Iva Lloyd1
The World Naturopathic Federation undertook the task of compiling a Health Technology Assessment (HTA) on naturopathy to provide an evidence-based summary of naturopathic practice and the safety, economics, and effectiveness of naturopathic care. Naturopathic doctors Iva Lloyd, Amie Steel, and Jon Wardle were the lead authors on the project.
The HTA resulted in a 750-page report, which took four years to complete.1 It was truly a global effort, with 51 naturopaths/naturopathic doctors (NDs) and 60 reviewers contributing to the HTA. The project was made possible due to the generous financial contribution of the Naturopaths and Herbalists Association of Australia (NHAA). The contributors from Canada included Dr. Iva Lloyd, ND (as lead editor of the HTA) and the following NDs from the Canadian College of Naturopathic Medicine: Monique Aucoin, Valentina Cordozo, Kieran Cooley, Deborah Kennedy, Paul Saunders, and Dugald Seely. Reviewers from Canada included NDs Tasnim Adatya, Anne-Hélène Genné, Verna Hunt, Colleen McQuarrie, Michelle Richea, Jim Spring, and Pat Wales.
The protocol and methods for the HTA were drafted in line with the World Health Organization (WHO) HTA guidelines, adapted to meet the specific requirements and nature of the naturopathic profession. The scope of the HTA was informed by research conducted by the international naturopathic community over the last 30 years encompassing over 2,000 peer-reviewed scientific articles, including more than 300 clinical studies involving over 100 different health populations. Seven international surveys on various aspects of naturopathic practice were also conducted to support the HTA.
The HTA on naturopathy serves two main goals. The first is to clarify the status of the global naturopathic profession, and the second is to address key questions raised by policy-makers, accreditors, regulators, and those looking to further understand the breadth and depth of the naturopathic profession and naturopathic practice.
The HTA provides a global and unified understanding of the naturopathic profession. The key points outlined in this report include the following:
“Chapter 7: Safety and Risks of Naturopathic Practice” provides research and rationale supporting the statement that direct risks associated with naturopathic care have been reported very infrequently and that the vast majority are minor. It describes the main categories of risk associated with naturopathic practice and reports that these are similar to any other health profession that employs a broad scope of practice. “Chapter 8: Economics of Naturopathic Care” provides a review of naturopathic cost-effectiveness research and outlines that naturopathic care is cost-effective, particularly for longer-term and chronic conditions and for persons with a higher disease burden.
Regulation involving the naturopathic workforce follows several legislative frameworks, including voluntary certification, co-regulation, negative licensing and occupational licensing or statutory regulation. Thanks to the support of a regulatory consultant, “Chapter 5: Regulation of the Naturopathic Workforce” provides a detailed review of the global regulatory status of the naturopathic profession and provides policy-makers with the rationale to support statutory regulation of the naturopathic profession globally. There are currently 34 WHO Member States (countries) with some form of statutory regulation for the naturopathic workforce. There are also 21 Member States across three WHO regions, including the European region, the Americas, and the Western Pacific region, with voluntary certification regimens.
“Chapter 6: Educational Standards for the Naturopathic Workforce” provides an overview of the status of naturopathic education globally. There are 131 naturopathic educational programs globally, with 39% residing in the South-East Asian region, 27% in the European region, 22% in the region of the Americas, 6% in the Western Pacific region, and 6% in the African region. There are two main types of naturopathic educational programs emerging globally: the doctorate-level training programs, at over 4,000 hours, which currently represents 52% of all programs, and the practitioner-level training programs, at 2,500 hours.
The bulk of the HTA addresses the research question. Chapter 14 outlines the importance of researching naturopathy as a total system of traditional medicine when designing and conducting research on naturopathic practice. Chapter 15 provides a closer exploration of the challenges and advancements that contemporary health research offers to naturopathic research and the opportunities that naturopathic research can provide to other areas of health research. Chapter 16 indicates that the international naturopathic research community has been actively publishing peer-reviewed research literature for over 30 years and has demonstrated a sustained commitment to codifying existing knowledge, generating new knowledge, and disseminating this knowledge to the naturopathic and wider allied-health clinical and research communities. Naturopathic research is conducted in most of the educational institutions that have a naturopathic program, especially in the United States, Canada, Australia, Germany, India, and New Zealand.
The twelve chapters in Section 5 summarize 235 original clinical research papers outlining the effectiveness of naturopathic care for the main conditions researched by the naturopathic profession and commonly treated by naturopaths/NDs. It also includes references to the 1,456 journal articles, including observational studies, reviews, and meta-analyses, related to health conditions. It highlights that naturopathic researchers have conducted original clinical research involving 81 different illness populations, including cancer, cardiovascular, complex immune, endocrine, gastrointestinal, mental health, musculoskeletal, neurological, skin, women’s health.
Naturopathic practice is known for its complexity and flexibility, with a range of treatments, therapies, and practices. The twelve chapters in Section 6 summarize over 300 clinical research papers on naturopathic therapeutics and practices for over 140 conditions. It highlights how such treatments are employed—singularly and in combination—by naturopaths/NDs, both in naturopathic clinical interventions and at times in collaboration with other health-care settings, and features pragmatic elements, such as multimodal interventions, flexibility in administration, and real-world settings. It also includes references to the 1,203 peer-reviewed observational studies, reviews, and meta-analyses examining the broad range of therapies commonly used in naturopathic practice. The naturopathic therapeutic modalities and practices highlighted in this section include complex naturopathic interventions, applied nutrition, clinical nutrition, herbal medicine, lifestyle modifications, mind–body medicine counselling, naturopathic physical medicine, hydrotherapy, acupuncture, yoga, and research on pharmaceutical-based interventions or comparisons.
In summation, the HTA highlights that naturopathy is one of the most common traditional and complementary medicine professions globally and has a practice presence in all WHO regions. Naturopathic practice is therapeutically diverse, with a consistent holistic and person-centred approach and a core philosophical and traditional knowledge framework that focuses on the effective prioritization of non-invasive or non-pharmacological interventions and preventive care. Naturopathy/naturopathic medicine is a safe and effective therapeutic intervention that has utility across different geographic regions, clinical settings, and conditions, and naturopathic practitioners are trusted and consulted by the global public for a wide range of conditions.
Given the promising emerging evidence base for naturopathy/naturopathic medicine shown in this HTA, it is warranted that individual policy-decision makers consider how to regulate and integrate naturopathy/naturopathic medicine in the manner most appropriate to their setting.
The full HTA is available as an e-book at https://worldnaturopathicfederation.org/project/health-technology-assessment-naturopathy/
For a hard copy of the HTA please contact the WNF at
All proceeds from the HTA will go towards supporting regulation of the naturopathic profession globally.
1World Naturopathic Federation, Toronto, ON, Canada.
Not applicable.
I have read and understood the CAND Journal’s policy on conflicts of interest and declare that I have none.
This research did not receive any funding
1. Lloyd I, Steel A, Wardle J, eds. Naturopathy—Practice, Effectiveness, Utility, Costs Safety. World Naturopathic Federation; 2021. http://worldnaturopathicfederation.org/health-technology-assessment-hta/
Correspondence to: Iva Lloyd, 33 The Bridle Trail, Unionville, ON L3R 4E7, Canada. E-mail: i.lloyd@naturopathicfoundations.ca
To cite: Lloyd I. Health Technology Assessment – Naturopathy. CAND Journal. 2022;29(1):4-6. https:/doi.org/10.54434/candj.109
Received: 26 January 2022; Accepted: 26 January 2022; Published: 24 March 2022
© 2022 Canadian Association of Naturopathic Doctors. For permissions, please contact candj@cand.ca.
CAND Journal | Volume 29, No. 1, March 2022