If you mean registration without formal regulation, ie, merely a way for those who call themselves “naturopaths” to inform the state (which, I think, does exist in a few places), I haven’t looked for information about those but I doubt that it would be possible to find accurate data.

Regarding patterns of use in a couple of states with formal licensing acts, here are some surveys:

http://www.biomedcentral.com/1472-6882/4/14

http://www.ncbi.nlm.nih.gov/pubmed/17606541?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

Here is a worrisome questionaire survey about certain patterns of use in Massachusetts, which has neither licensing nor registration of naturopaths:

http://archpedi.ama-assn.org/cgi/content/full/154/1/75

All of those survey reports were written by naturopaths or their apologists. To some extent that is worth considering when reading them.

I don’t howl with outrage; I agree with everything you’ve written, but with caveats. What you didn’t add, possibly for the sake of brevity but possibly to avoid getting too close to the feared “l” word, is that there would inevitably be several certification programs: SBM (ours), “holistic,” “integrative,” “homeopathic,” etc. Whether that would result in more or less quackery is anyone’s guess; whether that would matter is a matter of opinion: if people were left to choose for themselves, without government pretending to know best, at least they wouldn’t be bamboozled by government–which is worse than being bamboozled by quacks, because government ought to be trustworthy.

Thus caveat emptor, on its face, seems better than “trust your government to protect you,” if your government is being manipulated by the very forces that you need protection against.

There is also the unanswerable question of “which is better, greater freedom or greater safety”? It is unanswerable because it is a matter of opinion, and like it or not our society has, for this moment in health care, been moving in the “greater safety” direction–even if that safety is, to some extent, an illusion. It is on that basis that I write my criticisms of state boards and other governmental schemes, knowing that as long as they exist we must argue for their betterment, in the midst of the typical, exasperating commotion of democracy as we currently know it here in the U-S of A.

Getting back to the “l” word, moreover, there is another point that we all probably agree upon: an appropriate role of government is to prevent and prosecute fraud in the marketplace. Thus for some products in some circumstances in some markets, caveat vendor takes precedence over caveat emptor. I believe that health practices are among those products (a point made by Jarvis and Barrett years ago). The only difference between homeopathy being passed off as medicine and, say, white paint being passed off as cream, is that it takes a greater level of sophistication and technical expertise to recognize the first fraud than it does the second. What that means, of course, is that the scoundrels responsible for the first fraud–who, in most cases, lack such sophistication themselves–can more easily pull the wool over Big Brother’s eyes.

Thus we must be vigilant and fight the good fight. Government will always be uncertain about some things: who does it annoint as the expert? Politics are inevitable. I don’t know whether a certification scheme would be better or worse than what we have now, and I believe it is unknowable other than by trying it. I don’t think we as a society will decide to try it anytime soon.

The problem here is a nearly inevitable result of having state licensure of doctors. Before you start howling with outrage, I want you to do a thought experiment involving a voluntary certification program for doctors, kind of like the Good housekeeping Seal of Approval. Let us ignore all the issues of starting such a program and assume, for the sake of argument, that it is in place and established.

The program would presumably publish a list of doctors that met its approval. Doctors would be permitted to advertise their certification to prospective patients as a way of attracting customers. If a doctor failed to get certification, he or she could still practice medicine, albeit he would have a tougher time attracting customers without the certification. It is even possible that his professional options would be severely constrained since no hospital would hire him without it.

However, because such a program is purely voluntary, the guy failing to get certification would have little recourse should it be denied to him. The rules governing hearings and protests would be up to the certifying organization, and less subject to political pressure than a legislatively established organization.

Moreover, the people putting up the money to fund the organization (whether doctors paying a membership fee or hospitals wanting to assure a good supply of doctors – much like insurance companies funding Underwriter’s Laboratories) would want to conserve the organizations mission since the original mission is what they are funding.

The income of the certification organization would also be dependent on how good a job doctor’s customers perceived it to be doing. Thus, a certification agency that looked like it was bending over backwards to maintain the certification of a poorly performing doctor would tend to lose its reputation, resulting in a reduced value ascribed to the certification, resulting in fewer doctors seeking the certification, resulting eventually in a loss of revenue. Moreover, one can safely assume that such a cheapening of standards or violation of its mission would anger a sufficient portion of the membership that they would publicly splinter off of the organization, resulting in a very quick feedback cycle that punishes the lowering of standards.

The state boards create a problem:
1) They reduce the value of competing certification programs to 0.
2) They are susceptible to political pressure by legislators who are clueless about medicine.
3) Because they have the power to prevent a person from plying his or her trade, they have an onerous decisionmaking system that is biased towards giving people second or third chances.

The point I am getting at with this long post is that incentives matter. When the state does something, the people performing the task are rewarded/punished not for the quality of their work but based on criteria that are largely orthogonal to the quality of their work. Most people use the word “politicization” to describe this phenomenon.

Thanks for the advice. I will keep you informed. I copy off articles from this Blog and give them to my associates. The good news is I have started a Skeptic Society here and about half of my residents are interested and coming. We have a small univeristy in town and a lot of the faculty from their are interested and coming, particulary from the biology department and the psychology department. I will get that book you recommended. Again thanks

You are in a difficult situation, but one that is becoming more common and that won’t begin to abate until rational practitioners take a stand. For starters, I’d recommend reading Val Jones’s first post on SBM (if you haven’t already):

A “Shruggie” Awakening – One Doctor’s Journey Toward Scientific Enlightenment

You might also try to get your other colleague to read that post; he sounds like a “shruggie.”

Next, go here: http://www.sciencebasedmedicine.org/?s=%22Science%2C+Reason%2C+Ethics%2C+and+Modern+Medicine%22+

All the while, insist that your new colleague be specific about what practices she advocates. If you are unfamiliar with them, look for explanatory articles at rigorous, skeptical sites such as SBM or Quackwatch, and try to get other faculty and residents to read them, too.

Keep us informed.

OK by me. I have here some polar bear liver. I understand it’s lovely broiled and has lots of beneficial nutrients.

Oh, wait. He’s also including “natural products of the human endocrine glands.”

Well just in case he’s feeling a bit lacking in energy how about a jolt of epinephrine? Say about 20 mg IV? It’s all natural, remember.

That belief alone should be sufficient to disqualify him from the practice of medicine.