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.