Respectful Insolence

I had come across a rather amusing mea culpa by GruntDoc in which, while discussing an amazingly inappropriate notice regarding guidelines for emergency room chiropractic reimbursement, he admits to having in the past referred our best and bravest to chiropractors. I can understand why he did it, given the circumstances he described. However, what bothered me was this statement:

In my six-plus years of being on-call in the hospital emergency department (ED), I have seen numerous ED physicians gain familiarity with the indications for chiropractic consultation. I have enjoyed seeing the attending physicians learn to appreciate the role of the chiropractor in the ED. Even more enjoyable is witnessing the ED physician’s growing dependence on their staff of chiropractors.

Whatever benefits (or lack thereof) chiropractic may have in the treatment of chronic back pain, one thing you can say about alternative medical treatments with some confidence is that they are in general pretty uselesss for acute problems of the kind seen in most emergency rooms. Next they’ll be calling chiropractors in to treat spinal fractures.

GruntDoc’s anecdote got me thinking about another case of wildly inappropriate use of alternative medicine. It’s a case that came up on a mailing list that I subscribe to, and it caused a fair amount of discussion. In essence, I’m talking about an organization called Natural Doctors International. It is, in essence, Doctors Without Borders, except with woo. This is what they do:

Natural Doctors International provides free healthcare services to underserved communities by offering volunteer medical rotations for licensed naturopathic physicians and other Complimentary and Alternative Medicine (CAM) practitioners worldwide.

Natural Doctors International

  • Offers long-term volunteer rotations for naturopathic physicians.
  • Provides donations of medicine, medical supplies, and equipment.
  • Establishes and develops community projects that improve health.
  • Organizes short term medical brigades for ND’s, DO’s, DC’s, MD’s NP’s, herbalists, acupuncturists, and Lac’s that deliver free health care.

Yep, it’s just what developing nations need: More non-evidence-based medicine.

One member of the list asked exactly what I was thinking when I read about this organization: “Does it provide any scientific medicine?” It’s a very reasonable question. For one thing, most developing nations have more than their share of shamans, herbalists, and other practitioners of native or alternative medicines, some of whom actually strongly resemble naturopathy. Do these countries really need more woo? I think not. There’s almost always plenty of home-grown woo right there. Or does NDI believe that woo from developed countries is better than indigenous woo? It certainly seems that way to me, anyway, even though it is stated elsewhere on the website:

The cultural healers are an integral part of the informal, and in some cases formal, of most developing countries. At NDI we give the utmost respect to all traditional healers and value the incredible wealth of knowledge many traditional healers have.

(I’m sorry for the lack of direct links. The NDI website is one of those truly annoying websites that uses way too much Flash animation. Indeed, I had to retype everything I quoted because the site didn’t allow me to cut and paste any of the text.)

Let’s see what volunteers are expected to do:

ND’s are expected to perform minor surgery procedures when necessary, assist with births and emergency consultations when appropriate, prescribe nutraceuticals, homeopathics, botanical medicine preparations, or pharmaceutical drugs as appropriate, and provide house calls for elderly patients and others unable to come to the hospital.

Does anyone see a problem with this? Although MD’s are trained in prescribing pharmaceuticals, in this nation at least, ND’s are not. Do the health officials in the countries to which these NDs are being sent know that they are not qualified to prescribe drugs or do surgery? Take a look at this site, for instance, which describes areas that ND’s are trained in. There’s homeopathy, energy healing, feng shui, healing touch, acupuncture, and a whole lot of other woo, but no mention of scientific medicine or pharmaceuticals. Look at the description of the Association of Accredited Natural Medical Colleges, which claims that naturopaths take the same sciences as “allopaths” but the site is chock full of woo. (In essence, to me it looks as though they spend the first two years studying basic science and then the last two years expunging the memory of that science and replacing it with woo.) Or look at the description here at the Southwest College of Naturopathic Medicine. Again, there’s lots of woo there, but no mention of scientific medicine, and an ND degree does not allow one to practice standard medicine–at least, not in the U.S. NDI claims that MDs also volunteer, but MDs who are of such a mindset to join such an endeavor would be quite likely to be just as willing to use woo as any ND. Moreover, I get the distinct impression browsing the site that naturopaths and alternative practitioners by far make up the largest group volunteering.

The main complaint seemed to be that the question was impudent, that it didn’t recognize the sacrifice these made by these naturopaths or their altruism. Certainly, they should be applauded for their desire to help. However, there’s help, and then there’s effective help. This sort of “help” could well be worse than no help at all. What these impoverished regions need is not more woo, but more scientific medicine. Consider this: The single medical intervention that could save more lives than anything else in such regions would be to make available vaccines. Yet antivaccination views tend to be distressingly widespread among naturopaths, who tend to view vaccines as–well–unnatural insults to the immune system. Take “Dr.” John Ruhland, a naturopath who goes so far to say:

About ten percent of children in the U.S. now have learning disabilities. Many holistic physicians believe this is partly due to immunizations.

There are excellent alternatives to immunizations. If parents have done the basic research and want further information, they can discuss specific alternatives with a naturopathic physician, based on each child’s unique circumstances.

He even links to the kingpin of antivaccination sites, the National Vaccine Information Center.

Yes, such attitudes are just what Third World countries need more of, don’t you think? No, what they need is more vaccination, not some woo-meister telling them they don’t need vaccinations. Naturopaths also frequently use what they describe as “natural antibiotics” in lieu of real antibiotics in conditions where real antibiotics are indicated. Yes, when infectious disease is rampant, that’s just what I’d want.

Finally, what is one really huge cause of morbidity and mortality among infants in such countries? It’s something that we in developed countries hardly even think about because it is not a problem. I’m talking about infectious diarrhea, which claims 1.5 million children a year worldwide. You may also remember that I discussed a clinical trial examining the effect of homeopathy on infectious diarrhea and questioned the ethics of using woo in Third World nations. At least the clinical trial was done with some supervision by physicians; letting loose naturopaths would guarantee no oversight.

It’s an old cliche that the road to hell is paved with good intentions. Here I see good intentions and a dirt road. It won’t be long, though, before it’s paved as smoothly as the Autobahn. There’s a reason that Doctors Without Borders does not recruit naturopaths, acupuncturists, or other CAM practitioners. The kind-hearted CAM practitioners who want to bring their brand of woo to impoverished parts of the world would do the intended beneficiaries of their charity more good if they were just to cut a check to Doctors Without Borders and save the woo for the credulous here at home.

Comments

  1. #1 Alex
    May 2, 2007

    Isn’t it even more worrying that the buggers are expected to perform surgery?

  2. #2 Ruth
    May 2, 2007

    I’ve made jokes about ‘where are Chiropracters Without Borders’, I never thought anyone would seriously propose this.

    I remember overhearing a recruiter for the Peace Corp, complaining they didn’t need any more poly sci or English majors, just med techs, engineers and agronomists who actually knew something of value to poor contries.

  3. #3 Calli Arcale
    May 2, 2007

    I hate to say it, but in some parts of the world, woo is actually an improvement over what they currently get, which is often nothing at all, especially when it comes to births. :-( Consider Tibet, where many women give birth in utter squalor, assisted only by a relative, and that only if they are lucky. Even an ignorant assistant would be better than nothing. At least they could run for help.

    That said, it does distress me to see them getting what I consider to be greatly substandard care, presented as if it’s the pride and joy of America, something equivalent to Medecins sand frontiers. And it horrifies (but doesn’t surprise) me to see that they’re openly admitting to doing things in third world countries which they cannot legally do in this country, like prescribing pharmaceuticals and practicing surgery. This is better than nothing — but that’s faint praise indeed, and even the poorest of the poor deserve better than that. In a way, this is the cast-off scraps of our country’s medical system. I see it as an insult to them that they are getting what amounts to substandard charity. It’s like donating spoiled food, or medicines past their sell-by date, or obsolete computer parts. It’s insulting to the recipients, and reflects poorly on America.

    You’re quite right, Orac. It would be better if these people donated to the legitimate charities.

  4. #4 Koray
    May 2, 2007

    What is their faith in the local woo healers based on anyway? Isn’t there a chance that these developed countries may have failed at developing “good” woo just like they failed at other things?

  5. #5 RavenT
    May 2, 2007

    Yes, this is just wrong. It’s also bordering on, if not outright, oppression to take advantage of someone’s lack of access to care to practice prescribing, performing surgery, and assisting at risky births when you wouldn’t be qualified to do so in a country that had access. If they really want to make a valuable contribution, they should work to build accessible clinics and fund real basic medical care.

    And I say that as a massage practitioner who values evidence-based practice and social justice. Touch is an essential part of human life and interactions, and I fully support its use as an adjuvant (supplementary) treatment–say to reduce pain or anxiety or nausea caused by radiation or chemotherapy treatments for cancer care–but anyone who would claim it can replace the basics of fundamental health care and sanitation is wrong on so many levels.

    Same with this–it’s just wrong to divert time and energy away from basic medical needs. They could be donating, or raising funds, or working to provide “barefoot doctor” basic emergency and paramedical training for local people who will stick around long after they’ve gone home. There are many ways to help that don’t require you to be a conventional medical practitioner; playing at surgery or prescribing at the expense of the disadvantaged isn’t one of them, though.

  6. #6 Sastra
    May 2, 2007

    My understanding is that in the U.S. most so-called alternative medicine practitioners usually treat the “worried well,” folks with problems which tend to heal themselves, or people with chronic conditions which fluctuate over time. Something tells me that this is not the sort of thing that’s going to be coming into third world emergency clinics.

    For some Natural Healers, it could be a rather rude awakening. How many acupuncturists, homeopaths, and Reiki Masters in the local “Wellness Clinic” at the strip mall have had their patients regularly die on them?

  7. #7 Dean
    May 2, 2007

    No worries mate… If this NDI “Quacks Beyond the Pond” shtick is like everything else associated with alternative medicine it’s probably just a ruse for a tax-deductible overseas vacation. They’ll most likely spend the majority of their time site-seeing, checking out brothels and partying. In fact, they’ll probably come back with more diseases than they’ll actually treat.

  8. #8 Joe
    May 5, 2007

    In their first two years, naturopaths (and chiropaths) attend high-school level science courses. It only looks comparable to medical education “on paper.”

  9. #9 Andrea
    August 7, 2007

    The comments here only support the widespread ignorance in this country about what is called “alternative” medicine. Granted, there are charlatans who have contributed to this, just as there are charlatans in allopathic medicine -many who, unfortunately, do not lose their license even when there is blatant malpractice in many cases. It’s very political. There is science to support many forms of complementary medicine, it’s just validated scientifically in other countries, of which this country does not typically accept. In addition,clinical results are often not the same as controlled study results. It is also important to understand that there is a huge political force in play in this country involving the FDA, the AMA and the pharmaceutical industry. It’s all about money. Lots of it.

    Research does show that in times of plagues and so on, those countries with homeopathic hospitals have more successes and less deaths than so called allopathic hospitals. As for vaccines, studies are limited on their effects and there are no studies on long-term effects. Furthermore, drug companies hold no responsibility for damages incurred due to bad vaccines. There is a federal committee, funded with YOUR tax dollars, that determines who has been injured by vaccines and then allotments are paid out accordingly. We do not know the long-term effects – no studies have been done. Could the increase in diabetes be associated with any of those, such as the hepatitis vaccine? We may never know. Not that I am opposed to vaccines, I just think we need to keep an open mind. Furthermore, it is disconcerting that there is now a push to deliver oral drops of numerous vaccines to newborn infants before they leave the hospital – vaccines for many third world diseases. Why is this necessary? It isn’t – just more money for the drug companies. While many scientists who do research for these companies believe in the good the bottom line is that money still drives it. We are a capitalist environment after all – good or bad, depends on how it is applied.

    Most European countries offer people alternatives to their health care and there is more of an attitude of complementary care. The British Royal Family even uses homeopathy. China decided to continue their original forms of Chinese medicine along with the 2oth century medicine when they modernized their healthcare system. They did this because they realized there was validity to each. The US had homeopathic physicians and medical schools until the AMA formed a very powerful political anti-homeopathy campaign. This has been to the detriment of our healthcare system. Today’s preventive medicine is NOT preventive – it is entirely early detection. Our current system is broken in more ways than one. Chronic diseases are on the increase due to our lifestyle factors, not addressed by modern medicine unless it is to take a pill or do surgery. Obesity is treated with diet pills and gastric bypass surgery. Diabetes is in epidemic numbers. Congestive heart failure is on the rise and you’re considered at risk just because you are over 40. Same with diabetes. Intestinal disorders are also on the rise. A typically trained MD does not know how to treat anything if it doesn’t have a drug or surgery that applies to it. They also do not ask a person how their life is going – do they have stress, how are they eating, do they exercise. A holistic practitioner encompasses all of that. Much of modern disease is a direct result of poor lifestyle choices. As for the comment that alternative medicine practitioners are probably site-seeing and checking out brothels and partying – attend any conference for medical physicians in this country and you will see plenty of that. I know, I’ve been an RN for over 20 years and I have worked in all areas of medicine – allopathic and complementary. There is a place for each and every individual should have a choice, not be forced to have only one option because of politics and ignorance. The first rule in medicine is first, do no harm. Unfortunately, many of today’s “cures” or treatments often create as much harm as what they are supposedly treating. Do your research with an open mind and talk to people who have utilized both.

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