“Doctors” of Naturopathy in Minnesota? Or: Barbarians at the gate

I know I’m a bit late to this game, but those of you who read ERV, Denialism Blog, and Pharyngula didn’t think that their prior mention of this story about how the State of Minnesota is going to allow naturopaths to claim the title of “doctor” would stop me from jumping right in even if I am a day late (which in the blogosphere might as well be a year), did you?

If you did, you don’t know me very well, even after three years of blogging. This sort of thing is the raison d’être of this blog, and just because blogging about an antivaccine rally last week and about Abraham Cherrix yesterday took precedence didn’t mean I wouldn’t get around to this soon afterward. After all, it’s a matter of priorities. Besides, if I had pulled the trigger sooner, I wouldn’t have had the opportunity to feel a mix of schadenfreude and a moment of “I feel your pain” as PZ expresses embarrassment that his state and his party signed on to this nonsense.

So what, exactly are we talking about? Let’s take a look:

It took 99 years, but Minnesota has finally given official recognition to the practice of naturopathic medicine, which relies on the body’s powers to heal itself.

Under a new state law, naturopaths — who use everything from herbal remedies to biofeedback — will be allowed to register with the state and call themselves doctors without fear of running afoul of the medical establishment.

Alright, let’s stop a minute right there. The reporter who wrote this article needs to learn a thing or two. “Relies on the power of the body to heal itself”? That’s what naturopaths claim, but with little evidence to support that contention, unless what they mean is really “letting the body heal itself,” if you know what I mean, as in providing no effective treatment. The reason is that, along with some herbal medicines that might have some pharmacological effect and dietary interventions that might or might not promote good health, naturopathy emphasizes all manner of woo, including “detoxification” and various forms of “energy healing,” among other modalities–even homeopathy, arguably the most ridiculous of all the pseudoscientific “healing modalities” that fall under the rubric of “complementary and alternative medicine.” But let’s hear it from the horse’s mouth, so to speak, namely the American Association of Naturopathic Physicians (ack! how can they call themselves “physicians” without having an MD?):

Naturopathic physicians are trained in the art and science of natural healthcare at accredited medical colleges. Integrative partnerships between conventional medical doctors and licensed NDs are becoming more available. This cooperation makes more effective therapies available to consumers. It increases patient satisfaction in their relationships with their care providers. More people are recovering their health by adding naturopathic medicine to their health care options.

Naturopathic medicine is a system of medicine that assists in the restoration of health by following a set of specific rules. A basic assumption is that nature is orderly, and this orderliness is designed to result in ongoing life and well being. This dependable orderliness is believed to be guided by a kind of inner wisdom that everyone has. This inner wisdom can be assisted to return a person to their best balance by naturopathic treatments.

“Inner wisdom”? Does this remind anyone of “intelligent design”? Of course one can’t help but wonder what causes this “inner wisdom” to go so far awry as to permit diseases as nasty as cancer. How does a naturopathic “doctor” use this “inner wisdom” to cure cancer, for instance? I’ve never really been able to figure it out. I’ve also never been able to figure out how a naturopath decides on what specific woo to use on a given patient. What is the evidence that leads one to conclude that herbs or supplements are the best therapy in on case (never mind which herbs or supplements) or that acupuncture is best for another or homeopathy for yet another? What scientific evidence informs a naturopath’s decisions? Oh, wait. They don’t need no steeekin’ science; they listen to the “wisdom of the inner body.” They do, however overstate the risks of vaccines and lean strongly towards being outright anti-vaccine. Meanwhile the official position of the AANP is that homeopathy is just ducky and should be taught as part of the curriculum on schools of naturopathy.

Despite Minnesota being the latest domino to fall (meaning that perhaps PZ shouldn’t feel quite so bad), the recognition by state licensing bodies of non-scientific medical woo like naturopathy is nothing new. The last time I checked, thirteen states (Alaska, Arizona, California, Connecticut, Hawaii, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont and Washington) license naturopaths (although not all of them allow them to call themselves “doctors”). Minnesota is just the fourteenth. Of these states, Arizona has gone even farther. It’s gone so far as to license homepathic physicians. Specifically, any real M.D. who takes some training in homeopathy can then label himself a “homeopathic physician” and practice as such in Arizona, basically allowing them to practice all manner of quackery, including chelation therapy, detoxification, or basically anything, science be damned. The end result has been that many physicians who’ve had problems with medical board actions against their medical licenses in other states could come to Arizona and obtain an “M.D. (Homeopathic Physician)” designation. Because the standards for homeopathis are so lax, these problem physicians have little trouble setting up shop in Arizona as “homepathic physicians” and practicing, even to the point of being able to dispense controlled substances. One result has been some spectacular examples of patient harm.

PalMD has already discussed the relative laxness of the standards for becoming a “naturopathic doctor” compared with the standards of medical school, leading him to suggest to prospective naturopaths that “if naturopathic school is so rigorous, just go to medical school. We can always use compassionate, intelligent primary care physicians, and we promise to give you an education in the real science of healing.” I agree. One aspect of this story that has barely been commented on is where the resistance to licensing naturopaths in Minnesota came from. Surprisingly, the strongest resistance was not from the medical community (as it should have been) but rather from naturopaths’ fellow woo-meisters:

To those covered by the new law, it’s simply a way to get more respect and professional freedom for a particular brand of holistic medicine. But others see it as an assault in a turf war that could benefit a few highly trained practitioners at the expense of others.

“What they’re trying to do is become the gatekeeper for natural health, so nobody else can practice,” said Greg Schmidt, who runs the Minnesota Natural Health Legal Reform Project, which led a pitched battle to sink the law.

Despite assurances to the contrary, the fissure remains.

“I didn’t realize how much of an issue it was going to be,” said Rep. Neva Walker, DFL-Minneapolis, who championed the bill for years before it finally passed and was signed into law in May. “[I] didn’t realize somebody who had supported all forms of alternative healing for years was going to be an enemy.”

The reason should be obvious, though. This new legislation will allow naturopaths to order lab tests and diagnostic tests–and even admit patients to hospitals. At least legislators didn’t allow them to do minor surgery (Recall Arizona’s experience with allowing woo-meisters untrained in surgery to do minor surgery.) This law, however, does produces a real divide between naturopaths and the rest of the “alternative medicine” crowd of “haves,” who could bolster their woo with many of the trappings of scientific medicine, and the “have-nots,” who would be limited to what they always could do before. Moreover, unlike the infiltration of woo into academic medical centers, which occurs as woo-friendly academic physicians push to allow more and more of this stuff be practiced and taught in medical schools, the path to being a naturopath is much shorter, allowing naturopaths to practice independently on patients in much less time than it takes physicians to reach that stage.

Of course, naturopaths crave the recognition and patina of scientific validity that licensure brings. After all, the state wouldn’t license quackery, would it? Well, yes it would, because the licensing of professionals is a political and public policy issue, not a scientific issue. As far as science- and evidence-based medicine go, there’s no good reason to elevate naturopathy to the same level as scientific medicine. Worse, when patients hear the word “doctor,” they usually don’t know enough to distinguish between “naturopathic doctor” or “medical doctor.” Of course, the blurring of the line is the whole point.

Another aspect of regulating dubious medical practices as though they were scientific medicine is that many “alternative” medical practitioners don’t like it. The reason for this is simple as well. Why should they submit to regulation? What’s in it for them? Right now they don’t have to do anything at all, just set up a shingle and be careful not to make claims that can get them busted for practicing medicine without a license. With regulation, suddenly there are standards to meet. They may be ludicriously pseudoscientific standards, but they’re standards. Will the undeserved patina of respectability provided by state licensure allow them to make more money? In some cases, the answer would be no, making licensure a lot of headache for little or no benefit. Finally as “licensed professionals,” there’s the very real question of liability. If a profession is licensed by the state, patients have the real expectations that there should be standards and may actually sue when they perceive those standards not to have been met. I wonder if these new naturopathic physicians in Minnesota carry malpractice insurance. They’d better, because in becoming more like real physicians in the eyes of the law they’re inevitably going to share another aspect of being a real physician that none of us like: fear of malpractice suits.

The bottom line, as you may have guessed, is that this push for more licensure of “specialties” like naturopathy is part of the broader campaign for unscientific and pseudoscientific practices to seize the mantle of scientific respectability without actually doing the work and research required to earn it. In this, it can be viewed as being of a piece with the infiltration of non-scientific woo into former bastions of scientific medicine. Purveyors of dubious therapies are using a multipronged strategy to achieve “respectability” aimed not just at medical schools, but at government in the form of NCCAM and laws such as the new law in Minnesota. Nor is the media exempt; increasingly we are seeing credulous puff pieces with not one whit of science or whiff of skepticism touting how great it is that medicine is “integrating” the so-called “best of both worlds.” I tend to attribute the relative lack of resistance of the medical profession to the infiltration of so-called “complementary and alternative” medicine mainly to a combination of disbelief that anyone can take stuff like homeopathy and reiki seriously, a lack of scientific training among most physicians that leaves them vulnerable to being impressed by not-so-impressive evidence, a fear of being seen as a monopolistic cartel for “suppressing” CAM, and, above all (in my view at least), a strong reluctance to be perceived as “close-minded” in their criticism. The end result, if advocates of evidence-based medicine do not act, will be a world in which the line between effective medicine and quackery becomes so blurred that it may take decades to unblur it–if it is ever unblurred at all.