Naturopathic Medicine

[jmj11]

Now this is an honest question, not trying to start fights.  I'm confused about this.  I live in the epicenter of Naturopathic medicine and I suspect that 60% of my patients have seen a naturopath and 20% have a naturopath as their PCP. If you read the Naturopathic Medicine school websites, they seem to have a rigorous requirement of a BS degree in the sciences with things like organic chemistry.  Then the program, according to them, is four very compressed years. They claim (this part I don’t agree with) that they study “Alopathic  Medicine” to the point of the level of an MD but then go “beyond that” to study natural medicine.

 

However, from what my patients tell me that their Naturopath told them, it seems, as a field, to have a very poor understanding of basic human physiology and anatomy.  I’m not talking about one philosophy of care vs another but basic science.

 

As part of their marketing, they always say that we (in evidence-based medicine) only treat the symptoms with dangerous drugs and surgery and they treat the actual root cause.  Sounds beautiful.

But here is an example of things I hear all the time that seem to point to this very poor level of education.

 

A patient of mine went to a Naturopath, who had been recommended by her mother. My patient suffers from severe chronic migraine (which, the pathophysiology has been well mapped out for over 10 years in evidence-based medicine).  This Naturopath first says they have a 100% cure rate. That alone should win them the Nobel prize in medicine if word got out.  Next the Naturopath tells them that headaches are always a symptom of toxins from the industrial age (pollution and the evil chemicals prescribed by “Western doctors”) in the body.  To prove this, the Naturopath had the patient take off her shoes. Then the Naturopath took off her shoes and placed her feet on top of the patient’s feet so she can feel her “electrical aura.”

 

Then the Naturopath opens a case of about 200 small vials.  They are all filled with "common toxins of the industrial age."  She held the bottles in front of the face of the patient one by one. When the Naturopath felt a disturbance in the patient’s aura, she would sit that toxin on the table.  Then when she was finished she had about six toxins identified as being in the patient’s body, causing her headaches.

 

The Naturopath then sold the patient about $200 (per month) of herbals that will "detoxify her body" and treat the real cause and make the headaches go away.  

 

So my question, I hear stories like this all the time. Many will try to say that this is an aberration but I don’t think so. So, are Naturopaths to be respected as well-educated providers that bring something good to the table, or do they understand the human body at the second grade level and believe in magic and get our patients to distrust us and go down rabbit hole after rabbit hole?  I won’t mention the word “con.” But what is the truth in this matter?

[BruceBanner]

Quack-o-paths.

 

If their training is so thorough and superior why aren't they recognized by the AMA or LCME?

 

I don't even think of them as medical providers. If they are going to practice such ridiculous unsubstantiated voodoo then they deserve no prescriptive license and should be relegated to the same societal strata as reiki, homeopathics, and fortune-tellers.

[acozadd]

Sounds like they put on a show for the gullable and impressionable, relying on placebo. Our body has some nifty organs responsible for clearing these so called "toxins," expensive supplements offer little to nothing. I have an in-law who has treated her hypothryoidism "naturally," only to find her TSH skyrocketed after being in a normal range for years. If it wasn't for those in evil evidence-based Western medicine, who knows what would have been the end result of that foolish experiment. "Here, take these "natural" pills that "naturally" stimulate the thyroid to make more thyroid hormone..." If her own TSH (as natural as it comes) can't do it, how the hell is some expensive BS pill going to?

[PACdan]

It was a sad day when I saw an ND on a Cancer Treatment Centers of America commercial. They are pushing for more and more practice rights in many states. There is an excellent series of writings by an ND graduate, turned researcher, that exposes the shallowness of their program. In Arizona there was a recent uproar when NDs were essentially convening fake IRBs to promote their "research" and profession. In my mind it really is a institution for people who so desperately crave the title of "doctor", no matter how they get it. Physicians need to unite strongly against their advancements. They simply do not practice medicine rooted in the rigors of the scientific method. Or medicine at all, as we consider it. From the exposures I have, it is akin to homeopathy, and quite dangerous. http://www.ted.com/talks/james_randi?language=en

[jmj11]

I have always like Randi's work.

[LKPAC]

It's hard to believe that quackery can still flourish in 21st century America, yet it does.

[DiggySRNA]

It's hard to believe that quackery can still flourish in 21st century America, yet it does.

 

For the same reasons why anti-vaxxers are so loud yet they're the first ones in clinics when they have the sniffles.

[sk732]

Fact is, these creatures are very good at telling people what they want to hear...I had a diabetic that was seeing one that was telling him not to eat any whole grains because his body "would turn it into sugar".  Apparently that person didn't have a good grasp of basic biochemistry or physiology, lol. 

 

Their big thing up here is telling people they need chelation therapy and sending them to their PCP's demanding expensive tests be done that are only covered by provincial health care plans if they're ordered by an MD/PA/NP...then they get mad when we say no.  These clowns are allowed to order tests through the labs of their choice, but the patient has to pay for them out of pocket then - so they try pulling the wool over our eyes.  A lot of these voodoo priests up where I used to work - the large majority of the folks around there are Mennonites, who largely believe that if it's natural, it has to be good for you.  Had a patient that had advanced adenocarcinoma of the lung, likely from radon exposure, that was convinced by her naturopath if she kept her B12 and cholesterol under control she'd live forever...had another I diagnosed with malaria of all things from a trip they'd been on who saw one of these live blood sample analysts and was told, surprisingly, that she "had parasites in her blood", though the twit couldn't rightly say what those might be and prescribed the usual Cal/Mag supps they all seem to do these days.

 

Needless to say, I kinda dislike some of these folks.

 

SK

[jmj11]

http://www.naturopathicdiaries.com/my-break-up-with-naturopathic/#more-268

[winterallsummer]

I have no problem with naturopathy if the patient is not being harmed.  The interaction alone, some may call the placebo affect, may be beneficial, if only to reduce the patient's underlying anxiety or give them hope.  And perhaps there are some remedies which are yet unproven - hell even in "real" medicine we use unproven therapies on a daily basis.  But when it becomes at all dangerous, putting the patient in financial binds, etc etc, I do not hesitate to tell patients how I REALLY feel about this.  To be honest, I am not so familiar with the profession as I don't think my state allows them to practice here.  But I take this view on natural remedies as a whole - okay if not harmful or financially burdening, but if so it's time to cut the crap.

 

Now if a patient came to me with the OP's story about the feet and chemicals, I would not hesitate to sincerely persuade the patient to never see this practitioner again, the same way I would get upset if I heard a family member of mine was being given this clown advice.

 

That being said let's say I have a fibro patient I have done everything I can for, and they want to go see this naturopath and they are getting better with them, and not taking any dangerous treatments or paying some asinine amount, then by all means they should continue seeing that practitioner.

[PACdan]

http://www.naturopathicdiaries.com/my-break-up-with-naturopathic/#more-268

 

Yup, this is the lady who writes on her experiences as an ND.

 

"Injecting chemically purified substances such as high-dose vitamin C, hydrogen peroxide, ozone, or baking soda." - What could go wrong?

[SocialMedicine]

I think ND professionals have something to offer.

 

I do not think an ND paradigm graduate degree and undergraduate variable training in the basic sciences give these practitioners command over human physiology. I suspect the education has a lot of non evidence based/non scientific method curriculum. I am sure a bunch of ND's make victims out of sick gullible patients. However, some MD and PA do the same thing with unnecessary and potentially dangerous procedures and medications. Recently was at a conference where a cardiology PA was very concerned that connected medical records would reduce the number of stress echocardiograms he performed. That is a tangent, sorry. 

 

I am curious what the U of bridgeport is doing. From what I *recall* they are in a department or school that includes many alternative degrees such as ND. I wonder if they have a strong interest in developing PAs with that specialty or at least offering it. 

[turnedintoamartian]

I have no problem with naturopathy if the patient is not being harmed.  The interaction alone, some may call the placebo affect, may be beneficial, if only to reduce the patient's underlying anxiety or give them hope.  And perhaps there are some remedies which are yet unproven - hell even in "real" medicine we use unproven therapies on a daily basis.  But when it becomes at all dangerous, putting the patient in financial binds, etc etc, I do not hesitate to tell patients how I REALLY feel about this.  To be honest, I am not so familiar with the profession as I don't think my state allows them to practice here.  But I take this view on natural remedies as a whole - okay if not harmful or financially burdening, but if so it's time to cut the crap.

 

 

Two quick points -

 

1.) There are ethical issues that are not addressed if placebo only effects are considered satisfactory for evidence of efficacy. How much money is a placebo worth anyway?

2.) Mainstream(?) treatments have a basis in biology and are at least plausible.  This is the not the case for homeopathy, which is part of the curicculum for ND training. 

 

I am guessing most people are very comfortable with non-pharmaceutical treatments whenever appropriate.  Perhaps the disconnect comes from the different standard naturopathy evidence holds itself to and the one "conventional" medicine is held to. This becomes especially important when patients choose unproven treatments in lieu of those that have good evidence behind them.  

[GreatChecko]

So if I tell someone that I'm going to give them Normale Saline or Obecalp to help them with pain and/or anxiety, is it wrong? Who is to say that it won't work, can't really PROVE it won't. It's all natural too.

 

I can see the ethical hazard here. So what is the difference between that and what some of these "ND's" prescribe?

 

I can even find articles on the internet "proving" it works! http://www.gomerblog.com/2015/04/status-dramaticus/

[jmj11]

I'm still puzzled about my original question, what do they study for those intense 4 years of "med school" that they say is tougher than "Alopathic" med school?  If this was a 1 year course after high school, it would make sense.

 

The other question raised by some is what is the harm in placebo treatments?

 

Our typical patient has suffered for years with daily or near daily migraines and are disabled or near disability.  Like all tertiary headache treatment centers, we find great success in 60% of our patients. Of the 40% that we cannot help, 20% just have bad disease. Just like some RAD is not controlled despite excellent treatment.  However, and this is where it hurts, the other 20% are not help-able (but could be) because of the influence their Naturopaths have had on them (while giving them no benefit over the previous years of treatment).  Their philosophy is that in nature, before intervention by humans, everything was perfect. There are no headaches in nature (in their opinion, while the research says that most of the cause of headache is in nature as genetic mutations).  So all headaches have a simple, man-made cause, toxins in our foods or toxins in the medicines that people in "western medicine" prescribe.  So when I tell one of these patients that they have at least one of 6 know genetic mutations and now that they have tried every non-pharmacological treatment under the sun, the only thing left and the thing that is most effective are medications. At that juncture they tell me I'm F.O.S. and don't come back.  That is the great harm this does.

[True Anomaly]

I'm still puzzled about my original question, what do they study for those intense 4 years of "med school" that they say is tougher than "Alopathic" med school?  If this was a 1 year course after high school, it would make sense.

 

Of course it's tougher than allopathic med school, because you have to set aside your logical and reasonable side to actually make it through

[Whitcc1]

http://www.naturopathicdiaries.com/my-break-up-with-naturopathic/#more-268

Wow!! Just spent the last hour reading through her blog! That is super scary how incompetent they are and the "standards" that they uphold... Not to mention how the school's completely shroud and overinflated all of their clinical hours.

 

I honestly had no clue that was what their education consisted of... Not to mention that their internal review board is a complete hoax!

 

My vital force is still reeling from reading all of that info!

 

 

 

Sent from my iPhone using Tapatalk

[BruceBanner]

I have a patient who is a Native American and frequently tells me he needs to go see his tribal healer for herbs and such to treat his hypothyroid and diabetes. Which is fine, just dont discount modern medicine next time your A1C comes back at 13%.

 

Most people---understandably so---have an innate aversion to taking more pills. This is what draws people to non-medical remedies, because if they can treat the problem without another pill or procedure, then why not, right? Natural = good.

 

The problem is, MOST folk and "natural" remedies have less to do with an actual plausible physiologic mechanism than good old placebo effect. There are mountains of evidence showing the lack of efficacy of countless 'alternative' remedies and supplements. I think for routine, self-limited problems like colds, aches and pains, and the like---most non-medical remedies are fine if they make you feel better (or think you feel better), because the problem will likely resolve anyway. But for true medical problems that need intervention to prevent morbidity and mortality, these remedies are either a waste of time or outright dangerous because you are delaying real treatment.

 

Most lay persons don't know what they don't know, and a big challenge in being a provider is getting stubborn patients to understand the decisions they are making and WHY you are recommending a certain drug or treatment. Some people though are just a lost cause and their n=1 anecdote is going to be more powerful to them than all the studies and medical rationality you can deliver.

[sk732]

The problem with a lot of people is they don't want to hear what they need to hear - only what they want to hear.  Most naturopaths are great at telling folks that - and then doling out oodles of expensive goodies that make people feel vindicated by their choice.  This brings me to an ethical issue I see with these and other practitioners - they sell and dispense what they prescribe.  It's a total conflict of interest...drives me nuts at the vet's office as much as it drives me nuts with these folks OR real physicians that sell what they script.

 

My mini rant of the day.

 

SK

[jmj11]

The problem with a lot of people is they don't want to hear what they need to hear - only what they want to hear.  Most naturopaths are great at telling folks that - and then doling out oodles of expensive goodies that make people feel vindicated by their choice.  This brings me to an ethical issue I see with these and other practitioners - they sell and dispense what they prescribe.  It's a total conflict of interest...drives me nuts at the vet's office as much as it drives me nuts with these folks OR real physicians that sell what they script.

 

My mini rant of the day.

 

SK

You hit the nail on the head.

[JohnnyM2]

It is easiest to fool those who most want to be fooled.

[winterallsummer]

Two quick points -

 

1.) There are ethical issues that are not addressed if placebo only effects are considered satisfactory for evidence of efficacy. How much money is a placebo worth anyway?

2.) Mainstream(?) treatments have a basis in biology and are at least plausible.  This is the not the case for homeopathy, which is part of the curicculum for ND training. 

 

I am guessing most people are very comfortable with non-pharmaceutical treatments whenever appropriate.  Perhaps the disconnect comes from the different standard naturopathy evidence holds itself to and the one "conventional" medicine is held to. This becomes especially important when patients choose unproven treatments in lieu of those that have good evidence behind them.  

 

Thanks for the reply.

 

Regarding the ethical issues about accepting something only as good as placebo as something anyone (ND, etc) can see and charge a patient for: First, my point is that the interaction itself may be beneficial.  The same way someone may "blow off steam" and then feel better.  We, PAs and docs, regularly prescribe medicine that has been proven no better than placebo.  We perform surgeries that have been shown to be no better than sham surgeries.  We order expensive studies that have been shown to not lead to any better outcome than cheaper studies, or no study (eg MRI for 6 months of back pain vs plain films alone; no better outcome.  Knee arthroscopy vs sham surgery alone; no better outcome.  Albuterol vs placebo inhaler; no difference in outcome regarding patient's self graded level of dyspnea BUT FEV better - but again this is getting a bit off topic.  It is much easier to go back and cite the tons of medicines, eg diabetic medication, we used that was eventually shown not to help but actually KILL people).  I could go on and on and on.  There are even large arguments to be had about tPA being no better than placebo!  My point is if you really get into the knitty gritty articles behind a lot of medicine you practice, you may begin to see - or at least this was my experience, I in no way intend to disrespect anyone even a little bit - that honestly, a lot of therapy we use is no better than placebo.  And this is not even counting the hundreds of medicines, surgeries and therapies we found were no better, and even worse, than placebo, years after using the medicine.  If you are interested I can cite some articles for you, but I think this is a fact we can all recognize.

 

Note that I am not comparing what we do to them.  We use a rigorous scientific method to try to get to only the therapies that work.  And, most of us, when using a medicine that we know may be no better than placebo (antibiotics for viral illness, non-statins for cholesterol, various medicines for AD, PD, etc etc etc), we either tell our patients it may or may not work, or we at least do not try to convince them this is a Godsend, as NDs may.

 

Ultimately, my point is, if they see an ND, are not harmed, are not being ripped off, and the interaction itself helps them in some way (and by the way, there are studies to show that a placebo works better than no treatment, and we could have a long discussion about the physiological changes that occur in being "cared for" and given a pill even if its a placebo, but again we are going to get way off topic), then go ahead.  But if they are being ripped off or hurt, I want them to stop immediately.  That being said, if my chronic back pain patient wants to see the chiro every few months and swears on his children it is the only thing that works, I do not personally step in and try to convince him he's wasting his time.  How would I help him by doing that, really?

 

For point #2, yes I agree.  We have many treatments no better than placebo, and treatments we used for years later proven worse than placebo.  But yes, the FUNDAMENTAL difference is we subject ourselves to the scientific method, and we do our best to only give treatment that work.  If an ND (and I won't generalize here) practices quackery but does not care to find out if it works, or KNOWS it doesn't work, or LIES to his patient and claims it works, then yes, that is a whole different thing.  I am just trying to put some perspective on this.  I do not endorse ND or homeopathy.  But when it does not hurt and if the patient thinks it helps, I do not always insist they stop that, either.  

 

Quoting you "Perhaps the disconnect comes from the different standard naturopathy evidence holds itself to and the one "conventional" medicine is held to. This becomes especially important when patients choose unproven treatments in lieu of those that have good evidence behind them."  Yes I could not agree more with you here.

[jmj11]

Thanks for the reply.

 

Regarding the ethical issues about accepting something only as good as placebo as something anyone (ND, etc) can see and charge a patient for: First, my point is that the interaction itself may be beneficial.  The same way someone may "blow off steam" and then feel better.  We, PAs and docs, regularly prescribe medicine that has been proven no better than placebo.  We perform surgeries that have been shown to be no better than sham surgeries.  We order expensive studies that have been shown to not lead to any better outcome than cheaper studies, or no study (eg MRI for 6 months of back pain vs plain films alone; no better outcome.  Knee arthroscopy vs sham surgery alone; no better outcome.  Albuterol vs placebo inhaler; no difference in outcome regarding patient's self graded level of dyspnea BUT FEV better - but again this is getting a bit off topic.  It is much easier to go back and cite the tons of medicines, eg diabetic medication, we used that was eventually shown not to help but actually KILL people).  I could go on and on and on.  There are even large arguments to be had about tPA being no better than placebo!  My point is if you really get into the knitty gritty articles behind a lot of medicine you practice, you may begin to see - or at least this was my experience, I in no way intend to disrespect anyone even a little bit - that honestly, a lot of therapy we use is no better than placebo.  And this is not even counting the hundreds of medicines, surgeries and therapies we found were no better, and even worse, than placebo, years after using the medicine.  If you are interested I can cite some articles for you, but I think this is a fact we can all recognize.

 

Note that I am not comparing what we do to them.  We use a rigorous scientific method to try to get to only the therapies that work.  And, most of us, when using a medicine that we know may be no better than placebo (antibiotics for viral illness, non-statins for cholesterol, various medicines for AD, PD, etc etc etc), we either tell our patients it may or may not work, or we at least do not try to convince them this is a Godsend, as NDs may.

 

Ultimately, my point is, if they see an ND, are not harmed, are not being ripped off, and the interaction itself helps them in some way (and by the way, there are studies to show that a placebo works better than no treatment, and we could have a long discussion about the physiological changes that occur in being "cared for" and given a pill even if its a placebo, but again we are going to get way off topic), then go ahead.  But if they are being ripped off or hurt, I want them to stop immediately.  That being said, if my chronic back pain patient wants to see the chiro every few months and swears on his children it is the only thing that works, I do not personally step in and try to convince him he's wasting his time.  How would I help him by doing that, really?

 

For point #2, yes I agree.  We have many treatments no better than placebo, and treatments we used for years later proven worse than placebo.  But yes, the FUNDAMENTAL difference is we subject ourselves to the scientific method, and we do our best to only give treatment that work.  If an ND (and I won't generalize here) practices quackery but does not care to find out if it works, or KNOWS it doesn't work, or LIES to his patient and claims it works, then yes, that is a whole different thing.  I am just trying to put some perspective on this.  I do not endorse ND or homeopathy.  But when it does not hurt and if the patient thinks it helps, I do not always insist they stop that, either.  

 

Quoting you "Perhaps the disconnect comes from the different standard naturopathy evidence holds itself to and the one "conventional" medicine is held to. This becomes especially important when patients choose unproven treatments in lieu of those that have good evidence behind them."  Yes I could not agree more with you here.

I agree with most of what you have said and patients are welcome to try and live with what they want. The problem is the following.  When a CAM practitioner lies to the patient and tells them that we (in evidence-based medicine) don't really care about them, that we want to prescribe dangerous toxins that will always hurt them in the end because we are only after money and we are paid off by the drug companies, while they, those in CAM, really do care and they actually treat the cause . . . that hurts the patient in the end.  Our therapies have been proven to greatly help 60-65% of patients.  When patients come in with this CAM attitude, it reduces our chance to help them to 0%, plus they always go away mad becuase we don't offer them the same made-up answers.

[True Anomaly]

A great quote I learned during my residency from one of our most senior attendings- "If you're going to prescribe a medicine that doesn't work, make sure it's cheap and side-effect free"

[fyrelight74]

Those people and the "Essentials Oil" Bandwagon get on my nerves.