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Need treatment, will travel (to Portland)

Global patients, wellness tourists seek out city's naturopaths


by: TRIBUNE PHOTO: JONATHAN HOUSE - Deborah McKay, a Southwest Portland naturopathic doctor, reviews the procedure for a palpatation of the thyroid gland. Patients from outside the U.S. increasingly are seeking out McKay and other local naturopaths.Mark Davis has an unusual medical specialty. The procedure is called a fecal transplant, and it involves placing donor feces into the colons of patients suffering bowel disease.

There are few medical practitioners performing fecal transplants for a variety of symptoms anywhere, so it isn’t surprising that Davis has patients traveling from as far away as Sweden and Spain. What is surprising is that Davis is a naturopathic doctor, one of many local naturopaths who are turning the medical tourism industry on its head.

In recent years medical tourism has involved U.S. citizens traveling to India for cheaper hip replacements or Mexico for inexpensive dental work. If people from outside the United States come here for medical care, typically it involves a specialty such as cutting-edge cancer treatment unavailable in their home countries.

And that pretty much describes what is occurring in Portland, according to the naturopaths treating international patients. For those in other countries looking for advanced naturopathic therapies, Portland, they say, is considered a destination.

Traditional, alternative mix

“We are the only place on the whole planet that both treats patients with naturopathic cardiology and trains doctors from the same location,” says Martin Milner, who estimates he has treated 50 or 60 international patients from countries including Pakistan, Japan and South Africa.

Milner’s specialty is naturopathic cardiology. He’s practiced in Portland for 30 years and is medical editor of a health newsletter that circulates widely in Canada, Europe and Australia. He says those countries have long traditions of naturopathy, but none have naturopaths with the breadth of conventional medical training that students at the local National College of Natural Medicine receive. Few have licenses for naturopaths, as does Oregon.

In Oregon, naturopaths have been able to prescribe drugs, unheard of in most other countries, Milner says, where naturopaths tend to focus exclusively on herbal medicine and nutrition. He says practitioners here use natural medicines and pharmaceuticals that are unavailable in most other countries. Even his patients who come from Germany, which has a long history of natural therapy use, are unable to get about half the therapies he prescribes.

Milner invented a slow-release natural compound thyroid hormone replacement medication. International patients who read about him or his therapies are told a first appointment has to be face to face. Subsequent appointments can take place via Skype.

Milner expects the attraction for international patients will only increase once the National College for Natural Medicine establishes a proposed center for excellence in partnership with Milner’s Center for Natural Medicine, expected later this year. He says that effort, which would provide students at the naturopathic college expanded clinical and research training opportunities, should “create a global market identity” for naturopathy in Portland.

Davis says there are a few dozen physicians around the globe performing fecal transplants, but they limit the therapy to one specific form of colitis even though there is a growing body of evidence that it can help in treating other gastrointestinal diseases. In most cases, the therapy is used after antibiotics have killed off microbes that grow in the gut to an extent that they can’t re-establish their necessary balance.

Physicians are reluctant to deviate from established standards of care, Davis says. But as a naturopath, Davis says, he can take a “more eclectic” approach to treatments. In fact, he says some patients who come in for fecal transplants tell him their physicians recommended the therapy but wouldn’t perform it.

Davis has treated about 10 international patients so far, and he has local stool donors ready when they arrive. The treatments — under review by the U.S. Food and Drug Administration — take about 10 days, with patients receiving one stool injection a day. Each stool injection introduces trillions of bacteria into the patient’s gut.

“People are willing to travel all over the world for someone with experience and knowledge and a focus for doing this,” Davis says.

Medical tourism for naturopathy fits perfectly into the growing niche of wellness tourism, says Josef Woodman, chief executive officer of Patients Beyond Borders, a North Carolina company that provides consumer information on global health care.

“I think what we’re seeing with consumer-driven care, especially with Generation X and Generation Y, it’s an underforecasted trend,” Woodman says. “Gen X and Gen Y are pursing alternative treatments. They don’t trust their doctors. And they’ve got the power of the Web for self-diagnosis and for pursuing alternative treatments.”

Needs unmet elsewhere

The Web seems to be bringing foreign patients in to Deborah McKay’s Southwest Portland practice, though many of McKay’s medical tourists are in their 40s, 50s and 60s.

McKay is a naturopathic doctor who specializes in hormone therapy. Many of her patients come for help with menopause, thyroid and weight loss problems. Virtually all leave her office with programs that require a change in diet and lifestyle, and more than half leave with a prescription for estrogen, or another specially compounded hormonal drug.

McKay says the prevalence here of compounding pharmacists used to working with naturopaths may be contributing to the stream of international patients. She has treated about a dozen patients from outside the United States, including residents of Japan, the Netherlands and Malta.

McKay says she doesn’t market her practice outside Portland, so as best she can figure, most of her medical tourists have simply come upon her website after Internet searching “naturopath” and “hormones.”

She has had a patient stay for as long as three months on a tourist visa and visit a number of local naturopaths for various ailments. Others come for a week and manage two visits to McKay’s office.

“Their needs are not being met,” McKay says. “They’ve tried and tried. They think they know what they need, and I’m trained as a holistic doctor, and I’ll catch it,” McKay says.

What Portland naturopathic doctors are witnessing is new, says John Connell, professor of Human Geography at the University of Australia and author of “Medical Tourism.” But, Connell says, it might be a natural next step in the growing medical tourism industry.

In Europe, Connell says, patients are now routinely referred across national borders for procedures when waiting lists become too long in their home countries. Historically, many U.S. and European patients have traveled to countries such as India hoping for more natural cures.

“Maybe the ultimate phase in medical tourism will be when medical tourists come from places like India for naturopathic medicine in the U.S.,” Connell says.

Woodman says international travel that combines wellness with tourism also is on the rise, with so-called wellness hotels trying to bridge the gap between traditional spas and alternative medical care for travelers. The Apollo hospital network in India has built facilities intended to lure Westerners for a day or more of ayurvedic treatment, the traditional Indian form of medicine. In October, New Delhi will host the first global wellness tourism conference.

Davis says it doesn’t hurt that his global patients are coming to a city with a growing international cachet, especially if they arrive during the summer months.

“My out-of-town patients almost always say, ‘I love Portland,’ “ Davis says.