research papers on naturopathy

• Research article
• Open access
• Published: 18 February 2020

Overview of international naturopathic practice and patient characteristics: results from a cross-sectional study in 14 countries

• Amie Steel   ORCID: orcid.org/0000-0001-6643-9444 1 ,
• Hope Foley 1 , 2 ,
• Ryan Bradley 1 , 3 , 4 ,
• Claudine Van De Venter 1 ,
• Iva Lloyd 5 ,
• Janet Schloss 1 , 2 ,
• Jon Wardle 1 &
• Rebecca Reid 1 , 2  

BMC Complementary Medicine and Therapies volume  20 , Article number:  59 ( 2020 ) Cite this article

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Naturopathy is a distinct system of traditional and complementary medicine recognized by the World Health Organization and defined by its philosophic approach to patient care, rather than the treatments used by practitioners. Worldwide, over 98 countries have practicing naturopaths, representing 36% of all countries and every world region. The contributions of naturopaths to healthcare delivery services internationally has not been previously examined. Thus, the primary intention of this research was to conduct an international survey of naturopathic practice and patient characteristics in order to gain insight to the breadth of their practices and the type of clinical conditions routinely encountered.

The cross-sectional study was conducted in naturopathic clinics in 14 countries within 4 world regions including the European (Portugal, United Kingdom, Switzerland, Spain), Americas (Canada, United States, Chile, Brazil), Western Pacific (Hong Kong, Australia, New Zealand) and African (South Africa). Naturopathic practitioners in each country were invited to prospectively complete an online survey for 20 consecutive cases. The survey was administered in four languages.

A total of 56 naturopaths from 14 countries participated in the study, providing a mean of 15.1 cases each (SD 7.6) and 851 cases in total. Most patients were female (72.6%) and all age categories were represented with a similar proportion for 36–45 years (20.2%), 46–55 years (19.5%), and 56–65 years (19.3%). A substantial majority (75%) of patients were considered by the participant to be presenting with chronic health conditions. The most prevalent category of health conditions were musculoskeletal (18.5%), gastrointestinal (12.2%), and mental illness (11.0%). The most common treatment categories prescribed or recommended to patients by the participants were dietary changes (60.5%), lifestyle and behaviour changes (56.9%), herbal medicines (54.2%) and nutritional supplements (52.1%). Many patients were known by participants to be receiving care from a general practitioner (43.2%) or a specialist medical practitioner (27.8%).

Conclusions

Naturopathic practitioners provide health care for diverse health conditions in patients in different age groups. The global population would benefit from researchers and policy makers paying closer attention to the potential risks, benefits, challenges and opportunities of the provision of naturopathic care within the community.

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Introduction

Naturopathy is a distinct system of traditional and complementary medicine (T&CM) recognized by the World Health Organization (WHO) [ 1 ]. The World Naturopathic Federation (WNF), established as an internationally representative body for the naturopathic profession globally [ 2 ], defines naturopathy as a system of healthcare with a deep history of traditional philosophies and practices, medically trained practitioners and a breadth of natural treatment options to serve patients [ 3 ]. In many countries, the educational model for naturopathy is comparable to biomedical training with its foundation in anatomy, physiology and diagnostics. Naturopathic clinical education emphasizes non-drug based treatments including lifestyle-oriented self-care; preventive behaviors, dietary nutrition, physical activity, and stress-management counseling; clinical nutrition (i.e., targeting pharmacologic actions by nutrients for specific diseases irrespective of nutrient status); herbal medicine; homeopathy and hands-on manual therapies, more so than over-the-counter and prescription drug therapies or surgical interventions [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ].

Notably, although naturopaths have unique training in treatments not represented in other areas of medicine, the profession is defined more by its philosophic approach to patient care, rather than the treatments used. The philosophy has been codified into seven principles including: First Do No Harm ; Doctor as Teacher ; Apply the Healing Power of Nature ; Treat the Whole Person ; Treat the Cause ; Wellness ; Health Promotion and Disease Prevention [ 3 ]. These principles provide a conceptual model for patient encounters, including a comprehensive consultation and examination process, common approach to clinical diagnostic processes, and the application of various treatments. Worldwide, 98 countries are known to have naturopathic practitioners, representing every world region [ 13 ]. The largest proportion of countries in any world region where naturopathic practitioners are providing care is North America (67%) [ 14 ], and this region also has one of the more established regulatory positions for naturopaths [ 15 ]. In North America, where much of the early professional formation of the naturopathic profession was centered, naturopathy is licensed in six Canadian provinces and 20 US states as well as the Washington District of Columbia (D.C.) and the territories of Puerto Rico and the U.S. Virgin Islands [ 16 , 17 ]. In Europe, where naturopathy and its precursors (such as nature cure) originate and have been practiced for centuries, naturopathic practitioners are reported in over 30 European countries [ 15 ], only three of which regulate naturopathic practice [ 15 ]. Only a slightly lower proportion of countries in Latin America (43%) have naturopathic practitioners [ 14 ]. In Asia, naturopathic practitioners have a significant presence in India, Nepal, Hong Kong, Indonesia, Malaysia, Singapore and Thailand while naturopathic practitioners are also one of the dominant traditional medicine systems in Australia and New Zealand [ 14 ].

Although several evaluations of naturopathic practice (including prospective clinical trials and retrospective practice audits) suggest favorable contributions of naturopaths to both patient health outcomes, and established measures of primary care quality [ 6 , 7 , 8 , 11 , 18 , 19 ] the contributions of naturopaths to healthcare delivery services internationally has not been previously examined via formal research. Given many health conditions remain challenging to manage, either due to limitations in available treatments (e.g., chronic pain [ 20 ]) or the complexity of the conditions themselves (e.g., mental health conditions [ 21 ]), contemporary health systems should aim to utilize all resources at their disposal. An examination of the role of naturopaths in health care may present an opportunity to elucidate additional healthcare resources that are as yet unrecognized to mainstream health services and administrators. Thus, the primary intention of this research was to conduct an international survey of naturopathic practice and patient characteristics in order to gain insight to the breadth of practices and the type of clinical conditions routinely encountered in naturopathic visits.

Aim and study design

This cross-sectional survey aimed to describe the characteristics of typical naturopathic practices and their associated patients internationally.

This study was conducted in naturopathic clinics in 14 countries within 4 world regions including the European (Portugal, United Kingdom, Switzerland, Spain), Americas (Canada, United States, Chile, Brazil), Western Pacific (Hong Kong, Australia, New Zealand) and African (South Africa).

Participants

The study included naturopathic practitioners who were currently in practice and a member of a naturopathic association recognised by the WNF. Participants were required to have been in practice for at least five years, preferably seeing more than ten patients per week, and to have a computer terminal in their clinic. Naturopaths were excluded if they identified as practising within a specialised field (e.g. primarily focused on treating cancer or female reproductive conditions).

Recruitment

The World Naturopathic Federation shared an invitation from the research team with recognised naturopathic professional associations in preselected countries to forward on to their members. The countries included were identified by the World Naturopathic Federation as having sufficient infrastructure within the naturopathic profession to facilitate recruitment while also permitting global geographical distribution. Naturopathic practitioners interested in participating in the study accessed study documents online, including an information sheet and consent form. Following online screening, an automated email was sent to the research team who then emailed the participants a direct link to the online survey instrument. Participants were asked to prospectively complete the instrument for 20 consecutive cases. At the beginning of the survey the respondent was asked whether they had missed completing a survey about any previous patients and, if yes, queried to provide the reason the patient was not included.

Document translation

The invitations email, information sheet, screening instrument and survey were all initially drafted in English and then translated into French, Spanish, and Portuguese by native language speakers. The translated documents were then cross translated back to English by a second group of individuals. All translations were coordinated by the World Naturopathic Federation. The research team then checked the translations for accuracy with the original English documents. No discrepancies were found, and the translated documents were used in the study.

The survey was administered in four languages (English, French, Portuguese and Spanish) via Survey Gizmo. The survey included five domains: (1) Patient sociodemographics, (2) Chief complaint/reason for care, (3) Interprofessional care, (4) Prescribed or recommended treatments and (5) Naturopathic interpretation of the health condition.

Patient sociodemographics

Participants were asked to provide information about patients’ sex (male, female, non-binary) and age categories. No protected health information was collected in the survey.

Reason for visit

The survey queried the reason the patient visited with the naturopath on each occasion including: the visit type (initial visit or follow up consultation) and the nature of the primary complaint for which the patient was seeking assistance (i.e., chronic, acute, unsure). The naturopaths were also asked to identify the chief complaint for the patient, collected through a two-stage process. Firstly, participants were asked to select one of 17 system-based categories (e.g. gastrointestinal, respiratory, cardiovascular, autoimmune) for the patient’s presenting complaint. Upon selection of the system, survey logic populated a more specific list of conditions from which participants were required to select an option. For each list of conditions an ‘other’ option was also available which allowed respondents to manually enter a condition not included on the list. The list of conditions was developed based on an internationally available naturopathic clinical textbook [ 22 ].

Interprofessional care

Naturopaths were asked to identify any other health professionals (general practitioner, specialist doctor, allied health professional, complementary medicine practitioner, other health professionals) known to be providing care to the patient for the presenting complaint, where applicable.

Prescribed or recommended treatments

The survey also included items that asked naturopaths to identify the treatments prescribed or recommended to the patient based on a list of treatment categories (e.g. herbal medicines, dietary changes, acupuncture, lifestyle recommendations). The list was developed based on the most common therapies reported by the World Naturopathic Federation in the Naturopathic Roots Report [ 23 ].

Naturopathic interpretation of the health condition

Respondents were asked to indicate any other health systems they considered relevant or important to the management of the patient’s presenting complaint (e.g. endocrine system, gastrointestinal system, reproductive system). The same list of health systems used to capture data about the reason for the patient visit was employed for this survey item but respondents were able to select as many response options as they felt appropriate.

Data management and analysis

Data were exported from Survey Gizmo as four separate Microsoft Excel spreadsheets. The data were merged into one dataset. All non-English responses to specific items were translated to English using a priori developed translations. All non-English open text responses were translated using Google Translate. All open text ‘other’ responses were cross-checked by a member of the research team (AS) against the available response options. For example, if a respondent selected ‘gastrointestinal system’ instead of ‘autoimmune condition’ for a patient presenting with coeliac disease then they would have entered this into the ‘other’ category. In these cases, the response was reallocated to the appropriate response. All data were then coded and imported into Stata 14.2 for analysis.

Descriptive statistics were tabulated as frequencies and percentages and chi square tests were used to test associations and compare groups. Treatment categories were collapsed into grouped variables for the following : lifestyle and behavioural changes (lifestyle, exercise, meditation, mind-body and rehabilitation exercise); manual therapies (massage, bodywork, acupuncture); invasive treatments (intravenous therapy, injection therapy, colonics, mesotherapy, chelation therapy, surgery); other energetic medicines (flower essences, tissue salts); other traditional medicine systems (traditional Chinese medicine, Ayurveda, humoral therapy, Unani medicine). Cumulative variables were also generated for the total number of treatment categories prescribed and the total number of other health systems considered by the naturopath to be relevant or important to the patient’s primary complaint.

Ethical clearance

This project was approved by the Human Research Ethics Committee of the Endeavour College of Natural Health (#20181017).

A total of 56 naturopaths from 14 countries participated in the study, providing a mean of 15.1 cases each (SD 7.6) (see Table  1 ). The participants were drawn from countries representing the European, Americas, Western Pacific, and African world regions. The majority of naturopathic practitioners were female (62.5%) and their age was fairly evenly distributed although the most prevalent age group was 26–45 years (37.5%). Most participant naturopaths had been in practice for between 5 and 15 years (5–10 years, 44.6%; 11–15 years, 25.0%) and reported an average of 11–20 (35.7%) or 21–30 (21.4%) patient visits per week). In 4.1% of responses the participant naturopath indicated they had missed providing data for one of their patients.

Table  2 presents the sociodemographic characteristics of patient encounters ( n  = 851) as reported by the naturopathic practitioners. The majority of patients were reported by participant naturopaths as female (72.6%). All age categories were represented in the details reported by the participant naturopaths, with a similar proportion for 36–45 years (20.2%), 46–55 years (19.5%), and 56–65 years (19.3%). Approximately two thirds (67.0%) of patients were described as attending the participant naturopaths’ clinic for a follow up visit. A substantial majority (75%) of patients were considered by the participant naturopath to be presenting with a chronic health condition.

The primary reason for the patient visiting with the participant for naturopathic treatment was quite varied and is presented in Table  3 . The most prevalent categories of health condition were musculoskeletal (18.5%), gastrointestinal (12.2%), and mental illness (11.0%). General wellness and prevention was also cited as a primary reason for patients consulting with the participant naturopath (6.7%). Eleven of the 17 categories of health conditions were described as the primary presenting complaint for between 6 and 3% of all patients. Patients reported by participant naturopaths as presenting with a musculoskeletal complaint as their primary concern, were most frequently identified as having chronic musculoskeletal pain (48.4%), injury (19.1%), or osteoarthritis (12.7%). Participant naturopaths indicated patients reporting a gastrointestinal condition were most frequently presenting with irritable bowel syndrome (31.7%), gastro-oesophageal reflux (17.3%), or food allergy, intolerance or sensitivity (16.4%). When asked to identify other physiological systems or health concerns being considered in the management of each patient’s health, the gastrointestinal system was most commonly selected (40.8%). Less common but still prevalent was general wellness and prevention (28.7%) and the endocrine system (23.8%). Participant naturopaths reported considering a mean of 2.4 other physiological systems or health categories for each individual case when developing a treatment plan (SD 1.7, range = 0–14) (data not shown in table).

The most common treatment categories prescribed or recommended to patients by the participant naturopaths were dietary changes (60.5%), lifestyle and behaviour changes (56.9%), herbal medicines (54.2%) and nutritional supplements (52.1%) (see Table  4 ). Less common were acupuncture (27.2%), manual therapies (22.1%), homeopathy (22.0%), and counselling/psychotherapy (18.7%). Participant naturopaths reported prescribing or recommending a mean of 4.0 different treatment categories for each individual case (SD 1.8, range = 0–10) (data not shown in table).

Table  5 presents the details of other health professionals, as known to the participant naturopath, to be providing care to the same patient. Many patients were known to be receiving care from a general practitioner (43.2%) or a specialist medical practitioner (27.8%). Co-treatment by an allied health practitioner (12.4%) or a complementary medicine practitioner (10.9%) was less prevalent. According to the participant naturopaths, approximately one third of patients (33.0%) were known to be only consulting with the participant naturopath to manage their primary health concern.

The results presented here represent the first known examination of international naturopathic practice. There are key findings with particular importance for the understanding of naturopathy in the context of contemporary healthcare practice and policy. Firstly, in all geographic settings naturopaths appear to treat patients with a diverse range of conditions and across all ages and gender. In many cases, they may also provide care to these patients without the involvement of other health professionals, indicating that they are practising as the primary care provider. These characteristics highlight the versatility of naturopathic practice as they align with the established definition of primary care in that it “addresses any health problem at any stage of a patient’s life cycle” [ 24 ]. Therefore, the scope of naturopathic practice may go beyond being solely classified as an additional complementary health care system alongside standard conventional care.

The patients visiting naturopaths in our study presented with conditions which not only demonstrate diversity, but also include conditions recognised as contributing strongly to the global burden of disease. The most recent Global Burden of Disease study reports ischaemic heart disease, stroke, respiratory infections and diarrheal diseases among the five leading causes of early death in 2017; all of which the participants in our study were treating (see Fig.  1 ) [ 25 ]. Four out of the five global leading causes of disability (low back pain, depressive disorders, headache and diabetes) were also among those reported by participants as the primary reason of their patient’s visit (see Fig.  2 ) [ 26 ]. Furthermore, nine of the ten leading causes of early death expected in 2030 are also featured in the list of conditions for which patients were described as seeking treatment for from a naturopathic practitioner [ 27 ]. The current and potential future contributions being made by naturopathic practitioners toward mitigating the effects of these conditions on the global burden of disease are, at present, unclear and deserving of further attention. Many of these conditions are noncommunicable diseases (NCDs) with high quality established evidence for preventive care and health promotion counselling to reduce established risk factors [ 28 ]. Considering the fact naturopaths are treating NCDs, measuring and quantifying their contributions to reduced disease burden and impact on national medical expenses for countries warrants further investigation.

Leading causes of early death in 2017 and Expected leading causes of early death in 2040 (Source: Global Burden of Disease Study, 2017) [ 25 ]

Early death and disability - causes and risk fctors in 2017 (Source: Global Burden of Disease Study, 2017) [ 25 ]

A prominent feature for the majority of the NCDs commonly treated by naturopaths in this study is the importance of diet and lifestyle as evidence-based primary prevention, particularly for cardiovascular disease [ 26 , 28 ], diabetes [ 29 ], lung cancer [ 30 ], chronic kidney disease [ 31 ], and chronic obstructive pulmonary disease [ 32 ], with additional emerging evidence for Alzheimer’s disease [ 33 ] and lower respiratory tract infections [ 34 ]. Interestingly for the latter, prevention of lower respiratory tract infections has been linked to various factors including improved sleep, dietary modifications, improved immune function, and psychological support suggesting that a holistic approach to clinical care is required [ 34 ]. Holism is integral to naturopathic philosophy, and preventive care is reflected in the core naturopathic principle of Disease prevention and health promotion [ 3 ]. While primary prevention is a global priority for the health conditions causing early death and disability, it is also worth noting that primary care practitioners may be challenged to accommodate preventive health care service delivery within their usual care load [ 35 ]. As such, naturopathic practitioners may be an untapped health resource in many health systems which can relieve the burden on primary care physicians [ 36 ]. While our study does not detail the specific prevention, screening or treatment methods used by the clinician, the data suggests they were considering body weight, metabolic disorders, and diet and lifestyle changes in the context of patient care; all of which are important modifiable risk factors for morbidity and mortality [ 25 ]. Further clinical research that explores the patient outcomes of naturopathic care for the prevention of these globally important conditions is urgently needed.

This study also describes unique and diverse treatments employed by naturopathic practitioners as part of routine patient care, that are not delivered, or counselled on, by other types of clinicians. While some treatments were prescribed or recommended in most cases (dietary modifications, lifestyle changes, herbal medicines, nutritional products), there were many other treatment categories reported. In addition, the study results evidence that the clinicians were employing multiple treatments in the care of an individual patient. This finding aligns with a report by the WNF describing the content of naturopathic curriculum worldwide which noted that clinical nutrition (dietary prescription), applied nutrition (individualised nutritional product prescription), and botanical medicine (herbal medicine) are taught in more than 90% of recognised naturopathic programs internationally [ 23 ]. According to the WNF Roots Report [ 23 ], lifestyle counselling is not commonly taught within naturopathic curricula, but was still listed in more than 70% of cases in our study. This discrepancy between the use of lifestyle prescription in practice and the frequency of its inclusion in naturopathic curricula highlights a need for further investigation of the content and impact of tacit content and the need for naturopathic educational organisations to address any gaps in training in some countries. Given the importance of lifestyle interventions in prevention and management of NCDs and the findings of our study this is an important area of naturopathic care.

The variance in therapeutic tools employed by naturopathic practitioners in our study also reinforces the position held by the WNF that the naturopathic profession is a traditional system of medicine defined by its philosophies and principles [ 3 ] rather than by specific practices. For example, the frequency with which naturopathic practitioners in our study identified considering other physiological systems and health concerns when managing an individual’s primary presenting complaints may demonstrate the clinician’s application of core naturopathic principles such as: Treat the whole person , Treat the cause ; and Disease prevention and health promotion [ 3 ]. Yet the treatments employed by naturopathic practitioners may vary across countries when applying these principles. This difference in application may be due to the influence of various local social, cultural, and legislative frameworks [ 15 ]; a factor contributing to the complexity of global naturopathic practice. These local differences may also impact on care provision and whether naturopathy is being accessed in a complementary or primary care context. Previous research has indicated the potential for naturopaths to be functioning as primary care practitioners [ 37 ]. Legislative frameworks in specific states in the United States and Canada already clearly position naturopathic practitioners as primary care physicians [ 15 ]. The extent to which a primary care capacity is filled by naturopathic practitioners may vary in different countries but is a topic worthy of further exploration.

Equally, research evaluating the effectiveness of naturopathic care ideally should employ a whole practice research designs that accounts for the complex treatment mix and individualised treatment approach characteristic of naturopathic practice. Available evaluations of outcomes from naturopathic practices suggest naturopathic care may improve the outcomes of patients with cardiovascular conditions, diabetes, chronic pain, autoimmune disease, mental illness, and chronic obstructive pulmonary disease [ 38 ]. While there may be evidence supporting the application of specific treatments used by naturopathic practitioners in the management of some of these conditions [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ], further research is required to fully quantify the impact and effectiveness of naturopathic care on the clinical outcomes across the diverse health complaints clinicians appear to be treating. Additionally, while all of conditions identified in this recent review are among those reported in our study as the primary reason patients have visited with naturopathic practitioners, there are also numerous conditions for which naturopathic care has not been examined.

Limitations

As usual, the findings reported here should be viewed within the context of the study’s limitations. While this is the most comprehensive global study to date examining the characteristics of naturopathic clinical practice, it cannot be viewed as generalizable to the entirety of the international naturopathic profession. Instead, this study provides preliminary data that should be examined in more detail or in larger, more focused studies. The diversity of naturopathic practice in different geographical areas will be affected by social, cultural and legislative influences which should be carefully considered within unique national and regional settings. However, the scope and ethical constraints of this study did not permit inter-regional analysis. The recruitment frame, limited to members of professional associations, also biases the results toward those naturopaths who may be more academic, transparent and/or generally professional in their practices. Equally, the requirement for participants to have a computer at their clinical location may have also introduced a bias, as naturopaths without access to a computer in their clinic may have other practice differences compared to those that do. Due to the heterogeneity of practice locations and the pilot nature of this study, it was decided to have a few practitioners from each country only. However, as described by the Agency for Health Research and Quality, a level of representativeness can be afforded by a practice-based research study conducted in a minimum of five locations and with at least 15 participating clinicians [ 49 ]. The survey data also relies on self-report, which may result in additional bias. Equally, some survey items required participants to report on patient characteristics and the accuracy of this data was not independently confirmed by the researchers. Similarly, patients were not contacted directly for confirmation of their chief complaints nor their engagement with other health care practitioners involved in their care. Despite these limitations, this study offers an important contribution to the understanding of naturopathic practice at a global level.

Naturopathic practitioners provide health care for diverse health conditions across the life course. Patients are consulting with naturopathic practitioners for support with health conditions of global importance and there is emerging evidence to suggest naturopathic care may benefit individuals with some of these conditions. Overall, this study suggests naturopathic practitioners may represent an aspect of primary care and disease prevention that is accessed by patients around the world. The global population would benefit from researchers and policy makers paying closer attention to the potential risks, benefits, challenges and opportunities of the provision of naturopathic care within the community.

Availability of data and materials

The datasets generated and analysed during the current study are not publicly available due to intellectual property agreements but are available from the corresponding author on reasonable request.

Abbreviations

District of Columbia

Non-communicable diseases

Traditional and complementary medicine

World Health Organisation

World Naturopathic Federation

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This project was funded by the World Naturopathic Federation (WNF). Representatives of the WNF were involved in preliminary stages of study design and analysis. IL provided feedback on the survey design and assisted with selecting the countries included in the study. IL also provided final review and minor editing to the manuscript after analysis and interpretation had been conducted by independent members of the authorship team.

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AS, RR, IL and HF were responsible for study design. IL coordinated instrument translation and participant recruitment. AS and HF managed data collection. AS conducted the analysis. AS, HF, JS, RB and CVV prepared the first draft of the manuscript. All authors edited and reviewed the manuscript. The author(s) read and approved the final manuscript.

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Steel, A., Foley, H., Bradley, R. et al. Overview of international naturopathic practice and patient characteristics: results from a cross-sectional study in 14 countries. BMC Complement Med Ther 20 , 59 (2020). https://doi.org/10.1186/s12906-020-2851-7

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DOI : https://doi.org/10.1186/s12906-020-2851-7

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Please note you do not have access to teaching notes, global naturopathy research as reflected by scopus during 2000-2019.

Collection and Curation

ISSN : 2514-9326

Article publication date: 21 June 2021

Issue publication date: 14 October 2021

The purpose of this study is to analyze research output in the naturopathy field at the global level and to examine the various trends in scientific literature available on naturopathy using bibliometric analysis.

Design/methodology/approach

The data was collected from the SciVerse Scopus database published from 2000 through 2019. The search was conducted using Medical Subject headings entry terms, i.e. “Naturopathy” OR “Naturopathic Medicine” using the “Document” search option. The search results comprised of documents that had these above search terms in their article title, abstract and keywords. The retrieved documents were then analyzed concerning different parameters like the growth of publications, authorship patterns, productive countries and institutions, highly cited papers, top prolific authors, funding agencies and document types.

The results of this study reveal that a total of 1,099 documents were published during 20-year time span. The most preferred publication type is research articles 683 (62.14%). Germany, USA, Australia, India and Canada were the most productive countries in terms of the number of scientific documents. The findings also show that the most preferred journal in the field of naturopathy is MMW Fortschritte der Medizin , with 115 documents followed by Journal of Alternative and Complementary Medicine with 58 documents. In contrast, the journal BMC Complementary and Alternative Medicine had the highest citations per paper (17.85). For the 20-year study period, the average value for the degree of collaboration was calculated as 0.57, indicating 54% of the total publications in naturopathy were multi-authored. The value of the collaboration coefficient (CC) signifies the levels of multi-authored papers. CC was highest in the year 2019 (0.55) indicating that the publications were contributed in collaboration rather than in isolation and the number of multi-authored/mega-authored papers outnumbered the single authors in the collection of all authors in the year 2019. Bastyr University, USA was the most productive Institution. Journal articles were the most preferred form of publication.

Practical implications

This study traces various trends in the research behavior and preferences of researchers in the field of naturopathy. It thus can be of immense help to identify strong areas in naturopathy research. Further, this study will help the librarians to identify the core/preferred journals in naturopathy. 

Originality/value

This paper makes an endeavor to carry an extensive bibliometric study that provides an overview of emerging trends in naturopathy research.

• Bibliometrics
• Authorship pattern
• Collaborative research
• Collaboration coefficient
• Naturopathic medicine
• Naturopathy
• Nature cure
• Research trends
• A degree of collaboration
• Collaborative index

Khan, N.A. , Ahangar, H. and Jhamb, G. (2021), "Global naturopathy research as reflected by Scopus during 2000-2019", Collection and Curation , Vol. 40 No. 4, pp. 166-177. https://doi.org/10.1108/CC-06-2020-0024

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Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974

Affiliation.

• 1 Department of Research and Clinical Epidemiology, The Canadian College of Naturopathic Medicine, Toronto, Canada. [email protected]
• PMID: 19718255
• PMCID: PMC2729375
• DOI: 10.1371/journal.pone.0006628

Background: Anxiety is a serious personal health condition and represents a substantial burden to overall quality of life. Additionally anxiety disorders represent a significant cost to the health care system as well as employers through benefits coverage and days missed due to incapacity. This study sought to explore the effectiveness of naturopathic care on anxiety symptoms using a randomized trial.

Methods: Employees with moderate to severe anxiety of longer than 6 weeks duration were randomized based on age and gender to receive naturopathic care (NC) (n = 41) or standardized psychotherapy intervention (PT) (n = 40) over a period of 12 weeks. Blinding of investigators and participants during randomization and allocation was maintained. Participants in the NC group received dietary counseling, deep breathing relaxation techniques, a standard multi-vitamin, and the herbal medicine, ashwagandha (Withania somnifera) (300 mg b.i.d. standardized to 1.5% with anolides, prepared from root). The PT intervention received psychotherapy, and matched deep breathing relaxation techniques, and placebo. The primary outcome measure was the Beck Anxiety Inventory (BAI) and secondary outcome measures included the Short Form 36 (SF-36), Fatigue Symptom Inventory (FSI), and Measure Yourself Medical Outcomes Profile (MY-MOP) to measure anxiety, mental health, and quality of life respectively. Participants were blinded to the placebo-controlled intervention.

Results: Seventy-five participants (93%) were followed for 8 or more weeks on the trial. Final BAI scores decreased by 56.5% (p<0.0001) in the NC group and 30.5% (p<0.0001) in the PT group. BAI group scores were significantly decreased in the NC group compared to PT group (p = 0.003). Significant differences between groups were also observed in mental health, concentration, fatigue, social functioning, vitality, and overall quality of life with the NC group exhibiting greater clinical benefit. No serious adverse reactions were observed in either group.

Relevance: Many patients seek alternatives and/or complementary care to conventional anxiety treatments. To date, no study has evaluated the potential of a naturopathic treatment protocol to effectively treat anxiety. Knowledge of the efficacy, safety or risk of natural health products, and naturopathic treatments is important for physicians and the public in order to make informed decisions.

Interpretation: Both NC and PT led to significant improvements in patients' anxiety. Group comparison demonstrated a significant decrease in anxiety levels in the NC group over the PT group. Significant improvements in secondary quality of life measures were also observed in the NC group as compared to PT. The whole system of naturopathic care for anxiety needs to be investigated further including a closer examination of the individual components within the context of their additive effect.

Trial registration: Controlled-Trials.com ISRCTN78958974.

Publication types

• Randomized Controlled Trial
• Anxiety / therapy*
• Middle Aged
• Naturopathy*
• Plant Extracts / therapeutic use*
• Psychotherapy
• Withania / chemistry*
• Plant Extracts

Associated data

• ISRCTN/ISRCTN78958974

Research is an essential aspect of any system of medicine. Research on naturopathy / naturopathic medicine is supported by a number of naturopathic research institutes and peer-reviewed journals.

• Naturopathic Research Institutes
• Naturopathic Research Resources
• Peer-Reviewed Naturopathic Journals
• WNF Research
• Rapid Reviews
• Writing Research Papers – Support Tools

The following is a list of WNF research:

Current WNF research:

Systematic review of natural health products used during the pandemic.

Previous WNF research:

“ Naturopaths’ mobilisation of knowledge and information in clinical practice: an international cross-sectional survey ”

“ Community education and health promotion activities of naturopaths/naturopathic doctors: results of an international cross-sectional survey”

“ Overview of international naturopathic practice and patient characteristics: results from a cross-sectional study in 14 countries ”

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Unifying Principles of Naturopathic Medicine Origins and Definitions

Naturopathy was founded in the United States in 1901 by Benedict Lust, MD 1–9 who collaborated with other leaders to build the profession. 9 Naturopathy emerged, grew, formed, fragmented, and declined under internal debate and external political pressure; rising again in the 1970’s. It grew from Naturopathy into Naturopathic medicine starting in the 1960’s, expanding from 1 college, 6-8 21 licensed states, 3 licensed provinces and approximately 200 licensed Naturopathic physicians in North America 1 , 2 , 3 to 7 colleges, 22 licensed and regulated states, 3 regulated territories and districts, and 5 licensed and regulated Canadian provinces in the US and Canada; becoming an estimated 8000 licensed ND’s in North America by 2019. 10 , 11 , 12 and approximately 100 000 naturopaths worldwide in the process of professionalizing. 13

After the profession’s decline in the 1950s and 1960s, during the profession’s rebirth in the 1970’s, the re-emerging profession became more grounded in medical sciences. Its regrowth was fueled by a young generation with relatively few veteran teachers due to a missing generation. Much of the wealth of early generation naturopathic scholarship and clinical experience had not traversed the profession’s near demise, trickling into the classrooms of the 1970’s and 1980’s. Clinical mentorship and classroom teaching by this era’s senior physicians and clinicians was influential. The profession’s roots were neglected out of ignorance, for the most part, along with perhaps, a youthful arrogance.

By the early 1980s, it was apparent that attempts to regenerate the progress made by Lust, Lindlahr and Carroll would require the creation of a unified professional organization and all which that entailed: more schools, accreditation for schools, national standards in education and licensure, clinical research, increased federal and state legislation, and the articulation of a coherent definition of the profession for legislative purposes, as well as for its own internal development. These accomplishments would be necessary to be able to demonstrate the uniqueness and validity of the profession, guide its educational process, and justify its status as a separate and distinct medical profession. 1 , 2 , 3 , 9

In 1986, the newly formed (1985) American Association of Naturopathic Physicians (AANP) began this task of developing a unified professional organization under the leadership of James Sensenig, ND (president) and Cathy Rogers, ND (vice president). Four tasks were developed and committees with specific chairs were delegated: (1) Accreditation of Naturopathic schools through governmental accreditation bodies (Joseph Pizzorno, ND), (2) Standard independent national licensure examination (Ed Smith, ND), (3) A peer-reviewed scientific journal (Peter D’ Adamo, ND). The fourth was the Select Committee on the Definition of Naturopathic Medicine , appointed to develop a new unifying definition of naturopathic medicine, co-chaired by Pamela Snider, ND and Jared Zeff, ND with committee members Bruce Milliman, ND, K. Wilson, ND, William Wulsin, ND, and Peter Glidden, ND. The Select Committee on the Definition of Naturopathic Medicine succeeded in its 3-year effort, culminating in the unanimous adoption by AANP’s House of Delegates (HOD) of a comprehensive, consensus definition of naturopathic medicine in 1989 at the annual AANP convention held at Rippling River, OR. 1 , 2 , 3 , 14 , 15 , 16

From 1987-1989 The Select Committee led the US profession in an iterative, progressive process of inclusive, profession wide input, review, classification of agreements and disagreements, negotiation, revision, publication of serial drafts and repeated review. The first point of unanimous consensus was to define the profession by its principles, not by its modalities. The Committee sought a defining statement which represented the profession’s highest water mark, the best of its common thinking and aspirations vs. a mediocre and less controversial statement. Conflicts were acknowledged, publicized in open meetings and elsewhere, then negotiated. Superlative common language was sought as opposed to settling on low common denominators in language. Robust arguments and passionate discussions were encouraged rather than suppressed; all with the aim of agreement and codifying the best possible statement, which was achieved. Group meetings were held at conventions, schools and elsewhere; thousands of written inputs and telephone calls were invited, received and organized, shaping the evolving draft sand interim reports. 16,17,18,19 Naturopathy’s historical principles and scope of practice were researched; there was no record of a national unifying definition within a governing body, formally representing the profession through a stakeholder vote. Lusts journals including the Naturopath and Herald of Health and other individual writings provided fertile contributions for discussion. Canadian engagement was welcome, robust and influential. 16-19

An important part of the process was that all conflicts were negotiated in open meetings. The final meeting held to complete the Definition Position Paper addressed two conflicts about specific language. These conflicts were delegated by the co-chairs to an external mediator, who facilitated the profession’s organizational and committee leaders in coming to final consensus, resolving these remaining and potentially divisive polarities concerning language. A fundamental and unique aspect of this Definition was its basis in definitive principles, rather than in therapeutic modalities as the defining characteristics of the profession. Until this point the only extant national definition available was through the US Department of Labor and Industries—a modality-based statement. 20

When AANP’s House of Delegates (HOD) passed the Resolution formally adopting the Definition of Naturopathic Medicine Position Paper the HOD asserted and ratified that these principles would continue to evolve with the progress of knowledge, and should be formally reexamined by the profession as needed, perhaps every 5 years. 14-19 From 1996 - 2000 four additional principles were proposed to the HOD for consideration. None were adopted, however they are valued and used in teaching.

AANP’s House of Delegates formally reaffirmed the 5-page Definition of Naturopathic Medicine Position Paper and Principles in 2000 and 2011 by House vote, adding one phrase: “prescription medication,” to the Practice section. The Position Paper was formally reviewed in 2005, 2006, 2007, 2008, and 2009 by HOD’s Position Paper Review Committee with no changes recommended. 15

The following are the definitions of the unifying Principles of Naturopathic Medicine. 15

The Healing Power of Nature (Vis Medicatrix Naturae)

The healing power of nature is the inherent self-organizing and healing process of living systems which establishes, maintains and restores health. Naturopathic medicine recognizes this healing process to be ordered and intelligent. It is the naturopathic physician’s role to support, facilitate and augment this process by identifying and removing obstacles to health and recovery, and by supporting the creation of a healthy internal and external environment.

Identify and Treat the Causes (Tolle Causam)

Illness does not occur without cause. Causes may originate in many areas. Underlying causes of illness and disease must be identified and removed before complete recovery can occur. Symptoms can be expressions of the body’s attempt to defend itself, to adapt and recover, to heal itself, or may be results of the causes of disease. The naturopathic physician seeks to treat the causes of disease, rather than to merely eliminate or suppress symptoms.

First Do No Harm (Primum Non Nocere)

Naturopathic physicians follow three precepts to avoid harming the patient:

• Naturopathic physicians utilize methods and medicinal substances which minimize the risk of harmful effects, and apply the least possible force or intervention necessary to diagnose illness and restore health.
• Whenever possible the suppression of symptoms is avoided as suppression generally interferes with the healing process.
• Naturopathic physicians respect and work with the vis medicatrix naturae in diagnosis, treatment and counseling, for if this self -healing process is not respected the patient may be harmed.

Doctor As Teacher (Docere)

The original meaning of the word “doctor” is teacher. A principal objective of naturopathic medicine is to educate the patient and emphasize self-responsibility for health. Naturopathic physicians also recognize and employ the therapeutic potential of the doctor-patient relationship.

Treat the Whole Person (Tolle Totum)

Health and disease result from a complex of physical, mental, emotional, genetic, environmental, social and other factors. Since total health also includes spiritual health, naturopathic physicians encourage individuals to pursue their personal spiritual development. Naturopathic medicine recognizes the harmonious functioning of all aspects of the individual as being essential to health. The multifactorial nature of health and disease requires a personalized and comprehensive approach to diagnosis and treatment. Naturopathic physicians treat the whole person taking all of these factors into account.

Prevention (Preventare)

Naturopathic medical colleges emphasize the study of health as well as disease. The prevention of disease and the attainment of optimal health in patients are primary objectives of naturopathic medicine. In practice, these objectives are accomplished through education and the promotion of healthy ways of living. Naturopathic physicians assess risk factors, heredity and susceptibility to disease, and make appropriate interventions in partnership with their patients to prevent illness. Naturopathic medicine asserts that one cannot be healthy in an unhealthy environment and is committed to the creation of a world in which humanity may thrive. 15

World Naturopathic Federation Report. Pg. 11-12. June 2015. Lloyd et al. 13

According to a World Naturopathic Federation (WNF) Report in 2015 “as shown in the chart, the naturopathic principles codified in 1989 are very consistent across all countries that practice naturopathy / naturopathic medicine.” 13

The WNF’s report on Naturopathic Principles summarized data from the WNF’s 42 country survey, with the following statement: “In 1986 the American Association of Naturopathic Physicians (AANP) formed a committee that consisted of naturopathic doctors Pamela Snider, Jared Zeff and others. These practitioners spent over three years reviewing the historic data and documents and interviewing over 1000 people. In 1989, a definition of naturopathic medicine and the description of the six naturopathic principles was formally codified and accepted by the two North American national naturopathic associations (American Association of Naturopathic Physicians (AANP) and the Canadian Association of Naturopathic Doctors (CAND). As shown in Chart 3, the naturopathic principles codified in 1989 are very consistent across all countries that practice naturopathy / naturopathic medicine.” 13

The WNF’s survey report of an average 94.16 % concurrence with the language in the original 1989 AANP Definition of Naturopathic Medicine Position Paper’s six Principles statements in 42 countries was an indicator of an underlying global sense of professional unity of identity, despite the profession’s ongoing debates. The authors believe that it is the investment in transparency, inclusivity and the “long time listening” within the profession which surfaced the deepest patterns of the profession’s agreement. Ensuring a forum for negotiating what appeared at times to be intractable conflicts and, in every case, led to a positive outcome in language, birthed a well crafted unifying and timeless statement. In that sense, they were not authors of the document but midwives of a process of re-establishing the profession’s identity through its principles, as a platform for rebuilding all aspects of Naturopathic medicine. The authors acknowledge and thank the thousands of voices in North America and around the world who find resonance woven through diversity. Though timeless, these principles must continue to be allowed to evolve with the progress of our knowledge and our understanding.

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• NATURE INDEX
• 17 April 2024

Researchers want a ‘nutrition label’ for academic-paper facts

• Dalmeet Singh Chawla 0

Dalmeet Singh Chawla is a freelance science journalist based in London.

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Researchers hope to apply insights from the initiative to display nutrition-facts labels on food packaging to academic publishing. Credit: Spauln/Getty

Inspired by the nutrition-facts labels that have been displayed on US food packaging since the 1990s, John Willinsky wants to see academic publishing take a similar approach to help to inform readers on how strictly a paper meets scholarly standards.

A team at the Public Knowledge Project, a non-profit organization run by Willinsky and his colleagues at Simon Fraser University in Burnaby, Canada, has been investigating how such a label might be standardized in academic publishing 1 .

Willinsky spoke to Nature Index about what he hopes to achieve with the initiative.

Why should academic papers have publication-facts labels?

I, like many others, have grown concerned about research integrity . Through transparency, we want to show how closely journals and authors are adhering to the scholarly standards of publishing. We want to help readers, including researchers, the media and the public, to decide whether an article is worth reporting on or citing.

The facts that we have selected for the label include publisher and funder names, the journal’s acceptance rate and the number of peer reviewers. The label also shows whether the paper includes a competing-interests statement and an editor list, where the journal is indexed and whether the data have been made publicly available. Averages for other participating journals are listed, for comparison.

It’s important that such information is readily available. When we conducted an exercise with secondary-school students, asking them to find these facts for a single academic article online, many of them took 30 minutes to do so. Some couldn’t find the information. This finding justifies the need for the label: it shouldn’t take half an hour to establish that a journal adheres to scholarly standards.

How did you create the label?

The US nutrition-facts label has been proved to change people’s behaviour, specifically their food-purchasing habits 2 . Given that so much work went into the label’s development, I thought it would be wise to build on its design.

On the basis of our early consultations with researchers, editors, science journalists, primary-school teachers and others, we created a prototype with eight elements that reflect scholarly publishing standards. We’re now gathering feedback, and might decide to change some of the facts, or to add others. Some people, for example, suggested that we include the number of days that the peer-review process took to complete.

The current version of the publication-facts label. Credit: J. Willinsky & D. Pimentel /Learned Publishing ( CC BY 4.0 DEED)

We’ve built in ways to automatically generate the label, to ensure that the format is standardized across journals and articles and to make the label available in several languages. We have created a third-party verification system, too, to ensure that authors’ identities are not revealed to peer reviewers and vice versa. This relies on authors, reviewers and editors using ORCID, the service that provides unique indicators with which to identify researchers.

The label will be displayed on the article landing page of the journal website and will be included in the article PDF.

How are you trialling the label’s use?

We’ve completed work with ten focus groups involving journal editors and authors in the United States and Latin America. We also interviewed 15 science journalists about what kinds of fact they’d want to see at a glance.

We built the label specifically for journals using the scholarly publishing workflow system Open Journal System (OJS), run by the Public Knowledge Project. By the middle of the year, we hope to launch a pilot programme involving more than 100 journals using the OJS. The goal is to explore the prospects of industry-wide implementation of the label by next year.

How could journals be compelled to display such a label?

Unlike the nutrition-facts label, which was mandated by the US government, the publication-facts label is the result of voluntary concern about research integrity in the publishing industry.

Although many groups, such as the International Association of Scientific, Technical and Medical Publishers and the Committee on Publication Ethics, manage concerns about research integrity by releasing guidelines on best practices and accumulating tools to flag suspicious activity, we feel that they have not addressed the fact that open access is public access . We need to adapt our practices to cater to the needs of different audiences, not just those in academia.

Although we’re initially building the label for OJS journals, it is an open-source plug-in that other publishing platforms will easily be able to adapt. The software is currently listed as being ‘under development’ on GitHub and will be shared there on release.

We want to show the publishing industry that we’ve piloted this in our own environment and that it is readily adaptable. We want to show that, although you could build your own label, for the sake of comprehensibility, it’s better to have a common format.

doi: https://doi.org/10.1038/d41586-024-01135-z

This interview has been edited for length and clarity.

Willinsky, J. & Pimentel, D. Learn. Publ. 37 , 139–146 (2024).

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Kessler, D. A., Mande, J. R., Scarbrough, F. E., Schapiro, R. & Feiden, K. Harv. Health Policy Rev. 4 , 13–24 (2003).

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