Tensions in Naturopathic Education

Dear Editor:

I'd like to respond to Wardle and coauthors' recent article, ¹ “Review of Tensions and Risks in Naturopathic Education and Training in Australia: A Need for Regulation,” which claims that naturopathy in Australia “remains entirely unregulated” and attributes “consequences on professional outcomes” to this lack of regulation. This view does not represent the actual situation. Wardle and colleagues pay insufficient regard to existing high standards among complementary and alternative medicine (CAM) practitioners in Australia, disparage naturopathic education, and give unnecessary lip service to the wonders of government regulation and academia, as if both these are intrinsic to good naturopathic practice.

High-quality self-regulation is the norm in Australia's major CAM practice associations, to which most practitioners belong. ² The Journal of the Australian Traditional Medicine Association, the Australian Journal of Medical Herbalism (of the National Herbalists Association of Australia), and The Natural Therapist (of the Australian Natural Therapists Association) highlight this quality.

Wardle et al. discuss “proliferation of commercial education providers in the sector,” perhaps suggesting that this causes social or profit-drawing problems; through such proliferation, could money somehow be going to the wrong people? Although Australia's largest privately owned naturopathy college, Endeavour, now has several campuses, Wardle and colleagues do not acknowledge the success and popularity that created such growth, instead targeting all such colleges' use of government funding, including long-term student loans of the kind public university students are entitled to.

Wardle and colleagues claim private-sector CAM education takes place “at expense of the university sector, which is financially disadvantaged in naturopathic education delivery through extra academic and research obligations not shared by private for-profit providers.” Agreed: a major focus of universities is to cultivate academics, “scholarly culture,” and build research capacity. CAM private training colleges, however, aim to cultivate naturopathic and related practitioners. Wardle and colleagues are conflating notions around a track record of research and academic publication with an understanding of quality in naturopathic and teaching practice.

Does desire for such publication history feed into attempts to satiate the mill that constantly demands “proof” of CAM efficacy and safety (while often rejecting evidence when it's provided)? Yet most medical practitioners and students will never be challenged about publication track record or research activities. Nor is an expectation of research to prove validity of their profession and its activities regularly leveled at doctors through academic literature, either within or about their field of practice.

Wardle et al. overlook CAM's safety record, ³ which belies their assertions of inadequacy, patchiness, heterogeneity, and emphasis on skills as opposed to knowledge, from naturopathic education, whether or not naturopaths' slice of the educational attainments cake always closely resembles a medical slice. Wardle and colleagues even imply that grandfathered practitioners are unskilled.

Many CAM practitioners don't want extensive regulation to mimic biomedicine: It hasn't always promoted safety, it limits even “integrative” practice options, and its collegialism can dominate in ways that obscures healing.

Previously, Wardle and coauthors ⁴ found that interest in having patients' stories heard, holism, traditional outlook, affinity with nature cycles, and a degree of stoic independence translated into patients' reasoning for accessing alternative healthcare, according to 20 naturopathic practitioners in Queensland. It seems unlikely these patient values would be better served by a stringently regulated naturopathic “workforce.”