Recently, there’s been a movement afoot among purveyors of that special brand of “natural” woo known as naturopathy to convince various legislatures and regulatory bodies that they not only are capable of serving as primary care physicians but that they should be allowed to do so. My first impression was laughter–that is, until I realized that the naturopaths are serious. For example, in New York, naturopaths, spearheaded by the New York Association of Naturopathic Physicians, are lobbying to be given the power to prescribe medications. Never mind that, despite their claims to the contrary, their training is only a fraction of that received by real primary care doctors, whose specialties include internal medicine, family practice, pediatrics, and in some cases OB/GYN. They do not do the three or four years of additional training after they finish school, as real primary care physicians do. Worse, what they do learn in school teaches them that homeopathy, traditional Chinese medicine, herbalism, chiropractic, therapeutic touch, and all manner of woo are effective. As far as I’m concerned, any medical “specialty” that accepts the One Quackery To Rule Them All, One Quackery to Find Them, One Quackery to Bring Them All and in the Darkness Bind Them (homeopathy) as a valid medical treatment, is not capable of applying science and evidence to the care of their patients.
I first started noticing the issue a couple of months ago when I was made aware by Kimball Atwood and I started paying more attention to this issue after blog bud PalMD issued his naturopath challenge. It’s a devilishly simply ploy. PalMD, a real primary care physician, presented what should be to any primary care physician a relatively straightforward patient that any doctor might see in his or her practice and challenged naturopaths to tell him what they would do with this patient. Elsewhere, he issued a similar challenge, only with a different case. Thus far, the responses he’s received from naturopaths have been–shall we say?–underwhelming. One naturopath ordered a whole bunch of unnecessary laboratory tests and recommended a low carb diet and a whole slew of supplements without an evidence base to support their use. Not impressive. In fact, it made me very afraid of what might happen if naturopaths are ever allowed to function as primary care physicians.
Unfortunately for Canadians, British Columbia is about to find out:
New regulations, announced by Health Services Minister George Abbott on Thursday, also significantly expand the role of other health professionals, including midwives and registered nurses.
Expanding the role of midwives, registered nurses and naturopathic physicians allows B.C.’s health system to offer more options for patients, Abbott said in a news release.
British Columbians made it clear during the Conversation on Health that they want increased choice and better access to health services, and today we are meeting our 2008 throne speech commitment to expand the scope of practice for these professions.
Now, I really don’t have a problem with expanding the role of registered nurses. For the most part, I don’t have a problem with expanding the role of midwives, as long as they have adequate backup for when they get into trouble. However, expanding the role of naturopaths? Oh, woo is me! Of course, naturopaths are practically orgasming over this:
Dr. Christoph Kind, president of the B.C. Naturopathic Association, hailed the government move.
“Now we have the authority to be able to work with the pharmacy, with the pharmacists,” he said. “It will also allow better co-management with other heath-care providers, including medical physicians, so I think all in all it’s going to enhance the care that patients get in B.C.”
No. It’s not. What it is going to do is to give naturopaths virtually carte blanche to “integrate” quackery with scientific medicine, true to the “promise” of “integrative” medicine. It’s not enough to treat your hypertension with boring old drugs whether you need them or not, no doubt created by nasty big pharmaceutical companies, the better to separate you from your cash. Oh, no. All manner of pure quackery can now be yours as a patient! Back in the days when naturopaths only prescribed supplements and herbal remedies, the harm they could do was somewhat limited. Now that they can order diagnostic tests and prescribe all non-controlled drugs (essentially anything other than narcotics, certain sedatives, and chemotherapeutic agents), there’s no stopping them, at least in British Columbia.
What puzzles me, though, is the question of why. Why on earth would naturopaths want the power to prescribe real drugs, manufactured by big pharma and its minions? It doesn’t make sense. It goes against everything they are taught in school; it goes against every bit of philosophy inculcated into them during their “training”; indeed, it goes against naturopathy itself! So why are naturopaths so hot on conning legislators into believing they are qualified as “primary care physicians” and thus should be allowed to function as such? Why aren’t they happy with their current scope of practice?
One obvious answer is legitimacy. They crave legitimacy, and they know they don’t have it. They also recognize that science- and evidence-based medicine does have legitimacy. Moreover, they also know that, if they are licensed by the state, they immediately gain the patina of respectability. After all, the state wouldn’t license them if they weren’t a legitimate specialty, would it? That’s what appears to be happening in Minnesota, which recently jumped on the bandwagon of licensing naturopaths. Most importantly, legitimacy allows them to be paid by insurance companies. After all, if naturopaths are licensed, it is harder for insurance companies to resist calls to pay for naturopathic treatments. Worse, it’s a snowball effect. The more states and provinces that license naturopathy, the harder it is for other states to resist the ever-widening snowball rolling downhill.
One thing that I find rather amusing about this whole issue is how naturopaths have utterly betrayed their beliefs and their profession. After all, to them big pharma is bad; “natural” medicines are always better. To them, pharmaceuticals are harmful because they aren’t “natural” and vaccines are highly suspect because they don’t entail getting the diseases against which the protect “naturally.” How often do naturopaths rail against the “drugging” of patients by “allopathic” doctors with mood altering drugs or with blood pressure medicines, claiming that “natural” remedies, diet, or homeopathy works better? Or against how we treat diabetes, preferring instead to recommend various supplements?
In the end, as much as I realize we must battle against the legitimization of quackery. However I take some comfort in how desperate naturopaths seem to be to be given the power to do exactly what we “allopathic” physicians do and prescribe all those nasty, toxic , big pharma profit center drugs to patients. I find vindication in the fact that many herbal medicines and supplements favored by naturopaths are so frequently intentionally adulterated with “real” drugs. To me, it’s the ultimate admission that naturopaths at some level must know that their nostrums are ineffective quackery. They need real medicine to give the illusion that they do anything for patients other than provide them with placebo medicine and an ear to listen. Certainly, there’s nothing wrong with lending an ear to listen, but you don’t need to prescribe placebo medicine in order to accomplish that.