Annette Schultz had been told by her medical doctor that she had irritable bowel syndrome. It was causing her a lot of pain. The doctor offered medication and suggested taking fiber to keep the pain in check, she says.
Schultz wanted to get at the root cause of her pain and treat that, and she didn’t want to use a prescription drug. According to the Mayo Clinic, a number of nondrug approaches — from acupuncture to hypnosis to diet — could help treat her disorder.
Instead of seeking help from her medical doctor, Schultz followed a recommendation from her Pilates instructor and friend to see a naturopathic physician, Diana Crumrine of Foothills Family Medicine in Boise.
“She talks to me not just about what my pain is, and, ‘Here is a prescription,’ but also what’s going on with me emotionally and mentally, what’s going on in my life,” Schultz says. “She works with me on diet and exercise and supplements to help me deal with my problem.”
Schultz has seen Crumrine for a couple of years, making her part of a growing number of Idahoans who are turning away from medical and osteopathic doctors as their sole health-care providers and seeking out chiropractors, acupuncturists, naturopathic providers and others.
There is tremendous debate in scientific and health-care communities about the use of such alternative providers. Some of their approaches have been shown to work on some conditions, with fewer side effects than prescription drugs may have. Other approaches are no more effective than a placebo. And many have been poorly studied or have shown no evidence of effectiveness; they can cause harm if used in lieu of care that has stood the test of high-level clinical testing.
Some alternative providers lack sufficient medical training to treat people effectively. In Idaho, where regulations are loose, patients must beware.
But medical doctors are in short supply in the state, and “alternative” providers like Crumrine are multiplying to meet demand from patients.
The motivations vary, but most patients are like Schultz: They want more participation in, attention to and options for managing their overall health.
‘A PHYSICIAN WHO WILL REALLY LISTEN’
A local medical doctor says that’s what she is hearing from patients.
“Our practice attracts people who want that alternative or holistic approach. It’s not that medication is bad. It’s just not all there is,” says Gail Eberharter, a medical doctor in Boise who also practices acupuncture and whose practice includes nutritionists.
“Almost everyone says, ‘I’m looking for a physician who will really listen to me, and who won’t discount what I’m telling them,’” Eberharter says. “... They really want someone to know their story and have a sense of who they are as a person and not just maybe their two or three diagnoses. And I think there’s a huge need and demand for this.”
And who can blame them? she says. Who can blame many of the doctors, too, for working quickly when they are expected to fit a large number of patients into a single day?
Eberharter’s patient Betsy Robinson, 62, began receiving acupuncture from Eberharter about 20 years ago, at Eberharter’s suggestion. Robinson has a genetic condition that affects her joints and connective tissue, and she has asthma, pain and muscle tightness. She incorporates exercise and physical therapy into her treatment plan, as well as acupuncture.
“It’s made it so I’m not as dependent on as many medications,” Robinson says.
MORE THAN PIN PRICKS
Meggan Baumgartner owns Healing Point, a solo practice in Moscow. In the decade she has practiced there, the number of acupuncturists has grown from three to six or seven.
“I have people driving ... four to six hours in a day to receive a treatment, and what’s nice is that with the expansion and numbers of acupuncturists increasing in the state, hopefully they’ll be able to drive less far to receive treatments,” Baumgartner says.
She uses Chinese medicine too. And she also does a lot of what other alternative providers say they do: talking to patients, listening, making dietary and lifestyle-change recommendations.
She has patients from infants to seniors, and she is hearing from more people now than she did 10 years ago. “I’m often at a place where I can’t take new patients,” and she sees 25 to 35 patients a week for an hour to an hour-and-a-half per visit, she says.
“A lot of people think acupuncture is good for pain, which it is, and sometimes that’s what brings people in,” she says. “But I call myself a GP, meaning a general practitioner, which means I see all kinds [from] gastrointestinal to things like fibromyalgia, multiple sclerosis, cancer patients, [and] other neurological disorders that aren’t always well treated by the Western world.”
Some patients will “use me as just general wellness and preventive care. ... They’ll come in to me to support their immune system.”
An acupuncturist cannot cure cancer, but he may be able to help with managing nausea or pain from the cancer and chemotherapy or other treatment.
Asked if she refers patients for treatment by medical doctors, Baumgartner says she will if someone has strep throat or may have meningitis or another contagious disease that requires prescription-drug treatment. She also sends patients who have certain disorders back to their medical doctors if she suspects something like liver or kidney disease.
One profession benefiting from the growth is chiropractic.
Joe Betz is the president of the Idaho Association of Chiropractors. He has practiced in Boise and Eagle for 14 years, when the number of chiropractors in Idaho has grown from less than 500 to more than 700.
One reason is likely the broad authority Idaho chiropractors have to diagnose and treat. They can order lab tests and perform X-rays. They are working to win authority to give injections.
“There are other states that are much more restrictive with regards to what they can do, and we have a much broader scope,” he said.
Betz practices “mostly family-based care, using chiropractic biophysics — more of what we call corrective chiropractic care.”
In other words, he is not among chiropractors who expect to work for years on a problem. He also does not advertise the ability to treat autism, fibromyalgia and other disorders that are notoriously hard to treat and whose causes and solutions are an area of ongoing research.
“I don’t know of any high-level research on chiropractic and autism or fibromyalgia, for that matter,” he says. He says it is possible some chiropractors see improvements in the overall well-being of patients after they work on the patients’ necks and backs.
When Betz hears from patients their reasons for seeking his care, he learns they are looking for a completely “drug-free option to try to help with their overall health.”
In other words, while chiropractors are not primary-care providers, some patients are viewing them as such.
“You see with these medical practices being absorbed in these hospitals ... there’s demands on them to provide more services and see more patients,” Betz says. “It doesn’t decrease the quality of care — that’s not been shown — but from the patient’s perspective it does.”
WHAT IS ACCEPTABLE?
Crumrine, the Boise naturopathic physician, is among a small number of naturopathic physicians who have tried to get licensure in place, because, they say, many more naturopaths lack the formal education to make decisions about what they are and aren’t capable of doing.
She says she hears a couple of times a year from patients who have had bad experiences with naturopaths, and there is no way to evaluate or discipline those providers.
Crumrine hails from Twin Falls and spent many years in the coastal Northwest, earning a college degree from Linfield College in Oregon and a four-year naturopathic doctorate from Bastyr University in Kenmore, Wash., a Seattle suburb. She returned to Idaho in 2010 to open her own practice. She shares a North End cottage with three other alternative practitioners: a chiropractor, an acupuncturist and a massage therapist.
Asked what a naturopathic physician does, Crumrine explains that her role is to help people make changes that enable them to be healthier.
“We’re using lifestyle medicine to either prevent chronic diseases from happening or we’re working with patients who have high cholesterol, diabetes, high blood pressure [and other health problems] rooted in lifestyle.”
‘NO RULES’ FOR NATUROPATHY IN IDAHO
She says naturopathic physicians are not primary-care providers in Idaho, and there are limits to what they can do. If someone shows up with a condition that seems to need antibiotics or any other prescription drug, she says, she’ll send the patient to a medical doctor.
Crumrine and a gynecologist recently sent Schultz, the patient with bowel pain, to get a colonoscopy “just to rule out anything serious.”
Not all naturopaths are trained the same. Few hold a degree from an accredited school, which is why Crumrine and the roughly 20 other Idaho naturopathic physicians who graduated from Bastyr or another accredited program fought last year to keep their licensure statute on the books.
At the urging of some naturopathic providers, the Idaho Legislature passed a law in 2005 to establish licensing for that profession. The law did not specify educational requirements; that was left to the licensure board to set by rule. But the board began to issue licenses before the rule was written. The Legislature halted licensure in 2007 by shutting down the board.
There are hundreds of naturopaths in the state, but few of them have degrees from accredited programs, Crumrine says. The Council on Naturopathic Medical Education has accredited Bastyr University and six other schools in the U.S. and Canada. California requires licensed naturopathic physicians to have graduated from one of those schools.
No Idaho naturopaths east of Boise have a degree from one of the accredited schools, Crumrine says.
“There are many within Idaho who maybe have been practicing for years, or are self-taught, or there are many distance learning or online certificate programs,” Crumrine says. “Idaho is a haven ... because there are no rules.”
Licensure could allow Idaho naturopathic physicians to accept insurance. It would define their education requirements and scope of practice and provide oversight and a board to which patients could file complaints.
“It is, for us, a public-safety issue,” Crumrine says. And for that reason, “we have historically had the support of the medical community, which is not always the situation in other states.”
But as the fight over educational standards dragged on, the Legislature in the 2015 session opted to scrap licensing altogether by repealing the law. The sponsor of that legislation told KTVB that the law wasn’t being enforced and there were not enough naturopaths to sit on the governing board.
WEIGHING THE COST AND THE BENEFITS
Crumrine says naturopathy seems to be gaining popularity, especially among younger people — those in their 20s and 30s — who want to learn about probiotics or fish oil or other ways to supplement their diets and be healthier “both now and in the future.”
But it can be expensive without insurance. Crumrine’s office charges $185 for a 90-minute intake visit and $80 for follow-up visits.
Patients often turn to alternative medicine after they have gone through the family-practice or specialist physician system and did not receive the answers or cures they wanted. By then, they are willing to pay full price.
That was true of Schultz, the patient who says her irritable bowel syndrome is better now.
Schultz is 53, a year younger than her mother was when she died after living with lupus, breast cancer and diabetes. “She had so much medication and so many side effects, and it ruined her,” Schultz says.
She is taking supplements, including a high-dose vitamin C tablet and an “adrenal support” supplement whose ingredients include siberian rhodiola root extract, holy basil leaf, ashwagandha and wild oat milky seeds.
She credits her improvement to Crumrine and to visits with a counselor to work on some of the stress she believes was a major cause.