It began with a dream, the zeal of youth, and the knowledge of a few elders. Oh, and $200 in cash.
Forty years later, Bastyr University is a vibrant nucleus of naturopathic medicine, with two thriving campuses, thousands of graduates, multiple degree tracks, a robust research agenda, and an uncanny knack for making waves far greater than its modest size would predict.
The Bastyr University epic is a story of commitment and dedication, of following and manifesting an ideal. It tells of the rebirth of a distinctly American medical lineage that, four decades ago, was on the verge of extinction.
In many ways, it is also the saga of holistic medicine itself, a movement in which this particular school has played a very vital role.
“We started with nothing. Just a few young people who didn’t know the word ‘impossible,’” says Joe Pizzorno, ND, one of the school’s founders, and its president for the first 22 years.
Launched in 1978 in rented classrooms at a Seattle community college, the 4-year post-graduate school then called the John Bastyr College of Naturopathic Medicine trained just 31 students in its first year. By 1989, it became the first naturopathic college to win accreditation by the Northwest Association of Schools and Colleges. Its ranks began to grow at 15% to 20% per year.
Today, Bastyr’s two campuses—the “mothership” in Kenmore, WA, and a recently opened school in San Diego—train more than 1,300 students annually. In addition to its core 4-year ND degree, Bastyr also offers 22 other advanced degrees in nutrition, midwifery, acupuncture, oriental medicine, and other healing modalities.
The Early Years
“If you go back to 1978, things were really grim for naturopathic medicine. Only 6 states licensed naturopaths. There was only one naturopathic college in all of North America (National College of Naturopathic Medicine, which at the time was located in Seattle but later moved to Portland, OR).
“There was no money, no foundations. The most modern textbook was written the year I was born. All media coverage was negative,” Pizzorno recollected.
He himself had only recently graduated from NCNM, one of seven students—“the biggest class they’d had in decades.”
Born and raised in California, Pizzorno already had a PhD in materials science from Cornell, and was working at the University of Washington’s department of rheumatology, researching treatments for arthritis and gout, when he first encountered naturopathy.
“I didn’t know anything about natural medicines. I was a very conventional science guy.”
But his perspective changed when a roommate’s wife, who’d suffered from arthritis for years, saw a naturopath and quickly experienced improvements she’d not obtained through conventional drug treatment. Intrigued, Pizzorno went to meet this doctor to find out what he did.
“He said, ‘I taught her how to eat properly, and I detoxified her liver.’ That was a paradigm-shifting moment!”
Another turning point was a research project at UW. “In our lab there was an MD doing post-doc work on a drug for arthritis using ducks bred for arthritis. When kept in cages, the ducks looked miserable. So she and her husband created a duck run with a little pool, fresh lettuce. These ducks started to run around, interact with one another. And they didn’t get arthritis, even though genetically bred to do so! This was a second major “A-ha” moment. Fresh food, exercise, absence of trauma, outdoor access…no arthritis.”
Pizzorno decided to go to NCNM, which he described as “a remnant” of a once vibrant profession that integrated botanical medicine, nutrition, hydrotherapy, homeopathy, physical manipulation techniques and other “eclectic” modalities marginalized following the Flexner Report and the consolidation of allopathic medicine in the 1920s and 30s.
“He was a physician in the sense of high level skills in diagnosis and treatment, but also a healer in his way of activating patients to get better,” says Pizzorno. “He was, to me, a model of what a real healing physician looked like.”
Though Dr. Bastyr taught at the school that bears his name, he was never involved in its development or management.
By the late ‘70s, Pizzorno was convinced that naturopathic principles were sound, but the existing educational and clinical frameworks were inadequate to make good on the larger promise of the paradigm.
“I could see that what we were doing was helping patients. We were seeing patients whom conventional medicine had failed, and with these foundational concepts of nutrition, detoxification, and the like, we could get them better.
I realized we had to come up with better standards for education and research.”
With the fervor of a young man discovering his mission, Pizzorno envisioned a new institution grounded in contemporary science, but respectful of the essential naturopathic axioms, today articulated as The Six Principles:
The Healing Power of Nature: Trust in the body’s inherent wisdom to heal itself.
Identify & Treat the Causes: Look beyond symptoms to the underlying cause.
First Do No Harm: Utilize the most natural, least invasive, and least toxic therapies.
Doctor as Teacher: Educate patients in achieving and maintaining health.
Treat the Whole Person: View the body as an integrated whole in all its physical and spiritual dimensions.
Prevention: Focus on overall health, wellness and disease prevention.
“I mentioned to my receptionist that I wanted to start a school. Her mother, whom I was treating for rheumatoid arthritis, sent me $200, which I used to pay Bastyr,” says Pizzorno.
Enlisting the talent and energy of two other NCNM grads—Les Griffith and William Mitchell—along with a skilled former UW administrator named Sheila Quinn—Pizzorno set about building a school. It quickly began attracting talent.
“I hired PhD’s to teach basic sciences---biochemistry, physiology, anatomy. For diagnostics, I brought in MDs because they’re very good at making diagnoses. For therapeutics, I brought in practicing naturopaths. There was no money. I printed up brochures and catalogs myself. Somehow, 31 students came, based on the promise we were articulating. I used their deposits to lease lab and classroom space.”
It was not until the early 90s that the school was on firm fiscal footing. By that time, it had moved from rented classrooms to its current campus— a former Catholic seminary. It was also getting research grants from the National Institutes of Health, despite vehement denouncements by medical critics of naturopathy.
A Very Fertile Time
Bastyr’s emergence was part of a wave of enthusiasm for holistic medicine in the late ‘70s, recalls journalist John Weeks, who from 1983 to 1989, was the school’s communications officer and first fund-raiser. He later became executive director of the American Association of Naturopathic Physicians, and one of the foremost journalistic voices in the field.
Shortly after Bastyr was founded in ’78, there was another naturopathic school started in California that didn’t succeed (Bastyr’s highly successful San Diego campus opened in 2012). The American Holistic Medical Association (now known as the Academy of Integrative Health & Medicine) was founded in ’78, the Holistic Nursing Association was ’79. Planetree was founded in ’78. The Herb Trade Association, predecessor to the American Herbal Products Association, started in ’77, Weeks recollected.
“This was around the time that Herbert Benson’s landmark book, The Relaxation Response, and Kenneth Pelletier’s, Mind as Healer, Mind as Slayer were published, and David Eisenberg was making his first trips to China. It was a very fertile time.”
Bastyr hired Weeks for $1,000 for 4 months, during which he was charged with generating media attention and attracting donors.
“I wasn’t an “alt med” guy. I was a Nader-esque journalist working in politics,” Weeks says. “But what I saw and heard there resonated with me. They had a balanced view of science, but were also trying to include the softer side of medicine not well-reflected in regular medicine. They took an “innocent until proven guilty” view of other medical traditions. They had respect for elders, for nature, a sense of stewardship, and an international perspective.”
Though the school was small, Week’s saw tremendous potential.
“This was in ’83. At that point we were just becoming a national presence because six months before, the school became the first in the country recognized by the US Department of Education where someone could study herbal medicine homeopathy, nutrition etc, and get student loans to do it. This was a big deal.”
One of the early milestones on the long road to establishing credibility for the school—and for naturopathy at large—was the publication of https://www.elsevier.com/books/textbook-of-natural-medicine/pizzorno/978-1-4377-2333-5">The Textbook of Natural Medicine (Churchill Livingstone), which Dr. Pizzorno co-authored with Michael Murray, ND, in 1985. The two compiled the best data then available on nutritional interventions, botanicals, and other mainstay naturopathic modalities.
Initially it was available to Bastyr students, faculty, and a few practicing naturopaths in loose-leaf format. “We would send people updates periodically with new chapters,” Pizzorno told Holistic Primary Care.
Though it had humble beginnings, this compendium was an important step. “For the first time we clearly documented the scientific foundation for our way of looking at patients.” In the ensuing 33 years, the Textbook of Natural Medicine has sold roughly 100,000 copies, and not just to NDs. It has become one of the basic references for the entire holistic field.
The Fight for Survival
From the get-go, Bastyr University—like the newly revived naturopathic profession—had to fight for survival, facing outright hostility from mainstream medicine. To this day, many allopathic medical groups view the entire profession as “quackery.”
The animosity reflects a deep-seated aversion within allopathic philosophy toward “vitalism”—the notion that life is more than an aggregation of biochemical reactions, but rather is a manifestation of a fundamental, intelligent, animating force. Naturopathy, like Ayurveda, Chinese medicine, and other ancient healing systems, is unapologetically vitalistic.
“Right off the bat there were people against our existence,” says Cathy Rogers, ND, who trained at NCNM in the mid-70s, and served as Bastyr’s Dean of Admissions in the early ‘80s. “The night before orientation at Bastyr, a member of the board of Seattle Community College heard from a prominent Seattleite who said they shouldn’t be hosting naturopathic medicine, and tried to shut the thing down. We had to overcome obstacles.”
The saving grace at that point came from the wife of the chancellor of the community college system, who, despite her skepticism had experienced resolution for her menopausal symptoms after consulting with a naturopath. “So the chancellor became friendlier to us,” recounted Rogers. “The only reason our medicine was able to go forward is because it helped a person in a key position.”
But the battle got even more intense once Bastyr sought formal accreditation.
“The accrediting agency initially accepted our application, but then they made a new rule saying that they couldn’t accredit any new single-degree school. So we met as a team, and I remember Weeks saying we need to go public with this,” Rogers recalled. She added that initially, she was against the whole idea.
“I wanted to nail up a proclamation for why we shouldn’t get accredited. Yes, it would enable students to have financial aid. But I was concerned that they (the mainstream accreditation board) would have more of an effect on us with regard to what we could teach. The way we survived in the past was to keep our heads down and not go public. So this was a big shift to be visible. It was a big, big fight that we ultimately won.”
While it is by no means easy for today’s naturopaths, there is far more public and collegial support than there was in the late ‘70s, says Pizzorno. He remembers some of his mentors being taken out of their offices in handcuffs, in front of their patients, “because they were teaching about diet, herbs, and other things everyone now knows are the right ways to go forward.”
Integration & Collaboration
Though the process of change is slow, there is no question that there has been a movement toward integration and collaboration between NDs and conventionally-trained MDs—especially those who practice holistic and functional medicine.
Sydney Freggiaro, a 4th year ND student at Bastyr, and recipient of the school’s 2018 Founders Award, points out that Bastyr residents are now doing rotations at Harborview Medical Center, a majorSeattle-area hospital. There, they interact with MDs, and engage with patient populations that might not otherwise see a naturopath.
Friendly relations between Harborview and Bastyr trace back to 1986 when Dr. Jane Guiltinan, a clinical professor at Bastyr, was asked to sit on Harborview’s board, thus becoming the first ND to serve on the board of a US public hospital.
Freggiaro says today’s NDs and ND students are taking leadership roles in some of the foremost integrative medicine organizations, including the Integrative Health Policy Consortium, in which they collaborate with MDs and medical allopathic students.
She believes naturopaths are uniquely qualified for team-based integrative care. They receive thorough training in the basics of biomedicine through a curriculum quite similar to that of conventional medical schools. They’re also schooled in basic pharmacology and simple surgery.
But the therapeutic emphasis at Bastyr—and the other seven accredited naturopathic medical schools--is on nutrition, botanicals, application of nutraceuticals, and the psychological, social, and spiritual aspects of health.
“I can speak a lot of “languages”--basic ayurveda, basic acupuncture, basic conventional,” Freggiaro told Holistic Primary Care. “Maybe we’re the grand connectors, making sure the patient values and goals are being seen and shared. We’re finding spaces where we fit in.” She herself plans on a career in adjunctive care in her home state of Nevada, which currently does not license naturopathic physicians.
Licensure & Coverage
Freggiaro’s situation underscores a unique challenge facing this burgeoning profession: Currently, only 20 states formally license naturopaths, but the defined scope of practice varies from state to state, as does coverage by health insurers.
In Washington state, NDs are more or less on par with primary care MDs: in addition to freely practicing the holistic modalities for which they’re trained, they can also prescribe some drugs, perform minor surgeries, deliver babies—all of which have been challenged by critics who argue that naturopathic training is inadequate preparation for full-scope primary care practice.
“Here in Washington, I’m integrated,” says Freggiaro. “That’s something I really treasure about Bastyr; I’m interfacing all the time with mainstream clinics and doctors. I can refer someone to a cardiologist. I can call into the ER, call a urologist. I can speak conventional medicine, and I can do conventional medicine if my patient needs it. But it is rooted in naturopathic philosophy.”
Freggiaro’s planned move back to Nevada will put her under very different circumstances. But she’s opting to go where the need is great and the number of naturopathic practitioners is currently very small.
Though the profession clearly faces many challenges, Harlan Patterson, Bastyr’s new president, believes naturopathy is ready for prime time. He says this from the perspective of a man with a financial background, who spent much of his career in senior leadership roles at the University of Washington, and the Fred Hutchinson Cancer Research Center.
“This is a really fascinating and positive time for natural medicine. More and more people are taking advantage of what used to be called ‘alternative’ medicine. But I don’t think it can be called alternative anymore. When 30-40% of people are using it, its just part of the culture. This is especially true of the younger population, which is very skeptical of “Big” anything---Big Food, Big Pharma, Big Hospitals. They want to live long, healthy, happy, ecologically sustainable lives. Many of the conventional approaches don’t resonate very well with them.”
Patterson, who has been at Bastyr’s helm for a year, but previously served on its board of directors for 6 years, believes interdisciplinary teams that include naturopaths and that emphasize prevention and health promotion—rather than just disease management--will become more common in the near future.
The demand for this is not only from the general public, but also from within mainstream medicine.
“I’m now seeing a lot of interest on the part of allopathic practitioners, clinics, and hospital systems trying to get engaged. They want to provide preventive care, but don’t know how. They want to partner to develop collaborations. We’re getting to the point where it is possible to develop truly integrative healthcare teams.”
In a marked shift from the past, today’s naturopathic graduates tend to be more interested in working in integrative group practices rather than in the old-school model of solo independent practice, Patterson told Holistic Primary Care.
In large part, this reflects the economic realities of modern clinical practice which, everyone interviewed agrees, can be harsh for recent grads.
“The economics of my student loan are a huge challenge for me,” says Freggiaro. “I paid almost the same amount to attend Bastyr that an MD student at UW would pay, but they have a guaranteed salary at the end of that tunnel. I don’t.
“There are lots of very successful NDs out there, but you have to be creative, find your niche. It is one of our greatest challenges as a profession. My MD counterpart gets paid for a 7-10 minute office visit. That’s not medicine to me.
How do we hold true to the roots of our philosophy and practice, and still become mainstream enough, accessible enough in this day and age?”
Cathy Rogers, whose clinical career spanned the indie practice era, says that few of today’s young naturopaths would ever be able to get out of debt via the old time “classical” naturopathic practice model. The cost of the training is high, but the earning potential has not kept up. Good naturopathic practice is inherently time-intensive.
While she sees the profession’s movement from margin to mainstream as a positive one for patients, it does carry some risk: in trying to adapt themselves to the clinical and fiscal demands of a highly dysfunctional healthcare system, naturopaths could find themselves compromising the core principles that make their profession unique.
“The schools definitely chose to go the family practice / primary care approach as the main focus. That’s what the schools are teaching. My worry is that the students are not getting exposure to the older ways of working with modalities that support the body’s ways of healing.” Rogers’ concerns are shared by many in the field.
As president of Bastyr, Patterson is well aware of all of these issues.
“We do have the problem that we’re not on insurance par with MD services. We have to fix that over time. By working in integrative settings, the patients and the other practitioners will start to demand coverage in the package of insurance. The integration of that viewpoint into insurance plans will happen more quickly with greater inside advocacy.”
But after decades working within mainstream hospital systems, Patterson has no illusions about health insurance plans or their motives.
“We don’t want to be treated exactly like family medicine MDs in insurance. That’s not what we want to be going for. We have to figure out how were going to get an insurance company that supports practitioners in getting people healthy.” Ultimately, this is not about joining a broken system, but helping to recreate a system that is more supportive of keeping people healthy.”
Does integration inevitably mean compromise for naturopathic medicine? Patterson thinks not.
“My point of view is that you don’t really have to sacrifice your principles at all. You shouldn’t. It’s not about naturopaths becoming like other providers, it’s about bringing your philosophy and skill set in there. You don’t ignore the existence of conventional medicine, acute care, drugs, and surgery. It’s a part of reality, and it is sometimes the appropriate approach. But we need to think from the patients’ point of view, we need to think about the whole, and think about therapeutic order--choose the lowest level of intervention first.”
An Enduring Legacy
Bastyr University, and the people who built it, have endured much over the last 40 years, and they have also contributed much to the broader field of holistic medicine.
John Weeks points out that a number of the Institute for Functional Medicine’s key educators—including IFM’s Assistant Director of Medical Education, Dan Luckazer—are Bastyr graduates. Sheila Quinn, who edited the Textbook of Functional Medicine along with IFM founder David Jones, MD, brought more than a decade’s worth of experience with naturopathy at Bastyr into her work in functional medicine.
Tabatha Parker, ND, currently the interim executive director of the Academy of Integrative Health and Medicine (AIHM) was previously on the faculty at Bastyr.
“I see the mark of the NDs in so many places,” says Weeks, who believes that the naturopathic curriculum developed at Bastyr provided a framework for a number of the holistic and integrative training programs for allopathic doctors, including the University of Arizona’s highly influential fellowship.
“The ‘naturos’ have laid down a foundation that many others have borrowed from, Weeks told Holistic Primary Care. “The naturopathic model begins with respect for a holistic healing perspective as its base. I don’t think that naturos fully get this, that their 4-year residential training program will be the reference standard for decades to come.”
Patterson sees an organic convergence between naturopathic and functional medicine that will only increase in the coming years.
“I definitely see that (functional medicine) as synergistic. We’re trying to create a bigger tent here, and they are also trying to create a bigger tent. We have quite a number of conventionally trained healthcare professionals—MDs, PAs, nurses, who are frustrated with the conventional system and the limitations it imposes.
“There’s an opportunity here to bring these people in via functional medicine,” says Patterson. “We’ve done that as one-offs at Bastyr. They come to Bastyr to get an ND and move forward. We are thinking about maybe creating an intentional pathway for those kinds of folks. That’s really what the functional medicine folks are doing. The functional medicine approach is not identical, but it is much more aligned with naturopathy than the conventional approach, especially in primary care.”
Looking toward the future, Pizzorno sees two major challenges facing the naturopathic profession: The need for greater training in nature-based primary care, and the need for replicable models of financially viable naturopathic clinics.
“We really need more year-long residencies in primary care, to fine tune skills. Only about 50% of naturopathic grads get residencies because there’s no funding.” Like Patterson, Pizzorno sees collaborative MD-ND practices as increasingly important for the future of the field.
Looking back through the decades to the earliest days of the school he founded, Pizzorno is hopeful for the future. “We’ve made huge advances. We now have financial aid, federally-funded research, federally-funded post doc opportunities. Eventually the salaries will go up too. The people who are drawn to the profession believe in what we’re doing. More and more people see it as a viable profession. It used to be because it was “alternative,” it was a counterculture thing. Now it’s just because it’s good medicine.”