Naturopaths vie for Medicare reimbursement with a dubious survey

Naturopathy is a pseudodiscipline that resembles a Chinese menu of quackery, in which naturopaths select one from column A and two from column B, with each column containing a list of modalities ranging from pure quackery like homeopathy and traditional Chinese medicine to mundane modalities that naturopaths embrace, “rebrand” as “alternative,” and woo-ify and oversell in the process, such as nutrition and lifestyle interventions like exercise. Despite this, naturopaths are deluded enough to believe themselves qualified to be primary care practitioners. Worse, they’ve been having some success at achieving licensure in far too many states, most recently Maryland. (They’re even trying to achieve this in my own state.) Meanwhile, in a seeming contradiction to their entire philosophy that “natural” is better, they keep pushing for more prescribing rights that would allow them to prescribe real pharmaceutical medications, despite their utter lack of qualifications to do so and their hostility towards science.

For all their successes in state legislatures at becoming licensed in more and more states, naturopaths still have one hurdle that they so want to leap. That hurdle is the insurance issue. They want their specialty to be treated like real medicine, like a legitimate medical specialty, by insurance companies. Basically, they want to be able to bill insurance companies for their services. Even more than that, they want to be accepted by Medicare, because whatever Medicare reimburses, most insurance companies will agree to reimburse. If naturopaths could crack that Medicare nut, then full reimbursement from most, if not all, insurance companies would soon follow. Knowing that, you will know the purpose of a survey that’s being touted by the American Association of Naturopathic Physicians (AANP), with a press release proclaiming, Study Finds High Demand for Naturopathic Physicians Among Older Americans. Basically, it was a survey of older Americans living in states in which naturopaths are licensed. The key finding was that 55% of older Americans who live in states that license naturopathic physicians would consider seeking care from a naturopathic physician and that “100% would likely visit a naturopathic physician if the visit were covered by Medicare.”

From the press release:

Dr. Kasra Pournadeali, President of the AANP, remarked, “The seniors I and many other naturopathic physicians see understand the importance of self-care, personal responsibility, and non-drug methods in staying healthy. They also understand how naturopathic physicians have training in natural and conventional methods and are best-equipped to recommend effective non-drug treatments when appropriate. Isn’t it time to end the mandate that seniors can only access a physician trained solely in costly, drug therapies? Isn’t it time to allow our elderly access to other effective and less-costly methods?”

And:

“The study is a wake-up call to policy makers,” commented Jud Richland, CEO of the American Association of Naturopathic Physicians (AANP). “Seniors are saying loud and clear that they want Medicare to provide access to holistic care providers such as licensed naturopathic physicians. Millions of Americans have paid Medicare taxes all their working lives, but when the time comes to participate in Medicare, they find that the services they want aren’t available.”

Seldom have I seen the purpose of a survey so blatant. The AANP is basically arguing that, because seniors are interested in naturopathy and would consider going to a naturopath if naturopathic services were reimbursed, Medicare should reimburse naturopaths for their services. It’s not a particularly persuasive argument, even less so after I perused the actual survey report itself, and how it’s constructed.

Unfortunately, I don’t see the actual survey itself anywhere; so I can’t judge the validity of the questions. A company called Infosurv, which appears to specialize in marketing research and customer surveys, which seems appropriate in this case given that the AANP was clearly doing this survey as market research designed to be used to influence legislators. In any event, simply from the way that the results are reported, I can tell that a lot of assumptions went into the survey and potentially skewed the results. For example, the first issue examined, apparently, involved questions about whether the respondents (384 adults age 65 and over in states in which naturopaths are licensed) were interested in “natural healing.” Not surprisingly, they were:

Three-quarters of Medicare beneficiaries prefer that their doctor use natural therapies, such as improved diet or supplements, before prescribing drugs or surgery. This finding is not surprising given the number of older Americans who take one or more prescription drugs and who worry about the side effects of those drugs. The survey found that 88% of seniors are currently taking prescription drugs, and more than four in ten seniors who take prescription drugs worry about side effects.

Of course, most people don’t want to have surgery! Of course, most people don’t want to have to take prescription drugs! Surgery is painful and, depending on the nature of the surgery, can lay you up for a while. Taking drugs every day is drudgery, and there are certainly potential side effects, which can range from barely noticeable to debilitating. Indeed, I’m surprised that only 42% of the respondents who take prescription drugs reported being worried about side effects, while 58% were not. In other words, well under half of seniors taking prescription drugs number reported worried about side effects. (See? I can spin things, too!) It’s very obvious, though, what this survey is doing. It sets up the idea that seniors want “natural” treatments (never mind that supplements, by and large, are no more “natural” than pharmaceutical drugs).

Next, the survey asks about interest in naturopaths and finds that 55% of seniors would “consider seeing a naturopathic physician for their health care needs.” One wonders what percentage of respondents actually know what a naturopath is. My guess is that the survey told them, and told them this (taken from the survey report):

Naturopathic physicians emphasize non-invasive, natural therapies. They resort to prescribing drugs only when absolutely necessary or to referring patients to other health care professionals when surgery may be advisable.

If I didn’t know what naturopathy is, how it encompasses all manner of “natural” quackery, how it is based on prescientific vitalism at its core, I’d be half tempted to be favorably inclined to a medical specialty described thusly myself. Of course, I do know, and I wouldn’t be the least bit interested in going to a naturopath. My guess, however, is that few of the respondents knew what, exactly, a naturopath is or what sorts of treatments they recommend. If they knew what homeopathy was and that training in homeopathy is required in schools of naturopathy and the naturopathic licensing examination, they might not be so impressed with the promise of “natural therapy.” If they knew how slight the evidence base for naturopathy was and how traditional physicians do promote prevention and “natural” treatments that naturopaths have co-opted from science-based medicine (such as dietary changes and exercise), they might be less impressed. If they knew how naturopaths frequently use pseudoscientific diagnostic modalities like traditional Chinese medicine “tongue diagnosis,” they might be a lot less impressed.

Finally, here’s the pitch:

Federal law does not currently include naturopathic physicians among those health professionals who can participate in Medicare. As a result, many seniors are not able to obtain care from a naturopathic physician despite their desire to do so.

Of those seniors who would consider seeing a naturopathic physician, only 23% would do so if they had to pay the full cost of the visit out of pocket. However, when Medicare coverage is an option for individuals who would consider seeing a naturopathic physician, the picture is much different. Nearly 100% of respondents said they would consider seeking care from a naturopathic physician if the naturopathic physician were included in Medicare.

Of course, seniors would consider naturopathy if it were reimbursed by Medicare! If you don’t have to pay more than a co-pay for something like naturopathy, that puts it on the same tier as a regular doctor visit as far as cost. Add to that the apparently glowing description of naturopathy as “natural” and resorting to drugs and surgery only as a last resort, and of course naturopathy seems appealing, particularly when coupled with a dire estimate of the number of deaths due to adverse drug reactions, a commonly cited but questionable (at best) and misleading (at worst) statistic, which is mentioned in the AANP survey report. It’s not clear whether it’s mentioned in the survey itself, but it wouldn’t surprise me.

This survey is worse than useless, being nothing more than a blatant advertising tool for the AANP in its never-ending war to get more states to license naturopaths and to persuade CMS to allow Medicare to reimburse for naturopathic services. It’s so thin and transparent, so utterly without substance, that I wonder why the AANP even bothered.