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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"

 

Perhaps against my better judgement, I'm going to post a dissenting view.  I am not a naturopath or a homeopath or an essential oil salesman.  

 

It's critical here to notice a couple of things.  1)  If you look hard enough, you can find a few quacks in any field to slander the rest of the profession.  I worked, for a long time, with a board-certified internal medicine MD who claimed he could cure all kinds of disease by bleeding his patients (yes, sometimes cups of blood--as in the very therapy that killed George Washington).  And he did this all the time, in practice.  Now, I'm not going to use his goofy practice, combined with that of a few others, to launch a claim that MDs are quacks.  Likewise, we've all heard the statement that treatment-related death is one of the top causes of death in the united states.  While malpractice and over/mis prescribing is a glaring a severe problem, you can't exactly use this claim to discredit all of western biomedicine.  There are a lot of good doctors out there.

 

To the point, everyone's an expert and a critic on everyone else's practice.  I'd be shocked if anyone posting animately on this thread has ever been to an ND or had a long conversation with one directly.  I don't agree with the ND plight that they're adequately trained as PCPs and should therefore be licensed as such.  (There's no question they get drilled hard--those who have graduated from one of the handful of accredited ND schools--in the biosciences, but their clinical training leaves enormous amounts to be desired.)   However, just because someone offers a dissenting viewpoint or simply doesn't have the backing of enormous pharmaceutical conglomerates to design and publish as much conclusive research as the establishment does not mean their practices hold no water.  Sure you can start ripping into some aspect of their philosophy or practice that either a) you don't understand or b) is straight goofy.  But in my experience, most of the misunderstanding is semantic.  

 

To the point, my kids are 2 and 5.  Neither of them have ever taken a pharmaceutical prescription or even (with the exception of Miralax, briefly) an OTC drug (yes, including Tylenol).  Ever.  This is not because my kids never get sick.  This is because the current mainstream paradigm is often way too aggressive (some would use the word "arrogant") when it comes to basic prescribing and primary care medicine.  I'm not remotely against western medicine and am in fact enrolled to become a PA!  But the ND response is an important balance to some unhealthy trends currently prevailing in western medical culture.  

 

To conclude, before getting on a forum to start slamming an allied health profession, it's important to at least investigate objectively--not through blogs and pick-and-choose examples from the internet.  Set up a study and seek to prove or disprove a hypothesis.  Specifically, find an ND--not any ND, and certainly not an obvious quack, but a well-recommended ND (i.e. one that books months in advance)--and make an appointment for treatment or a cup of coffee.  I've done this.  I've met some goofballs, and I've met some extremely informed and intelligent providers as well.  In my experience, there's more common ground here than many of us realize, when you get right down to it, and perhaps if we were doing a better job of integrating effective natural methods (such as informed nutritional and lifestyle counseling, and openness to the possibility that 2000-year-old plant remedies might have a place in medicine, and a more conservative approach to prescribing), perhaps there wouldn't be so much attrition to the growing field of alternative medicine.  

 

And to those who are firing off, willy-nilly, over essential oils: next time you're around an FDA-approved "antibiotic" "natural" spray cleaner (I mean the type the FDA approves for labeling "antibiotic" without containing bleach), look at the ingredient list.  You'll see essential oils of Thyme and Oregano, most commonly, because these substances are extremely antibiotic and very effective as such.  Then look into all the research Vanderbilt university is doing on EOs and all the promise they truly have to offer.  Don't slander an entire type of plant extract (again used for thousands of years) simply because a few mom's are getting involved in multi-level marketing of such products.  Talk to someone who knows what they're doing and get some experience before blasting out to the internet about what experts we all are about Essential Oils.  

 

A good rule of thumb: if it's growing in popularity, there is very likely some value in it--whether its some healing quality of a "CAM" therapy or simply a way to avoid a harmful medication.  2 cents.  

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A good rule of thumb: if it's growing in popularity, there is very likely some value in it--whether its some healing quality of a "CAM" therapy or simply a way to avoid a harmful medication.  2 cents.  

I see the point you are making but I have to disagree with this statement. The whole lemming metaphor ring any bells?

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I have found over the years that ND's and other purveyors of alternative medicine (and there are many different brands out there), particularly around where I presently and used to work, generally do what many of us don't do - they tell their/our patients what they want to hear, not what they need to hear.  People generally don't want to be told that they need to get off their bums and exercise, eat properly, take long introspective looks at themselves to deal with psychological issues, etc.  They want something to make things go away now - and there really aren't that many silver bullets out there.  My old SP used to say that "Modern biochemistry has allowed many people to continue living the bad lives they like and have grown accustomed to" and unfortunately that's true - this has led to us prescribing this and that and more when we should be sticking to the KISS principle.  Nothing annoys me more in the ER when an 80 something year old shows up, with a diagnosis that really adds up to "T.R.O" (Time's Running Out), is on a gazillion meds, some of which are to treat the effects of another, but for what reason?  Conversely, I've had many a patient in my office (when I worked in one) that were seeing an herbalist or ND or blood analyser, that were being handed out bad information (like without even a real grasp of  basic physiology or biochemistry), told they must stop all their meds (some of which were on hardly anything) and all would go away with "Potion XYZ", that the practitioner sold them at a great price...or they'd get put on very expensive chelation therapy that has been proven time and again to be worthless...or told that their Stage 4 lung cancer would go away if they watched their cholesterol and B12 levels.  The CAM providers have told them there is a silver bullet and it was bought into.

 

Not trying to start a flame war here, but the reason a lot of us are slagging down CAM practitioners is because we've had to undo a lot that these folks have done.  As I alluded to in an offshoot of this thread, everyone that walks into my exam room claiming they're taking "Potion XYZ" because it's natural and therefore harmless, gets the same speech.  First, natural does not equate to harmless or even good for you.  Secondly, a large number of our drugs are actually derived from nature.  Lastly, to paraphrase Paracelsus, ALL substances are poisons - how you use it and how much you give will differentiate a cure from badness.  This last bit is extremely important, since many people jump on band wagons and assume if a little is good, lots must be better...then they end up in the ER.

 

$0.02 (Canadian)

 

SK

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I see the point you are making but I have to disagree with this statement. The whole lemming metaphor ring any bells?

You're misinterpreting what I said.  If a medical treatment (especially one that perpetuates and survives via word-of-mouth referral over decades and centuries) grows in popularity there is likely some value to it.  That's not to say we should take it hook line and sinker.  That's to say, rather than knee jerk malign it because it's not mainstream, perhaps we ought to speak directly to people who have seen benefit from such treatments to really give it a fair investigation.  I'm not advocating blind implementation based on popularity.  I'm merely suggesting that if an ND, for example, whose services are largely paid for as an out-of-pocket burden for patients and who is (in some cases) filling his or her clinic for years on end, booking months out, completely based on word of mouth (results-driven) referral, we may be able to learn something from that person...

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First, natural does not equate to harmless or even good for you. 

 

Secondly, a large number of our drugs are actually derived from nature. 

 

Lastly, to paraphrase Paracelsus, ALL substances are poisons - how you use it and how much you give will differentiate a cure from badness.  This last bit is extremely important, since many people jump on band wagons and assume if a little is good, lots must be better...then they end up in the ER.

 

1st: Absolutely true.  If you speak to an experienced herbalist--especially a Chinese medicine herbalist who doses quite high with potentially toxic herbs--they will caution use before mastery.  The same could be said of potentially toxic pharmaceuticals. 

 

2nd: "Derived from nature" is meaningless.  Everything is derived from nature: chlorine, atom bombs, kit kat bars, essential oils, and beta blockers.  A general rule of thumb--as evidenced by the vastly lesser number of treatment related deaths by CAM providers compared to mainstream prescribing--the further we manipulate and purify a substance from its natural form, the greater the chance for toxicity.   I think this mainly has to due with dose.  The more potent (refine) a chemical becomes, the more toxic it will potentially be.  In natural state, most substances are less potent than the chemically refined, pharmaceutical form.  This is why Valarian Root tincture is available over the counter but Valium requires an Rx. Trying to equate the dangers of herbalism or nutritional therapy with that of pharmaceutical treatment is, statistically speaking, completely ridiculous.  

 

3rd: I absolutely agree.  You'll be interested to learn the traditional Chinese word for herbal medicine is Du Yao, which directly translates as Medicinal Toxin or Toxic Herbal Medicine.  You can easily kill someone with Chinese herbs if you don't know what you're doing which is why internal medicine doctors who study TCM in China undergo a medical training of at least 5 years and, more commonly, 8-10, before going into clinical practice.  I think part of the problem we're seeing among hobbyist herbalists is inadequate training, and we're using our limited exposure to the less credible form of the medicine as a paint brush for those disciplines as a whole.  

 

I will point out that the number of severe adverse events due to natural remedies (like Chinese herbs, homeopathic, essential oils, etc) is close to zero compared with mainstream prescription--a significant finding.  

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Zoopeda, I think many things you say are true.  There are several reasons that people flock (at least in this area) to CAM for treatment and the problems of, what many in that world call, "Western Medicine" is to blame.  We have our bad apples. We have this messed-up system for seeing patients, where we have to see patients faster and faster just not to go bankrupt, that patients are rightly fed up with.

 

I do think that CAM practitioners bring something to the table. I ask every patient that I see, "have you tried acupuncture, massage, naturopathic, chiropractic” as far as my intake. I often recommend acupuncture even though the evidence support its benefit for headache patients is very limited.  I never say bad things about these practitioners to my patients.

 

The problem I face is 30% of my patients follow with a chiropractor, naturopath, or both.  Virtually every single one of them has listened to their CAM practitioner dissing us in evidence-based medicine for years.  They come into my office spouting, like parrots, “I don’t want dangerous drugs, they only treat the symptoms.  I want to find the real cause and fix it.”  They usually add that the naturopath has told them that the reason I will prescribe drugs is 1) I’m too stupid to know about the real causes of headache (which the naturopath has the freedom to just make up on the spot), 2) I don’t really care about them (to find the “real cause”) and, I’ve been paid off by the drug companies to prescribed drugs so I can get rich and  3)  Prescribing drugs will always hurt the patient in the end because we know they are all toxic and all cancers are caused by these man-made toxins.  I make money off making people sick, so I'm motivated to keep them sick by prescribing toxins. Do you realize how hard it is to help a patient when they come with these pre-conceived ideas?  The CAM side are the ones that must stop this spiteful chatter. I'm sure that not all do this, but many do. Just read their advertising.  I agree, there are MDs and DOs out there (like Dr. Oz) who are just as bad about making things up on the spot and telling patients what they want to hear.

 

I also want to add a philosophical background to all of this, in case anyone is interested and not assuming that you don't already know this.  Most of us like to believe that the way we think and act is based on a very logical process.  Most of it is not. It is based on culture and things like social mores. For example, I was required to wear a tie in a previous job and I do sometimes now out of habit.  The tie is a totally irrational piece of clothing.  While once, a very long time ago, it may have served a logical purpose of catching crumbs and stains that drip down from the chin, now that is the last thing you want it to do.  We wear them out of culture expectations.

 

There was a philosophical movement that was started by several people in several different places in the late seventeenth and during the eighteenth centuries in Europe that have had a profound effect on American culture, and view of "natural" since the 1960s.  It usually takes 200-400 years (in the past, faster in the age of Internet) for ideas to reach the masses.  I will pick just one of the key player, Jean Jacque Rousseau, the philosopher of the French Revolution.

 

He was the son of Calvinist parents in Geneva, Switzerland. The Calvinists (like most Protestants) had a view of nature that it was damaged by the original sin of Adam and therefore we humans had the right to improve on it, redeem it and even tame it.  The Catholics were somewhat on the same page but for a different reason. The early Catholics, via people like St. Augustine, adopted the metaphysical view of nature from Plato, that this material world is only a shadow of reality, which resides in the heavens. So nature wasn’t seen as perfect but inferior.  Even the Darwinists could reach some agreement with the aforementioned groups because they saw nature as not perfect, but adapting and evolving.  Some natural mutations were harmful and some helpful. We had the freedom to create treatments to fix the bad mutations. None of those people would ever have the view that nature and “natural” were idealistic states.

 

Rousseau, in exhaustion of the Thirty Years (religious) wars and the oppression of the French (and other monarchal states) by the Aristocrats and elites, came to a philosophical conclusion that nature, when left alone, was perfect. It was the intervention of humans that spoils nature.  All human suffering, in his view, was due to human intervention.  This became the backbone of the French Revolution because they assumed, philosophically, if they got rid of the human intervention of the Church and the State (which were indeed abusive) that humans in their natural state would find utopia.

 

This is too long already but I will say that if you jump ahead, this thinking did catch on and with the help of “Madison Ave.” type marketing the term “Natural” or "Organic" is seen as nearly perfect and “artificial” (meaning having human influence) is seen always as bad.  Therefore, medications, made by those dirty humans, is always bad and plants are always good.

 

I only have time to type this much because of jet lag and waking up at 3 AM. So, for your good fortune, by tomorrow, I hope, my typing will go silent. :>)

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Ideas (good or bad) have consequences. Rousseau was wrong in his philosophy as we all see that nature when left alone causes earthquakes etc. and many people die.  On the other hand, humans can't control nature either. Interesting to learn about the French Revolution.  In retrospect we see the flawed thinking that led to many deaths during the Revolution and getting rid of the humans did not work.  Utopia is impossible.

 

It is also (usually) impossible to dissuade humans from their choices and giving patients the best information available to them is they key.  I have started using WebMDs reference for the herbals, vitamins, minerals, oils, etc as it has an overview of the side effects, efficacy, studies available and what conditions some of the CAM therapies will help or harm. 

 

I make up my own essential oil face cleanser, BTW.  I wouldn't drink it though. 

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Ideas (good or bad) have consequences. Rousseau was wrong in his philosophy as we all see that nature when left alone causes earthquakes etc. and many people die.  On the other hand, humans can't control nature either. Interesting to learn about the French Revolution.  In retrospect we see the flawed thinking that led to many deaths during the Revolution and getting rid of the humans did not work.  Utopia is impossible.

 

It is also (usually) impossible to dissuade humans from their choices and giving patients the best information available to them is they key.  I have started using WebMDs reference for the herbals, vitamins, minerals, oils, etc as it has an overview of the side effects, efficacy, studies available and what conditions some of the CAM therapies will help or harm. 

 

I make up my own essential oil face cleanser, BTW.  I wouldn't drink it though. 

Les Miserables is set in this Rousseauan Post-Monarchical "Utopia." 

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The book was so much better than the musical and the movie with Liam Neeson was so much better than the musical, which in my opinion stank.  I do not understand why the musical won some academy awards except that the actors just vote for themselves in their narcissistic lives.

 

Victor Hugo had it right:  Life is about redemption. Literature is so much better than movies.  

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 ...I'm merely suggesting that if an ND, for example, whose services are largely paid for as an out-of-pocket burden for patients and who is (in some cases) filling his or her clinic for years on end, booking months out, completely based on word of mouth (results-driven) referral, we may be able to learn something from that person...

 

We have. It's called the power of expectation and placebo.

 

I look at CAM practitioners the same way as I look at anti-vaxxers: they are doing the public a disservice. If a provider is going to have such a flagrant disregard for evidence-based practice, then how I can I (or a patient) trust them to make appropriate treatment choices in any given scenario? Their decision-making is fundamentally flawed. It has nothing to do with their intent. I'm sure the vast majority of CAM practitioners really have the patient's best interest at heart and really believe they are performing a noble service.

 

But with such deliberate ignorance of the scientific process---they aren't. It's fantasy. And it's not just a few "bad apples", every profession has those. If we cant rely on them to use the best available evidence and research for a particular condition, or at least give the patient the OPTION of the standard of care, and explain to them WHY it is the standard of care, then they don't deserve a medical license, in my opinion.

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Someone raised the issue of placebo earlier (I think it was this thread), so I thought I'd post this study from last year regarding surgery and placebo effect.

 

http://www.bmj.com/content/348/bmj.g3253

 

74% in the placebo arm improved, and 51% of placebo patients had outcomes equal to the surgical patients.  Not bad.

 

Time to lump surgeons in with naturopaths??    ;)

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Someone raised the issue of placebo earlier (I think it was this thread), so I thought I'd post this study from last year regarding surgery and placebo effect.

 

http://www.bmj.com/content/348/bmj.g3253

 

74% in the placebo arm improved, and 51% of placebo patients had outcomes equal to the surgical patients.  Not bad.

 

Time to lump surgeons in with naturopaths??    ;)

I think we need to seriously look at real outcomes to procedures to name a few things. We should be "evidence-base," so the evidence should support the treatments.

 

So, I just came out of a room with a patient with bad headaches, whose PCP is a natruopath. I started the patient on a low-dose beta blocker. She had a 40 lb weight gain (according to her) in three weeks, + about seven other horrible side effects. She said that she went to her natruopath. She, the natruopath,  put a weight in the patients hand and rubbed my beta blocker on her chest and her hand dropped. So, the natruopath concluded that my beta blocker was toxic to her and I should have known better.  Now the patient has lost all trust in me. However, she has had 4 migraines / week for years under the natropath's care and now my hands are tied due to distrust. I have said absolutely nothing negative about he natruopath. I could have the patient better in 3 weeks, but now it will be almost hopeless. 

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Can someone please forward me the paperwork I need to complete to start getting my drug company kickbacks for writing prescriptions? All I have gotten so far are pens and they are not helping to fund my lavish retirement plans.

You still get pens? I haven't seen a Drug pen since the early 2000's.

 

Sent from my S5 Active...Like you care...

 

 

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I think we need to seriously look at real outcomes to procedures to name a few things. We should be "evidence-base," so the evidence should support the treatments.

 

So, I just came out of a room with a patient with bad headaches, whose PCP is a natruopath. I started the patient on a low-dose beta blocker. She had a 40 lb weight gain (according to her) in three weeks, + about seven other horrible side effects. She said that she went to her natruopath. She, the natruopath, put a weight in the patients hand and rubbed my beta blocker on her chest and her hand dropped. So, the natruopath concluded that my beta blocker was toxic to her and I should have known better. Now the patient has lost all trust in me. However, she has had 4 migraines / week for years under the natropath's care and now my hands are tied due to distrust. I have said absolutely nothing negative about he natruopath. I could have the patient better in 3 weeks, but now it will be almost hopeless.

There's definitely more to this story, but why not follow up with the ND to discuss possible collaborative treatment outcomes. If all is lost at this point, perhaps a frank and open-minded discussion could help all parties.

We have. It's called the power of expectation and placebo.

Placebo: all those who are claiming that literally 100% of ND treatments work based on placebo effect are simply misinformed. NDs have full prescriptive rights in Oregon (where I last practiced). Is this to say those drugs are due to placebo? Such a claim comes from the type of entrenched ignorance that cannot be changed via internet chat forums. As someone who has seen a few naturopaths do some really great things for patients, I hope more moderate PA readers will seek to interview and critically examine NDs and their methods directly (i.e. in person) rather than snipe and malign from afar, without any interpersonal interaction whatsoever.

 

I would say the same thing to a slanderous ND who maligns his patients against another well-intending practitioner (such as a PA) as well.

 

 

**I am not an ND nor do I aspire to be one.

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No one is claiming 100% anything. It's clear as day you have a closet hard-on for naturopaths because you have known a few personally. This is a personal experience bias and not as rational as you think it is.

 

None of us need to have interpersonal interactions with naturopaths or any other CAMer for that matter to make the judgment that they are, more often than not, pseudoscientific quacks. This data is out there for public access. Here is an exhaustively referenced report on active Maryland naturopaths, including their training (in numbers)---as well as what they are saying, claiming, and practicing:

 

http://sfsbm.org/index.php?option=com_content&view=article&id=486:naturopathic-board&catid=52:legislative&Itemid=435

 

If you want more laughs, here's a plethora of direct quotes from practicing naturopaths:

 

https://www.sciencebasedmedicine.org/what-naturopaths-say-to-each-other-when-they-think-no-ones-listening/

https://www.sciencebasedmedicine.org/nd-confession-part-1-clinical-training-inside-and-out/

 

Insight into their "regulations" and practice habits:

 

http://www.aacijournal.com/content/7/1/14

https://www.sciencebasedmedicine.org/wild-west-tales-of-a-naturopathic-ethical-review-board/

https://www.sciencebasedmedicine.org/licensing-naturopaths-the-triumph-of-politics-over-science/

https://www.sciencebasedmedicine.org/twenty-days-in-primary-care-practice-or-naturopathic-residency/

 

And an assortment of other unsubstantiated beliefs and practices:

 

https://www.sciencebasedmedicine.org/naturopathy-vs-science-allergy-edition/

https://www.sciencebasedmedicine.org/igg-food-intolerance-tests-what-does-the-science-say/

https://www.sciencebasedmedicine.org/naturopathy-vs-science-autism/

https://www.sciencebasedmedicine.org/naturopathy-vs-science-fake-diseases/

https://www.sciencebasedmedicine.org/naturopathy-vs-science-vaccination-edition/

 

This isn't slander or maligning, it's accountability. We're not talking about a few bad apples here. And we're not talking about how nice or well-intentioned they are, or how many naturopathic patients "feeellzz" better after some voodoo. The profession---if you can call it that---is chock full of crank beliefs, unsubstantiated practices, and dubious training and licensing standards. Do these things exist in the allopathic world? Absolutely. But they are the exception rather than the rule, and the reason why we are so regulated and standardized.

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No one is claiming 100% anything. It's clear as day you have a closet hard-on for naturopaths because you have known a few personally. This is a personal experience bias and not as rational as you think it is.

 

I'm not going to keep going around and around about this.  I would never claim you have a bias because you know a few MDs who really helped you out or helped family members.  I didn't know what an ND was until my dad met one and turned his health around as a result.  So, sure, I have a bias for competent providers regardless of title and think it's important to thoroughly investigate face-to-face before passing judgement or making blanket statements about a field.  There are always quacks out there, regardless of credentials.  Maybe the problem is that the Quack % is higher among NDs than it is among other professions?  It doesn't matter.  I've met a few NDs who are doing great work.  Obviously that's going to inform my opinion.  Probably crass to consider this a "hard on," but at least I'm willing to interview a provider before I pass judgement on his field.  I'm done here. 

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While those references certainly appear damning, I note that only one is directly from a (presumably peer-reviewed) scientific journal, while the other 11 links are from an anti-naturopathy organization.  Now, being a partisan organization of any sort isn't a bad thing per se, but it does mean that I expect the arguments to be one-sided and present their position in the best possible light, which the one I read in depth (the first one) certainly appears to do.

 

I'm sure everyone would welcome randomized controlled trials of naturopathic medical techniques, although their focus on individualization of therapies would render creating a RCT problematic.

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I'm not going to keep going around and around about this.  I would never claim you have a bias because you know a few MDs who really helped you out or helped family members.  I didn't know what an ND was until my dad met one and turned his health around as a result.  So, sure, I have a bias for competent providers regardless of title and think it's important to thoroughly investigate face-to-face before passing judgement or making blanket statements about a field.  There are always quacks out there, regardless of credentials.  Maybe the problem is that the Quack % is higher among NDs than it is among other professions?  It doesn't matter.  I've met a few NDs who are doing great work.  Obviously that's going to inform my opinion.  Probably crass to consider this a "hard on," but at least I'm willing to interview a provider before I pass judgement on his field.  I'm done here. 

 

I think that's awesome that your dad was able to turn his health around with help from a ND.  Maybe he was obese and diet and exercise was recommended or something along those lines?  The issue I have is when a patient has a malignancy, for example, and a non-evidence based treatment is offered.  I won't pass judgement on each naturopath, but it's certainly fair to say the profession and training is not based on scientific evidence.

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