It wasn’t so long ago (less than a week, actually), that I noticed what I referred to as a paean to the quackery known as naturopathy. It appeared—where else?—on that wretched hive of scum and quackery known at The Huffington Post. It was even entitled My Love Affair with Naturopathy. Not unexpectedly, this very article revealed just what quacks naturopaths are, as it told the story of a woman with vague symptoms, “messed up menstrual cycles,” and other complaints who went to a naturopath and was blown away by the “personalized” attention and even more happy that this particular naturopath actually gave her a diagnosis to tie all of her problems together. Never mind that the diagnosis (“adrenal fatigue”) is a bogus diagnosis with no support in science. It was a diagnosis, and she loved it.
Well, just yesterday I became aware of another paean to naturopathy on the same wretched hive of scum and quackery, only this time it wasn’t from the patient’s perspective. Rather, it was from the naturopath’s perspective. It’s a post by a naturopath named Michael Stancliff entitled You’re What Kind of Doctor? My answer to that question, of course, would be something along the lines of saying that naturopaths are:
- Fake doctors
- Not a doctor (which is what “ND” really stands for in my mind)
- Pretending to be a doctor
The list goes on, and I’m sure you’ll be happy to add to it.
If there’s one thing that naturopaths crave, it’s respectability, to be considered to be equals with real doctors. To achieve this, they will do almost anything—anything, that is, except learning real science and giving up the pseudoscience and quackery that make up so much of naturopathic treatment. But first, like all good naturopaths, Stancliff has to distance himself from what he views as quacks. I’m not like those people, he says in essence, I’m a real doctor:
What we do probably wouldn’t make for a popular TV show like House or Grey’s Anatomy. Preventing heart disease and cancer through diet or helping someone break the pattern of insomnia is not nearly as exciting as rare diagnoses or ethically questionable emergency transplant surgeries. In fact, when some “alternative” health approach is portrayed on one of these shows, you can be fairly certain it’s why the patient is so ill. Ironic, considering the now-famous JAMA article reporting “medical treatment” as a leading cause of death in the United States.
Oh, goody. Stancliff not only thinks he’s better than quacks, but he seems to think that he’s better than doctors. Of course, the article he cites is the infamous article by Barbara Starfield that I deconstructed a couple of years ago. Let’s just put it this way. Starfield’s conclusions don’t really pass the “smell test.” Starfield estimated that between 230,000 and 284,000 deaths occur each year in the US due to iatrogenic causes or physician error, making this number three in the leading causes of death for all Americans. To recap briefly my previous criticism, this figure has actually always bothered me. The reason is simple math. Each and every year in the U.S., approximately 2.5 million people die. If Dr. Starfield is to be believed, approximately 10% of all deaths are from iatrogenic causes, which would make iatrogenic death the third leading cause of deaths in the U.S. after heart disease and cancer. There’s a bit of a plausibility problem there. I suppose it’s possible that doctors kill more patients than strokes, but it seems highly unlikely for a number of reasons.
So why do I doubt the Starfield paper? Patients in hospitals tend to be sick and more prone to complications. For one thing, Starfield counts 80,000 deaths from nosocomial infections in hospitals. Nosocomial infections (hospital-acquired infections) are a big problem, no doubt, but lumping them in with medical error and iatrogenic causes is rather questionable. Many nosocomial infections can’t be prevented easily and are not the fault of the physicians treating the patient. Moreover, nearly all of these numbers were derived from hospital studies. Similar considerations apply to non-error adverse reactions, which are said to claim 100,000 deaths a year. Remember, these were not medicines given in error. To compare this number honestly, you have to look at it in comparison to the number of lives saved every year by these medications. In other words, one has to compare the risks versus the benefits, and the vast majority of these studies don’t even try to do this.
But I digress. Mentioning that paper has a tendency to irritate the crap out of me.
Stancliff then introduces what he’s trying to get across by claiming that most people, when they hear the word “naturopath,” think of “magic wands, potions, and Kramer’s holistic healer friend on Seinfeld,” clearly trying to set himself up in contrast to such wackiness and obvious quackery before trying to convince you that he’s a real, honest-to-goodness doctor, dammit! Stancliff brags about having taken biochemistry, anatomy, and pathology, and claims that he learned how to use the same diagnostic tests, physical examinations, and medical imaging. As I said, he’s practically screaming, “We’re real doctors! Really, truly we are!”
But he’s not, and naturopaths are not. Unfortunately, too many states are licensing naturopaths:
Depending on the state, our naturopathic medical license covers everything from dietary advice to pharmaceuticals and suturing wounds. For instance, in California my license is nearly identical to that of a nurse practitioner or physician’s assistant. In Washington and Oregon, the license covers a greater scope of practices and ND care is covered by nearly every insurance provider.
Naturopaths’ scope of practice is like that of nurse practitioners or physicians assistants? That’s a burn on NPs and Pas, isn’t it? There is one glaring difference that I can think of, though. I greatly respect NPs and PAs. I work with them on my clinical days. Naturopaths, on the other hand, are doctor wannabes whom I do not respect, and Stancliff doesn’t take long to justify my disrespect, for all his protestations that, honestly, really, and truly he takes the same classes as doctors and should be treated as a real doctor. Naturopathic practice can never be truly science-based. The reason is simple:
Homeopathy means to give a medicine in a very small dose. Scientifically, we don’t know why it works, because the doses are so small. Naturopathic medicine is not how medicine is given specifically, but based on our six principles. Naturopathic medicine refers to an approach to treating people, and tends to favor natural and low-force interventions. Our treatments with patients might include dietary changes, supplementary nutrients, exercise, herbal medicine, pharmaceuticals or homeopathy. So homeopathy can be part of an ND’s treatment plan, but it’s not the only tool in the shed. That said, other medical providers may use homeopathy as well, and it doesn’t make them naturopathic doctors.
No, homeopathy means giving medicine in a nonexistent dose, the original component having been diluted to the point that nothing is left. In any case, given that homeopathy is nothing more than magical thinking, no naturopath can be considered scientific or to be practicing medicine that is science- or evidence-based. Of course, naturopathy does mix the plausible with the utterly implausible, such as dietary changes and exercise, but it mixes it with pure nonsense like homeopathy, most of traditional Chinese medicine, and the irrational, non-evidence-based use of various supplements. Unfortunately, even when using ostensibly “evidence-based” modalities, naturopaths somehow manage to “woo-ify” them.
Stancliff is also very protective of the term “doctor,” way more so than most real doctors are. For example, he really, really doesn’t like it when he’s called a “naturopath,” dismissing people with “questionable training” who “call themselves ‘naturopaths,'” even bragging how he’s reported people advertising themselves as having the ND degree but do not to state medical authorities. Of course, in reality, mental masturbation over the difference between a “naturopath” and a “naturopathic doctor” serves no one but naturopathic doctors protecting their turf as ruthlessly as they accuse MDs of protecting their turf. It doesn’t matter that licensing pseudoscience and quackery does nothing other than to legitimize pseudoscience and quackery. It dos not make the pseudoscience and quackery any less pseudoscientific or quacky.
Nor does petitioning the government to allow naturopaths to be treated as primary care physicians, as this recent petition to the Obama Administration to be considered for purposes of “Obamacare” to be primary care docs:
Licensed naturopathic physicians should play an integral part in patient access to alternative medicine within the Federal Healthcare Law (Obamacare) as they serve as primary care physicians within the complementary health care field.
With Americans spending over $34 billion dollars spent annually on alternative medicine, the inclusion of licensed Naturopathic physicians would offer patients the option of seeking alternative medicine care covered by insurance AND provide access for those currently unable to afford care.
Licensed Naturopathic physicians are able to diagnose and treat both acute and chronic disease and are experts in nutrition, herbs, and other holistic therapies.
I’m not sure why naturopaths are petitioning the federal government, given that the vast majority of regulation of the medical profession occurs at the state level, but this is just the latest in a long line of gambits by naturopaths to try to claim legitimacy for thmselves that their discipline hasn’t earned through science and clinical practice. Whether it is a single naturopath like Stancliff or organized naturopathy acting in the interests of single naturopaths like Stancliff, naturopaths crave respectability and want to be treated as equal. Too bad they don’t seem to understand that being treated like a doctor means behaving like a doctor and treating patients like a doctor.