Crossing the Fringe

Similar to medical doctors, naturopaths attend a four-year naturopathic medical school, where they learn about Western medicine and natural therapies, and train in primary care.
to medical doctors, naturopaths attend a four-year naturopathic medical school, where they learn about Western medicine and natural therapies, and train in primary care.

In her cozy office in Hampden, Dr. Emily Telfair, ND, walks past a massage table that she uses for craniosacral therapy, a gentle form of bodywork that helps release tension, and stops in front of a small dispensary of homeopathic remedies. The dark bottles sit on the top row of a bookshelf, next to a rack stacked with white towels and blankets. Telfair picks up two bottles, returns to her desk and begins mixing some homeopathic arnica. She squeezes a few drops of heavily diluted liquid made from the arnica plant into a tube of milky white sugar pellets. “You can buy it at Whole Foods,” Telfair, who has a warm and welcoming manner, says about the remedy, “but I like to mix the medicines so I can put a little of my own energy into it.” On a small white label she writes “2 to 3 pellets as needed/ trauma,” then explains that homeopathic arnica is the ultimate first aid remedy; taken orally, it is used to help the body heal from bruises, pains and sprains.

Telfair is a naturopathic doctor, and the type of medical care she practices—which emphasizes treating the whole person through prevention strategies and natural therapies—has long been thought of as an alternative form of health care. That may change in March, when Maryland becomes the 17th state (along with Washington, D.C., Puerto Rico, and the Virgin Islands) to license naturopathic doctors, a feat that took nearly four years to accomplish. The Maryland Board of Physicians will regulate the licenses, as it does for nine other allied health professions, including physician assistants and athletic trainers. Once licensed, the roughly 25 naturopathic doctors in the state, who have been limited to making wellness recommendations, can perform physical and laboratory tests and order and interpret diagnostic imaging tests such as X-rays and MRI scans, giving them the right to “practice responsibility in the way we’ve been trained,” Telfair says.

Similar to medical doctors, naturopaths attend a four-year naturopathic medical school, where they learn about Western medicine and natural therapies, and train in primary care. A typical first session with a naturopath lasts one to two hours and costs around $200 to $300 because the services are not covered by insurance. Naturopaths go through a patient’s health history, nutrition patterns, sleep habits and energy levels looking for patterns of stressors. They’ll often make nutrition and lifestyle recommendations and prescribe supplements. And they can treat patients with a variety of ailments, even those who are on conventional medications. “Sometimes there are natural therapies that can help prevent some of the side effects [of those medications],” Telfair says.

This was the case for breast cancer survivor Diane McComb, who was prescribed Aromasin after having a lumpectomy. McComb had terrible side effects from the medication, including severe bone and back pain, profuse sweating, difficulty sleeping and breathing, and elevated blood pressure and cholesterol. But because the medication decreased the likelihood that McComb’s cancer would return, her medical oncologist recommended she continue with the Aromasin and take more medication to lower her blood pressure and address her pain. Not wanting more drugs, McComb chose to stop taking medication altogether.

“Everybody was alarmed so much that they actually sent me to a therapist to make sure that I wasn’t stopping treatment because I was suicidal,” she says. But McComb was firm in her decision, so her surgeon recommended she see Dr. Stephany Porter, ND, a naturopathic doctor in Millersville specializing in oncology.

During McComb’s early visits, Porter analyzed her blood work and found high levels of residual pesticides and preservatives. She recommended that McComb go on a short-term modified vegan diet to get the chemicals out of her body, and that she cut back on milk and yogurt in the long term because the type of cancer she had is reactive to dairy products. Porter also prescribed supplements to promote breast health and hormone health.
“Her approach was about wellness, and it’s very individualized. She took a lot of time analyzing the results of my blood work and monitoring my progress,” McComb says. “I had no side effects other than really good health returning.”

McComb had such a positive experience that her family became involved in the naturopath licensing effort, telling her story before Maryland’s House of Delegates and State Senate, while her husband, Jim, became the lobbyist for the Maryland Naturopathic Doctors Association.

Jennifer Salaverri, a behavioral health coordinator at Magellan Health, also found relief when she saw Dr. Stacey Kargman, NMD, who practices in Owings Mills and at the Ruscombe Mansion in Baltimore. Salaverri was having severe digestive problems, but “I had gone to every GI doctor and really wasn’t getting anywhere with it,” she says. Kargman did a blood test and a saliva test, and recommended that Salaverri cut out soy, dairy and gluten for a few months to heal her stomach. She also prescribed a probiotic supplement.

“Probiotic has become a buzzword, but you don’t know which one to take,” Salaverri says. “She was able to guide me to a specific one that made a huge difference.”

Despite these favorable patient experiences, some still oppose the licensure of naturopathic doctors, particularly a group called the Society for Science- Based Medicine, which insists that medical practices be “based in science and reality.” The group, whose Board includes four medical doctors, has taken issue with some naturopathic treatments, especially homeopathy, saying that there is no clinical evidence to support its effectiveness. The National Center for Complementary and Integrative Health, part of the federal government’s National Institutes of Health, has come to the same conclusion, adding that although the Food and Drug Administration regulates homeopathic remedies, it does not evaluate their safety.

Telfair acknowledges that it is a challenge to quickly publish ample research on homeopathy, even though there is a journal called “Homeopathy” dedicated to the subject (and edited by Dr. Peter Fisher, Her Majesty Queen Elizabeth II’s physician). “Research takes funding and it takes time, and we are a smaller emerging profession,” she says, adding that there are only 3,700 naturopathic doctors nationwide compared with nearly 915,000 medical doctors.

Then there is the issue of education. The Society for Science-Based Medicine says that naturopathic doctors lack the clinical training to provide care, pointing out that they have at most 6,500 hours of training versus an average of 21,000 hours that medical doctors receive. Despite this gap, “Their licensure allows them to treat any patient for any condition, which I think is really something that needs to be questioned,” explains Gregory S. Pokrywka, MD, an assistant professor at Johns Hopkins School of Medicine, director of the Baltimore Lipid Center and a member of the society.
Telfair counters that those training hours for medical doctors include hospital rotations in obstetrics, surgery and psychiatry—specialties that naturopathic doctors do not practice. “We don’t do surgery; we don’t deliver babies. It’s not an apples-to-apples comparison,” she says.

The licensing law reflects this difference: When the new regulations take effect in March, naturopathic doctors will not have the right to perform surgeries or refer to themselves as “physicians,” and the Maryland General Assembly still needs to decide if they will have any authority to write prescriptions.

But, Telfair adds, “We are well trained to do what we do, and we do it safely. If we didn’t, we wouldn’t be making the progress and having the results we do.”

Dr. Lauren Richter, a doctor of osteopathic medicine (DO) practicing functional integrative medicine at the University of Maryland School of Medicine who collaborates with naturopathic doctors on patient care, agrees that they are more than capable providers. “The naturopaths I work with are some of the most gifted practitioners I know,” she says by email. “I believe that they would be well suited to help with providing primary care alongside MDs and DOs, especially since there is such a strong need for primary [care] providers.”

And ultimately, licensing naturopathic doctors serves consumers. “People deserve to have access to different health professionals,” says Dr. Carrie Runde, ND, who is a naturopathic doctor at Casey Health Institute, an integrative primary care practice in Gaithersburg, as well as at a private practice in Roland Park that she owns with her husband, Dr. Kristaps Paddock, ND. “I tell people I have this great toolbox to use. Sometimes you may need a medication or a drug, but sometimes you have other options. And I think people really like to hear those options.”

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