Among the most controversial healthcare professionals you might run into these days are those who practice what’s known as naturopathic medicine.

That approach to healthcare is based on the belief that the human body possesses “an inherent self-healing” ability, according to the American Association of Naturopathic Physicians. Naturopathic practitioners resist drugs and surgery, relying instead on giving patients lots of attention and personalized advice, and turning to a variety of “natural” or “holistic” treatments.

Those include approaches—such as changes in diet, exercise, and lifestyle—that medical doctors (M.D.s) and doctors of osteopathic medicine (D.O.s) also often embrace.

But critics say that many keystones of naturopathic care, such as homeopathy and intravenous vitamin treatment, haven’t been scientifically proved.

Confusing Distinctions

To make matters even more confusing for consumers, there are two main branches of naturopathic practitioners: naturopathic doctors (N.D.s), who have graduated from a four-year naturopathic school and passed a licensing exam given by the Council on Naturopathic Medical Education; and unlicensed naturopaths, who have not completed those steps but practice anyway. That’s generally legal as long as they stick to basic lifestyle advice.

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The American Association of Naturopathic Physicians says it wants N.D.s in all states to be recognized as licensed medical professionals because that would differentiate its members from unlicensed naturopaths.

And it argues that N.D.s should be allowed to work as primary care physicians, prescribe medication, diagnose diseases, and seek insurance payment just like M.D.s and D.O.s.

Lobbying by the AANP has prompted 15 state legislatures to consider bills that would expand or clarify the scope of what N.D.s can do.

But critics—including the American Academy of Family Physicians, which represents many primary care doctors—worry that granting N.D.s the same rights and privileges as M.D.s and D.O.s could harm consumers.

They say that N.D.s aren’t as rigorously trained as medical doctors—who usually study for about a decade before practicing on their own—and that many naturopathic treatments are ineffective and potentially dangerous.

A Fight for Legitimacy

The scope of what N.D.s can now do varies widely by state.

In 20 states plus the District of Columbia, N.D.s are generally allowed to order certain medical tests, such as blood tests and X-rays, and write at least some prescriptions. But in other states they are no different from naturopaths: restricted to offering health advice and nonprescription treatments.

The American Association of Naturopathic Physicians says that distinguishing between N.D.s and untrained naturopaths would protect consumers. “Without licensure, it’s kind of the Wild West,” says Robert Kachko, an N.D. in Connecticut and a board member of the organization. “If anyone can call themselves a naturopath, you end up with people going to completely untrained practitioners, thinking that they’re seeing a real doctor.”

But opponents worry that allowing N.D.s to practice like M.D.s will add to the confusion. “Patients can easily be misled into thinking that an N.D. license is the same as an M.D.’s,” says Britt Hermes, a former naturopathic doctor who says she grew disillusioned with the field after observing what she considered unethical treatment of cancer patients. “It’s essentially allowing them to practice medicine without any real medical training.”

Dubious Science

Timothy Caulfield, a professor of health law at the University of Alberta in Edmonton, Canada, and a longtime skeptic of alternative medicine, says he understands why naturopathic medicine appeals to some consumers: N.D.s are attentive, and treatment plans are personalized.

The problem, Caulfield says, is that many of their treatments aren’t evidence-based. “I went to a naturopath, and it was a totally pleasant experience,” he says. “But I left with $250 in homeopathic solutions and herbal supplements that are completely useless.”

Homeopathy, for example, is based on the notion that tiny doses of a toxin can cure certain medical conditions. (Drinking small doses of pollen dissolved in large quantities of water to cure a pollen allergy, for example.) But a large and growing body of research has found that homeopathy doesn’t work any better than a placebo, or sugar pill.

Some critics say that even less contentious parts of naturopathy tend to be steeped in pseudoscience. “No one disagrees that diet and lifestyle are important,” says Michael Munger, M.D., president of the AAFP. “But a lot of the specifics naturopathy offers are bogus.”

For example, N.D.s sometimes base dietary advice on a patient’s blood type. But a 2013 review in the American Journal of Clinical Nutrition concluded that there was no scientific evidence to back that approach.

When ‘Natural’ Isn’t Safe

N.D.s say that homeopathy and other “natural” therapies are worth trying first because they’re less toxic than pharmaceuticals. In fact, safety is a key selling point of naturopathic medicine. N.D.s call it the “therapeutic order,” meaning that practitioners should start with the safest treatments available.

“We’re not against drugs or surgery,” Kachko says. “But that shouldn’t be the first thing that we do.”

The AAFP and other supporters of standard medical care say that argument fails on several counts.

First, M.D.s are also trained to focus on doing the least harm and to avoid riskier treatments until safer ones have been exhausted. “Naturopaths like to say that they focus on health, while we just treat illness,” Munger says. “But that’s not true. Preventive healthcare is a staple of primary medicine.”

Second, many treatments that N.D.s offer aren’t in fact natural. “There is nothing natural about infusing massive doses of herbs or vitamins into your bloodstream,” says Pieter Cohen, M.D., of the Harvard T.H. Chan School of Public Health, who studies the dietary-supplement industry.

And last, while standard medical care can harm patients, so can naturopathic care. There’s no reliable information on how often such harm occurs, but there are some documented cases.

For example, the Food and Drug Administration reported last March that a 30-year-old woman died after receiving an intravenous infusion of curcumin (an ingredient in the spice turmeric) from a naturopathic practitioner to treat eczema, a relatively benign skin condition that’s usually treated with steroids. According to the FDA, medical authorities concluded that the curcumin—which was deemed ineffective by a comprehensive 2017 scientific review—caused her death.

Proceed With Caution

If you’re considering naturopathic medicine, think twice. First, talk with your primary care doctor. If your goal is to improve your health through diet, exercise, or other lifestyle changes, your M.D. or D.O. may well be able to help just as well.

If you opt for naturopathic medicine anyway, be skeptical of claims that it’s safer, more natural, or less profit-oriented than conventional medicine.

Remember that while N.D.s have more formal medical education than naturopaths, neither practitioner is as rigorously trained as an M.D. or a D.O.

And keep in mind that most naturopathic treatments are usually not covered by insurance, so you’ll most likely have to foot the bill yourself.