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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

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