Naturopaths and supplement manufacturers: In bed together to promote naturopathic licensure

After yesterday’s epic mid-week rant about a man who thinks he knows what skepticism is but clearly doesn’t, it’s time to get back to business. The best way to do that is to go back to an article that came out the other day and that I had meant to blog about but temporarily shelved in favor of yesterday’s rant. It’s a topic that’s very relevant to me right now given that the Michigan legislature is considering a bill (House Bill 4531) that would give naturopaths a broad scope of practice almost the equal of that of primary care physicians, the only difference being that naturopaths wouldn’t be allowed to prescribe controlled substances. I plan on posting an in depth analysis of the bill in the near future. In the meantime, though, what caught my attention was an article on STAT by Rebecca Robins entitled Naturopaths, often derided as quacks, push to go mainstream—with help from vitamin companies. It describes how naturopaths have renewed their push for licensure in various states and how they’re being helped by supplement companies.

If there’s one thing I’ve learned about naturopaths over the years, it’s that they’re persistent. They play the long game. Even though currently they are only licensed in 17 states, the District of Columbia, Puerto Rico, and the US Virgin Islands, they never give up. As many times as they persuade woo-sympathetic legislators in various states to introduce bills to license naturopaths and see those bills defeated, they keep coming back again and again and again until they win. In a way, you kind of have to admire the way they wear down the opposition. Clearly, state medical societies aren’t prepared, which is obvious from the STAT article:

Naturopaths, who practice an alternative medicine heavy on herbal supplements, are making a big push to gain more authority and stature across the United States, including the right to do more hands-on patient care and to be reimbursed by Medicare.

That’s raising concern among critics who see naturopaths as quacks — and who warn that offering them state licenses, insurance reimbursements, and other recognition only legitimizes their pseudoscience.

This is, of course, exactly why naturopaths crave state licensure so much. First, state licensure legitimizes a speciality by placing the imprimatur of the state on it. Quite reasonably, people look at a specialty that’s licensed by the state and presume that it must be a real profession with a real basis in science and reality because otherwise the state wouldn’t license it. Now, you and I know that this is not necessarily true. Many states license quackery. After all, every state licenses chiropractors and lots of states license acupuncturists. However, the average citizen doesn’t know this and assumes that state licensure = legitimacy. The sad fact, however, is that state licensure ≠ legitimacy. I wish it did, but it doesn’t, at least, it doesn’t necessarily.

So what’s the strategy? Take it away, Ms. Robbins:

Next Monday, more than 100 aspiring and practicing naturopaths plan to storm Capitol Hill to rally support for a federal pilot program that would allow them to be reimbursed by Medicare for some patients. Naturopaths are also lobbying for expanded authority to diagnose and treat patients in a handful of states, including Massachusetts and Michigan.

And:

But in the US, the American Association of Naturopathic Physicians is optimistic that the public is ready to embrace its approach.

The AANP plans to host its first big consumer health fairs this summer, in D.C. and Utah, complete with cooking demonstrations and yoga for the whole family. And the group recently hired two new staffers to lead a more aggressive PR strategy, including a former TV journalist.

“There’s a lot of excitement with the increase in consumer demand for natural remedies,” said Ryan Cliche, executive director of the AANP.

The group’s goal: Pushing all 50 states to license naturopaths by 2025.

That’s an ambitious goal, probably unattainable, but there’s no doubt that naturopaths can make considerable progress towards it, particularly if state medical societies remain silent.

As I’ve discussed more times than I can remember, naturopaths like to represent naturopathy as a form of “natural medicine” that utilizes the “healing power of nature.” Unfortunately, in reality, naturopathy is the modern day incarnation of the 19th century “natural living” movement in Germany. Early naturopaths objected to contemporary science-based medicine, particularly germ theory and vaccinations, instead advocating the “water cure,” fasting, herbs, homeopathy (or, as I like to call it, The One Quackery To Rule Them All), colonic “detoxification,” and other popular methods of the era. Unfortunately, little has changed in naturopathic practice in 150 years, although naturopaths are much better at cloaking their quackery in scientific-seeming trappings, and some of them have embraced laboratory tests in a big way as part of their embrace of the dubious specialty of functional medicine.

Despite the efforts of modern naturopaths to argue that their profession is scientific, in reality naturopathy is now, as it was in the 19th century, rooted in prescientific vitalism. Basically, naturopathy is based on a belief in the “healing power of nature. For those of you who aren’t familiar with the lingo, any time you hear someone refer to the “life force,” as naturopaths frequently do, you’re looking at vitalism, the idea that there is some sort of mysterious, yes, “life force” that is present in living matter and makes it alive. In essence, vitalism is the philosophical doctrine that states that life has a quality (the “life force,” “vital force,” or any of a number of other terms such as “life energy”) independent of physical and chemical laws, such as an immaterial soul. Many forms of alternative medicine are based on vitalism. For example, acupuncture claims that sticking needles into “meridians” through which qi (the life energy or force) flows will redirect the flow and relieve symptoms and/or cure disease. Reiki practitioners claim that they can direct life energy from the “universal source” into patients for healing effect, which is why I like to say that if you replace the term “universal source” with “God” you have faith healing. Basically all “energy medicine” claims that its practitioners can somehow manipulate “life energy” to healing effect. Not surprisingly, naturopathy embraces pretty much all of these modalities, and more.

Particularly popular among naturopaths is a belief that disease is caused by “toxins.” These toxins are seldom validated by science. In many cases, they aren’t even identified. Yet, “detoxification” is a major theme in naturopathic treatments, with unscientific and sometimes dangerous treatments, such as chelation therapy (to “detoxify” heavy metal overload) and colon cleanses, including the infamous coffee enemas, being advocated to help patients “detoxify.”

Now here’s the interesting thing. Before I get to it, consider this fact. One of the most common attacks leveled by quacks at advocates for science-based medicine is what I like to call the “pharma shill gambit.” With that in mind, consider this passage from the STAT article:

The makers and sellers of herbs and supplements have a big stake in the expansion of naturopathy — and they’re putting money behind it. “Corporate partners,” many of them dietary supplement makers, have collectively contributed more than $270,000 to fund the AANP’s work this year.

One of the AANP’s top contributors: Emerson Ecologics, which distributes nutritional supplements and vitamins and gave $50,000 to the group.

Emerson’s ties to naturopath advocacy run deep. The New Hampshire-based company employs AANP President Jaclyn Chasse as an executive overseeing scientific and regulatory affairs. (Emerson and Chasse didn’t return requests for comment.)

The AANP trains its board members about conflicts of interest and requires them to recuse themselves from conversations or votes that might pose a conflict. The group “takes this very seriously,” Cliche said. The Consumer Healthcare Products Association, which represents the makers of dietary supplements, declined to comment on the funding.

How often do we hear complaints from proponents of “natural medicine,” be it naturopathy or whatever form of alternative medicine you can think of, about ties between prominent physicians and pharmaceutical companies? Such complaints were justified and in fact only echoed complaints from mainstream medical sources about cozy relationships between physicians and big pharma. The American Medical Student Association (AMSA), in particular, has been very active in lobbying for rules requiring more disclosure of gifts from industry and discouraging physicians from being on company speaker bureaus. The result of this movement from various mainstream medical groups has been a whole slew of rules and laws about what physicians are allowed or not allowed to take, what must be disclosed, and the like. Clearly, naturopaths in general and the AANP in particular seem not to realize that their getting into bed with the supplement companies is no different from physicians and medical groups having been in bed with pharmaceutical companies. The irony is rich. It is indeed tempting to reply to the “pharma shill gambit” with the “supplement shill gambit.”

Of course, I don’t object on principle to a company like Emerson Ecologics having a grant program that funds whatever the company wants to fund. Basically, Emerson Ecologics sells , herbal medicine, traditional Chinese medicine supplies (like acupuncture needles and supplies), homeopathic remedies, and, of course, dubious medical tests. What I expect from such a program, however, is the same level of transparency that is now required of pharmaceutical grant programs because, obviously, if more states license naturopaths Emerson Ecologics potentially stands to benefit financially from increased sales. Not surprisingly, it supports all sorts of woo organizations.

How successful with the naturopaths be? Unfortunately, I’ve heard from readers anecdotal reports that these sorts of arguments are received fairly well by legislators, as this interview with Amy Rothenberg, the head of the Massachusetts Society of Naturopathic Doctors:

Rothenberg tried out a handful of arguments on each aide she met: The state loses tax revenue when Massachusetts-based naturopaths like her must practice in neighboring states where they can get licenses. Patients are at risk when anyone — even a Senate aide— can hang up a shingle and call themselves a naturopath with no regulatory oversight.

She even nodded toward the opioid crisis that is ravaging communities in the state. “There are a lot of things we can do shy of prescribing opiates,” she assured one aide.

The part about losing money is a silly argument. After all, if naturopaths are quacks who harm patients (and they are), why would a state want to bring them within its borders just to avoid losing money. I would counter by saying that licensing naturopaths would cause economic harm to Massachusetts citizens becaue it would result in more people who can ill afford it wasting large sums of money on useless supplements and nostrums. Also, the argument about “anyone” hanging up a shingle and claiming to be a naturopath is disingenuous, because right now at least such people are limited to giving advice and selling supplements, lest they be charged with practicing medicine without a license. They can do a lot less damage that way, and even then they do plenty. License these quacks and give them a wide scope of practice and they can harm a lot more patients—with the imprimatur of the state behind them. Moreover, it is not necessary to embrace the quackery that is at the heart of so much naturopathy (homeopathy, anyone?) to address the opioid crisis. Unfortunately, all of these arguments appear to resonate among legislators far more than they should, as I’ve heard from anecdotal reports from readers.

The last example, however, shows us skeptics and advocates for science-based medicine what we are up against and what we must learn to counter:

The aides seemed to really start listening, though, when Rothenberg shared a personal story: Her own experience a few years ago as a patient being treated for breast and ovarian cancer.

She didn’t hesitate to get surgery, chemotherapy, and radiation at Massachusetts General Hospital. But she also sought care from a naturopath in New Hampshire, driving six hours round trip for her weekly appointments, where she got intravenous vitamin infusions, breathed pure oxygen in a pressurized chamber, and got recommendations for plant-based remedies like bromelain, an enzyme derived from pineapples. Six months after finishing chemotherapy, she felt so good she completed a triathlon.

“I’m a perfect example,” she told one aide, “of somebody who would love access in the state.”

Human beings, particularly politicians, live for stories. A single powerful anecdote can be far more powerful than a folder full of statistics and scientific studies. Regular readers will recognize that everything Rothenberg subjected herself to is pure quackery that added nothing to her care. Surgery, chemotherapy, and radiation are what cured her, not the intravenous vitamin infusions (I’m guessing she was into high dose vitamin C), the hyperbaric oxygen chamber, and the enzyme therapy (enzymes are degraded by stomach acid and enzymes before they ever get into the rest of the digestive tract). Yet a story like this resonates.

That’s why, in addition to our facts and science, we need stories. I can tell stories of the breast cancer patients I’ve seen who were treated by naturopaths, leading their tumor to progress to the point where it eroded through the skin, leaving a bleeding, stinking mess of rotting tumor tissue stuck to the woman’s chest wall, leaving them in chronic pain and eventually killing them. I could tell them the tale of the orange man. Such cases are, thankfully, uncommon, but I’ve seen enough of them over the years, starting during my general surgery residency, to paint a grim picture. Even more effective would be patients with advanced cancer who were treated by naturopaths as their cancers progressed and have now realized their mistakes. Such patients are rare, though, because patients who choose quackery to treat their cancer have a very hard time admitting their mistake, particularly publicly. Some never do.

Naturopaths will continue to push for licensure. They’re not going away, and now they have industry support. We’re going to have to prepare to beat back those efforts wherever they occur.