My husband, Taylor, contributes another article for ND this week. He depicts a gruesome tale of a field chef mutilating his hand. Taylor then eloquently relates this experience to naturopathic education by examining reading assignments for Bastnyr’s basic and clinical science courses and the faculty who teach them. Enjoy!
Where Archaeology and Medicine Meet
I have almost zero medical training. I am CPR and first aid certified with the American Red Cross, and my medical experience has been limited to bandaging the blistered hands of undergraduate archaeology students in Kazakhstan. One year, my first aid training was put to the challenge when our local cook in Uzbekistan sliced off his thumb.
Before breakfast, he had tried to smooth the edges of a wooden cutting board with a large knife. Rather than accurately widdle the rough spots down, he gripped the board and held it up against his waist for firm support as he hacked at the edge. He was applying so much pressure to the board and force to the knife that when he missed, the blade went right into the end of thumb and out the other side.
That morning, out of our tents and hungry, we found him sitting next to the cooking fire, his thumb wrapped in bloody cheesecloth. “We’re not having breakfast today.”
But lunch was on. He still wanted to work! He refused to be taken to the medical clinic, because that five-hour jeep ride would have ended his summer income.
He wanted his thumb to be exposed to the air or wrapped up in that dingy cloth. That was a stupid idea. First, he was cooking our food. Second, we were in remote mountains, and it was dirty. The project director and I insisted that he listen to me for his own well-being. After much back and forth, he let me clean, apply antibiotic ointment, and wrap up his thumb. Then a few hours later, he decided his thumb was healed, so he ripped off the bandage, which caused another bloody mess.
For days, I re-cleaned, re-applied antibiotic, and re-wrapped his thumb. Everyday he would rip off the bandages and toss them into the fire, so, as he said, “the blood doesn’t attract the wolves.”
It was a thumb war. Luckily, he didn’t get an infection, but unfortunately, we didn’t hire him again.
Chipping Away at Naturopathic Education Claims
As I’ve been following Britt’s saga and learning more about naturopathic education, I thought this story would be relevant, inasmuch as archaeology and medicine overlap, to a pattern I’ve noticed in the many anecdotes I’ve read about her former profession. When I was managing the cook’s thumb injury, I knew it was a moderate medical emergency, but we acquiesced to his demands that he remain with us and work under the condition that I monitor him. Who was I to think I had the skill set to know what to do? His thumb was messed up, and he was in a lot of pain. Did he damage a nerve? Was he ever going to stop bleeding? Could he develop chronic pain or even gangrene? Could a doctor have re-attached the dismembered piece?
In this situation, I knew I was overstepping my first-aid training, but I did it anyway. After a day or so, I remember having a delusional rationale, “I’ve got this.”
Why?
I think I made this cognitive error for similar reasons to naturopaths in thinking they can treat patients as though they are physicians. Naturopaths want to please. They want their patients to feel like they are pulling weight in the clinical picture. Naturopaths cannot afford to be hard asses, so they want everything to just keep on keepin’ on.
Students are indoctrinated in thinking that their naturopathic education makes them qualified to practice medicine as primary care providers. In defining their scopes of practice for real medicine, they either place a point of reference at MDs and DOs or mid-level providers, like physician assistants and nurse practitioners. These two medical professions have been granted great responsibility by society, and their training reflects this burden.
Britt has already shown that naturopathic clinical training is laughable compared to what medical students receive. The naturopathic schools claim to provide at least 1,200 hours of clinical training, but much of this time is spent learning bogus therapies on a vast majority of patients who have uncomplicated health conditions and often no clinically observable diseases. None of this training occurs in hospitals, and naturopathic rotations are extremely short, probably because students are required to continue showing up to class lectures in pseudoscientific topics like homeopathy, naturopathic manipulation, and others that appear on her transcript.
In my opinion, the matter is settled: naturopathic schools and organizations have utterly misrepresented ND clinical training, and what little training they give in the 561 hours that most closely resemble primary care is more or less hogwash according to medical science.
However, this is only half the picture of naturopathic education.
Whole Systems?
I’ve noticed that naturopathic groups sometimes pull away from an emphasis on clinical training in their advertizing and instead highlight that material taught in class lectures prepares ND students to be physicians.
For example, refer to these excerpts:
“A licensed naturopathic physician (ND) attends a four-year, graduate-level naturopathic medical school and is educated in all of the same basic sciences as an MD, but also studies holistic and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness. In addition to a standard medical curriculum, the naturopathic physician also studies clinical nutrition, homeopathic medicine, botanical medicine, psychology, and counseling.” http://www.naturopathic.org/education
“The AANMC member schools are four-year professional level medical programs that result in a doctor of naturopathic medicine degree/diploma (ND). Students are educated in all of the same basic sciences as an MD or DO as well as the latest advances in science in combination with natural approaches to therapy, disease prevention, and clinical education. In addition to a standard medical curriculum, the naturopathic physician is required to complete four years of training in clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine and counseling.” http://aanmc.org/naturopathic/faq/
“Educated in all of the same basic sciences as a medical doctor (MD), a naturopathic doctor uses the Western medical sciences as a foundation for diagnosis and treatment.” http://www.bastyr.edu/academics/areas-study/study-naturopathic-medicine/about-naturopathic-medicine
“Our naturopathic medical degree program is comprised of rigorous academic study and extensive supervised practice. You’ll learn the same basic sciences as you would at a conventional medical program and additionally, you’ll learn all the naturopathic therapies. Graduates become primary care physicians with a focus in preventative medicine and natural treatment.” http://www.scnm.edu/academics/doctor-of-naturopathic-medicine/
“As a student in the naturopathic physician program at National, you will study the same basic sciences as an MD, but you will learn holistic and natural approaches to therapy with a strong emphasis on disease prevention and optimizing wellness. You’ll study alongside students from other professional degree programs and thereby have the opportunity to share perspectives and experiences.” https://www.nuhs.edu/academics/college-of-professional-studies/naturopathic-medicine/
Is is true that naturopathic students get the same basic sciences education as medical students? Are they challenged according to a conventional medical curriculum? Does the ND degree demand rigorous academic study?
Naturopathic Reading Data
Britt has a collection of her course syllabi for every class she took at Bastyr. Many, but not all, of these documents contain the courses’ reading assignments. I decided that a simple presentation of the books that were required and recommended in addition to the actual number of pages of assigned reading for some of her basic and clinical sciences courses would help answer the above questions. (I wish I had comparable data for other medical professional degrees, so I will have to leave it up to someone else to compile these.) I was able to pull data for 12 basic and clinical sciences courses. Of the classes I sampled, all were singular courses in that subject, except for pediatrics, which is a two-part series with an optional advanced course.
Let’s begin with a list of the required and recommended texts for these courses:
BC 5110 Histology
Required:
- Wheater’s Functional Histology (5th edition). Young et al.
- Histology Laboratory Guide. Love and Frederickson.
Recommended:
- Basic Histology: A Text and Atlas (11th edition). Junqueira and Carneiro.
- Histology: A Text and Atlas (5th edition). Ross.
- Color Atlas of Histology (3rd edition). Gartner and Hiatt.
- diFiore’s Atlas of Histology (9th edition). Eroschenko.
BC 5112 Embryology
Required:
- The Developing Human, Clinically Oriented Embryology (7th edition). Moore and Persaud.
Recommended:
- Human Embryology (3rd edition). Larsen.
- Langman’s Medical Embryology (9th edition). Sadler.
- Dudek’s Board Review Series on Embryology
BC 6204 Immunology
Required:
- Janeway’s Immunobiology (7th edition). Murphy et al.
BC 6209 Infectious Disease
Required:
- Medical Microbiology (4th edition). Mims et al.
- The Sanford Guide to Antimicrobial Therapy. Gilbert et al.
NM 7313 Gynecology
Required:
- Novak’s Gynecology (14th edition). Berek.
- Women’s Encyclopedia of Natural Medicine (2nd edition). Hudson.
Recommended:
- Contraceptive Technology (19th edition). Hatcher.
- Glass’s Office Gynecology (6th edition). Curtis and Hopkins.
- Women’s Gynecologic Health. Jones and Barlett.
NM 7306 Oncology
Required:
- Oxford Handbook of Oncology (2nd edition). Cassidy et al.
NM 7302 Gastroenterology
Required:
- Naturopathic Gastroenterology. Yarnell.
NM 8308 Endocrinology
Required:
- Basic and Clinical Endocrinology (8th edition). Greenspan and Strewler.
- Endocrinology and Naturopathic Therapies (8th edition.) Powell.
PM 7305 Orthopedics
Required:
- Photographic Manual of Regional Orthopaedic and Neurological Tests. Cipriano.
Recommended:
- Physical Examination of the Spine and Extremities. Hoppenfeld.
- Orthopedic Physical Assessment. Magee.
NM 7314 Pediatrics 1
Required:
- Nelson Essentials of Pediatrics (5th edition). Kliegman et al.
- Current Pediatric Diagnosis and Treatment (17th edition). Hay et al.
- Herbal Treatment of Children: Western and Ayurvedic Perspectives. McIntyre.
Recommended:
- Encyclopedia of Natural Healing for Children (2nd edition). Bove.
- Superimmunity for Kids: What to feed your children to keep them healthy now and prevent disease in their future. Galland.
- Medications and Mother’s Milk (11th edition). Hale.
- The Breastfeeding Answer Book (3rd edition). Mohrbacher.
- Naturally Healthy Babies and Children: A Commonsense Guide to Herbal Remedies, Nutrition and Health. Romm.
- Vaccinations: A Thoughtful Parent’s Guide: How to make safe, sensible decisions about the risks, benefits and alternatives. Romm.
- Pediatric Telephone Protocols: Office Version. Schmidt.
- The Vaccine Book. Sears.
- Naturopathic Pediatrics. Skowron.
- Homeopathy for Children and Infants. Ullman.
NM 7315 Pediatrics 2
(same as NM 7314 Pediatrics 1)
NM 9316 Advanced Pediatrics
Required:
- Current Pediatric Diagnosis and Treatment (17th edition). Hay et al.
Recommended:
- Naturopathic Pediatrics. Skowron.
- Pediatric Telephone Protocols: Office Version. Schmidt.
- Herbal Treatment of Children: Western and Ayurvedic Perspectives. McIntyre.
- Encyclopedia of Natural Healing for Children (2nd edition). Bove.
- Homeopathy for Children and Infants. Ullman.
Deep breath.
Let’s pay attention to the pediatrics 1 and 2 courses. These classes require a book that teaches Ayurvedic medicine for children, and they recommend several very questionable texts in herbal remedies, homeopathy, dubious nutrition, and vaccine alternatives. The Bob Sears Vaccine Book appears in this list, and it is the second listed vaccine alternative text! If this is not proof that naturopathic education is anti-vaccine, then I don’t know what else could drive this point home.
At Bastyr, naturopathic students are exposed to these ideas in their clinical science courses in pediatrics and they then go on to rely upon this anti-vaccine ideology in practice where they can make up their own recommendations.
Three other courses listed above require texts based in naturopathy and alternative medicine: gynecology, gastroenterology, and endocrinology. In fact, gastroenterology only requires one book, which is written by a naturopath.
The other basic and clinical sciences seem to require and recommend books that would appear in curricula of programs at medical schools or nursing and PA programs. Although, I cannot know if this assumption is true. (Readers please help out!)
How Much Science or Pseudoscience?
I took this analysis a step further and counted up all of pages that were assigned for these courses. In the table below you will find each course presented alongside its lecture hours per Bastyr’s 11-week quarter, its number of reading pages assigned for standard medical texts, naturopathic texts, and totals, the type of degree held by the main instructor, and a simple calculation of the average number of assigned pages per week.
Like I said at the beginning of this post, I have no medical training and have not taken any medical coursework. I cannot comment on the reading load for such classes in a standard medical curriculum, but I’d bet a lot of money that medical students read at least an order of magnitude greater than any of these Bastyr courses.
However, I can compare the Bastyr reading load to graduate classes I’ve taken in anthropology. I can say that without a doubt no class I have ever taken in graduate school assigned less than 100 pages per week. For any lecture or seminar, I read multiple ethnographic monographs (these are long!), scores of peer-reviewed journal articles, and read many more hundreds of pages of articles in order to write a 30-50 page research paper per class each semester. This workload was standard. The reading load expressed in these 12 courses at Bastyr is meager, and anthropologists don’t usually have people’s lives in their hands.
From looking at the syllabi, I see that the assessment criteria for these classes seems a bit weak. None of the classes required a research paper, except Endocrinology. Britt reports that her paper was a review of oxytocin therapy for posttraumatic stress disorder; her paper is 3.5 pages long. Nearly all of the classes have take home exams, and many have in-class presentations which make up a significant percentage of the final grade (usually 20-30%). This finding recalls that Bastyr clinical training allows students to present to one another on a disease if they don’t ever get first-hand experience treating a patient with said disease.
Who Is Teaching?
I’d also like to draw the reader’s attention to the types of degrees that the instructors of these courses hold. You’ll notice that 8 out of the 12 instructors have ND degrees. Remember these are basic and clinical sciences courses that are supposed to be on-par with a standard medical curriculum. Last I checked, medical school courses are taught by medical doctors, who also might have a PhD. There was one course, Immunology, taught by a PhD in my sample. Interestingly, a veterinarian co-taught histology, which is fine as his/her training is science-based. (This veterinarian also taught Bastyr students cadaver anatomy.) I guess it is not that surprising that a chiropractor taught orthopedics at Bastyr (this person also has an ND degree and is an acupuncturist–all three!). Then I learned something really weird.
You’ll notice that I placed an asterisk next to the letters “DN.” I did this so you’d know it is not a typo, but actually an abbreviation for “Doctor of Naprapathy.”
What the fuck is that? (Excuse my French; I mean German.)
According to Wikipedia, naprapathy is an offshoot of chiropractic and osteopathic developed in the early 1900s by one of D.D. Palmer’s early students. The system focuses on manipulative therapy of connective tissue and includes a host of weird therapies using temperature, light, electricity, sound, and air, among other “radiant energies.” So yea, there is a person who is a so-called doctor of radiant energies teaching embryology and infectious disease to Bastyr’s naturopathic students. Notice that for these classes, this DN had assigned an average of 39 and 34 pages per week respectively. That’s not rigorous at all!
When I asked Britt if she remembered that particular instructor was a DN, she could not recall. She had never heard of naprapathy. Though she did cringe and report that those classes were “terrible.”
Limitations
I’d like to acknowledge limitations of my analysis. First, I did not randomly sample these courses. Not all of Britt’s syllabi enumerate reading assignments. I looked through all of the syllabi and found twelve that did have readings listed that were also basic or clinical science courses. Some of the syllabi listed the actual page numbers, which made counting convenient. Yet, many syllabi listed chapters or sections, which was annoying. I had to turn to the dark depths of the Russian internet to find digital copies of the books from which readings were assigned in order to count up the pages. (I then promptly destroyed the files.)
Despite this sample not being randomized, I argue that it doesn’t need to be. In order for a naturopathic education program to claim its courses are on par with those of a medical school program, every single topic must be up to snuff. Falling below the bar in just one area severely limits a student’s ability to understand the extreme complexity of human biology and clinical decision making. That is, a real medical program has to be comprehensive, otherwise it is nothing. Once components are removed from any course, the whole curriculum is deficient. Consequently, students are not as good, and then patients suffer.
Serious Lessons
In my opinion, these findings are a disgrace to a profession that claims to produce physicians. Why aren’t other naturopaths or students sounding the alarm?
I’d argue that naturopathic students are already primed to chew up and digest the pseudoscience that is taught to them at schools like Bastyr. They are hungry to become the versions of doctors from which they are fed. When they take their basic and clinical science courses, they no doubt learn challenging material, and I’d guess that many struggle. Some of my theory is supported by the fact that all naturopathic schools offer 5-year tracts to earn an ND degree. Unfortunately, this accommodation is probably a necessity given that the admission standards are so low for naturopathic programs despite the course load not being anywhere near as demanding as real medical school.
The students are likely so obsessed with the ideological underpinnings of natural healing, anti-vaccine apologies, magical energies, life forces, yada-yada, that they cannot comprehend that no matter how many times one wields medical instruments or dawns a white coat, they don’t know how much they don’t know. They are stuck on the symbol of being a doctor but are not prepared for the gory guts of medicine.
It seems to me that such cognitive dissonance results in major barriers to the acceptance of science and real medicine. Naturopathic education looks like it is so insulated from outside scrutiny that anything goes inside the bubble. Because of its inability to integrate medical standards of care and jettison the junk science across the profession, naturopathic education trains students to keep patients happy with strong rapport. They are kind and charismatic. They tell patients what they want to hear: I’ll let you vaccinate your kids later or never; I’ll treat your cancer with these vitamins and herbs; I’ll spend 90 minutes per appointment with you; or I’ll constantly offer you hope and charm till the very end.
I understand why we kept our cook with his busted thumb at work. He needed the money and insisted he remain. We could have paid him in full even if he left early and hired another cook and been just fine. He didn’t want a hand out, and he was tough.
But, the reality is that he was a bad cook. Our food was late and tasted bland. He overbought and wasted food. We should have sent him to the medical clinic and hired a new cook. He might yet have his thumb intact, and we might have eaten really amazing Uzbek food. Instead, we indulged him, but this decision placed his health at risk and was a gastronomical failure.
Lesson learned: always prioritize the standard of care and look at the whole clinical/archaeological picture.
Your gut depends on it!
Image credits: 1) Flickr user bghull, some rights reserved. Changes were made. 2) Jacob Winter, with permission, rights reserved.
Taylor is a doctoral candidate in archaeology at Kiel University.
“Why aren’t other naturopaths sounding the alarm?”
If I’m one of those ‘other’ naturopaths whose livelihood depends on clients accepting my ability to provide health care that is not only equivalent to but in most ways superior to that provided by competitors (who principally are made op of licensed physicians), the last thing I’m going to do is sound an alarm ND training falls far short of preparing anyone to do so. “Dammit, Jim–I’m a naturopath, not a martyr!”
True. I should have posed the question with regard to the students too, so I edited the sounding the alarm line. You’ll also see I added a picture of our poor cook at the end of the post 😉
I agree, JGC. How can you sound an alarm, and still financially survive as a practicing ND? It is a very serious ethical quandary. I read emails every day from naturopaths who agree with the statements here on ND, but cannot afford (financially and socially) to speak out publicly. Maybe ND students need to fill this role?
I have read many ND student blogs, majority of students at either Bastyr or that silly cult in Oregon. All these students have in common that they believe they are going to a real medical school like MD/DO students do. They describe themselves as science nerds, link to Atuwande and advertise how hard their next biochem or homeopathy exam is going to be. They all had the option of going MD or DO but chose, due to a variant form of Noblesse Oblige the ND path. Reading practice websites, blogs, tweets, or watching youtube videos of naturopathic physicians, you can see either the delusion or desperation of wanting to be comparable to an MD or DO – Pay attention in the links provided, whenever discussing MDs and DOs (whom are “Western” or “Conventional” Medicine) and how they position themselves.
https://www.youtube.com/watch?v=-D0TBge9SX8
https://www.youtube.com/watch?v=Iyj3jbthpWg
The scary ND, RN Holly Lucille who is a perfect example of Dunning-Kruger doing what she does best: Marketing; she is talking to UCLA pre-health students about Naturopathic Medicine: https://vimeo.com/18290808
there are so many videos on the delusion that is naturopathic medicine – a good source is Larry Cooke: https://www.youtube.com/playlist?list=PLEE2270DB4377E121
https://www.youtube.com/watch?v=iSodczAej_Q
Absolutely scary….
I just watched the asthma video on the Larry Cooke link above. Absolutely scary is correct. The presenter obviously had little real understanding of the disease physiology, diagnosis, or treatments. Standard of care medications were discouraged (with a special emphasis on the steroids are bad story line). Her recommended therapies were a cornucopia of unproven crap.
More proof that ND stands for “not a doctor”.
wow i didn’t know asthma was caused by childhood antibiotic use and childhood immunizations. Naturopaths are obviously doing groundbreaking research.
Britt
Thank you for all the work you are doing to educate legislators and the public. Perhaps you can send a letter to the ontario government as well?
http://www.theglobeandmail.com/life/health-and-fitness/health-advisor/reality-check-new-rules-for-naturopaths-fail-to-ensure-safety/article24822353/
It’s hard to expect that ND students will ‘sound an alarm’ when they believe their ‘medical’ education is in ‘many ways’ superior to that of an MD or DO.
http://maxjcohen.com/?p=396
http://maxjcohen.com/?p=346
Wow. That pediatric reading list is a cornucopia of anti-vaccine crap.
But when “Naturopathic Doctors” want legislators to allow them to treat children, you have never heard people so 100% pro-vaccine.
To borrow an insight from a well-known book by Milan Kundera, here we begin to glimpse a sense of the incredible lightness of being a naturopath. Except that the lightness touches not only the naturopath but also the hapless patient. Thank you Taylor and Britt!
“As a student in the naturopathic physician program at National, you will study the same basic sciences as an MD, but you will learn holistic and natural approaches to therapy with a strong emphasis on disease prevention and optimizing wellness. You’ll study alongside students from other professional degree programs and thereby have the opportunity to share perspectives and experiences.”
Why, this sounds as if they competently communicate fully researched process improvements and interactively synergize pandemic methods of empowerment to dramatically utilize parallel infomediaries of healing process.
Also, Bastyr has a book by Dana Ullman as recommended reading. That tells you everything you need to know about the level of education provided…
I can’t imagine ND students will sounds the alarm either; they are actively drinking the kool-aid and (probably) incurring student debt while filling their heads with pseudo-science.
No one likes to admit they’re wrong. No one likes to think they’ve been fooled. In my experience, it’s far easier to admit inadvertant idiocy & ignorance once you’ve endured a significant level of fucked-uped-ness in your own life, usually somewhere around your 40s & 50s, and you no longer care about what other people think but care MORE about preventing harm to others. :/
Thank you both for providing such great information!
I’m wondering if most of the folks already drank the Kool-Aid before or during their naturopathic studies. I can’t imagine what it would be like being a student at one of these schools. Was it a cult-like atmosphere while studying at Bastyr? Britt, were you and others struggling to question and rationalize quack science but were too far invested in time and money? Were you indoctrinated into thinking conventional medicine and “big pharma” were making people worse? Or perhaps my questions would be explained another time in your fantastic blog!
I’m wondering this as well. I can’t help but think that for most of them, it starts with a seed of thinking ND training is worthwhile and effective and that seed sprouts dramatically as they spend time and money hearing the anti-science nonsense
Thank you for the interesting essay. Live and learn, eh?
I’d like to ask Britt a related question: How central to ND education is the Pizzorno textbook now? At one time, it seemed this was THE text used.
Jann Bellamy got a copy of 2012 Pizzorno and found it had added a full chapter on diagnosis and treatment according to Four Humors Theory. That certainly would seem to dispute those who claim naturopathy is moving toward science-based practice.
Thanks for your support Linda! Pizzorno’s text is recommended in many classes, and generally considered a “must-have” book. Although, I never owned it. No class taught exclusively from his text. Pizzorno guest lectured for classes, which was very exciting for the students, including me. We loved listening to him speak. I assume he is still very respected by the students, still makes appearances on campus from time to time, and that his book is still highly recommended. Naturopathic is not moving toward a science-based practice. In my opinion, NDs are using bad studies, fake ethical review boards, and misrepresenting scientific conclusions in literature to justify naturopathic practices.
It really is no one’s fault that you are a pathetic and crappy doctor but your own. The fact you cant take accountability for your own medical inadequacies simply is a tradgedy that you yourself should OWN and stop blaming a school or a profession when there are 1000’s of amazing naturopathic doctors working in the trenches every single day providing amazing life saving and live changing care. I helped 8 patients today and every single patinet told me I have changed their lives forever and they will always be grateful they found me as their doctor. If you hate naturopathic medicine so much why dont you just work as a primary care doctor pushing drugs in Arizona which is well within your full prescriptive right. You can quite easily push penicillin, prozac, percocet, clonazepam and whatever other synthetic crap you advocate for as an NMD.
I know you can do this and you know you can do this but instead of actually working as a doctor as it once was your dream I think you have concluded that you hate being doctor, you hate helping people, you hate working with people, you hate paperwork and you hate medicine in general. You most likely are just simply very lazy as most bloggers are! Otherwise there is absolutely nothing stopping you from practicing an allopathic paradigm of prescription drug pushing and you could be quite successful doing this. So lets all just embrace the reality that you as a doctor in general are a TOTAL FAILURE and you should quit wasting time and cyberspace on bashing a profession that DOES saves lives every single day…especially every day that I go to work….and do something more productive than whine about this crap and your student loans on a blog that your Mommy and Daddy are most likely paying for.
ummm….. http://rationalwiki.org/wiki/Argumentum_ad_hominem
Enjoy 🙂
Al
Actually the revolting Princess Peach was simply being insulting. She was not advancing an argument by claiming negative personal qualities in Britt. Peach’s behaviour is obnoxious but not, technically, irrational.
However, if she thinks she has saved lives with naturopathy then she is a delusional [redacted]wit, which I do intend as insult not as rational argument. They both have their place.
Sorry, I didn’t know [redacted] was a rude word.
🙂
I was thinking about the third part of the quote: abuse the person 🙂 but that may be my bias, I’ve been surrounded by too many assh*le for my own tastes.
Al
Any reason why we should give an imaginary video game character any credit whatsoever?
Are you Belle Gibson?
Ha!
Attn/warning web host: When I clicked on Princess Peach’s hyperlink, my computer got infected with some sort of malware. Now I can’t use Safari and I have to take my computer to the Apple store for repairs. Is there any way to validate the legitimacy of a link before allowing it in the comments???
Hi: I believe someone must be seeing my posts about tech problems but not posting them. That’s fine. Update: I reset Safari, and the malware infection seemed to correct itself. (I never have problems with my Mac getting infected, so I didn’t know how to do that simple step.) Still, I’m suspicious about the link embedded in Princess Peach’s name. Any way to get rid of that link–for the benefit of your other readers?
ALSO: the problem I was having with the links to the article “Food as Medicine” seems to have resolved itself. Thanks. Cheers.
Hi Kelley,
I am going to remove the Princess Peach hyperlink. I am not sure what posts you are referring to that are not getting posted. Everything you have written appears in the comments section.
Yes, my posts are there now. It took a few hours for them to appear. I guess since I’m a new commenter they were hung up in moderation for a bit.
I’m glad you removed the Princess Peach hyperlink. Oddly, when I clicked on it, the first thing that showed up in the address line of my Safari window was “notmyfaultyoureacrappydoctor.com” for a couple of seconds. It looked like that was the URL that was loading. Then it went to a “system alert” error message, got stuck there, and suggested a phone number I needed to call to fix my computer’s “security issues.”After a couple of attempts at restarting my computer, it took a phone call to Apple support for me to figure out how to reset my browser and move past the error message loop. Fortunately, no infection with malware.
Looks like Princess Peach was trying to conduct a little cyber-harassment against your readers. Not so Princess-like. Nor Peachy.
How very evil of Peach. Glad you alerted me to this issue so I could erase the hyperlink. Thank you!
Just curious, why so much information is given about Naturopath and how unprofessional they are, including comparing them to MD/DO, while none about the actual education of MD and DO, about how many mistakes and death cases are there per year because of MD’s and DO’s mistreatments? Naturopathic Doctors are not MD or DO and never will be. So what is the point to do the clap with one hand?
I have no inclination to go back and count pages from my syllabi, but I do know I spent the vast majority of my time outside the classroom and clinic reading textbooks and scientific papers during my time at NCNM. Anyway, I would love to hear from some of the MDs who comment on this blog as to how much reading they were assigned during med school. NCNM is just down the hill from Oregon Health and Science University (OHSU). Because of this proximity, ND and MD students would often be found studying in the same coffee shops, libraries, etc. Although anecdotal, several MD students comment to me that their course work was much less than mine. Additionally, while we did use “naturopathic” texts at NCNM, we also used the same standard basic and clinical science texts as the students at OHSU and even shared some instructors. I think the didactic education was quite up to par at NCNM compared to OHSU, but I 100% agree with everything Britt has written with respect to clinical education and the need for real residencies.
See, we weren’t “assigned” reading in med school. We had to get off our asses, be proactive, and figure out on our own what we needed to read to master the coursework. We were expected to master the material, not just check off boxes.
Thanks for the feedback NH PCD,
While we were assigned reading in most classes at NCNM, the assignment was the minimum the instructor felt necessary to keep up with the next lecture. However, you make a good point. We also were expected to go far beyond the minimum assigned reading as necessary to master the material. I can’t speak for anyone else, but that is exactly what I did.
I found that when I was in medical school that the majority of students spend their whole life studying. I was always amazed at the capacity of some students to study. There were some students who would go to class 8-5. Then go study from 8-2 am everynight. I found it unbelievable now little they would sleep. Third year was our main clinical year and we often would work up to 120 hour weeks with regular 36 hour shifts on call.
I don’t think naturopaths have any concept of how hard md study and work. There are supposedly rules in how hard a resident works, if they want to succeed in their field they must ignore those rules.
A typical surgical rotation for a med student when I trained was pre round at 430 am, round with residents at 5:30 then meet staff at 630, then operating room 730 to 16:00, then round on ward till 18:30. Then you could go home if not on call. If on call then you would work all night admitting patients through emergency, putting out fired on ward and then assisting in emergency surgeries. The next day according to the rules you can go home around noon. But everyone knows if you want a good grade or want to do surgery then you must stay until the end of the day. We would do these call nights every third night!!! Translated to 120 hours per week!!! In addition to this we had to study because there are constant exams and pimping by your staff.
How many 36 hours shifts did you do in naturopathy school?!?
David,
I believe you may have a misconception about what NDs think. You wrote, “I don’t think naturopaths have any concept of how hard md study and work.”
But see my post above extracted here, “NCNM is just down the hill from Oregon Health and Science University (OHSU). Because of this proximity, ND and MD students would often be found studying in the same coffee shops, libraries, etc. Although anecdotal, several MD students comment to me that their course work was much less than mine.”
I think NDs are well aware of how hard MDs study and work. But it seems perhaps the opposite is not true. I definitely spent my “whole life studying” while in naturopathic medical school.
The unfortunate part of naturopathic school, as Britt well points out, if the quality of clinical education due to a sever lack of patients coming into the schools’ clinics and lack of residencies for all students. This is a very very serious problem in the naturopathic education. The very best clinical experience I obtained during my time at NCNM was at a Gates funded offsite acute care clinic for the homeless that was jointly staffed by ND students and MD students. Why was it the best? Simply put, because it had patients in need of care.
Turnbach
If these things were to happen in an Md office then it is highly likely that they would be reported to their respective college and would be punished. When naturopath does things wrong nothing happens. I have reported multiple cases of blatant malpractice to the naturopathic board and serious harm, without any consequence. I have reported a couple of local gp who have interfered in the treatment of my patoents with pseudoscientific beliefs and there was swift consequences. 99% percent of md adhere to the standards of care whereas perhaps 1% of naturopaths adhere to the standards of care They do and say whatever they want without consequence. They claim to be naturopathic oncologists and pediatric naturopaths with Minimal extra training. The whole thing is a farce.
Part of the problem, of course, is unlike the case for science-based medical care as practiced by licensed physicians that there really are no established standards of care for naturopaths. It’s hard to demonstrate a naturopath has done something wrong, when there is no established baseline ‘doing it right” standard to compare their actions to.
Testing…
Sorry NH Primary Care Doc, I missed that your comments went to spam for some strange reason.
I can’t reply to timmurbach, so I’ll write my reply here-
We were not “assigned” reading in med school. We were expected to get off our asses and figure out for ourselves what we needed to read and study to master the material. We were expected to understand and master the coursework, not just check off “assignments.”
I believe the ND profession has grown so much in recent years due to a widespread deep dissatisfaction of the current health care models. I don’t believe the schools are perfect in any way. Yet I think we can all agree that many patients are not being effectively treated by current medical professionals and standards of care–and I think we can also agree that this is likely because not every compound or therapy that has yet to be found effective has been scientifically studied in double-blind placebo controlled trials and has been the through extremely expensive and arduous FDA approval process. ND schools do teach a fair amount about treatments that have more of a historical or traditional use as opposed to being a standard of care, but it seems obvious to me that anyone applying to an ND school or visiting an ND as a patient is well aware of this, and is looking for something in addition to and beyond standards of care. I also have a wild argument that I’m certain this particular audience will not agree with–there may be a time and place in medicine for traditional, emerging, or maybe even, God forbid, “pseudo” science! ND practices are full of patients who have been to numerous mainstream medical specialists without resolution of their health issues. Is it so wrong to try less studied treatment modalities if such treatments have a long traditional history of being safe, potentially effective, and the patient is on board to try them? Better that they experiment under the supervision of someone with at least a fair amount of medial training and with experience and resources than reading about alternative treatments online and trying them alone. Britt said herself in her interview that in her ND residency (and I assume after) she generally consulted UpToDate and such databases that contain standards of care (as do MDs , myself, and most NDs I know), and she doesn’t have many regrets about the way she practiced at that time. There are extreme examples of poor care by NDs, as Britt has pointed out, but I would argue that there are such in every profession. Standard medications can be wonderful when they work (especially if minimal side effects), but they don’t work for subsets of patients, as is clearly demonstrated in clinical trials as well as clinical practice. There are also standards of care that rely on therapeutic trials of drugs, with the hopes that one will work (look at drug treatments for depression for example). There is so much we don’t know. I love science and research. Yet there isn’t much money out there to study botanicals and treatments such as hydrotherapy, because of course these things aren’t patentable–who is going to front the millions for large clinical trials on such modalities when there is no money to be gained? Thus we are stuck with either the “patentable pharmaceutical drug model” (which can be wonderful at times but not always), or alternative treatments need to become popularized enough by the public using them successfully to warrant interest and study by NCCIH or universities or other research groups. When such research comes out, then we can rely on the research, good or bad. In the meantime, desperate patients want to try something. It isn’t a black and white world out there…I hope this blog can be one tiny step in helping ND schools critically evaluate themselves and continue to get better, as I believe they are filled with amazing and dedicated students and teachers truly want to help patients.
Liz
Naturopathy: not a science based medicine yet continues to seek association with science based medicine while also criticising it. Limited to no oversight with extremely poor ethical approval processes. Treats people with unproven and often discredited treatments. Naturopaths try very hard to measure the Emporer’s nose averaging rather than actually measuring it.
“Is it so wrong to try less studied treatment modalities if such treatments have a long traditional history of being safe, potentially effective, and the patient is on board to try them?”
When there’s no reason to believe the treatments will be effective, or if instead they are knonw to be ineffective (as the case with many of the ‘mainstream’ ND interventions such as hydrotherapy, acupuncture, homeopathy, etc.) then yes: I believe it’s wrong to offer nothing other than false hope.
“I also have a wild argument that I’m certain this particular audience will not agree with–there may be a time and place in medicine for traditional, emerging, or maybe even, God forbid, “pseudo” science!”
What would the right time and place to embrace something that either isn’t known to be effective, or is known to be ineffective?
“but they don’t work for subsets of patients, as is clearly demonstrated in clinical trials as well as clinical practice.”
If ‘not working for everyone’ is a reasonable concern to have regarding science-based medicine, isn’t ‘not working for anyone” a valid criticism for ND treatments like homeopathy and acupuncture?
“who is going to front the millions for large clinical trials on such modalities when there is no money to be gained?”
Companies like Boiron, already making millions producing and selling botanicals, and the naturopathic schools and professional organizations already charging clients for receiving treatments like hydrotherapy, I’d hope. They’re the ones claiming efficacy.
“or alternative treatments need to become popularized enough by the public using them successfully”
How would you suggest the public go about demonstrating their use isin fact successful, if not by means of well designed and appropriately controlled studies?
Liz brings up a good point that I will try to elucidate more clearly. The definition of “evidence based medicine” includes three prongs: the anecdotal clinical experience of the treating health care practitioner, patient values and expectations, and the best available external evidence (i.e., RCTs or in their absence studies and other data of lesser quality).
I believe both NDs and MDs strive to apply evidence based practice in their respective fields. Please do not think or promote the false notion that all medicine practiced by MDs is backed by solid RCT evidence. Nothing could be further from the truth. I have also spoken and consulted with, as well as been a patient of, enough MDs to know that most of them are too busy to keep current with the medical literature, even in the limited area of a specialty. I have also known of doctors in both professions who had no business practicing medicine as have I known excellent doctors in both professions, despite any shortcoming or strengths of their respective educations.
I’d like to see any ND who graduated from an accredited school publically write anything that contributes to the real advancement of medical science OR write anything that unequivocally supports the global scientific consensus on at least 5 distinct medical topics. Go.
Hi Taylor,
Isn’t that a bit of “guilty until proven innocent” attitude? Why use that sort of tactic if what you are interested in is truth?
What would you consider evidence of contribution “to the real advancement of medical science?”
What would consider an article that is based on hard science that does not “support a global scientific consensus” as having the potential to be “a real advancement”? Can a consensus ever turn out to be wrong?
Without defining what you consider a contribution, it would be difficult to find evidence in support of one. The scientific literature is a wash with studies presenting contradictory evidence. Consensuses often arise when group of experts come together to sort through the totality of evidence to determine the most probably correct interpretation of both complementary and contradictory evidence. Science is a large and ever evolving landscape and such consensuses are not often arrived at. Some expert panels will offer a consensus as well as noting minority opinions. The Select Committee on GRAS Substances (SCOGS) opinion on caffeine provides such an example.
With respect to a direct response, published scientific articles are not typically searchable by degree of the author(s). For example if you search PubMed on degree names you won’t find an articles by people with those degree, but you will find articles if search by an individual’s name. Thus, to answer your question would require knowing the name of ND’s who have published articles. This adds a level of difficulty and therefore time to any legitimate attempt to investigate this question.
Because the number of NDs is far less than the number of MDs, I would suspect that the numbers of NDs so inclined to engage in scientific publication is relatively small although I certainly know of some. The following link may be a good place to start if anyone is so inclined: http://ncnm-helfgott.ncnm.edu/about-helfgott/153-2/
You’re mixing up a central tenent of the criminal justice system with a type of logical fallacy:
https://yourlogicalfallacyis.com/burden-of-proof
Hi Taylor,
You are very tricky. I am not making a claim. I am saying “innocent until proven guilty” as a central tenet. But your link actually supports my response to your original comment.
It is you that is making an implied claim through negative association. In plain language, your implied claim is: “No “ND who graduated from an accredited school” has “publically write[n] anything that contributes to the real advancement of medical science OR write[n] anything that unequivocally supports the global scientific consensus on at least 5 distinct medical topics.”
Now in accordance with the link you posted, you must assume the burden of proof to substantiate that claim. Go!
In fact you made a claim on June 30 that NDs strive to implement evidence based medicine. That was the claim for which I wanted to see evidence. You’re mixing up claims and calls for evidence. I wasn’t being tricky. Are you sure that you are not a meat popsicle?
Taylor,
Really?!!
Your original post on this thread is dated July 8th. Now you are saying that your July 13 comment in this thread applies to another thread that has never been discussed as part of this thread. Now there is a logical error. Please, from here forward, address any comments to a post in the thread of the same post or at least reference them so that it is clear what you are referring to.
With respect to my June 30 post comment that you now claim to have been referring to, I point out that I stated a belief. It was my intention that by making clear that I was stating a belief, my comment (or claim if you like) was to be take as an unsubstantiated statement of what I trust, but have not proven, to be true. Perhaps it would be better if I substitute the word “hope” for the word “believe” and rephrase my June 30 statement as follows: “I hope both NDs and MDs strive to apply evidence based practice in their respective fields.”
i just dont get it turnbach. It is not complicated to make a very simple placebo controlled trial. All the studies on that link you provided are all case studies, opinions and pilot studies. Why not do a useful study? What are the naturopaths scared of? you have to admit that it intuitively makes sense that you should have a placebo and the observers should be blinded to make it valid. This is not some western medicine concept, it just makes sense.
I just offered that list as a starting point that is easily identifiable for ND authors. I have no idea why the studies there are what they are. I have not even looked at the studies at the link. I suggest that you contact the institution and ask. Why not RCTs? Maybe it is a funding issue; they are expensive to conduct properly.
Here is a clinical trial from PubMed authored by some NDs.
I am curious when people will stop saying something is valid because it is on Pubmed. It’s a database, not a publisher or scientific authority.
Oops David,
Here it is: PMID: 24684456 http://www.ncbi.nlm.nih.gov/pubmed/24684456
Taylor,
I do not think anybody in this thread has said something is valid simply because it is on PubMed.
However, one PubMed indexed author (an MD) has written, “In order to be formally considered a peer-reviewed scientific article there needs to be published under recognized standard. The most widely recognized standard is the PubMed National Institute of Health guidelines. Virtually all valid scientific publications adhere to this standard. This is evidenced by their ability submit and list papers on PubMed.”
David asked for RCTs, I provided one that I am aware of because I recently read it.
Part of being a scientist is obtaining, critically, reading the full text version of published scientific articles, and forming an educated opinion as to the articles validity based on its reported materials and methods (of primary importance), reported results, conclusions, cited references, etc.
So, in your original post in this thread, you asked for evidence. I have gone out of my way to provide a small bit of what is “out there.” It is up to scientists with training and experience in the biological sciences as applies to medicine to evaluate the evidence I provided (note, I have provided data for evaluation, not an opinion of the validity of the data) and form their own opinions of the validity of that evidence.
clearly being indexed on Pubmed doesn’t argue what has been claimed in the publication is valid–Pubmed indexes articles in J Med Hypotheses, after all.
I think the timeline is clear. Let me parse it out…
April 14, 2015: I published this blog post.
June 26, 2015: Comment by Liz
June 30, 2015: Comment by tmurbach
July 8th, 2015: I ask for evidence that NDs publically endorse some medical standards of care or make a new contribution
July 13th, 2015: tmurbach asks if this is guilty until proven innocent.
I think the rest of the discussion is even clearer. Why are you responding with incredulity?
Well, because I did not look beyond the threat of your post. If it was intended to be a response to my post of July 30, why start a new thread rather than reply to my post? If starting a new thread, why not clearly state to what post it referred. As posted, it appeared as a general assertion unconnected to other posts.
However, the mystery is now solved and addressed. Thanks.
A central tenet of logic is that you cannot prove a negative. Saying there is “no such thing as” is a negative.
You can hypothetically prove that an ND that has graduated… has written… by simply providing an example. It is impossible to prove that no such ND exists.
Therefore the burden is quite clearly on those claiming such existence, not on the someone asking to be shown.
And if these published NDs are so common, surely it would be easy to name one.
Ken, as I mentioned, author’s post-nominal letters are often not given in publication. I have also pointed out that ND authors are probably not common by virtue that NDs are not common. A subset of a rare thing cannot itself be common. However, I did, nonetheless, provide many links to publications by NDs for the evaluation of interested parties.
and the evaluation properly failed you; Pubmed is just a search engine not a journal; the link provided by you is of a Naturopath “medical” school with silly research topics such as: “Using Our Relationship With Food to Promote Greater Cohesion Between Mind, Body, and Spirit.” published in the silly ‘journal’ Naturopathic Doctor News & Review (NDNR – go to website, it’s all fluff). Most of the ‘research’ on your link is fluff and is published in nonsense ‘journals’ for either integrative or alternative (why the distinction, since it is the same Bu.llsh.t) ‘medicine.’ Most of the research done is not by NDs but rather PhDs that are affiliated with the nonsense ND ‘medical’ schools (e.g. Zwickey). NDs need to just understand that you are not doctors, you haven’t gone to medical school, you’re not geeky, you’re not ‘sciency’, you’re just wannabes that get hired by ‘biotech’ companies that just want to sell the next cool looking bottle of St. John’s Wort. The sooner you get this, the sooner you will be able to leave your nonsense degree behind and maybe get a masters in science at a real university or an MD or DO degree if you wish to become a physician.
@Liz: “Yet there isn’t much money out there to study botanicals and treatments such as hydrotherapy, because of course these things aren’t patentable–who is going to front the millions for large clinical trials on such modalities when there is no money to be gained? Thus we are stuck with either the “patentable pharmaceutical drug model” (which can be wonderful at times but not always), or alternative treatments need to become popularized enough by the public using them successfully to warrant interest and study by NCCIH or universities or other research groups. When such research comes out, then we can rely on the research, good or bad. In the meantime, desperate patients want to try something.”
The old standby of unpatentability is just that: patents on botanicals, be they formulations, methods of preparation, or applications, are numerous and continue to be filed. As for the money to conduct clinical trials, leaving aside the $100s of millions taken in by Boiron in the sale of sugar pills, the earnings of the dietary supplement industry in the U.S. alone is more than sufficient to conduct clinical trials to determine the efficacy of various medicinal plants, many of which remain neglected and lacking toxicology studies to establish their safety.
Given the recent allowance by the FDA for “botanical medicines”, which allows their prescription as drugs or OTC products (provided sufficient characterization of the active constituents, their mechanism of action, and clinical trials to demonstrate efficacy), one can expect that more than a few interests will be eager to bring them, patents and all, to the market.
Just going to put it out there….but i think one of the biggest problems of all is that others besides MD were allowed to call themselves doctors. Naturopaths, chiropractors, optometrists, dentists etc. Not to say that MD are necessarily the best and should be the only ones (even though they are), but to prevent blurred lines. It is funny to me that naturopaths and chiros often do not want to be associated with those nasty pill pushing MD, but they are very happy to the blur the lines when it comes to being called doctors. A large portion of the public have no clue that naturopaths, chiros, and optoms did not go to medical school and these professions like it that way. Just like a neurosurgeon went to medical school and specialized in neurosurgery, a naturopath went to medical school and specialized in naturopathy. Or so they would like the public to believe. These paraprofessionals should call themselves profesor so and so or master so and so or king so and so, but just not doctor as it greatly confuses things and is not deserved!
Liz
I think your thoughts and ideas are in the right place but unfortunately it is far from reality. Naturopaths can indeed do a lot of harm as they do not have the knowledge or experience to diagnose diseases, and most of the diagnoses they do make are fake diseases. As in Britts most recent post, you can see the harm they do by overtreating. I do believe that in alternative health school they are fed the same lines over and over, such that MD just push pills. I recently visited my family physician and she spent 20 min talking about nutrition, my diet and suggested lifestyle changes. Even though my cholesterol is quite high, she did not prescribe any medication. I guarantee if I went to a naturopath, I would get a whole laundry list of herbs and vitamins I need to buy, numerous tests ordered, a few made up diagnoses, and maybe even a couple of IV therapies! It is quite ironic to me that chiro and naturo always claim that MD just order tests and push pills and don’t see the whole patient etc etc. But in reality that is what naturopaths do (test after test, intervention after intervention)! That is OK because it is all natural!
David,
Again, I think you are operating on misconceptions regarding NDs. Yes, all of those things you mention may happen in an ND’s office. All of them may also happen in an MD’s office (there are MDs that practice outside the conventional MD model). However, I don’t think it is fair to say that all of those things would happen in every ND’s office or the office of every MD that embraces alternatives to conventional standards of care.
NDs absolutely do have the knowledge to diagnose disease, and despite the problems currently inherent in their clinical training can absolutely gain the experience.
During my time at naturopathic medical school, I never heard, “MD just push pills” promoted. Some students may have held that view, but it certainly wasn’t part of the naturopathic education or indoctrination. The fact is, NDs do not need to “cut off the heads of others to make themselves taller.” All we need to do is to learn and be the best we can be and to continue to strive for improvements within our educational institutions and the profession in general.
Now, it may well be true that all some minority of MDs (and some NDs as well, no doubt, in states where they are so licensed) do is push pills. But it would be highly unfair to label all MDs for the sins of a few and it would be wrong to go around promoting such a misconception.
Turbach
Can you comment on all the diagnoses that Britt has nicely listed on her guide for patients seeking naturopathic help. You seem to be trying to legitimize naturopaths as going similar work to MD. All the patients I have ever seen that see naturopathy come back with one of these bogus diagnosed. It is almost comical how everyone has adrenal insufficiency, candidiasis and leaky gut syndrome. Whenever my patients say they have seen a naturopath, I start listing off these diagnoses for them even before they have a chance to tell me what the naturopath said.
Don’t forget Chronic Lyme Disease! They all have that, too.
Hi David,
Let’s see what character limits in the comment box allow for (maybe I can split comments among several boxes sine you asked for “comment[s] on all the diagnoses that Britt has nicely listed”). Here goes:
• Chronic mononucleosis
“Chronic EBV infection is a rare disorder characterized by ongoing symptoms of an infectious mononucleosis syndrome with active viremia.”(source: UptoDate.com) Personally, I have only ever seen one patient that fit this description.
Acute infectious mononucleosis on the other hand is a primary infection that can have many different manifestations and can also have sequalae and complications. For example, the causal link between EBV and certain cancers has been established.
• Chronic Lyme disease
I have not seen any patients with a diagnosis of Lyme disease. I am aware of some practitioners (both NDs, MDs, and other degrees) who claim to treat chronic Lyme disease, but this not an area I have investigated.
Post 6 (final):
• Thyroid conditions (including Wilson’s Temperature Syndrome)
With respect to Wilson’s Temperature Syndrome, because so many people talk about this in so many different ways, I took it upon myself to learn about it from the horse’s mouth (i.e., Dennis Wilson, MD). My impression after attending Wilson’s training, the impression that I have formed is that it is not a valid medical diagnosis and is not based on validated and reproducible diagnostic procedures of any kind. I believe its recommended treatment protocol has a real potential to do great harm.
With respect to other thyroid conditions, there are many legitimate medical diagnoses involving the thyroid, the most prevalent being hypothyroidism. The most common cause of hypothyroidism in the developed world is chronic autoimmune/lymphocytic thyroiditis (aka Hashimoto’s thyroiditis). Diagnosis of hypothyroidism relies both on the clinical presentation of the patient as well as results of laboratory testing as there are many symptoms associated with hypothyroidism, but only a small handful are sensitive and none are specific. Personally, I believe that mistreatment and/or misdiagnosis of hypothyroidism is rampant on both sides of the spectrum (too many alternative practitioners do not understand the value of TSH in diagnosis and too conventional practitioners rely on a laboratory reference ranges that is too broad according to various endocrinology associations—this of course is an oversimplification, but serves to capture, in summary, much of the controversy). You told me about patients coming to you from NDs, now I get to tell you that the most common patients that have come to me from MDs. These were symptomatic hypothyroid patients being mismanaged, something that I do not find comical at all.
Part 2 (I’m changing Britt’s order to fit more per post due to character limits):
• Chronic pancreatitis
From UpToDate.com (citations omitted): “Chronic pancreatitis is a progressive inflammatory disease of the pancreas. It is characterized by structural changes that result in irreversible exocrine and/or endocrine pancreatic insufficiency. The structural changes include diffuse or focal destruction, sclerosis, acinar cell loss, islet cell loss, inflammatory cell infiltrate, and pancreatic duct abnormalities. Intraductal obstruction may be caused by protein-plugs and/or calculi.
Because the pancreas has a large reserve capacity, symptoms of pancreatic failure do not develop until there is loss of over 90 percent of pancreatic exocrine function. Most patients with chronic pancreatitis initially experience recurrent abdominal pain, which may progress to persistent pain. Less commonly, patients are asymptomatic or have minimal symptoms until developing signs of advanced disease, such as diabetes mellitus or fat and protein malabsorption. With advances in diagnostic methods, the diagnosis of chronic pancreatitis is becoming more common in children.
A variety of pathologic processes can cause chronic pancreatitis in children. However, no specific etiology can be identified for many cases, termed “idiopathic chronic pancreatitis.” Hereditary pancreatitis is a form of chronic pancreatitis that often presents during childhood and adolescence; it will be discussed briefly here and in detail in a separate topic review.”
• Genetic conditions (including MTHFR deficiency)
Genetic conditions, including MTHFR polymorphisms, exist. Personally, I do not believe that MTHFR polymorphisms have a very large impact on the health of a patient and their clinical presentation. I just have not seen evidence to support that they should be tested for and treated any differently than whatever clinical manifestation is being attributed to them would be treated in the absence of such testing.
Part 3:
• Multiple chemical sensitivity
UpToDate.com (citations omitted): “Idiopathic environmental intolerance (IEI) or multiple chemical sensitivity is a subjective illness marked by recurrent, vague, nonspecific symptoms attributed to low levels of chemical, biologic, or physical agents … IEI is not a distinct, valid medical entity. Symptoms lack specificity, there is no reliable case definition or set of diagnostic criteria, and there are no consistent objective diagnostic physical findings or laboratory tests … The most frequently used term for this condition is “multiple chemical sensitivity,” but many other terms have also been used, including “environmental illness.” The World Health Organization in 1996 proposed the term “idiopathic environmental intolerance” (IEI) be used instead, because it avoids unsubstantiated assumptions of etiology, and many people attribute symptoms to environmental agents other than chemicals, such as food or electromagnetic forces”
• Heavy metal toxicity
Toxicity due to heavy metals such as arsenic, lead, and mercury is well established. Please refer to any comprehensive medical reference (e.g., The Merck Manual) or database (e.g., UpToDate.com) or conduct a search of PubMed.
Part 3 (first try didn’t post, so hopefully not a repeat:
• Multiple chemical sensitivity
UpToDate.com (citations omitted): “Idiopathic environmental intolerance (IEI) or multiple chemical sensitivity is a subjective illness marked by recurrent, vague, nonspecific symptoms attributed to low levels of chemical, biologic, or physical agents … IEI is not a distinct, valid medical entity. Symptoms lack specificity, there is no reliable case definition or set of diagnostic criteria, and there are no consistent objective diagnostic physical findings or laboratory tests … The most frequently used term for this condition is “multiple chemical sensitivity,” but many other terms have also been used, including “environmental illness.” The World Health Organization in 1996 proposed the term “idiopathic environmental intolerance” (IEI) be used instead, because it avoids unsubstantiated assumptions of etiology, and many people attribute symptoms to environmental agents other than chemicals, such as food or electromagnetic forces”
Heavy metal toxicity
Toxicity due to heavy metals such as arsenic, lead, and mercury is well established. Please refer to any comprehensive medical reference (e.g., The Merck Manual) or database (e.g., UpToDate.com) or conduct a search of PubMed.
• Candiasis (yeast or candida overgrowth)
Certainly candidiasis is an existent medical condition. Many improperly educated alternative practitioners have mistakenly referred to local mucocutaneous infection occurring in multiple locations (e.g., the gastrointestinal tract and the vaginal mucosa) in one patient as systemic candidiasis, which is a life-threating septic condition that occurs in the immunocomprimised, resulting in the “guilt by association” labeling of any ND treating candidiasis as bogus.
• Leaky gut
Leaky gut is well documented in the medical literature. I suggest a PubMed search. Try terms such as zonulin or tight junction. Try searching the term permeability instead of leaky.
Part 4:
• Food intolerances or allergies based on IgG testing
I am not aware of any validated IgG testing for food hypersensitivities. Therefore, I do not recommend the use of these tests.
Terminology notes: IgG mediated food allergies either exist or they do not exist depending on whether you adhere to a strict definition of allergy as an IgE mediated type I immune hypersensitivity (which would be the way an immunologist would likely limit use of the term). If this is your definition of allergy, then clearly there are no IgG mediated allergies. If you allow for the use of allergy to describe IgG mediated type IV immune hypersensitivities then they do exist. Regardless, of how you may or may not want to limit use of the term allergy, I hope we can agree that type IV immune hypersensitivities are real.
Because of the lack of validated diagnostic testing, I do not know of a definitive way of testing for their presence. IgE testing, on the other hands, is available and validated. For anything else, if suspected, I recommend a food elimination and reintroduction be conducted using as strict are reproducible a methodology as patient compliance will allow. This will not tell you if a patient is having an IgG reaction or some other kind of intolerance or sensitivity, but it will help to identify specific foods or food groups that a patient is reacting to and which temporary or permanent avoidance of will have a favorable impact on the patient’s presentation.
Post 5:
• Adrenal fatigue
First lets make it clear that adrenal fatigue does not mean adrenal insufficiency!
The problem with it as a diagnosis of adrenal fatigue is that it has no accepted and consistent definition in conventional medical literature. However, there are some alternative theoretical definitions floating around. I think a lot of what is talked about as adrenal fatigue is based on these old and largely unproven hypotheses such as the “general adaptation syndrome” and the more recent “maladaptive stress syndrome.” If the patient has unexplained fatigue, I think the better diagnosis is 780.79 (other malaise and fatigue).
Perhaps what people really mean by the term adrenal fatigue is an abnormal or inadequate stress response. Once we have some mutual understanding of what we are really talking about a few things need to happen, not the least of which is a proper differential diagnosis. Things like clinical depression, anxiety, thyroid disorders, sleep disorders etc need to be ruled out (hard to make a true and complete DDx without a real patient history and presentation). If a proper evaluation and work up has been completed and all important differentials have been ruled out, I believe one could move forward with empirical treatment of “adrenal fatigue” (i.e., treatment intended to support the stress response) as there is a body of research (albeit not the strongest of evidence) demonstrating some clinical efficacy of so-called “adaptogenic” compounds. Further these typically have a good history of being safe.
If going down the road of treating adrenal fatigue, the treatment plan should contain a reasonable period for reassessment and if the empirical treatment has not helped the patient it should be discontinued within a reasonable timeframe and investigations continued.
‘NDs absolutely do have the knowledge to diagnose disease”
Dr. Lipson’s Primary Care Challenges would argue otherwise, as would Brett’s experience related in “Finding Cancer as a Young Naturopathic Doctor”, as wouldnaturopathy’s embrace of mythical diagnoses such as chronic Lyme disease, etc.
In Canada The Naturopathic schools are like MD schools, but of course have a different approach at times. Not to bash MDs, but when I had an esophageal ulcer the stuff he put me on, just made me sicker and wither away to nothing! I told him, that we needed to switch it up because it is negatively affecting me. But he just said stick with it. So got sick of him (literally), and tried another alternative. I was given a list of some great naturopathic doctors in my area by a friend. I was open minded, so I went. My naturopath is quite great and knowledgeable. She looked at all my medical records and x-rays, had a physical test, and so on. She healed my ulcer, pushed my hernia back without surgery (which my previous MD didn’t even mention or acknowledge), got my gut flora back, helped me with anxiety and depression, had a proper nutrition write up. She did a spectacular job, and I feel better than I was when I was a teenager! She is a proper doctor, and to say that NDs shouldn’t call themselves doctors, wow. You could be a doctor of philosophy, doctor of psychology, and so on. Being a doctor, just mean that they just got their doctorate. I guess the English language is just confusing to you then. No worries it is to most people. It is so sad to read what most of you wrote about this article. So black and white, bashing each other like ignorant children. All because they had one bad experience, or just really bias. I go to both an ND and a new MD (she is a lot better than the quack that made me even more sick). Both are equally great, sometimes for the same diagnosis, but they have different specialties. I all just depends on who you go to. People are just people, neither is ever going to be perfect. So get over you bias attitudes, and acquire some wisdom. Hopefully there is no spelling or grammar errors in my post didn’t read it over, had to go. But be well to all! Both are equally awesome 😛
Dani:
I am sorry you had a bad experience with an MD. However, you are sorely misled if you think naturopathic training in canada is similar to MD. I am an MD in vancouver and there is a naturopathic school here. Anyone with an undergraduate degree who is willing to pay the price can get into this naturopahtic school, whereas 99% of those same people could not get into medical school here in vancouver. Then you have the training. In naturopathic school they are trained by other naturopaths and low level scientists. They do not see any sick patients as they do no training in the hospitals. They have zero training in an emergency room setting. They are not trained by PHD scientists and high level MDs like in medical school. Furthermore, somehow, after 4 years of naturopathic school (with zero training in hospital or with sick people) a naturopath is ready to treat and prescribe. However an MD with significant training in MD school, is not even close to ready, and must start a residency where the real training starts. A naturopath would not last ten seconds in an environment where patients are not walking wounded. So Dani, please do not try to pretend naturopaths have any more training in canada, then they do elsewhere in the world. Basically there training is read in books and with healthy patients!!
https://www.painscience.com/articles/medical-training-wins.php
please read this article Dani
I read the article. I am not pretending. You say that Nauropaths don’t do any residency, well they do in Toronto. I am not saying they have more training else where, I just said in Canada. Just read from books hahaha. This reminds me of some geologist and engineers always bugging each other about who is better, that their career is a joke. Well guess what, just because they have a different approach and different training doesn’t mean their job is meaningless. IT IS JUST A JOB. You stick to MD stuff and they will stick to their ND stuff. You need to have schooling before you go into a naturopathic course. There are prerequisites. Most have science degrees before they go in. To call them low level scientist, childish. Its like if you were put into a physics career, how would you do? So stop pretending like MDs are so much better than NDs. You say that people going into naturopathic schools couldn’t get into your school. 99%, that is your statistic, more like a made up one. Well guess what, I was in Md school for quite sometime with good grades, and discovered I was just more interested in what naturopaths were doing. It just suited me more, MD suit you more. Relax, and get over it. You and your opinion is no better than anyone else, and neither is mine. Agree to disagree. MDs have their place in life, and so do NDs. There are good ones and bad one in both professions. MDs and NDs equally are not going to know everything, they are just one person. That is why I stay in touch with both. Medical sciences is just a never ending learning experience. So that is my last comment, because arguing isn’t really worth it with some people who can’t even evolve their thinking or can’t even say to themselves: hey, that medical profession is just different than mine, that’s all. Have a good life, I know I will enjoy mine. I am not going to be all sullen about this.
So naturopaths do a 5 year hospjtal based residency like I did That is interesting, as far as I know naturopaths are not allowed in the hospjtal. Thanks for correcting me.
Also dani, if you can prove that you were in an accredited medical school and left on your own accord as you said. I will write you a thousand dollar check. I simply do not believe you.
There was another naturopath, Colleen Huber, commenting here or perhaps on ScienceBasedMedicine.org that she went to real med. school but didn’t fancy it, so went ND school after which she became a “cancer specialist” whereby she gives her patients IVs of baking soda (http://natureworksbest.com/dr-tullio-simoncini-sodium-bicarbonate-cancer-treatment/). I suspect she is also making her switching-sides story up as well. Or, perhaps Dani is Colleen.
I just looked her up. On her website she quotes a 90% cure rate of cancer. It is amazing how naturopaths can make these clajms without repercussions. I would have my practice closed tomorrow by the college if I made such unsubstantiated claims.
In addition to that website, check out this other naturopathic group she is runs: http://naturopathicstandards.org
It’s a target rich site for quackery. Sadly, in Arizona, this is all legal.
Presuming that 0 patients have approached her with indications of cancer, 90% of 0 is still 0.
I know. What bullshit. There is no way someone with that lack of writing skills was is in medical school.
However, for me, the big giveaway is that she calls it “Md school.” I have never, ever, ever met someone who called medical school “MD school”. Never.
“You and your opinion is no better than anyone else, and neither is mine.”
Perhaps. But their facts are a great deal better than your nonsense.