The “Safety of Naturopathic Treatment”
In their nationwide effort to convince lawmakers to pronounce them primary care physicians, “educated” naturopaths have repeatedly claimed that their “natural” treatments are “safer and gentler” than those offered by medical doctors. The Alliance Legislative Workbook, a website that for several years provided strategies and “talking points” for ND-activists seeking state licensure, made this assertion in 2001:
Malpractice insurance rates [for licensed NDs] are generally less than $4000.00 per year, indicating the safety of naturopathic treatment as assessed by insurance companies. Master Insurance Trust reports that of the naturopathic physicians for whom MIT provides liability insurance, there have been only four incidents reported to the company for follow-up. However, nothing has been paid in either settlements or judgements on any of these items. “While this pooling of physicians is much too small to base actuarial considerations, this claims experience is clearly superior.” (Jeffrey D. Brunken, Program Manager, MIT, Letter dated May 21, 1990.)
Jury Verdicts Northwest, a legal database which records court cases in Washington and Oregon, the area of the country with the largest number of naturopathic physicians, shows no judgments for malpractice against N.D.s since the database was started in 1983. One in five M.D.s is sued each year in the US (AMA).
Why is malpractice so much lower among naturopathic physicians?
Naturopathic methods are less likely to cause injury than orthodox methods. Prudent dietary and lifestyle changes, for instance, are unlikely to cause harm. Naturopathic physicians by philosophy and training use the least invasive means to treat and prevent disease. This results in less injury to patients. Naturopathic physicians also have excellent diagnostic and referral skills. There is no significant history of complaints against naturopathic physicians resulting from a missed diagnoses, the most common cause for suits in a general practice. From insurance data, it appears that naturopathic physicians as a group know the limits of their methods and refer patients to other practitioners or specialists when appropriate.
The Colorado DORA “Sunrise Review”
Malpractice premiums, claims, and judgments are notoriously poor measures of either the presence or absence of harm. Nevertheless, NDs have continued to make political hay by claiming that their methods are particularly safe. Linda Rosa and Larry Sarner of the National Council Against Health Fraud have been active in opposing the ND licensing push in Colorado. A couple of years ago they asked if I knew of examples of licensed NDs having harmed patients. They had been communicating with the Colorado Dept. of Regulatory Agencies (DORA) as it prepared a “Sunrise Report” on “Naturopathic Physicians,” its second in 8 years. According to Mr. Sarner,
They apparently have all the evidence they need for the “traditional” [naturopaths], which has helped make the case for “protecting the public” against them by excluding them from practice. But as was told to us, they don’t have a single example of an “educated” naturopath being harmful, much less a number that would convincingly make the case that formal naturopathic training and knowledge makes no difference. Yesterday’s article (“Death by Natural Causes”) was timely, but when we sent it to DORA, they said the case only involved allegations of wrongdoing at this point, though they were glad to see the information and requested we feed them more of same.
My answer was, more or less, as follows (I sent a copy of it to DORA, apparently to no avail). I’ve added some new information that wasn’t then available. If some of this is duplicated from what I’ve written elsewhere, I apologize.
It is true that it’s difficult to find many cases of “educated” naturopaths harming patients. In my opinion the reasons are several:
1. There are few “educated” NDs to begin with. There are approximately 2500 throughout the US, or an average of 50 per state. By comparison, there are more than 12,000 MDs in Colorado alone. “Traditional” naturopaths claim that their numbers are many times those of “naturopathic physicians,” but there are no objective data to support this claim.
2. Self-regulating boards and malpractice suits will not expose such cases, because they will typically judge them to meet the “standard of care” for NDs, as is illustrated by the cases below. Thus in states with licensure, regulation does exactly the opposite of its intended effect: rather than protect the public, it shields NDs and their practices from regulatory and civil court scrutiny.
3. Most patients who seek medical care from naturopaths are unaware that virtually all naturopathic practices are unacceptable, and discover this only if a disaster occurs. For every disaster there are likely to be multiple near-disasters that no one, including patients and NDs, recognizes.
4. Most patients who have sought care from naturopaths are aware that they have chosen to venture outside of the mainstream, and are therefore likely to have a higher than usual level of cognitive dissonance even if they are capable of recognizing some dubious practices. What this means is that they are more reluctant to acknowledge or report such practices, because doing so would amount to an admission of bad judgment.
5. Most naturopathic practices are inert and thus not physically dangerous (although some are, as in the cases below). Harm by NDs is therefore more likely to be due to errors of omission (by diverting patients from effective treatment) than to errors of commission. Such “opportunity cost” harm is less likely to be reported by patients, who may be unaware of it. Nevertheless, it is just as dangerous as frank physical injury, and in all cases it amounts to fraud. That such omissions are real, contradicting the assertion that ”naturopathic physicians as a group know the limits of their methods,” is evidenced by a passage on p. 19 of a booklet entitled Naturopathy: Recommended for Licensure in Massachusetts, offered to the Massachusetts Special Commission by Barbara S. Silbert, DC, ND, “representing the Massachusetts Society of Naturopathic Physicians”:
CONDITIONS TREATED BY NATUROPATHIC PHYSICIANS
- Naturopathic Physicians treat most conditions which out-patient family practice medicine can treat.
- The type of patients who come to see Naturopathic Physicians include those:
- who are successfully treated but having side effects from the medication
- who are “successfully” treated but would like to eliminate the condition rather than continue on maintenance medication (depression, arthritis, hypertension, recurrent ear infections, irritable bowel, migraines, reflux, etc.).
- who want to avoid the recommended conventional treatments (infertility, depression, arthritis, synthetic cholesterol lowering agents).
- who want to prevent recurrences of problems (abnormal PAPs, chronic sinusitis, menstrual pain).
- who want to enhance the effectiveness or reduce side effects of conventional treatments (cancer, heart disease, pain relief).
- who have a condition for which there is no conventional diagnosis an/or [sic] conventional treatment.
- who are interested in natural treatments as a first choice.
- The goals of naturopathic treatment are:
- To cure the disease, to make all medications unnecessary.
6. Some harm that is exclusively psychological or emotional is unlikely to be recognized by those who lack medical sophistication. Here is an example: naturopaths tell parents that many common childhood problems, including ear infections and attention deficit disorder (ADD), are wholly or in part caused by multiple food allergies. This is almost always false. The child who is given this erroneous “diagnosis” is unnecessarily sentenced to years or even a lifetime of cumbersome, distasteful, and socially awkward dietary constraints. Anyone who has gluten-sensitive enteropathy, for example, knows what a project it is to avoid the offending substances. Imagine a ruse in which many people are falsely led to believe, by licensed “primary care doctors,” that they have intolerances to molecules that are nearly ubiquitous in packaged foods and foods served in commercial eateries.
7. Many patients have a reasonably good sense of when to seek real, as opposed to fanciful, care. Thus NDs are unwittingly saved from themselves by patients and MDs. The frequency with which this occurs is unknown.
“You can’t hold a naturopathic doctor to a medical doctor standard of care…”
There have been, however, deaths and serious injuries either directly caused by NDs or resulting from state endorsement of NDs as “doctors.” Several examples follow. The NDs were either known or almost certain to be licensed, as the case reports demonstrate.
Case I: Unnecessary death of a woman given “chelation therapy”
In 2003, a 53 year-old woman in Oregon died from acute hypocalcemia (rapid lowering of blood calcium) caused by intravenous Na2EDTA “chelation therapy,” which a licensed naturopath had given her to “remove heavy metals.” The Centers for Disease Control (CDC) reported: “The Oregon State Naturopath Licensing Board is conducting an investigation to determine whether Na2EDTA or CaEDTA was administered to this patient.” The Oregon Naturopathic Board found that the naturopath “was medically negligent in performing a chelation procedure,” but the order does not name the chelating drug, nor does it comment on the infusion rate—the most important predictor of hypocalcemia.
The order also makes no comment on the purported “indication” for the treatment, and there is no reason to believe that it viewed that as negligent: the Oregon naturopathic formulary lists “EDTA” without a cation, adding, “Board approved certification required before therapeutic IV chelation is allowed.” In 2003 such certification was likely to have come from the American College for the Advancement of Medicine [continuing education courses, an ACAM course titled “Heavy Metal Detoxification.” Thus it is virtually certain that Na2EDTA was the drug that killed the woman, and “therapeutic IV chelation” is a state-sanctioned oxymoron in Oregon. The ND himself is an ACAM member.
Such baseless, dangerous treatment is among the worst that quackery has to offer, as explained at length elsewhere. The case illustrates the folly of a state conferring self-regulatory power on “health” practitioners whose tenets are irrational: the Oregon State Naturopath Licensing Board had encouraged the very practice that killed the woman! From a medical ethical standpoint, it mattered not at all which of the two chelating agents she received for the bogus purpose of “removing heavy metals.” They are equally unethical when given for fraudulent reasons, even if one [Na2EDTA] is more dangerous than the other. The Oregon Naturopathic Board placed the practitioner on probation—he had also practiced recklessly in several other respects—but it will allow him to resume administering Na2EDTA after 3 years if he “completes all qualifying educational requirements as provided in the Board’s administrative rules.” Back to square one.
Case II: Unnecessary death of a teenage girl with an asthma attack
This is the case referred to above, “Death by Natural Causes.” In summary, in 2001 a 16-year-old girl in Washington state, suffering from an asthma attack, was taken by her mother to the family’s “primary care doctor”: a licensed ND. The ND couldn’t see the patient immediately, and in the meantime arranged for her to undergo acupuncture elswhere in the office. Twenty or thirty minutes later the ND emerged and gave the child vitamin B12 and an “herbal tincture.” The child went home, got worse, and died within a few hours—in the family car as her father was pulling up to an emergency room.
There is disagreement between the parents and the ND over what actually happened: the ND adamantly claims that she advised the parents to take the child to the hospital right away; the parents, just as adamantly, claim that the ND did not do that. There is no question that the ND failed to use any of several standard clinical tools to determine the severity of the girl’s asthma attack. There is also no question, among those familiar with physiology, pharmacology, and modern medicine, that the ministrations offered by the ND are useless for the treatment of asthma.
As Larry Sarner reported above, DORA apparently did not consider this case to be particularly telling because it “only involved allegations of wrongdoing at this point.” From a purely legal standpoint that may be correct, not only because of the disputed facts, but also because of the state-sponsored ambiguity of the ND’s role as a “physician.” Regardless of the disputed facts, however, the case illustrates why a state should not license practitioners who claim to be “primary care providers” but who have not been trained to practice modern medicine. As a consultant to the reporter who wrote the article for Seattle Weekly, I had the opportunity to read several of the depositions from the civil case. What they show is the folly of the State of Washington having granted licensure to NDs.
The plaintiffs argued that the treatment of acute asthma is not within the scope of practice of NDs. But NDs themselves list asthma as the 5th most common reason for patient visits, and their legal status in Washington had suggested to the mother that the ND could competently treat asthma: the ND is called a “physician”; her own website states that “NDs have the same training as a general practice MD”; the Boeing Corporation’s health insurance covered the ND as the family’s “primary care provider”; ND literature (easily available online and elsewhere) is replete with “expert” treatises on asthma and other common and uncommon medical problems.
Washington formally relies on NDs to determine their own standards of care, even though such standards conflict with medical facts. The Naturopathy Program Advisory Committee of the Washington State Department of Health consists of three NDs and two public members. A statute quoted in one of the depositions for this case stipulates that “health care providers…exercise that degree of care, skill, and learning expected of a reasonably prudent health care provider…in the profession or class to which he belongs…” ((RCW 7.70.030(1)(1)); emphasis added). This statute, in all probability, originally applied to allied health professionals such as nurses, physical therapists, nutritionists, etc. It almost certainly was not intended to provide a safe haven for physician-impersonators, but by licensing NDs the state of Washington has made it appear to do exactly that.
Thus the state, the ND, the field of “naturopathic medicine,” the Boeing Corporation, and the health insurance company all conspired to send an erroneous and, as it turned out, deadly message to the girl’s family: that the ND is a real doctor who is competent to treat a child’s asthma. The expert witnesses were correct that there can be only one standard of care, but the state, by imposing more than one standard when it licensed naturopaths, declared otherwise. Is it surprising that this would confuse and endanger health consumers? Isn’t the state of Washington, by dint of its decision to license NDs, the real culprit here?
Finally, the article is replete with opinions by NDs who judged the care given the child to have been perfectly acceptable. According to a Washington ND
who helped write the state law regulating naturopaths, ‘you can’t hold a naturopathic doctor to a medical doctor standard of care…’
The naturopathic board in Arizona, in which the ND defendant was also licensed, reportedly exonerated her upon receiving her report of the case. Thus both the influential Washington ND and the Arizona Board upheld care that included a shoddy diagnostic workup and useless treatments of acupuncture, vitamin B12, and “herbal tinctures” for a teenager who would die of a treatable disease within hours. The Washington State Dept. of Health also appears, so far, not to have found reason to discipline the ND.
If the child had been brought to the emergency room only an hour earlier, she would almost certainly have been saved. Neither her parents nor the naturopath would have known how close she had come to dying. How many such “near-misses” occur on a regular basis?
Case III: Nasal septum fracture caused by “NeuroCranial Restructuring”
“NeuroCranial Restructuring” is the absurd practice of inflating balloons in the nasal passages to effect a “controlled release of the connective tissue tension to unwind the body and return it toward its original design.” It was “created” and is taught by Dean Howell, ND, a Bastyr graduate who, according to his website, is licensed in the state of Washington. In 2003 the Archives of Otolaryngology reported that an ND in Washington had fractured a patient’s nasal septum while performing this technique. NeuroCranial Restructuring is a variant of “bilateral nasal specifics,” which was offered in the Bastyr course catalog at least as recently as 2001 (Bastyr University, in Kenmore, WA, is the flagship of naturopathic “medical” schools).
In 1983 an Alberta naturopath killed a 20-month-old girl using the same technique. A judge called it “outright quackery” but sentenced the naturopath to only a $1000 fine and one day in jail.* This suggests that the naturopath’s status as a “health care provider” had shielded him from more fitting punishment. We don’t know who the ND was who caused the nasal septum fracture in Washington, but there is a good chance that it was either Howell himself or someone taught by Howell. He or she was almost certainly licensed. The Oregon Board of Naturopathic Examiners lists “craniosacral therapy” (another nonsensical method, from which “NeuroCranial Restructuring” was derived), among its continuing education courses for NDs. Such a listing further illustrates the folly of licensing “educated” naturopaths.
Case IV: The Death of Debbie Benson
The following report was posted a few years ago on Quackwatch:
My good friend Debbie Benson died July 15, 1997, at age fifty-five. I had known her for thirty years. Her official diagnosis was breast cancer, but she was really a victim of quackery. Conventional treatment might have saved her, but she rejected the advice of her oncologist and went to “natural healers.”
Debbie was a registered nurse at the Kaiser hospital in Portland, Oregon, but she had a deep distrust of standard medical practice. She didn’t have a mammogram for nine years, and when she did — in March 1996 — it showed a cancerous lump in her breast. She had the lump removed, but she refused the additional treatment her doctor recommended. Instead she went to a naturopath who gave her — among other things — some “Pesticide Removal Tinctures.”
Soon after that, lymph nodes swelled in Debbie’s armpit. The naturopath said that this was merely the effect of the herbal remedies he was giving her and not to worry. Belatedly, she returned to her oncologist at Kaiser hospital, where the lymph nodes were biopsied and found to be cancerous. Once again, she refused the recommended treatment. Unfortunately, the cancer was spreading throughout her body.
Debbie continued to patronize “alternative healers” in the Portland area. One even claimed to diagnose her with a pendulum! She found another lump in her breast, but the cancer had invaded her liver and was no longer treatable by standard methods.
During the last weeks of her life, another naturopath gave Debbie a skin preparation that was supposed to draw the tumor out of her. This stuff caused an ugly open sore on her breast. By this time, her liver was failing and she felt awful. The naturopath told Debbie she was feeling bad as a result of this medicine, and to get more sleep. When Debbie became too weak to get out of bed and the imminence of her death was obvious, the naturopath blamed Debbie’s turn for the worse on “giving up.”
I have reported Debbie’s mistreatment to state regulatory agencies, and they are investigating.
During my research for the Massachusetts Special Commission, I wrote the author, Kenneth Spiker, wondering if anything had come of the case. He replied:
Had I been a Portland resident I would have done a more thorough investigation. I don’t know how much chance a lawsuit would have had in Oregon, even if a person had documentary evidence such as cancelled checks, medicine bottles, left over herbs, etc. If naturopaths are allowed to practice, then who’s to say that the standard of care wasn’t followed? Another naturopath?
Debbie was always a counterculture type of person. We used to go to peyote meetings in the 60′s at the Native American Church. She had her baby in a tipi on a commune in New Mexico. There’s still a whole counterculture out here, often associated with hobbit communities in Berkeley, Portland and Mendocino (where I live), where flaky alternative medical advice is passed around and there’s not a critical thought in a carload. I met a fellow at a party just last week who declared that he had come down with some kind of flu or crud, and bravely asserted, “I healed myself!” “How do you know that God didn’t heal you?” I asked. Evidently he had gone to some sort of alternative healer and he’d been instructed to “Put his disbelief on a shelf.” This fellow wasn’t an ignorant peasant, but a retired lawyer.
This stuff is rampant. If Debbie had been persuaded by her friends to try some herb or incantation, I wouldn’t be so angry about it, that’s her choice. But she went to a fake healer who was sanctioned by the State of Oregon and was persuaded to shell out a large amount of money for worthless cures. She made her choices and who’s to say for sure that even pursuing conventional medicine she would have lived? But I don’t like to see exploiters and cheats get away with their crimes.
The story of Debbie Benson and the response of her friend, a reasonable citizen-observer, further demonstrate why state governments should not appear to endorse nonsensical health claims—even though a few citizens may be ardent believers in those claims. I wasn’t able to find out who the naturopaths in the case were, but it’s likely that they were licensed, given Mr. Spiker’s statement and the fact that such licensing exists in Oregon.
Case V: “Adult Female Patient Instructed to Cease Taking Thyroid Medicine”
This case, ironically, was provided by DORA itself:
In July 2004, a Colorado woman visited a naturopathic physician who is licensed as a naturopathic physician in Montana, and as an acupuncturist in Colorado. The practitioner held himself out to the public as having extensive clinical experience in proctology, homeopathy, minor surgery, hemorrhoid treatment, spinal manipulation, and laboratory diagnostics. The patient informed the practitioner of her under active thyroid that had been persistent for the previous eight years. The patient alleged that the naturopathic physician sold the patient “USP” Armour thyroid medicine (pig gland), for which prescribing authority (medical license) is required in Colorado. Within a month, the patient suffered from hot flashes, hair loss, fluid retention, weight gain, and fatigue. A blood test was performed at the office of the endocrinologist, who reported that the results indicated a very low thyroid level. The endocrinologist indicated that the implications for not taking prescription thyroid medication in the long-term could be fluid retention, weight gain, sluggishness, rise in cholesterol levels, myxedema, and heart attacks. An injunction by the Colorado Board of Medical Examiners was imposed on the naturopathic physician for engaging in the unlicensed practice of medicine.
The final disposition (September 1, 2005) of this case between the Colorado State Board of Medical Examiners and the naturopathic physician (defendant) included the following terms: (1) the defendant will not engage in the practice of medicine as defined in section 12-36-106, et seq., C.R.S., (2) the defendant will not perform any kind of surgical operation (as defined in the permanent injunction) upon a human being, and (3) the defendant agreed not to practice proctology, surgery, the writing of or dispensing of prescriptions for prescription drugs, intravenous therapy, vitamin and mineral injections, topical anesthesia injections, and obstetrics.
The irony is that the ND in this case was, apparently, an “educated” naturopath. Each of the claims and methods attributed to him are typical for the cult as a whole, and only got him into trouble because Colorado did not have licensure for NDs. Thus it is a near certainty that the sanctions meted out by the Colorado Medical Board, appropriate though they were, would not have been issued by a hypothetical Colorado naturopathic board. Yet DORA contends that NDs should become licensed in Colorado.
Cases VI-VIII: Unnecessary deaths from colchicine overdoses
Last year 3 more deaths occurred in Oregon and Washington, each caused by overdoses of the highly toxic drug colchicine. It had been administered intravenously as a treatment for back pain, which should make any modern physician cringe. I don’t have time to discuss these cases in detail, but newspaper reports here, here, here, and indexed here showed that they involved NDs, at least one MD, and a shady compounding pharmacy that had mispackaged the drug in a concentration 8x that indicated on its label. Many readers of the linked stories concluded that the compounding pharmacy was entirely culpable, but I disagree. The NDs and the MD strike me as exuberant children left alone in a room with with nothing but matches and a pile of newspapers to play with. Another match in the box was undoubtedly Na2EDTA, as evidenced by one of the letters referring to treatments for “heavy metals.” My view is that of this letter-writer:
Re: Fatal doses leave doctor with questions
This use of colchicine is outrageous. In the medical profession, IV colchicine is never recommended even for gout because of the potential harmful adverse reactions. Oral dosing is safe because patients stop at appropriate levels because of GI side effects. IV does not have this built in safety feature. That is a major reason it is never given IV. Even oral can cause neuropathy (damage to nerves in arms and legs) if used for a long period of time. This is NOT a benign medication. This is yet another reason that Evidence-Based Medical Care should be the norm.
That IV colchicine for back pain is not some rare outlier among the practices of NDs and quack MDs is shown by this paragraph, quoted from p. 69 of the same booklet cited above, offered by NDs as evidence favoring their licensure in Massachusetts:
Colchicine is a drug derived from the autumn crocus plant. It is used in conventional medicine to treat gout. Alternative physicians also give colchicine intravenously to treat herniated discs. The success rate is said to be 90%. Widespread use of colchicine could substantially reduce the number of people who require disc surgery, saving billions of dollars per year.
Those words had been written by Alan Gaby, MD, a quack who was “Professor of Therapeutic Nutrition and a member of the Clinical staff at Bastyr University from 1995 to 2002.” So much for “natural and gentle,” and so much for “the least invasive means to treat and prevent disease.”
No, I won’t get dragged into the “medicine is the 3rd leading cause of death” BS
I am aware, because I’ve gone through the exercise so many times, that apologists for “naturopathic medicine” will respond to this blog with a tired, tu quoque fallacy: how can I talk when “conventional” medicine is so bad? I’ve answered this on numerous occasions and I don’t plan to do it again here. If anyone would like to peruse those discussions, they are among the articles linked from Part 1 of this series. I would consider, in another setting, debunking the “3rd leading cause” myth, but I suspect that Harriet will be doing that soon. That some MDs are also quacks is certainly true—that’s what most SBM blogs are about—but no excuse for NDs; two wrongs don’t make a right.
The difference, which I hope remains so, is that quacks constitute a tiny, fringe group among MDs. They are the absolute, unquestioned Standard Bearers of “naturopathic medicine.”
A final look at DORA: how Bureaucrats Think
The 2005 DORA report, flawed as it is, offers on pp. 36-7 an “answer” to the fundamental question raised last week: why would bureaucrats attempt to “regulate” a field that lacks objective standards? I’d like to think that the following quotation refers to a voluminous opinion, however misapprehended, offered to DORA by yours truly. Maybe it does, but DORA never sent me even an acknowledgment of receipt:
An argument raised in opposition to the Applicant’s proposal [for licensure of NDs] is a broad assault upon the efficacy of naturopathic practice. This opposition makes little or no distinction between groups or philosophies lumping all naturopathy into the realm of quackery. Many of these arguments are not compelling, but the most sophisticated of them holds that naturopathic practices are not proven effective by medical standards for testing, and, consequently, naturopathic doctors or physicians are not medical doctors.
This review concurs with those premises but differs in the conclusion drawn from them. To dispense with the easiest case, naturopathic doctors are not medical doctors and the application for regulation does not assert that they are, or should be construed as such.
This review concurs with the opponent’s position that naturopathic practice may not satisfy the requirement of allopathic medical research standards. This standard, however rigorous and time-tested, is not the standard for regulation of a profession. Colorado currently regulates acupuncture and chiropractic, modalities that may be or once were subject to the same criticisms. The regulatory test for government intervention in consumer choices, and barring clear evidence of fraud, or other compounding factors, is to determine the proper level of education, experience, examination, and subsequent scope of practice. This, coupled with disciplinary authority over practitioners who violate the state’s standards constitutes the proper role of government. Ultimately, given a safe market place in which to choose, consumers will make the appropriate decisions more efficiently than will government.
This review therefore is not convinced by the arguments of opponents who believe that naturopathy should not be regulated because of the lack of efficacy of the practice itself.
Wow. There are so many contradictions, misconceptions, and begged questions there that it boggles the mind. Maybe someday I’ll take it apart sentence by sentence, but right now I’m plain tuckered out.
Next week: are NDs truly experts in nutrition and “natural remedies”?
*Butler K. A Consumer’s Guide to Alternative Medicine. Buffalo, NY: Prometheus Books; 1992:82
The Naturopathy Series:
- “CAL”: a Medico-Legal Parable
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 1
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 2
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 3
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 4
- Colorado is Nearer to Promoting Naturopathic Pseudomedicine—Aided by the Colorado Medical Society
- Naturopathy and Liberal Politics: Strange Bedfellows
- Open Letter to Dr. Josephine Briggs
- Smallpox and Pseudomedicine