Dec 14 2012
Disingenuous: Deconstruction of a naturopathic white paper
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28 Responses to “Disingenuous: Deconstruction of a naturopathic white paper”
“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?
@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.
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.
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?
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.
@OldSkeptic
Yeah, the needling could result in a nasty infection. The manipulations could result in a stroke.
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.”
Correction: Stenger states that science is the systematic, not the systemic, study of observations… etc.
My apologies for the typo!
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.
# 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.
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).
tgobbi, don’t forget their misuse of x-rays, etc, usw.
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?
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.
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.
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”
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.
@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.
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.
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.
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.
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.
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.
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…
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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