Jun 27 2008
The “Science” and Ethics of “Natural Medicines”
This and the next entry in the current “Naturopathic Medicine” series* deal with the cult’s claim of expertise in “natural medicines” or “natural remedies.” These include herbs (“botanicals”), glandular extracts, vitamins, and minerals. A large fraction of the Textbook of Natural Medicine (TNM), “the most thoroughly researched and carefully referenced text on natural medicine,” is devoted to these agents. They are keys to the practice of naturopathy and to a core claim of “naturopathic physicians” that legislators tend to swallow: that NDs offer something that most MDs do not.
During the deliberations of the Massachusetts Special Commission, NDs produced Dr. Alan Trachtenberg, a fresh-faced ingenue who had briefly been Acting Director of the federal Office of Alternative Medicine, to testify on their behalf. He suggested to the Commission that naturopaths could be the “learned intermediaries” that the public needed to help make sense of the myriad “natural remedies” that became freely available in the wake of the Dietary and Supplement Health and Education Act of 1994 (DSHEA). This is from his written testimony:
Another advantage of state licensure, is that the holder of a professional license who provides or recommends a product, then becomes responsible for the quality and safety of a product. In an unregulated marketplace, such a learned intermediary can be invaluable to the consumer. Since naturopaths do often provide dietary supplements and herbal products directly to their patients, it is vital that they have an enforceable code of professional ethics. Such a code of ethics becomes enforceable with State licensure.
It is also beneficial for the patient to have a practitioner who knows enough about biochemistry, physiology, pharmacology, and physical diagnosis to adequately assess a patient’s clinical response to a product. These products are essentially complicated but unregulated drug mixtures. My understanding is that licensable naturopathic doctors have all taken these courses during their four years of training and passed standardized exams that test their mastery. There is no such quality assurance for the other kind of naturopathic practitioner.
Instead of relying on Dr. Trachtenberg’s “understanding,” let’s submit his two assertions—that of a “code of ethics” and that of “mastery” of the topic of “natural medicines”—to real scrutiny. In doing so I confess that I have plagiarized, to some extent, pieces that I’ve written elsewhere.
The Ethics of “Naturopathic Physicians” Selling Drugs
Shortly before the Special Commission was convened, a “supplements” company called MotherNature.com issued the following press release (emphasis added):
FOR IMMEDIATE RELEASE
Contact: Aliza Schlifkin Sharon Rice
Ruder Finn MotherNature.com
MOTHERNATURE.COM ANNOUNCES STRATEGIC ALLIANCES
WITH TWO HEALTHCARE ORGANIZATIONS
Agreements with Landmark Healthcare and the AANP Offer Marketing of
MotherNature.com Products & Information to Millions of Patients
CONCORD FARMS, MA (January 6, 2000) – MotherNature.com (Nasdaq: MTHR), a leading online information source and e-tailer of vitamins, supplements, minerals, and other natural and healthy living products, today announced partnerships with two leading alternative care health organizations to provide natural health products and information to their members. The agreements with Landmark Healthcare and the American Association of Naturopathic Physicians (AANP) will promote MotherNature.com to millions of patients and healthcare practitioners of the two organizations.
The American Association of Naturopathic Physicians is the leading organization for Naturopaths, representing about 650 active physicians. A licensed naturopathic physician (N.D.) attends a four-year graduate-level naturopathic medical school and is educated in all of the same basic sciences as an M.D. but also studies holistic and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness.
With this new alliance, an AANP doctor can set up a personal dispensary on MotherNature.com and become part of MotherNature.com’s Wellness Advisor Network, an online, interactive forum to improve patient care and extend the relationship between patient and practitioner beyond the office walls. The N.D. can then send a patient to their personal site to learn about and purchase the natural products they find efficacious in treatment.
“It is an excellent added value for our N.D.’s to provide their patients with easy access to a trustworthy source for the broad array of natural health products and information they recommend every day in clinical practice,” added Sheila Quinn, Executive Director of the AANP. “We look forward to growing this partnership with MotherNature.com and finding new and innovative ways to work together.”
About MotherNature.com, Inc.
MotherNature.com, Inc. (Nasdaq: MTHR) established an Internet site in 1995. It is a leading online retailer of a vast array of vitamins, supplements, minerals, and other natural and healthy living products. MotherNature.com is also a leading provider of health information on the Internet, with contributions from a panel of health and medical professionals. The company maintains its corporate office in Concord, MA, a distribution center in Springfield, MA, and a customer support center in Acton, MA.
This profit-seeking arrangement was entirely consistent with the AANP’s “Sales of Medications by Physicians” position paper:
SALE OF MEDICATIONS BY PHYSICIANS
I. The AANP is a strong proponent of Preventive Medicine and considers adequate nutrition to be of primary importance in the maintenance of health and the prevention of disease.
II. There are numerous references in the medical literature that document the existence of subclinical disease and the fact that the chances of anyone consuming a diet that meets the RDA for all nutrients is extremely unlikely.
III. There are numerous citations in the medical literature about the efficacy of homeopathic, botanical and other natural substances as medications to be used in the treatment of disease. It is common knowledge that many of the medications prescribed by Naturopathic Physicians (such as homeopathic and botanical medications as well as certain nutrient supplements) are not available elsewhere.
IV. Certain medications, although available through retailers, exist in these markets as different formulations than the physician determines most effective for his patients. These “optimal formulations” may only be available through companies that sell exclusively to physicians.
V. Certain formulations are classified as “legend drugs” (even through they may be natural origin). These medications may be obtainable via a prescription yet are not readily available through retail pharmacies.
VI. In general, the companies that supply products to physicians are under strict scrutiny by the FDA. This ensures certain standards of quality control. While true for the majority of companies that supply health food stores, certain companies may avoid FDA regulation.
VII. Any selling of medications within a doctor’s office must be based on addressing the needs of the patient. The making of profit is always viewed as a secondary consideration. This is an extension of the code of ethics of the state and national associations governing the conduct of Naturopathic Physicians.
VIII. While the retail selling of medications could be construed as a conflict of interest on the part of the physician; as long as the underlying intention remains the patient’s best interest and not to make profit, and no other source for the formulation and quality of the medication that the physician feels is adequate exists, this remains a legitimate and viable service.
IX. The AANP expects that its members act conscientiously and within accepted codes of ethics concerning these and all professional matters. Any breach of this should be reported to the AANP if writing as identified.
Principal Authors: Martin Milner, ND, Konrad Kail, ND
Adopted at the 1990 Annual Convention.
Regarding the AANP and MotherNature.com, here was the deal:
1. Can I keep my in-office dispensary and benefit from MotherNature.com’s Wellness Advisor Network? Yes. You can maintain business as usual, using the Wellness Advisor Network to order professional line products at wholesale for your dispensary.
5. How does the AANP benefit when I join the Wellness Advisor Network? The AANP receives 1% of all the retail transactions made by your patients through your Web site. By integrating the Wellness Advisor Network into your practice, you generate revenues that will help maintain and build our organization.
6. What is the benefit to AANP members? The AANP has negotiated a 24% referral fee structure for our members – 4% more than the 20% received by other providers. The referral fee is paid on the retail sales from your patients through your website.
That pact was not surprising for organized “naturopathic medicine.” Consider the means by which it achieved licensure in Utah in 1996, as reported by the National Council Against Health Fraud (NCAHF):
HEALTH FOODS INDUSTRY GROUP GETS
NATUROPATHIC PRACTICE ACT IN UTAH
The sweetheart relationship between naturopaths and the health food industry became more transparent with the passage of a naturopathic licensure act in Utah. Health Forum, the lobbying organization that pulled off the action, was led by Rae Howard, President of the National Nutritional Foods Association (NNFA), and President of Good Earth Natural Foods at Orem, Utah. In NNFA Today (5/96, p.9) Howard boasts that: “every state legislator received a visit by representatives from Health Forum and other constituents. Grassroots meetings and training sessions were held throughout the state beginning last September, to explain the bill to consumers, train them in the political process and organize support.”
Such boosting has continued. Here is a partial list of Corporate Sponsors of the recently successful ND licensing effort in California:
CANP is the California Association of Naturopathic Physicians. California ANP Sponsors are generously helping in the licensing effort in California.
California Association of Naturopathic Physicians 2002-2003 Natural Partners Program
The CANP wishes to thank the following companies for their generous financial support in 2002-2003:
CANP Corporate Leader
CANP Corporate Partner
- American Specialty Health Plans
CANP Corporate Donor
CANP Corporate Sponsor
- Douglas Labs
- Integrative Therapeutics Incorporated
- New Hope Natural Media
- Pure Encapsulations
- Specturm Organic
- Whole Foods Market
The AANP itself touts its sponsorship by a host of “supplement” companies, dubious “laboratories,” and other companies making a buck off of organized quackery.
The naturopathic “medical schools,” which one might expect to be pristine, are not immune to the same temptation. This item appeared in the 1995 summer edition of the NCAHF news:
HEALTH FOODS INDUSTRY INFLUENCES
Bastyr University, a naturopathic college in Seattle, has added several board members who are associated with the natural products industry. Included are Past President of the National Nutritional Foods Association Martie Whittekin, Sandy Gooch, founder of Mrs. Gooch’s Natural Foods Markets, Michael Murray, ND, Director of Research and Product Development at Enzymatic Therapy, and Jerry Schlesser, ND,DC, President and CEO of IsoChem Corporation. [Natural Health Advocate Winter, 1995 (a publication of Bastyr University as "an update for the natural products industry.")]
Comment: The symbiotic relationship between naturopathic education and the health food industry (natural foods, herbal remedies, dietary supplements, and homeopathic remedies) is scandalous. If drug companies were wielding comparable influence on a medical school there would be a national outcry. It makes naturopathic education appear to be a conspiracy between the health food industry and pseudomedicine.
No kidding. In 1988 Bastyr had been the happy recipient of $20,000 worth of money and equipment from American Biologics, the major Laetrile pusher. That was at a time when Bastyr was poor and $20,000 was real money.
ENZYMATIC THERAPY, INC.
Ira Milner, RD, reports (Nutrition Forum, Nov-Dec, 1990) on his experience of attending a New Jersey seminar along with “more than 100 retailers and a few chiropractors” put on by Enzymatic Therapy, Inc. of Green Bay, Wisconsin. Before the program began, participants were asked to sign a “guarantee” that they were not agents of the FDA, Better Business Bureau, or any other consumer protection agency; and, that they would not tape the seminar for use against the company by any government agency. The seminar lasted from 9 am to 6 pm, and featured company president Terence J. Lemerond, ND, BS, CNC, Kenneth R. Daub, DC, and Michael T. Murray, ND, who practices naturopathy in Bellevue, Washington and teaches “therapeutic nutrition” at John Bastyr College, a naturopathic school in Seattle. Milner details how these promoters work to circumvent the law in the promotion of unapproved drugs disguised as nutritional products. Milner says, “rather than seek FDA approval, Lemerond and his associates have been using subterfuge to ‘distance’ illegal claims from their product labels. The fact that this effort has prospered is not the result of its cleverness but of FDA sluggishness. As should be obvious from this report, evidence of wrongdoing is not difficult to obtain.”
Does Michael T. Murray sound familiar? He’s the co-author/co-editor of the Textbook of Natural Medicine and a member of the Board of Regents of Bastyr University, the most conspicuous of naturopathic “medical schools.” Murray continues to capitalize on his apparent academic stature by shilling for such enterprises as “Natural Factors,” a purveyor of herbs and vitamins, and “BodyBalance,” a company that hawks dubious laboratory tests directly to unwary consumers.
So much for a “code of ethics.”
Next week: the “mastery” of the topic.
*The Naturopathy Series:
- “CAL”: a Medico-Legal Parable
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 1
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 2
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 3
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 4
- Colorado is Nearer to Promoting Naturopathic Pseudomedicine—Aided by the Colorado Medical Society
- Naturopathy and Liberal Politics: Strange Bedfellows
- Open Letter to Dr. Josephine Briggs
- Smallpox and Pseudomedicine
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