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Guest ERCat

I almost applied to ND school way back in the day but decided not to as it is not a very solid career path. And I am so glad I went PA! I also just completed a rotation at a naturopathic clinic! So I have seen first hand what they do.

 

First I do have to say that in many ways they have a much better understanding of anatomy and physiology than you think. I was very impressed by their knowledge of the muscles in my back, for example. They were able to isolate exactly why I have the neck and back pain that I do! They also tend to look more beyond the surface and really try to identify why patients have the problems they do. They are more likely to look at diet and lifestyle as factors in illness which I appreciate.

 

However, I've hated this rotation for multiple reasons. One, a lot the stuff they do is based on pseudoscience. In fact -- most of it cannot be backed up by studies. For example, I have had to sit through 2-3 hour visits of "muscle testing" (where they put a medication on a patient's chest and ask the muscles if it is effective or not... No lie) and "cleaning the patient's aura." Homeopathy is another weird thing, too. They look for key words about a patient and their symptoms and then look for remedies that would cause those symptoms in a normal patient, then give that remedy to the patient to bring them back in balance (that's basically the premise of homeopathy). There's also a lot of IgG testing for food sensitivities which all the major immunological associations have found to be quacky. And according to these naturopaths everyone has adrenal fatigue and blah blah.

 

But there are naturopaths out there that really do try to work with evidence based medicine. They don't all do the quacky stuff as described above.. They do things that have at least some basis in scientific evidence (acupuncture, diet changes, herbs and supplements, etc.) and prescribe meds when necessary.

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Neither do a lot of them. They are less standardized than NPs (which is really scary).

It is useful and enlightening to do some research on this subject. Here is what I have learned: First of all, to get into Bastyr University, one of the preeminent naturopathy schools, there is a list of pre-reqs which is strikingly similar to PA school pre-reqs. They require HCE and shadowing. The curriculum is VERY extensive and looks like excellent medical training, though it isn't clear what happens in the classroom. They offer masters degrees and doctoral degrees requiring a bachelors for admission. Clinical work and residencies are available. These people take themselves VERY seriously. Naturopathic schools are organized under the AANMC. They have a national certification exam. In short, they are modeling themselves in ways similar to PA/NP/MD etc. Although currently only licensed in 17 states, they want to be licensed everywhere and they view themselves as another legitimate branch of medicine, like DO and MD, coexisting as respected colleagues with allopathic physicians.

 

I am not writing this post in support of NDs, I just want to inform those who view naturopaths as witch doctors (admittedly I have been in that camp) that they are pursuing a course towards full legitimization and, no doubt, plan to have their services eventually covered by insurance. Since there are few of them, they can open an independent medical practice and charge for a range of services not offered by traditional medicine. Those who are distrustful of doctors and conventional medicine will flock to their doors and they could become very high income earners. Note that there is confusion when taking about Naturopathic medicine and alternative medicine. There are schools offering bachelor's degrees in alternative medicine. I personally regard this as pure hocum and feel sorry for students led into these useless programs (my opinion) unless they go on to pursue an advanced degree.

 

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Bastyr is a very well regarded program in the ND world. many are not. Last time I checked they had an affiliation agreement with seattle pacific university for a 6 yr dual ND/FNP program, which allowed its grad to practice full scope naturopathy and western medicine as PCPs.

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Guest Paula

Does the new AAPA president really practice reiki?

 

are you starting a rumor or did I miss something in all these posts?

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There are five accredited institutions in the US that offer 4-year doctoral level training in "naturopathic medicine."  http://aanmc.org/schools/

 

Prereqs for entry are the same as those for MD/DO school (Gen Chem, O Chem, Bio, & Physics)--2 semesters each, the one exception being these schools often only require one semester of Physics.  An example, http://www.ncnm.edu/academic-programs/school-of-naturopathic-medicine.php 

 

Granted the program is 4 years, ultimately the science curriculum is more comprehensive than that of a PA or NP program (more histology, embryology, cadavers and other labs): http://admissions.ncnm.edu/files/2013/10/ND-4-year-Program-Layout-2015.pdf  (You can confirm this on their NPLEX board exam website or review materials.  https://www.nabne.org/home/exam-overview/)

 

The HUGE difference from PA and MD training is the lack of clinical training required for full licensure (also viewable in the previous link: 7.5 credits per quarter for last year; similar to NP programs).  And UNlike NP programs that often work out of busy hospitals and established clinics, ND practice is still on the fringe where exposure to more acute or serious illness is often limited.  (I say that from extensive personal experience.)  They're also far less competitive than NP programs, in terms of admissions.  Whether or not they should be PCPs is a different debate.  Whether or not homeopathy is valid is as well.  The primary concerns on this forum regard integrity of the curricula and accreditation factors, so hopefully posting a few links should shed some light.  You should also note the conspicuous lack of reiki from any ND curriculum ;-P

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I can understand many of your concerns regarding naturopathic medicine, but hope that you will listen to a few of my points. I am a graduate of Bastyr University and a licensed naturopathic doctor. I am also in PA school. The reason behind my decision to go back to school are many, including better clinical rotations, the desire to be a licensed provider in all states, and increased job opportunities. If someone considering ND school came to me for advice, I would tell them to choose another career. The reason behind this is not because they would receive a poor education at Bastyr University, it is because their job opportunities would be slim to none unless they have tons of money in the bank to start their own clinical practice. 

 

I cannot speak about other ND schools, but Bastyr University does NOT teach muscle testing to students and does NOT provide education on the use of bogus machines (rife machines), crystals or pendulums to diagnosis. Many NDs, including myself, do not believe in homeopathy and do not use it in their practices at all. The basic science classes that I had to take were top notch, with anatomy, physiology, and pathology all being more difficult and more extensive than my PA classes. I had 1 trimester of anatomy lab in PA school, 2 hours a week. In ND school, I had a full year of anatomy lab for 4 hours a week. I had one trimester of pathophysiology in PA school, 2.5 hours a week. In ND school, physiology and pathology were separate classes and both lasted a full year. My physical exam class at Bastyr was just as challenging and extensive as the one in PA school. At Bastyr, I had to take immunology, embryology, infectious diseases, and histology. These classes are nowhere to be found in my PA curriculum. 

 

ND students are not exposed to the variety of conditions and number of patients compared to MD, PA, and DO students. I admit that this is a problem, but the Bastyr Clinic is not practicing pseudoscience. ND schools have their own clinics where students have clinic shifts. Most shifts are general medicine, but there are some specialty shifts including HIV/AIDS, peds, minor surgery (removal or warts, moles), and diabetes/cardiovascular wellness. Blood draws, PAP smears, insertion of IUDs, strep and mono tests, sports physicals, wellness exams, immunizations, removal of warts and moles, EKGs, and spirometry all took place at the Bastyr Clinic. Treatments included pharmaceuticals, exercise and diet recommendations, stress reduction techniques, herbal medicine, and supplements. I suspect that the clinical education at ND schools will improve further with time.

 

Keep in mind that there are tons of people getting nutrition and online naturopathy degrees and then calling themselves naturopaths, or worse yet, naturopathic doctors. These people are not trained at an accredited institution and are giving integrative medicine a bad rap. None of the NDs that I know are against pharmaceuticals and none of them would instruct a patient to forgo standard medical therapy. We are taught INTEGRATIVE medicine, not alternative medicine. The world "alternative" means that patients have to choose, and this is just not the case. The best outcome is when these 2 areas of medicine combine. 

 

I have neglected to post for a long time because I felt that it would end with me feeling breathless yet getting nowhere. It is easy to see that many of you have your minds already made up. I ask, though, that you please not put all integrative medicine practitioners into the anti-vaccine, anti-pharmaceutical boat. Many of us are very level-headed people who understand complex disease processes and how to appropriately treat them. 

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I am glad that you posted this.  Given the program that you have described, I feel significant professional empathy for a rigorous program being diluted by shams.  I feel the majority of people working in healthcare know what that is like to push themselves educationally only to find that societal and business constructs detract and denigrate their training.

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...The basic science classes that I had to take were top notch, with anatomy, physiology, and pathology all being more difficult and more extensive than my PA classes. I had 1 trimester of anatomy lab in PA school, 2 hours a week. In ND school, I had a full year of anatomy lab for 4 hours a week. I had one trimester of pathophysiology in PA school, 2.5 hours a week. In ND school, physiology and pathology were separate classes and both lasted a full year. My physical exam class at Bastyr was just as challenging and extensive as the one in PA school. At Bastyr, I had to take immunology, embryology, infectious diseases, and histology. These classes are nowhere to be found in my PA curriculum.

 

This is the part of your post I take exception with. You seem to suggest your ND school experience was more medically rigorous than your (current?) PA school. But your PA school only had anatomy lab for one trimester, for 2 hrs./week? Mine has 3 semesters at 4 hours per week, so longer than your ND program. You only did a trimester of pathophys in PA? Ours is integrated across the entire length of the didactic program, almost 4 semesters, and ranges from 3-6 hours per week. So, more than your two semesters of pathology and physiology in ND school. Do I get a doctorate now?

 

You suggest multiple times that things at your ND program were just as extensive and challenging as your PA school, but your only reasons for pursing PA is the wider acceptance and better clinical rotations? If you feel that your ND education was superior, why would you not stick it out and find a way to make it work? You clearly sound as if you believe its training modalities were better. Surely you could find a place to practice as an ND, as others have stated here, they have seen many successful ND practices. Instead you are investing a large amount to pursue PA school, where by your own admission, is not bestowing you the same level of medical instruction.

 

I have a hard time not seeing your statements as an indictment of PA school.

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I feel you are nitpicking hours here and hours there.  I would suggest that the take home point is that this guy feels his ND program hit certain important subjects harder than his PA program.  Somewhat a side issue whether or not YOUR program has an hour to hour equivalence to either of his.  With 120+ PA programs, there are certainly those with more and those with less.  I think what has probably surprised you is the suggestion that there are those with less given the nature of this thread.

 

Also, I would suggest some temperance when you ask, "Why not stick it out?"  To put it bluntly, come talk to me after sinking 10 years into a line a work that is basically dissolving around you with little hope.

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Also, I would suggest some temperance when you ask, "Why not stick it out?"  To put it bluntly, come talk to me after sinking 10 years into a line a work that is basically dissolving around you with little hope.

 

Sorry, I don't have much sympathy for those that claim ignorance of the realities of choosing to become an ND and then have a hard time establishing practice. Or are unable to practice in the State of their choosing. Or find pushback from the medical community. In the same way I don't respond well to those that take a higher risk pathway to MD, through off shore institutions, and fail to graduate or match. These risks are not unknown or new and, in the world-wide electronic age, are readily researchable.

 

For some, the pursuit to be called "doctor" pushes aside the associated risks of a given path. Complaint after the fact is buyer's remorse.

 

Caveat emptor

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Sorry, I don't have much sympathy for those that claim ignorance of the realities of choosing to become an ND and then have a hard time establishing practice.

 

People get excited about stuff.  They pursue careers that don't pan out.  Entire professions disintegrate every decade.

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Sorry, I don't have much sympathy for those that claim ignorance of the realities of choosing to become an ND and then have a hard time establishing practice. Or are unable to practice in the State of their choosing. Or find pushback from the medical community. In the same way I don't respond well to those that take a higher risk pathway to MD, through off shore institutions, and fail to graduate or match. These risks are not unknown or new and, in the world-wide electronic age, are readily researchable.

 

For some, the pursuit to be called "doctor" pushes aside the associated risks of a given path. Complaint after the fact is buyer's remorse.

 

Caveat emptor

 

The ND poster explained "Why PA" in the original post.  Better clinical training and more sustainable pay.  Two good reasons to leave an academic degree (which, without many patients, is essentially what an ND is) if you feel you just need more clinical training and a degree that will boost your ability to repay loans.  There's nothing wrong with trying to make it in a field and then reassessing and returning to school to repair deficiencies and improve credibility.  The catch-22 of the ND profession right now is that on one hand, the political and licensure situation is severely limiting their access to patients during clinical training and beyond.  On the other hand, they require (as do any PCPs) significant clinical training in order to become competent and legitimate enough to warrant more widespread licensure and practice.  You can't exactly pump out expert clinicians with a relatively poor clinical training, and you can't fill a clinic to train clinicians if no one there has the clinical training and expertise to handle a high volume of sick patients.  I realize there is a chunk of people here (most of whom have never met an ND) who thinks the biggest reason NDs should not be licensed is because of dubious practices, but my hope is that, through civil conversation and a willingness to keep an open mind, providers will consider the fact that NDs spend 4 years in school, full time, studying medicine.  Most of them are actually pretty reasonable people if you're willing to have a conversation and be open to learning something new.  

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That is far from reality. Valium can not be compared to valerian root tincture. How about opposite: synthetic ascorbic acid is pretty benign pure substance but viper venom or amanita phalloides ticture will kill you in a heartbeat.

 

On your earlier passage on publishing. NIH awards multiple grants for "natural substance" research. There are labs in a strictly academic settings that are trying to prove the effects of teas, soy, omega oils, lycopene etc etc on cancer, high blood pressure and inflammation. When they have credible results, they are published and presented on the national meetings. All these have nothing to do with that juju that is being sold as natural remedies.

 

What adds to their credibility is the fact that we, as human beings, can adapt, regenerate and get rid of many things by ourselves. We know how many doctor visits can be avoided or (on the big schema of things) would have similar outcomes to doing nothing. Another really unknown is chronic management of chronic diseases. New drugs come, trends and recommendations change that mean more harm could be done. However, when it comes to serious things like surgery, emergency and life and death situations - there is no alternative to traditional medicine. It is hard to convert Afib with herbs or do a PCI with valerian root.

 

My 0.02. People go to NDs because they listen and have to talk to the patient. Docs do not. Soon PAs will join docs with 20 min per patient BS.

 

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.  

 

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That is far from reality. Valium can not be compared to valerian root tincture. How about opposite: synthetic ascorbic acid is pretty benign pure substance but viper venom or amanita phalloides ticture will kill you in a heartbeat.

 

On your earlier passage on publishing. NIH awards multiple grants for "natural substance" research. There are labs in a strictly academic settings that are trying to prove the effects of teas, soy, omega oils, lycopene etc etc on cancer, high blood pressure and inflammation. When they have credible results, they are published and presented on the national meetings. All these have nothing to do with that juju that is being sold as natural remedies.

 

What adds to their credibility is the fact that we, as human beings, can adapt, regenerate and get rid of many things by ourselves. We know how many doctor visits can be avoided or (on the big schema of things) would have similar outcomes to doing nothing. Another really unknown is chronic management of chronic diseases. New drugs come, trends and recommendations change that mean more harm could be done. However, when it comes to serious things like surgery, emergency and life and death situations - there is no alternative to traditional medicine. It is hard to convert Afib with herbs or do a PCI with valerian root.

 

My 0.02. People go to NDs because they listen and have to talk to the patient. Docs do not. Soon PAs will join docs with 20 min per patient BS.

Tuna,

I appreciate the debate, but I think you've taken my point out of context a bit.  Of course there are terribly toxic natural substances.  The reason I tried to emphasize that "GENERAL rule of thumb" was simply a restatement of what we already know: regardless of substance, dose makes the poison.  And it so happens that most pharmaceutical drugs are refinements of natural substances (in one form or another) that, ultimately, serve to standardize dose and increase potency.  As far as I am aware, far more drugs are refined to increase potency (from natural forms) than are diluted down from their natural states.  I happen to have corroborating first hand experience that's relevant here.  Before PA school, I directly managed a Chinese herbal pharmacy for several years at a clinic that treated several hundred patients every day.  Most of those patients received herbal prescriptions (a dispensary of 350 herbs, many of which were even considered "toxic" at a high dose, but therapeutic at low).  Every adverse event that was reported back to us came across my desk.  Thousands upon thousands of prescriptions.  Never did anyone so much as go to the hospital after taking their herbal remedy.  (The most severe reactions we had were nausea, vomiting, diarrhea, and changes in blood pressure--all extremely rare by medical standards.  Most people did just fine.)  On the other hand, we have to be much more careful with drugs because, at such potent doses, they have the potential to kill.  We just studied digoxin in class, which is a perfect example.  For centuries, the extract of foxglove was taken from several grams of the root (per dose).  Today, if that amount were to be given in pharmaceutical form, the dose would be fatal.  This is all I meant by "generally" since herbs fall somewhere between nutritional therapy and drug therapy and therefore carry a general toxic burden somewhere in between.  

 

As for the self-healing bit.  No question, the NDs I've met really seem to embrace that aspect of healing, and many of them admit that to be the curative aspect of so-called homeopathy.  ("Replace this drug with this magic little pellet and, wa la, three weeks later, your cold has been CURED!")  But actually, many people go to NDs because they would rather not take drugs unless they have to.  If you go to one yourself, you'll see that on the one hand, you're right: much of what they do is nothing very sexy as far as medical treatments go (nutrition, lifestyle guidance, etc).  On the other hand, many NDs are filling the demand for non-pharmaceutical options--which very often means, yep, the body heals itself.  It's true, many of them have all the time in the world to sit with a patient for 2 hours to listen to whatever issues come to mind.  But if you actually go to a credible naturopath (i.e. one who graduated from an accredited institution, is licensed in the state of practice, and does not have openings for at least a week or two), you will see, first hand, they do more than listen and nod.

 

Several schools I applied to required me to shadow a PA before application to ensure I knew "what I was getting into."  I'm so glad I did, because I learned so much about what PAs do compared to all the misinformation flying all over the place--much of it among educated populations.  As with any profession, you really can't know what someone really does for a living unless you approach them to experience first hand.  It's a slow process, but as PAs and MDs interact more and more with NDs, everyone will start to see each other for who they are.  

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However, when it comes to serious things like surgery, emergency and life and death situations - there is no alternative to traditional medicine. It is hard to convert Afib with herbs or do a PCI with valerian root.

PS- No question here.  I think you'd be hard-pressed to find an ND who would tell you they're better equipped to handle emergency care than the local ED.  Those guys are working, largely, in chronic disease management (although are making a push for primary care as well).  

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  • 2 months later...

My latest installments:

 

1) Today, 58 year old lady in may headache follow up clinic came in with severe abdominal RUQ pain, when to the ER for the same two weeks ago.. US confirmed multiple GB stones. I didn't see her labs but she said her liver enzymes were abnormal and elevated bilirubin.   The surgeon wanted to schedule a cholecystectomy she wanted to discuss it with her primary care first (a naturopath).  He is doing abdominal wraps with cod liver oil with the purpose of dissolving the stones.

 

2) Last week I saw a 18 year old girl with a new daily headache. I noticed a goiter, pulse of 110, ankle clonus. When I suggested that she had a thyroid problem, they (her mother and her) admitted that they had seen a endocrinologist who dx her with Graves disease and wanted to do radioactive iodine ablation.  They went back to their primary care, also a naturopath, who warned them not to do the iodine but that the thyroid is reacting to toxins in her diet.  She is on a detox diet for the past three months.  Her symptoms are worse. Her new daily headache, in my opinion, is part of her hyperthyroidism.  Her mom rejected that diagnoses and they left, with her mother refusing all treatments or suggestions from me.

 

It is a different "science" than what I know as reality.

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Did these "naturopaths" graduate from an accredited ND program and go on to pass boards and attain licensure in the state in which they're practicing?  If not, you might as well delete your comment.  

 

If so, two things are possible: 1) There's more to the story than what was presented here, or 2) One or both of these people are committing malpractice and will end up in court and/or losing a license should these diseases run the course you're implying they will (and, God-willing, no one will suffer or die as a result).  

 

An interesting coupe of anecdotes, for sure.  Let us know how the reality of these two scenarios pan out.  Maybe they are glaring examples of what's wrong with allowing NDs to practice, or maybe they are carefully-presented fodder for the obvious majority opinion on this thread.  No sarcasm implied; I truly wonder which of these scenarios is most accurate... 

 

I do think, as one last point, that if we're going to hold NDs to a baseline standard of "Do No Harm," it better be the same standard as for other mainstream providers.  You'd be hard pressed to find proof that NDs are killing as many (by %) of their patients due to error or negligence than are conventional mainstream providers.  

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I just found this lengthy thread and found it quite interesting.

 

I have worked around NDs in two states, Texas and Washington and in Texas I worked with Mexican Curanderos (healers). I say worked "around" because one thing I noticed in both states with NDs and chiropractors is that we don't speak the same language. I had a much more community oriented relationship with the curanderos and grew up in the culture. Some are not good and more of a witch doctor and some are really common sense folks like a good smart grandma or grandpa and knew their limits.

 

The differences in the approach to medicine seems adversarial to me. The NDs tell the patients that allopathic and osteopathic medications are poison and harmful and the chiropractors tell everyone they have a leg length discrepancy and a curved spine and that adjusting their neck will cure their elbow and their ear infection. 

 

NDs keep taking my patients off Synthroid and putting them on Armour thyroid which is made from dead pigs (think Armour meat company) and their TSH bounces like a ping pong ball for the next 6 months because the Armour thyroid is inconsistent batch to batch and contains both T3 and T4 in unpredictable amounts. I don't Rx it. Patients keep saying it is natural - I say "so is marijuana and foxglove but it doesn't mean it can't hurt you." I have thyroid disease and they still don't trust a "not natural" product even though I am living proof that a stable TSH is a good thing................

 

I have never received communications from an ND or the DCs in my community. They don't want to talk to me but they sure want me to order their labs and xrays but let them deal with the results. I won't do it - if I order something then I have to have a clinical reason and interpret it appropriately and address it. 

 

The patients come out with an "us" and "them" perspective. 

 

It shouldn't be that way and I am trying to figure out where it comes from - their educational process, our educational process, lack of ND licensure regulations and practice limitations, what else???

 

Growing up in Texas, one could get a chiropractic degree by mail. Not really spurning confidence there.

 

One rheumatology practice where I am now actually employs an ND to help patients approach an anti-inflammatory diet and supplements. Meh, not sure on that one either.

 

I think we all desire a hierarchy and order to things and there just isn't a good order between allopathic/osteopathic medicine and ND and DC and that makes it hard to talk to patients logically when we have no collegial relationship with a lot of these folks.

 

I wouldn't stand for a patient to be harmed by malpractice. Then again, it is hard to show them that some things recommended are pure bunk because there is NO scientific data or studies to show them.

 

So, no good answers here, but I share the frustration and lack of understanding of alternative practices. That said, 5000 years of Chinese medicine is not that shabby and I find acupuncture to be highly beneficial to a lot of patients and I like osteopathic manipulative medicine for musculoskeletal issues. I guess I have seen positive results with those without harm over a period of 25 years and have a confidence level.

 

I think we all need to keep talking about it and think about ways to address it so that patients know we have their best interests at heart and want good things for them.

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