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Night of the living naturopaths

Colorado’s “degreed” naturopaths (NDs) are nothing if not persistent. Starting in 1994 they have tried seven times to convince legislators that the Colorado’s public needs protection from what “traditional” naturopaths (traditionals) do, and that the best way of providing that protection, they claim, is to bestow licensure on the guys with the college degrees. The irony in this is that the NDs could well be the more dangerous practitioners.

Legislators have been largely sympathetic to the concerns of the more numerous traditionals who fear the loss of their right to work as naturopaths. The NDs have tried neutralize these opponents by reassuring them they could continue to practice naturopathy, but the traditionals don’t buy that. And they won’t easily forfeit the title of “naturopath” to which they believe to have more claim.

So what we have here in Colorado is near 20-year turf war between two types of naturopaths: the NDs who seek legislation to transform naturopathy into a protected guild, and the traditionals who are happy with the status quo. There is no love lost between these groups. Legislators repeatedly advise them to resolve their differences before asking for licensure again, but they haven’t gotten close to détente.

Colorado NDs have made no secret of their economic motivations. Before the 2011 legislative session, the Colorado Association of Naturopathic Doctors (CAND) was reinvigorated by the passage of the Patient Protection and Affordable Care Act which has this “non-discrimination” provision:

(a) Providers- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures. [Sec. 2706]


CAND cited this provision in their Spring 2010 newsletter, adding:

There has never been a more important time for states to realize the positive impact of state licensing laws that dictate a full scope of practice for qualified naturopathic doctors….In short, naturopathic doctors in licensed states will now be a part of major insurance offerings.

With the lure of mandated reimbursements, we can predict NDs not only in Colorado, but around the country, to be making a renewed push for licensure.

What Gets Lost

In all the years that naturopath licensure has been considered, it is maddening that the most fundamental questions are rarely, if ever, considered by Colorado policymakers: What do NDs offer the public that is unique and effective healthcare? Do NDs have a scope of practice and objective standards to inform regulation?

Over the years, the Colorado Department of Regulatory Agencies (DORA) has been responsible for providing legislators with a factual background reports on naturopathy and making recommendations regarding licensure. In their “sunrise” report, there is considerable evidence that DORA puts a heavy thumb on the scales in the favor of the NDs. DORA has dismissed criticism of naturopathy with the assertion that regulation is solely about protecting the public and that regulators have no duty to determine if a profession’s practices are efficacious or validated by science. Alas, many legislators follow DORA’s lead on this.

In the last sunrise review, DORA calls naturopathy a “philosophy” which is “not tied to any particular therapy or modality.” So it’s not surprising that the operational definitions regarding naturopathy in the legislation have been vague to the point of being almost meaningless. Bill language itself has made naturopathy sound so chicken-soup-innocuous that one might think the legislators would question the need to regulate naturopathy at all. Here, from the 2011 bill:

“NATUROPATHIC MEDICINE” MEANS A SYSTEM OF HEALTH CARE PRACTICES FOR THE PREVENTION, DIAGNOSIS, EVALUATION, AND TREATMENT OF INJURIES, DISEASES, AND CONDITIONS OF THE HUMAN BODY THROUGH THE USE OF EDUCATION, NUTRITION, NATURAL MEDICINES AND THERAPIES, AND OTHER MODALITIES THAT ARE DESIGNED TO SUPPORT, STIMULATE, OR SUPPLEMENT THE HUMAN BODY’S OWN NATURAL SELF-HEALING PROCESSES.

“NATUROPATHIC MEDICINE” INCLUDES NATUROPATHIC PHYSICAL MEDICINE, WHICH CONSISTS OF THE THERAPEUTIC USE OF THE PHYSICAL AGENTS OF AIR, WATER, HEAT, COLD, SOUND, LIGHT, TOUCH, AND ELECTROMAGNETIC NONIONIZING RADIATION AND THE PHYSICAL MODALITIES OF ELECTROTHERAPY, DIATHERMY, ULTRAVIOLET LIGHT, ULTRASOUND, HYDROTHERAPY, AND EXERCISE.

In sunrise reviews, DORA devoted only half a page to describing ND practices: a summary of the “remedy” homeopathy and a characterization of “hydrotherapy” as the use of water “in any of its forms” at “various temperatures” for its “revitalizing properties.”

At a legislative hearing in 2011, my testimony was shut down when I started describing a few other ND practices. It apparently was not relevant to deliberations. But with the prospect of facing yet another ND licensing bill this year, I thought it might be useful for legislators to see what Colorado NDs actually practice.

So in Nov/Dec 2011, I surveyed 88 NDs in Colorado advertising their services on the Internet, almost entirely through their business websites. I tallied up the practices they offer in Table 1:

Modality
Count
Pct
Clinical nutrition
73
83%
Herbal/botanical Medicine
73
83%
Homeopathy
71
81%
Supplements
45
51%
Detoxing/fasting
39
43%
Hydrotherapy
30
34%
Food & other allergy testing
27
31%
Lifestyle counseling
27
31%
Mental health counseling*
26
30%
Acupuncture**
24
27%
Traditional Chinese medicine
24
27%
ND manipulation & mobilization
23
26%
Bio-identical hormones
22
25%
Cancer support and/or therapy
20
23%
GYN/infertility services
19
22%
Heavy metal testing
19
22%
Craniosacral therapy
18
20%
IV & IM nutrition
18
20%
Cold & Flu treatment
16
18%
Saliva and/or hair testing
14
16%
Applied kinesiology
12
14%
Functional medicine
12
14%
Qi gong, TT, Reiki, or Energy Medicine
12
14%
Environmental medicine
11
12%
Anti-aging medicine
10
11%
Massage
10
11%
Childbirth/OB
9
10%
Mind-body medicine
9
10%
Weight loss program
9
10%
Candida Treatment
8
9%
Chelation
8
9%
Specialty labs
7
8%
Visceral manipulation
7
8%
Ayurvedic medicine
6
6%
Body work
5
6%
Intuition or insight to diagnose
5
6%
Parasite testing
5
6%
Prolotherapy
5
6%

* None of the NDs who offer mental health services have any type of mental health licensure, even though it’s extremely easy to become a “registered psychotherapist” in Colorado.

** 19 NDs are currently licensed as acupuncturists; an additional five NDs without acupuncture licenses offer acupuncture.

Practices publicly offered by four or fewer NDs are: acupuncture injections (1), aromatherapy (1), Brain Chemistry Balancing (2), colonics (3), colostrum for children (1), Crossinology (1), DAN (4), Drum Circle & Capoeira (1), equine massage (2), minor surgery (1), Orthobionomy (1), Peat Moss Therapy (2), Plant Stem Cell Therapy (3), probiotics (3), sweat lodge for children (1), testosterone replacement (4), trigger point injections (1), and unpasteurized products (2). A few additional practices will be discussed below.

Without valid diagnostic methods, the issue of ND treatments almost becomes a moot question. So it is notable that one-fourth of the NDs reveal that they favor unreliable diagnostic methods, i.e. “specialty labs” (such as Great Smokies), applied kinesiology, NAET, and intuition.

Twenty-eight NDs posted their fees on their websites, so I gather that information, as well in Table 2:

Initial consult
Subsequent visits
Adults
$200
Range: $100-$375
$99
Range: $55-$155
Children
$145
$84

This strikes me as a pretty scary list of diagnostic and treatment practices, and they ain’t cheap. Some are clearly practices to avoid at any price, such as visceral manipulation, IV chelation, and home birth. But in reading the ND websites, I found that even the more innocuous-sounding practices (such as homeopathy and hydrotherapy) – unfettered as they are by any standards – can take on dangerous and sadistic forms. A few examples:

Cowboy homeopathy?

“Snake Bite Kit…$89.00…Crotalus hordius [30C], a homeopath remedy derived from the rattlesnake venom, has shown benefits with doses at 15 minute intervals.

Kids would much rather just get a shot for the flu

Wet Socks Treatment… great for relieving – and even preventing… colds, flu … [The icy socks will be dried by the body's circulating blood… Soak cotton socks in ice cold water (or keep a pair in the freezer)… Also consider wet tee-shirts and underwear when treating the chest and pelvic areas.

You get yourself an infrared heat lamp, put it in a big box, and voila’!

The Life Vessel is…one of the newest technologies in the emerging fields of natural healthcare paradigms in the 21st century….[It] works to eliminate the source of chronic disease…

LactoHerbalism?

Once the child is born and is nursing if any problems arise with the infant I treat the mother. This is an effective and efficient way to treat a nursing child since I can give herbs/nutrients to the mother (that I could not give directly to the infant) which the child will receive through the breast milk.

“Clinical nutrition”? How bad could that be?

The most common practices of Natural Therapy in Cancer Care are: Alternative Medicine – Therapies are used in place of standard medical treatments, for example a special diet to “treat” cancer in lieu of an oncologist’s suggested treatment plan….

Routine IV infusions

If caught at first sign of symptoms, a nutritional IV can be a perfect way to ward off cold and flu… A nutritional IV takes about an hour to infuse, however for a super quick boost for the immune system, a Wellness injection is the perfect solution! …a combination of B12 and specific immune boosting homeopathics…

Many nutrients …are needed in much higher doses then the government recommended dosing schedule (R.D.A) which is only necessary to prevent overt disease, not to maintain health. IV therapy is a safe and fast way to supply the body with adequate levels of minerals and vitamins…

IV hydrogen peroxide? Holy gas embolism!

Using IV route of administration of nutrients allows for maximum concentration of nutrients to reach tissues that need it the most….What are some of the nutrients used? There are a lot of options but the most used are B- vitamins like B1, B2, B3, B5, B6, Vitamin C, Calcium, Magnesium, Hydrogen Peroxide, Glutithione, and many others….Cells now have enough energy to eliminate accumulated toxins. This process may lead to a detoxification reaction, bringing about symptoms of fatigue, nausea, headache and bowel changes.

Good ol’ fear-mongering

26 vaccine doses in the 1st year of life and over 50 doses total before kindergarten!!! That’s a lot… this study in Germany shows a 2-5 Time Increase in Diseases and Disorders in Vaccinated Children over Non-Vaccinated. Make sure you do your homework parents! [sic]

Why cleanse? …Our water supply is contaminated with heavy metals, fluoride, parasites and non-soluble minerals.

They learn this in “college”?

When you are flying, homeopathic remedies should be carried on your person, walking through the metal detector will NOT harm them. Putting them in your luggage or carry-on results in them getting X-rayed and losing their potency. [E] is a general practitioner who enjoys integrating the wisdom of vitalistic medicine with the latest research of modern medicine…

[T]he detoxification process is a great starting place for most…Once food allergies and sensitivities are removed, it is easier to establish what symptoms remain and need to be dealt with.

Homeopathy…[Dr. B] has never heard a really convincing explanation for how this mysterious system of medicine really works. She suspects it is a quantum physics thing, which isn’t her field!

Far-Infrared Sauna… The heat produces an artificial “fever” and urges every organ of the body into action. While outwardly relaxed, your inner organs are as active as though you were jogging or mowing the lawn.

And an offer for you and three of your most toxic friends

It is our pleasure to offer you a free colon hydrotherapy session after three of your friends visit us. Refer three, get one free!

“We’re Physicians…”

Arguably, the most dangerous thing about NDs may be their inflated view of their own abilities, equating themselves with “physicians.” As many Colorado NDs are licensed as naturopathic physicians in another state, they can mention this fact in advertising and possibly circumvent their licensing law’s proscription against using the protected title of “physician.” A similar dodge is possible by mentioning their membership in the American Association of Naturopathic Physicians. They use many other misleading terms in describing their practices:

“family medicine” (12)
“pediatric” (30)
“primary care physician”* (3)
“sports medicine” (9)
“naturopathic obstetrics” (1)
“medical school” (5)
“naturopathic medical school” (6)

Here are representative statements made by Colorado NDs about their qualifications:

Licensed naturopathic physicians have attended a 4-year graduate level program at accredited institutions where they receive the same basic science education as their counterparts in regular medical school. Naturopathic doctors also participate in a clinical program which spans over two years. Naturopath’s are distinctively situated to be primary care doctors due to their intensive training in both western medical sciences and traditional healing forms.

“We’re Physicians…Only Better”

NDs tell legislators that licensure would allow them to work closely with healthcare professionals, but a number of their statements suggest an implacable animosity towards the medical profession:

[W]hen it comes to chronic care, conventional healthcare is far from superior and often does not have the tools needed to truly get people healthy.

The current, mainstream model of medicine ignores the real causes of disease and illness…Chances are, the answer to your health problems is NOT another prescription.

I utilize traditional and functional lab tests as part of the diagnostic process. These are tests that not every doctor orders, much less understands.

Only in Colorado

Colorado has some fairly high-profile NDs practicing without licensure. Two teach at Metropolitan State College’s Integrated Therapeutic Practices department, a program that includes a “Pre-ND Club.” A chain of three Boulder pharmacies has had roaming NDs giving advice to customers. One Boulder ND is on the faculty of Bastyr and the College of Homeopathy in London. Another ND gives her address as the US Air Force Academy.

The Tim Tebow of Colorado NDs was not included in the survey because I could find no evidence that he currently sees patients, but he now publishes his own magazine, does TV spots, and works with a large grocery chain promoting his “Optimum Wellness” program.

Conclusion

Colorado’s NDs market a laundry list of pre-scientific vitalistic practices to the public. Though not the subject of my survey, it appears that some of the more popular practices, such as “clinical nutrition,” may be significantly different from one ND to another.

It is notable that homeopathy, which has been so thoroughly invalidated by science, is still an ubiquitous offering by Colorado NDs. I find this to be a measure of their devotion to vitalism and how far removed they are from having a scientific temperament.

It appears that predicting what any one ND will prescribe for any particular condition is not possible. Colorado NDs appear to each have their own pet practices, even when they are a husband-wife couple working together. How can there be meaningful regulation of a “profession” with no operational definition of substandard practice?

At one legislative hearing, Mark Johnson, MD, Director of the Jefferson County Health Department (and President of the Institute for Science in Medicine), aptly characterized naturopathy as “this squishy thing that you can’t get your hands around.”

DORA may not be interested in efficacy, but if protecting the public from harm is its responsibility, this agency should be be looking very closely at ND practices. In particular, evidence of ND opposition to childhood vaccination and other public health measures should be made available to legislators.

Unless there is a profound change in political environment, Colorado NDs are going to get their licenses to practice medicine and the mandatory third-party reimbursements that go with them. And like in horror movies, these remanent 19th century practitioners who prey on the vulnerable will be even harder to stop. Truly scary.

Recommended Reading

AMA Scope of Practice Data Series: Naturopaths, American Medical Association, Sep 2009.

Posted in: Naturopathy, Politics and Regulation, Public Health

Leave a Comment (81) ↓

81 thoughts on “Night of the living naturopaths

  1. WilliamLawrenceUtridge says:

    This should be the ND official slogan:

    Naturopathy – we’ll prescribe anything except evidence!

    There’s a t-shirt in there somewhere.

  2. David Gorski says:

    It is notable that homeopathy, which has been so thoroughly invalidated by science, is still an ubiquitous offering by Colorado NDs. I find this to be a measure of their devotion to vitalism and how far removed they are from having a scientific temperament.

    Colorado naturopaths can’t reject homeopathy even if they wanted to. Homeopathy is considered an integral part of naturopathy, with large amounts of class time devoted to it in naturopathy schools. It’s also required material, because the naturopathic board examination tests freshly minted “naturopathic doctors” on homeopathy. It’s even considered one of naturopathy’s “core clinical sciences.” (Apologies for putting “homeopathy” and “core clinical science” in the same sentence. It’s not me. Really. It’s how naturopaths view homeopathy.)

    http://www.sciencebasedmedicine.org/index.php/naturopathy-and-science/

    I would so love to get my hands on that examination to see what sorts of questions are asked.

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  4. EKrumbeck says:

    As a naturopathic medical student, obviously I disagree with much of your post. I don’t think that assessing services listed on websites (which are designed for marketing purposes!) counts as a scientific analysis of what naturopathic physicians actually do. Though I agree that many of these pseudo-scientific “services” do make our profession look dubious.

    I assure your readers that the standard naturopathic curriculum at accredited schools does NOT include most of the services that you listed, and in general the coursework is completely evidence-based (perhaps with the exception of homeopathy, but that requires a much longer conversation). For a discussion of what the naturopathic education actually entails, you can visit my blog (I hope that’s Kosher): http://naturalmedicineisthebestmedicine.blogspot.com/2011/05/so-youre-going-to-be-like-almost-doctor.html

    I also believe that calling naturopathic medicine “vitalistic” is also not necessarily true. I have another blog post on that subject as well: http://naturalmedicineisthebestmedicine.blogspot.com/2011/01/vis-medicatrix-naturae-vitalism.html

  5. Scott says:

    @ EKrumbeck:

    I took a look at those posts. The first provides no indication that the curriculum is evidence-based. Classes being CALLED something is meaningless. The second is simply wrong:

    the body’s inherent ability, which is ordered and intelligent, to heal itself.

    That is vitalism. Straight up, and quite explicitly.

  6. Harriet Hall says:

    @EKrubeck, “I don’t think that assessing services listed on websites (which are designed for marketing purposes!) counts as a scientific analysis of what naturopathic physicians actually do.”

    If you have an acceptable scientific analysis, bring it on! Saying “I assure you” and citing your own blog are not acceptable evidence.

  7. David Gorski says:

    Indeed. Erika bolstered the argument that naturopathy is based on vitalism quite nicely.

    Perusing Bastyr University’s curriculum, I see more than just homeopathy. For instance, there’s myofascial analysis, various manipulative therapies, traditional Chinese medicine, and more. I will give Bastyr credit for making most of its courses sound like regular medical school courses. Gross anatomy? One wonders if they teach acupuncture points, iridology, reflexology, or the like. Nutrition? What passes for “nutrition” in naturopathy is a hopeless gmish of science-based with woo and quackery. Botanical medicine? One wonders what therapies are touted there.

    No, I’m afraid that naturopathy is a discipline that dilutes its science-based modalities with a whole lot of woo, the way homeopaths dilute their remedies with water. When they’re done, there’s nothing left of the original substance. Which is why, I guess, it’s fitting that homeopathy is a “core clinical science” in naturopathy.

    I also note that Erika wrote a most interesting post on homeopathy fairly recently. She wrote:

    I should note here that Hahnemann calls the ability of the body to heal the “Vital Force” of a person. According to Hahnemann it is the vital force which recognizes a homeopathic treatment, and the vital force which precipitates change. Obviously this concept is a little outdated in modern science, but I think it can be a good metaphor for the way our bodies heal and produce homeostasis (see my article on The Vis Medicatrix Naturae). In my opinion, the vital force can include all the biochemical, mechanical, electrical, and neurological processes which cause change.

    The problem is, Hahnemann didn’t intend basing homeopathy on the “vital force” as a metaphor. He really meant it. The “vital force” is what homeopathy is based on, and that’s vitalism. Homeopathy is considered one of the “core clinical sciences” of naturopathy, which means that at least one of the “core clinical sciences” of naturopathy is based on vitalism, whether Erika wishes to admit it or not.

  8. DrRobert says:

    @Ericka Krumbeck, 5th year student at Bastyr,

    I assure you, that if you believe your education is on par with that of M.D.s you are severely delusional. Since we’re sharing blog posts, go ahead and read mine about naturopathy: http://www.skepticalhealth.com/2012/01/18/naturopathy/

    If you for a minute believe you possess even a single percent of the knowledge that M.D.s have then you are only fooling yourself. For example, ask yourself if you understand the dangers of treating symptomatic pheochromocytoma with beta blockers (don’t bother Google-ing it and copy/pasting some response that you will not understand) – oh, what’s that? Your education would just suggest chelation therapy? Consider the difficulties of designing a retroviral therapy consisting of both nucleoside and non-nucleoside reverse transcriptase inhibitors for HIV patients. My research shows that your education for HIV treatment consists of “St. John’s Wort.” Excuse me while I laugh.

    A review of the Naturopathy textbook from Bastyr, a textbook which was written by the president and faculty of Bastyr, finds these flaws, among thousands others:

    A) The chapter on the treatment of anginal (coronary artery) heart disease does not even mention the use of nitrates, beta-blockers or calcium-channel blockers — all of which are standard, effective, FDA-approved treatment for this condition. Failure to use one or more of these agents in the treatment of severe angina would probably be considered medical malpractice. There is no mention of “statin” drugs to lower cholesterol and prevent further progression of coronary heart disease. The use of angioplasty or bypass surgery for patients unresponsive to pharmacologic therapy is dismissed. “Chelation” — a totally irrational and unproven form of treatment — is discussed favorably. However, at the end of this chapter, it is stated that “patients with unstable angina pectoris . . . should be hospitalized”, thus tacitly admitting that naturopathic methods may be ineffective and that serious cases may require medical or surgical treatment found only in hospitals.

    B) The chapter on congestive heart failure recommends unproven nutritional supplements, but says nothing about the standard (and usually effective) treatment. with diuretics and ACE-inhibitors, which have been shown to give comfort to, and prolong, the lives of these patients, It does, however, admit that “In later stages, adjunct (prescription) drug therapy is Usually necessary”, but gives no details,

    C) The chapter on high blood pressure says nothing about the diagnostic work up that is often needed to rule out certain curable causes (such as certain diseases of the adrenal gland, or obstruction in the aorta or the renal arteries). It recommends diet lifestyle changes and the use of herbs but admits that severe cases unresponsive to these “natural” measures may require treatment with pharmaceuticals (presumably under the management of a conventional medical doctor). However, it ends with the dangerous advice that once control of high blood pressure has been achieved with drugs, the naturopathic physician should have the patient “taper off ” the medications. For some such patients, a reduction in medication risks sudden resurgence of severe hypertension and the possibility of a stroke or heart attack. Most patients with severe hypertension need to remain on medication indefinitely, or for many years.

    D) The chapter on diabetes says very little about the use of insulin, nothing about oral hypoglycemic drugs, and nothing about the diagnosis, prevention or treatment of diabetic acidosis– except to warn that it is a medical emergency that will require hospitalization,

    E) The chapter on epilepsy says nothing about the use of anti-epileptic drugs, without which many cases simply could not be adequately controlled. Uncontrolled epilepsy is dangerous.

    F) The chapter on HIV infection and AIDS advocates various types of herbal and “natural” remedies but gives no information about conventional drug therapy. Although it is admitted that no clinical studies have yet demonstrated the effectiveness of naturopathic medical care in HIV infection when used alone, or even as a supplement to conventional medical treatment, the chapter nevertheless ends with this advice: “We urge physicians to apply the principles of naturopathic medicine in the care of their HIV positive patients.” As if this neglect of the proven life-prolonging value of anti-viral pharmacotherapy were not shocking enough, the chapter also fails to recommend drug treatment of pregnant women with HIV infections, which is standard practice for the prevention of HIV transmission to the newborn. Neglect of such treatment would surely be considered malpractice in the medical profession.

    You claim to have taken courses in anatomy, physiology, and histology? Explain how this information, which is a completely ridiculous and dangerous way to “treat and prevent asthma” is in your textbook (written by Emily Kane, the editor of the Naturopathy “journal”)

    Taking baths with a cup or so of 3% hydrogen peroxide in the water to bring extra oxygen to the entire surface of the skin, thus making the lungs somewhat less oxygen hungry. This method can be performed preventively. It may be useful to assess the alignment of your spine. Often the upper thoracic vertebrae will be out of alignment after an asthma attack, which will ultimately put pressure on the lungs and possibly precipitate another attack. Getting regular maintenance soft-tissue work (massage), specifically between the shoulder blades, followed by a Chiropractic adjustment to the thoracic vertebrae, can reduce the frequency of attacks in chronic asthma, and the severity of attacks in acute asthma.

    or

    A good case of smallpox may rid the system of more scrofulous, tubercular, syphilitic and other poisons than could otherwise be eliminated in a lifetime. Therefore, smallpox is certainly to be preferred to vaccination.

    and

    So, what can I do to lower my risk of getting breast cancer? Keep your breasts happy and healthy. Love them and yourself. We often develop illnesses because of our own unresolved feelings and lack of love for ourselves.

    Your education and practice is deplorable. You aren’t a “medical student” and you’re not going to be a “doctor.” So, when your parents and friends as “so, you’re going to be, like, almost a doctor, aren’t you?” You should answer “No. I am not going to be a doctor. I have learned multiple years of quackery and am a danger to any patient that I interact with.”

    Also, if you think your boards mean *anything* go ahead and read that blog post I linked. It talks about a governmental finding where all board scores were being vastly rounded upwards such that no naturopath failed the boards. A complete scam.

    I apologize that I’m not even 1% as politically correct as everyone else posting here. I just think naturopaths are scum and I’m astonished that anyone could be so foolish as to waste four years of their life learning a load of useless crap.

    @Dr. Gorski, I’ve been trying to get my hands on sample NPLEX questions for a while but simply cannot.

  9. chaos4zap says:

    One time I was out with some friends and I went to the bar to order a drink. I approached the bar next to a younger guy that was sitting there, just staring blankly at the bar with his beer in his hand. I thought it was a bit odd, but ordered my drink and didn’t pay much attention. As the bartender was getting my drink, the kid turned to me and said “I got in….”. I wasn’t sure I heard him so I replied with a slightly confused “I’m sorry, what?” Once again, he repeated and I asked him “Where? Where did you get in?” He replied with the name of a local chiropractic school. I quickly realized that this kid wasn’t sullen and down, as I had previously thought, but he was in a daze because he must not have believed he would get in. Trying my best not to face-palm irgh tin front of him, I just bit my lip and was barely able to muster a very neutral nod in his general direction. When I read EKrumbeck’s post, I get the feeling that he may have been that same kid, just located at a different bar at a different time. Whatever it is that people end up doing with their lives, most would think it a plus to be making a difference. When you are offered an opportunity for something like Chiropractic school or something like a Naturopath school, I would imagine that most people only have a very tenuous notion of what it is they are getting into. Most average young people, like the majority of the general population assume that these are closely related to MD’s and think if them as some kind of specialists. Then they start the school, the kool-aid is drank and the person no longer has the perspective and ability to overcome the cognitive dissonance that would surely follow admitting that what they are engaging is, is by-and-large…Pseudoscience. College is much too late to be teaching critical thinking skills. By that stage in life, it may already be too late for allot of people.

  10. Quill says:

    I confess to probably having been a mild “shruggie” when it comes to a lot of the “natural” stuff being promoted by “degreed professionals” such as naturopaths. I simply hadn’t paid much attention to these kind-seeming people.

    However, after reading this post and Dr. Robert’s blog post and excerpts from the textbook review, I have to say that I am truly aghast at this. (Yes, I’m using the word aghast as it truly reflects how I’m feeling. No hyperbole.) I’m also at a loss for further words.

  11. rwk says:

    “My research shows that your education for HIV treatment consists of “St. John’s Wort.” Excuse me while I laugh”.

    Excuse me DrRobert while I still laugh about your researched blog that says Myofascial Release is Rolfing.

    And implying it’s only done by chiropractors and naturopaths.

    Most of your posts suggest you have no real world experience with any of the “quacks” you condemn.

    Thank goodness for Google and Wiki.

    Shouldn’t you be seeing patients or studying science based medicine ? You must have lots of free time.

  12. DrRobert says:

    Just google “naturopathy hiv st johns wort”

    “Recommendations, by the Bastyr University AIDS Research Center, for treatment of HIV-positive patients with St. John’s wort and garlic” (both of which have been shown to reduce blood levels of highly active antiretroviral therapy agents)

    @rwk, I love that you’re still trolling me. Must have really gotten underneath your skin. Perhaps you need to adjust one of your subluxations that’s causing nervous system interference and bad body balance?

  13. Quill says:

    Well, it just gets worse for me. After reading up on these bizzare NDs, I wondered if there were any naturopathic “doctors” near where I live. There is a center for “integrative medicine” nearby, and surprisingly enough they list MDs and NDs on their staff. The centers founder is an MD who (according to their website) “practices an integrated model of health care” and “…has long believed in an integrated model of wellness in which it is not important which path is followed.” Uh, what? The rest of the staff includes another MD, several NDs, homeopaths, acupuncturists and massage therapists as well as a yoga teacher.

    What happens when real medicine is corrupted by all this junk science, superstition and naturopathic “modalities”? It shows in what services they offer. Here’s the complete list:

    • Acupressure
    • Acupuncture
    • Ayurveda
    • Biofeedback
    • Chinese Medicine
    • Chiropractic
    • Colon Hydrotherapy
    • Conscious Breath
    • Counseling
    • Emotional Freedom Technique (EFT)
    • Eye Movement Desensitization Reprogramming (EMDR)
    • Enzyme Therapy
    • Esthetic Wellness
    • Family Medicine
    • Food Allergies
    • Health Rejuvenating Exercises (HRE)
    • Healthy Cooking
    • Homeopathy
    • Hypnotherapy
    • IV Chelation
    • Light & Sound Therapy
    • Marma Therapy
    • Massage
    • Medical QiGong
    • Nambudripad’s Allergy Elimination Technique (NAET)
    • Oleation
    • Meditation
    • Preventative Medicine
    • Reflexology
    • Sensory Integration
    • Yoga
    • Yoga Nidra

    I was really surprised to find an MD founding such a place, so I went to the California Medical Board’s website to verify her license. The medical degree is listed as being awarded in 1992 by University of Rajasthan, S.M.S. Medical College. Also listed in the file record are two events from 2011, one a formal filing by the Attorney General to have her medical license revoked for malpractice (including gross negligence), the other a civil court judgment award against her for malpractice in the amount of $636,782.00. (Not clear if these two cases are directly related.)

    If anyone would like to read a legally documented list of the various “treatments” including naturopathic and ayurvedic that were offered by this quack, I invite you to read a copy of the lawsuit by the State of California below. It is truly scary reading.

    http://www2.mbc.ca.gov/LicenseLookupSystem/PhysicianSurgeon/document.aspx?path=%5cDIDOCS%5c20110323%5cDMRAAADE2%5c&did=AAADE110323222930250.DID&licenseType=A&licenseNumber=67699

  14. pmoran says:

    DORA has dismissed criticism of naturopathy with the assertion that regulation is solely about protecting the public and that regulators have no duty to determine if a profession’s practices are efficacious or validated by science.

    The two are obviously interdependent, depending upon what naturopaths claim and advise with regard to critical medical treatments.

    It is vital also that legislators understand that naturopathy is mostly an optional add-on to normal medical services. Most of the public will never consult one, while those who do are likely to be very high consumers of medical attentions of all kinds, with at best patchy, uncertain, non-specific benefits from the additional medical interactions.

    So CAM should, in general, never be funded by the same pool as is conventional care. If insurers are required to reimburse for it then they should be permitted to do so at a higher premium, so as to not be spreading costs over everyone.

  15. Chris says:

    The following is the link to the clinic a relative went to for help with her psychological issues:
    http://www.childhomeopathy.com/

    She actually discovered that it didn’t work. She was not happy with those folks, and went back to the real psychiatrist. Oh, and do check out what conditions they claim to treat at the Children’s Homeopathic Clinic. It is positively frightening.

    Oh, is Ericka at Bastyr now? Woo hoo! Someone who can answer a question I have tried to find out for years.

    Back in the late 1980s and earlly 1990s Bastyr rented a school district building in north Seattle (it was on Latona Ave NE) before it moved to a former seminary across Lake Washington. About that time there was a television news report that they were going to embark on a full study of homeopathy. I believe this is the news report where I first heard homeopathy described. I never heard what happened to that study.

    Ericka, it has been twenty years, so it must have been completed. Where are the results?

  16. Cowy1 says:

    Whoa fellas, don’t bash nature! It’s NATURAL and therefore wholesome and yummy and good and can’t ever be bad. Or natural might refer to your leather shoes. Or natural might be getting some purlent drainage from your urethra or your pubic lice.

    Actually today in clinic I had a lady tell me she wanted a “natural” childbirth. I contemplated the meaning of this for a moment before asking her what “natural” meant to her. Means she didn’t want an epidural. Obviously this is totally “natural”.

    BTW “natural” childbirth to me is the mother naked in some cave screaming and bleeding being attended to by a couple of other ladies while her husband tries to fend off the grizzly bear who wants an easy meal.

  17. Brandt says:

    Doctors Gorski and Robert – I don’t know how mocking someone’s beliefs and speaking down to them is helpful or productive in any way. I would bet that Ericka dismisses everthing that you have written and finds a way to justify her beliefs which she presumably will not call into question. She will write-off this blog because of the arrogance and closed mindedness of its participants.

    “One wonders if they teach acupuncture points, iridology, reflexology, or the like. Nutrition? What passes for “nutrition” in naturopathy is a hopeless gmish of science-based with woo and quackery. Botanical medicine? One wonders what therapies are touted there.” = This guy is a jerk.

    “I assure you, that if you believe your education is on par with that of M.D.s you are severely delusional. Since we’re sharing blog posts, go ahead and read mine about naturopathy: http://www.skepticalhealth.com/2012/01/18/naturopathy/

    If you for a minute believe you possess even a single percent of the knowledge that M.D.s have then you are only fooling yourself.” = This guy is also a jerk. (the hyperbole doesn’t help).

    I don’t think that this tactic is necessary or productive when you have substantial evidence on your side and CAM has a foundation that is hard to believe in if you have any training in logic or cirtical thinking or a basic understanding of science.

    I hope that both of you are more successful on the operating table because you just lost one here. (not me of course, I love this blog)

  18. WilliamLawrenceUtridge says:

    EKrumbeck, what does your innate intelligence say about favism? Type I diabetes? Trimethylaminuria? Phenylketonuria? Proteus syndrome? Huntington’s disease?

  19. Harriet Hall says:

    @EKrumbeck,
    In your article, you mention the 5 principles of naturopathy: “Treat the Whole, Treat the Cause, Prevention, First Do No Harm, and Doctor as Teacher.”

    I contend that those are the principles of medicine. As I said in an article in Skeptic magazine, “The things naturopaths do that are good are not special, and the things they do that are special [like homeopathy] are not good.”

  20. DrRobert says:

    @Dr Hall, that one sentence so aptly summarizes all of CAM that I’m amazed it’s not printed on a t-shirt yet.

  21. David Gorski says:

    Indeed. Harriet nailed it in a single sentence.

  22. EKrumbeck says:

    Good questions for me… It’s impossible for me to respond to all the comments, so I apologize. I only listed two of the blog posts, but I do have a number of others that explain more thoroughly the philosophy of naturopathic medicine, the difference between ND’s and conventional physicians, and – most importantly for your site – two posts about the role of science in naturopathic medicine (look in the archives – they are some of the first few postings). I wrote these specifically because I’ve had so many questions about the profession, my experience with the profession, and whether or not we are crazy quack hippies who chant and do drum circles while waving herbs at our patients (most of us are not. MOST of us).

    All I can speak to is of my experience at Bastyr. The first two years of schooling were dominated by basic sciences – anatomy, physiology, biochemistry, pharmacology, etc – taught by PhD’s in these subjects. The last 2 years (3 in my case, I took some time off) are the so-called “clinical sciences” (gynecology, EENT, etc) taught by a combination of MD’s and ND’s. Since we have few textbooks for natural medicine, most lectures were heavily cited by the latest in scientific studies. Of course, I have no way of proving that to you, I can only tell you that this has been my experience.

    Myofascial analysis is simply analysis of the muscles and fascial tissue – e.g., which muscles are hypertonic leading to orthopedic problems (kinematic chains, etc), similar to what a PT would learn (though they go into more depth, I’m sure). Nutrition class is just that – nutrition (dietary therapy, micronutrient, macronutrient therapy). No, Bastyr specifically does NOT include iridology or the other courses you listed in core curriculum, though some may be offered as electives (sigh). Botanical medicine courses are taught with pharmacognosy in mind, and with the latest evidence cited, but that’s difficult because research is just scratching the surface of botanical therapies.

    So the main beef you will have left is Homeopathy. As one of the comments noted, I did write a post about homeopathy, attempting to be as neutral as possible. Frankly, I myself am a huge skeptic. I am not alone amongst naturopaths, though there are many strong proponents as well.

    Lastly, yes there are errors in the Textbook of Natural Medicine. Research catches up with all of us, and last I checked the book has not been revised in many years.

    As I said earlier, I can only speak to my own experience – in my experience the majority of my colleagues are sound minded, evidence-based practitioners. However, just as there are rogue MD’s, there are the outliers in our community as well. Unfortunately they tend to attract more attention than the rest of us.

  23. daijiyobu says:

    Enjoying the view.

    EKrumbeck said “the majority of my colleagues are sound minded, evidence-based practitioners.”

    a) I’d be interested if Bastyr presently requires its naturopathy students to read and study the Textbook of Natural Medicine 3rd edition edited by NDs Pizzorno and Murray. When I was at UBCNM, only the first edition existed and it was too expensive, basically, based on taking about 11 courses a semester, to bother buying to read on the side. Then out came the 2nd edition, and the 3rd edition. Yet, so few NDs likely have read the chapters within it ‘on the essentially naturopathic’. I have. Here’s a link to a chapter filled with nonsense labeled “science-based natural medicine” ( http://www.naturalmedtext.com/storedfiles/sample_Chapter%203%20-%20A%20Hierarchy%20of%20Healing%20-%20The%20Therapeutic%20Order.pdf ).

    b) Here’s what a BASTYR ND here in CT does in practice, as I have been informed from firsthand participants: using what I surmise is a Vega or electrodermal machine that also makes homeopathic remedy treatment suggestions, he tests and treats patients. But it gets better. The patient can send in urine to be tested in follow-up, and if that actual patient is not around, the ND places one of the staff onto the electrodermal part of the procedure and uses them as a surrogate for the patient. The simultaneously employed urine sample fixes any inaccuracy in the electrodermal measurements of, obviously, SOMEBODY OTHER THAN THE PATIENT. Then, new homeopathic remedies are cooked up in that ND’s lab and sent out to the patient. (e.g., that ND has written homeopathy questions for their national North American exam — http://www.nefha.com/about/; http://www.nefha.com/ — “therapies well rooted in medical science”; http://www.ingelsfamilyhealth.com/blog/ — “electrodermal screening (EDS) is an effective method of determining a child’s sensitivities).

    One of the points I’d like to make is that, if you use the TNM in ‘a’ as a bellwether for naturopathy — after all it is the TEXTBOOK — then all that I’ve discussed in ‘b’ above is perfectly acceptable.

    Nonsense = scientific rigor /

    the simple electroconductivity of someone’s skin — which is merely a combination of moisture, salinity and the pressure applied to the contacts — is all of a sudden profoundly insightful.

    -r.c.

  24. Linda Rosa says:

    “The things naturopaths do that are good are not special, and the things they do that are special [like homeopathy] are not good.”

    What is it that naturopath do that is good? Or should I ask what can they be trusted to do well?

  25. gretemike says:

    Ericka,

    You undermine your own argument when you say things like:

    “whether or not we are crazy quack hippies who chant and do drum circles while waving herbs at our patients (most of us are not. MOST of us).”

    (and)

    “Bastyr specifically does NOT include iridology or the other courses you listed in core curriculum, though some may be offered as electives (sigh).”

    (and)

    When you generally discuss the inclusion of homeopathy in the curriculum, and your own doubts about homeopathy.

    Instead of trying to improve your argument, try understanding how this looks from our point of view. These bloggers are right, what that “college” is teaching is plain nonsense, and therefore what NDs practice is also nonsense. And I suspect that without Google you really don’t have any idea what pheochromocytoma means or (in detail) what a beta blocker is used for or when it is contraindicated. And I’m sure you are aware that over the years HIV has gone from being a death sentence to a chronic disease, and that mainstream medicine and not herbs is responsible for that impressive fact. That ought to add to the apparent doubts you have about your . . . education.

    Dr. Roberts was harsh, but not as harsh I think as wasting lots of money on a worthless degree and possibly harming people who may come to you for help. Instead of being offended by him, think seriously about what he has said. Perhaps you are young enough to change direction and eventually attend a real medical school.

  26. Harriet Hall says:

    @Linda Rosa,
    “What is it that naturopath do that is good? Or should I ask what can they be trusted to do well?”
    They do good things when they do some of the same things MDs do.
    But they can’t be trusted because they mix good medicine with quackery.

  27. kathy says:

    Thanks for a super item of woo advertising to put in front of my Honours class later this year, when I try to teach them critical reading. I mean the one about homeopathic treatment of snake bites … they’re gonna love that one! They are all hyperaware of what a snake can do to you … several of them have seen it in real life … they will really enjoy pulling that advert apart. And maybe something will stick in their heads for the future too.

  28. gretemike says:

    Ericka,

    You say you are to be a real doctor: try putting that to the test, literally. Practice questions for the real medical licensing exam can be found online, here and likely elsewhere:

    http://www.usmle.org/practice-materials/index.html

    Give it a shot and see how you measure up.

  29. Scott says:

    Perhaps you can explain this…

    When what’s purported to be reliable science is presented alongside that which is completely false, why should one trust that the science actually is reliable?

    How is it credible to teach principles of biology and chemistry on the one hand, then ask questions on the licensing exam that necessarily require the test-taker to completely discard all of those principles?

    How can naturopaths possibly be on a par with MDs when their education is both less extensive, and includes significant time wasted on outright falsehoods? (4 years in school matches up, but 1200 hours of clinical education isn’t even vaguely comparable to a multiyear residency.)

  30. DrRobert says:

    @Erika, a PhD can teach at any level, from kindergarten to grad school. I guarantee you that you are not learning these subjects at a rigorous level. I don’t want to particularly embarrass you, but I’ll be more than happy to ask you hundreds of questions that you should have learned in the “basic sciences.”

    I am deeply troubled by the fact that you refer to the egregious statements in your textbook as “errors.” They aren’t “errors.” An error is having a decimal placed too far over (incidentally, an error of this magnitude resulted in ten times the administration of Lasix to a patient). A really bad error is perhaps confusing hypo and hyper in a complicated explanation – which could lead to a complete misunderstanding of basic physiology. What was in your book is much, much worse than an “error.” To be completely honest: the recommendations from your textbook and “leading professionals” are idiotic. A kinder person would say “misinformed”, or “mislead.” But I’m of the opinion that a person has to be a complete moron to write that you can treat asthma by bathing a kid in hydrogen peroxide. There’s just no other way to say it. And to advise someone with HIV to take St. Johns Wort is dangerous and will take years off their life. As already stated, we can treat HIV and prolong life for decades. Your treatment would shorten their life. The naturopath textbook is possibly the most offensive and dangerous thing ever written, and the practice uses this book of death to persuade sick people into shirking legitimate medical treatment and pursuing quackery instead.

    Note, that is not an insult to you. It’s an insult to the people whom you’ve put your trust in to be educators.

    What we are all saying is correct. Listen to us. I’m being especially blunt because of the severity of the situation. I feel terrible that you’ve wasted so many years and so much money on your education. It’s like a person who has invested their life savings into a failing business. But, why do you think naturopaths can’t be licensed in most states? Don’t you think that if naturopaths were partaking in a legitimate medical practice that they would welcome you with open arms? Do you think naturopathy possesses some unique genius that the states are “too dumb” to recognize? Do you think you are learning unique material that “doctors don’t know”?

    The truth is going to hurt. I’ve read the documents (they are on Naturowatch, under Licensing) and besides the whole thing about naturopaths being dangerous quacks (and the fact there are so few naturopaths it would be cost prohibitive to run the whole thing), the truth is that there is a serious concern that a naturopath who goes through 4 years of education is more dangerous than a random Joe that randomly decides to call himself a naturopath. Yup. How bad is naturopathy when the concern is that the more you learn in the subject, the more danger you are to the general population?

    Here’s the bottom line: You will not be treating disease. You do not know how to diagnose disease. If a patient casually mentions neck pain when drinking alcohol, what would you suggest? Whatever you just said, you just missed Hodgkin’s lymphoma. You do not know these things. People will die under your care because you present yourself as a “doctor” but you don’t know anything about disease or medicine.

    I’m sure you won’t change your mind, but believe in the fact that your education is not at all comparable to a doctor’s, and that the majority of what you learned is probably false or at best half-truths. I know you want to believe you are a “doctor” and you are going to ignore us, and honestly by reading our arguments it is only going to make you believe stronger in naturopathy, but I sincerely hope that there is a small bit of doubt always residing in the back of your skull, such that when you encounter a patient with serious disease you refer them to a real doctor instead of killing them with naturopathy.

    @To the moderators: I sincerely apologize. I know the tone of this excellent blog is to be respectful, and insulting is not tolerated. But this girl has to be made aware of her situation.

    @Quill, that case is a scary, scary situation.

    @LindaRosa, I am relatively new here. I’m guessing you are Emily Rosa’s mother? If so, I have so much respect for both of you. I can’t imagine how much it must sting to be a TT practitioner and find out your practice was disproven by a 9-year-old.

    @Dr. Gorski, I found some NPLEX questions (joke):

    1. An elderly man comes to the emergency department with fever, headache, a stiff neck, and photophobia. He is HIV positive with < 50 CD4 cells and a history of pneumocystis pneumonia. Head CT w/o contrast is normal. CSF shows 2,500 WBCs that are all neutrophils; gram stain is normal. What is the best initial therapy?
    A) Recommend diet changes to rid the body of toxins
    B) Administer IV EDTA chelation therapy to rid the body of toxins
    C) Offer colonic irrigation to rid the body of toxins
    D) Stick needles in the patient to restore the balance of chi
    E) Provide homeopathic remedies

    2. A 74-yr-old male with history of aortic stenosis comes to the emergency department having had 5 red/black bowel movements over the last day. His pulse is 112, BP 96/64. What is the next best step in management?
    A) Recommend diet changes to rid the body of toxins
    B) Administer IV EDTA chelation therapy to rid the body of toxins
    C) Offer colonic irrigation to rid the body of toxins
    D) Stick needles in the patient to restore the balance of chi
    E) Provide homeopathic remedies

    3. A 58-yr-old female with metastatic breast cancer comes in with back pain. The spine is tender. She has hyperreflexia of the legs. What is the most urgent step?
    A) Recommend diet changes to rid the body of toxins
    B) Administer IV EDTA chelation therapy to rid the body of toxins
    C) Offer colonic irrigation to rid the body of toxins
    D) Stick needles in the patient to restore the balance of chi
    E) Provide homeopathic remedies

    4. A 52-yr-old woman is found to have brown feculent fluid draining from her wound drain 9 days after a sigmoid resection for colorectal cancer. The patient is afebrile, has stable vital signs, and is without complain. What is the next step in management?
    A) Recommend diet changes to rid the body of toxins
    B) Administer IV EDTA chelation therapy to rid the body of toxins
    C) Offer colonic irrigation to rid the body of toxins
    D) Stick needles in the patient to restore the balance of chi
    E) Provide homeopathic remedies

  31. Scott says:

    Oh, and one more…

    How does shrugging off a few of the worst offenses against reality as “electives” improve the ND’s case? The fact that they are still offered necessarily indicates that students actually take them in some significant number.

  32. WilliamLawrenceUtridge says:

    DrRobert, your questions are all obviously trick questions. A true naturopath exam would include two more responses:

    F) Big Pharma
    G) All of the above

    Naturally, the correct answer is always G.

    I still want EKrumbeck to tell me what my innate intelligence has to say about favism, type I diabetes, trimethylaminuria, phenylketonuria, Proteus syndrome and Huntington’s disease.

    I would also like to know what advantages herbs have over drugs. And overall, what’s the difference between a medical doctor and a naturopath; if there’s so much overlap between the science both groups learn, why don’t all naturopaths just go into medicine?

    Brandt, the thing about CAM is, it doesn’t use evidence. If CAM used evidence to guide its decision making, treatment, teaching and so forth, it wouldn’t exist. CAM is propaganda, it’s make-believe, it’s wishful thinking and a rhetorical trick. Trying to convince people through evidence simply won’t work because it’s not about the evidence. It’s about the Health Fairy (like the Tooth Fairy, but for grown-ups).

    The only thing naturopaths and related CAM professions offer is a chance for the worried well to indulge in some emotion-based coping and pay for some poorly-focused psychotherapy. And every so often they’re really good at convincing people with cancer to die of it.

  33. chaos4zap says:

    What exactly does a Pharmacology class entail that leads to Homeopathy? Almost any major at any university has prerequisites that require basic courses in biology, chemistry, etc.. (most taught by PhD’s) and I seriously doubt those people would think themselves doctors after such basic introductions. The idea that you study the same topics, with the same rigor as M.D.’s. does not add up to how the outcome of your efforts could be pre-scientific, un-proven (at best) and often times completely unnecessary interventions.

  34. Chris says:

    I still want to know about that big study on homeopathy that Bastyr announced they were going to do around twenty years ago.

  35. Brandt says:

    WilliamLawrenceUtridge – I believe that you mistate the point.

    “Brandt, the thing about CAM is, it doesn’t use evidence. ” It does indeed use evidence for its support. However, the nature and quality of the evidence is not of the type that is likely to produce true beliefs. There would be no believers if there was no evidence. The problem is that the evidence is weak and most people are not trained to evaluate different types of evidence.

    In any event, my point is that certain responders on this forum use methods that are counterproductive to what I believe the aim of the forum is – namely to educate the uninformed that using a science-based method to develop a system to treat disease is the most effective system of which we are aware. I may be mistaken on this but that seems to be gist to me. However, using ridicule and deprecation to persuade someone that their beliefs are incorrect is likely not effective. Someone who holds dubious beliefs and is open-minded enough to engage in this forum – maybe even question her own beliefs – and instead of engaging her in a dialogue is subject to abuse. Using reductio ad ridiculum argumentation only entertains those who share your beliefs but likely does little to persuade. It seems to me that there must be a better way. In the Socratic dialogues, Socrates asks the right quesitons to expose the Sophist’s lack of knowledge not call them idiots.

  36. Linda Rosa says:

    Harriet wrote: “’What is it that naturopath do that is good? Or should I ask what can they be trusted to do well?’
    They do good things when they do some of the same things MDs do. But they can’t be trusted because they mix good medicine with quackery.”

    I think you are still yielding too much ground to NDs. If they “do good things,” I contend these could be more a matter of dumb luck.

    Some years ago, a prominent immunologist in Colorado took a look at the major textbook used at Bastyr to see what it had to say about the diagnosis and treatment of asthma. His findings (the below) were reported to DORA, but were totally ignored in DORA’s “Sunrise Review of Naturopathic Physicians.” I think this is an exceptionally telling report on a common condition that MDs must have considerable experience in diagnosing and treating. Here is the immunologist’s report:

    “To determine the nature and adequacy of the teaching in Naturopathic schools, I analyzed the chapter on asthma, which is pp 1095-1104 in the book, Textbook of Natural Medicine by Joseph E. Pizzorno, Jr and Michael T. Murray (2nd edition, Churchill, Livingston, 1999). This text is a current one, comprising 1615 pages.

    The chapter on asthma, has a total of 6 lines devoted to the diagnosis of asthma. This is inadequate — there are other diseases which mimic asthma but they are not mentioned.


    “After this sketchy preliminary, the authors go right to therapy.


    “There is no description of how to take a good history from an asthmatic patient. This is a crucial omission, as often the clues to the causes are found in the history.

    “There is no mention of the presence or absence of a family history of asthma or other allergies. This is important to know because the family history can also give information about the patient and his/her offspring and their allergic potential.

    “There is no description of the physical examination findings other than that the patient wheezes.


    “There is no mention of how to assess the severity of the asthma, or its seasonal or geographic variation.


    “There is no mention of the fact that asthma is a potentially fatal disease. It is more prevalent than the authors state, and adults and children in the US die of asthma every year.


    “There is no mention of the value or use of recognized factors, including:


    • Chest x-ray or CT scan
    • Concomitant sinus disease or hay fever
    • The sometimes fatal reactions to aspirin
    • Breathing tests — spirometry or peak flows
    • “Rescue medication” such as inhaled bronchodilators
    • Adrenaline (epinephrine)
    • Oxygen
    • Corticosteroids
    • Exercise aggravation of asthma
    • Roles of stress and panic
    • Instead, there is attention to very controversial factors such as —
    Asthma and pertussis vaccination
    Hypochlorhydria (low gastric acid)
    Candida (yeast) overgrowth
    Role of food additives


    “Allergies are mentioned and the doctor is urged to see that the patient eliminates all “food allergens” but the chapter fails to discuss how they are to be identified. They mention noting “positive food and/or inhalant allergy tests” but fail to state which tests should be used and how the results should be interpreted. They do not mention specifically skin prick tests or RAST analysis nor the very questionable applied kinesiology method.

    They mention allergy to household pets but do not state how these are to be identified nor what to do when they are.


    “They fail to counsel the student that there are many cases of asthma who appear to be non-allergic.

    There is a brief section on acute asthma. Here it is in its entirety: ‘An acute asthma attack can be a medical emergency. If unable to administer magnesium, refer patient to an emergency room immediately.’ This refers to intravenous magnesium, which is not often used for this purpose. What, no epinephrine? No oxygen? No antihistamines? No inhaled bronchodilators?


    “I have not commented on the efficacy of the treatments described because that is irrelevant to the point that the material provided about the etiology, diagnosis and pathogenesis of asthma are so inadequate as to make considerations of naturopathic treatment premature.


    “This chapter is important in understanding what current naturopathic students are being taught. This is because the authors, Pizzorno and Murray, are faculty members at the Bastyr University, Kenmore, Washington. This is usually cited as among the best of the Naturopathic schools. Thus, this book is a peek into the Naturopathy classroom.


    “Nonetheless, their teaching in this chapter about a common, serious and potentially fatal disease is totally inadequate.”

  37. Harriet Hall says:

    “I think you are still yielding too much ground to NDs.”
    That’s better than being unreasonably dogmatic. It is demonstrably false to say that they never do anything that is good. I reject naturopathy not because I think it is 100% bad but because so many bad things are indiscriminately mixed with a few good things.

  38. Scott says:

    “Brandt, the thing about CAM is, it doesn’t use evidence. ” It does indeed use evidence for its support. However, the nature and quality of the evidence is not of the type that is likely to produce true beliefs. There would be no believers if there was no evidence. The problem is that the evidence is weak and most people are not trained to evaluate different types of evidence.

    I disagree. Yes, there’s some very weak evidence that comes up. But that’s not the source of the belief. The beliefs pretty much arise because they sound good. Evidence is sought afterwards, in an attempt to support the belief.

    “There would be no believers if there was no evidence,” in particular, is exceedingly naive. There is evidence that the Earth is flat, then?

  39. Linda Rosa says:

    Harriet wrote: “It is demonstrably false to say that they never do anything that is good.”

    I didn’t say that. I said:

    “If they ‘do good things,’ I contend these could be more a matter of dumb luck.”

    Your position, as I understand it, is that there is one or more medical conditions that the majority of NDs are reliably able to diagnose and treat. What are they?

  40. Scott says:

    @ Brandt:

    It occurs to me that one possible source of confusion would be the precise boundaries of the definition of “evidence.” For concreteness, the definition I am using holds that something along the lines of “I did this and my cold went away a couple days later” is “not evidence.” If you’re considering that to be “weak evidence” then our positions may be more similar than I previously realized.

  41. Harriet Hall says:

    @Linda Rosa

    “I didn’t say that. I said:”
    I didn’t say that you said that, I just said it was false, and that is why we should avoid sounding dogmatic.
    You did say “if” rather than “when” they do good things.

    “Your position, as I understand it, is that there is one or more medical conditions that the majority of NDs are reliably able to diagnose and treat.”

    You understand wrong. An example of what I meant: a naturopath might advise a patient with high blood pressure to exercise, lose weight, and limit salt. That is good: it is part of what an MD advises, but that doesn’t mean the naturopath is reliably able to treat HBP. Perhaps it will be clearer if I say it is good but it isn’t good enough.

  42. Linda Rosa says:

    Harriet: “You understand wrong. An example of what I meant: a naturopath might advise a patient with high blood pressure to exercise, lose weight, and limit salt. That is good: it is part of what an MD advises, but that doesn’t mean the naturopath is reliably able to treat HBP. Perhaps it will be clearer if I say it is good but it isn’t good enough.”

    We no doubt have similar understandings of naturopathy, but it is my position that precise language is vitally important, especially when we need to convey to policy makers the risks of naturopathy.

    The words “good” and even “not good enough” are, in my opinion, inaccurate in describing a profession that cannot provide the public with reliable diagnostic services, to say nothing of treatment. I contend that it is misleading to refer to the above scenario using the word “good” and that using such words to describe ND practice can lead to unintended consequences, such as the licensure of NDs because legislators feel pressured to provide some sort of healthcare to under-served rural and poor populations.

    You might think me a stickler for precise language, but I’m a piker next to the NDs. One year, the “degreed” NDs told Colorado legislators how they found it possible to get around the Medical Practice Act which regulates “diagnosis and treatment.” They claimed that they would be guilty of violating the act only if they diagnosed *AND* treated, but not just one or the other!

  43. DrRobert says:

    @Dr. Hall, I think the problem with NDs is the same as chiropractors. As you have said, a chiropractor would be fine if they stuck to the couple of specific types of LBP that their treatment is possibly effective for, and didn’t do all the quackery like promoting anti-vaccination materials, adjusting necks (resulting in stroke, death, and paralysis) or utilize iridology or other quack diagnostic techniques.

    Similarly, a ND would be fine if they would just offer decent, common sense counseling for patients with conditions that can be influenced by diet and lifestyle modifications. They could recommend changes for patients with heart disease and just stop there. However, their textbooks (which they’ve devoted 4 years to studying) dictate utilizing IV chelation therapy with EDTA for heart disease. So, I don’t know if the question is: “can a ND give good advice without giving bad advice,” or “is a ND’s good advice is worth the bad advice.”

    It’s almost a risk-benefit analysis. Do we get enough benefit from a ND telling us to eat better and exercise if they also convince us to use IV EDTA chelation? Do we get enough benefit from a ND telling parents common triggers for asthma if they also tell the parent that they can treat an asthma attack by bathing the child in hydrogen peroxide? Do we get enough benefit from a ND telling us about safe sexual practices, when the ND also treats STDs with ineffective methods? Do we get enough benefit from a ND telling us about communicable disease transmission if they also tell us that they can make us so healthy that we wont get sick? Do we get enough benefit from a ND telling us about cancer risks if they also counsel us to not use radiation and chemotherapy, and instead irradiate our blood with UV light?

    Consider how we see manage disease. We counsel, we offer advice, and also offer medications if indicated. Similarly, a ND will counsel, possibly offer decent advice, and then proceed with treatment. I don’t believe that the average naturopath knows which of their advice is “good” and which of their advice is “lethal.”

    Since hypertension was mentioned, here is the review of their textbook off of Naturowatch:

    The chapter on high blood pressure says nothing about the diagnostic work up that is often needed to rule out certain curable causes (such as certain diseases of the adrenal gland, or obstruction in the aorta or the renal arteries). It recommends diet lifestyle changes and the use of herbs but admits that severe cases unresponsive to these “natural” measures may require treatment with pharmaceuticals (presumably under the management of a conventional medical doctor). However, it ends with the dangerous advice that once control of high blood pressure has been achieved with drugs, the naturopathic physician should have the patient “taper off “ the medications. For some such patients, a reduction in medication risks sudden resurgence of severe hypertension and the possibility of a stroke or heart attack.

    They learn this “set of advice” as a whole. To them, the advice for diet and lifestyle changes are just as important as herbs and terminating pharmaceutical treatment for an extended period of time. You and I would never ignore pharmaceuticals when treating HTN, and likewise a naturopath wouldn’t ignore whatever it is they were taught. (Also, we have to consider that the naturopath is telling a patient with Addison’s to “eat better.”)

    Wife is yelling something about dinner being ready :)

  44. Harriet Hall says:

    @Linda Rosa,

    For someone who is advocating precise language, you are not very careful about distinguishing between saying a profession is “good” – which I did not – and saying that some of the things they do are good. it would be “inaccurate” to describe naturopathy as good; it is not “inaccurate” to say that some of the things they do are good, the things that MDs do too. It is not misleading to say that advising weight loss, exercise and salt restriction for HBP is a good thing. It would be misleading to say that such advice is sufficient by itself or when combined with nonsense. It is not misleading to say that a stopped watch is right twice a day as long as you also point out that it is wrong for the other 23 hours and 59 minutes.

  45. Linda Rosa says:

    Harriet,

    “…saying a profession is ‘good’ – which I did not…”

    That was not my meaning.

    Regarding this statement: “It is not misleading to say that advising weight loss, exercise and salt restriction for HBP is a good thing.”

    I think this statement can be misleading. Happenstance “good thing” ND measures aren’t *good care.* In order to say that anything an ND prescribes has value, it is first necessary to concede that NDs are able to reliably diagnose. Please refer to the immunologist’s report I provided above. He did not bother to evaluate ND treatments for asthma because unreliable ND diagnosis made treatment a moot point.

  46. Harriet Hall says:

    @Linda Rosa,
    “In order to say that anything an ND prescribes has value, it is first necessary to concede that NDs are able to reliably diagnose.”

    As it stands, that statement is false. I hope you didn’t mean it the way it looks. An ND might prescribe a healthy diet that is applicable to everyone, with or without first making a reliable diagnosis of anything.

    Do you really think the statement “advising weight loss, exercise and salt restriction for HBP is a good thing” is misleading? I contend that the statement itself is not misleading, although it could be used to mislead. It would only be misleading to mis-use the statement in a way that made it look like it supported naturopathy.

    A few of the things naturopaths do happen to be some of the same good things MDs do. In no way does that imply that naturopathy is a good thing. It isn’t. I would love to see naturopaths abolished; but dogmatically refusing to admit that they ever do anything good would not be the way to go about it.

  47. DrRobert says:

    Ladies, ladies. You are both incredible people and our community is fortunate to have both of your brains. We all agree NDs are horrible people that may occasionally say something that is common sense good advice.

  48. Brandt says:

    Scott – anecdotal evidence is evidence, as is simple observation – the world does appears to be flat when you look out the window. However, your education tells you otherwise, and you are persuaded by stronger evidence to believe that the world is round. My point however is teleological not epistemological but it doesn’t seem to matter in the context of this forum.

  49. rwk says:

    Hey Dr Robert butt out! Let them go at it . Instead of MD vs DC or ND, it’s MD vs know it all RN.
    It’s also good to see Dr Hall letting the other side have it.
    Maybe your next.

  50. JPZ says:

    As a fellow Coloradian, I thank you for your insights.

    Your article used a pseudo-survey (very similar to one largely dismissed here before but again only to discredit views contrary to skeptic bias – citation on request) to conflate good and bad practices that supposedly have a Colorado address. If 4000 idiots advertize their services as being in Colorado (to increase their Google hit rate), and 20 legitimate services do so as well, then the average is that all Colorado providers are idiots. And then you cherry pick references that particularly offend you as a LOL to others on “S”BM. The actual, not-the-head-up-their-arses-biased scientists are not amused. You can do better. Do not fall victim to those who too easily accept any bad thing you say about your opponents.

    Try the discussion route.

  51. pmoran says:

    I would like to distance myself from some of the above statements.

    Medical interactions are complex and cannot be wholly described by our simple “working better than placebo”, physicochemical model.

    To say so is not the justification for pseudoscience that it inevitably gets portrayed as within skeptical circles. It merely states what we all suspect deep down, that we cannot always predict how psychological forces will affect the individual illness experience.

    Our bias stems partly from the undoubted critical importance of the physicochemical model within serious illness, but also the fact that we skeptics don’t want to have to confront the awful possibility that nonsensical explanations of illness and their associated treatment rituals may actually help some patients with some conditions even after “proper” medicine has failed to satisfactorily resolve them ( — for one of a number of possible reasons that don’t in any way invalidate the primacy of the science-based approach to medicine).

    So Harriet is right to be cautious. If I am right, it is not even clear that it would be an entirely good thing if CAM was completely abolished (you would not stop at naturopathy). In the very long term we would hope that advances in therapeutics and improvements in general “doctoring” would reduce the need for people to turn to anything else.

  52. tanha says:

    What do you folks think is the difference between a naturopath and an Integrative Family Medicine osteopathic doctor? I’ve never seen SBM folks criticize homeopathy and craniosacral in the osteopathic medical school curriculum or the integrative medicine fellowship programs?

    “Ladies, ladies. You are both incredible people and our community is fortunate to have both of your brains.”
    I wouldn’t necessarily put Harriet and Linda in the same category, especially if Linda thinks her “survey” is science- or evidence-based medicine.

  53. DrRobert says:

    @tanha, a “Web-site survey” is indeed not scientific in nature, but the results are nonetheless evaluable. I trolled and was trolled by a scummy chiropractic marketing website and it afforded me the opportunity to survey scummy chiropractors: http://morechiropatients.com/blog/chiropractic-marketing-articles/the-advice-prospective-patients-get-about-chiropractic Within the same thread, I read a plethora of chiropractic contradictions with these quacks telling me “we don’t treat disease!” and “we fix nervous system interference!” and “we fix subluxations to cure disease!” Is it to be said that my interaction with these nutjobs is outside the realm of things that can be commented upon? Similarly, these quack naturopaths are advertising things on their websites that they can’t possibly understand, let alone treat.

    Should we so quickly dismiss Mrs. Rosa’s survey as not “evidence based”? Honestly, if you consider a study in which surveys are performed, I would trust the results of a Web-site survey over a “fill in the blank, but it’s kinda obvious what I’m getting at” survey of practicing naturoquacks.

    @pmoran, I agree and disagree. I agree that naturopaths may sometimes say things that are considered “good advice”, but I do not believe naturopaths are capable of separating what may be considered good advice from advice that may indeed be lethal.

  54. Harriet Hall says:

    @tanha,

    “What do you folks think is the difference between a naturopath and an Integrative Family Medicine osteopathic doctor?”

    Big difference. In the US, DOs have equivalent training to MDs and are accepted into the same residency programs. Naturopaths do not have the same education: their training does not involve seriously ill patients in hospitals, surgery, or most prescription drugs, and they are taught many implausible things that are not taught in schools of osteopathic medicine. DOs start out with what they need to know to do good science-based medicine: some of them unfortunately fall for the “integrative” myths just as some MDs do.

    “I’ve never seen SBM folks criticize homeopathy and craniosacral in the osteopathic medical school curriculum or the integrative medicine fellowship programs?”

    That brings up a couple of good questions:
    1. I am not aware that homeopathy is part of the curriculum in osteopathic schools. Is it?
    2. In 2002, two osteopathic professors wrote “Our own and previously published findings suggest that the proposed mechanism for cranial osteopathy is invalid and that interexaminer (and, therefore, diagnostic) reliability is approximately zero. Since no properly randomized, blinded, and placebo-controlled outcome studies have been published, we conclude that cranial osteopathy should be removed from curricula of colleges of osteopathic medicine and from osteopathic licensing examinations.” I don’t know how many colleges are still teaching it. Do you? It has certainly been de-emphasized, and even manipulation has become a much smaller part of osteopathic practice and many recent graduates seldom use it.

    I think we all criticize homeopathy and craniosacral wherever it occurs. I particularly deplore the integrative medicine fellowships for physicians. Integrative and quackademic medicine have been addressed repeatedly on this blog.

  55. Linda Rosa says:

    JPZ –

    Colorado legislators are frequently asked to determine whether or not the “degreed” naturopaths should be licensed *as a group.* So the services that Colorado NDs have in common is germane to the question of licensure. Also the range of practices. Those “cherry picked references” are valuable in illustrating the far-flung range of bizarre practices and beliefs.

    I think you’re suggesting that this survey pool of NDs was not necessarily fellow “Coloradians.” With one exception, the subjects of the survey are all listed on the website of the Colorado Association of Naturopathic Doctors as “degreed” NDs practicing in Colorado, or they work with an ND on this list. I excluded some of these either because there was no information about their practice online, or because I found their only practice had a physical address outside of Colorado. Actually, after nearly 20 years of NDs seeking licensure in Colorado, I know a fair number of these people by name, face, and reputation.

  56. Harriet Hall says:

    In Linda’s defense, I don’t think she represented her informal survey as “science-based.” I don’t think there are any good published studies to go by. If you know of any information that contradicts what she found, please share with us. In the absence of rigorous studies, a survey like hers is surely better than nothing.

  57. gretemike says:

    For the person who was trying to find actual NPLEX questions, I can’t find them either but I did find instructions for getting a free NPLEX study guide if that would interest you. The instructions are at the top of this link:

    http://www.naturopathic.org/content.asp?admin=Y&contentid=496

  58. Larry Sarner says:

    @Harriet Hall: At the risk of not making myself clear, either, my take is the same as Abraham Flexner remarked, in his transformative survey of American medical education 102 years ago, about what he termed “sectarian medicine”: “[The] scientific method cannot be limited to the first half of medical education. The same method, the same attitude of mind, must consistently permeate the entire process. The sectarian therefore in effect contradicts himself when, having pursued or having agreed to pursue the normal scientific curriculum with his student for two years, he at the beginning of the third year produces a novel principle and requires that thenceforth the student effect a compromise between science and revelation.” (p. 157) Today’s naturopathic “medical” doctors have an education compromised in just the way that Flexner described a century ago. That is worth pointing out. But its explanatory value is diminished by conceding that these compromised practitioners coincidentally “do some good things,” for therein is an implicit acceptance of them as possibly reliable practitioners. With such slender threads, whole coats of legitimacy can be woven. In political tussles, such admissions are made at the peril of one’s position.

    Candidly, it matters not at all that some degreed NDs ever do anything right. Overall, they are by definition substandard practitioners of medicine. The logic of consumer protection — and specifically of professional regulation in the public interest — excludes them from the legitimate practice of naturopathy as medicine.

    @JPZ and @tanha: Linda’s survey discovers that the admitted practices of 88 Colorado NDs are pseudo-scientific in nature. It was inspired by a survey of Canadian NDs which made a similar discovery in 2010 (Caulfield & Rachul, “Supported by science? What Canadian naturopaths advertise to the public,” Allergy, Asthma, and Clinical Immunology, 2011 Sep 15; 7:14). Further, her survey is not an induction from a mere sample of a target population; as a review of websites for 88 of the reported 100 license-seeking NDs in Colorado, it is very nearly exhaustive. After proper analysis, I think her methodology and results could eventually warrant reaching the same conclusion as the Canadians in their peer-reviewed journal article, to wit: “A review of the therapies advertised on the websites of clinics offering naturopathic treatments does not support the proposition that naturopathic medicine is a science- and evidence-based practice.”

  59. DrRobert says:

    @Larry Sarner, thank you for that reference to the Canadian naturopaths, I had not seen that before.

    The “full” is here: http://www.naturowatch.org/general/ads.pdf

  60. daijiyobu says:

    Dr. Hall said: “I reject naturopathy not because I think it is 100% bad but because so many bad things are indiscriminately mixed with a few good things.”

    As a persistent ‘watcher’ of naturopathy globally [as long as it is English language based!!!], I regard the ‘good’ that they do as camouflage for the ‘bad’ / essentially naturopathic.

    The scientifically-supported ‘good’ is equated with what is, truly, the science-ejected ‘bad’ as a requirement in naturopathy. Just look at the principles page of the Oregon Board of Medical Examiners, which states that things like homeopathy [and the supernatural!] survive rigorous scientific scrutiny.

    I’ve termed the antithought process epistemic conflation, the blending of knowledge types. I’ve termed the effect licensed falsehood.

    Their general MARKETING label is “science based natural medicine”, and yet you find that TRULY their claim is the absurdity: science subset nonscience. And government sanctioned.

    This is quite easy to show.

    I argue that naturopathy is a form of racketeering [though I don't want SBM to get in trouble for that language, as it is my language, I emphasize] and not merely unfair trade: a racket is when a fake problem is created by a person who then offers the solution, for personal gain. I think you can add the idea of ‘something systematic / instituted’, like a mob apparatus or an education apparatus, because I think racketeering is specific to RICO.

    So, when naturopathy claims that they are different from the regular physicians because they don’t merely treat the symptoms but the cause, they are engaging in racketeering: they are saying only we have the TRUE answer, and if you persist with THEM you will continue in your suffering.

    What’s interesting is that the problem created is FALSE [medical science is most often about 'the thing itself' and its DIRECT treatment, first and foremost, when possible] and naturopathy’s solutions are truly FALSE. Like detoxification, food as medicine, homeopathy, craniosacral therapy, NAET, Bowen, megasupplementation, herbal tinctures that have no hematic presence, applied kinesiology, NLP etc.

    It is a complete TRAVESTY in terms of doctoral level science education, because it is a mockery of science, thought, medicine, anylsis, and the like.

    -r.c.

  61. Harriet Hall says:

    It is not “good” for an ND to recommend good things in the context of a pseudoscientific discipline, but the good things he recommends are undeniably good in themselves. If we are so dogmatic that we categorically refuse to ever use the word “good” in association with anything an ND does, even when he recommends the same preventive health measures that MDs do, it makes us sound like denialists and we risk losing all credibility with those we are trying to persuade.

  62. David Gorski says:

    If we are so dogmatic that we categorically refuse to ever use the word “good” in association with anything an ND does, even when he recommends the same preventive health measures that MDs do, it makes us sound like denialists and we risk losing all credibility with those we are trying to persuade.

    Indeed. Just as there’s a fine line between being open-minded and being so open-minded that one’s proverbial brain falls out (one, ironically enough, that I flirted with just this week in my post), there’s a fine line between being properly skeptical and close-mindedness. As someone who’s been accused on multiple occasions of being close-minded and too dogmatic in my routine excoriations of CAM/IM, I find it rather amusing now to be accused of being too open-minded based on my most recent post and now to be arguing against excessive dogmatism here by coming firmly down on Harriet’s side in this one (although it’s really hard for even an old “dogmatic, close-minded” CAM opponent like myself not to take such a tack when I see statements like “it matters not at all that some degreed NDs ever do anything right” because even if the issue is consumer protection it does matter, at least a little).

    At this rate, I’ll be soon declaring myself in complete agreement with Peter Moran on everything and extolling the virtues of placebo effects. :-)

  63. tanha says:

    Harriet, your post was quite interesting. Thanks for your comments.

    “Big difference. In the US, DOs have equivalent training to MDs and are accepted into the same residency programs. Naturopaths do not have the same education: their training does not involve seriously ill patients in hospitals, surgery, or most prescription drugs, and they are taught many implausible things that are not taught in schools of osteopathic medicine. DOs start out with what they need to know to do good science-based medicine: some of them unfortunately fall for the “integrative” myths just as some MDs do.”

    I have two cousins who went to medical school in 1996. One who got a 24 on the MCAT went to Western University (a DO school in California) and the other who received an MCAT score of 35 who went to Bastyr (ND school in Washington). Both purchased the same basic science books (ask the ND student to list out the science books she had to read ), both dissected cadavers in their first years, took OSCE exams in their last year, and 2 board exams before graduation. The ND student got most of her training in an out-patient facility while the DO student got most of his in hospitals. Interesting though, the Western University students have to do a couple of 12 week out-patient osteopathic medicine rotations — one of which is an expensive cash practice in Santa Monica that was strictly THERAPEUTIC TOUCH and cost patients $700 per visit. Holy shit! And someone here thought the $100 ND visits were expensive. But you are right, the DO student got into a residency program while the ND student did not get into one (because shockingly there are not enough openings for the number of students who graduate). And I see that as huge shortcoming in the ND education.

    To answer your question, YES the osteopathic student learned about homeopathy and craniosacral and therapeutic touch as part of his curriculum and this isn’t because of a “new wave” of CAM interest. It is because that’s what differentiates DOs from MDs.

    I don’t see how they don’t have the same training. The only difference I see is that DOs don’t study herbs or nutrition. Otherwise they are the same as far as medical school, and begin to differ vastly with post-graduate training. I believe that its only a matter of time before NDs will be excepted into hospital residencies. My relative tells me that their was an ND accepted into a cardiology fellowship in Arizona and and an ND that did a residency at the Yale Griffith hospital. Bastyr residents take shifts with University of Washington family medicine residents in hospitals. Again NDs and DOs are not very different. I appreciate your attempt to not have such a dogmatic outlook.

  64. Harriet Hall says:

    @tanha,
    I am appalled that homeopathy is part of the DO curriculum. How many schools? Is it required or elective?
    There is no way that NDs can qualify for medical residency programs. Do you have any information about the two cases you describe? I expect there is more to those stories.
    Bastyr students may be following family medicine residents around, but I doubt that they are responsible for treating patients.
    Despite some superficial similarities that may appear to outsiders, NDs and DOs are far apart in their education and their philosophy.

  65. DrRobert says:

    @tanha, I suspect that you either misunderstand or were given faulty information. There is no way a ND was accepted into a cardiology fellowship because it requires having completed an internal medicine residency, which a ND would never possibly qualify for, due to a number of reasons, such as not possessing the M.D. or D.O. degree, and having to take the USMLE Step series. You can’t “challenge” the USMLE. Ie, you can’t just study all day and sign up to take the tests and then you’re a doctor. You absolutely must have certain credentials before applying for the exams, such as graduating from a US medical school, or if you’re a foreign doctor, graduating from a medical school approved by the ECFMG. There is no way that NDs are “taking shifts” with family medicine residents. NDs have no such training that would remotely allow them to function in a hospital. As Dr. Hall said, perhaps they are just shadowing/observing, which really means nothing. I also don’t believe someone scored a 35 on the MCAT and went to ND school.

  66. Chris says:

    My son spent two nights at the UW hospital, being admitted via the emergency department. We saw a family practice resident, a neurology resident and several other doctors in and around the hospital, including one attending doctor being followed around by a gaggle of interns who came into my son’s room. Absolutely none of them of NDs.

  67. gretemike says:

    The pro-ND camp seems to be in the awkward position of trying to look as much as possible like an MD (touting their supposed similar training) which necessarily downplays everything that makes NDs unique. I am not a doctor and cannot use my own experience to determine whether NDs have as much basic training as a MD. I can, however, use reliable sources to look at what makes NDs different (via Bastyr’s curriculum, the Vermont naturopathic drug guidelines, etc.). What I see is a lot of homeopathy, colloidal silver, “non-toxic pharmacology” (which is evidently meant to be the opposite of chemotherapy), and so forth. And although I’m not a doctor, I’m educated enough to understand why those concepts are bogus. So ultimately the question of whether or not MDs and NDs have the same basic education is irrelevant. What is relevant is that the stuff that makes NDs different than MDs is nonsense.

  68. tanha says:

    Harriet, I’m sorry. I can only speak of what I’ve learned from my relatives. I don’t know a thing about the other DO schools. …I asked for names. Decker Weiss is the ND that apparently completed a cardiology fellowship. Google can give you more info. The Yale Griffin hospital info can be found here: http://www.imc-griffin.org/Staff.htm

    Chris, I’m sorry to hear your son was hospitalized… From what I was told the UW/Bastyr residents have shifts together at community medical centers and not in hospitals, where they see patients independently. There is no reason for me to believe my relative is lying about the UW/Bastyr residents.

  69. tanha says:

    “What is relevant is that the stuff that makes NDs different than MDs is nonsense.”

    Gretemike: you are mistaken if you believe homeopathy, colloidal silver, etc are only upheld by NDs. Some of the most outspoken “CAM therapy” proponents are DOs and MDs (think Joseph Mercola, Mehmet Oz, etc).

    I google “colloidal silver and MD”, and look — http://drlwilson.com/Articles/SILVER.HTM — an MD that is encouraging its use! You can also google “homeopathy and MD” and again get a ton of hits on MDs that practice homeopathy.

  70. tanha says:

    And gretemike, I have to include this gem: http://www.umm.edu/altmed/articles/homeopathy-000352.htm

    Best quote from the University of Maryland Medical Center:

    “Does my medical insurance usually cover homeopathy?
    Insurance companies are more likely to cover homeopathy when the person providing the service is a licensed health care professional, such as an MD or DO who also practices homeopathy.”

    And would you look at that impressive reference list.

  71. tanha says:

    And lastly, LindaRosa in all the time you spent googling errrr I mean “researching”, did you come across the University of Colorado HOSPITAL website. Check out the services offered, which includes mind-body medicine and herbs:

    http://www.uch.edu/conditions/integrative-medicine/#ServicesConditions

  72. Harriet Hall says:

    @tanha,

    No one has said that “homeopathy, colloidal silver, etc are only upheld by NDs.”
    Please, no “tu quoque” arguments! We are well aware that some MDs espouse nonsense. Some medical schools even teach it. Quackademic medicine is an unfortunate development, and this blog constantly points out bad examples and tries to combat the trend. The point is that mainstream medicine is largely based on good evidence and aspires to be ever more science-based, while the education of NDs systematically encourages nonsense.

  73. tanha says:

    Please, no“tu quoque” arguments!

    Harriet, my point is that I don’t see the difference between naturopaths, osteopaths and and MDs that practice Integrative Medicine. (With the assumption that what I’ve learned about their medical training and residencies to be correct).

  74. Harriet Hall says:

    @tanha,
    “I don’t see the difference between naturopaths, osteopaths and and MDs that practice Integrative Medicine.”

    Admittedly, when DOs and MDs act like NDs, there isn’t much difference!

    The biggest difference is that the education of NDs systematically encourages unscientific nonsense, while the education of DOs and MDs does not. And another big difference in education is that NDs miss out on the experience of treating seriously ill inpatients in hospitals: they do not have that base of knowledge and experience to support their judgment, so they are more likely to miss diagnoses and treat improperly.

  75. Larry Sarner says:

    @David Gorski,

    t doesn’t matter — not even a little bit. As Linda has been trying to explain, they are not *qualified* to perform even those things that would be “good” (by definition if something that might be done by a qualified MD). Harriet has stated flatly — maybe even dogmatically — that it must be acknowledged that NDs sometimes might do things that an MD would do with the same clinical presentation. Why that doesn’t matter *at all*, is that there is no reasonable way to predict what an ND will do in any given clinical presentation. They are not MDs. They are not trained liked MDs. They do not know what MDs know. Above all, they do not think like MDs. A good thing in their hands could be inappropriate or dangerous. It’s a crap shoot for the patient.

    This part of the debate goes to the very heart of social responsibility. Imagine if you will a med-school grad who knows enough to do some “good things”, but who happens to not have sufficient medical judgment to pass the licensing exam. Is it close-minded of regulators to not hand out the license? Why is it dogmatic to say that it doesn’t matter — even a little — that while the candidate demonstrated knowing some good things, he still has no business going anywhere near a patient?

    And to suggest that sometimes an ND will do the right thing is to leave the door open for their apologists to suggest that there is some wiggle room in the scientific position, or that since NDs are “sometimes good” means that politicians should not “throw out the baby with the bathwater”. I’ve been around the legislative block in chaotic Colorado enough times to know how the butterfly effect can magnify one’s slightest utterance into a legislative rout.

    Dogma is having belief trump reality. In this case, it is not Linda who is guilty of that, as has been darkly hinted.

  76. Larry Sarner says:

    Replying to @tanha:

    One big difference between DOs and NDs is that DOs qualify to take, and then pass the medical licensing exam. In other words, they qualify to be physicians. Their education and clinical residencies must prepare them appropriately; naturopathic education and clinical experience obviously does not do this. Another big difference is that after DOs get their licenses, they are held to objective standards of practice. There is some social accountability that yanks hard at them from practicing anything that smacks of substandard medicine; naturopathic standards is an oxymoron.

    Linda didn’t have to google to know about CU med-school’s lamentable flirtation with CAM; it’s been around for awhile now. A couple of years ago, I attended a lecture there by an ND who was pushing naturopathy and the latest licensure effort. Before you press “send” on another google search, let me scoop you with another revelation about Colorado’s “higher” education system. One of the NDs in Linda’s survey is an adjunct faculty member at Denver’s Metropolitan State College (which wants to rename itself Metropolitan State University). He is also the faculty advisor (and maybe organizer) of MSC’s “Pre-ND Club”.

  77. Harriet Hall says:

    I still say “it must be acknowledged that NDs sometimes might do things that an MD would do with the same clinical presentation”

    If there is anything dogmatic about that, I don’t see it. I think it would be dogmatic to refuse to acknowledge it.
    When a proponent points out that an ND recommended something similar to what MDs recommend, we can’t say no he didn’t, we must say yes he did BUT.

    Obviously, it is bad if he accompanies those good things with other things that are bad, or if he fails to do other essential good things along with them, or if he does the good things for the wrong reasons and gives his patients nonscientific misinformation about the rationales.

    I think we are getting hung up on the difference between an accurate statement of fact and inaccurate interpretations of the implications of that fact.

  78. daijiyobu says:

    gretemike said “the pro-ND camp seems to be in the awkward position of trying to look as much as possible like an MD”:

    Actually, take a look at this web page from Iowa. The ND crowd has a bill for licensure going through their state legislature presently (see http://www.iowand.org/aboutus.html ).

    They so wish to resemble MD in title that they say:

    “our goal is to create and maintain legislation that allows full scope of practice for naturopathic physicians (ND and NMD) within our level of training [...] Jessica Curcio, NMD — President.”

    NMD, MD, ND … caveat emptor [like a used car lot].

    In other words, watch how medicine, in my view, is losing its professional status because the contents can no longer be trusted to serve the patient from a position of ‘knowledge integrity’ / trust.

    -r.c.

  79. JPZ says:

    @Linda Rosa

    I have to say that you provided a clear and well said POV to counter my comment. Very well done, and thank you for providing your insights!

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