Articles

Naturopathic organ repositioning coming soon to Pennsylvania?

Pennsylvania legislators need to know only one thing about House Bill 612 (licensure of naturopathic “doctors”) to vote against it: As a means of “naturopathic musculoskeletal therapy” the bill would allow naturopaths to “reposition body tissues and organs.”

This is impossible. You cannot “reposition” tissues and organs of the human body by external manipulation.

Why does this tell us everything we need to know about these naturopathic doctors and why they shouldn’t be licensed in Pennsylvania? For one thing, this is no mistake a bill draftsman made in understanding what naturopathic practice includes. House Bill 612 was obviously drafted by naturopaths. That means naturopathic doctors actually believe they can “reposition” your body’s tissues and organs. And that speaks to their poor education and training. They don’t even understand basic anatomy.

For another, it tells us naturopathic doctors reject evidence-based medicine as a standard of practice. There is no evidence that this “repositioning” of organs and tissues is beneficial for any condition or disease, even if they could do it in the first place, which they can’t.

And for yet another, this certainly calls into question their understanding of the disease process and their diagnostic skills. One has to wonder exactly what health problems they think these purportedly out-of-place organs are causing. And how do they go about determining which organs are out of place and where they should go? Or when they have been successfully returned to their proper position? Again, this should raise alarming questions in the legislators’ minds about their education and training.

Yet, if this bill passes, naturopathic doctors will become state-licensed providers of primary care. Yes, primary care providers. It says so right there in the definition of “naturopathic medicine.” (Mark Crislip thoroughly debunked the notion of naturopaths as primary care doctors in a post deconstructing a naturopathic white paper on the subject.) This will allow naturopaths to “reposition” the organs and tissues of unsuspecting Pennsylvania citizens, possibly claiming a right to insurance reimbursement for the privilege, another problem with this bill we’ll get to later.

Of course, this fantasy treatment could be excised from the bill. But that would do nothing to resolve the substantial questions about their education, training, and abilities to perform the most basic tasks of primary care, or any other form of evidence-based healthcare, or even reality-based health care for that matter. And there are plenty more naturopathic fantasy treatments allowed by House Bill 612 even if you get rid of this one. We’ll get to a few more in a minute.

This affinity for fantasy treatments among naturopathic doctors is explained in the first part of the bill, Section 103, which defines “naturopathic medicine” as:

a system of primary health care practiced by doctors of naturopathic medicine for the prevention, diagnosis and treatment of human health conditions, injuries and diseases and that uses education, natural medicines and therapies to support and stimulate the individual’s intrinsic self-healing processes.

This is the central fallacy of naturopathic practice, one that sounds appealing but is at its core meaningless. “Intrinsic self-healing processes” is simply another way of referring to vitalism, a long-discredited, pre-scientific notion that bodily function is controlled by some incorporeal force unknown to science or medicine. As Steve Novella pointed out, vitalism was a placeholder, used to explain bodily functioning until biology, chemistry, physiology and anatomy developed science-based explanations for these functions. Except for naturopaths, who’ve remained stuck in vitalism.

Naturopaths have tried to backfill a scientific explanation into the pre-conceived notion of an “intrinsic self-healing process.” When they can convince a group of respectable physiologists (say, those holding faculty appointments at major research universities or medical schools) that their explanation is credible, I’ll believe it too. Until then, I won’t and no one else should either.

Of course, when you start from the premise that the body is governed by this non-existent life force pretty much anything that you can fit into that paradigm will fly, and naturopaths have used this to their full advantage in devising diagnoses and treatments no responsible medical doctor would agree with. Hence organ repositioning.

More nonsense

Other implausible and unproven treatments either mentioned specifically in the bill or permitted under its broadly defined categories, such as “naturopathic physical medicine,” include all those mentioned in David Gorski’s summary of naturopathic practice:

If I’ve pointed it out once, I’ve pointed it out a thousand times. Naturopathy is a cornucopia of almost every quackery you can think of. Be it homeopathy, traditional Chinese medicine, 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, it’s hard to think of a single form of pseudoscientific medicine and quackery that naturopathy doesn’t embrace or at least tolerate.

This bill will also allow naturopathic doctors to pump patients full of unnecessary vitamins and minerals intravenously, and use other favorite and potentially dangerous treatments such as peat baths, colonic irrigation (which the Journal of Family Practice warned against in this 2011 article), fasting and severely restricted diets, and recommendation of dietary supplements of unknown safety and effectiveness, to name a few. Naturopaths will be able to diagnose diseases they’ve invented, such as chronic yeast overgrowth, ubiquitous toxins (that no one else seems to be able to find), and food “sensitivities” (again, that no one else seems to be able to detect).

In addition to what we might politely refer to as their “unique” diagnoses and therapies, N.D.s will also be able to use some conventional diagnostic means such as mammography, X-rays, and lab tests. They will be able to perform physical exams, including well baby checkups and vaginal and proctologic exams. But permitting naturopaths to do these things and their knowing what they are doing are two entirely different things.

Naturopathic education, such as it is

I trust no one could get to this point in reading and think that naturopathic doctors have sufficient education and training to diagnose and treat patients. Unfortunately, all naturopathic licensing bills make the mistake of assuming their education and training is somehow the equivalent of, or at least close to, that of a medical doctor.

House Bill 612 makes this same unfounded assumption. An applicant to practice as a naturopathic doctor must have “completed a doctorate-level naturopathic medical program” accredited by an accreditation agency recognized by the U.S. Department of Education and must pass an examination administered by the North American Board of Naturopathic Examiners (The “NPLEX”). Let’s see what this education, accreditation and examination are really like. This is ground we have covered before at SBM, but it bears repeating because I have never seen a shred of evidence that the sponsors of this bill, or any state naturopathic licensing bill, have ever set foot on the campus of a naturopathic school and critically evaluated its programs, or looked at one of these licensing exams or researched the requirements for becoming an accrediting agency. All the bills I’ve read simply parrot language obviously supplied by naturopaths.

So here’s what’s actually going on: These naturopathic “medical” schools have simply appropriated the word “medical” and pasted into the school’s name. There are five of these schools in the U.S. and two in Canada. Unlike medical schools, where students must score well on the grueling MCAT to be accepted, there is no entrance exam. All are private and none are part of a mainstream public or private university or college. Unlike real medical schools and science departments at other colleges and universities, their faculty members have published little and do virtually no research.

The Council on Naturopathic Medical Education has been approved by the U.S. Department of Education to accredit naturopathy schools. While naturopaths pushing licensing seem to want to use this as a sort of federal government seal of approval, it is nothing of the sort. The goal of the Department is to ensure that accredited schools meet certain financial, disclosure and similar requirements in order to protect prospective and current students from such problems as financially unsound institutions or schools that are dishonest about post-graduation job opportunities. It is also designed to determine which schools can take advantage of student loan programs. The accreditation program is not designed to protect the public health by ensuring these schools instruct their students in the use of safe and evidence based healthcare. It does not mean that graduates are capable of practicing primary care, nor of providing health care at all. The Department does not vet course content. That is simply not the function of the accreditation programs.

Nor does passing the NPLEX exam guarantee the delivery of quality healthcare by naturopaths. This somewhat mysterious document seems to be carefully protected by naturopaths. No one outside of naturopathy appears to have seen a copy or reviewed its contents. In fact, even when Kimball Atwood asked for a copy as part of a state-appointed commission reviewing naturopathy licensure for Massachusetts in 2002 he couldn’t get one. (Naturopaths are still not licensed in Massachusetts, even after trying numerous times. I think they are up to a dozen attempts, maybe more.) No person voting on House Bill 612 should miss reading Dr. Atwood’s series on naturopathy, which you can find referenced here.  It would be unconscionable to vote without this information.

Let’s also look at a huge gap in their training, which we’ll discuss in the context of their claims to being “primary care” providers.

Primary Care Practice?

As mentioned, this bill will allow naturopaths to practice primary care. N.D.s would have the same scope of practice as an M.D. or D.O. primary care physician but be limited in some of the therapies they could offer. (For example, they could not prescribe controlled substances.)  They will be able to see, and treat, any patient of any age with any disease or condition, no matter how serious.

Full scope of practice as a primary care physician, including all prescription drugs, is actually the goal of the American Association of Naturopaths. Naturopaths are willing to accept a more narrow scope, as is apparently the case in Pennsylvania, and then return for increased scope once entrenched. They have achieved this in Washington state, including mandatory insurance coverage, with interesting results. Two reviews of insurance claims for naturopathic care revealed that less than 2% of the insured adult and pediatric population made such claims, indicating an extremely low use of licensed naturopathic doctors for health care even where they are fully licensed and covered by insurance.

In defining what a primary care physician does, I turn again to an American Association of Family Physicians definition:

Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (the “undifferentiated” patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis.

Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (e.g., office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and managed by a personal physician often collaborating with other health professionals, and utilizing consultation or referral as appropriate.

Note specifically that this bill would allow the N.D. to see and treat the “undifferentiated patient” straight out of N.D. school, with 1200 hours of clinical training.  This training is usually done in naturopathy school clinics where the students typically see patients who have a variety of mild, self-limiting conditions, such as colds and musculoskeletal pain. Compare this to the clinical training medical students must have before they can become board certified in family practice, general internal medicine or pediatrics (the three primary care specialties in medicine). During med school, in the third and fourth year, students see patients in a variety of settings (hospital, office, emergency room) in clinical rotations among a variety of specialists (pediatrics, surgery, oncology, obstetrics etc.). After graduation they also spend an additional three years, at about 80 hours per week, in clinical training. For an idea of what they do during that residency, you can find a broad outline of the curriculum for a three-year family practice residency at Penn Medicine on its website.  Again, naturopathic doctors do not have this training.

Naturopathic treatment of pediatric patients is especially troubling because of naturopathic opposition to vaccination. Studies have found:

  • A negative influence of naturopaths on mothers’ decision to vaccinate children.
  • Consultation with a naturopath significantly decreased the likelihood of receiving a flu shot among women in contact with young children.
  • Children in Washington state were significantly less likely to receive recommended vaccinations if they saw a naturopathic doctor, and significantly more likely to be diagnosed with a vaccine-preventable disease if they received naturopathic care.

Forced insurance reimbursement? And other problems.

To add insult to injury, the Affordable Care Act’s non-discrimination provision may require reimbursement of naturopathic health care if naturopathic doctors are licensed. That is certainly what they are aiming for.  And they aren’t shy about making a huge fuss when they aren’t included in physician practice groups because they don’t practice evidence-based medicine.

House bill 612 will require naturopathic doctors to refer a patient to a physician “when the patient is presenting a contraindication to the practice of naturopathic medicine.” I am not even sure what that means. (Based on what we know about naturopathic practice one might argue that pretty much all patients present with a “contraindication to the practice of naturopathic medicine.”) In any case, note that it will be the N.D. who makes the call here. That presents two problems. First, N.D.s already think they are capable of practicing as primary care physicians. Given this overblown view of their abilities, abilities I feel fairly sure I’ve just demonstrated they do not possess, might one not be concerned that they will fail to realize their shortcomings when a patient needs a referral? Second, given their lack of training in diagnosing patients, who could be confident that they will be able to recognize a disease or condition requiring referral in the first place?

Nor should Pennsylvania legislators take comfort in the fact that naturopaths would be regulated by the state medical board. The board can only regulate within the confines of the scope of naturopathic practice granted by this bill. It will have no authority to prevent naturopaths from doing anything the legislature says they can do. In fact, regulation by the medical board will create quite a quandary. How will the board determine, for example, whether a naturopath’s repositioning of an organ fell below the standard of care? How about an injection of vitamins and minerals for “flu prevention”? Or a prescription for homeopathy?

If I were Rep. Mark Mustio, the bill’s main sponsor, or any of the other legislators who signed on as sponsors, I would be furious with the naturopaths for putting me in this position, subject to ridicule for sponsoring such bill. Rep. Mustio can redeem himself, and save his colleagues a lot of embarrassment, by quietly withdrawing House Bill 612 from consideration before it even comes up for a vote before the House Professional Licensure Committee on June 5th.

Posted in: Herbs & Supplements, Homeopathy, Legal, Naturopathy, Politics and Regulation, Vaccines

Leave a Comment (80) ↓

80 thoughts on “Naturopathic organ repositioning coming soon to Pennsylvania?

  1. daijiyobu says:

    NPLEX Part II content can be found from one of their study guides, like

    http://www.healingmountainpublishing.com/catalog/clinical_boards_manual.html .

    This is the “clinical sciences” part, that contains HOMEOPATHY, and they say at HMP:

    “we recommend using this book in conjunction with the Naturopathic Clinical Board Review Study Questions, the Naturopathic Clinical Boards Practice Exams, and the clinical flashcards. Together they form a complete system for passing the clinical portion of the NABNE/NPLEX examination.”

    Mucho dinero!

    Too rich for me to obtain to take a look at, though I did just recently purchase a bundle of the Journal of Naturopathic Medicine in print running from 1990 to 2000 for a small price. A rare find: with the AANP being the listed publisher and them claiming it’s a scientific journal yet with articles in it like “Homeopathic Prophylaxis” (1994). Roughly speaking, by the way, I’m in my twentieth year of reading naturopathic literature and licensed falsehood / the naturopathillogical march on.

    I did the NPLEX Part 1 in 2000, and it was basic medical sciences with nothing besides regular basic medical sciences. Those sciences, and science in general of course, are IRONICALLY not the basis of what’s essentially naturopathy and yet they’re called basic medical sciences as if!

    -r.c.

  2. @Jann Bellamy

    This is impossible. You cannot “reposition” tissues and organs of the human body by external manipulation.

    Conditions like hiatal hernia can be alleviated by bodywork therapeutic massage. More complex cases require surgical intervention, but this is not first choice of treatment.

    Women use Arvigo Maya Massage to help with fertility issues, though I never looked into this procedure, some female patients have used it with success.

  3. idoubtit says:

    I’m in PA, what should I do? Should I contact my legislator? Should I ask my PA friends to do it also? Or what particular person or organization should I target my complaint?

    1. Cheryl Gentry says:

      You should do your homework. The author should be sued for the stories she is peddling.

  4. sksuttonmd says:

    Well there was the belief in the wandering womb as a basis for hysteria. I guess they could treat that
    http://en.wikipedia.org/wiki/Wandering_womb

  5. StaphofAsclepius says:

    Once again, your name is apropos, FastBuckArtist.

    Type I Hernias are largely asymptomatic. Assuming the person in the YouTube video has a Type I hernia, is he doing a pre- and post-manipulation barium contrast study to show that it worked? Is it efficacious? Or is this youtube video sufficient “evidence” and study for you to condone it? By the content of your posts, I do not think you grasp the concept of real evidence vs anecdote.

    http://www.uptodate.com/contents/hiatus-hernia?source=search_result&search=hiatal+hernia&selectedTitle=1~75

    I’m assuming that your link to an article on the Oprah site is also your version of “evidence” for efficacy of this massage. I see exactly zero citations to back up the claims the article makes. It is also written by the daughter of Dr. Oz; she makes a living off writing “healthy living” books. Where are the studies showing that this massage helped anyone?

    Try again… or just ignore everything posted on this site and continue passing off anecdotes and articles written by people with an absent knowledge of pathology, physiology, anatomy, and other basic sciences, and who coincidentally, have a vested monetary interest in purveying these “treatments”.

  6. Jann Bellamy says:

    @ idoubit

    There are a number of things you can do. Yes, please contact your legislators and ask your friends to contact their legislators. If you or anyone else you know is a medical professional (doctor, nurse, etc.) call your professional organization (local and state) and make sure they are actively opposing House Bill 612. You can find out more about how to contact your legislators here: http://www.legis.state.pa.us/.

    I put up a website with information on naturopathic education and practice to assist opposition to naturopathic licensing: http://www.no-naturopaths.org. It also has additional resources you can consult. If you go to the “Legislative Alerts” page (click on the “More” tab at the top and then “Legislative Alerts”) you will find a pdf with specific information about this bill, its sponsors and the committee members who will vote on it on June 5. Please contact as many of these people as you can. The information will be updated to reflect this committee’s vote and track its progress through the legislature if it passes there.

    @ everyone

    The website is following all naturopathic licensing bills in the U.S. You can find out if anything is pending in your state too.

    THANKS!

  7. mdcatdad says:

    Organ repositioning? Sounds like feng shui is the latest woo to be incorporated in naturopathy!

  8. SteveJ says:

    Maybe they’re really mob doctors trying to pass themselves off as legitimate businessmen. “Pay us our money or we’ll rearrange your organs.”

  9. windriven says:

    “Two reviews of insurance claims for naturopathic care revealed that less than 2% of the insured adult and pediatric population made such claims,”

    US health care spending (2010) was $2.6 trillion*, physician and clinical services accounted for 19.9% or $517.4 billion. If quack poseurs get 2% that is over $10 billion dollars wasted. How many more MDs could we train for 10 billion per year? How much scientific research could be funded?

    @Jann Bellamy

    Huge thanks for the no-naturopaths website! It is apparently too late for my home state of WA (we put the ‘wa’ in qwack ;-)) but it isn’t too late for most other states.

  10. @StaphofAsclepius

    Its short term pain relief, not a cure (the hernia massage). My grandmother had a hernia condition, it was caused by a spine injury that tilted the body into an unhealthy shape. While the abdominal massage obviously did nothing for the cause of the problem (spine injury), it does provide relief from pain and discomfort in the digestive tract.

  11. windriven says:

    Sorry – forgot the link. The statistics I mentioned in the comment above are courtesy http://www.cdc.gov/nchs/fastats/hexpense.htm.

  12. steney01 says:

    Couple specific disturbing things in this PA bill…
    The degree is granted after 4100 hours of training, aka, 2 years or less, only 1200 hours of which need to be supervised clinical training, which is 6-8 months. And after that they’ll be ordering x-rays and mammograms and interpreting them? Terrifying.

    On page 10, line 5, the bill suggests that continuing education credits can be obtained by “(E) Any other provider providing a program related to naturopathic education, if the provider has submitted an application to and received approval from the Pennsylvania Association of Naturopathic Physicians or American Association of Naturopathic Physicians.”
    So ongoing education is obtained through any organization affiliated with the Naturopathic associations. And since these associations do not endorse evidence-based medicine and do not endorse mainstream medical treatment there is therefore no requirement that Naturopathic “physicians” keep up with basic, modern clinical medicine whatsoever.
    Not surprising of course, but I feel like they really snuck that part in there after A-C, which actually suggested they get credits from some mainstream accredited groups.

    Write your legislator!

    1. Tim says:

      I don’t know where you’re getting your numbers. The naturopaths to which the bill is referring requires 4 years of graduate school averaging 26 credits a quarter/semester.

      1. WilliamLawrenceUtridge says:

        That’s an awful lot of schooling to learn about magic and nonsense…

        1. Tim says:

          Tell me about it, potions class is awesome!

          Oh wait… no… that’s not right… I meant biochemistry, anatomy, physiology, embryology, physiotherapy, gross human anatomy, neurology, counseling psychology, physical examination, histology, pathology, immunology, pharmacology,
          lab diagnostics, orthopedics, cardiology, nephrology, pediatrics, and minor surgery.

          Gosh that’s a lot of schooling in science just to sell snake oil.

          Although, we also do study herbs for botanical medicine and make medicine from them… so… I guess we do perform magic and make potions.

          1. Anthony says:

            Taking my wife to gwcim.com on Wed for a follow-up appt and the day after I’m going to drandrewlipton.com for an initial appt. ;) So far he appears to be the closest to a ND in PA.

          2. Anthony says:

            you forgot to mention that ND school also has the same pre-reqs and MD/DO/DMD/PharmD school.

          3. Chris says:

            If you really studied chemistry in a naturopathic school you would realize that homeopathy is worthless.

          4. WilliamLawrenceUtridge says:

            you forgot to mention that ND school also has the same pre-reqs and MD/DO/DMD/PharmD school.

            A thought exercise – what would you say to someone who gets an engineering degree, then starts up a company to manufacture perpetual motion machines?

            What about a biologist who goes on to support intelligent design?

            A geologist who supports biblical literalism and a 7,000 year old earth?

            A historian who denies the Holocaust?

            An Egyptologist who claims the pyramids were built by aliens?

            A dentist who believes in the tooth fairy? A dentist who doesn’t believe in tooth decay?

            A lawyer who endorses the “free man on the land” movement?

            A nutritionist who believes a healthy diet is composed of coke and nacho chips?

            A geographer who searches for Atlantis?

            These are disciplines that would seem to betray their roots, in much the same way as someone who passes biochemistry but endorses homeopathy.

            1. Anthony says:

              I forgot to mention that our labs have improved since implementing ND treatment plan – love that Weston A. Price real food stuff, etc. I’m still recovering from early childhood on the food pyramid diet scheme. Could someone please comment on the fact that there are professional grade vitamins, supplements and herbs that only professionals have access to.

  13. WilliamLawrenceUtridge says:

    Its short term pain relief, not a cure (the hernia massage). My grandmother had a hernia condition, it was caused by a spine injury that tilted the body into an unhealthy shape. While the abdominal massage obviously did nothing for the cause of the problem (spine injury), it does provide relief from pain and discomfort in the digestive tract.

    Even if that’s even symptomatic relief and isn’t causing other problems, it’s a very far cry from “organ repositioning” applied to all the organs in the torso.

    At least you’re admitting it’s only short-term pain relief. You should treat the problem, not the symptom though. Also, everyone knows that massage therapists recommend exercises that cause more problems in the future, that way they will always have clients. I’ve avoided massage for years and am in extremely good health, which is proof that all massage is worthless.

  14. windriven says:

    @StaphofAsclepius

    Great nom de internet ;-)

    You are wasting your time with FBA. Logic, science and rigorous reasoning are as foreign to him as Beowulf is to yard hen.

  15. goodnightirene says:

    @Jann Bellamy

    Is it worthwhile for non-residents of PA to contact legislators?

    @windriven

    As a native Washingtonian, I’m becoming increasingly embarrassed by my home state. The paradox of the population being well-educated, well-read, and at the same time, so credulous, is deeply disturbing. Although the woo is strong here in the Midwest as well, we aren’t as quick to legally sanction it (I say this not being 100% sure of the status of every brand of woo–acupuncture is licensed, but not naturopathy to my knowledge).

  16. goodnightirene says:

    I am having increasing difficulty accessing this site. It takes forever to load and when it does, it’s (oh-oh, don’t know the word for it) not the right format, not HTML?

  17. qetzal says:

    @FBA,

    Really? You believe massage helps fertility because of an article on Oprah.com?

    You must be related to that girl from the State Farm commercial who thinks her date is a French model because she met him on the internet, saying “They can’t put anything on the internet that isn’t true.”

  18. Linda Rosa says:

    Regarding Visceral Manipulation, a LTE in the NEJM described serious damage done by a Boulder practitioner:

    “Doctor finds liver damage after massage”

    BOSTON, Dec 22 [1999] (Reuters) – Sometimes a deep body massage can be a little too deep.

    A 39-year-old woman was ill for six months after a massage therapist apparently rubbed too hard and damaged her liver, causing a painful accumulation of blood called a hematoma, Dr. James Trotter of the University
    of Colorado Health Sciences Center reported in Thursday’s New England Journal of Medicine.

    Even after the damage was discovered, Trotter’s patient experienced nausea and low-grade fevers that caused her to lose 23 pounds (10.5 kg). Subsequently, she recovered fully….

  19. Linda Rosa says:

    Pennsylvania legislators should be concerned about what I found today on the Facebook site of the Colorado Association of Naturopathic Physicians (CoAND).

    I went there figuring they would be the first to know if Gov. Hickenlooper has signed the bill to regulate Naturopathic Doctors (NDs) in Colorado. (No news on that front.)

    What I found by merest chance was a graduate of Bastyr (listed as practicing in Colorado in violation of the state’s Medical Practice Act) posting this astonishing statement:

    “Hi there, Natural Grocers had a comment on their Facebook page that the final bill said people can’t bring children 2 or under to us…If so, I will just see children for free and say it’s not a part of my practice.”

    Moreover, no one from CoAND advised this ND that under the bill she cannot lawfully “TREAT A CHILD WHO IS LESS THAN TWO YEARS OF AGE” – not that she cannot *charge* for treating a child under two.

    Here we see NDs plotting before the bill is even signed into law how they will ignore the law – and in full view of the public!

    Is this the ethic Bastyr teachs NDs? Alas, this disregard for the law is only too common among NDs. We have seen many examples of NDs in legislative hearings distorting their education and practices, and admitting they break present law (by practicing medicine without a license) and will continue to do so if the bill is not signed into law.

  20. Jann Bellamy says:

    @goodnightirene:

    Yes, I do think it’s valuable for those not living in states where naturopathic legislation is pending to contact the legislators, especially those on a committtee voting on the bill. I have done this, as have others, in opposing “CAM” legislation. And you can be sure the CAM providers are doing it.

    Yes, the SBM site is having some difficulties — our computer wizards are trying to work it out. We hope this will be resolved soon. Hang in there with us!

    @goodnightirene and windriven:

    I don’t think the fact that CAM providers are already licensed in your state means that you can’t do something. Call your legislators and ask to talk to them about your concerns that CAM providers are (at best) ripping people off and (at worst) harming them. Legislatures can pass new laws to restrict, or even take away, the ability of a “CAM profession” to practice. Here in Florida, the state used to license naturopaths but stopped doing so in 1959. Unfortunately, the state was stuck with the ones already licensed and had to keep regulating them and letting them practice for the next 50 years — which is another reason states shouldn’t license them in the first place.

  21. windriven says:

    @Jann Bellamy

    “Call your legislators…”

    I have. There are a couple with whom I am close. Bottom line is that there is a vocal constituency supporting naturopaths and not enough of a constituency fighting it. My legislators have the attitude that people want naturopathy here and it is better to regulate them than not. I’m pretty sure that I could pressure a particular state senator to introduce a bill but there’s a better chance that Th1Th2 will become president of the AMA than that bill would have of getting out of committee.

    I don’t know the details of how FL managed to repeal licensure but I’ll make it my business to try to find out. Meanwhile I have little confidence that the infiltration of woo into mainstream health care delivery will abate. If I were a lobbyist I’d much rather have Big Naturopathy as my client than Big EBM. Holistic, tender, aromatherapeutic, patient-centered care is a lot easier to sell to a non-technical audience than evidence with scary words and p <0.05.

    I think I need a drink :-((

  22. goodnightirene says:

    @JannBellamy

    The site seems much better–oh, those wizards! Maybe they can do something for my aching back? (digging all that manure into the raised beds–ouch).

    Okay, I will go to the webpage and find out who to contact. Is email sufficient? I’m okay with snail mail if it’s more effective.

    For what it’s worth, I don’t think it’s possible to turn the clock back in Washington. The population is about 60% non-native, and a huge chunk of those moved there specifically to join the woo-society. At least two of the towns I used to live in are considered to be New Age “vortexes”–I was never clear exactly what that means, but it draws the faithful like rabbits to my Swiss Chard (got the fence up today too!).

    The thing is that all those people who quit going to church didn’t quit “believing”, they simply “converted” to Wootheism.

    @windriven

    “Holistic, tender, aromatherapeutic, patient-centered care is a lot easier to sell to a non-technical audience than evidence with scary words and p <0.05."

    And there you have it. I raise my glass to yours!

  23. windriven says:

    @irene

    Wootheists! I love it!

    “I raise my glass to yours!”

    And I’ll be drinking a very nice Cotes du Rhone* in about 3 more hours. I’ll raise my glass to you for introducing me to one more ‘theism’ that I don’t believe in :-)

    *I don’t know how often you get down to Oly but Patrick at Olympic Wine Merchant does a fabulous job. Local guy owns and operates and has tasted most of the bottles he sells.

  24. Chris says:

    windriven, do you remember Kent Pullen. He was a very conservative King County council member who pushed the county into supporting naturopathic medicine.

    He died when he was sixty years old. No one has ever said from what (minor adrenal gland problem), but I suspect that his faith in alternative medicine had a part. From the above obit:

    Pullen, who earned a doctorate in chemistry from the University of Washington in 1967, was a longtime supporter of alternative medicine and said in March he was receiving both traditional and nontraditional care. He said he “utilizes the best of both worlds.”

  25. windriven says:

    @Chris

    That happened not long after I first moved here. I remember hearing about it but I really didn’t have any context about the guy so it didn’t make much of an impression.

    It is interesting that his doctorate was in chemistry – from UW no less – yet he swallowed the whole woo thing. Scientists who embrace clearly non-scientific beliefs leave me with an aching case of cognitive dissonance. I truly would like to understand how a person can embrace two mutually exclusive philosophies without their head exploding.

    Totally off the subject but I highly recommend Dan Dennett’s new book Intuition Pumps.

  26. Chris says:

    windriven, I have noticed many with advanced science degrees have swallowed the woo stuff. I believe this blog has a few articles on the subject, or at least a couple of the authors on their own blogs. Like this on on Nobel Disease.

    Since Mr. Pullen worked for Boeing in an engineering/science capacity I suspect that his degree was in inorganic chemistry, and he had about as good a grasp at biology and medicine as Viera Scheibner (Phd in micropaleontology).

  27. Chris says:

    windriven:

    And I’ll be drinking a very nice Cotes du Rhone* in about 3 more hours.

    For once in May I noticed the sweet woodruff blooming while I have some riesling in the house. So I made one glass of May Wine, which I just poured. Hmmm… I don’t know. It is a bit odd, though not unpleasant. I don’t think I’ll try it again. The plant is doing what it needs to do: be pretty in a shady spot.

  28. elburto says:

    @Windriven – That is a depressing statement from your representatives.

    Argumentum ad populum isn’t a great way to decide policy. I mean, a lot of people want meth, crack, heroin, and other substances, some people want to burgle houses, and nobody would say “Well they want it, so we might as well legalise and regulate it”.

    Then, you get wooligans wanting to play doctor despite having no medical training, and all of a sudden “But they really, really want to take their male-believe doctoring out into the real world, to real patients” is a valid reason to grant them their infantile wishes? Wow.

    If that was happening here I’d need more than a stiff drink to help me. I admire your restraint.

    @StaphofAsclepius. – Logic and FBA are sworn enemies. Trying to reason with him is like trying to teach cats to speak Greek. It’s fun for a while, but totally pointless.

    Perhaps someone could naturopathically massage his brain out of wherever it’s currently stuck, and pop it back into his cranium, before it’s too late.

  29. Jan Willem Nienhuys says:

    Are you not a bit too harsh on “intrinsic self-healing processes” (ISHPs). This phrase is based on the observation that it often happens that if you are sick, you get better all by yourself. A superficial wound will heal. In some cases healing is a bit better and quicker if you treat it. Surgical treatment of wounds and fractures can certainly be classified as support and stimulate ISHPs. Staying in bed when you have a fever likewise. Giving antibiotics is a mighty support when the immune system is having trouble coping with a bacterial infection.

    The pretense of these naturopaths is that what they do is of any use for the many ISHPs in our body. Other practitioners make similar claims, saying that they ‘stimulate the immune system’.
    Mark Crislip has deconstructed this type of claim on SBM here: http://www.sciencebasedmedicine.org/index.php/boost-your-immune-system/

    So the proper translation of ‘support and stimulate the ISHPs’ is ‘when you get better naturally all by yourself, this will happen too under the care of a so-called naturopath’.

    Of course thet doens’t mean it is true, because no one has properly established that natural healing of anything is any quicker when the patient visits a soi-disant naturopath, and certainly not when compared to visits to properly trained MDs.

  30. medicalrevolt says:

    Let me begin by mentioning I am an Internal Medicine physician and am married to a Naturopathic Physician. I want to comment on a few misunderstandings in this article. First is the general premise. When they speak of organ repositioning they are not talking about putting your liver in your pelvis and your kidney in your chest. They are mostly talking about spinal manipulation like chiropractors do. But they also want it to include things such as relocating a shoulder, reducing a hernia and so on. Secondly as mentioning above the intrinsic self healing process is very real. Is it caused by some guiding unseen force? I don’t know. Who cares? what I do know is that we as physicians rely on it every day. It is why people heal after we cut them open for surgery, it is the real reason people get better from infections (antibiotics only help), it is the reason that cancer does not kill us all in childhood because our body is constantly killing off cancerous cells before they can become a problem, it is why bones heal together if you just do nothing more than make sure they are in the right position. Most of what we do in medicine is merely helping the body’s intrinsic healing process along. Lastly, your stance that naturopathic medical training in insufficient to practice primary care is wrong. My wife’s training has prepared her MUCH better for primary care than mine. Most of what we in internal medicine call preventative medicine is nothing of the sort. It is early detection of disease after it has already occurred. My wife practices true primary care by addressing diet, exercise, stress relief, and catching nutritional deficits before they become a problem. A very small percentage of internal medicine and even family medicine training these days is spent in the outpatient setting. Almost all of it is spent in the hospital. As for homeopathy and some other practices of natural medicine doctors, well I do have my issues with them as well and question their effectiveness. But they are harmless which I can’t say for much of what we do.

  31. ConspicuousCarl says:

    When they speak of organ repositioning they are not talking about putting your liver in your pelvis and your kidney in your chest. They are mostly talking about spinal manipulation like chiropractors do.

    Do you really think that comparing it to chiropractic makes it sound less stupid? You are basically saying, “it may sound ridiculous and dangerous, but it isn’t because they don’t actually do it.” Whatever.

  32. WilliamLawrenceUtridge says:

    When they speak of organ repositioning they are not talking about putting your liver in your pelvis and your kidney in your chest. They are mostly talking about spinal manipulation like chiropractors do. But they also want it to include things such as relocating a shoulder, reducing a hernia and so on.

    So they’re either doing something that has zero to do with organs (chiropractic manipulation) or it’s something that has nothing to do with organs and something they aren’t qualified for. Terrifying.

    Secondly as mentioning above the intrinsic self healing process is very real. Is it caused by some guiding unseen force? I don’t know. Who cares? what I do know is that we as physicians rely on it every day. It is why people heal after we cut them open for surgery, it is the real reason people get better from infections (antibiotics only help), it is the reason that cancer does not kill us all in childhood because our body is constantly killing off cancerous cells before they can become a problem, it is why bones heal together if you just do nothing more than make sure they are in the right position. Most of what we do in medicine is merely helping the body’s intrinsic healing process along.

    Yes, exactly. So why do naturopaths natter on as if they were doing anything unique then?

    My wife’s training has prepared her MUCH better for primary care than mine. Most of what we in internal medicine call preventative medicine is nothing of the sort. It is early detection of disease after it has already occurred. My wife practices true primary care by addressing diet, exercise, stress relief, and catching nutritional deficits before they become a problem.

    Jebus, where did you go to medical school? You didn’t learn anything about scurvy, rickets or beriberi? You don’t recommend all your patients eat an adequate diet high in fruits, vegetables, whole grains and lean protein? You don’t recommend regular exercise? You don’t recommend weight loss to obese patients? It sounds like you might be the incompetent one then.

    It also sounds like your wife is completely redundant to a dietician, or even a personal trainer.

    And when do you see nutritional deficits beyond iron deficiencies and perhaps B-vitamins? Naturopaths like to pretend people are borderline deficient all the time, but the RDIs are set quite high and meeting them is more than enough, for the majority of the population, to ensure good health. Particularly if you’re eating a diet high in fruits, vegetables and whole grains, like all well-trained doctors recommend.

    As for homeopathy and some other practices of natural medicine doctors, well I do have my issues with them as well and question their effectiveness. But they are harmless which I can’t say for much of what we do.

    The practice of CAM is inherently unethical. Their practices are either unproven, or disproven, or redundant to conventional care. Unproven practices might be effective, but real doctors must avoid these practices lest they be harmful but the harms are not yet known (many of the CAM promoters are keen to adopt rat studies as if they applied immediately to humans, pretending they were practicing the cutting edge of medicine; may I point out that this sort of practice would lead them to prescribing thalidomide). Further, if they are effective and safe, by promoting them without evidence they are slowing down the acceptance of the intervention because conventional care is reluctant to test quackery because of guilt by association.

    Disproven practices should be discarded, but naturopaths and CAM promoters never discard anything because they aren’t evidence based. They are practicing deceptive fake medicine, essentially charging their patients to lie to them and administer placebos.

    Practices redundant to conventional care are obviously redundant. Given the fees charged by CAM promoters for recommendations already mainstream, this is again unethical since you can get the information for free off the internet.

    So even if your wife is a “good” naturopath and follows the science, she’s essentially practicing medicine without a license and without most of the armature of real, effective medicine.

  33. windriven says:

    “As for homeopathy and some other practices of natural medicine doctors, well I do have my issues with them as well and question their effectiveness. But they are harmless which I can’t say for much of what we do.”

    Why? Do you find chiropractic to be scientifically based and homeopathy not? Do your wife’s patients get to pick and choose which forms of quackery they get? How do they decide?

    As to your assertion that quackery does no harm, that has been covered encyclopedically in these pages and thoroughly debunked. Just the naturopathic aversion to vaccination should be enough to judge naturopaths to be dangerous fools of the most extreme sort.

    Yours is one of the most disturbing comments I’ve ever encountered on SBM – a trained physician arguing in favor of allowing charlatans to engage in patient care. If you have issues with your preparation as an internist you should address that with your medical school.

  34. Jann Bellamy says:

    @medicalrevolt

    “the intrinsic self healing process is very real. Is it caused by some guiding unseen force? I don’t know.”

    What we do know is that there is no evidence that an “unseen force” is guiding the intrinsic self healing process and until we do have such evidence, it is best not to practice medicine (naturopathic or otherwise) as if there were such a force. But, assuming, for the purpose of argument, there is such a force, why do you assume that anything a naturopath does affects this force? Maybe the force acts on its own, oblivious to human interventions.

    What we also know is that the body’s intrinsic self healing process is governed by certain physiological phenomena, grounded in science, and if we understand these processes we can design interventions to, as you put it, “help the body’s intrinsic process along.” And that is the difference between naturopathy and science-based medicine. Naturopaths assume a self healing process based on an unseen force (e.g., vitalism) and presume, without any evidence that this force exists, to treat the body as if they could influence this force. Further, they do this without any evidence that their supposed influence on the force is effective. Medicine discovers, via the scientific method, how the intrinsic process works, and designs interventions to aid this process, and then tests these interventions to see if they actually work.

  35. @medicalrevolt

    We need more doctors like you who understand the benefits of minimum-harm treatments, non-surgical intervention and preventative care. Pharma lobby has fought hard for years to minimize preventative care training in medschool curriculum. Harms pharmaceutical product sales revenues.

    “Organ repositioning” is badly named, I dont like to use that term. It does sound silly, as if you are trying to move the kidney to the chest or something. It confuses non-medical people (Jann Bellamy is a lawyer). I prefer the term therapeutic massage, it reflects more accurately what we do.

    PS: Dont bother arguing with windriven and carl, they’ve been thorougly indoctrinated, you’ll have better success telling the Pope that God doesnt exist. Beyond hopeless.

  36. windriven says:

    “Dont bother arguing with windriven and carl, they’ve been thorougly indoctrinated, you’ll have better success telling the Pope that God doesnt exist. Beyond hopeless.”

    @ConspicuousCarl

    I’m honored to be in your company!

    @FBA

    I think it was LaPlace who said ,”I have no need for that (god) theory.” More good company :-)

  37. WilliamLawrenceUtridge says:

    The difference between the pope and doctors, between God and medicine, is empirical proof. Also the difference between CAM and real medicine.

    Despite the apparently pernicious and vile influence of Big Pharma on med school training, somehow it got out that regular exercise and a diet high in fruits, vegetables and lean proteins are good for you.

  38. norrisL says:

    What the? Repositioning organs. A whole new level of insanity

    What is it with people like naturoquacks, do they have a “need” to be important (impotent?), a need to se their amazing skills to save people. Why didn’t they just go and study medicine? Well, I think we all know why that is. If these twits want to practice their imaginary skills, let them do it on themselves.

    1. germano says:

      Will someone please inform these ‘quacks’ that nobody’s repositioning organs; it’s called visceral manipulation/mobilization, and it’s a scientifically prove technique to mobilize the fascial envelopes and ligamentous attachments of organs. (http://www.squamishintegratedhealth.com/wp-content/uploads/Bove_Chapelle_11_Adhesions.pdf) Ask any surgeon about the affects of abdominal adhesions and functional ileus post surgery. Dr. Bove, who is published in the most respected of journals, just received a large research grant from the NIH (and not under CAM), to continue this research. As one who uses this technique everyday in my clinic, I can assure it works. And by the way -thank you all for being so closed minded- it keeps my practice full of all the people who get no help with their HEALTH from allopathic medicine. (nothing like that 7 mins with one’s doctor to really learn about one’s health!)

    2. germano says:

      “…that an estimated 44,000 to 98,000 among them die each year as a result of medical errors.” http://jama.jamanetwork.com/article.aspx?articleid=192908
      Wow, I’m writing my State rep. right now to do something about these ‘sciencey’ MDs.

  39. rdscptic says:

    I believe there is a hint of evidence some of these people have been able to reposition organs.

    Say, for example, their own larynx approx. 2-3 feet lower and to a more posterior position?

  40. ConspicuousCarl says:

    @windriven:

    Same here, though I worry that the pope doesn’t fit in with our cabal.

  41. idoubtit says:

    Bad news: http://idoubtit.wordpress.com/2013/06/04/pa-house-bill-612-on-licensing-naturopaths-opposition-fail/ I wish we’d had more time with this. But I wonder if it would have helped.

  42. @Sharon

    It would pass anyway. The arguments against integrative medicine are too weak.
    Dont worry, nobody will be coming after you with a syringe full of vitamins, you can still go to your MD.

  43. windriven says:

    @idoubtit

    I wonder if Mustio would vote in favor of alchemists running the PA Dept. of Environmental Protection or if he’d fly in an aircraft designed by people who had an ‘alternative’ hypothesis of flight?

    You asked: “Why did physician groups not object to this? Was there not enough/no counterview?”

    I have no idea why physicians’ groups didn’t lobby against this. Perhaps they feel they need to be warm and fuzzy and integrative and politically correct. Perhaps they’re too arrogant to see naturopaths as a threat. Perhaps they didn’t see it coming – though that one is hard to believe. I suspect the truth is that there are enough physicians who buy into woo that it is difficult for professional groups to mount an effective counteroffensive.* How’s that for bleak?

    As to your second question, this is exactly what I have found in WA. The quacks have put together a formidable lobbying effort while the opposition is loosely organized. The legislators I’ve spoken with have the attitude that it might be quackery but there is consumer demand for it so it is better to regulate them than to let it operate in gray areas.

    *I think it was Harriet Hall who blogged several months back about the rejection of EBM principles by a significant fraction of practicing physicians. I remember wanting to open an artery after reading it.

  44. coming99 says:

    OK my fellow educated people. Guess what? We live in the US. Therefore, the citizens have and deserve the right to choose their own healthcare modalities–even the the ones that are not backed by pharmaceutical industry money such as Naturopaths.

    The medical industry is run by science based medicine but the nation’s health in the toilet. Give Naturopaths the chalk to see if they can do any better before you nail them to the stake.

  45. Jann Bellamy says:

    @idoubtit “Bad news”

    House Bill 612, as amended, did get voted out of Mustio’s committee. It is now in the House Rules Committee and no hearings are currently scheduled there. I am not sure how many more committees it must go through in the House, but then it must go to the full house for a vote, and after that to the Senate and whatever committees it will be assigned to there, and then the full Senate for a vote. So, there is a ways to go and you certainly still have time to oppose the bill.

    There a few amendments of note. The naturopaths would be under the medical board, not their own board. They would still have to graduate from a naturopathic “medical program,” but the program’s being accredited by the naturopath- run accrediting agency would no longer automatically make the program’s graduates eligible for licensure. The program would have to be approved by the medical board. Not that I want this bill to pass, but I read this provision as creating a wonderful opportunity for the medical board to investigate these ND schools and see what is really going on.

    The provision allowing their ordering diagnostic imaging is no longer in the bill. But they can still order lab work and therefore order such tests as “hair mineral analysis, ” a prelude to the administration of their quack “detoxification” therapies.

    The provision preventing their using real drugs seems to have been tightened up a bit.

    An ND would not (as provided in the original bill) have to get two letters from physicians (MDs, DOs) stating they would be willing to be available for consultation to the ND and agree to accept referrals. I imagine the MDs and DOs want nothing to do with that.

    As far as the Pennsylvania medical society goes, I can’t tell what their position is now. While before these amendments were made they opposed the bill, nothing on the website has changed so I don’t know whether they will oppose the amended bill or not. The amendments, whether they oppose the bill or not, are obviously designed to appease them.

    “Organ repositioning” is still in.

  46. WilliamLawrenceUtridge says:

    @coming99

    So you believe that the pharmaceutical industry should be criticized – but not naturopathy? You think that naturopaths are unaffected by financial incentives? Why are naturopaths immune to the lure of money even though real doctors, with orders of magnitude more training and experience, are not? You think that naturopaths don’t have lobbyists?

    Why should the methods of naturopathy not have to prove they are effective? Do you think they are effective? If so, wouldn’t it be relatively easy to demonstrate this in well-controlled tests?

    You think that organs can be repositioned?

    Also, I don’t live in the US. I’m Canadian, and I have a provincial health care service which fortunately doesn’t reimburse for visits to naturopaths or chiropractors. The nice thing about centralized reimbursements is that you can control costs in part by deciding which interventions are evidence-based, and which aren’t – and further, which are worth the money.

    Most of the methods of naturopathy predate the era of scientific medicine, in many cases they predate the existence of the germ theory of disease. We’ve had many of modalities for centuries. Why do you think longevity rates were as low as they were until the advent of the germ theory of disease, the cell theory of biology and discarding of the theory of vitalism?

    1. Anthony says:

      A basic tenant of healthcare is the patient’s right to choose. That’s what it comes down to. The politicians and the establishment is not here to judge but to give the constituency the right to choose.

      1. WilliamLawrenceUtridge says:

        You might have a point if naturopaths provided health care. They don’t. They charge for advice you can get for free off of the USDA, CDC or WHO’s website, or they charge for services and products which have no proof of working. Your comment is akin to defending the right to choose to invest in Bernie Madoff, or a company producing perpetual motion machines. The right to choose should be an informed one, backed by factual information. Lacking that information, you have no idea what you’re buying. Would you prefer to buy your food in a sealed box marked “groceries” from someone who never tells you what’s in it, and sometimes substitutes melamine for flour?

        1. Anthony says:

          I wonder what you think of MDs who are certified in functional medicine?
          http://www.gwcim.com/
          The run-of-the-mill science based MD/DO practice seems to be like the cop who shoots first (prescription drugs or surgery) and asks questions later (multiple follow-ups usu to adjust or prescribe more drugs or surgery). The ND is more like a detective who takes the time to get the details about the case before making an arrest. Go figure that Euro countries have better healthcare while at the same time they are also more accepting of naturopathy and homeopathy.

          back to n=1, my personal experience: I took my wife to top MDs (Penn physicians) 2 out of 3 prescribed SSRIs and sent us out of the door. Now the ND actually listened and prescribed more labs (blood and stool) and the diet and supplements have helped enormously also thanks to Weston A. Price guidelines.

          By the way, check out the clinic’s website and notice how MDs are the bosses and they hire the “non-science based” professions to work for them. I implore everyone to reach out the functional medicine MDs and find out what they know. http://www.gwcim.com/

      2. weing says:

        “A basic tenant of healthcare is the patient’s right to choose.”

        Assuming you mean tenet and not tenant, yes it is. If competent, patients have the right to choose whether to take the medication, have the surgery, etc. They make informed decisions about real options and not some fantasies. There is no right to defraud people, especially with my money.

  47. idoubtit says:

    @Jann Bellamy: Well that does not sound as smooth sailing as Mustio made it out to be. I will take a look at the amended version and get the word out.

    Thanks.

  48. The bill passes with overwhelming support 23 votes for, 1 against. I suppose 100% support is too much to ask for but 95% is sufficient.

    Thats right, naturopath haters. You are the 5%.

  49. It’s only a professional licensure committee vote so far, looks like I got excited too early. The house vote is still coming.

  50. WilliamLawrenceUtridge says:

    Among politicians. Look up argumentum ad populum.

  51. Dan says:

    I’m so disappointed that my rep is signed up as one of the co-sponsors :( I just sent him a message and I’m hoping it’s not too late to stop this madness…

  52. WilliamLawrenceUtridge says:

    @Anthony

    SBM has an article on functional medicine. Actually, it has two. The MDs here probably think it’s a certification in nonsense.

    You may think that about doctors, but that doesn’t mean it’s true. A doctor who doesn’t prescribe smoking cessation, high-quality diet and exercise in general is probably guilty of malpractice at that point. Pretending diet and exercise are “alternative” treatments is a great way for a naturopath to justify their practice – it’s just deceptive.

    European countries probably do better because they have publicly-funded health care systems, which have tremendous advantages in terms of economics and health. The US lacks such a system, though Obama is trying to set up a variant.

    I don’t really know much about the Weston Price foundation but it’s certainly not giving mainstream dietary advice. Dr. Hall linked to this webpage in a previous post.

  53. WilliamLawrenceUtridge says:

    Will someone please inform these ‘quacks’ that nobody’s repositioning organs; it’s called visceral manipulation/mobilization, and it’s a scientifically prove technique to mobilize the fascial envelopes and ligamentous attachments of organs…Ask any surgeon about the affects of abdominal adhesions and functional ileus post surgery. Dr. Bove, who is published in the most respected of journals, just received a large research grant from the NIH (and not under CAM), to continue this research.

    Hello germano. Honestly, by defending this statement by reference to PMID 22196431, which you link to, you aren’t helping things. That is a preliminary study in rats. You probably realize this, but people aren’t rats. Regarding medical knowledge, rat studies are seen as among the very first steps in a body of research, for many reasons. They are cheaper than people, there are fewer ethical concerns, you can cut them up, and they age much more rapidly. Thus they are useful in what we would call “hypothesis-generating” studies for humans, which try to spin-out and test new ideas. If the rat studies are promising, they might move on to a second animal model that more appropriately matches with humans on the relevant measure. To view a rat study as conclusive is really an error in reasoning, unless one’s goal is to improve the health of rats. Thus, the article you link to is at best a starting point for future studies, particularly when discussing humans. For instance, a search on pubmed for “visceral manipulation” and “visceral mobilization” turns up only 9 and 3 hits respectively, and the most relevant one seems to be the publication of a study protocol to examine whether visceral manipulation would help as an adjuvant to physiotherapy, for back pain (there are also some case studies and rat work, which again are far from proof, and some studies involving visceral manipulation via surgery which do not apply). In other words, in terms of a research basis, visceral manipulation has many claims but essentially no proof and is only at the very earliest stages of investigation. Further, if you look at the actual proposed law, it does not specify this being a post-surgical technique for adhesions. It, in fact, places no limits on it whatsoever and doesn’t mention the word “adhesion” at all. Dr. Bove seems to be doing the correct thing by starting in rats and moving from there, which raises the question – why is anyone doing this in people (except for the fact that they can make money off of it)? How do you know this helps, how do you know it doesn’t make things worse? When can you start performing such manipulations, and is it limited solely to post-surgical interventions?

    As one who uses this technique everyday in my clinic, I can assure it works.

    Don’t you consider this somewhat unethical? How do you know you are really helping people? How do you know they wouldn’t merely get better on their own? How do you know you aren’t making things worse and delaying healing? A reminder that jumping from rat studies to human interventions would permit the prescription of thalidomide, which is harmless in rats. Do you support the prescription of thalidomide? Another reminder that the people who used bloodletting as a medical intervention would also assure us that this technique, used every day in their clinics, works. Personal experience is not sufficient, as it is often an inaccurate assessment of results – humans are simply not very good at admitting they were wrong, but are excellent at remembering positive outcomes and forgetting negative ones.

    And by the way -thank you all for being so closed minded- it keeps my practice full of all the people who get no help with their HEALTH from allopathic medicine. (nothing like that 7 mins with one’s doctor to really learn about one’s health!)

    Why is it “closed-minded” to ask for proof before charging someone money for an intervention you can’t be sure will work? That seems to hold to a rather high ethical standard, certainly higher than someone willing to charge for unproven techniques that may in fact make things worse. It is open-minded to admit that there is the possibility a particular technique might work but to suggest testing. It seems rather closed-minded to insist a technique works without recognizing the limitations of the evidence. I really hope you are not worsening the adhesions you are attempting to heal, or inadvertently causing hernias. Perhaps you should use an objective scoring criteria to assess whether patients improve, and keep careful records of which patients experience adverse outcomes, submitting the case series to a peer-reviewed journal. From there a proper clinical trial could be proposed.
    Incidentally, the first time I saw my current doctor, it was for a full, hour-long history and baseline health assessment. Not seven minutes. In cases where I have had simple, single-issue medical complaints, they have been as short as seven minutes, which I regard as efficient.
    Also, regarding this:

    “…that an estimated 44,000 to 98,000 among them die each year as a result of medical errors.” http://jama.jamanetwork.com/article.aspx?articleid=192908
    Wow, I’m writing my State rep. right now to do something about these ‘sciencey’ MDs.

    Yes, real medicine must work hard to reduce medical errors, that is why articles such as the one you linked to are important. They form part of the self-reflective practice of medicine that allows it to reduce errors and improve recovery rates – the slow, creeping, incremental improvement of medicine that has improved longevity and reduced complications over the past century.
    Of course, the fact that medicine has these errors says absolutely nothing about whether organ repositioning works. It’s not like we have to choose between medical errors and organ repositioning, even if medicine were completely unscientific it would still require independent proof to show that organ repositioning did anything.

  54. WilliamLawrenceUtridge says:

    Oh wait… no… that’s not right… I meant biochemistry, anatomy, physiology, embryology, physiotherapy, gross human anatomy, neurology, counseling psychology, physical examination, histology, pathology, immunology, pharmacology, lab diagnostics, orthopedics, cardiology, nephrology, pediatrics, and minor surgery.

    So if you learn about all that, why does your curriculum include homeopathy? Why does it include acupuncture? Why does it include herbal medicine when most of them are untested, and if tested they often don’t work? Why incorporate vitamin dosages beyond those needed to maintain normal health, why extend into megadoses and why in supplement form rather than from food? Why the emphasis on vitalism, which was discredited several centuries ago? If you are so close to doctors, how are you different? Why not just become a doctor? Or a nutritionist?

    Gosh that’s a lot of schooling in science just to sell snake oil.

    I heartily agree with that.

    Although, we also do study herbs for botanical medicine and make medicine from them… so… I guess we do perform magic and make potions.

    Why not study pharmacognosy, so the active molecules in the plants can be purified, standardized, synthesized and improved upon for human consumption? Why persist in using what is essentially a dirty drug of unknown strength and often poorly-understood pharmacokinetics? Why are naturopaths so strongly associated with an opposition to vaccination? Why do naturopaths not simply follow the science, which again would make you redundant to real doctors? If you aren’t following the science, then aren’t you just charging people money for unproven treatments? Why do naturopaths spend so much time attacking physicians and the mainstream medical system rather than proving their techniques work? In which case, the mainstream medical system can simply adopt them, again demonstrating that you are appear to be redundant to them in every way except the willingness to promote unproven interventions.

    I’m not questioning your desire to help people or do good, I’m just curious why you think you offer anything that conventional medicine can’t. What does naturopathy bring to medicine that doctors don’t? And if you talk about the amount of time you can spend with a client, I will point out two things:
    - your clients are often paying out-of-pocket for these services, you just happen to be cheaper than real doctors
    - this is a structural problem rectified by training more doctors rather than endorsing a “medical” system based on a logical fallacy (i.e. nature wants you to be healthy)

  55. WilliamLawrenceUtridge says:

    @Anthony

    Taking my wife to gwcim.com on Wed for a follow-up appt and the day after I’m going to drandrewlipton.com for an initial appt.

    Why go to a naturopath instead of an actual physician?
    Are you concerned by the fact that one of the images on the front page for that clinic shows a person giving acupuncture without wearing gloves? The needles may be sterile, but hands are not. Even in cases where hands are washed or an alcohol scrub is used, bacteria still exist underneath the fingernails, and easily spread to the rest of the hand.
    Are you concerned by the fact that GWCIM was a participant in the TACT trial? Particularly given the positive, shining endorsement given in Dr. Kogan’s summary is at odds with the actual study results which concluded “These results provide evidence to guide further research but are not sufficient to support the routine use of chelation therapy for treatment of patients who have had an MI”? And particularly given the many criticisms ventured of the study?

    you forgot to mention that ND school also has the same pre-reqs and MD/DO/DMD/PharmD school.

    Sure, but those prerequisites are then abandoned during the schooling proper. None of those prerequisites support vitalism, the belief in an “essential energy” found in life (but not found in any research on life). Despite this fact, there are numerous treatment modalities that are predicated on vitalism – homeopathy is one, acupuncture and TCM are another (qi), and ayurvedic medicine is a third (prana). One simply can’t believe in the precepts of organic chemistry, which is based on evidence and centuries of successful empirical research demonstrating that living and nonliving things are made of various combinations of the same fundamental particles, and vitalism, which is based on the assumption that there is a fundamental difference between living and nonliving things. Pharmacology is based on understanding the pharmacokinetics and pharmacodynamics of molecules moving through the body, whereas most of the herbs used have not been studied for these properties, making their safety and efficacy unknown, or have been investigated and for the most part found to be ineffective or toxic. There are rare exceptions (willow bark, since improved to aspirin, and St. John’s Wort, whose side effects are now recognized as they were not in the past) but mostly herb are treated as panaceas rather than unproven drugs of uncertain potency and unknown doses.

    The prerequisites of medical school give you the basics to understand the fundamental point of medicine – we are systems of tissues combined into organs that work along the lines of basic laws. The systems are mutually-reinforcing and this point is further emphasized during med school and practice. In contrast, the systems taught in naturopathic college are mutually-contradictory, with no way to determine the true from the false. If your TCM diagnosis is running piglets but your ayurvedic diagnosis is “aggravation of vata dosha”, how do you decide which is correct?

    Are you concerned that Dr. Lipton offers breast thermography despite it having an underwhelming ability to detect tumors?

    1. Anthony says:

      Oh, I have a concern. Patient and personal feedback and experience can sometimes trump science-based medicine. Going to the holistic clinics feels like taking my favorite car to the factory certified technician as opposed to most doc offices which feel like jiffy-lube. Our cars/bodies do come out feeling and performing better than when they went in.

      1. Harriet Hall says:

        @Anthony,
        “Going to the holistic clinics feels like taking my favorite car to the factory certified technician”

        That may be what it “feels” like, but what it really “is” like is like taking your car to an auto detailer for cosmetic improvements when you have an engine problem.

        1. Anthony says:

          I agree there’s an engine problem but the MDs tossing SSRIs in the tank to make us “feel” better just isn’t going to cut it. Scratch the word medicine out of the title and rename it Science-based disease management for more accuracy.

          1. Harriet Hall says:

            @Anthony,
            So making us “feel” better is OK when holistic clinics do it without evidence but is not OK when MDs do it with evidence-based treatments?
            Admittedly, we don’t know what causes depression, but we do know that antidepressants are effective for severe depression. Do you think holistic clinics know the cause? Do you think their outcomes for depression are any better? Are there fewer suicides in depressed people who were treated holistically? References, please. MDs don’t just treat symptoms; we treat the cause whenever possible. We do know that bacteria cause pneumonia: we don’t just treat the patient’s symptoms of fever and pain, we treat it with antibiotics.

            1. Anthony says:

              If you passed org chem you have my respect no matter what letters are behind your name. Also, our pre-pharma predecessors did have remedies that worked for various ailments but it seems when drugs came around we threw the baby out with the bathwater. It seems like the NDs are just trying to bring some of the baby back to complement science-based medicine.

              1. Harriet Hall says:

                @Anthony,
                “it seems when drugs came around we threw the baby out with the bathwater”
                Apparently you are misinformed about the history of pharmacology. Drugs didn’t “come around;” they were already there. And no baby was thrown out. The science of pharmacology evaluated the remedies that our predecessors had been using and found some that worked. A prime example is foxglove. The active ingredient was extracted, refined, and synthesized to improve safety and dosage control, leading to the pharmaceutical drug Digoxin. Pharmaceutical companies are constantly examining plants for sources of new drugs. The NDs are trying to bring back pre-scientific herbalism. They rely on what you call “patient and personal feedback and experience,” things that we long ago recognized were not reliable and that can NEVER “trump science-based medicine.” The plural of anecdote is not data, and as Mark Crislip has said, “In my experience” are the 3 most dangerous words in medicine.

          2. WilliamLawrenceUtridge says:

            If herbs are so safe and effective, wouldn’t it be relatively trivial to demonstrate this in well-designed trials? And aren’t you concerned these herbs might have adverse effects, like we found with St. John’s Wort, or kava kava, or willow bark (stomach bleeding, it’s why we have aspirin, which is easier on the stomach).

            If pre-pharma herbs were so effective, why did life expectancy increase so dramatically with the advent of pharmaceuticals?

            Pointing to herbs as alternatives to drugs seems just wrong to me. They are more precursors, early attempts at actual drugs that were imperfect in many ways – simply ineffective, poorly-adapted to their tasks (since none evolved to meet human needs), insufficiently concentrated and of uncertain potency that varies with many factors (season, temperature, soil, rain, part of plant, etc). In fact, the drugs we currently have are themselves precursors to future products that will have fewer side effects and better main effects, as we develop a better understanding of the proteome, the genome, and various other individual specifics that are currently to complicated to truly measure in randomized controlled trials.

            And again, if naturopaths are interested in science, why not wait until herbs and other approaches are demonstrated effective before implementing them? If they’re not interested in science, why pretend and attempt to invoke the scientific literature when it suits them, while ignoring it when it doesn’t? Why invoke prescientific medical systems at all?

            And always keep in mind – nature doesn’t care if you live. Smallpox is natural, as is death by cancer, paralysis by polio, bot flies burrowing into your brain, malaria, and death during childbirth. Nature is supremely indifferent to our survival, and when we die, nature and evolution will simply continue in our absence and fill the ecological niche we once occupied with something else (I’m betting on hyperintelligent raccoons).

  56. WilliamLawrenceUtridge says:

    Oh, I have a concern. Patient and personal feedback and experience can sometimes trump science-based medicine. Going to the holistic clinics feels like taking my favorite car to the factory certified technician as opposed to most doc offices which feel like jiffy-lube. Our cars/bodies do come out feeling and performing better than when they went in.

    This actually aligns with my theory of where CAM is useful, or at least perceived as useful by those who pay for it – as a form of emotion-focussed coping for health. Emotion-focussed coping is useful when there’s nothing objective you are willing or able to do about your condition, so you do something to make yourself feel better in the meantime. CAM is the “tub of ice cream when you are sad” approach to medicine.
    However, you are highlighting a structural problem that could be addressed – if doctors were permitted to take adequate amounts of time with more patients, that would address a lot of complaints about the medical system that drives people into the grasping, greedy claws of worthless and parasitic SCAMsters. Hopefully the US adopting some form of health care system will improve things, I know in Canada I never feel rushed when talking to my doctor.
    Your comment does underscore the point that SCAMsters add nothing to actual health care, they just make people feel better about it. At least you admit that you’re allowing a feeling to trump a rational decision.

    I agree there’s an engine problem but the MDs tossing SSRIs in the tank to make us “feel” better just isn’t going to cut it. Scratch the word medicine out of the title and rename it Science-based disease management for more accuracy.

    Do you suffer from major depression? You’re rather casually dismissing the fact that mental illness is a complicated, multi-factorial issue that can’t simply be brushed aside because you think it’s stupid. I know several people who have gone onto and come off of SSRIs. Some are on them permanently, and feel that they materially improve their lives and outlooks and are grateful for their existence. Some felt that they were useful for a transitory period where their suffering was pronounced and intractable.
    Have you ever known a doctor who used SSRIs to treat anything but a mental condition? And do you have a better solution that doctors can bring to the table, as opposed to, say, patients? Or society, which heavily stigmatizes essentially every form of mental illness? SSRIs are an imperfect tool in the treatment of mental illness, but they are still a tool that can be effective. It would be nice if we had a genuinely perfect tool – but we don’t.
    Perhaps you could advocate for greater resources for mental illnesses at a state and federal level, rather than blaming doctors for not being able to “fix” the most complicated structure we are aware of in the universe, the human brain.

Comments are closed.