Naturopathy is 80% quackery, 19% science-based modalities like diet, exercise, and lifestyle changes rebranded and infused with woo, and maybe 1% valid medicine. Yes, I know I’m probably being generous given that naturopathy is based on a vitalistic, prescientific worldview and originated in the 19th century German “natural living” movement, but I’m in a generous mood right now. The reason I’m in a generous mood is not because naturopathy has suddenly become less quackery than it was. Just view a few of my posts on naturopathy if you think my opinion’s changed. I still believe that naturopathy is pseudoscience and quackery, and naturopaths are only too happy to confirm that assessment discussing cases with each other when they think no one else is listening.
Naturopathy is, like many forms of alternative medicine, rather religion-like, cult-like, even. Belief matters more than evidence, and being “natural” matters above all else. That’s why it’s refreshing when a member of the cult actually leaves the cult. It’s unusual. Once a person has become a naturopath, it’s rare for that person to leave the pseudoscientific cult that is naturopathy. For one thing, it’s hard—very hard—for a naturopath to switch careers. I’m happy to say that such a thing has happened. A naturopath named Britt Marie Hermes got fed up with the fake medical system that is naturopathy and left. She more than left, however. She turned and started a blog about naturopathy called Naturopathic Diaries, describing her deconversion thusly:
For about 3 years, I practiced as a licensed naturopathic doctor in the United States. In 2011, I graduated from Bastyr University in Washington state and then completed a one-year residency in a private clinic. After my residency, I briefly practiced naturopathic medicine in Arizona.
I left the profession of naturopathic medicine to pursue a career in biomedical research. Since my departure, I have been working to understand my former biases towards naturopathic medicine and explore the ethics and evidence, or lack thereof, of naturopathic philosophy and practice. I’ve concluded that naturopathic medicine is not what I was led to believe. It is a system of indoctrination based on discredited ideas about health and medicine, full of anti-science rhetoric and ineffective and sometimes dangerous practices. This blog reveals what I’ve discovered about naturopathic medicine. Herein lies my story based on my personal and professional experiences.
This is big. This is great. Britt is just what we as supporters of science-based medicine need: a former naturopath who can shed some light on what naturopaths really do. Particularly informative is Britt’s story of why she became a naturopath. It begins with her suffering from psoriasis. Psoriasis, of course, is a disease that is very frustrating for both patients and practitioners. It’s a disease that waxes and wanes, that can be very difficult to treat, and that causes patients considerable distress. But that wasn’t so much the reason why Britt became disillusioned with medicine as it is currently practiced. This is:
My psoriasis story contains the necessary ingredients to reinforce misconceptions and myths about medicine and an attraction to alternatives. First, it paints allopathic medicine as cold and indifferent. The doctor in my story was unmoved by my grief over my diagnosis of psoriasis. He seemed like he was in a hurry. He offered me no sympathies. In my naturopathic bias, he did not care about the patient. He did the most terrible thing ever: he offered me a prescription drug and no other treatment options. (I even asked about other choices.) Lastly, he only treated my psoriasis, not me, the person. I remember that he did not ask about my family history, lifestyle, eating habits, or my spirituality. He stood in the doorway and only treated my disease.
These are classic arguments made by naturopaths to defend their medicine and demonize allopathic medicine. Naturopaths claim to treat the whole person, while medical doctors treat disease. Naturopaths claim to use the least force necessary, while medical doctors push pills. Naturopaths claim to have time for their patients, spending anywhere from 30 to 90 minutes with a patient, while medical doctors spend a mere 60 seconds with a patient. Lucky me, my doctor set me up for a powerful story to validate the use of naturopathic medicine!
In reality, I just got a grouchy doctor. One dermatologist clearly does not represent the entire field of dermatology, and truthfully, I have had many wonderful and warm dermatologists since this experience. But this one psoriasis story cemented my faith in naturopathic medicine, and I used it to convince others of the the miracles of naturopathy.
This is exactly the sort of disillusionment with science-based medicine that leads patients to quackery like naturopathy. I’ve heard the story again and again and again. Unfortunately, the current model of insurance-based reimbursement encourages—nay, demands—the sort of behavior that Hermes’ dermatologist exhibited. With reimbursement barely covering the cost of providing medical services, physicians find themselves forced to try to make a living on volume. It’s true for surgeons, but its especially true for primary care physicians. Spending 30-90 minutes per patient is a recipe for going out of business. Quacks like naturopaths, however, base their model on this. Indeed, as I discussed this very issue earlier this week when I discussed “integrative medicine” as the lure of the shaman-healer.
In fact, Hermes is very explicit about “belief” being central to naturopathy as she continues her deconversion story. And, make no mistake, that’s exactly what it is we’re talking about here, a deconversion story. She describes how doubt began to creep in, describing it as a slow process. First, Hermes encountered practices that to her seemed to portend only small clinical risks, but then, the longer she was in the profession, the more she saw and, as she put it, “began to witness serious and dangerous naturopathic practices.” She then points out that, even though she was a quarter of a million dollars in the hole due to student loans, she had to “drop her faith.” Those are the exact words that she used. She then justified them:
I intentionally use the word “belief” to describe my experiences with naturopathic medicine. Naturopathic medicine is a philosophy, a worldview, and even a lifestyle. It is not a real and distinct medical system. Not everyone has heard of naturopathic medicine, but its principals can be found in any alternative medicine doctrine. In fact, it’s as if naturopathic medicine includes any and all tropes counter to science and borrows loosely from medicine when convenient.
For naturopaths, it does not matter if science refutes the traditional ways of healing. Because for naturopathic believers, what matters is not about what science says, but about beliefs in an alternative, magical healing force. Naturopathic medical beliefs include pseudoscientific ideas like vaccines cause more harm than good, any disease can be successfully treated with homeopathy, alternative cancer therapies are safe and effective, and nutrition can cure mental illness. These beliefs are dangerous and their promotion is unethical.
Yes, as I’ve pointed out so many times before, you can’t have naturopathy without The One Quackery To Rule Them All, homeopathy. It’s part and parcel of naturopathy. It’s in all the curriculae of major naturopathy schools. It’s part of the NPLEX, the naturopathic licensing examination. Based on their belief system that “natural” is always better, naturopaths frequently promote antivaccine views. (I know there has been one naturopath featured on this blog who claimed not to be antivaccine, but even she couldn’t resist seasoning her writing and videos with antivaccine talking points. Not surprisingly, naturopaths contribute to the fear mongering about vaccines and genetically modified organisms (GMOs), the latter of which leads the lack of political will to strengthen vaccine requirements.
What’s amazing, and so much to Hermes’ credit, is that, unlike so many, she actually admitted she was wrong and did so explicitly in her application to the Medical Life Sciences program at the University of Kiel, which is a Master’s of Science program focusing on biomedical research. In particular, she described her deconversion as “getting out of the rabbit hole.”
One of the incidents that turned her on the path of knowledge, noting that naturopaths accuse her of “misrepresenting” the “good” naturopaths who provide what they describe as “high quality care.” As a counterpoint she describes a patient with “multiple chemical sensitivity disorder.” This patient showed up to her clinic for a regularly scheduled intravenous vitamin C and glutathione injection. Because the patient was late for the appointment and his naturopath was unavailable, Hermes had to see the patient to do the IV. She noticed that the patient’s hand was bleeding due to a dog bite.
Hermes wanted to do the right thing after irrigating the wound, namely give the patient a tetanus vaccine and oral antibiotics. This did not go over well with the patient’s regular naturopath:
The patient’s regular naturopath pulled me aside. This naturopath had overheard me consulting the patient and was furious I had recommended oral antibiotics and a vaccine, due to fears of exacerbating the patient’s “multiple chemical sensitivities.” I maintained that the patient had a deep animal bite, the patient was overdue for a tetanus shot, and the likelihood of an infection was pretty good. We debated for several minutes, and when neither of us agreed to change our minds, we decided to disagree and carried on with our tasks. By the time I had returned with the IV bag, this naturopath had spoken to the patient and made a convincing argument against my medical recommendation.
The patient said, “I don’t want oral antibiotics, and I am very afraid of getting a vaccine. Dr. so-and-so agrees with me.”
I had an idea. I suggested the patient apply a topical antibiotic prescription, take home a prescription for an oral antibiotic, and start taking this medication at the first signs of an infection (along with calling me). The patient would also get a tetanus shot on the way home. I helped arrange the vaccination appointment at a local pharmacy and dispensed a homeopathic remedy.
The only way I could convince the patient to get vaccinated was to recommend the homeopathic remedy Thuja, which is a common remedy prescribed by naturopaths for adverse vaccine reactions. When the patient outright refused to get vaccinated, I came up with the idea of using homeopathy to relax the patient’s fears.
So, in other words, in order to do the right thing, she had to trick the patient by doing the wrong thing. Why is that? Because naturopathy is so rooted in prescientific vitalism and pseudoscience that it demands the wrong thing and actively opposes the right thing. Worse, that’s what the patients want. They are drawn to this wrong thing (wrong from a medical and scientific standpoint). As Steve Novella described so accurately, naturopathy is a delusion. As Mark Crislip describes, the ignorance of naturopaths can result in the deaths of patients. As Kimball Atwood described, naturopathy is pseudoscience and prescientific vitalism. As I myself have described, it’s naturopathy versus science, with naturopathy being a a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease. As a result, typical naturopaths are more than happy in essence to “pick one from column A and one from column B” when it comes to pseudoscience, mixing and matching treatments including traditional Chinese medicine, homeopathy, herbalism, Ayurvedic medicine, applied kinesiology, anthroposophical medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine. If you don’t believe me, I could show you a veritable plethora of examples culled from naturopath websites.
Unfortunately, of all the forms of alternative medicine, naturopathy has arguably been the most successful at making a bid for respectability. Indeed, seventeen states, plus the District of Columbia and the U.S. Territories Puerto Rico and the Virgin Islands, license naturopaths. As documented by Jann Bellamy and the Society for Science-Based Medicine, naturopaths are constantly looking to expand that roster. Last year they succeeded (to an extent) in Maryland, but didn’t get anywhere near all that they wanted. They’ll be back, no doubt, to try to remedy that. They’re always back. They tried recently in my own state of Michigan, but the bill appears to have gone nowhere.
Meanwhile, in academia, “integrative” medicine programs integrate the prescientific belief system that is naturopathy with science-based medicine, with depressing results (e.g., the University of Kansas and Georgetown, among others). Professional societies dedicated to “integrative medicine,” such as the Society for Integrative Oncology, allow naturopaths to be full members. Indeed, both the current President and Immediate Past President of the SIO are naturopaths, Suzanna Zick, ND, MPH and Heather Greenlee, ND, PhD. A naturopath helped write the SIO’s recent clinical guidelines for breast cancer treatment. The list goes on. Even though you can’t have naturopathy without homeopathy, the “integration” of naturopathy continues apace.
That’s why Hermes’ contribution is valuable. Indeed, just this morning, she published an Orac-length description of the training that goes into the ND degree. Her key points include that naturopathic education exists in a bubble without any real oversight and that what Bastyr and other naturopathic schools say about themselves and their programs do not jibe with reality. Most importantly, she deconstructs a common deceptive trope repeated by naturopaths to make it appear that their education is the equivalent of that of an MD by detailing what her own education included. Amusingly (and a bit disturbingly), the clinical training in physical examination was risibly lacking:
Students were required to achieve physical exam benchmarks, such as a cardiovascular exam, a respiratory exam, a prostate exam, or a neurological exam. Students were only required to complete one exam in each system and may perform the exam on another student if a patient was not available or the student never had the opportunity to perform the exam on a patient. It was not uncommon for students to perform prostate and gynecological exams on each other in order to complete the required examination for competency. And in fact, the instructor of our advanced gynecology class (an elective course) asked the female students taking the course to act as standardized patients. When I learned this, I was happy that I did not register for the weekend elective course. The lack of actual patients to practice examinations significantly hinders naturopathic clinical training.
No doubt. One wonders how many female ND trainees dropped out of that particular course when they learned that they would be asked to undergo gynecological examinations by their fellow fumbling trainees. (As an aside, I’ve always admired women willing to be standardized patients for medical students. I can’t imagine what it would be like to let a succession of nervous, fumbling students anywhere near my sensitive nether regions, particularly given that they generally are not paid very much and do it more out of dedication to training doctors in women’s health.) In any case, in medical school, a lack of patients is rarely a problem, nor is a lack of supervision. In my year two physical diagnosis class, we had to do complete histories and physicals on a number of patients in the hospital. At the end of the course, our final examination consisted of being asked to do a random part of the physical examination (e.g., cardiovascular, pulmonary, musculoskeletal, neurological) and be videotaped doing it. The videotapes were reviewed by our professors and a major part of our grades. Then, throughout my clinical years (years three and four) and my residency I did more histories and physicals than I can remember, dozens turning into hundreds, and eventually thousands by the time I finished general surgery residency.
Particularly devastating is Hermes’ description of how there really isn’t a standard of care in naturopathy; basically almost everything goes. After all, when you abandon science and embrace modalities like homeopathy and traditional Chinese medicine, there really is no reason other than a combination of ideology and habit to choose one treatment over another for a given tradition. It’s an observation that I’ve made many times before, but it’s good to see it confirmed by a former naturopath, and it’s good to see a description of how there are there were “lengthy competencies for homeopathic medicine” in ND school, to confirm yet again how integral homeopathy is to naturopathy. The American Association of Naturopathic Physicians (AANP) is misrepresenting what naturopathy is to lawmakers in a bid to become licensed. Because the AANP is playing a long game, setbacks are just part of the game. The AANP always comes back again and again and again until it gets what it wants.
In the end, as I described, naturopathy really is very religion-like; so it’s not inaccurate to refer to Britt Hermes as an apostate. She’s put her fellow naturopaths on notice:
Naturopaths are notorious for blindly accepting information that fits their world-view and vigorously ignoring information that contradicts. I’ve seen it many times over.
It is easy for naturopaths to ignore information coming from critical websites and insulate themselves with others who think alike. They read the words “pseudoscience,” “quack” and “show the evidence” and run the other direction. For many years, I did the same, but now I know better. Therefore, I will do better.
To all naturopaths: You are officially on notice.
Let me just publicly welcome Hermes to the world of science and skepticism. I’m very glad she’s here and can’t wait to see her future posts. She’s evidence that, as difficult as it is to dissuade someone so invested in pseudoscience to embrace science, it can happen.
136 replies on “A naturopathic “apostate” confirms that naturopathy is a pseudoscientific belief system”
Good on Ms. Hermes for having the gonads to admit she was wrong. Very few people do that when the stakes are as high as their careers, even when it involves something much less egregious than naturopathy.
I was that dog bite patient, I let a deep cat bite fester in service to the notion that the body is self-healing, and in obedience to the anti-antibiotic/anti-vaccine axioms instilled and reinforced by my alt-med providers. With my infected swollen hand and forearm, in the moment when I accepted the standard of care as rendered by a legitimate physician, I allowed myself to be violated. That’s the gift alt-med gave me, complete and abject misplacement of my trust. The lesson learned since is that alt-med and its apologists accept no responsibility EVER for the harm they cause, both physical and mental.
Bastyr says,
“A regionally accredited, globally respected institution of natural health arts and sciences, Bastyr University is improving the planet through innovative education, research and clinical service.”
to which I say I can only hope a class-action lawsuit will be possible at some point for the students whose useful minds were derailed at great personal and financial cost.
I think it would be easier to make a case against alternative medicine if real medicine didn’t have so many skeletons in its closets. It’s hard for me to argue effectively with relatives who buy into all of the CAM nonsense when they point out that traditional has much entrenched fraud, greed and incompetence. How would you respond when it is pointed out that tens of thousands of needless surgeries are performed each year in the United States? That ineffective drugs, often with serious side effects, get to market due to fraudulent manipulation of clinical trials? That up to 200,000 deaths each year are due to medical errors? That the CDC estimates that over one million infections occur in hospitals each year, many due to poor practices. It would be much easier to argue against CAM if traditional medicine cleaned up its act.
To paraphrase Ben Goldacre: Just because the airline industry has problems does not mean that flying carpets work. The same applies to medicine. Those problems will be alleviated by science, not by embracing quackery. Also, that “200,000” figure is grossly inflated. For example:
http://www.jparksmd.com/blog/400000-dead-from-physicianhospital-error
Yay for Ms Hermes. Just this morning I was listening to an interview with a “naturopath” and all she could oofer was that she required ‘alopathic’ (read- real science/medicine) prove her wrong. And here was silly old me (an Intensive Care Trained Nurse) thinking that it was up yo the claimant to prove their assertions as correct. Bugger, back to the drawing board for me.
Sorry for my typo’s, I was a bit infuriated and didn’t proof-read my comment.
@ Alfred Nyby
Because the guy next door is a thief doesn’t give me the right to go around mugging people. From the point-of-view of the victim, he got robbed either way.
I would answer it would be a better world if, in all professional fields, medical included, we were a bit better at improving and enforcing standards.
Unless the alternative could prove it is faring better, then it is not a better choice.
Which leads me to:
It’s easy to criticize and second-guess when it’s not your job.
I dare CAM proponents to be better at preventing secondary infections in the same circumstances. No cheating like having twice the room and four times the man-hour resources; or comparing non-invasive settings with surgery or long-stay wards.
BTW, in the interest of fact-based discourse, [citation needed] on the 200,000 deaths due to medical errors and the few other numbers you quoted. And don’t forget to report the denominator. 20 deaths among 100,000 patients shows a lot more good medical skills than 2 deaths among 10 patients.
I agree comparing rates of various outcomes from an outpatient clinic not doing any invasive procedures with a hospital setting really isn’t fair. Now comparing CAM with outpatient well visits from the doctor rather than CAM vs ICU and ER-trauma situations might be a bit more fair.
Of course comparing a system with active surveillance and required reporting of adverse events (including not giving the medication when needed so the patient died) with one that doesn’t have any oversight keeping watch isn’t particularly fair, either.
Being $250,000 in debt and giving up recouping that debt as a practicing “doctor” – ouch!
I bet a lot of ND’s realize on some level how much bogosity there is in it … but that debt is a psychological trap.
Good for her and amazing to walk away from it.
It’s nice to have a counterpoint in Ms.Hermes to the former-doctor-turned-woo-artist types.
“I think it would be easier to make a case against alternative medicine if real medicine didn’t have so many skeletons in its closets.”
On the contrary, I think the importance of CAM cleaning up its act should be even more imperative to those who emphasize how terrible mainstream medicine is. If your only alternative is CAM, it had better have the highest possible standards and be constantly vigilant to root out quackery.
@Helianthus
One source of infection in hospitals is toilet aerosols. See http://www.tandfonline.com/doi/pdf/10.1080/02786826.2013.814911
Closing the lid may help:
Knowing this helped me prevent the urinary tract infections I’ve been bedeviled with – so many times, I’ve gotten a UTI and been mystified about how the bacteria got there.
After I started cleaning the toilet bowl often, and closing the lid before flushing – no more UTI’s.
Dangerous @10:
Once the quackery is rooted out, what’s left? — cheers – P
The APA now stands by this diagnostic criteria. Naturopathology: The persistent belief that a framework of empirical restraints is unnatural.
Wow, another person to admit they were wrong and to change! I’m starting to have some hope.
I hate the Cancer Centers of America ads on TV with a white-hot passion, and I notice that they offer naturopathy as one of their treatment modalities. It’s a for-profit hospital, which means someone (patient or insurance company) is being billed for all that quackery. I think a lot of people who go there think it’s some kind of nutritional counseling.
I LIKE the term “apostate.” Nice. Wink, wink.
Thank you everyone for your efforts and integrity, particularly Orac.
This is a repetition of my current SBM comment for those who wish to be activistic:
“FYI:
Today is the deadline to electronically submit testimony to the State of CT regarding what naturopaths here term licensure “modernization” [the irony!!!]:
NDs want prescriptive rights here in Corrupticut.
The email address where you can submit either PDF or Word attachments as testimony is:
[email protected]
I’ve written a specific Podcast episode, BTW, regarding this topic, just up:
http://naturocrit.blogspot.com/2015/03/the-naturocrit-podcast-episode-009a-mp3.html
And I’ve written a specific lesson plan for my Saturday Medical Law and Ethics course tomorrow that goes something like this:
should a group of practitioners who IGNORE science and CORRUPT science be given prescriptive rights when medicine’s code of ethics is obligated to ‘scientific integrity’?”
I think the obligatory joke that isn’t funny is to then state:
“Discuss.”
Or, shall I venture:
disgust!
Because I too know what its like to have a mortgage upon oneself for ND school, based upon lies.
Back in mid 1990s, the ND apparatus had stated, which I thought was true:
“naturopathic physicians are the modern day science based primary care doctor […] it is not a belief system.”
[see http://web.archive.org/web/19990221212454/http://www.teleport.com/~aanp/alliance/main.html ].
Take CARE.
-r.c.
This is kind of OT, but yesterday at Sprouts, I picked up a package of tea for treating high blood pressure — er, I mean for high blood pressure support — or something. Anyway, the back advised that the herb mixture in the tea has been used by traditional Chinese medicine to treat high blood pressure for “thousands of years”. I’m still trying to picture what a thousand year old traditional Chinese sphygmomanometer looks like.
OK, I know I’m going to be vilified for not having followed this discussion for years– until I saw it here, I had only heard the word “naturopath” and had no idea of what was involved– but I don’t get how people can
1) Pay off all that debt if they spend 90 minutes with patients.
2) Not be sued for malpractice if the outcomes are so disastrous?
I’m not sympathetic to the naturopaths, at least as described here, but I am also not sympathetic to the proposition that conventional medical practice will heal itself.
The science says, definitively for a while now, that yearly checkups have no benefit. Dr. E Emanuel, in a recent NYT piece, pointed out that eliminating those would free up PCP to better serve patients with actual complaints.
So, sorry Orac, but it isn’t a question of “Those problems will be alleviated by science, not by embracing quackery.”
I would elaborate but first I really want to answer my questions 1 and 2. I know it varies among states, but surely where there is licensing there must be some version of standard of care and liability?
1) Pay off all that debt if they spend 90 minutes with patients.
I don’t think every visit is 90 (usually the initial visit) and this may be why so many of them sell the supplements they recommend as that probably adds quite a bit of profit per patient. That and being a consultant for a dietary supplement manufacturer and other revenue streams.
2) Not be sued for malpractice if the outcomes are so disastrous?
I don’t know how many people only see the naturopath and probably if you eventually ended up at the ER the lawyer will go after them that has the deepest pockets like a large healthcare system rather than a small business. I believe naturopaths can carry malpractice insurance (not sure how the rates compare to MD/DO), if not just cover it with general business insurance types of policies. I’m sure the insurance industry has found a way to make money covering all the various alt med specialties.
And who came to the conclusion that yearly checkups don’t produce measurable health benefits? Clinical researchers and outcomes researchers. In other words, scientists. Getting physicians to embrace these scientific recommendations is now in the realm of science. Change never happens as fast as we think it should in medicine, but change does come. For instance, these guidelines:
http://www.emedicinehealth.com/checkup/article_em.htm
It’s also overly broad to say that yearly checkups have no benefit. Rather, they have no benefit for the average, reasonably healthy person.
In other words, it’s the medical equivalent of Sheilaism.
The mantra I keep hearing from my altie friends is “it works if you believe it will.” But if that’s so, then why don’t they think “allopathic” medicine works, since so many people trust their doctors? I once asked them that question.
They hadn’t thought about that. They thought about it for maybe 15 seconds , and then said they didn’t know. Nor did they particularly seem to care. It’s not important because it’s still about choice. Free choice. Finding what works for you and leaving off the rest.
Naturopathy is spiritual and therefore they think it’s not religion. No, not at all. But they compartmentalize and shift topics like skilled apologists. I see little distinction.
Taking an overview** of recent topics in the conflict between SBM and woo ( vaccines, cancer treatment, dietary trends), I unhappily suspect that there is a reasonable possibility that the ( so-called) western world ( Europe, N. America esp) will devolve into a bi-partite entity wherein two world views and compatible services exist although I am loathe to say it: it’s horrible. Even if the whimsy-based ™ is advanced and utilised by a relatively small minority, it is becoming established. Thanks lobbyists and Mr Verkerk ( amongst others and internet proselytisers.
If you think about it, a small segment of society already accepts faith-based explanations for reality as it is- this is just another affront to reality-based medicine.
** for which I seem to have a bit of talent
Yes, welcome to Britt. I left a note of encouragement on her site to make sure she knows she has support out here once she begins coming under attack from her former colleagues. I am a transplanted Seattleite, and there’s no end to the shame that Bastyr and the Discovery Institute are in this area…. what really worries me is not just the general acceptance of Naturopathy, but the state licensing/sanctioning, possible ability to prescribe pharma, and insurance coverage that the Naturopaths are going for. Do legislatures know nothing about medicine as a business is even run? Sit in on a quality oversight meeting or compliance or patient safety meeting sometime at a hospital/medical center. Watch at how they evaluate CLAIMS for physicians and providers. How can hospitals and insurance companies support Naturopathy when their claims evaluations use Standard of Care evidence? To be brought into any kind of mainstream fold, Naturopaths would ultimately have to comply with modern medical standard of care, or the lawsuits will explode. Can someone enlighten me as to what the Naturopathic “Plan” here is with respect to this? I really don’t get it ….
#19 Orac:
“Getting physicians to embrace these scientific recommendations is now in the realm of science.”
That makes no sense at all. The science is done, and has been done for a while. Now it is a matter of policy, whether public policy or business policy on the part of the entrepreneur-MD, of whatever kind of delivery organization might be involved. And consumers of course, except that “insurance pays for it now”, so there is no incentive to pass it up.
With all due respect, we are talking about the *practice* of medicine, which is not science but more like engineering or perhaps kintsugi. What you need to combat “alternative medicine” is an actual alternative to the inefficient and sometimes harmful (physically and economically) BAU model. (And I’m talking only about the USA, so apologies to those nations that do it better.)
As I said, I don’t know much about naturopaths but some kind of different training and focus is not inevitably inferior. Even in the anecdote, Ms Hermes recognized what she thought was a need for antibiotics and tetanus shot. Where did that come from if not her training? And if the other practitioner disagreed– well, I’ve had a regular MD almost visibly flip a coin in exactly that kind of deep wound circumstance, deciding how to treat me. No woo involved.
On a related note, a CBC affiliated consumer advocacy group created and received a licence for a “natural remedy” from Health Canada. Their application was approved in less than six months and one of their supporting documents was a photocopy of an entry from a homeopathic encyclopedia.
http://www.cbc.ca/news/health/health-canada-licensing-of-natural-remedies-a-joke-doctor-says-1.2992414
@zebra
She said in her blog that she learned that from Medscape and Up-to-Date.
So TCM in this context stands for The Chinese restaurant Menu?
#25 Laura,
Thanks, I was only going by what I read here. But the story simply doesn’t make sense– how are these people licensed to prescribe the antibiotics and tetanus shots in the first place? There must be some oversight of the training for that to happen, and treating wounds like that is very basic stuff.
Really, it would help if someone could actually describe what the rules are. Are there actual MD naturopaths or not? If not, how are they held liable for the results of their treatments? And if they are so against ‘artificial’ medicine, why would they want to be able to prescribe drugs?
Orac,
Because I throw criticisms at science based medicine does not mean that I support CAM. I do not. My argument is that science based medicine, with all the wonderful outcomes it has given the world, should not get a free pass for all of its flaws. Many of these flaws are preventable. Many are intentional. And these flaws are costly in lives lost and dollars wasted. Magnitudes more so than CAM.
I would think that you would want to do battle with quackery wherever it exists. Not just in the CAM world. The “science” in science based medicine has been corrupted and has much of its own quackery that needs to be addressed. It is corrupted by the pursuit of profits, moral and political agendas and tradition. When a drug company can withhold 17 of 20 studies for a new drug because of unfavorable results there is something seriously wrong. And when Americans are over medicated and undergo tens of thousands of needless surgeries each year. There is a long list of these shortcomings in science based medicine that can be expounded on.
Orac, with your background and communication skills I think that you could be very effective in writing more about these failings and help strengthen the trust in science based medicine. That would undermine the appeal of CAM to many people.
ut I don’t get how people can
2) Not be sued for malpractice if the outcomes are so disastrous?
I’m not sure how that would work. A naturopath who prescribes useless or (in the case of TCM) actively toxic treatments is simply following the professional standards of care.
@Alfred – there are plenty of examples of Orac & his evil twin (or is it the other way around) taking modern medicine to task for its shortcomings as well….you are tilting at windmills.
#29 herr doktor,
If they are licensed, or in some way recognized by the state, their practices would be scrutinized and regulated– you know, like cosmeticians and so on.
I don’t mean to be argumentative (on this point anyway) but so far I am hearing that there are these dangerous bogeymen out there, and somehow they are licensed to prescribe antibiotics (and other drugs?), but at the same time are immune from liability for doing harm?
I wouldn’t be at all surprised if the standards to which cosmetologists are held are more rigorous than those for naturopaths. I have a friend whose daughter qualified as a cosmetologist, and it was actually fairly difficult. Many students apparently fail.
And of course, when you miss the final test in cosmetology, you have to take a make-up exam.
@ Alfred Nyby:
As well as Orac, there is Ben Goldacre who has several books and a column.
You want a state-by-state description of naturopathic licensing laws?
One good thing I’ll give Bastyr is that they have kept intact the lovely chapel they inherited from the site’s previous incarnation as a seminary, which has great acoustics. I’ve worked several recording sessions there.
My father went to a naturopath for years, driving two hours each way for his appointments. Along with a painful and challenging diagnosis of chronic interstitial cystitis, he suffered from high blood pressure. While an extremely intelligent man, my dad is a pharmaphobe and wasn’t interested in taking blood pressure medication. Under his naturopath’s care, he did things involving biofeedback and such. Honestly, I don’t know the specifics except that his blood pressure remained seriously high for years. My sister and I both worked in an emergency room as RNs and we’d plead with him to do something about his blood pressure. We told him about patients we’d had with uncontrolled blood pressure.
I’m sure you can see where this is going.
My dear father ended up having a stroke. After six weeks in rehab (and being very, very lucky in his recovery), he suffered a myocardial infarction. And then a second heart attack. His physicians attributed the stroke and heart attack as consequences of those years of uncontrolled hypertension. Obviously my dad has responsibility for his choices but I am so angry at that naturopath for misleading him into thinking he was doing something about his hypertension.
I realize this is anecdotal but, damn, this kind of “health care” is allowed?
Britt Hermes new blog is fascinating and, as always, I look forward to what Orac and his faithful commenters have to say about all things woo.
when you miss the final test in cosmetology, you have to take a make-up exam.
GO TO YOUR ROOM.
zebra – I don’t think they are probably prescribing all that many drugs (even where they have the authority) because pharma is evil in ND world. But the way they get the ability to prescribe is through the legislature. If you can convince your friendly neighborhood lawmakers, it is legal. Often, their only real oversight is from a board of you guessed it other NDs. If you search this blog for Burzynski you will find out that even medical boards are often toothless enough that rogue practitioners can run amok for a quite a while without facing serious consequences. There isn’t the political will to fund these mechanisms for consequences. And take litigation, in some states they have actively closed off a lot of this through tort reform so it becomes cheaper and easier to settle out of court and have the insurance pay up a sum. This isn’t a real deterrent. I imagine most NDs carry some kind of insurance. Plus having seen the fanatical devotion that many in the woo world have for their providers I doubt that many of them would sue in the event of a bad outcome because of this.
Alfred – you are really conflating two separate problems and you need to do more research. A lot of time, energy, effort, and money is being spent on the problems of hospital care in particular infection management. A lot of reimbursement is being tied to these outcomes such that if a patient gets a post operative wound infection the hospital won’t get paid for treating it. Rates of infections in the hospital have dropped dramatically in recent years due to these efforts to improve wound care. Check out Dr. Crislip’s blog as he tells these stories. Nothing is 100% perfect. For each Vioxx scandal what about the 100s or 1000s of drugs that have been improved that have saved lives? Everything has a risk. No medical intervention is a 100% guarantee. Anecdote alert – My sister-in-law was enrolled in a clinical trial for severe Crohn’s disease. The medication helped her tremendously, she went into remission for several years after that trial. But the medication was not approved because it had the nasty habit of rapidly increasing the blood pressure in an unacceptable number of recipients. But for her it was a miracle. But it wasn’t approved because of side effects and careful testing. That’s how medicine works. One patients miracle may be another’s nightmare. Plus not everything can be found in studies. If the side effect is rare enough, it may not be caught in clinical trials and it may take a lot of data, in a lot of people, captured over years to find it. Plus, some side effects aren’t seen with short term use. Medicine, statistics, epidemiology, nothing is exact and we don’t get a crystal ball to see the future. But science at least evolves and learns from its mistakes.
Give me a break.
No one—and I mean no one, least of all, I—argues that SBM should get a free pass for its faults. And I do write about the faults and problems in SBM. Geez, use the search box and look for mammography, vertebroplasty, John Ioannidis’ name, and other things that I can’t remember off the top of my head. (There are nearly a decade’s worth of posts here, more than a decade if you include my predecessor blog on Blogspot.) Hell, between my posts on mammography here and on my not-so-super-secret other blog, I’ve attracted the ire of a very prominent radiologist. Perhaps I don’t blog about SBM shortcomings as much as you would like, but that’s just tough. I suspect that, even if I ramped up my blogging to be more than half about SBM it wouldn’t be enough. So I refuse to play that game.
Also, you should know—certainly regular readers do—that I tend to get a bit testy when I receive comments saying, in essence, “Why don’t you blog about what I want you to blog about? Why don’t you blog about what I think is important?” Make no mistake. That’s what you are, in essence, asking me. My response to such comments is, depending on my mood at the time, not infrequently quite impolite and almost always very blunt. This time around I will restrain myself and at least avoid profanity. I will, however, put it very simply.
This is my blog. It is my hobby. It is for me. I’m fortunate that my writing is good enough and informative enough that I’ve attracted some pretty decent traffic for a medical blog and a stable of awesome regular commenters. (Heck, last month was my all time peak traffic.) But traffic is not why I do this. If my traffic were back at the levels it was ten years ago, I would still be blogging.
I blog because I enjoy it. I blog about what interests me. If large numbers of people happen also to be interested in the same topics that interest me and to enjoy what I lay down enough to read it and comment about it on a regular basis, that’s an added bonus. It’s great. But that’s not the primary purpose. If I started to “do requests’ too often or write about what people like you think I should write about, I would likely rapidly lose interest and either go back to writing about what I enjoy writing about or quit blogging altogether.
There are many, many people who write effectively about problems with SBM, such as Ben Goldacre and many others. I do that sort of blogging from time to time, but only when a topic comes up that really interests me (such as mammography studies). If you want discussions of the shortcomings of SBM, you will almost certainly not get enough of them here to satisfy you. That is not going to change in the foreseeable future.
State by state licensure and privileges differ but I believe in all states (Narad will undoubtedly correct me if I’m wrong) naturopaths are regulated by naturopaths much in the same way chiroquacks “regulate” their own*.
*That is not to say that I’m extremely impressed with the way MD’s are always regulated but do a phenomenal job compared to the quacks.
Jann Bellamy maintains a website that tracks naturopathic licensing bills (among other things):
http://www.no-naturopaths.org
As does the Society for Science-Based Medicine:
http://www.sfsbm.org/index.php?option=com_content&view=article&id=121&Itemid=505
By the way, remember that German guy who tried to weasel out of his wager that measles isn’t caused by a virus?
A German court has ordered him to Pay Up, Sucka: http://www.rawstory.com/rs/2015/03/court-forces-man-to-pay-up-after-he-offers-105k-to-anyone-who-can-prove-measles-is-a-virus/
I have been wondering what kind of solution would be consistent with personal freedom.
With supplements, there are obligatory warnings in fine print that it’s not intended to treat anything.
Maybe something similar would help with alternative practitioners – if they were required to give patients a rating from an objective source of the quality of evidence for their treatment modality. Same thing with MD’s – if it’s just the doctor’s idea coming from their clinical experience, the patient should know.
A really good friend of mine has had a lifelong problem with vasovagal syncope, but it’s gotten worse with age, especially in the past few years,* leading to things like him fainting in the shower and slamming his head on the side of the bathtub. Worrisome, troubling.
He’s been seeing naturopaths and chiropractors about it mainly because SBM doesn’t really have anything to fix it with, and I guess going to quacks at least feels like doing something. He did at least agree to see real specialists just in case, which is good, although given the nature of his medical issue, I’d really rather he wasn’t going to chiros. But hey, who the f*ck am I?
*If you mention that it seems to be getting worse with age, though, you will typically get a response like “SHUT UP I’M NOT GETTING OLD.”
@ Kiiri #38
I have no argument with science. Science is where I place most of my hopes for a better world. The problem is that science is constantly under attack. Political, religious, and financial agendas undermine science’s authority. When the people with power, money and agendas control the message how is the Average Joe able to discern fact from fiction? Just think of the lengthy struggle it took to overcome the perversion of science by the tobacco companies.
As for your Vioxx scandal comment, do you think it is the only drug scandal? Have you read Ben Goldacre’s Bad Pharma? He doesn’t deny the good that is done by the drug industry, but that doesn’t give them a free pass for all of the scandals. We need more articulate communicators such as him to defend science and expose the scandals.
Well, South Carolina bans naturopathy outright. Tennessee* also has a weak prohibition on the books. Michael Cohen’s blog is pretty interesting on the general legal front.
* Not Texas, as listed on Jann Bellamy’s site.
People like Alfred are unaware of, or unwilling to acknowledge the vast amount of self-criticism and effort within the medical/scientific communities aimed at uncovering problems (generating the vast majority of the studies and reports eagerly cited by anti-science cranks). Beyond that, they ignore the tremendous amount of everyday quality assurance work that health and science professionals perform to minimize errors and improve outcomes.
If if annoys the Alfreds of the world that some professionals don’t spend 100% of their time on self-improvement but take an occasional break to criticize dangerous pseudoscience and quackery – well, too damn bad.
This story from the comments of Britt’s “On Notice” blog is chilling: http://www.naturopathicdiaries.com/on-notice/#comment-180
Naturally, not one of the naturopaths storming her site has dared to engage the commenter.
@ Dangerous Bacon #47
That’s a blatant mischaracterization.
For the last month or so I’ve been trying to decide how I feel about this :
https://gallery.mailchimp.com/35ee0fa27d80895fef237e0b2/files/HB_1075_AAP_naturopathic_Doc_statement_copy.pdf
Which I have no doubt is a direct result of this:
http://www.bastyr.edu/news/general-news-home-page/2013/06/colorado-passes-law-recognizing-naturopathic-doctors
I guess I’m just having a hard time 1) Understanding how supporting the above bill is really aligning the wishes of patients with the best evidence based practices when there is no evidence base to Naturopathy and 2) Believing that most Naturopaths are actually going to comply with the stipulations set forth in the bill. Only the third stipulation is even moderately enforceable.
Thoughts?
zebra–
If something is licensed and regulated by the state, that means that someone convinced the state government to license and regulate it. It doesn’t mean it works. Nor does lack of licensing necessarily mean that something doesn’t work. At best, the government looks at reality before deciding what to license. At worst, they look at who is contributing to their re-election campaigns. Sometimes it’s somewhere in between, and they’re listen to whoever shouts loudest in the media, or what their cousin’s neighbor told them.
If you live in a state where the legislature and governor can be relied on never to pass a stupid or misguided law, please identify it so I can look into moving there.
Remember, a bill was once introduced in Indiana that would have set the value of pi to 3.2:
https://www.agecon.purdue.edu/crd/localgov/Second%20Level%20pages/Indiana_Pi_Story.htm
Actually, it strikes me as being an accurate characterization.
Looks like a post on malpractice insurance for naturopaths and political maneuvering by the profession to gain licensure/ expand scope of practice would be of interest. Many office procedures and treatments by NDs are not actually covered by our malpractice insurance policies. For example, hCG for weight loss was not covered by my policy in Washington (and in Arizona too, I think) but many NDs currently use this weight loss protocol, despite the evidence that it does not work.
Thank you for the support, Orac and others!
zebra: In order to win a malpractice suit, you have to demonstrate that the harm you suffered was caused by the professional’s failure to follow his profession’s standard of care. In the case of naturopathy, there doesn’t appear to be any standard of care. Now spoilsport me thinks that means that naturopathy is not, in fact, a profession, but not everybody sees it the same way.
Thanks to MC at #50– I read through the Colorado bill, and I will guess from the somewhat vague Wikipedia article and other comments here that other states may allow slightly more or less scope to the practice. Still not clear on prescriptions (?).
So I will repeat my earlier point to Orac– if you want to deal with “alternative medicine”, you need to provide an alternative to the *system* that currently exists.
It is trivial and pointless to argue against idiotic treatments; you can go back and forth trading horror stories all day between conventional medicine and this stuff. It doesn’t change the fact that sewing up a cut finger and prescribing antibiotics shouldn’t require seven years of residency for the practitioner, with the associated cost multiplication. Likewise telling people they should eat less and exercise more, or ordering an x-ray to see if your ankle is sprained or broken. Or going in once a year to be reassured (falsely) that you will be fine until next year.
Set up a rational system and let the market operate; maybe people aren’t as stupid as you think.
zebra,
I will doubtless regret engaging you again, but I’m intrigued by your bizarre way of thinking about this.
I’m wondering how you acquired this astonishing power to read minds. What treatments did your telepathy tell you your doctor was considering? If your doctor was considering not giving prophylactic antibiotics and a tetanus shot for a deep animal bite, I suggest you consider changing your doctor.
The alternative to “the *system* that currently exists” is science-based medicine, which many of us, including Orac, are promoting. We have made great progress in making medicine more science-based, but there is a lot more to do. I see Orac’s criticism of alternative medicine as a part of this process.
Why should we ignore “idiotic treatments” when Orac and other physicians are regularly faced with their consequences? Orac has described seeing cases of advanced breast cancer, untreated because people have sought “idiotic treatments” instead of SBM. Is he supposed to keep quiet about this? Is this really “trivial”? Is a supposed medical practitioner risking a patient getting an infection by failing to prescribe antibiotics and a tetanus shot for an animal bite “trivial”?
It isn’t about trading horror stories, it’s about increasing the use of SBM. Why do you have this weird idea that we can either improve conventional medical practice, or attack bogus medical treatments, but not both?
That’s a complete non sequitur. What does criticizing naturopathy have to do with the training of doctors? As a matter of fact there is a trend towards nurse practitioners being given prescribing privileges and carrying out other tasks that were previously the sole domain of doctors. That strikes me as a better way of dealing with the problem than licensing people who believe in pixie dust as medical practitioners.
This is already happening. In my GP practice (in the UK) a nurse assesses my asthma, checks my cholesterol and weight, administers vaccines and gives dietary advice. BTW “the American Medical Association and other similar groups have moved away from the yearly exam. They now suggest that medical checkups be referred to as Periodic Health Assessments or Examinations and that they be performed every five years (for adults over 18) until age 40 and every one to three years thereafter”.
Yet over a million people in the US consult a naturopath every year, and the number of naturopaths is doubling every few years. Something is wrong, but I’m not at all convinced that the shortcomings of conventional medicine are to blame, and even if they are, the answer is surely more SBM, not more naturopathy.
I dont mind the middle class worried well using woo medicine, but when it comes to those who have had cancer surgery and decide that “Big Pharma” only make money out of people’s misery, I get really upset. I wonder how many parents send their children to naturopaths for so-called “vaccinations” or really serious illnesses. I believe that is child abuse. Working as an RN in the mental health area, I get really angry with really unwell patients/clients who want to try “natural medicine” to cure themselves. I realise that antipsychotics are not pleasant, but some so called “natural medicines” can be either useless or worse still, be very dangerous.
Prerequisite Coursework for entry to Bastyr, as part of your bachelor’s … and they insist on AT LEAST a C in these courses!!!
College-level Algebra: 1 course
Chemistry (science-major level): at least 4 courses. Must include a minimum of either two sequential courses in organic chemistry or one course in organic chemistry and one course in biochemistry. The chemistry sequence should include an introduction to biological molecules. (The standard prerequisite for science-major level organic chemistry is one year of general chemistry.) Appropriate lab work required.
General Biology (science-major level): 2 semesters or 3 quarters. Must cover concepts in cellular biology and genetics. Appropriate lab work required. Individual courses in the biological sciences may count if the above competencies are met, i.e., anatomy, physiology, microbiology, and botany.
Physics: 1 college-level course. It must be algebra-based; calculus-based is also acceptable. A lab is not required.
Psychology: 1 course. Introduction to psychology is recommended.
#57
Krebiozen, I value your medical opinion just as little as I do that of naturopaths– the doctor in question was verbalizing or ‘thinking out loud’, and it was clear that the case was borderline.
And I also don’t put much stock in arguments like “Something is wrong, but I’m not at all convinced that the shortcomings of conventional medicine are to blame,”.
Sounds like my discussions with climate Denialists– they are also “not at all convinced”…. .
The Colorado law was at least partially justified by the suggestion that costs could be reduced if some services were shifted to less expensive providers. Now, I have read numerous comments from MDs that argue against NP and PA as “alternatives” to BAU– even though in principle those would be providing SBM.
So, one interpretation would be that this is really about money and not about serving the public. In fact, Orac was complaining that doctors had to rely on volume to make money, which is why they couldn’t spend as much time with patients, which is why some of the more attentive woo-people were getting the business. But Orac does not explain how paying doctors more solves the problem, if there are the same number of doctors.
So, again, rationalize the system, and then we can see what choices people make. I am tired of subsidizing people who feel they need the immediate services of Dr House for every sniffle or backache or mildly depressing life event.
And please, I’ve said multiple times that I am talking about the US system, so why do you keep bringing up your anecdotes about UK?
As for problems with mainstream medicine – doctors who don’t keep up with medical research is a big one.
I came down mysteriously ill in 2007 – mentally fuzzy, fatigue, lowered consciousness. It seemed consistent with allergies to me. I had a long history of allergies and my allergy symptoms were usually just mental haziness or fuzziness – nothing obvious like sneezing, eyes watering, stuffy nose.
For years, I couldn’t find out the cause. I saw family doctors, but no help. I saw a couple of allergists, but my allergy testing gradually became negative over those years. So the allergists discouraged me from looking for an allergy cause.
One allergist, Dr. T, believed in looking for ideas in alternative medicine. He rattled off some “alternative” ideas that sounded bogus to me, like heavy metal poisoning. He suggested I might have a zinc deficiency, so I took a zinc supplement, which didn’t help. Also he ordered a brain MRI in case I had a brain tumor, that didn’t help either.
Finally, in my fuzzy-minded state I did personal experiments which showed me my sickness was indeed allergies – but more than one, so it was very difficult to figure out. I was being exposed to some molds AND I’d developed a severe allergy to my dog.
I told Dr. T that I seemed to have allergies anyway.
He repeated the allergy testing, it was still negative.
I asked him if I could have a dog allergy anyway.
He looked embarrassed, ducked his head and mumbled a bit, then came out with “No”.
So I looked at the medical research, and I found out that researchers had had evidence for years that people can have inhalant allergies with negative allergy tests – which has been dubbed “local allergic rhinitis”. Had he been in the habit of reading an allergy blog, he would have known that.
Similarly for the other allergist I saw.
That was no small hole in their diagnostic abilities, either. It means that people with rhinitis but negative allergy tests, might be able to help themselves by avoiding allergens, but they wouldn’t be told that. They also wouldn’t be offered allergy shots, which might help them.
Why would Dr. T look to alt-med to improve his diagnostic abilities, rather than keeping up with medical research??? Is this really a sensible place to look?
By the time I figured out what was happening, very slowly and with doctors hampering me rather than helping – my allergies had gotten very, very bad, with allergic reactions that lasted 5 days.
These doctors might have been able to help me figure it out earlier, before my allergies had become so bad, if they had just been keeping up with research!
61: “That was no small hole in their diagnostic abilities, either. It means that people with rhinitis but negative allergy tests, might be able to help themselves by avoiding allergens, but they wouldn’t be told that.”
This is so contrary to my experience I have to say something. I have rhinitis, but it is gradually improving. After getting referred to one specialist by the GP I was scheduled for x-rays and simultaneously referred to another specialist (a surgeon) for an in-depth examination by scope. An allergy was suspected though I was warned by every doctor that the usual battery of tests can turn up negative. They all told me steps to take to reduce allergen load in the home, before final diagnosis, telling stories of previous cases they had treated. At no time was I brushed off. Once a test came up positive treatment began, which is now ongoing and is working.
You seem to have encountered one or more particularly poor doctors. This is either extreme bad luck or your story lacks something.
So, wait, your “severe” allergy, which you self-diagnosed as LAR, included “nothing obvious like sneezing, eyes watering, stuffy nose”?
As I said, it mentally disabled me for years and made it hard for me to do anything physically.
And my allergic reactions lasted for 5 days (2 days now).
And I became severely sensitive to dog once I started avoiding them. I had to move out of my house, and I’ve had many allergic reactions a whiff of the air from a dog in a car.
Does that sound mild?
I think things have gotten better in the last few years, because more recent allergists haven’t told me that I can’t have allergies with negative allergy tests.
Also you may have had more obvious rhinitis symptoms.
My allergy tests went back to being partially positive after months of being outside my house. They went negative because of chronic allergic reactions – I think I know, sort of, how this can happen.
I’m getting allergy shots now, and I have local reactions to the shots. The shots seem to be helping, at least my allergic reactions aren’t as severe.
#63
Narad, it’s comforting to know that the insurance covering Beth/Laura’s ‘non-woo’ adventure in medicine doesn’t waste money on acupuncture and other silly stuff, isn’t it?
I mean, that would just be a placebo-type treatment relying on a confused person’s perceptions, right?
@zebra
What’s your point? You think insurance shouldn’t pay for my medical care?
#66 Beth
Unlike Krebiozen and Narad I don’t give medical opinions on the internet. But I do believe your description of your atypical symptoms, and I believe that you have correlated them with allergens.
That said, it sounds like you are looking for magic answers much like people who go the ‘alternative’ route, with little success and a lot of discomfort. So my point was that for some people in your position, maybe an alternative path, even if the effect is only the placebo effect, would make them feel better.
Certainly, it is not going to be clear whether your “allergy shots” are really making a difference or it is placebo, or resolving by itself.
@zebra
What makes you think I’m looking for magic answers?
They aren’t “allergy shots”, they are allergy shots.
That’s true, there’s no way to know whether the allergy shots are helping or whether I’m just getting slowly better because of not having a chronic allergic reaction. I was somewhat better before I started getting allergy shots.
However:
– that is also true for anyone who gets allergy shots
– there’s research that says that allergy shots do help for local allergic rhinitis.
– I didn’t say it was the allergy shots that were helping. I realize I can’t know for sure, but I want to do everything I can – as anyone in my situation would.
You seemed to not believe I actually have allergies. But my allergist thinks I do, and I wonder why you think you know better than he does.
@zebra
What makes you think I’m looking for magic answers?
They aren’t “allergy shots”, they are allergy shots.
That’s true, there’s no way to know whether the allergy shots are helping or whether I’m just getting slowly better because of not having a chronic allergic reaction. I was somewhat better before I started getting allergy shots.
However:
– that is also true for anyone who gets allergy shots
– there’s research that says that allergy shots do help for local allergic rhinitis.
– I didn’t say it was the allergy shots that were helping. I realize I can’t know for sure, but I want to do everything I can – as anyone in my situation would. The allergy shots are my best hope.
You seemed to not believe I actually have allergies. But my allergist thinks I do, and I wonder why you think you know better than he does.
Where, pray tell, have I “give[n] medical opinions”? Naturally, I will cop to pointing and laughing at your pretensions to lecturing about physics and statistics.
How about a response from a naturopathic doctor. Some perspective is always needed when your dealing with modern medicine! Notorious pushers of injected aluminum in vaccines recalled drugs that kill people and surgeries that are not necessary! Seriously you MD’s are dangerous! Only good for emergency situations like a bullet wound or a broken leg.
Behold a scathing response
http://youtu.be/ta1NZmwjvYQ
And by the way, I would love for there to be easy answers.
I’ve wondered – maybe if I got infected with helminths, that would do it. This is illegal in the USA, but clinics in Canada and Mexico do it.
I’ve wondered if acupuncture would do it (but I haven’t tried it).
One does wonder – maybe some treatment out there, is a quick answer.
My answers right now are actually very much not easy. The allergy shots make me sick; an allergy drug that I get makes me sick. And I get better – but it’s sloooow.
Umm…
Am I missing something, or did Beth just respond as Laura?
#70 Narad:
“Where, pray tell, have I “give[n] medical opinions”?”
Let’s see:
“So, wait, your “severe” allergy, which you self-diagnosed as LAR, included “nothing obvious like sneezing, eyes watering, stuffy nose”?”
#69 Beth– I said I believed you, which others may not. But, despite Narad’s childish sniping, I’m actually a very good experimentalist (not in medicine, I acknowledge) and what you are describing is too many uncontrolled variables and perhaps corrupt data. I hope it works out in the end but as a general rule “doing everything” often interferes with doing the right thing. Just sayin’.
And you find the “medical opinion” where, exactly?
SBM isn’t perfect, but it beats the alternatives. At age 20 I experienced a rash on my chest that recurred every 12-18 months. Over the next 33 years I sought treatment from four different physicians, Dr. C, Dr. A, Dr. L and a different Dr. L (I could add to the list my MD wife, who also had no alternative suggestion). All prescribed topical prescription meds and none cured it. Then I mentioned the rash, which had recurred, to the FNP (independent practitioners in Arizona) who was examining my teenager. She viewed the rash then wrote a prescription for two single doses of medication to be taken 10 days apart. That was 4 years ago and the rash has never recurred. The lesson for me was not to bash SBM, but to be relieved that I finally found a provider who had the correct training and/or experience to make the correct diagnosis and offer a cure.
@zebra #60: Your comment demonstrates a complete lack of understanding of how our health care system reimburses for care.
In the 1980’s, Medicare needed to change how doctors were paid; most doctors were fee for service. Medicare paid for hospitalization based on how long the patient was there. This created a system of incentives for hospitalizing minor issues and keeping the patient there much longer than they needed to be.
So they created the DRG: Diagnostic related group. Doctors today are paid a flat fee that includes so many days of hospitalization. If the patient leaves early, the doctor keeps the overage. If the patient leaves late, the doctor can’t charge more. This led to the “quicker but sicker” system of discharging patients. The perverse incentives were and are still there, just expressed differently.
In addition, reimbursements for office visits often don’t cover the actual cost of care when you include overhead (staff salaries, rent, equipment, utilities, taxes). Doctors today try to make it up on volume, leading to fragmented care and dissatisfied patients. It got so bad doctors left private practices and banded together in groups. It still wasn’t and isn’t enough. It’s so bad, that we’ve had doctors apply to be clinic instructors in the medical assisting program at my community college because when they deduct their expenses they are making minimum wage.
Granted, these are the GPs and FP docs. Specialists do a bit better because they can charge more, and everything they do is procedure based which reimburses more; the perverse system of incentives rewards high paid specialists who treat illnesses (and sometimes overtreat) at the expense of the GPs whose job is to keep people healthy and out of the hospitals.
Now lets look at your average naturopath. Most insurance doesn’t cover it, so they get paid cash. They don’t have to pay book keepers big bucks to deal with complex insurance rules and reimbursement rates that vary widely from insurance company to insurance company. They don’t have to fight to get paid because they get paid up front.
They need less staff. They don’t have to hire expensive registered nurses to manage the office staff. They don’t have to invest in a lot of expensive medical equipment since they don’t do a fraction of what a doctor actually does. They don’t have to pay astronomically high malpractice insurance rates.
They also get to pad their income by selling supplements that are highly overpriced. A doctor could never get away with this. They can’t own an interest in the lab that processes their labwork. Doctors are tightly bound by anti-kickback laws on labs and outpatient diagnostic centers. Naturopaths aren’t; in fact, it’s a mainstay of their business.
It is about money, but not in the way you think.
For those who think what I just said justifies the woo, nothing could be further from the truth. We need a system that rewards doctors for keeping people well, that refuses to pay for treatments that the SBM shows don’t work, and that deals with the well known problems with Big Pharma.
We do NOT need to throw out the baby with the bathwater just because SBM has had its problems. And unlike woo based systems, SBM admits its flaws and does strive to self improve itself.
@Beth #61: I’m sorry your doctor screwed up. But doctors today are so overworked it is hard for them to keep up on the peer reviewed literature much less a BLOG for pity’s sake. All your story justifies is getting a new doctor. It doesn’t justify demonizing all doctors with a broad brush.
Oh, no, it’s the anti dental student.
Beth and Laura are posting from the same IP address.
So…Beth/Laura or whoever you are, knock it off. Pick a ‘nym and stick with it. Switching ‘nyms without announcing it is considered using sock puppets and will not be tolerated. I’m therefore putting both of your IDs on automatic moderate until you tell me which ‘nym you’re sticking with.
” I had a long history of allergies and my allergy symptoms were usually just mental haziness or fuzziness – nothing obvious like sneezing, eyes watering, stuffy nose.”
Laura/Beth/Beth/Laura – I’m not a doctor either, but your description of “mental haziness” sounds more like severe depression than allergies. You’ve made up your mind that your allergies are creating your problems – you are not a doctor. You seem to be fixated on allergies and not considering any other possibilities. And then you become angry with your doctors! Yes, you have allergies but something else is ruining your life. Perhaps you should consider other possibilities for your health with your GP. Going to another country in order to be deliberately infected with helminths – parasites – seems like a very extreme step with feeble scientific justification. I’m sure you are worn out with your problems, but if you make up your mind in advance, you are NOT helping yourself.
Frankly, after reading the details of your personal medical problems, already my sympathy is with your doctors.
It’s not simply that there is no Standard of Care, there is in fact no Duty of Care, many of these practicioners have no concern over what happens to their patients as long as they are paid in advance.
The same thing goes on with ‘alternative nutrition’, there is no real thought as to the consequences of what they recommend as can be seen by a recent controversy in Australia over a ‘Paelo-diet’ book for babies:
http://www.aww.com.au/diet-health/diet-and-nutrition/2015/3/pete-evans-paleo-diet-book-for-babies-facing-ban-over-public-health-fears
The recipe that caused the uproar was allegely supplied by a Naturopath.
Notice that the people coming to attack Orac, modern medicine, or Britt Hermes either a) keep on harping on things that they claim are problems with modern medicine, as if that magically proves that naturopathy works, or b) dump a big fat load of incoherent word salad and think they’re being oh-so-clever.
If naturopathy actually worked, neither stratagem would be necessary. Res ipsa loquiter.
DevoutCatalyst @ 2: Thank you for, like Britt, being brave enough to do what you’re doing.
I.e., a YouTube video from Peter Glidden, partner in MLM scam with Joel Wallach.
Great choice, Shepard.
Phoenix Woman@82 : Well said! I wish I could express myself so pithily. zebra’s blustering arrogance was just asking for such a put-down.
A look at the Graham@81 link made my hair stand on end. It shows just how important it is what Orac (and others) are doing. Like the Ainscough scam, it’s fronted by smiling good-looking young people in (for the time being) the bloom of youth and health. And these people are in the business of killing babies….
One might recall that naturopaths were all excited (PDF) about Section 2706 of the PPACA. I’m inclined to wonder how they were planning to code those 90-minute visits to break even. Especially for Medicaid.
^ Also: Bad idea, Colorado.
(I also wouldn’t let a naturopath legally treat an animal bite under any circumstances, much less one to the hand.)
An illuminating statement fom the link put up by Graham @81 —
his health problems, including sensory processing issues and a compromised gut and immune system. She didn’t want to use commercial formula because of worries about ingredients.
That reminds me of the GAPS diet, previously featured at RI, and receiving attention last year in Ireland:
http://geoffsshorts.blogspot.com/2014/03/gaps-in-thinking-irish-times-promoting.html
#77 panacea
A perfect non-answer.
I repeat: Rationalize the system and let the market operate. I am tired of subsidizing people who feel they need the immediate services of Dr House for every sniffle or backache or mildly depressing life event.
A common rhetorical fallacy is false dichotomy, and you guys just can’t get enough of it. No mention of lower cost, more effective alternatives that are science-based, funny thing.
Maybe it really is all about the money?
zebra,
Borderline? You stated that it was “exactly that kind of deep wound circumstance”, i.e. “a deep animal bite, the patient was overdue for a tetanus shot, and the likelihood of an infection was pretty good”. I don’t think I am diagnosing anyone if I state that I would distrust any medical professional who did not suggest a tetanus shot and prophylactic antibiotics in that situation.
That isn’t an argument, that’s a statement of my personal opinion. I don’t believe that the shortcomings of conventional medicine are to blame for the widespread belief in vitalism and ‘purity of essence’ that is at the root of most alternative medicine. I think it’s a pervasive and erroneous idea that many otherwise sensible and well-educated people subscribe to.
Of course, my doubt that the popularity of alternative medicine is due to failures of conventional medicine is exactly like climate change denialism, just as my use of statistics to show that an individual’s likelihood of going 20 years without getting influenza is nothing remarkable is also exactly like climate change denialism. I’m beginning to think your frequent allusion to people with hammers seeing every problem as a nail is pure projection.
Where do you get that from? All I see is a claim that, “naturopathic doctors are going to be a key component in health care, saving the state millions of dollars through their focus on disease prevention and natural treatment, such as nutrition, lifestyle counseling and botanical medicine”. I see little evidence that this is actually the case.
How is naturopathy in principle providing SBM? I note that in the OP Orac suggested that perhaps 1% of naturopathy is valid medicine. I don’t know what you mean by PA.
Others have addressed the problem. There may be enough doctors in the US already if they are used more efficiently – a physical every five years instead of annually is an example, the use of nurse practitioners is another.
Sniffles, backache and depression can be symptoms of serious illness. If people go to naturopaths who don’t recognize a serious illness and treat it with homeopathy until it becomes so serious the patient has to go to the hospital, you might well end up subsidizing something very much more expensive.
I was pointing out that there are alternative ways of delivering these services that have already been shown to work, for example in the UK. As a matter of fact the use of nurse practitioners is increasing in the US as well.
Aaand you don’t have to look far to see the Venn Diagram of crank magnetism kicking in. Charlotte Carr’s story:
http://www.bubbayumyum.com/my-story-part-1/
Looking back it’s easy to see now that Willow always had a sensitive and upset tummy, but things didn’t really get out of control until about week 6 or 7.
We had just given Willow his Rotavirus immunisation, and the Infanrix immunisation. On the second day following the immunisations, he had extreme diarrhoea and a lot of vomiting and then the reflux followed. He always had reflux but things began to get much worse…..
….On the third night after this immunisation, Willow screamed from about 6pm until around 5am – you could see his veins raised all over his forehead and neck, his face turned a reddish/blue colour until finally he passed out from exhaustion, with his breathing heavy and irregular. In our delirious state we decided to not call an ambulance and just let it pass and wait till morning for yet another trip to the doctors. And there we were told, “it will settle down” for yet another time!
Willow’s little shaking hands got worse and developed into opening and closing of his hands. Non-stop. I could hear him all night tapping anything he could. His head, the cot rails… back and forth all night. Not for a few minutes. Hours and hours on end. What on earth was going on? Another trip back to the doctors. This time it was recommended for us to see a cranial therapist, osteopath and chiropractioner to check what was going on.
Within a few minutes of the appointment, the new therapist turned to me and said “Willow is stimming” and then asked “When did he have his immunisations?”
I want to point out here that this practitioner isn’t anti-immunisation. Not at all. They are however, very clear on the fact that some children don’t process the virus and heavy metals well at all. Willow was that exact child. He was presenting with extreme sensory processing issues. We now know Willow has MTHFR A1298C gene mutation.
Sounds to me like Beth/Laura/B might have an anemia. Has that already been ruled out?
zebra,
The libertarian answer to everything: the invisible hand will magically make everything OK.
What false dichotomy are you referring to? Please be specific. You’re the one who seems to think we can criticize problems with conventional medicine or alternative medicine but not both. That’s a classic false dichotomy.
You mean like using more nurse practitioners?
#82 phoenix
”
Notice that the people coming to attack Orac, modern medicine, or Britt Hermes either a) keep on harping on things that they claim are problems with modern medicine, as if that magically proves that naturopathy works, or b) dump a big fat load of incoherent word salad and think they’re being oh-so-clever.
If naturopathy actually worked, neither stratagem would be necessary. Res ipsa loquiter.”
“coming to attack” Paranoid much?
“proves that naturopathy works” Strawman much?
“If naturopathy actually worked”
But it doesn’t, so it must be competing with something that people are dissatisfied with– that they perceive doesn’t work for them, right? (res ipsa loquitur, or more colloquially, “duh”)
#94
Krebiozen, I am not going to respond further if you are going to do your filibuster thing as in #91. You aren’t making sense half the time and I’m not going to waste mine correcting you. Three points:
1.
NP = Nurse Practitioner
PA = Physicians Assistant
I use these as examples of science-based “alternative medicine”, without endorsing any specifics of training and regulation since again they vary.
USA v UK: PCP or GP or whatever you call them make twice as much in the US. So by what magic do you suggest that using more NP will stop USA MDs from complaining that they don’t make enough money? Should they be paid even more for doing less work?
2. False dichotomy: Naturopaths are taking advantage of a niche where they can provide certain services. The proper comparison would be with a hypothetical science-based practitioner. providing similar services, operating under similar recognition, regulation, and restrictions.
3. “Sniffles and backaches oooh it could be something serious.” But *science* tell us that is very unlikely, and thinking you must see a very expensive doctor every time to be reassured is Not At All different from the kind of unscientific woo you criticize.
zebra,
You mean responding to your points in turn? To you “filibuster” seems to mean making points that you are unable or unwilling to address. You really should check out a dictionary and learn what the rest of the world means by the word. Unless we are having a vote in the subject and my comments are preventing someone from making their point before that occurs, you are abusing the term.
I have been commenting here for several years now, and no one has ever told me I’m not making sense before. I suspect, not for the first time, you have a comprehension problem.
It would help if you defined abbreviations before you use them. I assumed by NP you meant naturopath. Which comments “argue against NP and PA as “alternatives” to BAU”? NPs and PAs are part of BAU (which I assume means “business as usual”), and are becoming more so.
Nonsense. Average GP salary in the UK is s £92,900 pa, which is $137,000 using today’s exchange rate. In the US a family doctor earns on average $156,000 pa. Not a big difference, certainly not twice as much.
As I wrote above, there is room for efficiency savings, allowing doctors to spend more time with each patient. If NPs, who are paid less, spend more time with patients weighing them, vaccinating, drawing bloods or whatever, that surely allows MDs more time with each patient doing what NPs are unable to do. I’m not clear on how it works in the US, but perhaps salaried GPs with bonuses for extra work and for reaching benchmarks, as in the UK, instead of being paid per patient as in the US, would work better than the current system.
There are many ways to approach the problem that don’t involve pixie dust. For example, my GP practice does telephone triage, so I don’t get an appointment automatically, I speak to a doctor on the phone first, and s/he decides whether or not s/he needs to see me in person. Since the UK spends less than half as much per capita on healthcare as the US, but still pays its doctors about the same and, according to the WHO, does better in terms of healthcare, perhaps the US can learn something from us, from our mistakes as well as our successes.
I think the view expressed here is that there is a choice between science-based medicine and fantasy-based medicine. How is that a false dichotomy?
It could. Lots of serious conditions from HIV to myeloma present with what first appear to be minor complaints.Why the need for sneering at that?
It’s isn’t about being reassured, it’s about excluding a serious underlying condition. Once that has been done, then it becomes about reassurance. A well-trained NP can triage patients and spot those that need closer attention. Any GP will tell you that more than 90% of the patients they see are suffering from self-limiting conditions that will resolve without treatment. However, if they miss the fewer than 10% that have serious conditions, or believe that a serious condition will resolve with homeopathy the patient has been done a serious disservice.
I think the push to focus on cleaning up EBM being directed at those who attack alternative faux-medicine is driven from frustration not necessarily with the slow evolution of medicine although that weighs in, but with the business and politics of medicine.
For example, research has not shown population wide screening for depression to be beneficial; even the psychiatrists whose blogs I read agree – and go even further stating it can be harmful. So what is happening in medical clinics around me? A whole lot of depression screening.
The strangest was when I was asked minutes before undergoing a routine colonoscopy if I was suicidal. Made me wonder what they would have done had I been, but even if I was, I would have said no. I spent an unpleasant day on the pre-procedure protocol and there was no way in heck I was going to have it cancelled for a stupid checklist screening question.
Back OT, naturopathy provides a service that the majority of GPs I think used to provide but is getting harder to find (at least in the US) and that is listening to the patient/client. Their crime is selling it as anything but.
On another note, this is garbage is still making the rounds.
http://www.delightfulknowledge.com/scientific-evidence-thoughts-intentions-can-alter-physical-world-around-us
A blog author left the link to the above article in response to a comment of mine a several days ago where I had left a link to a paper in The Lancet.
I was going to ask for thoughts on the water experiment but I did the self-help thing and searched this website. Orac has already written about this years ago so I can post the link back to one of his articles. I merely present it here as the way some are still being fooled by “the science of woo” and it never dies.
Yah, it took me a while to sort of this escapee from Z.’s internal monologue.
^ “sort
ofout“That’s not a dichotomy.
You’ve already acknowledged that you know nothing about the latter three.
To the extent that markets work, they require informed customers who have a real choice between sellers. Emergency rooms don’t really compete, because the person who calls an ambulance may not be given a choice, and is very unlikely to know things like which emergency room will offer them charity care because of their zip code, let alone what local hospital is good at treating the condition they haven’t yet had diagnosed.
“You can buy a truck from Zyzzy, or go over to Acme and they’ll sell you a sofa” isn’t a competitive transportation market.
Neither is “you can buy a working truck from Zyzzy, but once in a while you’ll need to see a mechanic. If you don’t like that, you could always order and pay for a truck from Acme, in your choice of colors, and they’ll keep sending you nice diagrams of the vehicle, and links to videos of people using trucks to haul their furniture, and when you come in to ask why it hasn’t arrived yet they’ll serve you herb tea and let you pet a cat.” Naturopathy is giving you a nice picture of a truck and a cup of herb tea, and telling you that you’re fine, when what you actually want is to drive across the state or help someone move furniture. Even people who talk about “good bedside manner” generally mean “I want a doctor who will treat me well while curing me,” not “I don’t care whether I get better, I just want someone to talk to.” (If what you want really is just someone to talk to, that shouldn’t be advertised or covered by insurance as treatment for migraine or cancer or influenza.)
psoriasis can be a bitch. My father was a GP. He said 1/3 of presentations were autosuggested, 1/3 were skin diseases.
….My Anecdotes, self discovered.. …. prescribed topical cortisone cleared up my psoriasis, it came back several times. Cut open a VitE capsule, applied contents, Ps. gone , never came back.
Threadworm, prescribed medication ineffective, piece of garlic inserted… immediately effective.
I wouldnt expect Med School Doctors to suggest either, I look after myself mostly.
Because of my (late) fathers ire, i would still never dare visit a chiro, let alone a Naturo….
SBM works. Except when it doesnt, eg Platinum chemo is being prescribed for wide range of cancers, because it works well in some. May be best to ask for significant statistics. eg Testicular cancer, platinium chemo is a clear winner, breast cancer, not so much.
OTOH i copped flack for using topical gentamicin for minor skin infections “Its too good, save it for serious infections…” they say. Well excuse me, Teenage acne was serious to me…
@Narad #86: I expect that insurance companies will still demand proof of safety and efficacy before they cover something. Insurance companies can still refuse to cover unproven or experimental treatments.
Oh, the quacks may be able to exploit this loophole for awhile, until government watchdog groups realize how much money is being wasted. This provision is actually a bad thing for naturopaths. First of all, the ACA doesn’t free them from the paperwork hell that is insurance reimbursement. Medicaid is notorious for what it limits patients getting, and half the country hasn’t accepted the Medicaid expansion yet. Finally, everything about the ACA is about outcomes. Taking Medicaid money means naturopaths and other CAM providers will have to be measured on outcomes. When the data comes in showing that quacks have bad outcomes, they won’t be reimbursed any longer, or won’t be reimbursed well enough to make it worth their while. Everything about how Medicare reimburses under the ACA is going to be outcomes based, and Medicaid does what Medicare does.
2706 is no panacea for quacks (pun intended).
@zebra #90: What I said was directly on point. I explained how medical reimbursement actually works. Saying, “I don’t hear you nahnahnahnah!” while holding your hands over your ears is not a rebuttal.
And no one is suggesting going to Dr. House for every sniffle.
@Krebiozen: zebra has it half right about NPs and PAs. They DO provide a level of medical service, but they are not “alternative practitioners” as they utilize the same SBM that physicians do, just on a lesser scale.
Nurse Practitioners practice advanced practice nursing; their practice overlaps medicine but does not replace it. It is evidence based, and they are held to a standard of care, and are liable for their own practice. Although the IOM has recommended they be allowed to practice to full extent of their capabiilties, in many states they still have to be supervised by physicians.
PAs always function under the supervision of physicians; they hold no independent licensure.
Both have sufficient training and expertise to handle common problems in health care, and to promote healthy living. In the case of NPs this is actually part of their philosophy.
zebra’s complaints as usualy are short sighted. The point is not to pay GPs more for doing less work as he suggested. The point is to fill in the shortage of GPs that exists in the US, especially in rural and low income areas.
zebra’s complaint that people go to the doctor over nothing is troubling. Certainly that can happen, but the issue I have is you don’t know it is nothing just by looking. Many serious illnesses present slowly and subtly. A dismissive attitude is how things get missed.
That’s not how it works in my experience, but learning which hospitals are better choices (assuming that one is in any position to choose) is a depressing fact of life for at least some of the uninsured. Then again, at least there’s the U. of C. Medical Center.
Well…. My point was indeed that what they were hoping to get themselves into was likely to be a shock to the system, yet the Slate item does point directly to this piece in the Seattle Times.
I’ll turn to private insurers in a subsequent comment.
^ But first I’ll add one thing regarding this:
This is something that occurs at the state level. The new Illinois governor, I’ve heard, has proposed eliminating dental benefits from Medicaid, although I thought they only sprang into existence for adults last year in the first place.
When I went to the ER for what turned out to be a badly inflamed gall bladder, the paperwork we got at check-in included one saying that charity care was available for people who lived in certain areas; it included part but not all of Manhattan (so neither the whole city nor the whole county in which that hospital was located). I had good enough health insurance that I didn’t need to apply for that help, fortunately.
It’s possible that the ACA has changed that. But people tend to work partly based on old information, because nobody has time to keep up with absolutely everything. And nobody sends around information “by the way, if you think you might need charity care in New York State, here’s how it works as of $date.”
#104 panacea,
Orac complains about the quantity and quality of ‘training’ for naturopaths. Therefore, it is logical to assume that he would be equally concerned with the lack of training for NP.
It is simply disingenuous to focus on the woo-factor when the real objection is to any challenge to the MD/entrepreneur model. Your long exposition on compensation says just one thing– “gosh, I spent all those years and money so I could start a business, and I’m not as successful at it as I expected.”
Yep, and there are incredibly talented people who devoted every minute of their lives to becoming really good musicians, now busking in the subway in between their barrista shifts. Too bad, huh?
Countries other than the exceptional USA manage to deliver health care, better or as good, at much less cost. Doctors get payed substantially less, depending on how you measure compensation. The systems vary, but they all eschew the phony libertarian, phony capitalist, rhetoric that doctors have traditionally used to block reform here.
Now, I just saw a TV ad by some national NP association suggesting that people get primary care through NP. I would conjecture that if the primary care market were saturated with scientifically trained non-MD practitioners, who spent time with patients and concentrated on keeping them healthy, naturopaths and others would have a very hard time breaking in. That, again, is the valid comparison– not between naturopath and MD.
And yes, people do have ridiculous anti-science expectations that they should have Dr House available for every boo-boo. If you care so much about rural and low-income areas, you would recognize the obvious fact of how many resources are wasted by all the unnecessary consumption among the better-off.
Only if you assume training for naturopaths and nurse practitioners to be equally removed from science-based medicine. Which they aren’t.
Are you under the impression that Orac is in private practice or something? (They’re in the minority overall nowadays, BTW.)
^ Well, depending on who you ask; that was from a WaPo item citing “Medical Group Management Association” numbers from 2008.
That assumes that it is the time spent with patients giving advice on lifestyle that is the attraction of naturopathy. I strongly suspect it is a belief in the underlying philosophy that drives this. There is a common belief that health depends on an ample supply of ‘bioenergy’ and its free flow through the body. It also holds that modern medicine depends on ‘cutting, burning and poisoning’, instead of stimulating the body’s natural healing mechanisms. I struggle to imagine people who hold these misguided beliefs going to a NP who works within a SBM framework, any more than a patient who demands antibiotics for their viral sore throat will be fobbed off with ginger tea.
It also assumes that naturopaths are competent at primary care. It would appear they are not. When the patient in the example in the article I linked to dies prematurely of a cardiovascular event because his naturopath is reluctant to prescribe a statin, an ACE-inhibitor, aspirin, and a beta blocker, the statistics will likely show that he died in a conventional hospital, and he will become another of the stats that altmed proponents like to wave around to prove how bad standard medical care is.
I struggle to imagine an NP not being subject to the exact same pressures that a PCP is. Of course, unlike Z., the subject is complicatied.
^ “that an MD PCP is”, and, while I’m at it, “complicated”
Allowing NPs to function as PCPs is also subject to legislative hurdles.
As for “letting the market sort it out,” that’s what produced the current system in the first place, unless one wants to pretend that insurers aren’t part of it.
See also another Kimball Atwood entry.
@zebra #109 “Orac complains about the quantity and quality of ‘training’ for naturopaths. Therefore, it is logical to assume that he would be equally concerned with the lack of training for NP. ”
Except there is no lack of training for NPs. Nurse practitioners receive advanced education and clinical training on top of being experienced registered nurses. Currently the standard is master’s level preparation (which is what the MD is btw), though it is quickly moving to the DNP level of education. APRN practice is science based on the same bodies of knowledge used by both professional nurses and physicians.
Comparing APRNs to naturopaths is apples vs watermelons. They are nothing alike. The former is evidence based. The latter is not.
Now I have no idea what Orac personally thinks about NPs. The AMA does not think they have the requisite training but the Institute of Medicine does . . . and has the data to back it up. Naturopaths have no data whatsoever.
What I wrote about how physicians are reimbursed is not a pity party for physicians who can no longer use the independent entrepreneur model. It’s a statement of fact on how the system works, the problems with the system, and the effects on both providers and patients. The fact is we are moving towards treating physicians employees instead of independent providers, and that will probably be a good thing in the long run.
You are so determined to bash doctors but the fact is nothing I have said supports continuing out of date practices, nor is there some great conspiracy among doctors to rip off the public. Most doctors care about their patients and strive to do the right thing, and it is most unfair to paint them with a broad brush because you’re soured on how the system works.
FWIW, if the naturopath curriculum matched the standards of the nurse practitioner curriculum, they’d be turning out nurse practitioners. Which would be a decided improvement, IMHO.
Yep.
I’ll just put this here.
http://www.health24.com/Parenting/News/Australian-study-calls-homeopathy-useless-20150316
#119 Panacea:
“Now I have no idea what Orac personally thinks about NPs.”
Yep.
Re: Australian NH&MRC announcing uselessness of homeopathy (Julian Frost @122)
In other startling news, a Vatican spokesman announced that, following a major investigation, it can be revealed that the Pope is Catholic. Meanwhile, a team of researchers in Canada have discovered that some faeces found in forests have an ursine origin.
(snark off)
It seriously ticks me off that my tax, via the government rebate for private insurance, contributes to pseudomedicine, including the nonsense that is homeopathy. The private insurance companies here include coverage for this crap.
I might be late in sharing this, but sorry I am a bit busy. Daily Beast on Homeopathy: http://www.thedailybeast.com/articles/2015/03/17/sorry-hippies-homeopathy-is-totally-useless.html
Some real gems in the piece like: “From a scientific perspective, homeopathy is pure, unalloyed shitcrockery.”
That is pure gold, Dr Johnson. 😉 THank you for sharing it.
Z.’s dogged reasoning skills shine through yet again.
I enjoyed another conversion story like this from the guy who also originally wrote about Orthorexia Nervosa (the unhealthy obsession with eating healthy). Bratman was a true believer practicing naturopath and then figured out he was a quack, and wrote the story linked here …
The Adventures of Holistic Harry (also known as Confessions of a Quack)
http://www.orthorexia.com/hh/
It could use a bit of an edit but was an entertaining and enlightening story.
palindrom: Once the quackery is rooted out, what’s left? — cheers – P
Huzzah! I’m puzzled when I read her account of homeopaths/naturopaths doing exams. A good friend of mine is a homeopath and prides herself on the fact that they don’t even treat symptoms, they treat “the whole person.” (So there’s no need for an examination.)
“Treating the whole person” means that you ask them questions to draw out their personality and preferences, then prescribe the (worthless) remedies based on that. This is akin to a doctor basing his treatment on your zodiac sign, fer chrissakes. It’s ONLY quackery.
Laura #43, “With supplements, there are obligatory warnings in fine print that it’s not intended to treat anything.”
See, this is where I’m confused. The FDA has been starting to come down hard on supplements if they make specific health claims. How can my food co-op sell those worthless homeopathic remedies, which are accompanied by a chart the outlines what they cure? Both are unregulated and uninspected substances, so how can the outright quacks get by with this?
LinnieMae:
Law isn’t always logical. Homeopathy got a legislative okay early in the 20th century, with the right to define a homeopathic “pharmacopia” and add things to it as they like. That means the FDA has no authority to ban them. (They FTC or a state attorney general might have authority to prosecute false advertising in the few cases when the homeopath claims to be providing a measurable quantity of something, but it’s not anyone’s priority.)
Supplements come under a more recent law that basically says that you can sell a huge range of things as “supplements” so long as they aren’t explicitly and individually banned and you don’t make any specific claims about what they’re good for. So they slap vague and irrefutable claims like “supports immune function,” whatever that means, onto everything from vitamin C (your average U.S. doctor doesn’t see scurvy very often these days) to ginkgo extract. And once in a while someone tries to prosecute for fraud when it turns out that the alleged ginkgo pills contain garlic but no ginkgo, and the same company’s garlic contains neither garlic nor ginkgo.
I agree, this isn’t what the law should be, but it’s what the law is, and the FDA is reasonably limited to enforcing laws that currently exist.
Thanks for the historical background on this. After I had read about the lack of regulation on supplements awhile back I stopped taking them entirely. Seems we should be able to outlaw the use of those other worthless “remedies.”
Three years ago I took one of those remedies for dizziness on the advice of a homeopath friend because, you know, what could it hurt? A few hours later I ended up in the ER with full-blown vertigo, spent all night there with the dry heaves and a puzzled doctor. (Too embarrassed to tell him that I actually took one of those worthless remedies.)
Chances are good that the “remedy” had no effect and the mother of all dizzy spells would have happened anyway. Still, I won’t ever go near that stuff again and think it should be outlawed. I mean, who knows what they put in that stuff besides water if there’s no regulation and inspection?
Well, well, well. It seems that, finally, the FDA’s gonna step in and evaluate homeopathic treatments:
FDA warns consumers against homeopathy
Hearings next month.
” Also, that “200,000” figure is grossly inflated. For example:
http://www.jparksmd.com/blog/400000-dead-from-physicianhospital-error”
I have no investment in the 200,000 figure, but I’m pretty sure that blogger’s analysis of the math is just incorrect. Contrary to the blogger’s assertions, the study author didn’t just drop a factor from the four-factor analysis used in earlier studies to come up with his three-factor analysis. He used a three factor analysis, but one of his factors is different from any used in the earlier study, and it essentially encompasses the data from two of the factors in the earlier study. The study’s logic and arithmetic, at least, are sound. Conceptually it goes like this, I think:
38 adverse-event-caused deaths /4252 hospitalizations in sample= .0089.
.0089 * 34,000,000 = 302,600 hospitalizations per year that involve adverse-event-caused deaths.
69% of THAT small number were preventable.
.69 * 302,600 = 208,794.
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