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Voice of Reason: Licensing Naturopaths May Be Hazardous to Your Health

By Andrew A. Skolnick, Executive Director, Commission for Scientific Medicine and Mental Health

posted: 18 November 2004 07:13 am ET

Thirteen states and the District of Columbia now license naturopaths as primary healthcare providers and lobbying campaigns are underway to persuade lawmakers in other states to grant naturopaths rights as primary healthcare providers.

Many health authorities oppose licensing naturopaths because, they say, it will lower educational and professional standards and put the public's health at risk. They point to the unscientific, often anti-scientific attitudes of naturopaths and warn of the danger of further lowering safeguards and standards that were established to protect the public from the care of unqualified healers.

While proponents argue that licensing naturopaths would protect the public by establishing educational and practice standards for naturopaths, critics say that argument makes no more sense that claiming the establishment of educational standards for astrologers would make horoscopes more accurate.

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Naturopathy is no more based on science than astrology, say experts like Kimball C. Atwood, IV, M.D., who was an author of the Minority Report on Naturopathy to the Massachusetts Legislature (SRAM. 2004;8[1]:18-37).

Naturopathy is a hodgepodge of alternative healthcare practices that are said to boost the body's natural healing powers, through "natural," non-medical means, he says. Most practices of naturopaths are based on mystical and pseudoscientific beliefs. Many of their diagnostic procedures, such as hair analysis and iridology, have been scientifically discredited -- as have many of their treatments, such as homeopathy, "cranial osteopathy," coffee enemas, and chelation therapy for coronary artery disease. Despite the absence of scientific evidence that any of these work, naturopathic doctors adhere to these practices with unquestioning faith.

For example, many naturopathic doctors recommend that parents give their children homeopathic preparations instead of vaccinating them against diphtheria, whooping cough, tetanus, measles, and other crippling and deadly infectious diseases. They exaggerate the risks of vaccines and often falsely claim vaccines don't really work. With relatively few exceptions, the only children still stricken today by these ancient scourges are those not vaccinated.

One survey of naturopathic doctors in Massachusetts conducted by investigators from Children's Hospital in Boston found only 20 percent of the naturopaths surveyed said they would recommend to parents that they vaccinate their children. And only 40 percent said they would refer a 2-week-old infant with a 101 degree F. temperature for medical care.

Naturopaths also steer parents away from antibiotics that could prevent their children from developing scarlet and rheumatic fever -- once another great scourge of children. And they sell unproven remedies to patients at risk for heart disease and strokes instead of recommending drugs that have been proven to control high blood pressure and high cholesterol that cannot be controlled by exercise and diet.

Naturopaths also may endanger their patients because they lack the clinical training that is required of all medical doctors, Dr. Atwood says. While medical school graduates are required to undergo one or more years of intensive clinical training under the supervision of experienced physicians, naturopaths usually are allowed to practice right after graduation without an internship or other extensive clinical training.

Politics vs. Science

Despite the lack of scientific evidence for the safety and efficacy of naturopathy, legislatures in 13 states have decided to licensed naturopaths. Those states include, Alaska, Arizona, California, Connecticut, Hawaii, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington. Naturopathic doctors are also licensed in the District of Columbia, Puerto Rico and the U.S. Virgin Islands, and legislators in New York, Colorado, and other states have now sponsoring similar licensing bills

The American Association of Naturopathic Physicians (AANP) states that "naturopathic medicine has its own unique body of knowledge, evolved and refined for centuries" and is "effective in treating all health problems, whether acute or chronic." In addition, many are also trained in modern science, their advocates say, pointing to the curricula of the four naturopathic medical schools in the United States.

These schools provide their students with a 4-year curriculum that includes the same basic sciences taught in medical schools, along side the special instructions in "holistic and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness."

However, their critics argue, what naturopaths learn has little to do with either basic or clinical science. The basic core of naturopathy rests on occultism and pseudoscientific beliefs that are resistant to modification from scientific discoveries.

Perhaps the most distinguishing difference between a medical doctor and a naturopathic healer is that if you show a medical doctor scientific evidence that a drug is unsafe or doesn't work, he or she will stop using it. With few exceptions, naturopathic doctors base their treatments are seldom if ever swayed by scientific evidence.

In 1968, naturopaths asked the federal government to recognize their treatments for Medicare reimbursement, and this is what the U.S. Department of Health Education and Welfare concluded:

"Naturopathic theory and practice are not based on the body of basic knowledge related to health, disease, and healthcare that has been widely accepted by the scientific community. Moreover, irrespective of its theory, the scope and quality of naturopathic education do not prepare the practitioner to make an adequate diagnosis and provide appropriate treatment."

Little appears to have changed over the past four decades to bring naturopathy into the 21st century. And until naturopaths embrace evidence-based medicine and abandon their mystical and anti-scientific methods, they will endanger the public if allowed to practice medicine as primary care givers.

Establishing standards for those who use pseudoscientific and mystical practices will not transform them into competent physicians capable of practicing sound, evidence-based medicine. As Dr. Edzard Ernst, director of Complementary Medicine at the University of Exeter in England, warned, those "who believe that regulation is a substitute for evidence will find that even the most meticulous regulation of nonsense must still result in nonsense."

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Comments (6)

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natural_boise avatar
posted 11 September 2008, 8:41 pm ET

The distinction between those calling themselves 'naturopaths' who have taken a correspondance course and true naturopathic physicians (the post-bacchalaureate four year degree, N.D.) is not addressed by this article. There seems to be an unfortunate blending of the two disciplines by Mr. Skolnick in this article.

" ...only 20 percent of the naturopaths surveyed said they would recommend to parents that they vaccinate their children."
- Many viruses are safer when contracted as children than when an adult. The full-onset, natural exposure develops the antibodies that protect us for a lifetime, versus immunizations that many people do not continue on schedule once reaching adulthood.

"And only 40 percent said they would refer a 2-week-old infant with a 101 degree F. temperature for medical care."
- This is not a high fever for an infant. This symptom, not an illness of itself, can watched closely at home for any additional concerns without the need to run to an M.D.

"Naturopaths also steer parents away from antibiotics that could prevent their children from developing scarlet and rheumatic fever --"
- Many responsible people are persuaded by fear of being 'negligent' parents into accepting/demanding a prescription for antibiotics for a condition which may or may not be bacterial. Antibiotics do not work on a viral or fungal infection, and may make the situation worse. Antibiotics are unbalancing to the flora of the body, and over-prescribing has led to antibiotic-resistant bacteria.

"And they sell unproven remedies to patients at risk for heart disease and strokes instead of recommending drugs that have been proven to control high blood pressure and high cholesterol that cannot be controlled by exercise and diet."
- Many studies are ongoing to collaborate or disprove anecdotal evidence of the efficacy of natural 'remedies'. These are not the 'snake-oil' inferred by the author. Natural treatments often consist of standardized herbs, which are the basis of modern pharmacology but low-cost and unpatentable; mind/spirit/body reconditioning, including counseling, biofeedback, hypnotherapy, meditation, yoga, physical therapy, massage, art, dance, acupuncture, prayer/gratitude; nutrition modifications based on whole, natural, organic foods in proper proportions; regular physical activity beyond an exercise regimen.
Naturopathic belief is that almost all HBP and cholesterol issues can be brought to 'normal' with these dramatic lifestyle changes which most Americans are loathe to undertake, and these life-threatening conditions would not have even developed if such a lifestyle were followed throughout life.
There is nothing 'mystical' or unscientific about it except humanity.
pheephee35 avatar
posted 12 September 2008, 12:41 am ET
pheephee35 wrote:

And homeopathy doesn't work?  Well, using my naturopath I was cured of sinus problems that all the phenergan the ENT gave me did not fix -- except for 8 hours at a time. He was talking invasive procedures like scraping the sinuses.  I did not get the flu shot because the oncologist's nurse told me it was too late because I was on chemotherapy. I took the homeopathic remedy as prescribed by the naturopath and was up in a day and a half cleaning house and running errands, while my teenager laid in bed groaning for 3 days and moped around for a few more.  I did have to rest a little!
zz_blackjack avatar
posted 16 January 2009, 11:17 pm ET
zz_blackjack wrote:

Three paragraphs in to this article, I knew I had to put my two cents in.

"They exaggerate the risks of vaccines..."

Without knowing specifically what the author is referring to, I would have to point out the more than obvious: Thimerosal, along with several other ingredients included in many vaccines are known carcinogens and neurotoxins, with Mercury being one of the most toxic substances known to man. Even more enlightening is the recent evidence that points to Mercury as a contributing factor in developmental diseases like autism, a piece of knowledge that has become widely accepted by the FDA and other organizations as true.

"Naturopaths also steer parents away from antibiotics..."

With the widespread presence of MRSA, MDR TB, and other antibiotic-resistant strains of bacteria in hospitals, schools, and other public facilities, I would say that it is a very good idea to severely cut back on the use of antibiotics. Multi-Drug resistant bacteria are one of the most terrifying and real threats to public health today, and a little caution and skepticism years ago could easily have made this a non-issue.

This article appears to me to be loaded with broad, sweeping statements about a diverse and widely encompassing school of thought, and was in no way an objective or intellectual article. Many aspects of naturopathy have been studied rather exclusively despite supression by many members of the medical community. Garlic, and it's components have more scientific studies under their belts than almost all pharmaceutical drugs, that point to it's ability to fight infection (bacterial, fungal and viral), lower LDL cholesterol levels (with far less side effects than statin drugs), regulate blood pressure, slow aging, and even reduce tumor size. Ginger has been shown to be even more effective than some OTC motion sickness medications, with the added benefits of improving digestion and improving gastric emptying. The list goes on and on for any scientist willing to open their minds.

It is true that some branches of alternative medicine are so far away from the mainstream that there is almost no similarities; but the great thing about being a free people, able to pursue any intellectual avenue without fear of persecution, is that ideas can be introduced, studied, practiced, no matter how off-base. Many of the greatest scientific achievements throughout history came from radical free thinkers, often ridiculed in their time. I think that it a travesty to the ideals of science that so many of those who devote their lives to discovery would cast aside ideas at a glance, effectively closing their minds to untold possibilities. I see this as being a hindrance to the expansion of the collective pool of knowledge obtained by the human race, and nothing more than a group of scientific "elites" putting their objectivity aside and petting their own egos.

I must say, I am disappointed to see that the author of this article is a high ranking member of the medical community. I would have hoped to have seen a more convincing argument than what was presented. Even Stephen Barrett, a non-practicing psychologist who runs the website "Quackwatch.org" from the basement of his house can produce more evidence than you, Mr. Sklonick. I must say, as a fledgling member of the medical and scientific community, I am sad to find the same shotgun ignorance that I see when I hear Ann Coulter call a presidential candidate racially charged names on Fox news.
mineeds01 avatar
posted 13 March 2009, 6:43 am ET
mineeds01 wrote:

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<a href="http://www.mineeds.com/Seattle-Washington-Services/Naturopathic?utm_source=CommentingOnForumsBlogs
bhall avatar
posted 22 May 2009, 12:16 pm ET
bhall wrote:

Wow, guys. Really?
 
FYI:
Phenergan is used for nausea, not for anything sinus related.  I'll bet Pepto Bismol wouldn't have helped either.

A fever over 100.4 in any infant under 2-3 months of age is a significant medical concern.  It deserves a thorough workup including labs and possibly imaging.  Natural_boise's information about fevers above only applies to adults and older infants/children.

The autism/vaccine link has now been researched almost exhaustively.  Absolutely no link between the two has been found.  There is not really any debate about whether vaccines should be given anymore, except between pseudoscientists.  I have had a few naturopaths and chiropractors approach me on this issue, and when we have done literature reviews together, they have come to agree that the studies they were using to back up concerns about vaccines were deeply flawed and poorly designed.  Yes, vaccines do have a risk, but their benefits are enormous.  Vaccines have averted millions of childhood deaths.  Think about this:  Your child is more likely to have a serious adverse outcome from the car ride on the way to the doctor's office than from the vaccine.  As with any treatment, naturopathic or allopathic, you need to weigh the risks against the benefits.  My feeling on the subject is that not getting vaccines out of fear of bad outcomes makes about as much sense as not learning to read for fear of getting a paper cut.  I would have to recheck this, but my memory is that only one vaccine currently contains thimerasol (mercury), and long-term studies are indicating no adverse effects so far when compared to children who did not get the vaccine.

Alternative therapies often have merit.  The problem that MDs have with them is that they have been taught not to use a therapy that is speculative and has not been subjected to high-grade studies (randomized, placebo-controlled, prospective, double blinded).  Some docs are close minded, but I have found that the majority are just waiting for better research before they recommend most of these alternative therapies.

Antibiotics are still overused, but they do have their place.  I spoke with a doctor that was in med school when penicillin came out and he told me that the death rate from pneumonia was 60% when he started med school and 3% when he finished.

I think the author makes a good point regarding science.  A good way to judge a health care provider is whether he/she changes their practice when confronted with evidence that their treatment habits are harmful or ineffective.  Also, I have had extensive exposure with the mainstream and alternative medical communities and have never seen a single idea or study suppressed or ignored by medical professionals except when it was done poorly or was biased.  Sorry, guys.  There really is no conspiracy to keep America sick or uninformed.  

Be wary of any practitioner who spouts conspiracy theories, uses testimonials to back up their practices, or is unwilling to change based on emotion or close-mindedness.
spagyricus avatar
posted 01 November 2009, 12:47 pm ET
spagyricus wrote:

A perfect example of self-satisfying intellectual laziness: bias-laden, preconceived pap masquerading as the voice of reason.

"Establishing standards" for those who masquerade as "competent" physicians and pharmacists hasn't prevented them from facilitating the accidental death (or calculated mortality, in the case of pharmaceutical companies) of millions of people (often in the 3rd world, where clinical trials are relatively and conveniently unregulated in comparison to wealthy industrialised nations).

"Be wary of any practitioner who spouts conspiracy theories, uses testimonials to back up their practices, or is unwilling to change based on emotion or close-mindedness." - doesn't this describe a significant proportion of the orthodox medical establishment as much as any snake-oil merchant? Conspiracies regarding the intent of practitioners outside the dominant paradigm, testimonials by proxy courtesy of medical 'reality tv' shows, and an irrational emotional reaction to modalities which defy explanations which are limited to current scientific understanding (what would Hippocrates have said if you'd showed him an ECG? which reminds me - "Primum no nocere" - thalidomide, diethylstilboestrol, HRT, need I go on? How many people have been killed by Naturopathy or Acupuncture?)

"Medicine" as it is commonly understood in is itself a "hodgepodge"  - between surgery [where is the evidence-base - surgical RCDBT's?] and drugs [a quick scan through MIMS reveals an enormous proportion of frequently-prescribed medications have unknown or poorly-understood mechanisms of action, a charge often levelled at complementary and alternative medicine]. And that is without even scratching the surface of the influence wielded by drug companies over doctors and regulatory bodies (and ignoring documented out-and-out deception and fraud perpetrated by pharma-giants). Doctors, I could equally assert, "adhere to [their] practices with unquestioning faith". 

I'm not going to continue to pick this sloppy puff-piece apart, I have better things to do. And in case you think I am anti-orthodox: I am not  am not opposed to any single therapeutic approach (including orthodox medicine), per se, unless the weight of broad, rational, documented evidence suggests that the risks outweigh the benefits.

I am, however, tired of having to defend myself, my practice, and anything outside the orthodox square, against small-minded, pre-programmed, self-important idealogues. If you want a genuine argument, tighten up your premise, mister, and stop using unimaginative and inappropriately suggestive terms such as "occultism", "mystical" and "pseudoscientific".

I'm surprised that this article was accepted for publication given the fundamental lack of intellectual rigour.
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