position Statement Part III:
Overarching Restriction for Specialty Medical Organizations:
No specialty or other non-BOMEX secondary naturopathic medical organization involving the naturopathic profession shall infringe upon, intervene with, nor have jurisdiction over, the individual Rights of a naturopathic physician or their patients.
These Rights specifically include, but are not limited to, the physicians’ fullest scope of practice as allowed by individual State licensure or the broadest scope taught by accredited naturopathic medical schools.
Definitions and Considerations Constructing this Document:
Re: Specialty Medical Organization (SMO):
A group of physicians who have formed a private professional association in order to uphold and promote a common philosophy or suggest different or improved techniques of practicing within a modality and/or a field of medicine.
Re: Patient Choice:
The empowerment and inalienable right of a patient to decide and determine their individual treatment options and goals as long as this choice is preceded by an informed consent.
Re: Informed Consent:
The naturopathic physician (regardless of Specialty Medical Organization involvement) must educate their patient individually upon all medical options that are accepted standards of care as adopted by the AANP regardless of the physicians’ opinion or ability to perform such treatments. Proper consent shall be obtained from the patient that Standard of Care treatments were explained by the physician and denied by the patient.
Re: Standards of Care:
Standard of Care treatments as defined by the AANP shall not be construed as synonymous with evidence based treatments. Rather naturopathic physicians shall have the broadest latitude for treatment options as it is recognized that advances in medicine comefrom ideas and observations by the astute physician and are then validated by the scientific method.
Re: Patient Choice and ‘Patient Bill of Rights:
All patients should be guaranteed the following inalienable freedoms:
– To seek consultation with the physician(s) of their choice;
– To contract with their physician(s) on mutually agreeable terms;
– To be treated confidentially, with access to their records limited to those involved in their care or designated by the patient;
– To use their own resources to purchase the care of their choice;
– To refuse medical treatment even if it is recommended by their physician(s);
– To be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives;
– To refuse third-party interference in their medical care, and to be confident that their actions in seeking or declining medical care will not result in third-party-imposed penalties for patients or physicians.
– To refuse medical care that is the current preferred Standard of Care
Document History:
Phranq D. Tamburri,NMD = Original Draft and re-writes
Tom Kruzel, ND = Draft edit and contributions
Colleen Huber, NMD = Draft edit and contributions
Margarita Hernandez Guzman, NMD = Draft edit and contributions
Patient Bill of Rights (majority) credit: In 1990 the Association of American Physicians and Surgeons asserted that ‘medical care must be rendered under conditions that are acceptable to both patient and physician’ and adopted a list of Patient Freedoms in 1990, which was then modified in 1995 and adopted as a Patients’ Bill of Rights.