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Change.org Petition: “Naturopaths are not physicians: stop legitimizing pseudoscience”

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Britt Hermes, a graduate of the naturopathic college at the alternative medicine-focused Bastyr University, renounced her practice as a naturopathic doctor when she could no longer tolerate the pseudoscience and patient harm that characterizes naturopathy. On this blog and her own, Naturopathic Diaries, she has chronicled the insufficient education and training students receive before being allowed to practice as naturopathic doctors, deficiencies which all too readily can result in patient harm.

Her activism is not confined to blog posts. Her advocacy helped prevent an expansion of naturopathic prescribing privileges in North Dakota in 2015. Just this past Friday, she participated, as did I, in a presentation via conference call to the Colorado Department of Regulatory Affairs (DORA), organized by the Colorado Citizens for Science in Medicine. DORA will soon issue a report on the continued registration of naturopaths in that state. In her testimony, Britt told how her own naturopathic education and training made her woefully unprepared to practice.

A number of SBM commenters have wondered how they could do more to combat naturopathic efforts to become licensed as health care providers in all 50 states, as well as participating in Medicare, Medicaid and other publicly-funded programs. Britt just started a Change.org petition urging policy makers and legislators to “stop legitimizing pseudoscience.” She also posted some excellent talking points to rebut the misleading information naturopaths give lawmakers when lobbying. You can help by using the talking points in combating legitimization of naturopathy through licensing and inclusion in public insurance programs. You can also help by signing the petition and sending it around to others on your social media accounts.

Posted in: Announcements, Legal, Naturopathy, Politics and Regulation

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Nobody licenses quacks in my state! HB 4531 and the licensing of naturopaths in Michigan

NOTE: Anyone who has seen several derogatory articles about me on the web and is curious about what the real story is, please read this and this.

Just as nobody steps on a church in Peter Venkman's Manhattan, nobody licenses quacks in my state...I hope.

Just as no giant marshmallow man steps on a church in Peter Venkman’s Manhattan, nobody licenses quacks in my state…I hope.

Over the years, I’ve taken care of women with locally advanced breast cancer so advanced that it’s eroded through the skin, forming huge, nasty ulcers filled with stinky dead cancer tissue that’s outgrown its blood supply, leaving the patient in chronic pain. If the patient is fortunate, her cancer has not metastasized beyond her axillary lymph nodes (the lymph nodes under her arm), and her life might still be saved by a combination of chemotherapy, radical surgery, and radiation. If the patient is not fortunate, either the cancer has metastasized and she is doomed or hasn’t metastasized yet, but it’s invaded into the chest wall and the nerves in her axilla (the structures under the arm), making it impossible to remove surgically but not likely to kill her any time soon. In the latter case, chronic pain, infection, and blood loss is what the patient will look forward to until the cancer either metastasizes or invades a vital structure. Fortunately, I’ve only seen a handfull of these patients over the last 20 years. Fortunately, the number of such patients I’ve seen and taken care of has been small.

I fear that, before long, I’m going to bee seeing a lot more of them. Leave it to Jann Bellamy to wake me up to that possibility.

I’m referring, of course, to her post last week about yet another attempt by naturopaths to expand their scope of practice. Worse, this is happening in my state through Michigan House Bill 4531, which has been approved by the Michigan Committee on Health Policy and referred to the full House for consideration. Yes, of these patients I’ve seen with horrific neglected breast cancers, at least half of them had relied on naturopaths before they came to the attention of real oncologists and surgeons. The last time I wrote about naturopaths trying to expand their scope of practice in my state was in 2013 in the form of a bill that was not as broad as HB 4531, namely HB 4152. Fortunately, it went nowhere and, in contrast to HB 4531, didn’t even make it out of the Committee on Health Policy.

Although Jann has already ably discussed the bill and occasional Science-Based Medicine (SBM) contributor Peter Lipson has referred to naturopaths as fake doctors in white coats (which is true), as well as why naturopathy is unscientific and how he as a primary care internist not infrequently has to clean up the messes left when local naturopaths treat patients incompetently, this is my state, and I can’t help but chime in myself. What I will try to do is to predict what the potential consequences will be if HB 4531 passes and expands the scope of practice to be nearly as broad as that of MDs practicing primary care medicine. I will do that by looking at real world examples of naturopathic shenanigans and disasters both within our very own state, because these are the people with whom the reins of primary care will be shared if HB 4531 were to pass.
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Posted in: Homeopathy, Naturopathy, Politics and Regulation

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Legislative Alchemy: Michigan House Bill 4531 gives naturopaths a broad scope of practice

Legislative Alchemy

Legislative Alchemy

Michigan House Bill 4531, if passed, would give naturopaths one of the broadest scopes of practice in the U.S., essentially equaling that of a family practice MD or DO. The bill made it through all the necessary House committees and is now before the House for an initial vote determining whether it will proceed further in that body. If it passes there, it will move to the Senate and its committee process.

Most naturopathic licensing bills fail, even in those states where attempts are made year after year. Michigan is no exception. Both David Gorski (a Michigan resident) and I discussed the previous licensing attempts there. In the two states where naturopathic licensing or registration has succeeded in the last few years, they have been able to get only a much more limited scope of practice than the full primary care scope they desire. For example, in Colorado, there are severe limitations on naturopaths’ seeing pediatric patients. They must disclose they are not physicians, recommend to parents that their children have a relationship with a licensed pediatric practitioner, and give parents the CDC-recommended vaccination schedule. All this is to thwart their efforts to talk parents out of vaccinating their children by giving them “balanced” information that is actually full of anti-vaccination dog whistles.

In Maryland, where naturopaths are regulated by the Maryland Board of Physicians, they cannot call themselves physicians or claim to practice primary care. They must have a collaboration and consultation agreement with an MD or DO and attest to the Board that the ND will “refer patients to and consult with physicians and other health care providers.” NDs must also have patients sign a consent form stating that the ND’s practice is limited to the scope of practice allowed by law. They cannot deviate from what is termed “safe care of patients” whether or not actual injury to a patient is established.

If passed, HB 4531 would be a radical departure from that trend. This newfound success in moving the ball forward may be due to an influx of funds from Emerson Ecologics, a company that sells dietary supplements and homeopathic remedies to naturopaths for resale to their patients. The company also sells the sort of dubious diagnostic tests used by naturopaths in their practice. For example, they offer a test for “adrenal stress” (to discover, not just “adrenal fatigue,” but actual “exhaustion”) and a saliva test for hormone levels as an indicator of the need for “bio-identical hormones.” (Neither the test nor “bio-identical hormones,” which is actually a marketing, and not medical term, are recommended in evidence-based medical practice.) In March, Emerson Ecologics announced a “grant” to the Michigan Association of Naturopathic Physicians (MANP) of $10,000 to support the effort to obtain full licensure for naturopathic doctors in Michigan.
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Posted in: Legal, Naturopathy, Politics and Regulation

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Is there a naturopathic standard of care?

Stephans
Public outcry over the death of Ezekiel Stephan, the 19-month-old Alberta toddler who died of bacterial meningitis in 2012, continues to grow following last’s weeks court decision, which found both of his parents guilty of failing to provide the necessaries of life. David and Collet Stephan failed to seek appropriate medical care for their obviously-ill child, instead relying on a variety of vitamins, supplements, and remedies from the family’s own home business, Truehope Nutritional Support. While sentencing will not take place until later this year, David Stephan hasn’t hesitated to lash out with an open letter to the jury that suggests he remains unrepentant for the series of decisions that led to the death of his son:

I only wish that you could’ve seen how you were being played by the Crown’s deception, drama and trickery that not only led to our key witnesses being muzzled, but has also now led to a dangerous precedent being set in Canada.

The precedent referred by Stephan seems to his perceived “right” to prioritize his beliefs in what is demonstrable pseudoscience and quackery over the “right” for his child to receive appropriate medical care. Ezekiel had never seen a physician. He had received no vaccinations, including vaccination against Haemophilus influenza type b (Hib), a vaccine which protects against bacterial meningitis. And as he lay dying, the parents chose to use an Echinacea tincture recommended by a naturopath, Tracey Tannis, who never even examined Ezekiel. Given the involvement of Tannis in this tragedy, there are renewed questions about naturopathy in Canada, whether naturopaths are capable of self-regulation, and the standard of care they provide. (more…)

Posted in: Naturopathy, Science and Medicine

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Parents Convicted in Death of Toddler

Stephans

David and Collet Stephan, parents to the now-deceased Ezekiel Stephan.

This is a very sad and tragic case, and I have great sympathy for the extended family of Ezekiel Stephan, the 19-month-old who died of meningitis four years ago. In my opinion, there are many victims in this case.

The jury, apparently, agreed. Yesterday they returned a guilty verdict for Ezekiel’s parents, David and Collet Stephan, who now face sentencing for failing to provide the basic necessities of life to their son. It is reported that many of the jurors were crying when the verdict was given – clearly this was a difficult and emotional case.

Just the facts

As is often the case, there are different narratives of what happened, depending on your perspective. It is likely the jury had access to more facts than the public, and so their verdict, which was clearly difficult, needs to be taken seriously. Here are the basic facts as being reported:

In March of 2012 Ezekiel became ill with flu-like symptoms. His parents report that they thought this was a normal childhood illness and would pass. His mother reported to police that she thought he had croup. They treated him with natural remedies, mostly supplements. (more…)

Posted in: Ethics, Herbs & Supplements, Naturopathy

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Regulating CAM Aussie Style

640px-Flag_of_Australia.svg
CAM proponents view National Health Interview Surveys recording the supposed popularity of CAM, an amorphous conflation of anything from conventional medical advice to mythical methods, as an invitation to unleash even more unproven remedies on the public. My interpretation is quite different. I see the same figures as proof that we are doing too little to protect the public from pseudoscience.

In fact, state and federal governments are acting as handmaidens to the CAM industry by legalizing practices and products that have insufficient proof of safety and efficacy and, in some cases, are so scientifically implausible that they can never meet that standard. The federal government keeps “integrative” medicine centers at major academic institutions and private foundations afloat with taxpayer money by funding research that has failed to improve public health or the treatment of disease, despite seemingly endless trials, because “more research is needed”.

As we shall see, Australia has a more effective regulatory system for dealing with CAM. And the advocacy group Friends of Science in Medicine (FSM), an organization with goals similar to our own Society for Science-Based Medicine, is keeping the government on its toes, investigating violations of the law on its own and reporting them. We in the US could learn something from their two recent successful campaigns attacking misleading health claims. (more…)

Posted in: Chiropractic, Diagnostic tests & procedures, Guidelines, Legal, Naturopathy, Politics and Regulation

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Oregon Health & Science University SCAM Day

From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link)

From the Wikimedia Commons, originally posted by Flickr user Alex E. Proimos (link).  Oy.

I was looking over a recent class catalog from my alma mater, University of Oregon. I see the Astronomy Department is having a day devoted to astrology, inviting astrologers to talk about their profession. And the Chemistry department is having alchemists give an overview on how to change base metals into gold. And, to green our energy, the Physics Department, where I acquired my undergraduate degree, is having a symposium on perpetual motion machines. I am so proud.

I kid.

But not when it comes to SCAM (Supplements, Complementary and Alternative Medicine). Medicine is strange in that has no issues embracing pseudo-science. My medical school, OHSU, had an afternoon devoted to Integrative Medicine for the third year medical students, with lectures by a chiropractor, a traditional Chinese pseudomedicine practitioner, a naturopath and an integrative medicine practitioner. They also had a small group discussion of a case of irritable bowel syndrome where one of the discussion leaders was a……Qi……….Gong………..master. Really. I would be so pissed if I was going $166,000 in medical school debt and I was being taught about the approach to ANYTHING by a Qi Gong Master. It was a day to ignore that whole ‘science’ thing in the name of the school. (more…)

Posted in: Acupuncture, Chiropractic, Homeopathy, Medical Academia, Naturopathy, Science and Medicine

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Ezekiel Stephan: Another Pediatric Death by World View

Ezekiel
Reports of a disturbing chain of events that ended in the likely preventable death of a 19-month-old Canadian child have made the rounds this week. The case was discussed by friend of Science-Based Medicine Orac (who I believe is some kind of a protocol droid) on Respectful Insolence two days ago. But even if you’ve read that excellent post, please continue reading as I have updated information and, I believe, additional insight into this unfortunate outcome.

If this is your first encounter with the story, prepare to be angry and frustrated but don’t presume to know everything that happened. The numerous news reports, beginning back in 2013 when the parents were first charged and the case went public, are not all well-written and there are discrepancies between accounts. Add to that the announcements and fundraising efforts by the family on Facebook and various other crowdfunding websites, and their alleged side of the story as reported by disreputable sources steeped in pro-woo/anti-vaccine bias, and we have one confusing mess of facts and a heap of conspiracy claims to boot. The only aspect of this case that is completely irrefutable is that a child suffered and died, and that he was failed by people who should have known better. (more…)

Posted in: Science and Medicine

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Not natural, not safe: Grapefruit Seed Extract

The image is "natural", but is grapefruit seed extract a case of misleading advertising?

The image is “natural”, but is grapefruit seed extract a case of misleading advertising?

Where do you draw the line between “supplement” and “drug”? And how much processing of a “natural” substance can occur before it’s no longer “natural”? These seemingly-philosophical questions are very real when it comes to the supplement industry. In many countries, regulators have implemented weaker safety, effectiveness and quality standards for anything branded a supplement or natural health product. The result has been a boon and boom for manufacturers, with thousands of products flooding the market. This same boom has challenged consumers and health professionals who are seeking products that are safe, effective, and manufactured to high quality standards (and in the bottle you are buying). Nowhere is this challenge better illustrated than a supplement that I’ve seen for sale for some time. Grapefruit seed extract (GSE), according to promoters, is a panacea that destroy bacteria, viruses and fungi anywhere in the body, without any risk of harm. But the actual science is quite telling. Grapefruit seed is a supplement that’s of such poor quality that even herbal medicine boosters recommend against its use. (more…)

Posted in: Herbs & Supplements

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What naturopaths say to each other when they think no one’s listening, part 2

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When last I visited this topic, I started out by making a simple observation, namely by quoting John Wooden’s famous adage, “The true test of a man’s character is what he does when no one is watching.” What I was referring to was a private discussion forum for naturopaths known as Naturopathic Chat, or NatChat for short, and how a leak from the group had revealed the sort of pure quackery that naturopaths talk about when they are among themselves and think that no one else is listening. Basically, NatChat revealed just how quacky naturopaths are, based on the advice they gave each other about patients and their general discussions of what passes for “naturopathic medicine.” I found examples of naturopaths recommending intravenous peroxide, homeopathic drainage therapy, black salve (for a huge protruding breast cancer), and even ozone to treat a postsurgical J-pouch abscess that clearly required the attention of a colorectal surgeon. After naturopaths on NatChat became widely aware that someone on the list had revealed discussions on the list, apparently the moderators, instead of moving to another platform, stayed on Yahoo! Groups.

None of what I’ve described in this brief recap of my first post about NatChat should be surprising to regular readers of this blog, who would also know that we are not particularly fond of naturopaths, even the nice ones, who might be perfectly fine as people. Of course, it is naturopathy we don’t like, mainly because it is, as I like to describe it, a cornucopia of quackery based on prescientific vitalism mixed with a Chinese restaurant menu “one from column A, two from column B” approach to picking quackery and pseudoscience to apply to patients. Indeed, whenever the topic of naturopathy comes up, I like to refer readers to Scott Gavura’s excellent recurring series “Naturopathy vs. Science,” which has included editions such as the Facts Edition, Prenatal Vitamins, Vaccination Edition, Allergy Edition, Diabetes Edition, Autism Edition, Fake Diseases, and, of course, the Infertility Edition. We’ve also described just what happens when a naturopath tries to treat a real disease like whooping cough. The results are, to put it very mildly, not pretty.

Of course, as I’ve pointed out, any “discipline” that counts homeopathy as an integral part of it, as naturopathy does to the point of requiring many hours of homeopathy instruction in naturopathy school and including it as part of its licensing examination, cannot ever be considered to be science-based, and this blog is, after all, Science-based Medicine. Not surprisingly, we oppose any licensing or expansion of the scope of practice of naturopaths, because, as we’ve explained time and time again, naturopathy is pseudoscience and quackery.

Interestingly, what led the Reddit user and naturopathy critic NaturoWhat (who inspired my earlier post regarding NatChat) to give me the heads up as to what’s going on in NatChat again is an incident on the discussion board involving a naturopath who featured in the previous edition of my coverage of NatChat, Eric Yarnell. He’s a naturopath who tried to point out to his fellow naturopaths how black salve is a really nasty treatment because of the way it fries normal tissue just as badly as it fries abnormal tissue. He also appears to be one of those rarest of beasts, a seemingly pro-vaccine naturopath. I say “seemingly,” because whenever I encounter a naturopath billing herself as pro-vaccine (e.g., Erika Krumbeck), a closer examination of his or her views almost always reveals he or she believes in at least some antivaccine misinformation. Surprisingly, Yarnell is the naturopath who comes closest to actually being pro-vaccine that I’ve seen.
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Posted in: Naturopathy, Vaccines

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