Abuse of power or abuse of authority, in the form of "malfeasance in office" or "official abuse of power", is the commission of an unlawful act, done in an official capacity, which affects the performance of official duties. Malfeasance in office is often a just cause for removal of an elected official by statute or recall election. Officials who abuse their power are often corrupt.
In the United States, abuse of power has been cited in the impeachment of at least five federal officials. Two of these (Judge George English and President Richard Nixon)
resigned before their trial in the Senate could take place, and two
others were acquitted by the Senate. The first impeachment trial of
President Donald Trump concluded with the president being found not guilty on both articles of impeachment with one of them being the charge of abuse of power. At the state level, Governor Rod Blagojevich
of Illinois was impeached and unanimously removed from office by the
Illinois Senate in 2009 for offenses including abuse of power.
Institutional abuse
Institutional abuse is the maltreatment of someone (often children or older adults) by a system of power. This can range from acts similar to home-based child abuse, such as neglect, physical and sexual
abuse, to the effects of assistance programs working below acceptable
service standards, or relying on harsh or unfair ways to modify
behavior.
Impeachment of U.S. officials
James Peck
Federal Judge James H. Peck was impeached by the U.S. House of Representatives in 1830 on a charge of abuse of power. Peck had jailed a man for contempt of court after the man had publicly criticized him. The U.S. Senate acquitted him in 1831, with 21 voting guilty and 22 voting not guilty.
Charles Swayne
Federal Judge Charles Swayne was impeached by the U.S. House of Representatives
in 1904. He was accused of filing false travel vouchers, improper use
of private railroad cars, unlawfully imprisoning two attorneys for
contempt, and living outside of his district. He was acquitted by the U.S. Senate
in 1905. There was little doubt that Swayne was guilty of some of the
offenses charged against him. Indeed, his counsel admitted as much,
though calling the lapses "inadvertent." The Senate, however, refused to
convict Swayne because its members did not believe his actions amounted
to "high crimes and misdemeanors".
George English
Federal Judge George W. English was impeached by the U.S. House of Representatives in 1926, but resigned before his trial in the U.S. Senate
could take place. One of the five articles of impeachment alleged
"tyranny and oppression, and abuse of the powers of his office." The House voted to impeach by a vote of 306 to 60, but the charges were dismissed following English's resignation. He had been accused of abusive treatment of attorneys and litigants appearing before him.
President Richard Nixon resigned from office after the House Judiciary Committee voted to approve articles of impeachment,
but before the full House had a chance to vote on impeachment. Of the
three articles of impeachment, Article II charged Nixon with abuse of
power, alleging in part that:
Using the powers of the office of President of the United States, Richard M. Nixon, in violation of his constitutional oath
faithfully to execute the office of President of the United States and,
to the best of his ability, preserve, protect, and defend the Constitution of the United States,
and in disregard of his constitutional duty to take care that the laws
be faithfully executed, has repeatedly engaged in conduct violating the
constitutional rights of citizens, impairing the due and proper
administration of justice and the conduct of lawful inquiries, or
contravening the laws governing agencies of the executive branch and the
purposes of these agencies.
The article also cited five specific examples of alleged misconduct to substantiate this charge against the president.
The vote on Article II was bipartisan, with 7 of the 17
Republicans joining all 21 Democrats on the committee in approving
impeachment of a U.S. president for abuse of power.
Rod Blagojevich was impeached and removed from office as Governor of Illinois in 2009, on charges of abuse of power and corruption. Blagojevich was accused of several "pay to play"
schemes, including attempting "to obtain personal gain ... through the
corrupt use" of his authority to fill a vacant seat in the U.S. Senate.
The Illinois House of Representatives voted 114–1 (with three abstentions) to impeach Blagojevich for abuse of power, and the Illinois Senate voted 59–0 to remove him from office.
President Donald Trump was impeached
by the U.S. House of Representatives on December 18, 2019. The votes
for the charge of abuse of power in the House were 230 in favor, 197
against, and 1 present.
Voting in favor were all but three House Democrats and one Independent,
and voting against were all House Republicans and two Democrats;
representative Tulsi Gabbard voted present. During his trial in the Senate on February 5, 2020, he was found not guilty.
The votes for acquittal on the charge of abuse of power in the Senate
were 48 against (45 Democratic senators, 2 Independent senators, one
Republican senator), and 52 in favor (All Republicans). Of the two
articles of impeachment, Article I alleges abuse of power.
In October 2017, the Trump Administration agreed to settle a lawsuit filed on behalf of more than four hundred conservative nonprofit groups. These nonprofit groups claimed that they had been discriminated against by the Internal Revenue Service
for an undisclosed amount. This amount was described by the plaintiffs'
counsel as "very substantial." The Trump Administration also agreed to
settle a second lawsuit brought by forty-one conservative organizations
with an apology and an admission that subjecting them to "heightened
scrutiny and inordinate delays" was wrongful.
These acts by Lois Lerner
were performed between 2010 and 2012 as a way to try and deal with the
massive number of applications from organizations that were wanting a tax-exemption status.
Many of these organizations that were seeking the tax-exemption status
did not agree with how the government was being run and had 'tea party'
or 'patriots' in their name.
In February 2010, Judge John Leonardo found that Arpaio "misused the power of his office to target members of the Board of Supervisors for criminal investigation".
In 2008, a federal grand jury began an inquiry of Arpaio for abuse of power, in connection with a Federal Bureau of Investigation investigation.
On August 31, 2012, the US Attorney's office of Arizona announced that
it was "closing its investigation into allegations of criminal conduct"
by Arpaio, without filing charges.
Arpaio was investigated for politically motivated and "bogus"
prosecutions, which a former US Attorney called "utterly unacceptable". Phoenix Mayor Phil Gordon has called Arpaio's "long list" of questionable prosecutions "a reign of terror".
In 215 CE in Eastern Han China, Fa Zheng was appointed as the Administrator (太守) of Shu commandery (蜀郡) and "General Who Spreads Martial Might" (揚武將軍) by Liu Bei. He oversaw administrative affairs in the vicinity of Yi Province's capital Chengdu and served as Liu Bei's chief adviser.
During this period of time, he abused his power by taking
personal revenge against those who offended him before and killing them
without reason. Some officials approached Zhuge Liang,
another of Liu Bei's key advisers, and urged him to report Fa Zheng's
lawless behaviour to their lord and take action against him. However,
Zhuge Liang replied, "When our lord was in Gong'an (公安), he was wary of Cao Cao's influence in the north and fearful of Sun Quan's presence in the east. Even in home territory he was afraid that Lady Sun
might stir up trouble. He was in such a difficult situation at the time
that he could neither advance nor retreat. Fa Xiaozhi supported and
helped him so much, such that he is now able to fly high and no longer
remain under others' influence. How can we stop Fa Zheng from behaving
as he wishes?" Zhuge Liang was aware that Liu Bei favoured and trusted
Fa Zheng, which was why he refused to intervene in this matter.
In dictatorial, corrupt, or weak states, police officers may carry out many criminal acts for the ruling regime with impunity.
Individual officers, or sometimes whole units, can be corrupt or carry out various forms of police misconduct; this occasionally happens in many forces, but can be more common where police pay is very low unless supplemented by bribes. Police officers sometimes act with unwarranted brutality
when they overreact to confrontational situations, or to extract a
confession from a person that they may or may not genuinely suspect of
being guilty.
Research released in October 2021 shows that from 1980 to 2018 there
was an estimated 30,800 deaths due to police violence. That same study
indicated that the National Vital Statistics System has misclassified/underreported over 55% of the estimated police-related deaths in the US.
Elliott Broidy
Elliott Broidy was charged for illegally lobbying the US government officials for the government of the United Arab Emirates to influence the US foreign policy and run a disinformation campaign against the State of Qatar as well as Qatari-American businesses. Broidy, the former finance chairman of the Republican National Committee
at the time of the Donald Trump administration was charged with the
wrongdoing in a lawsuit filed by a Qatari luxury travel company, Abu
Issa Holding. Broidy, according to the lawsuit was paid by the UAE
government, for hiring internet-based influencers and trolls to spread misinformation against Qatar, stating that Qatari businesses sponsored terrorist groups.
OMT technique for the treatment of impotence in the 1898 Osteopathy Complete manual
Osteopathy (from Ancient Greekὀστέον (ostéon) 'bone', and πάθος (páthos) 'pain, suffering') is a pseudoscientific system of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. In most countries, practitioners of osteopathy are not medically trained and are referred to as osteopaths.
Osteopathic manipulation is the core set of techniques in osteopathy. Parts of osteopathy, such as craniosacral therapy, have no therapeutic value and have been labeled as pseudoscience and quackery. The techniques are based on an ideology created by Andrew Taylor Still (1828–1917) which posits the existence of a "myofascial
continuity"—a tissue layer that "links every part of the body with
every other part". Osteopaths attempt to diagnose and treat what was
originally called "the osteopathic lesion", but which is now named
"somatic dysfunction",
by manipulating a person's bones and muscles. Osteopathic Manipulative
Treatment (OMT) techniques are most commonly used to treat back pain and other musculoskeletal issues.
Osteopathic manipulation is still included in the curricula of
osteopathic physicians or Doctors of Osteopathic Medicine (DO) training
in the US. The Doctor of Osteopathic Medicine degree, however, became a medical degree and is no longer a degree of non-medical osteopathy.
The practice of osteopathy began in the United States in 1874. Osteopathy was founded by Andrew Taylor Still, a 19th-century American physician (MD), Civil War surgeon, and Kansas state and territorial legislator.He lived near Baldwin City, Kansas, during the American Civil War and it was there that he founded the practice of osteopathy. Still claimed that human illness was rooted in problems with the musculoskeletal system, and that osteopathic manipulations could solve these problems by harnessing the body's own self-repairing potential.
Still's patients were forbidden from treatment by conventional
medicine, as well as from other practices such as drinking alcohol. These practices derive from the belief, common in the early 19th century among proponents of alternative medicine, that the body's natural state tends toward health and inherently contains the capacity to battle any illness.
This was opposed to orthodox practitioners, who held that intervention
by a physician was necessary to restore health in the patient. Still
established the basis for osteopathy, and the division between
alternative medicine and traditional medicine had already been a major
conflict for decades.
The foundations of this divergence may be traced back to the mid-18th century when advances in physiology
began to localize the causes and nature of diseases to specific organs
and tissues. Doctors began shifting their focus from the patient to the
internal state of the body, resulting in an issue labeled as the problem
of the "vanishing patient".
A stronger movement towards experimental and scientific medicine was
then developed. In the perspective of the DO physicians, the sympathy
and holism that were integral to medicine in the past were left behind. Heroic medicine became the convention for treating patients, with aggressive practices like bloodletting and prescribing chemicals such as mercury, becoming the forefront in therapeutics.
Alternative medicine had its beginnings in the early 19th century, when
gentler practices in comparison to heroic medicine began to emerge. As
each side sought to defend its practice, a schism began to present
itself in the medical marketplace, with both practitioners attempting to
discredit the other. The osteopathic physicians—those who are now
referred to as DO's—argued that the non-osteopathic physicians had an
overly mechanistic approach to treating patients, treated the symptoms
of disease instead of the original causes, and were blind to the harm
they were causing their patients. Other practitioners had a similar
argument, labeling osteopathic medicine as unfounded, passive, and
dangerous to a disease-afflicted patient.
This was the medical environment that pervaded throughout the 19th
century, and the setting Still entered when he began developing his idea
of osteopathy.
After experiencing the loss of his wife and three daughters to spinal meningitis
and noting that the current orthodox medical system could not save
them, Still may have been prompted to shape his reformist attitudes
towards conventional medicine. Still set out to reform the orthodox medical scene and establish a practice that did not so readily resort to drugs, purgatives, and harshly invasive therapeutics to treat a person suffering from ailment,
similar to the mindset of the irregulars in the early 19th century.
Thought to have been influenced by spiritualist figures such as Andrew Jackson Davis and ideas of magnetic and electrical healing, Still began practicing manipulative procedures that intended to restore harmony in the body.
Over the course of the next twenty five years, Still attracted support
for his medical philosophy that disapproved of orthodox medicine, and
shaped his philosophy for osteopathy. Components included the idea that
structure and function are interrelated and the importance of each piece
of the body in the harmonious function of its whole.
Still sought to establish a new medical school that could produce
physicians trained under this philosophy, and be prepared to compete
against the orthodox physicians. He established the American School of
Osteopathy on 20 May 1892, in Kirksville, Missouri, with twenty-one
students in the first class. Still described the foundations of osteopathy in his book "The Philosophy and Mechanical Principles of Osteopathy" in 1892. He named his new school of medicine "osteopathy", reasoning that "the bone, osteon, was the starting point from which [he] was to ascertain the cause of pathological conditions".
He would eventually claim that he could "shake a child and stop scarlet
fever, croup, diphtheria, and cure whooping cough in three days by a
wring of its neck."
When the state of Missouri granted the right to award the MD degree, he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree.
In the early 20th century, osteopaths across the United States sought
to establish law that would legitimize their medical degree to the
standard of the modern medic.
The processes were arduous, and not without conflict. In some states,
it took years for the bills to be passed. Osteopaths were often
ridiculed and in some cases arrested,
but in each state, osteopaths managed to achieve the legal
acknowledgement and action they set out to pursue. In 1898 the American
Institute of Osteopathy started the Journal of Osteopathy and by that time four states recognized osteopathy as a profession.
According to the American Osteopathic Association
(AOA), osteopathic manipulative treatment (OMT) is considered to be
only one component of osteopathic medicine and may be used alone or in
combination with pharmacotherapy, rehabilitation, surgery, patient education, diet, and exercise. OMT techniques are not necessarily unique to osteopathic medicine; other disciplines, such as physical therapy or chiropractic, use similar techniques.
In reality many DOs do not practice OMT at all and over time DOs in
general practice less and less OMT and instead apply the common medical
treatments.
One integral tenet of osteopathy is that problems in the body's
anatomy can affect its proper functioning. Another tenet is the body's
innate ability to heal itself. Many of osteopathic medicine's
manipulative techniques are aimed at reducing or eliminating the
impediments to proper structure and function so the self-healing
mechanism can assume its role in restoring a person to health.
Osteopathic medicine defines a concept of health care that embraces the
concept of the unity of the living organism's structure (anatomy) and
function (physiology). The AOA states that the four major principles of osteopathic medicine are the following:
The body is an integrated unit of mind, body, and spirit.
The body possesses self-regulatory mechanisms, having the inherent capacity to defend, repair, and remodel itself.
Structure and function are reciprocally interrelated.
Rational therapy is based on consideration of the first three principles.
These principles are not held by Doctors of Osteopathic Medicine to be empirical laws; they serve, rather, as the underpinnings of the osteopathic approach to health and disease.
Muscle energy techniques address somatic dysfunction through
stretching and muscle contraction. For example, if a person is unable to
fully abduct
her arm, the treating physician raises the patient's arm near the end
of the patient's range of motion, also called the edge of the
restrictive barrier. The patient then tries to lower her arm, while the
physician provides resistance. This resistance against the patient's
motion allows for isotonic contraction
of the patient's muscle. Once the patient relaxes, her range of motion
increases slightly. The repetition of alternating cycles of contraction
and subsequent relaxation help the treated muscle improve its range of
motion. Muscle energy techniques are contraindicated in patients with fractures, crush injuries, joint dislocations, joint instability, severe muscle spasms or strains, severe osteoporosis, severe whiplash injury, vertebrobasilar insufficiency, severe illness, and recent surgery.
Counterstrain is a system of diagnosis and treatment that considers
the physical dysfunction to be a continuing, inappropriate strain reflex,
which is inhibited during treatment by applying a position of mild
strain in the direction exactly opposite to that of the reflex. After a counterstrain point tender to palpation has been diagnosed,
the identified tender point is treated by the osteopathic physician
who, while monitoring the tender point, positions the patient such that
the point is no longer tender to palpation. This position is held for ninety seconds and the patient is subsequently returned to her normal posture. Most often this position of ease is usually achieved by shortening the muscle of interest. Improvement or resolution of the tenderness at the identified counterstrain point is the desired outcome. The use of counterstrain technique is contraindicated in patients with severe osteoporosis, pathology of the vertebral arteries, and in patients who are very ill or cannot voluntarily relax during the procedure.
High-velocity, low-amplitude
High
velocity, low amplitude (HVLA) is a technique which employs a rapid,
targeted, therapeutic force of brief duration that travels a short
distance within the anatomic range of motion of a joint and engages the
restrictive barrier in one or more places of motion to elicit release of
restriction. The use of HVLA is contraindicated in patients with Down syndrome due to instability of the atlantoaxial joint which may stem from ligamentous laxity, and in pathologic bone conditions such as fracture, history of a pathologic fracture, osteomyelitis, osteoporosis, and severe cases of rheumatoid arthritis. HVLA is also contraindicated in patients with vascular disease such as aneurysms, or disease of the carotid arteries or vertebral arteries. People taking ciprofloxacin or anticoagulants, or who have local metastases should not receive HVLA.
Myofascial release is a form of alternative treatment. The
practitioners claim to treat skeletal muscle immobility and pain by
relaxing contracted muscles. Palpatory feedback by the practitioner is
said to be an integral part to achieving a release of myofascial
tissues, accomplished by relaxing contracted muscles, increasing circulation and lymphatic drainage, and stimulating the stretch reflex of muscles and overlying fascia.
Practitioners who perform myofascial release consider the fascia
and its corresponding muscle to be the main targets of their procedure,
but assert that other tissue may be affected as well, including other
connective tissue. Fascia is the soft tissue component of the connective tissue that provides support and protection for most structures within the human body, including muscle. This soft tissue can become restricted due to psychogenic disease, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow.
Some osteopaths search for small lumps of tissue, called "Chapman release points" as part of their diagnostic procedure.
Lymphatic pump treatment (LPT) is a manual technique intended to encourage lymph flow in a person's lymphatic system.
The first modern lymphatic pump technique was developed in 1920,
although osteopathic physicians used various forms of lymphatic
techniques as early as the late 19th century.
Relative contraindications for the use of lymphatic pump treatments include fractures, abscesses or localized infections, and severe bacterial infections with body temperature elevated higher than 102 °F (39 °C).
Effectiveness
A
2005 Cochrane review of osteopathic manipulative treatment (OMT) in
asthma treatment concluded that there was insufficient evidence that OMT
can be used to treat asthma.
In 2013, a Cochrane review
reviewed six randomized controlled trials which investigated the effect
of four types of chest physiotherapy (including OMT) as adjunctive
treatments for pneumonia in adults and concluded that "based on current
limited evidence, chest physiotherapy might not be recommended as
routine additional treatment for pneumonia in adults." Techniques
investigated in the study included paraspinal inhibition, rib raising,
and myofascial release. The review found that OMT did not reduce
mortality and did not increase cure rate, but that OMT slightly reduced
the duration of hospital stay and antibiotic use. A 2013 systematic review of the use of OMT for treating pediatric conditions concluded that its effectiveness was unproven.
In 2014, a systematic review and meta-analysis of 15 randomized controlled trials found moderate-quality evidence that OMT reduces pain and improves functional status in acute and chronic nonspecific low back pain. The same analysis also found moderate-quality evidence for pain reduction for nonspecific low back pain in postpartum women and low-quality evidence for pain reduction in nonspecific low back pain in pregnant women. A 2013 systematic review found insufficient evidence to rate osteopathic manipulation for chronic nonspecific low back pain.
In 2011, a systematic review found no compelling evidence that
osteopathic manipulation was effective for the treatment of
musculoskeletal pain.
A 2018 systematic review found that there is no evidence for the
reliability or specific efficacy of the techniques used in visceral
osteopathy.
The New England Journal of Medicine's 4 November 1999 issue concluded that patients with chronic low back pain can be treated effectively with manipulation. The United Kingdom's National Health Service
says there is "limited evidence" that osteopathy "may be effective for
some types of neck, shoulder or lower limb pain and recovery after hip
or knee operations", but that there is no evidence that osteopathy is
effective as a treatment for health conditions unrelated to the bones
and muscles.
Others have concluded that there is insufficient evidence to suggest
efficacy for osteopathic style manipulation in treating musculoskeletal
pain.
Criticism
The American Medical Association listed DOs as "cultists" and deemed MD consultation of DOs unethical from 1923 until 1962.
MDs regarded that osteopathic treatments were rooted in
"pseudoscientific dogma", and although physicians from both branches of
medicine have been able to meet on common ground, tensions between the
two continue.
In 1988, Petr Skrabanek
classified osteopathy as one of the "paranormal" forms of alternative
medicine, commenting that it has a view of disease which had no meaning
outside its own closed system.
In a 1995 conference address, the president of the Association of American Medical Colleges,
Jordan J. Cohen, pinpointed OMT as a defining difference between MDs
and DOs; while he saw there was no quarrel in the appropriateness of
manipulation for musculoskeletal treatment, the difficulty centered on
"applying manipulative therapy to treat other systemic diseases"—at that
point, Cohen maintained, "we enter the realm of skepticism on the part
of the allopathic world."
In 1998, Stephen Barrett of Quackwatch said that the worth of manipulative therapy had been exaggerated and that the American Osteopathic Association (AOA) was acting unethically by failing to condemn craniosacral therapy.
The article attracted a letter from the law firm representing the AOA
accusing Barrett of libel and demanding an apology to avert legal
action.
In response, Barrett made some slight modifications to his text, while
maintaining its overall stance; he queried the AOA's reference to "the
body's natural tendency toward good health", and challenged them to
"provide [him] with adequate scientific evidence showing how this belief
has been tested and demonstrated to be true." Barrett has been quoted as saying, "the pseudoscience within osteopathy can't compete with the science".
In 1999, Joel D. Howell noted that osteopathy and medicine as
practiced by MDs were becoming increasingly convergent. He suggested
that this raised a paradox: "if osteopathy has become the functional
equivalent of allopathy, what is the justification for its continued
existence? And if there is value in therapy that is uniquely
osteopathic – that is, based on osteopathic manipulation or other
techniques – why should its use be limited to osteopaths?"
In 2004, the osteopathic physician Bryan E. Bledsoe, a professor of emergency medicine, wrote disparagingly of the "pseudoscience" at the foundation of OMT. In his view, "OMT will and should follow homeopathy, magnetic healing, chiropractic, and other outdated practices into the pages of medical history."
In 2010, Steven Salzberg
wrote that OMT was promoted as a special distinguishing element of DO
training, but that it amounted to no more than "'extra' training in
pseudoscientific practices." It has been suggested that osteopathic physicians may be more likely than MDs to be involved in questionable practices such as orthomolecular therapy and homeopathy.
Retired MD and U.S. Air Forceflight surgeonHarriet Hall
stated that DOs trained in the U.S. are Doctors of Osteopathic Medicine
and are legally equivalent to MDs. "They must be distinguished from
'osteopaths', members of a less regulated or unregulated profession that
is practiced in many countries. Osteopaths get inferior training that
can't be compared to that of DOs."
Regulation and legal status
The
osteopathic profession has evolved into two branches, non-physician
manual medicine osteopaths and full scope of medical practice osteopathic physicians.
These groups are so distinct that in practice they function as separate
professions. The regulation of non-physician manual medicine osteopaths
varies greatly between jurisdictions. In Australia, Denmark, New
Zealand, Switzerland, UAE and UK the non-physician manual medicine
osteopaths are regulated by statute and practice requires registration
with the relevant regulatory authority. The Osteopathic International
Alliance has a country guide with details of registration and practice
rights and the International Osteopathic Association has a list of all
accredited osteopathic colleges.
Several international and national organizations exist relating
to osteopathic education and political advocacy. Similarly, there is
also an international organization of organizations for national
osteopathic and osteopathic medical associations, statutory regulators,
and universities/medical schools offering osteopathic and osteopathic
medical education, known as the Osteopathic International Alliance
(OIA).
The following sections describe the legal status of osteopathy and osteopathic medicine in each country listed.
Australia
A majority of osteopaths work in private practice, with osteopaths
working within aged care, traffic and workers compensation schemes or
co-located with medical practitioners. Osteopaths are not considered
physicians or medical doctors in Australia, rather as allied health
professionals offering private practice care. The majority of private
health insurance providers cover treatment performed by osteopaths, as
do many government based schemes such as veteran's affairs or workers compensations schemes. In addition, treatment performed by osteopaths is covered by the public healthcare system in Australia (Medicare) under the Chronic Disease Management plan.
Osteopathy Australia
(formerly the Australian Osteopathic Association) is a national
organization representing the interests of Australian osteopaths,
osteopathy as a profession in Australia, and consumers' right to access
osteopathic services. Founded in 1955 in Victoria, the Australian
Osteopathic Association became a national body in 1991 and became
Osteopathy Australia in 2014. and is a member of the Osteopathic International Alliance.
The Osteopathy Board of Australia is part of the Australian Health Practitioner Regulation Agency which is the regulatory body for all recognized health care professions in Australia.
The Osteopathic Board of Australia is separate from the Medical Board
of Australia which is the governing body that regulates medical
practitioners. Osteopaths trained internationally may be eligible for
registration in Australia, dependent on their level of training and
following relevant competency assessment.
Students training to be an osteopath in Australia must study in an approved program in an accredited university. Current accredited courses are either four or five years in length. To achieve accreditation universities courses must demonstrate the capabilities of graduates.
The capabilities are based on the CanMEDS competency framework that was
developed by the Royal College of Physicians and Surgeons of Canada.
A 2018 large scale study, representing a response rate of 49.1%
of the profession indicated the average age of the participants was 38.0
years, with 58.1% being female and the majority holding a Bachelor or
higher degree qualification for osteopathy. The study also estimated a
total of 3.9 million patients consulted osteopaths every year in
Australia. Most osteopaths work in referral relationships with a range
of other health services, managing patients primarily with
musculoskeletal disorders.
Canada
In
Canada, the titles "osteopath" and "osteopathic physician" are protected
in some provinces by the medical regulatory college for physicians and
surgeons. As of 2011, there were approximately 20 U.S.-trained osteopathic physicians, all of which held a Doctor of Osteopathic Medicine degree, practicing in all of Canada. As of 2014, no training programs have been established for osteopathic physicians in Canada.
The non-physician manual practice of osteopathy is practiced in most Canadian provinces. As of 2014, manual osteopathic practice is not a government-regulated health profession in any province, and those interested in pursuing osteopathic studies must register in private osteopathy schools.
It is estimated that there are over 1,300 osteopathic manual
practitioners in Canada, most of whom practice in Quebec and Ontario.
Some sources indicate that there are between 1,000 and 1,200 osteopaths
practicing in the province of Quebec, and although this number might
seem quite elevated, many osteopathy clinics are adding patients on
waiting lists due to a shortage of osteopaths in the province.
Quebec
Beginning in 2009, Université Laval in Quebec City was working with the Collège d'études ostéopathiques in Montreal on a project to implement a professional osteopathy program consisting of a bachelor's degree followed by a professional master's degree in osteopathy as manual therapy. However, due to the many doubts concerning the scientific credibility of osteopathy from the university's faculty of medicine, the program developers decided to abandon the project in 2011, after 2+1⁄2 years of discussion, planning, and preparation for the program implementation.
There was some controversy with the final decision of the university's
committee regarding the continuous undergraduate and professional
graduate program in osteopathy because the Commission of studies, which
is in charge of evaluating new training programs offered by the
university, had judged that the program had its place at Université
Laval before receiving the unfavourable support decision from the
faculty of medicine.
Had the program been implemented, Université Laval would have been the
first university institution in Quebec to offer a professional program
in osteopathy as a manual therapy.
Egypt and the Middle East
Hesham
Khalil introduced osteopathy in the Middle East at a local physical
therapy conference in Cairo, Egypt in 2005 with a lecture titled "The
global Osteopathic Concept / Holistic approach in Somatic Dysfunction".
Since then he has toured the Middle East to introduce osteopathy in
other Middle Eastern and North African countries, including Sudan,
Jordan, Saudi Arabia, Qatar, UAE, Kuwait and Oman.
In December 2007 the first Workshop on Global osteopathic approach was
held at the Nasser Institute Hospital for Research and Treatment,
sponsored by the Faculty of Physical Therapy, University of Cairo,
Egypt.
On 6 August 2010, the Egyptian Osteopathic Society (OsteoEgypt) was
founded. OsteoEgypt promotes a two-tier model of osteopathy in Egypt and
the Middle East. The event was timed to coincide with the birthday of
A.T. Still.
European Union
There
is no European regulatory authority for the practice of osteopathy or
osteopathic medicine within the European Union; each country has its own
rules. The UK's General Osteopathic Council, a regulatory body set up
under the country's Osteopaths Act 1993, issued a position paper on European regulation of osteopathy in 2005.
Belgium
Since
the early 1970s, osteopaths have been practicing in Belgium, during
which time several attempts have been made to obtain an official status
of health care profession. In 1999, a law was voted (the 'Colla-Law')
providing a legal framework for osteopathy, amongst three other
non-conventional medical professions.
In 2011, the former Belgian Minister Onkelinx set up the Chambers for
Non-Conventional Medicines and the Joint Commission provided for in the
"Colla-law" (1999). Their goal was to discuss and reach an agreement
between the various medical professions to rule on these practices. In
February 2014, only one practice, homeopathy, received its recognition.
The others, including osteopathy, remain unresolved.
Since 2014, the majority of the professional osteopathic
associations have joined together under the name of UPOB - BVBO (Union
Professionelle des Osteopathes de Belgique - Belgische Vereniging van
Belgische Osteopaten - Professional Union of Belgian Osteopaths) in
order to strengthen the image and vision of osteopathy (± 900
osteopaths). This unification also led in the creation of a website
which represents all aspects of osteopathy in Belgium. Its aim is to
offer Belgians a base of information about osteopathy, to provide access
to a national on-call emergency service as well as to osteopathic care
facilities for the less fortunates. The site has also a search engine
giving access to all osteopaths who exclusively practice osteopathy.
Lastly, the website serves as a platform to support actions working
towards the recognition of osteopathy. In 2020, they changed their name
to osteopathie.be
Finland
Osteopathy
has been a recognized health profession since 1994 in Finland. It is
regulated by law along with chiropractors and naprapaths. These
professions require at least a four-year education. Currently there are three osteopathic schools in Finland, one which is public and two private ones.
France
Osteopathy is a governmentally recognized profession and has title protection, autorisation d'utiliser le titre d'ostéopathe. The most recent decree regarding osteopathy was enacted in 2014.
Germany
Germany has both osteopathy and osteopathic medicine. There is a difference in the osteopathic education between non-physician osteopaths, physiotherapists, and medical physicians.
Physiotherapists are a recognized health profession and can
achieve a degree of "Diploma in Osteopathic Therapy (D.O.T.)".
Non-physician osteopaths are not medically licensed. They have an
average total of 1200 hours of training, roughly half being in manual
therapy and osteopathy, with no medical specialization before they
attain their degree. Non-physician osteopaths in Germany officially work
under the "Heilpraktiker"
law. Heilpraktiker is a separate profession within the health care
system. There are many schools of osteopathy in Germany; most are moving
toward national recognition although such recognition does not
currently exist. In Germany, there are state level rules governing which persons (non-physicians) may call themselves osteopaths.
Portugal
Osteopathy
is a governmentally recognized health profession and the title of
Osteopath is protected by Law (Act 45/2003, of 22 October, and Act
71/2013, of 2 September). Currently there are eight faculties that teach
the four-year degree course of osteopathy (BSc Hon in Osteopathy).
The practice of osteopathy is regulated by law, under the terms of the Health Practitioners Competence Assurance Act 2003
which came into effect on 18 September 2004. Under the act, it is a
legal requirement to be registered with the Osteopathic Council of New
Zealand (OCNZ),
and to hold an annual practicing certificate issued by them, in order
to practice as an osteopath. Each of the fifteen health professions
regulated by the HPCA act work within the "Scope of Practice" determined
and published by its professional board or council. Osteopaths in New
Zealand are not fully licensed physicians. In New Zealand, in addition
to the general scope of practice, osteopaths may also hold the Scope of
Practice for Osteopaths using western medical acupuncture and related
needling techniques.
In New Zealand a course is offered at the Unitec Institute of Technology (Unitec).
Australasian courses consist of a bachelor's degree in clinical science
(osteopathy) followed by a master's degree. The Unitec double degree
programme is the OCNZ prescribed qualification for registration in the
scope of practice: Australian qualifications accredited by the
Australian and New Zealand Osteopathic Council are also prescribed
qualifications.
Osteopaths registered and in good standing with the Australian
Health Practitioner Regulation Agency – Osteopathy Board of Australian
are eligible to register in New Zealand under the mutual recognition
system operating between the two countries. Graduates from programs in
every other country are required to complete an assessment procedure.
The scope of practice for US-trained osteopathic physicians is unlimited on an exceptions
basis. Full licensure to practice medicine is awarded on an exceptions
basis following a hearing before the licensing authorities in New
Zealand. Both the Medical Council of New Zealand and the OCNZ regulate osteopathic physicians in New Zealand. Currently, the country has no recognized osteopathic medical schools.
United Kingdom
The
first school of osteopathy was established in London in 1917 by John
Martin Littlejohn, a pupil of A.T. Still, who had been Dean of the Chicago College of Osteopathic Medicine.
After many years of existing outside the mainstream of health care
provision, the osteopathic profession in the UK was accorded formal
recognition by Parliament in 1993 by the Osteopaths Act.
This legislation now provides the profession of osteopathy the same
legal framework of statutory self-regulation as other healthcare
professions such as medicine and dentistry. This Act provides for
"protection of title". A person who expressly or implicitly describes
themself as an osteopath, osteopathic practitioner, osteopathic
physician, osteopathist, osteotherapist, or any kind of osteopath is
guilty of an offence unless they are registered as an osteopath.
The General Osteopathic Council
(GOsC) regulates the practice of osteopathy under the terms of the Act.
Under British law, an osteopath must be registered with the GOsC to
practice in the United Kingdom. More than 5,300 osteopaths were registered in the UK as of 2021.
The General Osteopathic Council has a statutory duty to promote,
develop and regulate the profession of osteopathy in the UK. Its duty is
to protect the interests of the public by ensuring that all osteopaths
maintain high standards of safety, competence and professional conduct
throughout their professional lives. In order to be registered with the
General Osteopathic Council an osteopath must hold a recognized
qualification that meets the standards as set out by law in the GOsC's
Standard of Practice.
Osteopathic medicine is regulated by the General Osteopathic
Council, (GOsC) under the terms of the Osteopaths Act 1993 and statement
from the GMC. Practising osteopaths will usually have a BS or MSc in
osteopathy. Accelerated courses leading to accreditation are available
for those with a medical degree and physiotherapists. The London College of Osteopathic Medicine teaches osteopathy only to those who are already physicians.
An osteopathic physician in the United States is a physician trained in the full scope of medical practice, with a degree of Doctor of Osteopathic Medicine (DO). With the increased internationalization of osteopathy, the American Osteopathic Association (AOA) recommended in 2010 that the older terms osteopathy and osteopath
be reserved for "informal or historical discussions and for referring
to previously named entities in the profession and foreign-trained
osteopaths", and replaced in the US by osteopathic medicine and osteopathic physician. The American Association of Colleges of Osteopathic Medicine made a similar recommendation.
Those trained only in manual osteopathic treatment, generally to
relieve muscular and skeletal conditions, are referred to as osteopaths, and are not permitted to use the title DO in the United States to avoid confusion with osteopathic physicians.
Naturopathy, or naturopathic medicine, is a form of alternative medicine. A wide array of pseudoscientific
practices branded as "natural", "non-invasive", or promoting
"self-healing" are employed by its practitioners, who are known as naturopaths. Difficult to generalize, these treatments range from outright quackery, like homeopathy, to widely accepted practices like certain forms of psychotherapy. The ideology and methods of naturopathy are based on vitalism and folk medicine rather than evidence-based medicine, although practitioners may use techniques supported by evidence.
Naturopathic practitioners commonly recommend against following modern medical practices, including but not limited to medical testing, drugs, vaccinations, and surgery.
Instead, naturopathic practice relies on unscientific notions, often
leading naturopaths to diagnoses and treatments that have no factual
merit.
Naturopathy is considered by the medical profession to be ineffective and harmful, raising ethical issues about its practice. In addition to condemnations and criticism from the medical community, such as the American Cancer Society, naturopaths have repeatedly been denounced as and accused of being charlatans and practicing quackery.
Naturopaths frequently campaign for legal recognition in the United States. Naturopathy is illegal in two U.S. states
and tightly regulated in many others. Some states have lax regulations,
however, and may allow naturopaths to perform minor surgery or even
prescribe drugs. While some schools exist for naturopaths, and some
jurisdictions allow such practitioners to call themselves doctors, the
lack of accreditation, scientific medical training, and quantifiable
positive results means they lack the competency of true medical doctors.
History
The term "naturopathy" originates from "natura" (Latin root for birth) and "pathos" (the Greek root for suffering) to suggest "natural healing". Naturopaths claim the ancient Greek "Father of Medicine", Hippocrates, as the first advocate of naturopathic medicine, before the term existed.Naturopathy has its roots in the 19th-century Natural Cure movement of Europe. In Scotland, Thomas Allinson
started advocating his "Hygienic Medicine" in the 1880s, promoting a
natural diet and exercise with avoidance of tobacco and overwork.
The term naturopathy was coined in 1895 by John Scheel, and purchased by Benedict Lust, whom naturopaths consider to be the "Father of U.S. Naturopathy". Lust had been schooled in hydrotherapy and other natural health practices in Germany by Father Sebastian Kneipp; Kneipp sent Lust to the United States to spread his drugless methods. Lust defined naturopathy as a broad discipline rather than a particular method, and included such techniques as hydrotherapy, herbal medicine, and homeopathy, as well as eliminating overeating, tea, coffee, and alcohol. He described the body in spiritual and vitalistic terms with "absolute reliance upon the cosmic forces of man's nature". According to the Merriam-Webster Dictionary, the first known use of "naturopathy" in print is from 1901.
From 1901, Lust founded the American School of Naturopathy in New York.
In 1902, the original North American Kneipp Societies were discontinued
and renamed "Naturopathic Societies". In September 1919, the
Naturopathic Society of America was dissolved and Benedict Lust founded
the American Naturopathic Association to supplant it.
Naturopaths became licensed under naturopathic or drugless practitioner
laws in 25 states in the first three decades of the twentieth century. Naturopathy was adopted by many chiropractors, and several schools offered both Doctor of Naturopathy (ND) and Doctor of Chiropractic (DC) degrees.
Estimates of the number of naturopathic schools active in the United
States during this period vary from about one to two dozen.
After a period of rapid growth, naturopathy went into decline for several decades after the 1930s. In 1910, the Carnegie Foundation for the Advancement of Teaching published the Flexner Report, which criticized many aspects of medical education, especially quality and lack of scientific rigour. The advent of penicillin
and other "miracle drugs" and the consequent popularity of modern
medicine also contributed to naturopathy's decline. In the 1940s and
1950s, a broadening in scope of practice laws led many chiropractic
schools to drop their ND degrees, though many chiropractors continued to
practice naturopathy. From 1940 to 1963, the American Medical Association campaigned against heterodox medical systems. By 1958, practice of naturopathy was licensed in only five states. In 1968, the United States Department of Health, Education, and Welfare
issued a report on naturopathy concluding that naturopathy was not
grounded in medical science and that naturopathic education was
inadequate to prepare graduates to make appropriate diagnosis and
provide treatment; the report recommends against expanding Medicare coverage to include naturopathic treatments. In 1977 an Australian committee of inquiry reached similar conclusions; it did not recommend licensure for naturopaths.
Beginning in the 1970s, there was a revival of interest in the
United States and Canada, in conjunction with the "holistic health"
movement. As of 2009, fifteen U.S. states, Puerto Rico, the US Virgin Islands and the District of Columbia licensed naturopathic doctors,
and the State of Washington requires insurance companies to offer
reimbursement for services provided by naturopathic physicians. On the other hand, some states such as South Carolina and Tennessee prohibit the practice of naturopathy.
The United States IHS (Indian Health Service) began accepting naturopathic doctors in their clinics and practice in 2013, also making loan repayment available to ND's.
In 2015, a former naturopathic doctor, Britt Marie Hermes, began writing critically about her experience being trained in and practicing naturopathic medicine. Her blog garnered a large following among skeptics while enraging some proponents of alternative medicine.
Sebastian Kneipp c. 1898, a Bavarian priest and forefather of naturopathy
Benedict Lust c. 1902, the founder of naturopathy in the U.S.
Britt Marie Hermes c. 2016, a former naturopathic doctor and major critic of naturopathic medicine
In 2003, a report was presented by Kimball C. Atwood, an American medical doctor and researcher from Newton, Massachusetts,
best known as a critic of naturopathic medicine, stating among other
criticisms that "The practice of naturopathy is based on a belief in the
body's ability to heal itself through a special vital energy or force guiding bodily processes internally".
Diagnosis and treatment concern primarily alternative therapies and "natural" methods that naturopaths claim promote the body's natural ability to heal. Many naturopaths in India now use modern diagnostic techniques in their practice. Naturopaths focus on a holistic approach, avoiding the use of surgery and conventional medicines.
Naturopaths aim to prevent illness through stress reduction and changes
to diet and lifestyle, often rejecting the methods of evidence-based
medicine.
A consultation typically begins with a comprehensive patient
interview assessing lifestyle, medical history, emotional tone, and
physical features, as well as physical examination. Many naturopaths present themselves as primary care providers, and some naturopathic physicians may prescribe drugs,
perform minor surgery, and integrate other conventional medical
approaches such as diet and lifestyle counselling with their
naturopathic practice.
Traditional naturopaths deal exclusively with lifestyle changes, not
diagnosing or treating disease. Naturopaths do not generally recommend
vaccines and antibiotics,
based in part on the early views that shaped the profession, and they
may provide alternative remedies even in cases where evidence-based
medicine has been shown effective.
Methods
Naturopaths are often opposed to mainstream medicine and take an antivaccinationist stance.
A 2004 survey determined the most commonly prescribed naturopathic therapeutics in Washington state and Connecticut were botanical medicines, vitamins, minerals, homeopathy, and allergy treatments. An examination published in 2011 of naturopathic clinic websites in Alberta and British Columbia
found that the most commonly advertised therapies were homeopathy,
botanical medicine, nutrition, acupuncture, lifestyle counseling, and
detoxification.
In 2020, a survey of methods used by naturopaths in fourteen
countries reported that 27% of clients received acupuncture, 22%
homeopathy, 16% "other energetic medicines", and 13.5% were given
hydrotherapy. A mean of 4.0 "treatments" were provided to each customer.
One-third (33%) of patients consulted with only the naturopath to
manage their primary health concern.
Equipment for administering large enemas, a bag and a bucket, each holding a gallon. Enemas and colonic irrigation are commonly used by naturopaths for a wide range of medical conditions, for which there are no known health benefits.A rectal bulb syringe for injecting a small enemaPerson undergoing ozone IV therapy with ultraviolet irradiation. According to the FDA, "Ozone is a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy."
Naturopathy as a whole lacks an adequate scientific basis, and it is rejected by the medical community. Although it includes valid lifestyle advice from mainstream medicine (healthy sleep, balanced diet, regular exercise), it typically adds a range of pseudoscientific beliefs.
Some methods rely on immaterial "vital energy fields", the existence of
which has not been proven, and there is concern that naturopathy as a
field tends towards isolation from general scientific discourse.
Naturopathy is criticized for its reliance on and its association with
unproven, disproven, and other controversial alternative medical
treatments, and for its vitalistic underpinnings. Natural substances known as nutraceuticals
show little promise in treating diseases, especially cancer, as
laboratory experiments have shown limited therapeutic effect on biochemical pathways, while clinical trials demonstrate poor bioavailability. According to the American Cancer Society, "scientific evidence does not support claims that naturopathic medicine can cure cancer or any other disease".
According to Britt Hermes, naturopath student programs are problematic
because "As a naturopath [student], you are making justifications to
make the rules and to fudge the standards of how to interpret research
all along the way. Because if you don't, you're not left with anything,
basically".
In 2015, the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; Naturopathy was one of 17 therapies evaluated for which no clear evidence of effectiveness was found.
Naturopathic
physicians now claim to be primary care physicians proficient in the
practice of both "conventional" and "natural" medicine. Their training,
however, amounts to a small fraction of that of medical doctors who
practice primary care. An examination of their literature, moreover,
reveals that it is replete with pseudoscientific, ineffective,
unethical, and potentially dangerous practices.
In
another article, Atwood writes that "Physicians who consider naturopaths
to be their colleagues thus find themselves in opposition to one of the
fundamental ethical precepts of modern medicine. If naturopaths are not
to be judged "nonscientific practitioners", the term has no useful
meaning".
A former licensed naturopathic doctor, Britt Marie Hermes,
states that "any product that is sold by a naturopath almost guarantees
that there is no reliable scientific data to support whatever health
claims are made,
and that while some naturopaths claim to only practice evidence based
medicine, "the problem is, all naturopaths in an accredited naturopathic
program are required to extensively study homeopathy, herbal medicine,
energy healing, chiropractic techniques, water therapy" and other
pseudoscientific practices.
Hermes further notes that, while some naturopaths claim that their
method can be effective treatments for psychological disorders, "no
naturopathic treatment has been clinically proven to be safe and
effective for bipolar disorder or any other condition."
According to Arnold S. Relman, the Textbook of Natural Medicine
is inadequate as a teaching tool, as it omits to mention or treat in
detail many common ailments, improperly emphasizes treatments "not
likely to be effective" over those that are, and promotes unproven
herbal remedies at the expense of pharmaceuticals. He concludes that
"the risks to many sick patients seeking care from the average
naturopathic practitioner would far outweigh any possible benefits".
The Massachusetts Medical Society states, "Naturopathic practices
are unchanged by research and remain a large assortment of erroneous
and potentially dangerous claims mixed with a sprinkling of
non-controversial dietary and lifestyle advice."
Safety of natural treatments
Naturopaths often recommend exposure to naturally occurring substances, such as sunshine, herbs and certain foods, as well as activities they describe as natural, such as exercise, meditation and relaxation.
Naturopaths claim that these natural treatments help restore the body's
innate ability to heal itself without the adverse effects of
conventional medicine. However, "natural" methods and chemicals are not
necessarily safer or more effective than "artificial" or "synthetic"
ones, and any treatment capable of eliciting an effect may also have
deleterious side effects.
Certain naturopathic treatments offered by naturopaths, such as homeopathy, rolfing, and iridology, are widely considered pseudoscience or quackery. Stephen Barrett of QuackWatch and the National Council Against Health Fraud has stated that naturopathy is "simplistic and that its practices are riddled with quackery".
"Non-scientific health care practitioners, including naturopaths, use
unscientific methods and deception on a public who, lacking in-depth
health care knowledge, must rely upon the assurance of providers.
Quackery not only harms people, it undermines the ability to conduct
scientific research and should be opposed by scientists", says William T. Jarvis.
In the 2018 Australian case against Marlyin Bodnar, who advised a
mother to treat her infant son's eczema with a raw food diet which
nearly led to the child's starvation death, Judge Peter Berman said,
"Well intentioned but seriously misguided advice is, as the facts of
this case demonstrate, capable of causing great harm and even death to
vulnerable children." Furthermore, Britt Hermes criticizes the "pervasive culture of patient blaming"
among naturopathic practitioners, where "when something doesn't work
for the patient and the patient is not experiencing all of the positive
effects and zero side-effects that are promised with the therapy, it's
never because the therapy doesn't work, it's because the patient didn't
do something right."
Measles cases reported in the United States fell dramatically after the introduction of the measles vaccine.
Many naturopathy practitioners voice their opposition to vaccination.
The reasons for this opposition are based, in part, on the early views
which shaped the foundation of this occupation.
A naturopathy textbook, co-authored by Joseph Pizzorno, recalls
anti-vaccine beliefs associated with the founding of naturopathy in the
United States: "a return to nature in regulating the diet, breathing,
exercising, bathing and the employment of various forces" in lieu of the smallpox vaccine.
In general, evidence about associations between naturopathy and
pediatric vaccination is sparse, but "published reports suggest that
only a minority of naturopathic physicians actively support full
vaccination". In Washington state from 2000 to 2003, children were significantly less
likely to receive immunizations if they had seen a naturopath.
A survey of naturopathic students published in 2004 found that students
at the Canadian College of Naturopathic Medicine became less likely to
recommend vaccinations to their patients and became more distrustful of
public health and conventional medicine as they advanced in the program.
The British Columbia Naturopathic Association lists several major
concerns regarding the pediatric vaccine schedule and vaccines in
general, and the group's policy is to not advocate for or against vaccines. The Oregon Association of Naturopathic Physicians reports that many naturopaths "customize" the pediatric vaccine schedule.
As of April 25, 2022, a British Columbia government report found
that 69.2% of naturopaths reported having received at least two COVID
vaccines or receiving a medical exemption. This was much lower than all
the other regulated medical professions in the report. The number for
two professions – dieticians and physicians/surgeons – was 98%.
As of 2016, the American Association of Naturopathic Physicians,
which is the largest professional organization for licensed naturopaths
in the U.S., is "still discussing its stance on vaccinations".
Practitioners
Naturopath practitioners can generally be categorized into three
groups: 1) those with a government issued license; 2) those who practice
outside of an official status ("traditional naturopaths"); 3) those who
are primarily another kind of health professional who also practices
naturopathy.
In Switzerland, these divisions fall between those with a federal
diploma, those recognized by health insurances, and those with neither
federal diploma nor recognition by health insurances. Naturopaths with
federal diploma can be divided into four categories: European
traditional medicine, Chinese traditional medicine, ayurvedic medicine
and homeopathy. The number of listed naturopaths (including traditional healers) in Switzerland rose from 223 in 1970 to 1835 in 2000.
Licensed naturopaths
Licensed naturopaths may be referred to as "naturopathic doctors" or
"naturopathic physicians" in 26 US states or territories and 5 Canadian
provinces. Licensed naturopaths present themselves as primary care providers.
Licensed naturopaths do not receive comparable training to medical
doctors in terms of the quality of education or quantity of hours.
In British Columbia, legislation permits licensed naturopaths to use the title "doctor" or "physician".
However, section 102 of the bylaw of the College of Naturopathic
Physicians of British Columbia (CNPBC), the terms "naturopathic" or
"naturopathic medicine" must be included anytime the term doctor or
physician is used by a member of the CNPBC.
Education
National University of Natural Medicine trains students in naturopathic medicine who are eligible to become licensed in some jurisdictions in North America.The herb garden at Bastyr University, another naturopathic program whose graduates can become licensed naturopaths in some North American jurisdictions
Licensed naturopaths must pass the Naturopathic Physicians Licensing Examinations (NPLEX) administered by the North American Board of Naturopathic Examiners (NABNE) after graduating from a program accredited by the Council on Naturopathic Medical Education (CNME). Training in CNME-accredited programs includes basic medical diagnostics
and procedures such as rudimentary physical exams and common blood tests, in addition to pseudoscientific modalities, such as homeopathy, acupuncture, and energy modalities.These accredited programs have been criticized for misrepresenting their
medical rigor and teaching subjects that are antithetical to the best
understandings of science and medicine. The CNME as an accrediting authority has been characterized as unreliable and suffering from conflicts of interest. The naturopathic licensing exam has been called a mystery by those outside the naturopathic professionand criticized for testing on homeopathic remedies, including for the use to treat pediatric emergencies.
Naturopathic doctors are not eligible for medical residencies,
which are available exclusively for medical doctors and doctors of
osteopathic medicine. There are limited post-graduate "residency"
positions available to naturopathic doctors offered through naturopathic
schools and naturopathic clinics approved by the CNME. Most naturopathic doctors do not complete such a residency, and naturopathic doctors are not mandated to complete one for licensure, except in the states of Utah and Connecticut. Continuing education in naturopathic modalities for health care professionals varies greatly.
Political activity in the United States
Naturopaths affiliated with the CNME-accredited schools lobby state,
provincial, and federal governments for medical licensure and
participation in social health programs. The American Association of Naturopathic Physicians represents licensed naturopaths in the United States; the Canadian Association of Naturopathic Doctors represents licensed naturopaths in Canada. Naturopathic lobbying efforts are funded by vitamin and supplement makers and focus on portraying naturopathic education as comparable to medical education received by physicians and on having high professional standards.
Medical societies and advocacy groups dispute these claims by citing
evidence of licensed naturopaths using pseudoscientific methods without a
sound evidence basis and lacking adequate clinical training to diagnose
and treat disease competently according to the standard of care.
Jann Bellamy has characterized the process by which naturopaths and
other practitioners of pseudoscience convince lawmakers to provide them
with medical licenses as "legislative alchemy".
Since 2005, the Massachusetts Medical Society
has opposed licensure based on concerns that NDs are not required to
participate in residency and concerns that the practices of naturopaths
included many "erroneous and potentially dangerous claims".
The Massachusetts Special Commission on Complementary and Alternative
Medical Practitioners rejected their concerns and recommended licensure. The Massachusetts Medical Society states:
Naturopathic medical school is not a
medical school in anything but the appropriation of the word medical.
Naturopathy is not a branch of medicine. It is a hodge podge of
nutritional advice, home remedies and discredited treatments ...
Naturopathic colleges claim accreditation but follow a true
"alternative" accreditation method that is virtually meaningless. They
are not accredited by the same bodies that accredit real medical schools
and while some courses have similar titles to the curricula of
legitimate medical schools the content is completely different.
In 2015, a former naturopathic doctor, Britt Marie Hermes, who graduated from Bastyr University and practiced as a licensed ND in Washington and Arizona, began advocating against naturopathic medicine.
In addition to opposing further licensure, she believes that NDs should
not be allowed to use the titles "doctor" or "physician", and be barred from treating children. She states:
Naturopaths aggressively lobby for
laws to issue them medical licenses. I would characterize this political
effort as a perverted redefinition of the words "physician", "doctor",
"medical school", and "residency" in order to mask the inadequacy of the
training provided in naturopathic programs. ND students do not realize
that they are taking educational shortcuts and therefore do not possess
any demonstrable competencies found in modern medicine.
Traditional naturopaths are represented in the United States by the
American Naturopathic Association (ANA), representing about 1,800
practitioners and the American Naturopathic Medical Association (ANMA).
The level of naturopathic training varies among traditional
naturopaths in the United States. Traditional naturopaths may complete
non-degree certificate programs or undergraduate degree programs and
generally refer to themselves as naturopathic consultants. These
programs often offer online unaccredited degrees, but do not offer
comprehensive biomedical education or clinical training.
Traditional naturopathic practitioners surveyed in Australia
perceive evidence-based medicine to be an ideological assault on their
beliefs in vitalistic and holistic principles. They advocate for the integrity of natural medicine practice.
Naturopaths graduating from accredited programs argued in 2002
that their training used evidence-based scientific principles unlike
traditional naturopathic programs, but this claim remains inaccurate.
Regulation
Naturopathy is practiced in many countries and is subject to
different standards of regulation and levels of acceptance. The scope of
practice varies widely between jurisdictions, with some covering
naturopathy under medical regulation and allowing practitioners to
prescribe drugs and perform minor surgery, while other jurisdictions
outlaw naturopathy entirely.
Australia
In 1977, a Commonwealth Government inquiry reviewed all colleges of
naturopathy in Australia and found that despite having syllabuses
appearing to cover the basic biomedical sciences, actual lectures had
little connection to those syllabuses and no significant practical work
was available. In addition, there did not appear to be significant or
systematic coverage of techniques favoured by naturopaths, such as
homeopathy, Bach's floral remedies, or mineral salts.
The position of the Australian Medical Association
is that "evidence-based aspects of complementary medicine can be part
of patient care by a medical practitioner", but it has concerns that
there is "limited efficacy evidence regarding most complementary
medicine. Unproven complementary medicines and therapies can pose a risk
to patient health either directly through misuse or indirectly if a
patient defers seeking medical advice." The AMA's position on regulation
is that "there should be appropriate regulation of complementary
medicine practitioners and their activities".
In 2015, the Australian government found no clear evidence of effectiveness for naturopathy.
Accordingly, In 2017 the Australian government named naturopathy as a
practice that would not qualify for insurance subsidy, saying this step
would "ensure taxpayer funds are expended appropriately and not directed
to therapies lacking evidence".
India
In India, naturopathy is overseen by the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy
(AYUSH); there is a 5½-year degree in "Bachelor of Naturopathy and
Yogic Sciences" (BNYS) degree that was offered by twelve colleges in
India as of August 2010. The National Institute of Naturopathy in Pune
that operates under AYUSH, which was established on December 22, 1986
and encourages facilities for standardization and propagation of the
existing knowledge and its application through research in naturopathy
throughout India.
North America
In five Canadian provinces, seventeen U.S. states, and the District of Columbia,
naturopathic doctors who are trained at an accredited school of
naturopathic medicine in North America are entitled to use the
designation ND or NMD. Elsewhere, the designations "naturopath",
"naturopathic doctor", and "doctor of natural medicine" are generally
unprotected or prohibited.
In North America, each jurisdiction that regulates naturopathy
defines a local scope of practice for naturopathic doctors that can vary
considerably. Some regions permit minor surgery, access to prescription
drugs, spinal manipulations, midwifery (natural childbirth), and
gynecology; other regions exclude these from the naturopathic scope of
practice or prohibit the practice of naturopathy entirely.
Canada
Five Canadian provinces license naturopathic doctors: Ontario, British Columbia, Manitoba, Saskatchewan, and Alberta.
British Columbia has the largest scope of practice in Canada, allowing
certified NDs to prescribe pharmaceuticals and perform minor surgeries.
U.S. jurisdictions that permit access to prescription drugs:
Arizona, California, District of Columbia, Hawaii, Kansas, Maine,
Montana, New Hampshire, Oregon, Utah, Vermont, and Washington.
U.S. jurisdictions that permit minor surgery: Arizona, District of
Columbia, Kansas, Maine, Montana, Oregon, Utah, Vermont, and Washington.
Two U.S. states specifically prohibit the practice of naturopathy: South Carolina and Tennessee.
Switzerland
The Swiss Federal Constitution defines the Swiss Confederation and the Cantons of Switzerland within the scope of their powers to oversee complementary medicine.
In particular, the Federal authorities must set up diplomas for the
practice of non-scientific medicine. The first of such diplomas has been
validated in April 2015 for the practice of naturopathy. There is a long tradition of naturopathy and traditional medicine in Switzerland. The Cantons of Switzerland
make their own public health regulations. Although the law in certain
cantons is typically monopolistic, the authorities are relatively
tolerant with regard to alternative practitioners.
United Kingdom
Naturopathy is not regulated in the United Kingdom.
In 2012, publicly-funded universities in the United Kingdom dropped
their alternative medicine programs, including naturopathy.
_(14756710206).jpg)
![Sebastian Kneipp c. 1898, a Bavarian priest and forefather of naturopathy[18]](https://en.wikipedia.org/wiki/File:Portrait_of_Sebastian_Kneipp._Wellcome_L0005598.jpg)
![Benedict Lust c. 1902, the founder of naturopathy in the U.S.[29]](https://en.wikipedia.org/wiki/File:BenedictLust.jpg)
![Britt Marie Hermes c. 2016, a former naturopathic doctor and major critic of naturopathic medicine[43]](https://en.wikipedia.org/wiki/File:QED_20161015_129.jpg)
_(14760420036).jpg)
