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Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 2

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.

“Appalled MD”

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”?

(Naaahhhh!)

*Butler K. A Consumer’s Guide to Alternative Medicine. Buffalo, NY: Prometheus Books; 1992:82

………..

 

The Naturopathy Series:

 

  1. “CAL”: a Medico-Legal Parable
  2. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 1
  3. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 2
  4. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 3
  5. Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 4
  6. Colorado is Nearer to Promoting Naturopathic Pseudomedicine—Aided by the Colorado Medical Society
  7. Naturopathy and Liberal Politics: Strange Bedfellows
  8. Open Letter to Dr. Josephine Briggs
  9. Smallpox and Pseudomedicine

 

 

Posted in: Health Fraud, Politics and Regulation, Science and Medicine

Leave a Comment (56) ↓

56 thoughts on “Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 2

  1. daijiyobu says:

    Speaking of the AANP’s Alliance Legislative Workbook, here’s a page I’ve highlighted

    – that I printed in 1997
    [see, http://www.scribd.com/doc/2203649/AANPAlliance-Science-Based-Not-Belief-Claim ] and still possess —

    wherein the AANP tells us:

    “naturopathic physician’s are the modern day science based primary care doctor [...] it is not a belief system.”

    So, mistakenly relying upon the truthfulness / integrity of that description — this AANP description was written for legislators!!! — I went to ND school [but, I stopped four years into it -- disgusted -- without graduating, but after amassing humongous debt] and found:

    a) the essentially naturopathic IS NOT science-based;

    b) naturopathy essentially IS a belief system.

    “Danger, Will Robinson, unethical sectarian pseudoscience!!!”

  2. Beowulff says:

    So, if I summarize correctly, removing some of the weasel wording, this whole issue comes down to these two points:
    1) When it comes to receiving patients, NDs want to be treated as equals to MDs. They want the respect of having a license on their wall, they want patients to regard them as family doctors, and they want health care to pay for their treatments.
    2) When it comes to accountability, NDs want special treatment. Evidence for their treatments is not required, and neither is medical knowledge to the level of an MD.

    So, they basically want to play with the big kids, but expect that the big kids follow their rules and go easy on them. Did that work well in the school yard for them? Why would it work in real life then?

  3. Zetetic says:

    Three years ago the Seattle Weekly wrote an article about the unfortunate death of a teen being treated by an ND for asthma.

    http://www.seattleweekly.com/2005-06-08/news/death-by-natural-causes.php

    I was a little surprised that the Seattle Weekly printed this article because the publication is decidedly counter-culture otherwise – the classifieds and personals are a hoot!

    Be sure to see the comment on the article posted by Kasra Pournadeali, ND, President of the Washington Association of Naturopathic Physicians. It mentions the “cooperative relationship” that NDs have with MDs here in the State of Washington! Ugh!

  4. Hermano says:

    Hello friends!
    I am very sad and angry to learn about patients dying under poor care.
    I read this post and immediately did some checking online.
    I have some comments, please correct me if I am mistaken.
    There are 6 deaths in total listed in this post
    1) Chelation therapy.
    I found multiple links online to physicians
    advertising chelation therapy as “very safe”, and, sadly, several cases of death caused by the MDs performing this procedure.
    It appears to be a fairly common, if controversial, medical practice, from the Google-y point-of-view.
    Certainly not unique to the naturopaths.
    2) Teen dies from an asthma attack.
    The ND strongly insisted that she recommended the teen’s parents immediately transport her to the ER.
    The only thing clear is that the ER is where the teen needed to be and where she did not get soon enough.
    The ND in question does not dispute this.
    Would a conventional GP been able to treat such attack effectively outside the ER?
    3) The Portland RN who did not trust conventional doctors and did not follow the cancer treatment they recommended.
    Very sad.
    I have no idea why an RN who works at a hospital would act as she did. Unlike most people her experience and contacts should have allowed her to find the very best specialists to help her.
    There are no details regarding who she saw. Apparently the state had been investigating her death, and apparently nothing came out of that investigation. Some more details would be very helpful.
    4-6) The 2007 colchicine related deaths in the Portland OR area
    This is fully 50% of deaths reported in this post.
    I read the following report http://blog.oregonlive.com/oregonianextra/2007/05/apothecure_statement.html

    An “emergency medicine specialist”, which must mean an MD, used colchicine, which is an experimental treatment for back pain.
    3 patients died because the drug was mislabeled and was 10 times stronger than it was supposed to be.
    There must be other medicines that would cause death when administered at 10 times prescribed strength.
    Sadly, there was no antagonist for colchicine which would have counteracted its effect and saved the patients.
    Is not the improper dosage the real source of these deaths?

    I appreciate that K. Atwood does not want to argue “naturopathic apologists” about deaths stemming from conventional treatments.
    Here is a comment form a medical doctor to the article about the colchicine deaths

    http://www.portlandtribune.com/news/story.php?story_id=117762598274410600


    Re: Bad medicine led to deaths

    This is a sad case where two patients died from poorly compounded medication from a small pharmacy. So what do we say about the more than 160,000 people a year who die from the appropriate dosing and use of pharma medications? The 160,000 we ignore and the 2 that died we hold up as examples of medicine newly gone BAD?

    “Mark L. Gordon, MD”

    (Not verified)

    Sun, Apr 29, 2007 at 02:06 AM

    Is this 160,000 deaths/year correct?
    I never suspected the number was that high.

    Regards,

  5. Stu says:

    Hermano, let me guess. You have a Google alert on “naturopathy”, the best to sweep in, play dumb and cut-and-paste?

    Sheesh.

  6. Hermano says:

    I talked to an ND about these cases, especially about the Portland nurse who died from cancer.
    Here is what I was told:
    1) There are some people who simply refuse to pursue conventional cancer treatments.
    2) Because of liability issues, this ND refuses to work with any
    cancer patient who is not already under oncologist’s care.
    3) This policy is the norm among most licensed NDs.

  7. DBonez says:

    Seems to me that a “Naturopathic Physician” is a lot like an impotent rapist: Sure there are limits to what they can do, but they can still be extremely dangerous.

  8. Joe says:

    Hermano talked to a quack who, typically, ducked the charges by saying “We don’t do that.”

    If it ducks like a quack …

  9. weing says:

    Hermano,
    An MD screws up and his patient dies, he is liable. Standard of care has been compromised and it led to damage. Malpractice insurance premiums increase as a result. An ND uses some weird treatment that kills a patient, does he/she pay? The standard of care is established by whom? NDs or MDs? The ND will say that there has not been a deviation from the standard of care. If no deviation, then no malpractice.

  10. Hermano says:

    weing,

    Do you have any evidence of what you suggest happenning
    commonly occurring?
    There is one case presented in this post that fits your suggestion, the chelation related death.
    I found multiple links online to MDs promoting chelation.
    http://www.healthybloodhealthybody.com/svc_ChelationTherapy.htm states:

    “WHAT ABOUT SAFETY AND SIDE EFFECTS?

    Chelation Therapy is among the safest of medical procedures. More than 500,000 patients have received over ten million treatments during the past 40 years. Not one death has been directly caused by Chelation Therapy, when properly administered by a physician who was fully trained and competent in the use of this therapy.”

    Would MDs be able to publicly advertise themselves in such manner if the medical authorities, e.g. Medical Board, Health Dep’t, strictly restricted this practice?

    The Oregon naturopathic board did discipline the naturopath who performed the procedure.
    http://www.circare.org/pd/mcbride_orders_20060510.pdf
    shows that the Oregon Naturopathic Board found D. McBride “medically negligent in administering chelation therapy” and “stayed the revocation of his license” (which I read as put him on probation) for 5 years.

    I am not defending chelation therapy, just pointing out that there are varying opinions among MDs regarding its safety and efficacy and that in a single case mentioned involving ND, the ND was disciplined and found ‘medically negligent’ by a naturopathic board.

  11. Joe says:

    Weing,

    At the bottom of the text, Kimball cites Kurt Butler’s excellent text “A Consumer’s Guide to ‘Alternative Medicine’” (which is still valuable, despite its age). Butler relates the case of a licensed ND, in Hawaii, who’s young wife was diagnosed (probably not by the ND) with Hodgkins (curable). He (the ND) treated her with “natural” cures (including laetrile) until she was too far gone for medical treatment except palliative care. The ND was not even reprimanded by the licensing board because he followed their standard of care.

  12. Hermano says:

    Another thought about the Oregon.

    K. Atwood states:
    “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.”

    Oregon has 774 licensed naturopaths according to the 2008 Colorado sunrise review on naturopathic physicians
    http://www.dora.state.co.us/OPR/archive/2008NaturopathicPhysiciansSunrise.pdf, see page 17.
    According to the U.S. Census, http://www.census.gov/statab/ranks/rank18.html, there were 262 doctors per 100,000 population in 2003 in Oregon.
    Oregon has 3.7mil residents and thus, approximately 9,700 doctors.
    In Oregon’s case, 774 vs 9700 is quite different from averaged 50 versus 12000 in Colorado.
    Furthermore, since “educated” NDs are licensed as physicians in Oregon, the doctor total of 9700 may even include them.

  13. overshoot says:

    Hermano:

    Chelation Therapy is among the safest of medical procedures. More than 500,000 patients have received over ten million treatments during the past 40 years. Not one death has been directly caused by Chelation Therapy, when properly administered by a physician who was fully trained and competent in the use of this therapy.”

    Abubakar Tariq Nadama, 2000-2005

  14. Joe says:

    Hermano,

    You linked to a particularly idiotic MD concerning chelation. You clearly cannot distinguish between fact and fiction. Are you not embarrassed to argue with medical professionals (not me) when you are so ignorant?

    See:

    The National Council Against Health Fraud on chelation
    http://www.ncahf.org/policy/chelation.html

    Chelation Therapy: Unproven Claims and Unsound Theories
    Saul Green, Ph.D.
    http://www.quackwatch.org/01QuackeryRelatedTopics/chelation.html

    http://www.sciencebasedmedicine.org/?p=132

    http://www.chelationwatch.org/

    Chelation can be safe; but it has few indications. Overshoot’s reference to the death of Abubakar Tariq Nadama is a problem of unsafe application (which is huge); however, the even bigger problem is that it should never have been applied, at all. There is no excuse for taking the risk of a “safe” procedure when a patient does not need it.

  15. I’m not surprised that Hermano would bite. A reiteration of points already made:

    “Chelation therapy” is dangerous quackery, no matter who is doing it. Yes, it is advertised online by MDs and DOs. They should be barred from the practice of medicine, period. That they are not is, unfortunately, a tribute to the success of the “health freedom” movement (read: freedom for quacks to defraud and endanger patients) of the past few years, aided by quackademics in medical schools and government.

    Fortunately, chelationists constitute a tiny fraction of the 800,000 licensed MDs and DOs in the US (only 800 are ACAM members, for example). For their sordid history, see the article cited here: http://www.sciencebasedmedicine.org/?p=118
    Contemporary chelation quacks, like contemporary cancer quacks, were inspired by Laetrile, the most infamous health fraud in American history.

    “Chelation therapy” thus remains a fringe practice among MDs and DOs. Rational members of the medical profession will continue to demonize it, hoping that it becomes nearly impossible to perform without threatening one’s license.

    In “naturopathic medicine,” conversely, it is touted as rational therapy that ought to replace modern medicine’s treatments for atherosclerosis. Evidence for this is in the Textbook of Natural Medicine, the continuing ed. courses and formulary promulgated by the Oregon N Board, in the booklet cited above, and other places that are “mainstream” in the cult. The Oregon N board’s discipline of McBride failed to acknowledge that the ND view of “chelation therapy” is itself the problem—not merely McBride’s bad luck in having killed someone with it. I made that clear when I wrote “back to square one.”

    Put another way, imagine the ACAM lobbying for, and winning, independent licensure to practice medicine according to its own “standards,” immune from scrutiny by regular medical boards. That, in essence, it what licensure of NDs amounts to.

    Regarding the asthma case, the disagreement between the parents and the ND is irrelevant. The parents never should have been led to believe that there was a reason to take their daughter to the ND in the first place. I made that point in spades above, and it was also made in this passage from the article in Seattle Weekly:

    “But suppose they were ‘natural freaks,’ as Su says Messer tried to make them seem, and refused the naturopath’s urging to go to the hospital. Why, Su asks, didn’t Messer call 911 herself? It’s the same question that a range of medical doctors ask. ‘Essentially, I’m watching someone getting ready to die,’ says McGough, the UW clinic chief, putting himself in that situation. He says he would simultaneously call the medics and take aggressive action to stabilize the patient, with nebulizer and oxygen treatments. ‘I’ll have that conversation’—with the parents about whether or not to hospitalize—’when the medics are there.’ ”

    Regarding colchicine, I made my points clearly above. So what if an MD was also involved? He is also licensed to kill. The quoted letter from Mark Gordon demonstrates his own lack of critical thinking. Rather than parrot that, read why in the pieces that I cited last week, in particular “Naturopathy, Pseudoscience, and Medicine: Myths and Fallacies vs. Truth.” http://www.medscape.com/viewarticle/471156

    The number of NDs in Oregon means…what? Oregon and Washington have more than other states, by far. I gave an accurate average number/state for the purposes of the point I was making to the Colorado DORA.

    Note to others: I’m sorry to say that the W^5/2 #8, due this weekend, will have to wait a few days. I’ll be out of web contact for a bit as soon as this comment hits the page.

  16. overshoot says:

    “Chelation therapy” is dangerous quackery, no matter who is doing it. Yes, it is advertised online by MDs and DOs. They should be barred from the practice of medicine, period. That they are not is, unfortunately, a tribute to the success of the “health freedom” movement (read: freedom for quacks to defraud and endanger patients) of the past few years, aided by quackademics in medical schools and government.

    Perhaps they should be, but the fact remains that regulatory boards of all sorts [1] are subject to “regulatory captivity” — the same phenomenon that causes the FCC to act as the advocate for radio/TV station owners, telephone companies, etc. in opposition to the general public they are supposed to represent.

    [1] Not just those set up to defend homeopaths, naturopaths, etc.

  17. Hermano says:

    Overshoot and K. Atwood,
    Thank you both for responding to my questions, I have read many and will certainly read all references provided.

    Chelation death(s)
    I am ignorant about chelation. My apologies.
    Until today, I only knew that it was a therapy used to treat a patient with a heavy metal poisoning.
    I have formed an opinion of chelation as something shady after meeting a woman couple years ago, who, I was told, lost her medical license for something chelation related.
    I borrowed ‘The Clinician’s Handbook of Natural Medicine’ by J. Pizzorno et al (Churchill Livingstone Pub., 2002) to learn more about the ND perspective on chelation.
    The Handbook does not list chelation as one of ‘Therapeutic Approaches’ for angina and atherosclerosis; those include diet, lifestyle modification, dietary supplements, and botanical medicines.
    It does describe chelation using EDTA as a “safer, cheaper, and possibly more effective” alternative to bypass surgery/angioplasty (p.40) and that there were no deaths or significant adverse reaction in over 500,000 patients “treated under controlled protocols”.
    I take these “controlled protocols” refer to the treatment of atherosclerosis in adults, not treating small children.
    Again chelation is not listed as a ‘Therapeutic Approach’ to artherosclerosis, it is listed as an alternative to surgical treatments.
    There is no mention in The Handbook regarding using chelation
    to treat autism.
    From reading about the 5 yo child who died following chelation treatment, http://www.timesonline.co.uk/tol/news/uk/article559318.ece, I learned that the number of autistic children treated with chelation has increased from few dozens in 2000 to 10,000 in 2005.
    I honestly do not understand how “regulatory boards of all sorts are subject to “regulatory captivity”” by their constituents.
    Perhaps naively, I also disagree that the purpose of all regulatory Boards is to defend practitioners. I hope it is to defend the interests of public.
    If chelation is as abominable as all told, and the numbers given show that 99.9% of MDs and DOs do not endorse it, how can those 800 ACAM members prevail over 799,200 doctors who do not support chelation?
    What internal arguments are raised against
    strongly condemning this practice by Health Departments, Medical Societies, and Medical Boards, and moving to penalize practitioners who perform it? It has to be better than 12 MDs out of 12,000 in Colorado use it and the Medical Board is afraid to act against them. That would be contrary to the argument made against self-regulation by small groups in previous post “reason that self-regulating professions are at least somewhat capable of acting objectively, in addition to the existence of objective standards, is that most are large enough to guarantee independence in their board deliberations. In Massachusetts, for example, there are 30,000 MDs.”

    Asthma death
    I wish SOMEONE has called 911.

    Colchicine deaths
    Pharmacy mislabeled the drug, a dose 10 times stronger than intended was lethal. Why is this any physicians’ fault?
    http://www.medicinenet.com/colchicine/article.htm which does not appear fringy lists the use of IV colchicine as a gout treatment.
    As an aside, I watched a great old medical murder mystery last night, “Green for Danger”. Dr. Barnes, the ‘anesthetist’, is blamed for a patient’s death during routine surgery. It’s a gas.

    The number of licensed NDs in Oregon is significant because it is
    large enough to compare their records with the records of Oregon MDs.
    Judging by the numbers in http://www.sciencedaily.com/releases/2006/09/060930094340.htm and the census numbers linked above, only about 10% MDs are family doctors (seems low to me) which in Oregon case would give a number similar to the number of licensed naturopaths.
    It would be a fair comparison to examine the records of both groups for safety, complaints, etc.. .
    Also, the Oregon data show what the numbers of NDs might be in other states were NDs licensed there.

  18. Hermano says:

    K. Atwood,

    Tangential to the numbers of family doctors.

    In 2001 Relman wrote “There is no current shortage of fully-trained primary care MDs in Massachusetts.” http://www.quackwatch.com/01QuackeryRelatedTopics/Naturopathy/relman3.html
    Do you recognize that there is such shortage now?
    The NY Times argues that the problem is quite severe in
    http://www.nytimes.com/2008/04/05/us/05doctors.html

  19. Joe says:

    Hermano wrote “… I am ignorant …”

    We know. You cited a quack doctor; now you cite the “Clinician’s Handbook” by Pizzorno, not even a doctor.

    Are you never embarrassed?

  20. Joe says:

    Hermano wrote “Tangential to the numbers of family doctors.”

    If you have a shortage of mechanics in your town, would you let primary-school kids work on your car? I don’t recommend it …

  21. Hermano says:

    I checked with some NDs. According to them, chelation can be an adjunct to bypass surgery/angioplasty, and in SOME cases a viable alternative.
    J. Pizzorno’s Handbook points to the ACAM as the authoritative body for chelation. As disreputable as ACAM may be, it is clear that here the NDs follow the lead of the MDs, who compose the entirety of ACAM’s officers and directors.
    http://www.acamnet.org/site/c.ltJWJ4MPIwE/b.2072047/k.A790/Our_Leadership.htm
    ACAM membership DOES include NDs.
    I checked the numbers of practitioners and their credentials for several states at http://www.acamnet.org.
    These numbers do not indicate that the NDs flock in overwhelming numbers to the ACAM banner and dispute K. Atwood’s assertion that “…imagine the ACAM lobbying for, and winning, independent licensure to practice medicine according to its own “standards,” immune from scrutiny by regular medical boards. That, in essence, it what licensure of NDs amounts to.”

    ND not licensed states:
    Massachusetts
    No credentials: 2
    MD: 12
    Minnesota(registration effective at a later date)
    No credentials: 1
    DO: 1
    MD: 3
    ND licensed states:
    Oregon
    No credentials: 4
    MD: 9
    ND: 7
    Washington
    No credentials: 4
    CNT?: 1
    MT?: 1
    DO: 1
    MD: 11
    ND: 1

  22. Daijiyobu, do you know if naturopaths still sell the supplements they recommend (prescribe) to the patients they “treat”?

    If so, do you have any estimates as to what % of their incomes is derived from the sale of supplements?

    Hermano, if you have info on this, I’d like to hear it.

    IMO, with the possible exception of veterinarians it should be illegal for those treating patients to sell them the products they prescribe.

  23. Joe says:

    Hermano is posting to site that notes ACAM and n’paths are quacks; yet he cites them as evidence supporting his position. I can’t be the only one who notes his confusion…

  24. overshoot says:

    Hermano is posting to site that notes ACAM and n’paths are quacks; yet he cites them as evidence supporting his position. I can’t be the only one who notes his confusion…

    Credo quia absurdum seems to be a prerequisite in some circles.

  25. Hermano says:

    Overshoot,
    I was pointing out that in states that license naturopaths very few join the ACAM.
    In Oregon just 7 naturopaths out of 774 licensed naturopaths are members of the ACAM, and in Washington only 1 out of 877.
    If naturopathy was all about chelation I would expect greater participation by the naturopaths in the ACAM.
    Do you have any reason to suspect that the member information
    given by the ACAM is unreliable?
    And thank you for terrific Wikipedia links.

    Sincerely and Honestly.

  26. Hermano says:

    rjstan,
    Prescribing vitamins and supplements are a large part of what the NDs do.
    Also, the NDs commonly prepare tinctures and such themselves for their patients.
    There are normally dispensaries at the clinics which provide these products.
    Are you critical about the connection between the NDs and the supplement companies, as some are critical of the relationship between the MDs and the pharma industry?

  27. Joe says:

    Overshoot, I think Hermano is telling us: “illegitimi non carborundum.” I caution him: “semper ubi sub ubi.” It could be embarrassing.

  28. Hermano says:

    Quod foetet?

  29. Yes, Hermano, I am critical of the connection between naturopaths and the supplement industry. I think the idea of a doctor prescribing a drug and a pharmacy filling the prescription is the way it should be. While that doesn’t guarantee against all abuse, it certainly greatly curtails it. It ensures that two professionals, a doctor and a pharmacist, check to see if the drug is appropriate for the patient. It also ensures that a greedy doctor is not tempted to overprescribe so that he can make extra money selling drugs or supplements to patients.

    I think it should be illegal for anyone who sees patients to sell them the drugs or supplements they prescribe.

  30. Fifi says:

    rjstan – You bring up a very important conflict of interest if naturopaths sell or somehow otherwise profit from what they prescribe or promote to patients. It’s funny how many promoters of CAM try to paint doctors as pill pushers when in fact it’s CAM practitioners who are pushing pills for profit!

    Another example of conflict of interest is organizations (non-profits!) like the “Centre for Advancement in Cancer Education” (sounds rather wonderful doesn’t it) at beatcancer.org which promotes JuicePlus and CAM (and charges for any “information”) under the guise of being a charity and profiting through being tax exempt.

  31. apteryx says:

    I certainly agree that there’s something quite fishy about a practitioner’s insistence you buy the product they have to offer, unless you are dealing with an herbalist or TCM doctor who makes personal or patient-specific recipes [a very important exception]. Not to engage in a “tu quoque argument” – for I think the practice is absolutely to be condemned in naturopaths – but I have heard that it is common for oncologists to purchase chemo drugs and resell them to patients – at a profit. People with private insurance and cancers *not* responsive to chemo not infrequently wind up getting chemo up to their last weeks of life. One wonders if a “temptation to overprescribe” exists there also, with more money at stake. Fifi is right that some CAM practitioners behave unethically due to a profit motive, but to suggest that the temptation does not exist in MDs may lull medical consumers into a false sense of security. The same questions should be asked of an MD that would be asked of a naturopath.

  32. weing says:

    If I have to give a patient a medication IV or even a vaccine, I have them buy it and bring it with them for administration. I lost too much money when I bought the meds myself. The reimbursement from insurers was less than the cost to me.

  33. Apteryx; “to suggest that the temptation does not exist in MDs may lull medical consumers into a false sense of security. The same questions should be asked of an MD that would be asked of a naturopath.”

    I for one have never suggested and would never suggest that the temptation does not also exist for practitioners of scientific medicine. In my previous 2 posts on the matter I tried to state clearly that I think that all practitioners treating patients should be prohibited from selling those patients the drugs they prescribe with the possible exception of veterinarians. (I won’t go into my reasons for that possible exemption here unless someone is interested.) As to whether or not herbalists, TCHs, and homeopaths should be exempt, I’d need a lot more information about their practices before I could form a personal opinion.

    Historically in the US, most practitioners of scientific medicine do not sell the drugs they prescribe. Pharmacists do. Historically, most practitioners of alt. med. do sell the drugs they prescribe. IMO, that is asking for trouble.

  34. Fifi says:

    Well I live in a country with public healthcare so there’s not the issue of “selling chemo drugs” that you claim happens in the US (though you just seem to be reaching for a way to pretend that doctors do the same unethical things that even you have to admit naturopaths do). beatcancer.org and JuicePlus seem to be particularly pernicious examples of the sleazy practices of supplement manufacturers and some CAM practitioners, particularly naturopaths who promote and sell supplements.

  35. apteryx says:

    Sorry, rjstan, the last two sentences in my last message were a response to fifi, not to you. You did not say that only CAM practitioners engage in, or should be prohibited from engaging in, this practice. Fifi’s comment, following yours, implied that this was not a problem in MDs’ practices.

  36. Hermano says:

    rjstan et al,

    I checked with two NDs. Both said they felt ‘iffy’ about the practice of selling supplements.
    One is salaried at a clinic run by an area hospital and does not profit in any way from the supplements, tinctures, etc.. sold at the clinic dispensary.
    Second one runs a private office and sells supplements to patients at a 50% to 100% markup above “doctor” prices.
    The supplements and vitamins are supposed to be better quality than those available at a discount drug store.
    These items are not normally available through retail outlets, when they are, as in the example of purified fish oil now available through a local supermarket, the prices are similar.

    Both practitioners commonly prepare herbal tinctures for the patients.

    Here are some things I find objectionable.

    Questionable practices which translate into supplement sales where the CAM practitioner may not even know about the supplements being prescribed.
    Examples, 1) “energy medicine” machines.
    http://seattletimes.nwsource.com/html/localnews/2004020606_miraclevantage18m.html
    details one device which its manufacturer promotes as a way to “boost office revenues by $100,000 a year by using the Vantage to detect any imbalances and selling supplements to correct them”
    2) applied kinesiology aka ‘muscle testing’.
    This is news to me, supplement sales are a big part of it.

    And here is a behemoth — direct sales or multi-level marketing (MLM) diet supplement industry.

    One company, The Nature’s Sunshine Products claims to have 600,000 distributors http://www.naturessunshine.com/us/company/history/history.aspx.
    Getting correspondence school ‘ND’ credentials is part of the
    program. See http://www.theherbdoc.com/resources/memberservices/Training/index.html.
    In comparison, professional ND organizations proscribe involvement with MLM pyramid schemes.
    From the College of Naturopathic Physicians of British Columbia Advertising Policy, http://www.cnpbc.bc.ca/doctors/documents/Advertising%20Policy.pdf,
    “4. Representation
    4.1 A Registrant must not:
    d. solicit or involve a patient to sell multi-level Marketing products for the direct or indirect
    benefit of the Registrant.”
    The diet supplement MLMers are where much of the active opposition to regulating NDs comes from.
    For example, The Sunshine Health Freedom Foundation, http://www.sunshinehealthfreedomfoundation.com, supported by the NSP, used its resources to organize the fight against regulating naturopathic medicine in Minnesota and other states this year.

  37. Fifi says:

    apertyx – Do you just have rumours about oncologists selling chemo drugs for a profit that you’re perpetuating or some evidence that this is a common practice or ever happens at all? The supplement industry, JuicePlus in particular in the US, has whole organizations devoted to promoting their product to cancer patients using deceptive practices (for a large profit margin selling products that often don’t even contain the nutrients they claim to contain).

    Really it just seems like you’re trying to divert attention from the fact that it’s a common (if not the usual) practice for naturopaths to sell the supplements they recommend. Doctors can write prescriptions and give away free samples but I’ve never had a doctor try to sell me anything. Granted, I’ve never had to visit a doctor in the US so I’ve never been dealing with a profit driven medical system. It’s possible that this happens in the US or other nations where medicine is expected to be a profitable business -which only highlights the problematic nature of mixing medicine with selling medications. The only time I’ve ever seen MDs selling products for profit in Canada has been those who are involved with the beauty industry – dermatologists and plastic surgeons who do purely cosmetic (not reconstructive) surgery – and even then I’ve never had a dermatologist pressure me to take prescription medication (sold at the pharmacy) or buy a line of products they’re selling (sold in their practice).

  38. Fifi says:

    Once again, it seems like the accusation that advocates of CAM so often throw at doctors – of being pill pushers – is really a much more accurate description of many naturopaths who are engaged in a rather clear conflict of interest.

  39. Fifi says:

    “4.1 A Registrant must not:
    d. solicit or involve a patient to sell multi-level Marketing products for the direct or indirect
    benefit of the Registrant.”

    This says nothing about selling or promoting products TO patients as part of one’s practice, it merely says NDs shouldn’t rope in patients to sell products FOR them as part of an MLM scheme. Under this guideline, NDs could still promote and profit from sales of products that they tell their patients they need to buy but they can’t try to make their patient buy extra to sell to their friends and family.

  40. daijiyobu says:

    Regarding naturopathy’s supplement industry ties, the AANP-AANMC Foundations of Naturopathic Medicine Project’s homepage [see http://www.foundationsproject.com/ ] — an endeavor which seeks to “create a codifying textbook of naturopathic foundations” — is clearly homeopathic & supplement industry WELL-sponsored.

    FNMP lists such donors as Seroyal (and Seroyal states the same at http://www.seroyal.com/seroyal/ ), Metagenics, Essiac, Boiron, Bezweken etc. Make no mistakes, though, about the level of sophistication that must be employed in combating naturopathy, because this movement is VERY well-heeled: Seroyal’s donation alone to FNMP recently was $500,000.

    As an expert critic of naturopathy myself, and since the title of Dr. Atwood’s article includes “pseudoscientific cult,” in support — though ‘cult’ doesn’t, in my view, do justice to the degree of naturopathy’s mindf*cking, bullsh*tting and absurdity — let me emphasize naturopathy’s keystone premise:

    that the body is operated by a “vital force” otherwise known as “God” aka “vis medicatrix naturae” per “vis is similar to what most religions consider as God/life force [...] philosophies of naturopathic medicine and of major world religions share beliefs [..such as] life is based on a powerful invisible ‘force’ [see the above homepage, and see http://www.foundationsproject.com/documents/Spirituality/Spirituality_Primary.pdf ].”

    I’ve labeled this facet of their broad syncretism — their vitalistic, spiritistic, teleological, pantheistic belief amalgam — autoentheism or animatistic self-divinity: the belief in a ‘universe-distributed’ impersonal god also within oneself.

    Overall, they are the people that MOST disgust me, who engage basically in these equations:

    the profoundly science-ejected is in fact firmly scientific;

    a sectarian article of faith / belief is — in fact — scientific fact.

    In other words, the mindset is that something is the same as something it is profoundly different from.

    Cultic: yes. Pseudoscientific: yes. Fraudulent, HUGELY.

    The publisher of the textbook will be Elsevier.

  41. daijiyobu says:

    And to answer rjstan@together.net [sorry for the delay, I was at TAM 6!],

    the amount of supplement income NDs derive from their dispensaries is BIG, and it is built into their curriculum:

    E.g., when I took lab diagnosis classes while pursuing my aborted ND at UBCNM (1998-2002), the DC instructor [a big AK practitioner, and later, a UBCNM ND grad., who now runs UB's 'Nutrition Institute,' see http://www.bridgeport.edu/pages/4983.asp was IN FACT also an salesperson for Metagenics, lecturing us through the computer-projector-powerpoint apparatus he'd use on the road as he pitched Metagenics / Great Smokes to alty practitioners.

    It was great [I jest]: often the lab findings would be through a Great Smokies test (now GDX), that — surprise-surprise — could be treated through a Metagenics supplement [branches of the same company, if I remember correctly].

    I garner that NDs are very profitable for Seroyal, and therefore the company hugely supports the AANP-AANMC project mentioned above.

    By the way, the Brady book (ISBN 1600370802) that is cited at the bridgeport.edu page above states this, as regards naturopathy’s homeopathy vitalism and as regards A.K.:

    “homeopaths believe that illness of the body is fundamentally due to a distunement of the person’s energy or life-force [...] homeopathic remedies are prescribed in order to retune [p.144] the vital force by imparting a specific energy into the body [...] an energy that would perfectly match the person’s vital energy [...] this resonance, or matching, of the energy frequency of the remedy and the vital-force is therefore given to reset the vital force [p.145...] consider practitioners utilizing A.K. who have formal training and have received board certification [...] make sure it is issued by the International College of Applied Kinesiology [p.135].”

    All in all, an academic nonsense collective.’

  42. apteryx says:

    Fifi – Here is a link to a New York Times article, dated 2006, on what has been termed the “chemotherapy concession.”

    http://www.nytimes.com/2006/03/08/health/08docs.html

    This article notes that it is possible for physicians to purchase these drugs at a sizeable discount, resell them, and thereby make a generous profit (some of which, indeed, does go to help with overhead, as does every other profit). Here is a link to the PubMed abstract of the first study referenced in the Times article.

    http://www.ncbi.nlm.nih.gov/pubmed/16522584?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

    It states that before a reform in 2003, Medicare reimbursement for chemo “greatly exceeded” drug costs. So perhaps the problem has since been reduced by the reduction of doctors’ profits, at least in that program. In the 1990s, though, patients with metastatic cancer (i.e., likely to be terminally ill) were prescribed more expensive drugs if the doctors were more highly reimbursed. The study’s authors felt that greater profit potential might have influenced prescribing behavior.

  43. apteryx says:

    Oh, and fifi, I’m not “trying to divert attention” from anything. I condemned improper profit-seeking behavior from naturopaths right up front.

  44. Hermano says:

    Fifi,
    Selling vitamins and supplements is definitely part of the picture for
    the NDs.
    Patients can and sometimes do get prescribed supplements and vitamins elsewhere, over the internet, from another practitioner, or wherever.
    MDs, who may not directly sell drugs to their patients, benefit financially from close ties to the drug companies.
    An MD specialist I know well well enjoys $150 meals paid by the drug company’s reps. I’ve never heard of a supplement company rep buying an ND any kind of meal.
    http://www.nytimes.com/2007/03/21/us/21drug.html details the financial ties between the MDs and the pharma industry in Minnesota.

  45. Hermano says:

    Fifi,
    Let’s look at a hospital where a patient gets a medical drug prescribed and administered in the same setting.
    Here is a blurb from http://seniorjournal.com/NEWS/Features/4-09-10Hospitals.htm
    “For the top 40 hospitals, the study found medical supply markups of up to $9,593%, drug charge markups as high as 6,796%, and operating room markups of up to 1,950%. In other words, the hospital that leads in supply charges puts an average sticker price of $9,593 on supplies that cost the hospital on average $100. On drugs, the national average sticker price was a 399% markup – an increase of more than 50 points over prior IHSP findings.”
    It does not look like there is an economy of scale here. You would think a large hospital might negotiate a better deal than an individual buying a drug at a pharmacy and pass the savings on to the patients.
    Does anybody know if the anesthesiologists usually markup their drugs?

  46. Zetetic says:

    Hermano – I’ve monitored hospital billing systems and interfaces and it is true that hospitals mark up drugs and supplies considerably. On the other hand, most hospitals have increasing numbers of capitated payment patients and they do not actually get paid for the markups you describe.

  47. Harriet Hall says:

    Naturopaths use homeopathy – charging anything for water is a markup.

  48. daijiyobu says:

    As someone who went through most of an AANMC ND program

    [at UB; and left voluntarily -- disgusted, ripped-off etc. -- particularly because of their homeopathy, TCM, AK, and overall 'epistemic misrepresentation' as embodied in naturopathy's principles

    {see OBNE, http://www.oregon.gov/OBNE/Aboutnaturopathy.shtml }]

    I should add that not only do “naturopaths use homeopathy,” as Dr. Hall has stated,

    a student is placed in this position — then and presently — as regards the whole AANP AANMC ND / NMD ruse:

    you must state that that which is profoundly nonscientific is in fact scientific {e.g., the vitalistic, supernatural, theistic, teleological etc.} to be licensed.

    It’s ludicrous:

    the ND licensure exam, the NPLEX Part II, is titled “Clinical Science” and presently part of that exam is homeopathy {see http://www.nabne.org/images/clbull.pdf }.

    So, yes NDs use homeopathy, but, specifically, “naturopaths are required to use homeopathy and misrepresent its scientific status” as they do their principles.

    Hell, the President of the AANMC, President and CEO of SCNM, and the ND of the Year 2007 [this is one person, Mittman] is a DHANP

    (see http://naturopathic.org/images/bulletins/2008_Awards_Docs/Physician%20of%20the%20Year%20-%20Call%20for%20Nominations%202008.pdf ).

  49. Dr. Hall, “Naturopaths use homeopathy – charging anything for water is a markup.”

    Not when it is well shaken by a person gifted in transfrerring spirits or healing properties from one substance to another.

  50. Hermano says:

    Is it just me, or the comments are getting a little weak?
    It did not take very long to degrade from a murderous cult to marking up bottled water.
    More fire and brimstone, please!

  51. Fifi says:

    apertyx – As I said, it’s entirely possible that in the US medical system that drugs are sold for profit by a clinic or physician (more likely a clinic or hospital since oncologists don’t have one-person private practices generally). However it really seems to me that you’re trying to divert the issue and make it appear that what is business as usual for NDs is just as common with MDs. It’s also worth pointing out that drugs for chemotherapy at least have some science and testing behind them so the patients are at least buying what they’re being sold, where NDs are selling supplements that often don’t even contain what the ND claims they do (though the ND is probably unaware that they’re being conned too since they’re working from a basis of faith not evidence to start with).

    Really all you’re doing is highlighting the very real problems – that I raised already – which occur when healthcare is a for-profit business run by people who can do math but know little about the practice of medicine and value profit more than people. Clearly there are some less principled doctors who are tempted into the same kinds of practices as NDs – some even work with NDs or go all the way into wooworld since that’s where the money is to be made. And, obviously the supplement industry and their front organizations lay down a carpet of cash and free lunches at the conferences they fund (they’re often aimed directly at nurses but snagging a doctor is even more desirable since it gives their purely commercial business the veneer of being medical and scientific).

  52. Fifi says:

    Hermano – Murderous and non-murderous cults have been selling magical water (or bits of string) that offer miraculous healing since….oh…well…since someone was foolish or desperately ill enough to buy water for the price of gold just because someone told them it was magic. The magical water idea seems to be particularly potent in America – look at how many people are willing to pay a premium for tapwater just because it’s in a plastic bottle! I don’t mean mineral or spring water but actual tapwater. Really, talk about having more money than brains!

  53. gdpawel says:

    In regard to the Chemotherapy Concession:

    Selling cancer chemotherapy with concessions creates conflicts of interest for oncologists

    http://www.healthyskepticism.org/news/2007/Jun.php

  54. Pingback: Bryan

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