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.

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.

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.

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

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.

“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.

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.

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”

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.

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.

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 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).

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.

I have no idea why it would feel so good.