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Disingenuous: Deconstruction of a naturopathic white paper

Science is the Concept by which
we measure our reality
I don’t believe in magic
I don’t believe in I-ching…
I just believe in science…and that reality.

John Lennon. Sort of.

As regular readers of the blog are aware, I am science/reality based.  I think the physical and basic sciences provide an excellent understanding of reality at the level of human experience.  Physics, chemistry, biology, anatomy, biochemistry, physiology, evolution etc. provide a reliable and reproducible framework within which to understand health and disease.  My pesky science may not know everything about reality, but day to day it works well.

“There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy. – Hamlet (1.5.166-7).”  

Perhaps, but all the medical advances in my lifetime have been not yielded new science, just (amazing) variations and extensions of known processes.  I sometimes think the blog should have been called reality based medicine, but science is the tool by which we understand reality, and while the tool is constant, our understanding of reality is prone to changing.  An understanding of the rules of the universe combined with an awareness of the innumerable ways whereby we can fool ourselves into believing that those rules do not apply to us is part of what makes a science and reality based doctor.

We are often told of the need to keep an open mind, but I like to keep it open to reality.  Not that I do not like fantasy and magic, it is a common category for my reading.  I just finished Red Country by Joe Abercrombie, and while I love the world he has created, I would not want to apply the rules of that imaginary world to my patients.   Well, one exception.  As Logen Ninefingers  would say, “You have to realistic about these things.” Fictional worlds should be limited to the practice of art, not the practice of medicine.

Part of having a scientific bent is the urge to classify.   Supplements, Complimentary and Alternative Medicine (SCAM) is such a hodgepodge of ideas and practices it is difficult to categorize. Carolus Linnaeus  I am not, but in my mind I have come to classify SCAM into four broad types.

Type 1:  Total nonsense with zero prior plausibility.  These are SCAMs based on ideas divorced from reality as I understand it, cannot have efficacy and do not have efficacy.  It includes, but is not limited to, homeopathy, acupuncture, chiropractic, ayurvedic, reiki and other energy therapies, iridology, applied kinesiology, craniosacral therapy, water therapy, and on and on and on.  Whenever I makes this kind of list  I am amazed at how

age cannot wither SCAM,
nor custom stale
It’s infinite variety.

People who inflict these modalities on others may be well intentioned, but as we all know “the road to Hell is paved with frozen type 1 providers. On weekends, many of the younger demons go ice skating down it.”

All type 1 SCAMs are useless, non-reality based magic*.  I would think anyone who proposes any type I SCAM for diagnosis and treatment should be kept as far from providing medical care as is feasible*.

Type 2: Those SCAMs that may or may not have efficacy.  These are mostly various herbs, whose reasons for use are often historical or related to aggressive marketing.  The prior plausibility that a given herb will actually have efficacy for a given disease is small, but not zero, and occasionally an herb or supplement, like red rice, is discovered to have actual active ingredients and effect.  Unlike pharmaceuticals, the actual contents of most herbs may be unknown and and efficacy is based on experience.  I stand by my opinion that, when it comes to therapeutic interventions, that the most dangerous words a health care provider can utter are ‘in my experience’.

Type 3: Those SCAMs where a little efficacy in the test tube or in a small poorly done study is blown out of all proportion to its real effect.  The effects are perhap real, often small, and usually not clinically relevant.  Green coffee beans are a recent example, thank you very much Dr. Oz.

Type 4:  SCAMs that are not SCAMs at all. For example diet and exercise.  Diet and exercise are often  part of the marketing of SCAM, and there is nothing alternative about diet and exercise as such.

Reality based doctors generally avoid the first type 1 SCAMs and may have a nodding acquaintance with types 2 and 3.  We all recognize the importance of diet and exercise although implementation will vary.

Naturopaths, in contrast, have a gobbet of reality based education in a sea of fantasy.  I have written about naturopathic education before.  The result was that one of the faculty of the local ND school, I forget which one, wrote a letter to my boss obliquely complaining about me.  Figures.  Didn’t write to me, oh no, went straight to my boss.

I became interested in SCAMs early in my practice when I was called to see a “leg infection”.  What it was a dead leg, wet gangrene, with the horrible smell only rotting human flesh can produce.  It was a 24 year old girl who had an osteosarcoma of her leg and rather than be cured with amputation she went to a naturopath who said she could he cured by, among other things, drinking alkaline water and herbs.  It didn’t.  She refused surgery by us. She had been brought in by her mother when she became unresponsive but perked up with fluids, letting us know her naturopath still assured her that he could cure the tumor, that the rotten leg was her body ‘rejecting’ the tumor.  That night the tumor, or the infection,  eroded into a major artery and she bled to death.  That is my idea of the archetype naturopathic care.

I have long been of the opinion that  you can judge a person by the company they keep.  The naturopathic education at my local school includes hydrotherapy, homeopathy, qui dong, colonics, the nature cure, herbs, and botanicals. Anyone who thinks homeopathy is an appropriate therapy for anything but thirst is in my opinion, unfit to care for others.  They are divorced from reality as I understand it*.

Once in practice naturopaths expand their practice into other areas that are, in my opinion, useless. Consider these Northwest ND’s:

Kevin Wilson, ND: “spinal manipulation, and prolotherapy. I prescribe many herbal medicines, specific nutrients at therapeutic doses, and homeopathic remedies. Some patients are candidates for intravenous therapies such as vitamin and mineral ‘cocktails’, dilute hydrogen peroxide for infections and soon, chelation therpy for chronic cardiovascular disease.”

Bill Walter, ND: Detoxification coaching. “Nearly everybody, for example, can benefit from nutritional counseling, stress-reduction training, or gentle detoxification.”

Kelly Fitzpatrick, ND: ”Nutritional Supplementation including Intravenous Therapy such as High Dose Vitamin C therapy.”

Liz Dickey, ND:  An emphasis on homeopathy.

Hilary Andrews:, ND: Treating autism by rebalancing the nervous system with drainage (what ever that is), dietary restrictions and probiotics.

Dawson Farr, ND: prolotherapy, detoxification,  and vitamin injection therapy.

Some offer wide ranging testing  for “Food Allergy Testing, Hepatic Detoxification Profile, Toxic Heavy Metal Analysis, Pesticide and Solvent Exposure Panel, Hormone Saliva Test, Comprehensive Diagnostic Stool Panel”.  I cannot say what these specific testing panels represent and for all I know could be just fine. Color me skeptical.

I see no end of wonky infectious disease testing used by naturopaths for Lyme and the use of live blood analysis.  For example,  the time an ND diagnosed a patient with a bacterial blood stream infection based on live blood analysis and offered the patient an expensive colonic detox as a cure. After hundreds of dollars of out of pocket testing, the patient saw me for a second opinion before spending several hundred dollars more. The patient had asthma as the cause of this symptoms and he improved with an inhaler. Another great ND diagnosis.

Why choose these NDs?  Because they are the authors of “Naturopathic Primary Care. A White Paper to help regulators, lawmakers, and administrators in Oregon address PCP shortages using naturopathic physicians.”

As Jann Bellamy discussed last week, there is an ongoing political debate over whether naturopaths should be credentialed as part of CCOs.   They shouldn’t.  The white paper suggests we should include people trained in therapies not based on reality and science and offering therapies not based in reality or science as primary care doctors. I suggest that would be a bad idea.

From the introduction:

As both the Affordable Care Act and Oregon’s own healthcare transformation move into full implementation, there has been much discussion about how to address the shortage of primary care providers. Many possible solutions have been proposed in response to this crisis, including the use of non-MD practitioners in helping meet Oregon’s primary care needs.

Oregon is in the excellent position of having a pool of highly trained non-MD primary care providers already licensed by the state and with the scope of practice and formulary needed to practice as primary care providers – Naturopathic Doctors (NDs).

This document offers clarity and insight to decision-makers, medical directors, and insurance administrators on the role that naturopathic medicine could play in serving Oregon’s population. It can act as a roadmap for Oregon’s new Coordinated Care Organizations and Healthcare Exchange insurers on how to effectively integrate naturopathic physicians to help meet the Triple Aim: better health, better care and lower cost.

What follows is an impressive spin for what it doesn’t mention: that  naturopaths have severely inadequate training in reality based medicine and it makes them unfit to be primary care medicine providers.  They forget to mention that the basis of their practice is nonsense*.

The initial description of naturopaths and their qualifications looks good on paper. Upon close inspection it resembles the Melanesian cargo cult. From a distance it looks like soldiers and planes and radios  and all the accoutrement of modern industrial society, but upon closer inspection everything is made of twigs and vines, the form without the function.  So too with the white paper. The overview looks good, examined in detail naturopathy’s

but a walking shadow, a poor player that struts and frets his hour upon the stage and then is heard no more: it is a tale told by an integrative practitioner, full of sound and fury, signifying nothing.*”

They start with a description of naturopathy:

 • emphasize prevention and self-care as a cornerstone of health;

• focus on patient-centered care, addressing the determinants of health in treatment plans;

• prioritize a “therapeutic order” that begins with minimal intervention and proceeds to higher intervention; and

• address the underlying cause of the condition rather than focus solely on symptomatic treatment.

It sounds good until you consider the tools used to apply that philosophy.  Homeopathy. Acupuncture. Hydrotherapy. Chelation. Live Blood Analysis. Craniosacral Therapy.  Flower Essences.  The nonsense that is often the subject of this blog. The twigs and vine equivalent of medicine. I entered “Portland Naturopathic Physician” into Google and went to site after site.  I could not find one that offered at least one non-reality based therapy.  The raison d etre of the field is to attempt to apply fantasy to reality.* I will admit that I could not find an office where all the equipment was made of vines and twigs, but then I was speaking metaphorically, not literally.

The same reasonable sounding overview of naturopathic education:

Didactic education in biomedical, diagnostic, and clinical sciences

• Biomedical and Diagnostic Sciences: physiology, anatomy, biochemistry, microbiology, pathology, immunology, etc.

• Clinical Sciences: clinical, laboratory and physical diagnosis, gastroenterology, pharmacology, rheumatology, endocrinology, neurology, gynecology, cardiology, etc.

• Therapeutics: botanical medicine, nutrition, homeopathy, physical medicine, counseling, pharmacology, minor surgery.

At our local naturopathic school they get 72 hours of pharmacology education, and twice (144 hours) as much training in homeopathy.  The have the opportunity to do electives to broaden their knowledge: 144 hours in homeopathy,  36 hours in qi gong, 26 hours in Aruyveda, 24 hours in energy work and 12 hours in colonics.”

If there is a litmus test by which you could judge magic vrs reality, it is homeopathy, perhaps the most popular and, arguably, the rankest of rank nonsense.  If a practitioner thinks homeopathy is reasonable, run. the  Here, as an example of the learnin’ in ND schoool, is a common treatment for nasal stuffiness in the naturopathic armamentarium:

Directions

Take a pair of cotton socks and soak them completely with cold water. Be sure to wring the socks out thoroughly so
they do not drip.
Warm your feet first. This is very important as the treatment will not be as effective and could be harmful if your feet are not warmed first. Soaking your feet in warm water for at least 5-10 minutes or taking a warm bath for 5-10 minutes can accomplish warming.
Dry off feet and body with a dry towel.
Place cold wet socks on feet. Cover with thick wool socks. Go directly to bed. Avoid getting chilled.
Keep the socks on overnight. You will find that the wet cotton socks will be dry in the morning.

Effects of the Wet Sock Treatment
This treatment acts to reflexively increase the circulation and decrease congestion in the upper respiratory passages, head, and throat. It has a sedating action and many patients report that they sleep much better during the treatment. This treatment is also effective for pain relief and increases the healing response during acute infections.

It is inexpensive, patient centered, self care, minimalist, and inexpensive.  It is also divorced from physiology and reality and is, for lack of a better word, stupid*.

It is not hard to find weird* naturopathic approaches for any disease. All you need is Google and search terms. My first hit for naturopathy and asthma:

Some doctors recommend taking baths with a cup or so of 3% hydrogen peroxide in the water to bring extra oxygen to the entire surface of the skin, thus making the lungs somewhat less oxygen hungry.

Say what?  I remember riding the bus to medical school and a naturopathic student noted what I was reading and struck up a conversation with me.  Warts, he informed me, are not due to a virus but the body walling off toxin and expelling them.  I thought he was either misinformed or a lunatic.  Turns out the root cause of warts is toxins, at least in the fantastical world of some naturopaths.  So much for the root of diseases.

It is almost like the old joke. How do you tell if a naturopath is speaking unscientific nonsense? If his mouth is open.

They then note that naturopaths are required to have 45 hours a year in continuing medical education.  Sounds good, they are kept educated.  But in what? The local naturopathic school is offering CME in Integrative Oncology.  As I have mentioned before, if you integrate cow pie with apple pie, the cow pie is not improved, the apple pie is made worse.

Included in the days education is

“Dr. Joseph Pizzorno, ND, describes diet-induced cellular acidosis, and how this phenomenon is documented to contribute to chronic diseases, including cancer, osteoporosis, diabetes and more.”

and the summary states

Diet-induced cellular acidosis is real and clinically significant. Cellular acidosis induces mitochondrial dysfunction, calcium loss from bones, increased risk of kidney stones, increased risk of cancer—the list is long and substantiates the long held belief that an alkaline diet is health promoting. Of particular significance in cancer, lower pH levels in the extracellular fluid increases intracellular calcium, which induces carcinogenic pathways, and promotes invasiveness and metastases.

Maybe I will get to see another death from wet gangrene from progressive cancer treated with alkaline water instead of effective therapies.  I hope not. The CME includes Ayurvedic medicine and acupuncture.  Maybe it sould be CNE, (the ‘N’ for nonsense*) since it certainly does not appear to include education in the science based biomedical sciences my job requires.  Collecting more vines and twigs into a simulacra of medicine is unlikely to improve medical care.

The white paper then notes that, like MD’s, there are residency training for naturopaths:

 Accredited residencies are available for one, two or three-year terms. Currently, all residencies are privately funded. Consequently, residency opportunities are not available for all graduates.

I count 55 residencies on the AANMC web site and there were 507 first year students enrolled in 2007-2008.  So at best 11% of  have training beyond naturopathic school, and one or two years at that.  I practice in a teaching hospital with medical students and residents and no one is ready to take care of patients on their own after medical school. And they have had to learn reality based medicine.

After 4 years of reality based medical school, MD’s have residency and fellowships where we have years of supervised training.  For me it was three years of internal medicine, two years of ID fellowship and two years of post fellowship training, all under the watchful eyes of senior physicians.  Naturopaths often go from school to practice.  Next time you see a naturopath, remember it is the same as seeing an unsupervised medical student. And a medical student extensively schooled in type 1 SCAM. Not that a residency under the watchful eye of another magician could improve their practice.

Sometimes men change for the better. Sometimes men change for the worse. And often, very often, given time and opportunity . . .’ He waved his flask around for a moment, then shrugged. ‘They change back.”
― Joe Abercrombie, Best Served Cold

Inadequate training and experience even in their own area, much less real medicine, and then thrown into the world under the mistaken impression that they are competent to care for people*.  It makes the next part of the white paper scary*:

Naturopathic Scope of Practice

Naturopathic doctors are licensed to work as independent providers in Oregon. They do not require supervision or oversight by other providers, and are licensed to:

• Diagnose, prevent, and treat disease;

• Perform physical exams including orificial exams (oral, vaginal, anal);

• Order x-rays, electrocardiograms, ultrasound, CT, MRIs, and laboratory tests;

• Draw blood and perform CLIA-waived lab tests in-office;

• Perform minor surgery;

• Provide prenatal, intrapartum, and postpartum care (with additional certification);

• Provide injections including vaccinations and IV medications;

• Prescribe all natural & pharmaceutical medications needed in a primary care setting;

• Are eligible for Drug Enforcement Agency (DEA) numbers for Schedules II- V (authority to prescribe controlled medications).

Just what I want poorly trained unsupervised medical students to do. As we have seen, it is not the broad concepts that make the scope of naturopathic practice problematic, it is the inadequate training, experience and fanciful modalities used that make the ND unfit to care for humans in health and disease*. The white paper make sound like real medicine, but men change back.

Standard of Care & Competencies

There is no naturopathic-specific standard of care. Naturopathic doctors are taught and held to the same standards of care as conventional providers.

No kidding.  Wander the web looking a naturopathic practices.  There is a complete lack of standards since any and all non-reality based practices are fair game.*

Treatment Guidelines

Condition-specific treatment guidelines present more of a challenge with naturopathic physicians than conventional providers. Each person’s treatment is individualized taking into consideration conventional treatment guidelines, but combined with a complex array of natural and conventional modalities that may vary among providers.

It is always harder to follow guidelines when you have no standard of care and their inadequate training would make them hard to understand and much of the tools of their trade are in direct opposition to science based reality.*

There is now

The Naturopathic Academy of Primary Care Physicians is newly created and is establishing a board certification program for primary care naturopathic doctors. However, it is still years away from a formalized program.

Oregon naturopathic primary care doctors are able to do all of the following:

• Examine, diagnose, prescribe and treat patients as family physicians;

• Manage all pharmaceuticals needed in a primary care setting;

• Manage patients’ routine preventive screenings, vaccinations and blood work;

• Order diagnostic tests, images, blood-work and labs;

• Perform well-child visits, women’s health visits, sports physicals, sign birth/death certificates, assist with advance directives, handicap permit and driver impairment, etc.;

• Perform minor surgery, including excisional biopsies and laceration repair;

• Coordinate care with a referral network of labs, specialists, physical therapy, behavioral health, social services, hospitals, and out-patient facilities;

• Educate patients about lifestyle, diet, stress management and chronic disease management;

• Write orders for residential facilities, hospice, in-home nursing care, etc.

I can’t see how a ND, with inadequate training in biomedicine, immersed in type 1  SCAM, little, or more likely no, post graduate training in biomedicine can “Examine, diagnose, prescribe and treat patients as family physicians.”  FP’s, besides 4 years of real medical school and three years of supervised residency, have continued and ongoing real biomedical education. It is why the joke is ND stands for Not a Doctor.

Proof is boring. Proof is tiresome. Proof is an irrelevance. People would far rather be handed an easy lie than search for a difficult truth, especially if it suits their own purposes.
― Joe Abercrombie, Last Argument of Kings

What little data there is suggests that utilizing a naturopath for primary care is associated with worse care: less cancer screening, mammography and Chlamydia screening   But considering they are trained in magic instead of modern bioscience, why would I expect otherwise*?

There is a pause while I had go buy a new computer.  I was drinking milk when I read the next section and did an impressive spit take into my keyboard when I read:

Immunizations

Naturopathic doctors are educated according to the public health laws of the state, and understand the role that vaccinations play in preventing communicable disease. But because naturopathic care is by definition patient- centered, many NDs will customize the vaccination schedule to address the patient’s risk factors, environment, and personal beliefs. See Appendix A: How NDs can help Oregon increase immunization rates.

and the white paper appendix says

 How NDs can help Oregon increase immunization rates

Oregon naturopathic physicians can help CCOs provide care for more patients and may in fact assist in increasing rates of immunizations in populations who otherwise completely opt out.

The Oregon Association of Naturopathic Physicians (OANP) is a strong proponent of preventive medicine and of the protection of children and adults from the serious consequences of infectious disease. Naturopathic physicians, as primary care providers, are morally obliged and legally required to uphold and carry out the public health mandates of the state. All physicians are also ethically obliged to give patients, parents and legal guardians accurate and current information on both the benefits and risks of all medical interventions.

It is no surprise that the reality does not match the spin given the long standing antipathy towards vaccines in large sections of the naturopathic community. Naturopathic care leads to fewer vaccinations and an increase in vaccine preventable diseases:

Outcomes included receipt by children aged 1-2 years of four vaccine combinations (or their component vaccines) covering seven diseases, and acquisition of vaccine-preventable diseases by enrollees aged 1-17 years. Children were significantly less likely to receive each of the four recommended vaccinations if they saw a naturopathic physician. Children who saw chiropractors were significantly less likely to receive each of three of the recommended vaccinations. Children aged 1-17 years were significantly more likely to be diagnosed with a vaccine-preventable disease if they received naturopathic care.

As naturopathic students move though their education, the support of vaccination declines:

We found that only 12.8% (40 of 312) of the respondents would advise full vaccination; however, 74.4% (232 of 312) of the respondents would advise partial vaccination. Importantly, both willingness to advise full vaccination and trust in public health and conventional medicine decreased in students in the later years of the programme.

The hesitancy of patients to get the recommended vaccines may be fed in part by the anti-vaccine nonsense perpetuated by many  NDs*.  Like Hilary  Andrews, one of the authors of the white paper, on vaccines and autism:

While the measles-mumps-rubella or MMR vaccine has been strongly linked to the onset of autism, I believe that prior vaccinations also play a cumulative role in this disease. Current vaccination schedules overload very young, fragile immune systems with a huge number of viruses.

Regular readers of this blog recognize the above paragraph as das ist nicht nur nicht richtig, es ist nicht einmal falsch!  Lets say that I am not so sanguine that naturopathy represents a way to increase vaccinations in Oregon, much less improvements in primary care.

I get the distinct impression the white paper is presenting information they think people what they would like to hear, rather than mentioning the unsavory and imaginary details that make up much of naturopathic practice.  But when it comes to money it is better to look good than be good*.

It is imperative to note that naturopathic physicians are independent practitioners. Patients increasingly also turn to naturopathic physicians as first point of contact providers and would refrain from care with a conventional doctor if they cannot access their naturopathic physician.

Health care in the US is a mess.  I have no clue what the solution is.  I hope for a single payer system.  I came to the conclusion long ago that sometimes there are sometimes no good solutions to some problems, just the least bad solution.  Right now health care is a mess in innumerable ways; a single payer system will make it a mess in one way.

If you have a problem in astronomy, you do not call an astrologer.  Sure, he knows the names of the planets and the stars and has a good patter about how his system works. But astrology is nonsense.  If you have a shortage of pilots, you don’t hire a transcendental mediation practitioner to levitate the plane.  At least not a plane I would get on.  And if you have a shortage of primary care providers, perhaps including those with inadequate training in  real medicine, extensive knowledge of fanciful fields who treat cancer with alkaline water and misdiagnose asthma as a blood stream bacterial infection, might not be the best choice to improve the health of the population.

The whole white paper is a disingenuous “argument by assertion… the logical fallacy where someone tries to argue a point by merely asserting that it is true, regardless of contradiction”.

Naturopaths have the knowledge and training to do primary care.

Not.

*Opinion.  I hate saying in my opinion out of paranoia, it is repetitive and ruins the flow of the prose.  So if you see an asterisk it refers to this footnote that points out,  yes,  that was my opinion.  This is all my opinion. Opinion. Opinion. Opinion.   So I am writing an opinion piece filled with humor. Everything not referenced is my opinion. OK?

Posted in: Humor, Naturopathy, Politics and Regulation, Public Health, Science and Medicine

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28 thoughts on “Disingenuous: Deconstruction of a naturopathic white paper

  1. mousethatroared says:

    “there is an ongoing political debate over whether naturopaths should be credentialed as part of CCO’s.   They shouldn’t.”

    I suspect the problem is different goals.

    Is the goal to improve the overall health of the population?

    Or is the goal to make voters of different demographics feel that their health concerns are being met?

  2. windriven says:

    @mouse

    You nailed it.

    If Oregon succeeds in barring NDs from CCOs I will have to reconsider my belief that politics is the only practice less valuable than homeopathy.

    @Dr. Crislip

    “I hope for a single payer system.”

    And I hope for nationalization of health care delivery for those on Medicaid and unsupplemented Medicare. We have a wonderful national healthcare delivery system already in place: the VA hospital system. Expanding their role to include care for Medicaid and Medicare patients would require additional funding to expand the system but might be expected to reduce overall expenditures on those populations. Moreover It would provide a test bed for a true single payer system and would allow clear comparisons of cost and quality between single payer and traditional models.

  3. daijiyobu says:

    Re: “drainage (what ever that is) [...and] speaking unscientific nonsense”

    Drainage is a form of homeopathy via a system called Unda made by Canada-based Seroyal.

    This is big in the naturopathy crowd, so much so that the company funds naturopathy’s new textbook project to the tune of half a million dollars [according to the naturopathy crowd].

    The blended remedies are number-titled and also therein drainage takes on a kind of numerology tint.

    No, they are just not regular homeopathy unicorn tears expressed in Latin.

    But wait, there’s more, if you order now…you get MAGIC numbers along with MAGIC Latin incantations!!!!!!

    Drainage is done to rid the body, of course, of………….

    toxins!

    You know, the toxins only naturopaths know you have and can only fix you concerning.

    Here’s one of the Northwest USA NDs on Youtube

    in “Dr. Dick Thom Basic Physiology — Emunctories”

    (see http://www.youtube.com/watch?v=JMdCBRXpVrQ )

    telling us about naturopathy’s detoxification centerpiece:

    Did you know that the gastrointestinal tract is the largest organ NOT the skin!!! [It's not, it's an organ system, BTW, duh. So, so much for ND understanding of basic medical science].

    But wait, there’s more…if you throw your brain out now…

    Did you know that urine is practically identical to sweat chemically, and because you need to pee often or you’re likely in a lot of trouble if you’r not you need to sweat often or you are in a lot of trouble with toxins so stay away from antiperspirants or you won’t be eliminating toxins through your skin. [I guess the idea is that if you don't have sweating armpits due to your antiperspirant, your ENTIRE skin's ability to sweat has been turned off! Tell that to my crotch in August after I run a 10k! Again, so much for an understanding of basic medical science and particularly basic physiology, the title of his video].

    Did you know that body odor is a INTERNAL problem moreso than an EXTERNAL problem? [so much for soap!].

    So, the ND’s lesson: be sweaty to be not-toxic, which will make you likely smelly because you have been told that your problems are not about hygeine they are more PROFOUND, but don’t wash because the cause of the problem isn’t your unkempt body’s surface as you’ll only be masking the cause and that’s what regular medicine does, but take these magic pills / drops which I dispense to you directly and come back, which you certainly will, because you will be sweaty, and smelly, and I’m sorry that you smell and are so moist but you can’t use antiperspirant or you’ll become toxic and not detoxify but don’t you see now, IT’S WORKING. These smells are the internal toxins leaving your body. You are ridding your body of toxins.

    So, sweating is SO important but then the ND contradicts [or should I say contraDicks, his name is Dickson!] this emunctory’s abilities / profound effects as an outlet by telling us that in normal health your urine output is equal to your water ingestion [and therein, your skin is not a set a kidneys at all].

    This reminds me of another Doctor (see http://www.youtube.com/watch?v=ML0gLVIsaOs ).

    -r.c.

  4. Old_skeptic says:

    Great post!

    One small quibble, though. You say that therapies “based on ideas divorced from reality as I understand it, cannot have efficacy and do not have efficacy.”

    But I wonder whether a few of them — the ones that involve actually doing something to the body — might have effects for reasons other than those that their proponents believe in.

    Acupuncture involves sticking needles into the body. Chiropractic involves manipulating the spine. The alleged bases of these techniques do not make scientific sense. But couldn’t the needles or the manipulations have some sort of effect, even if it’s unrelated to the theoretical basis of these therapies?

  5. DevoutCatalyst says:

    Some sort of effect, sure. Chiropractic feels good to some people, so they get manipulated. It’s a lousy massage is all. Acupuncture reminds some of Calgon — ancient Chinese secret, huh? It balances the ring around the collar system.

    You’ve really got me foamin’ this morning, Crislip, I’ve an insatiable urge to go bite a dog.

  6. Janet says:

    @OldSkeptic

    Yeah, the needling could result in a nasty infection. The manipulations could result in a stroke.

  7. tgobbi says:

    Crislip: “… science is the tool by which we understand reality”

    Just by coincidence, yesterday I began reading Victor Stenger’s “God and the Folly of Faith.” In the preface the author defines science as “… the systemic study of the observations made of the natural world with our senses and scientific instruments, and the application to human needs of the knowledge obtained.” As I entered this in the appropriate section of my files, I also found another definition of science, this from Robert L. Park: “Science is a search for cause and effect, not an epidemiologic majority.”

  8. tgobbi says:

    Correction: Stenger states that science is the systematic, not the systemic, study of observations… etc.

    My apologies for the typo!

  9. mousethatroared says:

    Regarding Chiropractors. I have to say, when I have a particular kind of tension in my upper back, there is nothing like a good back crack. The relief doesn’t last long, but hey a few minutes of relief is better than 0 minutes. Not worth visiting a chiropractor for, (particularly since the only chiropractor who I ever saw only made the pain he was supposed to be treating worse). I just trained my husband to crack my back.

    I have no idea why it would feel so good.

  10. tgobbi says:

    # DevoutCatalyst:
    Some sort of effect, sure. Chiropractic feels good to some people, so they get manipulated. It’s a lousy massage is all.

    If chiropractic were as simple as that it wouldn’t present such a danger to public health. It’s not all that benign. Unfortunately, the field represents an entire alternative to scientific medical care orbiting on the outer fringes of science. There are so many things wrong (and dangerous) about chiropractic that volumes can, and have, been written about it. To mention just a few of the more egregious examples:

    • It’s based on a demonstrably false theory of what causes disease: the nonexistent subluxation.

    • Significant numbers of practitioners are in the anti vaccination camp – perhaps upwards of 50% of them.

    • Many DCs are vocally anti medicine. I’ve encountered plenty who make a big deal of warning potential customers of the dangers of mainstream medicine.

    • In recent years there’s been a movement in the chiropractic community for DCs to pass themselves off as primary care physicians, qualified to perform physical examinations. This is a preposterous notion! I’ve had physicals performed by chiropractors and I can tell you than they bear no resemblance to what you can expect from actual doctors. For starters, no blood work, no urinalysis, no EKGs… They make a show of discussing medications with their customers, but only to warn them of the dangers of continuing to take them!

    • The possibility of chiropractic-induced stroke, while not a huge risk, does exist. Considering the lack of efficacy of chiro neck manipulations no risk is acceptable.

    • Chiropractors’ attempts to pass themselves off as specialists in various fields, especially pediatrics. They keep kids from getting genuine medical care including, as stated above, proper immunizations.

    As I never tire of stating, chiropractic isn’t a healthcare profession; it’s an elaborate marketing scheme.

  11. Calli Arcale says:

    There is no naturopathic-specific standard of care. Naturopathic doctors are taught and held to the same standards of care as conventional providers.

    This is a complete and utter bald-faced lie on their part. Well, the first part is true. There certainly is no naturopathic standard of care. But the second part is preposterous. Naturopaths are clearly not taught conventional standards of care (if they were, they’d hold MDs), and if they were held to the same standards, not a one would still hold a license. Naturopathy is, itself, and practically by definition, outside the standard of care of conventional medicine.

    And the things they say they can do!

    Never mind stuff like being able to order tests they’re not equipped to understand, or performing minor surgery (a scary thought in itself, given the quality of their training), or doing obstetrics. They say they can perform full body examinations, and that they can prescribe controlled substances! If a pervert or a drug dealer wished a perfect line of work, moving to Oregon to practice as an ND would seem quite logical, as it appears there is no oversight to protect the public from them abusing these privileges.

    I’m sure NDs will be quite offended at this implication, that their profession could be filled with abusers, and may even point out that abusers exist in other licensed professions. Consider the horrific pediatrics case out east not too long ago. Hundreds of victims, and his colleagues suspected but did not feel it was their place to report. That’s another problem. But since NDs are really *not* held to the same standards as MDs, how would they ever detect problems like that, and how would they respond?

    Want to score oxycodone? Maybe even Propofol, since they say they can do surgery? Go to Oregon, become an ND. Will only require the equivalent of an associates degree, so you won’t even be too much in debt for it. This reminds me of Moliere’s fabulous play “La malade imaginaire”. The title character is a hypochondriac who wants to marry his daughter off to a physician so he can get prescriptions for free. (Doctors have stopped treating him because he doesn’t pay his bills.) His daughter is repulsed by the idea, and in any case has fallen in love with a young man. They concoct a scheme to satisfy the malade’s desire by getting him credentialed to prescribe his own medicine, via a facical examination ceremony conducted by a traveling gypsy troupe who have been paid by the young lovers to pretend they are doctors. The play seems to be repeating itself in Oregon, only seroiusly (and without the dog-Latin).

  12. DevoutCatalyst says:

    tgobbi, don’t forget their misuse of x-rays, etc, usw.

  13. Ed Whitney says:

    Funny that prolotherapy should be mentioned in this thread since its therapeutic effect is a difficult topic to judge. Is it quackery?

    This web site emphasizes the importance of prior probability for clinical trials of interventions. What is your prior probability for prolotherapy? It purports to induce collagen formation in ligaments, and has mixed results in clinical trials. The Spine Journal recently characterized it as having a reasonable but not proven theoretical basis, a low complication rate, and conflicting evidence of efficacy.

    Epidural steroid injections for sciatica, which also have a reasonable theoretical basis, have recently been shown to have conflicting evidence of efficacy. A new meta-analysis at the Annals of Internal Medicine website reports that there is high quality evidence that they have only minor short-term and no measurable long term benefits. But many good spine physicians will tell you that they do benefit some patients with sciatica.

    The association of spinal injections with the recent outbreak of fungal meningitis due to contaminated steroid from a compounding pharmacy in New England, has put them in the public eye. It is not likely that these injections will be disallowed by Medicare or by other carriers.

    So my question is whether prolotherapy should be seen as naturopathic quackery while judicious use of epidural steroids are considered acceptable interventions. Are they qualitatively different or are they similar?

  14. pmoran says:

    There is no clearer warning of the risks of naturopathic medicine (whether licensed or not) than its apparent inability to grasp its own limitations.

    Legislatures thus need to understand how much everyday medical practice is balanced on a tightrope, with catastrophic patient harm a mere pen-stroke or scalpel-stroke, or a missed diagnosis away.

    If we cannot stop naturopaths being licensed (and there are arguments pro and con that depending upon who writes the legislation and how their services are funded), one thing that the medical profession should insist upon is that naturopaths be clearly identifiable as naturopaths. I think most of the public understands certain implications of that, so that such practitioners will tend to be used in a more discriminating, usually complementary, fashion.

  15. Jann Bellamy says:

    Just posted this comment on my Thursday blog post about Boiron by mistake, so I’ll repeat it here:

    According to the American Association of Naturopathic Physicians, naturopathic licensing bills will be introduced in 11 states in 2013, although they have named only 8 of these states: West Virginia, Arkansas, Florida, Colorado, Massachusetts, N.Y., Virginia and Maryland. A bill was recently filed in Arkansas:
    http://www.arkleg.state.ar.us/assembly/2013/2013R/Pages/BillInformation.aspx?measureno=HB1011.

    Their goal in states where naturopaths are currently licensed, but have less than primary care physician scope of practice, is to keep coming back to the legislature until they get full scope. Licensing is extremely important to them now because they can argue that, under the ACA, insurance companies must cover their services in states where they are licensed. I’ll be writing more about this during 2013.

    In the meantime, if you live in one of these states, or know someone who does, you would do well to educate your legislators about naturopaths. Otherwise, naturopaths get away with misleading statements about their education, training and treatments because there is no one to contradict them. If you are a health care professional, you can make sure your profession organization knows about the threat of naturopathy and urge organized opposition.

  16. mho says:

    As a cancer patient, I am horrified by the idea of naturopaths being licensed.
    When I first started reading about them this summer, I thought licensing would mean protecting the public, but it didn’t take long to understand that it would give them the imprimatur of legitimacy.

    There seems to be recruiting for naturopaths on several cancer support boards and I hope more bloggers will be writing about the incredible and dangerous arrogance of “board certified naturopathic oncologists”

  17. tgobbi says:

    MHO: “When I first started reading about them this summer, I thought licensing would mean protecting the public, but it didn’t take long to understand that it would give them the imprimatur of legitimacy.”

    That’s exactly right! Quacks of all stripes use their dubious licensing to convince the public that they’re legitimate.

    The average person hasn’t a clue that a license is strictly political and has nothing to do with science and whether or not a modality ha any basis in reality. I encounter this regularly – with the general public and with the quack practitioners themselves.

  18. windriven says:

    @pmoran

    “There is no clearer warning of the risks of naturopathic medicine (whether licensed or not) than its apparent inability to grasp its own limitations. ”

    Perhaps naturopaths should be licensed. But as they claim ‘the same’ training as MDs, perhaps graduating from an accredited MD program before entry into an ND residency should be mandatory. Admittedly, there are already a few nitwit MDs who dabble in quackery but at least those who do would be expected to actually know medicine. I suspect that the number of MDs who, after the grueling journey through medical school, would choose an naturopathy residency over surgery or internal medicine or anesthesiology would be trivially small.

  19. daijiyobu says:

    Oh, and I must add to my previous response about Unda homeopathy, oh what a wonderful set of ND web pages one gets with a google.com search “biotherapeutic drainage using the Unda numbers” without the quotes!

    For example, there is a 2005 women’s health book by ND Kaur, ND-MD Dean, and MD Danylack-Arhanic which invokes Unda therapy at least 48 times. In their ISBN 0778801276, 978-0778801276 we’re told:

    “detoxify and rejuvenate [...via] homeopathic drainage therapy: UNDA 10, Unda 21, and Unda 48 to balance hormones and decrease cellular toxins [...] the next month, use Unda 1, Unda 20, and Unda 243 [p.271].”

    Then you will have it all Unda control.

    When I was in clinical training in naturopathy school, my direct supervising ND was mega-Unda the spell of these magic beans and unicorn tears.

    But specifically, re: “if there is a litmus test by which you could judge magic vs reality, it is homeopathy, perhaps the most popular and, arguably, the rankest of rank nonsense”,

    I’d like to apply your litmus test to the naturopathy licensure exam, the NPLEX!

    Spoiler alert! The NPLEX quite absurdly includes homeopathy in its “clinical SCIENCE examination”

    (see http://en.wikipedia.org/wiki/Naturopathic_Physicians_Licensing_Examinations ).

    I do believe the test is positive.

    I bet you didn’t know science fulfills naturopathy’s fondest fantasies!

    ‘I’m afraid the patient does have pseudoscientia naturopathica.’

    I’m reminded of ICD code 318.1, the thought muddle is so blatant.

    -r.c.

  20. Mark Crislip says:

    When you search for ‘drainage’ in the SCAM world you discover all sorts of curious modalities and until the comments I had heard of neither biotheraputic drainage nor Unda numbers.

    Looks like I have me a blog entry in two weeks.

  21. Sastra says:

    Like Ed Whitney, I’d also be interested in reading a skeptical/scientific analysis of Prolotherapy.

    I have a friend who swears by it. However, she’s also into virtually every form of alt med nonsense there is, so I have particular trouble accepting her anecdotal evidence. Research on the internet didn’t reveal much. It seems to be a method of injecting irritants into the spine in order to encourage inflammation. As Ed suggests, there’s at least the theoretical possibility that there’s some actual benefit there. But I also see a lot of red flags… including the fact that I don’t like the company it keeps.

    It’s apparently been around for decades. When I ask my friend why it’s still considered “alternative” she brings up conspiracy theories. Not good.

  22. JayHawkDoc says:

    Naturopaths are, for me, the scariest of all alternative medicine practioners. They learn enough to speak convincingly about whatever woo they want to sell and cover it in medical terminology, but they don’t have nearly enough training actually diagnose, treat or prevent real disease.

    My experience includes an elderly woman I admitted to our ICU with an MI. She had primary thrombocytosis which had previously been managed by her FP and Hematologist. She saw a naturopath who instructed her to throw her hydroxyurea in the garbage because it was poisoning her. She followed this advice and her platelet count rose to 3 million…leading to an MI and subsequently a stroke. I reported her naturopath to the state medical board, but as noted, there is no standard of care so no action was taken. Horrible.

  23. DevoutCatalyst says:

    JayHawkDoc

    I once naively believed that there was a certain innate human decency that would kick in, a line that these alternative practitioners would not cross. Sadly you and many others have shown that this is not the case. These are hideous little monsters. This entire post is very depressing.

  24. kb says:

    LOL! I just finished the First Law trilogy this week and had highlighted that sentence about the irrelevance of proof, wanting to use it in piece about CAM and SBM. Crislip beat me to it…

  25. saveus says:

    First time commenting. I have no background in the sciences but do enjoy a little common sense, if I do say so myself.
    Currently, two relatives (by marriage, just to be clear) have expressed the desire for their chiropractors and naturopaths to become their primary care doctors. I no longer attempt to dissuade them – impossible. As a non physician and non scientist I am more discouraged than ever at the popularity of SCAM – it is shockingly pervasive. I had a friend tell me the other day that everyone knows that cancer (all cancer) is caused by a fungus and another that a cancer cure has been out there forever but big Pharma is preventing its disclosure. Sigh. Please keep up the good work.

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