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HEALING ARTS: Changing the ‘script’ Naturopathic physicians seek authority to write prescriptions

By Linda Conner Lambeck CTPOST 8-6-2016

The 411 on naturopathic medicine

Christian Abraham / Hearst Connecticut Media Jennifer Holdorf, right, clinic coordinator with the University of Bridgeport’s College of Naturopathic Medicine, with students Ryan Attar, left, and Matthew Castanho.

Christian Abraham / Hearst Connecticut Media
Jennifer Holdorf, right, clinic coordinator with the University of Bridgeport’s College of Naturopathic Medicine, with students Ryan Attar, left, and Matthew Castanho.

WHAT ARE NATUROPATHIC PHYSICIANS?

Naturopathic physicians diagnose and treat patients with a focus on natural healing. Instead of dealing with symptoms, they work with patients to root out the cause of an illness or prevent it altogether. They like to say they treat the “whole” person. The emphasis is on wellness, diet and lifestyle.

HOW DO YOU BECOME ONE?

To become licensed in Connecticut, an ND must attend a four-year naturopathic medical school that is accredited through the U.S. Department of Education. The training in the basic sciences is the same as a student in medical school would receive. Upon graduation, the ND must pass a licensing exam.

WHAT STATES ALLOW THEM TO PRACTICE?

With the passage of a bill this year in Maryland, there are now 17 states, plus Washington, D.C., Puerto Rico and the Virgin Islands, that license NDs. The scope of practice in each state varies. In some states, NDs can perform minor surgeries, but not in Connecticut. At present, 11 that license NDs allow some form of prescriptive authority.

BRIDGEPORT — Ryan Attar was drawn to naturopathic medicine through his experience as a diabetic.

“I saw a naturopathic doctor and it was the first doctor who sat down and talked about my diet,” Attar said, looking up from a laptop in a conference room at the University of Bridgeport’s Health Sciences Center. “I was like, wow. This is what you are supposed to do.”

As it stands, after Attar, 36, an Army veteran from Bristol, completes a four-year program in the UB College of Naturopathic Medicine in 2017, he won’t be able to prescribe insulin or blood-sugar monitors, if he decides to practice in Connecticut.

Connecticut has licensed naturopathic physicians for nearly a century, but it is in the minority of states that allow the practice, but do not give NDs the power to write prescriptions.

A special act passed by the Legislature and signed by the governor in the most recent session might change that. The law creates a committee under the supervision of the commissioner of public health.

The panel’s task is to report back to lawmakers on what additional training naturopathic doctors need to gain prescriptive authority, and what types of medication they should be allowed to dispense.

The committee has both supporters of naturopathy and members of the medical community, some of whom were strongly opposed to the idea of ND prescribers when it was up for debate in the Legislature.

Thus far, it is hard to tell whether the committee is about “how” or “whether” to expand the scope of naturopathic physicians’ practices.

Christian D. Andresen, chief of licensing for the state Department of Public Health, and Wendy H. Furniss, a branch chief for the department, have tried to steer the group toward consensus.

“The law is telling us to generate some initial direction that the Legislature can then perhaps turn into a kind of road map,” Furniss said, “a reasoned and safe path, not just a stop sign.”

Still explaining themselves

Prenguber, dean of the College of Naturopathic Medicine.

Prenguber, dean of the College of Naturopathic Medicine.

Naturopaths say their job is to prevent, diagnose and treat illnesses by supporting the body’s natural healing mechanisms. They focus on diet, nutrition, and lifestyle changes. Often, they work in conjunction with more conventional medical care providers.

Lack of prescriptive authority “is one of the things that holds us back.”
Marcia Prenguber, dean of the UB College of Naturopathic Medicine

Connecticut has allowed the practice of naturopathic medicine since 1920. The late state Sen. George “Doc” Gunther, of Stratford, was a naturopathic physician.

The state currently has 322 licensed naturopathic physicians. Nationwide, there are about 5,000 NDs, according to the American Association of Naturopathic Physicians.

Eighteen states and the District of Columbia license naturopathic medicine. Of those, 11 allow naturopathic doctors prescriptive authority.

UB has one of a handful of accredited naturopathic medicine programs in the country, founded in 1997. ND students at UB take two years of sciences — as a medical doctor would — plus courses in nutrition, herbal medicine, mental health and pharmacology.

UB students get about 72 hours of direct instruction in pharmacology, but the subject is also integrated into many other courses, said Dr. David Brady, vice provost for health sciences at UB.

The scope of service and training, however, still has some in the medical community puzzled.

Dr. Domenic Casablanca, with the Yale Northeast Medical Group in Shelton, called the move to put prescription pads in the hands of naturopaths premature.

“The training strength isn’t there,” said Casablanca, who is a member of the committee established by the Legislature. “That doesn’t mean they can’t get there.”

Seeking common ground

Brady and others, however, say UB naturopathic grads are trained in prescribing medications, and do it already in states where it is allowed.

He and other representatives of the state’s naturopathic community came to the latest state meeting with a proposed list of medications they say naturopaths should be allowed to prescribe — such as antihistamines, contraception and antibiotics — as well as list of exclusions, such as anti-cancer agents, barbiturates and anti-psychotics.

The group also offered a sample of an advanced clinical pharmacology course sylabus that could be offered if the state deemed existing training inadequate.

Dr. David Emmel, an ophthalmologist representing the Connecticut State Medical Society, said making a list of acceptable medications was a very challenging task, based on the level of training naturopathic students receive.

“I don’t think you even have a clue as to what our training actually is,” responded Dr. Rick Liva, a naturopathic physician in Middletown.

Practice appears to be a sticking point. Unlike medical doctors, naturopathic physicians don’t go through hospital residencies that would allow them to try out their drug-dispensing skills. Hospitals do not accept them as residents.

Instead, UB students do clinical rotations through the university’s health clinic, which sees about 25,000 patients a year. They also practice their craft in nursing facilities, public health clinics and even a Bridgeport elementary school.

The college health clinic has a ground-floor “dispensary” stocked with a large assortment of supplements, herbs, homeopathic remedies and fish oils.

“We are trained differently, not inadequately,” Brady said.

Brady pointed out that not long ago, Advanced Practice Registered Nurses had to wage their own battle to win prescriptive rights. Others countered that the process took years.

Christian Abraham / Hearst Connecticut Media Jennifer Goto, a student in the University of Bridgeport’s College of Naturopathic Medicine, works on patient data at the school. A state panel is considering whether the state should authorize naturopathic physicians to prescribe medications.

Christian Abraham / Hearst Connecticut Media
Jennifer Goto, a student in the University of Bridgeport’s College of Naturopathic Medicine, works on patient data at the school. A state panel is considering whether the state should authorize naturopathic physicians to prescribe medications.

“We need a transition,” said Donna Sanchez, representing the Connecticut Association of Nurse Anesthetists. “I would be supportive of a process.”

Wait and see

For Attar, who spent the summer interning in Vermont — where he said naturopathic physicians have full primary care rights — the outcome of the committee work will play into his decision on where to set up shop.

For UB, it could mean growing from an enrollment of 100 in the face of new competition. Maryland just allowed licensing of naturopathic doctors this year, and is also starting a school.

Lack of prescriptive authority “is one of the things that holds us back,” said Marcia Prenguber, dean of UB’s Naturopathic college.

Some naturopathic doctors practice both in Connecticut and Vermont. Others hold a second license in a field with prescriptive authority.

Kendra Becker is a practicing naturopathic doctor in Waterford who can prescribe medications, because the 2005 UB grad is also an advanced practice registered nurse.

She got the RN degree first, then decided it was not her kind of medicine. In practice for 11 years as an ND, Becker says she lives her life from a naturopathic standpoint.

“In truth, I probably prescribe about 10 pharmaceuticals a year,” said Becker. “One of the tenets of naturopathic medicine is to let patients be in the driver’s seat of their care.”

She said allowing naturopathic physicians to write prescriptions would put drug dispensing power in more responsible hands. The goal she said, is to figure out what is wrong, not mask it with a pill.