The Asheville-area practitioner was found guilty in 2002 of involuntary manslaughter in the death of an 8-year-old diabetic whose parents discontinued her insulin on Perry's advice.

"Here was a man calling himself a doctor of nutritional medicine," Carrboro naturopath Susan DeLaney said. "He had three degrees on his wall. But none of them was from a four-year naturopathic school."

As it is now in North Carolina, anyone can claim to be a naturopath -- a healer who uses natural remedies to promote well-being and prevent illness. But they are all technically practicing medicine without a license.

The act is a misdemeanor in North Carolina, and few are prosecuted.

For years, DeLaney has pushed for a state law that would license naturopathic doctors, also called NDs, who have graduated from four-year schools of naturopathic medicine.

"We want to be part of the health care team," DeLaney said.

With a licensing law, DeLaney and other graduates of four-year naturopathic schools want to distinguish themselves from those who took courses online or through the mail.

"They call themselves 'doctors' like I do," said Michael Smith, a Matthews naturopath and president of the N.C. Association of Naturopathic Physicians. "But our training is vastly different."

Medical doctors, who sometimes refer to NDs as "Not Doctors," oppose a proposed licensing law, partly because it doesn't include a method for ridding the state of naturopaths without four-year degrees.

Naturopaths who didn't attend four-year schools are even more vocal in opposition.

"If licensing is pursued, it has to be inclusive and not exclude the vast majority of naturopaths in practice," said Mike Causey, executive director for Citizens for Healthcare Freedom, based in Raleigh.

Naturopaths who don't attend four-year schools are educated in various ways. One popular school is Clayton College of Natural Health in Birmingham, Ala., which offers a variety of distance learning programs.

Four-year naturopathic schools are accredited by an organization approved by the U.S. Department of Education. Clayton is accredited by a different group, the American Association of Drugless Practitioners, which is not recognized by the federal government.

Boyd Landry is executive director of the national Coalition for Natural Health, which represents "traditional naturopaths" and other alternative practitioners.

He said distance-learning schools teach naturopathy "in its traditional and original form," and approval by the education department is not necessary.

Support for licensing naturopaths has been growing elsewhere. Fourteen states have such laws; none is in the Southeast.

It's impossible to know how many naturopaths practice in North Carolina, since there is no central registry or licensing board. The N.C. Association of Naturopathic Physicians, which represents only graduates of four-year naturopathic schools, lists about 20.

Students at four-year naturopathic schools take more than 5,000 hours of instruction, including 1,500 hours in clinical training, according to Karen Howard, executive director of the Association of Accredited Naturopathic Medical Colleges.

That compares with the average medical school student, who takes 4,794 hours of instruction, including 3,224 hours of clinical training, according to the Association of American Medical Colleges.

"We have to know everything that medical doctors know," Charlotte naturopath Crystal Abernathy said. "But we don't do what medical doctors do, and we don't pretend to. ... Both have a legitimate right to do their jobs."