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Licensing Naturopaths: the triumph of politics over science

Naturopaths shouldn’t get too excited about having a special week in their honor. The U.S. House of Representatives gave watermelons a whole month. As between naturopathy and watermelons for my good health, I’ll go with the watermelons any day. You’ll soon understand why.

Today is not my usual blogging day. But when David Gorksi announced SBM’s celebration of Naturopathic Medicine Week, I volunteered an extra post to answer the question I am sure is on everyone’s mind: How in the heck do they get away with this stuff?

The answer lies in the creation of Naturopathic Medicine Week itself: politics. Just as Sen. Barbara Mikulski turned her credulous acceptance of naturopathy into a Senate Resolution and slipped it by her Senate colleagues, clueless legislators around the country are sponsoring bills to license naturopaths, in some cases as primary care physicians. And it’s not as if these legislators don’t know they are incorporating quackery into primary care. Practices such as naturopathic “organ repositioning” (an anatomical impossibility) and Mark Crislip noted, what little data there is suggests that naturopathic primary care is associated with worse outcomes. But evidence is not necessary in the political realm. And now the political process has given naturopaths an additional incentive for licensure. They argue that the Affordable Care Act mandates reimbursement for their services.

Naturopaths are far short of their goal even though licensing bills have been introduced repeatedly in many states, only to fail. Naturopaths are licensed in 17 states, but have full prescription rights in only two, Oregon and Washington. Florida, my home state, is still on their wish list but no bill was introduced this year. (Florida actually rescinded naturopathic licensing in the 1950s.) Inquiries were made, but either they couldn’t find a sponsor or backed down for other reasons. Perhaps they were deterred by the specter of their previous attempt, which resulted in a Florida House Committee report concluding that “the proposed licensure of naturopathic physicians would likely increase the risk of harm to the public.”

In 2013, licensing bills were introduced in 10 states. So far, the naturopaths are one and four.

Licensing bills failed in Arkansas, Maryland, Rhode Island and North Carolina, but are pending in six others, Illinois, Massachusetts, Michigan, New Jersey, New York and Pennsylvania. Bills passed in the New York Senate and Pennsylvania House and are now pending in the other chamber. Key legislation expanding scope of practice or insurance coverage failed in Oregon, Alaska, Montana and Hawaii. In addition, the Alaska Department of Commerce, Community and Economic Development recently took away their authority to use “prescriptive nutrients.”

Colorado: “I’ll be back!”

After numerous failed attempts over two decades, the Colorado legislature passed a naturopathic registration (but not licensing) bill. The naturopathic lobbyists weren’t exactly straight with the legislators in this process. Naturopaths handed out a chart purporting to demonstrate that their education is at least equal to that of medical doctors. As you can see, the chart is based on the false assumption that somehow hours of education equates with quality of education. (On this same basis, I can make the argument that high school and college are equivalent.) Even assuming that is a proper basis for comparison, the chart totally misrepresents medical education and training by leaving off the additional three years of residency family practice and internal medicine physicians must undergo before they can practice.

Actually, what this chart convincingly demonstrates is that a good part of naturopathic education is eaten up with topics like homeopathy (110 hours), botanical medicine (herbs and dietary supplements, 110 hours), and Chinese medicine (160 hours). This is most interesting considering advice just out from the American College of Medical Toxicology and the American Academy of Clinical Toxicology (“Physicians Specializing in the Care of Poisoned Patients”).

Don’t use homeopathic medications, non-vitamin dietary supplements or herbal supplements as treatments for disease or preventive health measures.

When two groups whose collective motto is “Physicians Specializing in the Care of Poisoned Patients” tell us not to take something I think we all should listen, don’t you? Unfortunately for naturopaths, this pretty much wipes out the standard naturopathic formulary. Not that it will have any effect whatsoever on actual naturopathic practice, as they eschew evidence-based medicine.

But having granted them the privilege of practicing naturopathic medicine, the Colorado legislature had to go back and pepper the bill with all sorts of limitations in an attempt to satisfy the objections of those who think NDs present a danger to public health. This resulted in a scope of practice that falls far short of that accorded MD primary care physicians:

  • naturopaths are not licensed to practice, they are simply registered
  • must advise patients they are not medical doctors
  • cannot describe themselves as “physicians,” naturopathy not described as “primary care”
  • no prescription drugs and no telling patients to discontinue their medications
  • no treatment of children under two without an elaborate process in place to ensure they are also seeing a pediatrician and get the recommended vaccinations
  • must advise patients to have a medical doctor and attempt to coordinate care with same
  • no obstetrics
  • no independent supervisory board, advisory board only consisting of 3 NDs, 3 MDs, one pharmacist and 2 public members

Thus, while NDs may think they are primary care physicians, the State of Colorado most certainly does not agree. Now, you’d think the average person might pause to wonder: if naturopaths are telling the truth about their education and practice, why all the restrictions? Maybe that should tell Coloradans something. They vow to return to expand their scope of practice, a cautionary tale for states wishing to test the waters by giving NDs a limited scope of practice.

Still, there is plenty of room for mischief and the Colorado NDs seem to be making the most of it, even though full implementation of the law was delayed until June, 2014. They are, despite all evidence that they shouldn’t, busy selling patients on the idea that homeopathy and dietary supplements are beneficial.

And they are testing, testing, testing to find illusory problems they can treat. They’re using provoked urine tests to identify the ubiquitous toxins NDs claim permeate our bodies so that they can treat this imagined toxic overload with chelating agents. Here’s what the “Physicians Specializing in the Care of Poisoned Patients” have to say on that subject:

Don’t administer a chelating agent prior to testing urine for metals, a practice referred to as “provoked” urine testing.

Don’t order heavy metal screening tests to assess non-specific symptoms in the absence of excessive exposure to metals.

Don’t recommend chelation except for documented metal intoxication which has been diagnosed using validated tests in appropriate biological samples.

Why?

Chelating drugs may have significant side effects, including dehydration, hypocalcaemia, kidney injury, liver enzyme elevations, hypotension, allergic reactions and essential mineral deficiencies. Inappropriate chelation, which may cost hundreds to thousands of dollars, risks these harms, as well as neurodevelopmental toxicity, teratogenicity and death.

Seems like a high price to pay for a problem that doesn’t exist.

But that’s not all. Colorado NDs are testing blood and saliva so they can diagnose and treat “adrenal fatigue,” another imaginary condition (as explained here by the Mayo Clinic) with dietary supplements and strict dietary regimens. They are testing for “food toxicity” because “if you have one or more these symptoms, there is a 95% probability you’ll benefit from a food toxicity test.” This is followed by an impressive list of symptoms that makes one wonder what wouldn’t be a symptom of “food toxicity.” They is “genomic testing to determine genetic need for specific nutrients,” another dubious test debunked by Quackwatch. They are testing blood to measure IgG response to a wide selection of foods which, in the alternative reality of alternative medicine, raises the possibility of digestive problems. (Scott Gavura: “These tests lack both a sound scientific rationale and evidence of effectiveness.”)

The Quack Full Employment Act

We can’t leave Colorado and head east without mentioning the Natural Health Care Consumer Protection Act, or, as I prefer to call it, the Quack Full Employment Act, which also made it through the legislature and was signed into law by the governor. Apparently, this was a sop thrown to the traditional naturopaths in exchange for their not opposing the naturopathic doctors getting their registration act passed. It allows traditional naturopaths to continue practicing without fear of being charged with practicing naturopathy without a license. Although they use many of the same methods, traditional naturopaths don’t make any claim they are able to practice primary care medicine.

The Quack Full Employment Act is another one of those “health freedom” laws designed to allow anyone to practice medicine. All you have to do is avoid claiming you are practicing medicine and using medical terms. You can use made-up terms, though, and made-up treatments. Here is my take on the bill before its unfortunate transformation into actual law:

Let’s put this all together and see just what would happen should this bill become law. Virtually anyone can set up shop without any education or training in health care whatsoever, or a worthless on-line certificate if they prefer, and practice complementary and alternative “health care and healing arts therapies and methods.” They can see anyone who walks in the door, no matter how sick. They can provide any unconventional disease diagnosis they want, including making up diseases and conditions that don’t exist. CAM practitioners can then proceed to practice virtually any “healing arts therapies and methods” they can dream up, including recommending various nostrums that they then sell to the consumer. They have no duty to provide informed consent, no education and training in recognizing the need to refer to a physician and no duty to refer to a physician. And even if the CAM practitioner is injuring his “clients” right and left, the medical board must sit on its hands and do nothing as long as the CAM practitioner complies with a few rules. The board has no authority whatsoever to step in and stop it. Unlike every licensed health care professional in Colorado, who must answer to a regulatory authority, the unlicensed practitioner answers to no one.

Now the takeover of Colorado by quackery is complete.

Organ repositioning: an update

Let’s zip across the country to Pennsylvania, where a bill to license naturopaths as primary care physicians passed the House and is now waiting to be assigned to a Senate committee. I covered the bill’s provisions in “Naturopathic Organ Repositioning Coming Soon to Pennsylvania?

One thing not mentioned in that post was the bill’s sponsor Rep. Mark Mustio’s statement touting the fact that Cancer Treatment Centers of America employs naturopaths, a subject David Gorski thoroughly explored on Monday. Someone might wish to point out to Rep. Mustio that what CTCA permits its NDs to do is far narrower than what this bill would allow. CTCA NDs are under the supervision of medical doctors and allowed a very limited input into patient care. Even the ND-friendly CTCA doesn’t allow them to see patients on their own and certainly not in the capacity of a primary care practitioner. In fact, they don’t even refer to them as “doctors” or “physicians” in their naturopathic medicine section. They are “naturopathic clinicians” who are part of “your overall care team.” And I don’t see any reference to CTCA’s offering organ repositioning, fasting, detoxification, magnetic therapy, and any number of other naturopathic treatments NDs would be licensed to use if this bill passes.

As was true in Colorado before their registration act was passed, Pennsylvania naturopaths are already practicing naturopathy even without a license to do so. Their websites offer a window on what naturopathic practice would be like if they are licensed, likely multiplied by many more naturopaths attracted to one of the few states where they can legally practice. And a bill licensing them as primary care practitioners would surely expand the liberties they are already taking with their, shall we say, questionable practices.

Here we find ourselves in familiar territory. Pennsylvania naturopaths are advising patients to take dietary supplements, botanicals, and homeopathic remedies for their medical conditions despite overwhelming evidence that this is inappropriate. They are also “detoxifying” patients with fasts, as well as colon hydrotherapy and detox foot bath. They offer “flower essences to “energetically address emotional and mental issues.” One Pennsylvania naturopath claims to treat almost 50 different diseases and conditions on her website, including cancer, endometriosis, glaucoma, thyroid disease and HIV/AIDS. (I am not sure how one gets away with this without a license to practice a health care profession.) Another purports to have expertise in advising parents about childhood vaccinations, including holding this “workshop” for parents, even though naturopaths cannot legally administer vaccinations and naturopathic care is associated with lower vaccination rates and greater incidence of certain vaccine-preventable diseases.

A recent graduate of Bastyr, a naturopathic “medical school,” is a certified BioEnergetic Medicine Practitioner, an honor bestowed by a company selling homeopathic remedies and dietary supplements. A BioEnergetic Assessment is described as “one of the most exciting tools in the field of integrative health care because of its flexibility in identifying a specific and wide range of energetic imbalances.” From the company’s substantial offering of homeopathic remedies, nutritionals (glandulars, herbal cleanse formulas, enzymes and such), and botannicals (e.g., “spagyrically processed Chinese botanical blends”), I offer these examples of what a BioEnergetic Medicine Practitioner might use, after a properly conducted BioEnergetic Assessment, one assumes.

Circulopath: a complex blend of homeopathic remedies specifically designed to target the increase of circulatory flow (blood, lymph and interstitial fluid) in the tissue, organs and systems of the body.

And:

Adaptopath: an essential homeopathic remedy for boosting underpowered healing strategies by enhancing the body’s ability to adapt to stress.

As well, this naturopath employs a “Cellular Expansion Practitioner” whose clients “receive gentle and nurturing energy to address a wide array of health issues, including chronic pain, headaches, depression, weight loss, anxiety and infertility.” I’m no biologist, but “cellular expansion” doesn’t sound like a good idea at all. What if the cells expand too much?

Keep all of this in mind as you contemplate the Pennsylvania licensing bill’s definition of “naturopathic medicine:”

A system of primary health care practiced by doctors of naturopathic medicine for the prevention, diagnosis and treatment of human health conditions, injuries and diseases.

In other words, these naturopaths would become “primary care” doctors whose scope of practice covers the diagnosis and treatment of all patients, no matter what age and no matter their disease or condition. Can you imagine someone who thinks a BioEnergetic Assessment is a proper diagnostic tool and homeopathic remedies can treat cardiovascular disease seeing a patient as his primary care doctor?

And a few more things . . .

During my almost year-long monitoring of naturopathic licensing bills it has become increasingly clear that legislators are willing to unleash healthcare practitioners on the public who have no business seeing patients on their own, if they have any business seeing patients at all. This appears to be caused by two things.

One, they don’t have sufficient understanding of even basic science, which would otherwise make them instantly suspicious of any bill that included, for example, “magnetic therapy” or “organ repositioning” as a treatment. After all, one doesn’t need to be an organic chemist to understand why homeopathy cannot and does not work. Heck, I never even took chemistry and I understand it.

Two, they haven’t done the least bit of independent research to determine whether licensing naturopaths is in the best interest of the public health, safety and welfare. These bills are obviously written by naturopathic lobbyists and reasons for their adoption, if any are given at all, simply parrot the party line about naturopaths attending “accredited four year graduate medical programs,” their supposed ability to practice primary care, their use of “natural” therapies to support the “body’s intrinsic healing abilities,” and so on. Their constituents deserve better.

Posted in: Cancer, Energy Medicine, Herbs & Supplements, Homeopathy, Legal, Naturopathy, Politics and Regulation, Traditional Chinese Medicine

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