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Legislative Alchemy I: Naturopathy

Via the magic of “legislative alchemy,” state legislatures transform implausible and unproven diagnostic methods and treatments into perfectly legal health care practices.[1] Without the benefit of legislative alchemy, chiropractors, naturopaths, homeopaths, acupuncturists and other assorted putative healers would be vulnerable to charges of practicing medicine without a license and consumer fraud. Thus, they must seek either their own licensing system or exemption from licensing altogether.

Licensing bestows an undeserved air of legitimacy on “alternative” practitioners. Because a state’s authority to regulate health care lies in its inherent power to protect the public health, safety and welfare, the public understandably assumes licensing actually accomplishes this purpose. In fact, the opposite occurs. Any attempt to impose a science-based standard of health care becomes impossible when vitalism and similarly debunked notions of human functioning are enshrined into law.

Initial licensing is just a beginning. Once the beach head is established other benefits can follow, such as expansion of the scope of practice. If not granted in the initial legislation, “alternative” practitioners can return, seeking more goodies like self-regulation and mandatory insurance coverage.

Each year brings a fresh round of eager petitioners to the state house doors hoping to transform their base ideas into licensing gold through legislative alchemy. In this post, we look at how the naturopaths are faring. We’ll leave chiropractors, acupuncturists and the rest to a later post.

Naturopathy 101

Three years ago, Dr. Kimball Atwood wrote an excellent series of SBM posts on naturopathy, including efforts to license naturopaths in several states (In four parts: 1, 2, 3, 4)[2] Since then, naturopathy has fairly regularly appeared on SBM, its pseudoscientific practices and threats to public health offering plenty of grist (gluten-free or not) for the scientific mill in posts by Drs. Gorski (also this one), Lipson, and Kroll.

All posts are highly recommended, but if you’re pressed for time, here’s Dr. Gorski’s description of naturopathy:

…a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease. As a result, typical naturopaths are more than happy in essence to ‘pick one from column A and one from column B’ when it comes to pseudoscience, mixing and matching treatments including traditional Chinese medicine, homeopathy, herbalism, Ayurvedic medicine, applied kinesiology, anthroposophical medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine.

As well, according to a recent article in Maternal and Child Health Journal “published reports suggest that only a minority of naturopathic physicians actively support full vaccination.”[3] This should surprise no one, as it fully accords with naturopathy’s long standing opposition to vaccination (see also QuackWatch).

A review of Washington state insurance records reported in the article showed that children were significantly less likely to receive each of four recommended vaccinations (measles/mumps/rubella, chickenpox, diphtheria/tetanus/pertussis, and H. influenzae type B) if they saw a naturopathic physician. It would naturally follow then that pediatric use of naturopathy was associated with significantly more diagnoses of vaccine-preventable disease.

The Scorecard

In the first half of 2011 alone, bills to license naturopaths were pending before ten state legislatures. To date, only one has been successful, in North Dakota. Licensing bills failed in four states because they never made it out of committee. They remain pending in committee in five states.

Of the 15 states already licensing naturopaths, bills to expand the scope of practice (including expansion via self-regulation) were introduced in seven. These bills remain pending in two states, passed in two states, and failed in three states, again because they never made it out of committee. (A bill to expand naturopathic scope of practice is also pending in Washington, D.C.) Legislation mandating public and/or private health insurance coverage for naturopathic services is pending in one state, and failed to make it out of committee in two.

Licensing happens

In July, 2008, Dr. Atwood began the first of his four-part series, “Another State Promotes the Pseudoscientific Cult that is ‘Naturopathic Medicine,’” with the observation that Minnesota had just become the 15th state to license naturopaths. In July, 2011, North Dakota became the 16th state.[4]

North Dakota departs from those states giving naturopaths their own governing authority by establishing a State Board of Integrative Health Care. “Integrative health care,” that ever shape-shifting term, is not defined in the statute, but the Board appears to be a place to park things the state otherwise doesn’t know exactly what to do with. For starters, the Board will license and regulate both naturopaths and music therapists, but the barn door is left open for other “integrative” health care practitioners to apply for regulation.

The new Board must have at least five members, including one member of each profession (such as they are) regulated. One member must be an M.D. or D.O., although if no medical or osteopathic doctor is willing to serve the governor can appoint an advanced practice registered nurse (APRN) instead. Perhaps this indicates the level of enthusiasm for board service the legislature anticipates. The governor must also appoint a pharmacist, an APRN and a layperson, although no provision is made if none of them want to do this either.

The new law contains the typical boilerplate found in other naturopath licensing bills (discussed further below) although this one is unusually short on details and leaves it to the State Board of Integrative Health Care to sort out the specifics. The law does say that NDs cannot prescribe or administer drugs or ionizing radioactive substances or perform surgery. And even though the statute describes naturopathy as “a system of primary health care … for the prevention, diagnosis, and treatment of human health conditions, injury, and disease” a licensed naturopath “may not hold out to the public that the naturopath is a primary care provider.”

The law has two laudable provisions. First, naturopaths are prohibited from “the making of false or misleading statements about the licensee’s skill or the efficacy of any medicine, treatment, or remedy.” (Emphasis mine.) That last phrase is going to make it pretty quiet around the N.D. office. After all, if you can’t misrepresent the efficacy of, for example, homeopathic preparations or herbal supplements it’s going to be hard to come up with an explanation of exactly why you’re prescribing (or selling) them.

Second, another provision prohibits “the representation to a patient that a manifestly incurable condition, sickness, disease, or injury can be cured.” Too late for Hulda Clark, but at least the legislature had the good sense to take care that end on the bell curve of charlatanism.

Pending licensing legislation

Naturopathic licensing bills are now before the legislatures of Massachusetts (House Bill 2367, Senate Bill 1158), North Carolina (House Bill 847, Senate Bill 467) Illinois (House Bill 3350), Pennsylvania (House Bill 1717), and New York (Assembly Bills 1937 and 3057, Senate Bill 1803).

As with all naturopathic licensing legislation, these bills are based on three unproven notions: that the general public wants access to naturopaths, that naturopathic licensing protects the public from substandard health care practices, and that “educated” naturopaths are the answer to quality of care issues.

And as is true of other bills pending in 2011, both successful and not, these proposals to license naturopaths buy into the same false premise set forth in Massachusetts House Bill No. 02367:

Naturopathic health care [is] a system of health care practices for the prevention, diagnosis, evaluation and treatment of illnesses, injuries and conditions of the human body through the use of education, nutrition, natural medicines and therapies and other modalities which are designed to support, stimulate or supplement the human body’s own natural self-healing processes.

Yes, it’s those famous “self-healing processes,” which, if we can only hit them with the right plant, or animal part, or mineral, or electric current, or needle, or pressure, or thrust, or energy field, they will spring forth and do their job. They’re just being stubborn, you see, lurking there in the body, refusing to heal. Like little gods, they must be appeased with food and other amusements. And they like theirs natural.

Pennsylvania in particular wants to go after the body’s self-healing processes full bore. Its proposed licensing act would allow naturopaths to practice “behavioral medicine,” including cognitive therapy. As well, they could employ “naturopathic musculokeletal therapy” on, among other things, scar tissue and visceral organs, and “reposition … displaced body tissues and organs.” Then there’s electromagnetic energy, colon hydrotherapy, electrotherapy, magnetic therapy, low-level laser light, neural therapy, diathermy, dietary supplements and “bio-identical” hormones.

And what naturopathy licensing act would be complete without homeopathy, now with a new, improved statutory definition in Pennsylvania: “a system of employing substances of animal, vegetable or mineral origin which are given in microdosage in the prevention and treatment of disease.” “Microdosage”? How about “nonexistentdosage”?

One means of poking the body’s “self-healing processes” not available under any state’s proposed legislation is acupuncture. It is specifically prohibited except under one version of New York’s licensing bill, where it is not mentioned either as part of the permissible scope of practice or as a prohibition.

A Learner’s Permit to Practice Medicine?

One version of a New York Assembly licensing bill (A01937) and a Senate bill would prohibit the practice of naturopathy except under the supervision of a physician. (Assembly bill A03057 does not include this prohibition, and further allows “naturopathic childbirth.”)

Neither North Carolina’s Senate or House bill require actual physician supervision, but applicants for licensure must provide the North Carolina Naturopathic Doctors Licensing Board with a list of physicians from at least four specialty areas who have “agreed to work with … and accept referrals from the applicant.” The Senate bill would create an “Advisory Council” to “foster coordination and collaboration” between N.D.s, M.D.s and other health professionals “for the purpose of providing appropriate care for patients.” Naturopaths could not prescribe drugs in N.C.

In Pennsylvania, naturopaths would be regulated by the Board of Medicine. A “Naturopathic Formulary Committee” must include two physicians, a pharmacist, and someone with an advanced degree in pharmacology or pharmacognosy. Massachusetts establishes a naturopathic board which includes physicians and a pharmacologist. It does not give naturopaths prescribing privileges.

On the other hand, in Illinois, naturopaths would have their own board, which has no M.D. or D.O. physician members. However, both physicians and pharmacists must be on the “Naturopathic Formulary Council,” which would establish a formulary that can include prescription drugs.

The Illinois House licensing bill establishes a “Naturopathic Childbirth Attendance Advisory Committee” (which must include an M.D. obstetrician and a certified nurse midwife) to look into naturopathic education and training, then make recommendations regarding naturopathic childbirth attendance, which the Department of Financial and Professional Regulation must adopt as rules. The N.D. must pass the North American Registry of Midwives examination to practice “naturopathic childbirth attendance.”

All of these proposals indicate to me that the state legislatures don’t quite trust naturopaths. Naturopathy, as defined by naturopaths, is a free-standing health care philosophy (if you will) perfectly capable of operating without supervision from “mainstream” medicine. But the states aren’t buying it. While they are willing to consider licensing, it’s clear the state legislatures are not willing to unleash naturopaths on the public without some version of physician oversight. This is especially obvious regarding childbirth and prescription drugs. After all, for example, if one believes naturopaths are “real doctors” then why do they need to pass a midwifery exam to deliver babies?

This is an unfortunate half-baked approach. If the states don’t believe the education and training of naturopaths is up to par, then they shouldn’t license them at all. Instead naturopaths are given learner’s permits to practice medicine – they can be doctors, but only with adult supervision.

And now, for the good news

Naturopathic licensing bills failed in four states in 2011: Maryland, Virginia, Colorado, and Iowa. In Colorado it failed for the eighth time, largely due to the indefatigable Linda Rosa, RN, Larry Sarner and Mark Johnson, MD. In the past, the Colorado Medical Society has failed science-based medicine by supporting naturopathic licensing. This time around, according to Ms. Rosa, the Colorado Medical Society leadership stuck to their deal with the naturopaths to allow registration in exchange for naturopaths not using the term “physician” and limiting some of their scope of practice.

You can’t always get what you want…

But you can always go back and ask again, which is what’s happening in states already licensing naturopaths.

New laws in Washington and Arizona expand the scope of naturopathic practice. Arizona now allows IV administration of “nutrients.” The Arizona Naturopathic Medical Association requested “parenteral” administration authority but that word was changed to “intravenous” in committee.

In Washington, naturopaths will now be governed by their very own Board of Naturopathy, free of the meddling influence of M.D.s, D.O.s or pharmacists – the Board is composed of five N.D.s and two public members. In addition, naturopaths may now give orders to respiratory therapists and prescribe contraceptive drugs. A limitation on the use of “physical modalities” to those that are “non-invasive” was lifted.

Other bills failed to make it out of committee before the legislatures adjourned:

Alaska: would create a Naturopathic Medical Board for purpose of expanding allowed practices and procedures, including limited prescriptive authority.

Idaho: attempt to establish something called a “registered naturopathic practitioner,” which required no formal education if one had “practiced as a doctor of naturopathy” for 20 years.

Kansas: would expand the scope of naturopathic prescribing authority to include intramuscular, subcutaneous or intravenous administration of vitamins, minerals and homeopathic preparations, as well as prescription and administration of, among other things, whole gland thyroid. (If I may be permitted a comment: EEWWWW!)

Hawaii: would allow naturopaths to prescribe controlled substances.

New Hampshire and Oregon: would mandate insurance coverage of naturopathic services.

Still pending are bills in California to expand drug prescribing authority and in Hawaii to mandate insurance coverage for naturopathic services.

Hawaii law, very sensibly, requires the state auditor to submit a report assessing “both the social and financial effects of proposed mandated coverage.” In what I personally consider a new low in legislative drafting sleaziness, the Hawaii Senate’s concurrent resolution requesting the auditor’s study states:

WHEREAS, according to the American Cancer Society, naturopathy is ‘a complete alternative care system that uses a wide range of approaches such as nutrition, herbs, manipulation of the body, exercise, stress, and acupuncture … .’

Here’s a more, um, holistic view of the American Cancer Society’s statements on naturopathy for the state auditor’s consideration:

Available scientific evidence does not support claims that naturopathic medicine can cure cancer or any other disease, since virtually no studies on naturopathy as a whole have been published.

Available scientific evidence does not support claims that naturopathic medicine is effective for most health problems. Most of the claims of effectiveness are based on individual cases, medical records, and summaries of practitioners’ clinical experiences.

Excessive fasting, dietary restrictions, or use of enemas, which are sometimes components of naturopathic treatment, may be dangerous. Naturopathic treatment may involve taking unregulated herbs, some of which may have harmful effects.

As if that weren’t enough, the Hawaii Senate’s resolution adds:

WHEREAS, naturopathic medicine has become recognized as a therapy that is comparable in its effectiveness to more traditional medical and surgical practices for many types of illnesses…

Gosh, I looked and looked on PubMed and couldn’t find a single thing to support that statement. Maybe the state auditor’s research will turn up something.

By the way…

It would cost a whole lot of money – I don’t know how much, but a whole lot for sure – to draft and introduce licensing legislation and shepherd it through the legislative process in any one state. To do this in ten states in one year must cost an astronomical amount, especially in states the size of New York, Pennsylvania and Illinois. Who’s paying for this?

Conclusion

No person should be subjected to scientifically implausible diagnostic methods and treatments. States should be working to eliminate such practices, not giving out licenses to perpetuate them.

Passage of naturopathic licensing bills in the five states where legislation is pending would substantially increase the population subject to this conglomeration of pseudoscientific practices. But even one more licensing law in one state is one too many. Supporters of science-based medicine should actively oppose the “legislative alchemy” that is naturopathic licensing and, where licensing is already entrenched, oppose expansion of scope of practice and insurance mandates.

In fact, it is possible to eliminate existing licensing of naturopaths altogether, as Florida has done.

Notes

  1. See, Bellamy J., Legislative Alchemy: the US state chiropractic practice acts, Focus on Complementary and Alternative Therapies (2010)15(3): 214–222.
  2. For an excellent primer on naturopathy, see also, Atwood K., Naturopathy: A Critical Appraisal, Medscape, General Medicine. (2003);5(4). http://www.medscape.com/viewarticle/465994
  3. Downey L, et al, Pediatric Vaccination and Vaccine-Preventable Disease Acquisition: Associations with Care by Complementary and Alternative Medicine Providers, Matern Child Health J (2010) 14: 922-930.
  4. N.D. Cent. Code Ch. 43-58 (2011).

Posted in: General, Legal, Naturopathy, Politics and Regulation, Science and Medicine

Leave a Comment (22) ↓

22 thoughts on “Legislative Alchemy I: Naturopathy

  1. daijiyobu says:

    A term I use in sum, often, concerning this topic:

    licensed falsehood.

    I’m soon to do a post at Naturocrit that summarizes and quotes from the Princeton Review’s “best medical schools” paper-based guide and PR’s associated web pages.

    Yes, “no person should be subjected to scientifically implausible diagnostic methods and treatments” and I’d add ‘that are ACTUALLY State-sanctioned falsehoods’ [government as accessory and such].

    But, also, education consumers — parents and their children — need truthful and accurate descriptions of schools so they can be fully-informed when making very expensive decisions about education.

    A person may visit a naturopath and go through a complete cycle of clinical visitation for the cost of perhaps a few to several hundred dollars. That’s not much falsehood in terms of monetary cost / damage [e.g. so many naturopaths say they are science-based and yet dispense homeopathy and kind, then only accept payment in-full at time of service].

    Imagine a person who takes naturopathy’s false descriptions as factual — in good faith — and gears their undergraduate and graduate school tracks towards what inevitably is false and false-by-oath.

    That’s a six-figure monetary cost, all couched in I easily seen now is quite irrational and false:

    “been there, done that, saw the movie, wore the tee-shirt.”

    -r.c.

  2. Geoff says:

    “No person should be subjected to scientifically implausible diagnostic methods and treatments. States should be working to eliminate such practices, not giving out licenses to perpetuate them.”

    No. It is not the state’s job to regulate choice. When the problem starting out was government intervention, what makes you think that the solution is government intervention? Our government is FAR too corrupt to be trusted to make smart, scientific decisions.

    People need to use the judgment of their own mind to make decisions about their health. It is the job of private institutions like Science Based Medicine to propagate good information so that people do not choose scientifically implausible diagnostic methods and treatments, not that of the state.

    If you understood the magnitude of the government clusterf*** with regard to the lipid hypothesis, the food pyramid and agricultural subsidies; starting with the United States Senate Select Committee on Nutrition and Human Needs headed up by George McGovern (who was in the pocket of big agro); and its influence on the nutrition science taught in medical schools for the last 30 years, you would be far more skeptical of government.

  3. cervantes says:

    Geoff, I’m not sure exactly what you are trying to say but you seem to have this exactly upside down. What the naturoquacks are asking for is government intervention. Furthermore, for government to promulgate accurate information is not “restricting choice,” but supporting people in making wise choices.

    I don’t know what you mean by the “lipid hypothesis,” but it is true that historically, the federal dietary recommendations were influenced by agricultural and food industry interests and were not the best. Now they are much better. Our job is not to work against government providing any information to the public, but to work for providing accurate information unbiased by vested interests. Licensing naturopaths accomplishes the exact opposite.

  4. Geoff says:

    In the two sentences I quoted, he is not just calling for a removal of the federal licensing, he is calling for the government to protect the public from such practices. I agree with the general sentiment of the post, but my point was that government cannot be trusted to make decisions in the interest of public health. It has a long history of making poor decisions in this area, and there is no reason to expect that to change. Better to err on the side of individual responsibility as the road to hell is paved with good intentions.

    In that specific sentence, I was using the “lipid hypothesis” incorrectly to mean both the lipid hypothesis; which is that elevated blood cholesterol causes heart disease; and the diet-heart hypothesis; which is that saturated fat and dietary cholesterol cause blood cholesterol to go up. The “diet-heart hypothesis” is dependent on the lipid hypothesis, and taken together, they say that eating saturated fat and dietary cholesterol cause heart disease.

    I would prefer not to open up this can of worms right now, but science never actually proved any piece of that causal chain. It never proved that elevated cholesterol causes heart disease, only that it is correlated. It also never proved that saturated fat or dietary cholesterol raised cholesterol levels, and this isn’t even correlated. If SBM had been around in the 50s, it would have been tearing apart Ancel Keys’s epidemiology just as it tears down homeopathy.

    The nutrition guidelines are still trash. They are still based on the pseudoscience belief that saturated fat is harmful, which has very little scientific plausibility and is entirely unproven. They also call for what are likely the most harmful substances, the grains, as the primary source of our calories. They consider butter and lard to be “bad fats” and vegetable oil to be “good fats.” Further, they are based on the false premise that satiety is based on weight and/or volume of food, rather than being regulated over the long term in the hypothalamus.

  5. cervantes says:

    Hmm. The government has a long history of making poor decisions in the field of public health, and therefore the government should not promote public health? That’s quite a radical proposition. You’ll have to make an argument based on evidence, not mere assertion. In fact government inspects restaurants, which prevents a lot of food borne illness. You do not have the choice to eat at a filthy restaurant that will poison you, at least not if the government can help it. Is that a choice you want? Government provides clean water and safely deals with sewage. Do you want the choice to throw your excrement in the street and drink filthy water? I could go on and on.

    As for what you call the lipid hypothesis, while it is true that epidemiological evidence normally does not provide for strong conclusions about causation, this is a pretty well supported theory. And the recommendation that you should include vegetable oil in your diet is based in part on precisely the fact that it does slake hunger and makes you less likely to overconsume carbohydrates. Furthermore the current guidelines do not promote grain in general, but rather whole grains and legumes.

    Perhaps you work in the meat or dairy industry? If so you should disclose.

  6. Geoff says:

    I don’t work in the meat or dairy industry, but I eat quite a bit of both. I also go out of my way specifically to source my meat and dairy from grass fed sources that I trust for a number of reasons, including the fear of contaminated food.

    Still, you’re drawing a false equivalency between a very well supported theory about germs and bacteria and a completely unsupported theory about heart disease. Again, it wouldn’t be such a big issue if 1) government wasn’t making the most detrimental foods artificially cheap and 2) the medical community didn’t integrate this unproven hypothesis as part of its curriculum for the last 30 years.

    Lipid hypothesis is not a term I invented. It has been a part of the literature since the 1960s. Take a look at Chris Masterjohn’s writeup of the history of the term, as well as the diet-heart hypothesis, and how it came to be understood as true despite being unproven here: http://blog.cholesterol-and-health.com/2011/03/how-conflating-lipid-hypothesis-with.html. It is clear that lipoproteins play a role, but not the one that you think.

  7. AJ Gregg says:

    Geoff I think you are caught up in your diet dogma and need to re-examine the evidence, in its entirety.

    The link between saturated fat intake and blood cholesterol is fairly well established, and has been done in RCT fashion. Epidemiological data shows consistently(although not every time) that elevated cholesterol ‘increases ones risk’ – and decreasing blood cholesterol(done with statins and isocaloric substitution with PUFA) decreases one’s risk – which is entirely different from ‘elevated cholesterol causes heart disease’. There is no ONE cause(except in naturopathy, of course), there are several risk factors(smoking, diabetes, BMI. . .), and elevated cholesterol happens to be ONE.

    If you ask a 100 people to run across the highway, and let’s say 70 people die, 18 are injured, and 12 survive you cannot say for certain that running across the highway will kill you. . . BUT there is a lot of evidence to suggest running across the highway is not a good idea. We have this with saturated fat and cholesterol intake.

    When taking dietary advice, be careful what you read, it could kill you :)

  8. David Gorski says:

    The government has a long history of making poor decisions in the field of public health, and therefore the government should not promote public health? That’s quite a radical proposition

    Indeed. It appears to be a Libertarian-style position that is far more ideological than science-based. Either that, or it’s just a dislike of government based on his own personal bugaboo about cholesterol and fats. Take your pick.

    No one here claims government is perfect (perusing our posts about NCCAM and other government screwups should disabuse readers of that notion), but government intervention in certain areas does have a history of doing far more good than harm; i.e., the creation of the FDA and the CDC.

  9. Kenneth says:

    @daijiyobu

    “A term I use in sum, often, concerning this topic: licensed falsehood.”

    I propose an alternative: “licensed fraud”.

  10. aeauooo says:

    ‘“published reports suggest that only a minority of naturopathic physicians actively support full vaccination.” This should surprise no one, as it fully accords with naturopathy’s long standing opposition to vaccination.’

    Until this year, obtaining an exemption from immunizations for philosophical reasons in Washington State required only a parent’s signature on the Certificate of Exemption (COE) form. The result is that Washington has the highest percentage of kindergarteners with non-medical exemptions in the U.S.
    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6021a4.htm?s_cid=mm6021a4_w
    http://ajph.aphapublications.org/cgi/reprint/91/4/645

    A new law requires a health care practitioner’s signature on the COE, ‘stating that he or she provided the [parent] with information about the benefits and risks of immunization to the child.’

    ‘Physicians (M.D.), physician assistants (P.A.), osteopaths (D.O.), naturopaths (N.D.), and advanced registered nurse practitioners (A.R.N.P.) who are currently licensed in Washington are authorized to sign the exemption form or write a letter.’
    http://www.doh.wa.gov/cfh/Immunize/schools/exemption-FAQ.htm

    At least we managed to keep chiropractors off of that list.

    Caveat loophole: obtaining a religious exemption in Washington requires nothing more than a parent’s signature.

  11. Geoff says:

    @AJ Gregg

    I recommend that you reexamine the evidence in its entirety before making such claims. This includes long term studies like Framingham as well as intervention trials like Atkin vs. low fat and Cochran Collaboration studies like this one here: http://www2.cochrane.org/reviews/en/ab007957.html. It’s a house of cards at best, and blatant fraud at worst.

  12. cervantes says:

    Geoff, all that says is that there hasn’t been an adequate RTC of dietary strategies to lower cholesterol. The evidence is largely epidemiological, it is true — the Cochrane report doesn’t even discuss it, just says they couldn’t find an RTC to review.

    In any case, this is a weird hobby horse you’re riding and it’s totally off topic. It certainly doesn’t say anything in favor of naturopathy. Just sayin’.

  13. Geoff says:

    @Cervantes

    I’m not in favor of naturopathy, but I do think that it is important to leave the door open for the oddball, implausible treatment that actually works.

    Just because something is unproven, that doesn’t mean we need to be protected from it. We can protect ourselves, thank you very much. Things that work are unproven until they aren’t, and having governmental hurdles to overcome to get there is counterproductive and detrimental. Imagine if we had anti-vaccine leaders in charge of vaccination policy in this country at the turn of the 20th century. Where would we be today?

  14. Geoff says:

    To clarify that last leap, I am asserting that this is exactly what we have in the field of nutrition science today, people who believe something that is totally wrong and detrimental to our health. The problem though is not these pseudoscientists, but rather the system. Asking for more regulation is a step in the wrong direction.

  15. AJ Gregg says:

    It’s like saying smoking doesn’t cause lung cancer because there is no RCT to prove it. Sometimes epidemiological data is suffice.

  16. Hurray Florida! Usually Florida messes up a lot of things. Nice to see there’s a silver lining.

    I read the Hulda Clark story, having worked in a health food store several years ago that sold her books. I remember a customer coming in one day and preaching her gospel. Things particularly horrifying about her story include:

    “Clark subsequently arranged for all of Mrs. Figueroa’s front and molar teeth to be removed, prescribed more than 30 dietary and herbal supplements to be taken during a 12-week period, and badly burned her breast while administering treatment with a “Zapper” device.
    During the 3-month period of treatment, the tumor increased from 1.5 cm to 14 cm.
    Despite this fact, Mrs. Figueroa was falsely told that she was getting better, that tests for “cancer markers” were negative, and that pain she was experiencing did not reflect persistence of her cancer.”

    and

    “The evidence amply supports a reasonable belief on the part of these defendants [Grell and associates] that plaintiff [the Self Health Resource Center] was part of a network of persons and entities who acted recklessly, at best, luring Mrs. Figueroa into a bizarre, grotesque, and extremIely expensive regimen of “alternative” cancer treatments which has no effect other than to exhaust the Figueroa’s life savings and divert Mrs. Figueroa from conventional treatments, thereby reducing her prospects for recovery and survival [16].”

    How is this not some form of murder? I suppose when you’re insane, you believe you’re doing the right thing. I think that is the case with Hulda Clarke, and many other self proclaimed alternative medicine “gurus.”

  17. Jann Bellamy says:

    @ Geoff: “In the two sentences I quoted, he is not just calling for a removal of the federal licensing, he is calling for the government to protect the public from such practices.”

    Yes, but that is not the equivalent of “more regulation.” A single science-based standard for all health care would do, meaning all health care practices must have at least a plausible basis in science, and whether they do or not should be an issue decided by scientists. That alone would flush out a lot of the garbage in health care and actually reduce the amount of existing regulation, as it would eliminate licensing of “CAM” practitioners and would prevent their practicing.

    The level of evidence required to use any particular science-based healthcare practice is also an issue best left to scientists and science-based practitioners. I’m still tinkering with how to make that a statutory standard for all health care.

    Also, I’m a “she,” not a “he.” And the states license health care practitioners, not the federal government.

    “Just because something is unproven, that doesn’t mean we need to be protected from it. We can protect ourselves, thank you very much.”

    No we can’t. That’s why we had Hulda Clarke and why her ilk continue to make money off sick people. And the “worried well.”

  18. Geoff says:

    @Jann

    Sorry for the gender error. We have a Jan with one “n” in our company (pronounced like yan) and I guess I didn’t look at the name carefully enough to see the difference.

    To David’s point, the difference of opinion is largely philosophical/ideological. I am drawing the line at the point of choice. I take life as my standard of value. Our drives have evolved with the ultimate purpose of keeping us alive, passing on our genetic material. As such, a restriction of choice is a threat to ones life. From a philosophical perspective, I consider the distinction between state and federal government to be largely irrelevant, and I outline why in this post: http://www.armchairphilosophizing.com/2011/08/designing-moral-government-part-3-local.html.

    I understand there are hucksters out there who will sell anything, and gullible people out there who will buy anything, but at the end of the day both parties are acting freely, without coercion. Just because someone is wrong/pseudoscientific/lying does not mean that they are hurting people (beyond their wallet). Keep in mind that there is a difference between sanctioning the effectiveness of a treatment and sanctioning the safety of a treatment. The latter is within the scope of the purpose of government, the former is not.

    In a world in which government can be trusted to actually promote public health rather than corporate profit, I would still disagree with your position, but I can at least understand where you’re coming from. However, given our history, I think it is completely naive to suggest that this is ever a possibility. I assert the governmental nutritional guidelines as case in point number one as to why we can’t trust government to be objective about the science. I understand that you are not as jaded by this example as myself, but what I cannot understand is how this possibility, even if it’s not with respect to nutrition, does not register within your worldview.

    Agricultural companies make a lot of money destroying the environment with their unsustainable grain agriculture practices (practices that are subsidized by the government). Drug and insurance companies make a killing (as do healthcare providers, *ahem*), whether intentional or not, as a result of the dramatic rise in illness that has occurred since the introduction of the nutritional guidelines. If a grain/legume/dairy/nightshade free diet cures autoimmune diseases*, who is supposed to profit off of it? Who is supposed to fund the studies that would objectively prove it so? How do we get our nutritional guidelines back on track after 30+ years of pseudoscience?

    Government moves too slowly to keep up with science, and science changes too dramatically to restrict choice without a very high degree of certainty (e.g. the level of certainty we have with things like vaccines, antibiotics, hand washing, etc). “Plausibility” is not a sufficient level of scrutiny, particularly if plausibility does not include evolution, which is the unifying theory of biology: the “why” behind the “how.” When it comes down to it, though, each individual needs to take responsibility for his own health, needs to trust the judgment of his own mind to know what’s best for him. If he gets it wrong, he pays the ultimate price, but the fault is his, and his alone.

    If it turns out that I’m wrong, and every time I fried my eggs in bacon grease and added extra salt to them I was “clogging my arteries the way that grease clogs a sink” (a phrase that paints a picture that is not only implausible but factually wrong), I will not be upset. I will know that I, to the best of my ability, based on the best available information, made the best possible choices. Given that I am a post heart transplant patient who has this stuff carefully monitored (I had a thalium stress test last week), I doubt it would ever come to that, but I know it’s a possibility when one flies in the face of everything that the “experts” tell him. But I don’t do it for the sake of being “counter-culture,” I do it because I believe it is the correct interpretation of the facts. When I comment on your blog post that you took it one step too far by calling for the government to step in, I am not trying to stir up controversy, I consider this to be an unavoidable conclusion based on the history of government, and in particular the history of our government.

    When someone pays my friend Dale; who is an acupuncturist; for “treatment,” that is all that he is doing as well. I don’t think that Dale’s treatments work, but I do trust her to not hurt me or anyone else. I have tried acupuncture in the past, because as implausible as it seemed to me, it was covered by my insurance, so I figured it was worth a shot. I didn’t have any referrals, so my best course of action was to find someone who was licensed. Someone who, based solely on that license, I trusted to at least not hurt me, even if she didn’t help.

    *which to the best of my knowledge, it very likely does, at least anecdotally: http://robbwolf.com/2011/08/22/emelias-story-she-is-my-walking-miracle/

  19. GLaDOS says:

    Pennsylvania in particular wants to go after the body’s self-healing processes full bore. Its proposed licensing act would allow naturopaths to practice “behavioral medicine,” including cognitive therapy.

    I encounter more anti-psych from people in PA behavioral health than other eastern states. So, hmm.

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