After yesterday’s epic mid-week rant about a man who thinks he knows what skepticism is but clearly doesn’t, it’s time to get back to business. The best way to do that is to go back to an article that came out the other day and that I had meant to blog about but temporarily shelved in favor of yesterday’s rant. It’s a topic that’s very relevant to me right now given that the Michigan legislature is considering a bill (House Bill 4531) that would give naturopaths a broad scope of practice almost the equal of that of primary care physicians, the only difference being that naturopaths wouldn’t be allowed to prescribe controlled substances. I plan on posting an in depth analysis of the bill in the near future. In the meantime, though, what caught my attention was an article on STAT by Rebecca Robins entitled Naturopaths, often derided as quacks, push to go mainstream—with help from vitamin companies. It describes how naturopaths have renewed their push for licensure in various states and how they’re being helped by supplement companies.

If there’s one thing I’ve learned about naturopaths over the years, it’s that they’re persistent. They play the long game. Even though currently they are only licensed in 17 states, the District of Columbia, Puerto Rico, and the US Virgin Islands, they never give up. As many times as they persuade woo-sympathetic legislators in various states to introduce bills to license naturopaths and see those bills defeated, they keep coming back again and again and again until they win. In a way, you kind of have to admire the way they wear down the opposition. Clearly, state medical societies aren’t prepared, which is obvious from the STAT article:

Naturopaths, who practice an alternative medicine heavy on herbal supplements, are making a big push to gain more authority and stature across the United States, including the right to do more hands-on patient care and to be reimbursed by Medicare.

That’s raising concern among critics who see naturopaths as quacks — and who warn that offering them state licenses, insurance reimbursements, and other recognition only legitimizes their pseudoscience.

This is, of course, exactly why naturopaths crave state licensure so much. First, state licensure legitimizes a speciality by placing the imprimatur of the state on it. Quite reasonably, people look at a specialty that’s licensed by the state and presume that it must be a real profession with a real basis in science and reality because otherwise the state wouldn’t license it. Now, you and I know that this is not necessarily true. Many states license quackery. After all, every state licenses chiropractors and lots of states license acupuncturists. However, the average citizen doesn’t know this and assumes that state licensure = legitimacy. The sad fact, however, is that state licensure ≠ legitimacy. I wish it did, but it doesn’t, at least, it doesn’t necessarily.

So what’s the strategy? Take it away, Ms. Robbins:

Next Monday, more than 100 aspiring and practicing naturopaths plan to storm Capitol Hill to rally support for a federal pilot program that would allow them to be reimbursed by Medicare for some patients. Naturopaths are also lobbying for expanded authority to diagnose and treat patients in a handful of states, including Massachusetts and Michigan.

And:

But in the US, the American Association of Naturopathic Physicians is optimistic that the public is ready to embrace its approach.

The AANP plans to host its first big consumer health fairs this summer, in D.C. and Utah, complete with cooking demonstrations and yoga for the whole family. And the group recently hired two new staffers to lead a more aggressive PR strategy, including a former TV journalist.

“There’s a lot of excitement with the increase in consumer demand for natural remedies,” said Ryan Cliche, executive director of the AANP.

The group’s goal: Pushing all 50 states to license naturopaths by 2025.

That’s an ambitious goal, probably unattainable, but there’s no doubt that naturopaths can make considerable progress towards it, particularly if state medical societies remain silent.

As I’ve discussed more times than I can remember, naturopaths like to represent naturopathy as a form of “natural medicine” that utilizes the “healing power of nature.” Unfortunately, in reality, naturopathy is the modern day incarnation of the 19th century “natural living” movement in Germany. Early naturopaths objected to contemporary science-based medicine, particularly germ theory and vaccinations, instead advocating the “water cure,” fasting, herbs, homeopathy (or, as I like to call it, The One Quackery To Rule Them All), colonic “detoxification,” and other popular methods of the era. Unfortunately, little has changed in naturopathic practice in 150 years, although naturopaths are much better at cloaking their quackery in scientific-seeming trappings, and some of them have embraced laboratory tests in a big way as part of their embrace of the dubious specialty of functional medicine.

Despite the efforts of modern naturopaths to argue that their profession is scientific, in reality naturopathy is now, as it was in the 19th century, rooted in prescientific vitalism. Basically, naturopathy is based on a belief in the “healing power of nature. For those of you who aren’t familiar with the lingo, any time you hear someone refer to the “life force,” as naturopaths frequently do, you’re looking at vitalism, the idea that there is some sort of mysterious, yes, “life force” that is present in living matter and makes it alive. In essence, vitalism is the philosophical doctrine that states that life has a quality (the “life force,” “vital force,” or any of a number of other terms such as “life energy”) independent of physical and chemical laws, such as an immaterial soul. Many forms of alternative medicine are based on vitalism. For example, acupuncture claims that sticking needles into “meridians” through which qi (the life energy or force) flows will redirect the flow and relieve symptoms and/or cure disease. Reiki practitioners claim that they can direct life energy from the “universal source” into patients for healing effect, which is why I like to say that if you replace the term “universal source” with “God” you have faith healing. Basically all “energy medicine” claims that its practitioners can somehow manipulate “life energy” to healing effect. Not surprisingly, naturopathy embraces pretty much all of these modalities, and more.

Particularly popular among naturopaths is a belief that disease is caused by “toxins.” These toxins are seldom validated by science. In many cases, they aren’t even identified. Yet, “detoxification” is a major theme in naturopathic treatments, with unscientific and sometimes dangerous treatments, such as chelation therapy (to “detoxify” heavy metal overload) and colon cleanses, including the infamous coffee enemas, being advocated to help patients “detoxify.”

Now here’s the interesting thing. Before I get to it, consider this fact. One of the most common attacks leveled by quacks at advocates for science-based medicine is what I like to call the “pharma shill gambit.” With that in mind, consider this passage from the STAT article:

The makers and sellers of herbs and supplements have a big stake in the expansion of naturopathy — and they’re putting money behind it. “Corporate partners,” many of them dietary supplement makers, have collectively contributed more than $270,000 to fund the AANP’s work this year.

One of the AANP’s top contributors: Emerson Ecologics, which distributes nutritional supplements and vitamins and gave $50,000 to the group.

Emerson’s ties to naturopath advocacy run deep. The New Hampshire-based company employs AANP President Jaclyn Chasse as an executive overseeing scientific and regulatory affairs. (Emerson and Chasse didn’t return requests for comment.)

The AANP trains its board members about conflicts of interest and requires them to recuse themselves from conversations or votes that might pose a conflict. The group “takes this very seriously,” Cliche said. The Consumer Healthcare Products Association, which represents the makers of dietary supplements, declined to comment on the funding.

How often do we hear complaints from proponents of “natural medicine,” be it naturopathy or whatever form of alternative medicine you can think of, about ties between prominent physicians and pharmaceutical companies? Such complaints were justified and in fact only echoed complaints from mainstream medical sources about cozy relationships between physicians and big pharma. The American Medical Student Association (AMSA), in particular, has been very active in lobbying for rules requiring more disclosure of gifts from industry and discouraging physicians from being on company speaker bureaus. The result of this movement from various mainstream medical groups has been a whole slew of rules and laws about what physicians are allowed or not allowed to take, what must be disclosed, and the like. Clearly, naturopaths in general and the AANP in particular seem not to realize that their getting into bed with the supplement companies is no different from physicians and medical groups having been in bed with pharmaceutical companies. The irony is rich. It is indeed tempting to reply to the “pharma shill gambit” with the “supplement shill gambit.”

Of course, I don’t object on principle to a company like Emerson Ecologics having a grant program that funds whatever the company wants to fund. Basically, Emerson Ecologics sells , herbal medicine, traditional Chinese medicine supplies (like acupuncture needles and supplies), homeopathic remedies, and, of course, dubious medical tests. What I expect from such a program, however, is the same level of transparency that is now required of pharmaceutical grant programs because, obviously, if more states license naturopaths Emerson Ecologics potentially stands to benefit financially from increased sales. Not surprisingly, it supports all sorts of woo organizations.

How successful with the naturopaths be? Unfortunately, I’ve heard from readers anecdotal reports that these sorts of arguments are received fairly well by legislators, as this interview with Amy Rothenberg, the head of the Massachusetts Society of Naturopathic Doctors:

Rothenberg tried out a handful of arguments on each aide she met: The state loses tax revenue when Massachusetts-based naturopaths like her must practice in neighboring states where they can get licenses. Patients are at risk when anyone — even a Senate aide— can hang up a shingle and call themselves a naturopath with no regulatory oversight.

She even nodded toward the opioid crisis that is ravaging communities in the state. “There are a lot of things we can do shy of prescribing opiates,” she assured one aide.

The part about losing money is a silly argument. After all, if naturopaths are quacks who harm patients (and they are), why would a state want to bring them within its borders just to avoid losing money. I would counter by saying that licensing naturopaths would cause economic harm to Massachusetts citizens becaue it would result in more people who can ill afford it wasting large sums of money on useless supplements and nostrums. Also, the argument about “anyone” hanging up a shingle and claiming to be a naturopath is disingenuous, because right now at least such people are limited to giving advice and selling supplements, lest they be charged with practicing medicine without a license. They can do a lot less damage that way, and even then they do plenty. License these quacks and give them a wide scope of practice and they can harm a lot more patients—with the imprimatur of the state behind them. Moreover, it is not necessary to embrace the quackery that is at the heart of so much naturopathy (homeopathy, anyone?) to address the opioid crisis. Unfortunately, all of these arguments appear to resonate among legislators far more than they should, as I’ve heard from anecdotal reports from readers.

The last example, however, shows us skeptics and advocates for science-based medicine what we are up against and what we must learn to counter:

The aides seemed to really start listening, though, when Rothenberg shared a personal story: Her own experience a few years ago as a patient being treated for breast and ovarian cancer.

She didn’t hesitate to get surgery, chemotherapy, and radiation at Massachusetts General Hospital. But she also sought care from a naturopath in New Hampshire, driving six hours round trip for her weekly appointments, where she got intravenous vitamin infusions, breathed pure oxygen in a pressurized chamber, and got recommendations for plant-based remedies like bromelain, an enzyme derived from pineapples. Six months after finishing chemotherapy, she felt so good she completed a triathlon.

“I’m a perfect example,” she told one aide, “of somebody who would love access in the state.”

Human beings, particularly politicians, live for stories. A single powerful anecdote can be far more powerful than a folder full of statistics and scientific studies. Regular readers will recognize that everything Rothenberg subjected herself to is pure quackery that added nothing to her care. Surgery, chemotherapy, and radiation are what cured her, not the intravenous vitamin infusions (I’m guessing she was into high dose vitamin C), the hyperbaric oxygen chamber, and the enzyme therapy (enzymes are degraded by stomach acid and enzymes before they ever get into the rest of the digestive tract). Yet a story like this resonates.

That’s why, in addition to our facts and science, we need stories. I can tell stories of the breast cancer patients I’ve seen who were treated by naturopaths, leading their tumor to progress to the point where it eroded through the skin, leaving a bleeding, stinking mess of rotting tumor tissue stuck to the woman’s chest wall, leaving them in chronic pain and eventually killing them. I could tell them the tale of the orange man. Such cases are, thankfully, uncommon, but I’ve seen enough of them over the years, starting during my general surgery residency, to paint a grim picture. Even more effective would be patients with advanced cancer who were treated by naturopaths as their cancers progressed and have now realized their mistakes. Such patients are rare, though, because patients who choose quackery to treat their cancer have a very hard time admitting their mistake, particularly publicly. Some never do.

Naturopaths will continue to push for licensure. They’re not going away, and now they have industry support. We’re going to have to prepare to beat back those efforts wherever they occur.

Comments

  1. #1 Denice Walter
    May 19, 2016

    Unfortunately, I’ve known about alt med’s push for legitimacy since before the millennium.

    Orac’s minions might ‘enjoy’ learning about the Alliance for Natural Health- if they don’t already:
    it’s an international effort ( US/ Europe/ International divisions) and their websites delineate their plans in detail- which they call ‘campaigns’.

  2. #2 jrkrideau
    At the bottom of the lake (the bottom end that is)
    May 19, 2016

    I don’t know Orac, I am sure it was the hyperbaric oxygen chamber that cured the woman. I keep one in the back bedroom for whenever the cat coughs up a hairball and it’s been working fine. Strangely enough the cat has been spending a lot of time outdoors though.

    Here in Ontario, naturopaths have been licenced for close to 100 years (1925 apparently) and a few years ago the legislation was changed to set up a College of Naturopaths. Argh.

    I suspect delicensing is a lot more difficult than licensing so I don’t expect the situation to change.

    The good thing is that they are not covered by OHIP, the provincial health insurance plan, and I doubt they are likely to be any time soon. So while the College gives them an unfortunate air of respectability it does not give them access to medical insurance money, at least government funds, some private supplementary plans may cover them.

    In the US the real problem looks to be to be the ability to bill Medicare.

  3. #3 capnkrunch
    May 19, 2016

    Naturopaths will continue to push for licensure. They’re not going away, and now they have industry support. We’re going to have to prepare to beat back those efforts wherever they occur.

    This is the unfortunate thing. They can try as many times as they want and they only need to win once. We need to win every single time forever. It’s practically inevitable that eventually they will win.

  4. #4 Ross Miles
    Barrie ON
    May 19, 2016

    jrkrideau
    I doubt they are likely to be any time soon

    I would not bet any money on it as they got GST / HST* exemption in March 2014, where from my perspective, lost revenue equals taxpayer funding. The Naturopathy Act, 2007 which was law July 1, 2015 authorized Not a Doctor’s to prescribe, dispense, compound and sell drugs to a patient. ‘Qualification’ is with online modules (30 hours), interactive webinars (up to 15 hours), and self-study (3-5 hours per week) taking 3 to 4 months. “You can take the course at your own pace, and on your own time, without having to be away from your practice. ” They will keep it up, one step at a time, where a gain anywhere serves as an example to get the same elsewhere.

    ( *GST / HST is a consumer sales tax that has to be paid on goods and services. Go to a lawyer and one pays the tax on their hours billed )

  5. #5 Denice Walter
    May 19, 2016

    -btw- I like the duck-headed doctor:
    like the ancient Egyptian god of quackery

  6. #6 BA
    May 19, 2016

    If naturopath licensure is going to happen regardless one strategy would be to lobby heavily to place them under the Board of Medicine so they can be regulated, overseen, and disciplined by MDs (SCOTUS decision on NC dental board though is relevant).

    As an aside, I was just taking a COI training and this scenario was featured:

    Conflicts of Interest (cont.)
    Two high profile cases involving unethical treatment of human subjects also involved financial conflicts of interest.
    • Andrew Wakefield study of the link between MMR vaccines and autism: Along with many other problems, including charges of fabricating and falsifying research data, and using human subjects in the study without ethics board approval, Dr. Wakefield did not disclose to parents of children in the study that he had received money from lawyers planning to file suit against vaccine manufacturers nor that he had applied for a patent for a measles vaccine (a potential competitor to the current MMR vaccine).

  7. #7 Mark Thorson
    May 19, 2016

    The bromelain enzyme is absorbed undegraded from the gut into the bloodstream.

    http://www.ncbi.nlm.nih.gov/pubmed/9252520

  8. #8 Ellie
    Still on the green side of the grass
    May 19, 2016

    Nice to find out that bromelain cures everything. In my case, it would kill me. I didn’t realize how wide spread was its use, until I read this article and went to Google. Another reason to avoid Not a Doctors.

  9. #9 jrkrideau
    At the bottom of the lake, (the bottom end that is.)
    May 19, 2016

    #4 Ross Miles
    I had not realised the GST thing. My idea about OHIP was just that there is enough pressure on the health budget that adding a new class of billers is unlikely but with your information I may have to rethink this.

    I had thought the Liberals were slightly smarter than that. It is at a level of stupidity the Harper Gov’t would be proud of.

    BTW, speaking of Con stupidity, I finally filled in my census form this morning, .

  10. #10 Orac
    May 19, 2016

    The bromelain enzyme is absorbed undegraded from the gut into the bloodstream.

    That’s putting it rather kindly. From the abstract of the paper you cited:

    After oral multidosing (3 g/day), plasma concentration reached as much as 5,000 pg/ml by 48 h. From the plasma concentration curve, it could be estimated that an average of 10.8 micrograms of bromelain was present in plasma in the 3- to 51-h period.

    Only 10 μg made it through from a dose of 3 g/day. That’s. 1/300,000, or 0.0003%, of the enzyme that makes it through undigested.

    I knew that very tiny amounts of undigested protein can make it through the stomach and intestinal wall, but the amounts are very tiny and highly unlikely to be useful.

  11. #11 Ross Miles
    Barrie ON
    May 19, 2016

    jrkrideau
    enough pressure on the health budget

    This class of charlatan throws so much rice at the barn door that some is bound to get through, including how they are going to save the system money in addition to untold suffering. Sorry to make anyone sick with one Not a Doctor referencing the Act becoming law:
    “This is a long-awaited (in the works since before 2007!) and exciting announcement for Naturopathic Doctors. Becoming part of the RHPA opens the door for better integration with other regulated health professionals and improved collaborative care for our patients.
    5 fun facts about Naturopathic Doctors:

    Naturopathic medicine is a distinct system of primary care that addresses the root cause of illness or disease and promotes health and healing using natural therapies.
    Naturopathic Doctors are authorized in Ontario to perform 7 “controlled acts,” giving us the largest scope of practice of any “natural medicine” practitioner. Only medical doctors (MDs), nurse practitioners, and dentists are authorized to perform more controlled acts (we’re #4!).
    The titles “Naturopath,” “Naturopathic Doctor,” and “ND” are officially protected titles in Ontario, meaning that only those who have completed required training (undergraduate degree plus 4 years of naturopathic medical school) and met the requirements for licensing (North America and Ontario exams) can use these titles.
    Naturopathic Doctors are the natural medicine experts, integrating standard medical diagnostics with a broad range of natural therapies.
    Naturopathic treatment modalities may include clinical nutrition, botanical medicine, homeopathy, physical medicine, Asian medicine (including acupuncture), and lifestyle counselling
    As before, any tests performed via an ND are NOT covered by OHIP and must be paid out-of-pocket by the patient.

    The Ministry of Health and the Ontario Association of Naturopathic Doctors are working together to set up ND access to the following public health tests that were not previously available to NDs (date to be determined):

    CMV (IgM, IgG, DNA)
    Epstein Barr Virus
    Hepatitis A Total Antibody (Anti-HA V)
    Hepatitis B Core Antibody
    Hepatitis B Surface Antibody
    Hepatitis B Surface Antigen
    Hepatitis B DNA
    Hepatitis C Anti-HCV
    Hepatitis Viral Load
    HIV
    Lyme Serology Testing
    Rubella Antibody
    VDRL
    Chlamydia
    Gonorrhea”
    http://www.wavelengthwellness.com/big-news-for-ontario-nds/

  12. #12 wes
    Oz
    May 19, 2016

    “patients who choose quackery to treat their cancer have a very hard time admitting their mistake, particularly publicly. Some never do.” …and especially because they are frequently dead. Is there a legal database of cases full of stories told by their survivors?

  13. #13 prn
    May 19, 2016

    I don’t berate NDs for their short comings. To do so, would invite scorching some MDs for parity on far greater crimes.

    As it happens, I’ve never been to an ND’s office. I’ve seen some of their literature and

    I have been around a few physicians with CAM offerings. Some stay within the hard chemical and biological realm, and some don’t. If they don’t, I just smile and say you know me, “I’m a very chemical person”.

    I care about the tasks, not the fluff. If you can do the task well,

  14. #14 prn
    13 cont'd
    May 19, 2016

    you’re hired. If not, you’re “fired”. An accupuncturist MD ? “No thanks on the accupuncture, Doc”, but he’s great with an IV on a deep vein.

    I read about how indispensible oncologists are here, to the point of gunpoint medicine. Yet I know of a case of extremely fatal cancer, say ~0% OS in 2-3 yrs, none of the good biomarkers, and none of the usual disabilities.

    How is that? Yet no oncologist for 5 yrs. Oh, yes – just lucky. Or it must be a misdiagnosis.

    If you can’t help fix our problems, pls stay out of our way.

  15. #15 Ross Miles
    Barrie ON
    May 19, 2016

    Mark Thorson @7
    bromelain enzyme is absorbed undegraded

    I do not know much protein chemistry but I am not clear as to whether what little proteinases that can be absorbed from the GI tract is in a functionally intact form. Got anything on this?

    When looking for the current guess a dose it seems that 500 to 1,000 mg is suggested daily so that gets us back up above the realm of 1:1,000,000 for something that may be of some value. Seems like a lottery ticket description.

    prn @ 13 / 14

    One vague anecdote does not establish anything. Also consider that the ND regime has many fatal flaws to the point of wholly negating any harm that they may not do. The MD you describe is an outlier, not a description of the profession.

  16. #16 herr doktor bimler
    May 19, 2016

    bromelain, an enzyme derived from pineapples
    IIRC it’s a protease. Either the plants evolved it in order to dissolve any soft-bodied insect larvae attacking the fruit, or (more likely) so that we could use the fruit in stews and curries to tenderise the cheap meat.

    The rationale for Alt-Med usage is not entirely clear, unless there is a magical-thinking idea that it will tenderise tumours in the same way.

  17. #17 Not a Troll
    May 19, 2016

    The rationale for alt-med usage could come from articles such as this:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529416/

    IDK, I tried bromelain for digestive issues and found that with my GERD it just ended up tearing up my throat (not literally, but it really hurt). Nature is not always kind.

  18. #18 herr doktor bimler
    May 19, 2016

    The rationale for alt-med usage could come from articles such as this:

    Ah, a Hindawi publication, reading exactly like supplement-industry promotional literature, why am I unsurprised?

    found that with my GERD it just ended up tearing up my throat

    We are made of meat; swallowing meat tenderiser has side-effects.

  19. #19 Ross Miles
    Barrie ON
    May 19, 2016

    Dear doktor @ 18

    So dismissive of something that has 76 references, and is recent like end of 2012, including studies with piglets, and rats, and rabbits, and in vitro. Boy that is so all inclusive that I just had to print it, put it on the dartboard, and throw a dart to get a true random review sample as representative. As luck would have it while standing on my magic carpet I hit “4.7. Role of Bromelain in Surgery

    “Administration of bromelain before a surgery can reduce the average number of days for complete disappearance of pain and postsurgery inflammation [64, 65]. Trials indicate that bromelain might be effective in reducing swelling, bruising, and pain in women having episiotomy [66]. Nowadays, bromelain is used for treating acute inflammation and sports injuries [31].”

    So looking at reference 64, Tassman, G.C., Zafran, J.N., Zayon, G.M. Evaluation of a plant proteolytic enzyme for the control of inflammation and pain. J. D. Med. April 1964;19:73. Ah, seems to be about dental surgery and observational. Oops no longer around that I could find, ( http://jada.ada.org/article/S0002-8177%2865%2906011-7/references ) Item 15 and it was from 1964. Moving on to 65, oops Tassman again so we will skip right along to 66.

    Just look at the fancy title: Howat RCL, Lewis GD, THE EFFECT OF BROMELAIN THERAPY ON EPISIOTOMY WOUNDS—A DOUBLE BLIND CONTROLLED CLINICAL TRIAL. Journal of Obstetrics and Gynaecology of the British Commonwealth. 1972;79(10):951–953. and the results: “The rate of reduction of oedema and bruising was more rapid in the patients on bromelain than in those taking placebo especially when oedema and bruising were severe. The differences noted did not, however, reach statistical significance.” Hmm, back in 1972 we could figure that out. That must be the lesson.

    Lastly not quite sure how acute inflammation and sports injuries got got into surgery, but anyway, another reference from: Evidence-Based Complementary and Alternative Medicine. 2004;1(3):251–257; just has to have some value, right, right, please please. Hmm, all about osteoarthritis nary a word about the claim. I also grant that I was too glassy eyed to more than skim it, but then herr doktor, already knowed dat.

    Thanks to Not a Troll for the link.

  20. #20 herr doktor bimler
    May 19, 2016

    So dismissive of something that has 76 references

    I succumbed to the urge to make sweeping statements after binge-reading PGP comments.

    But consider Ref. 1 in the paper in question —

    It has been used as a medicinal plant in several native cultures [1]

    Ref. 1 does not support the claim in any way, simply referring us to Taussig & Batkin (1988):

    It has been used as edible fruit and medicinal plant in several native cultures and its active extract bromelain has been chemically known since 1876 (1).

    Where Taussig & Batkin are citation [2] in the original paper. So the first of the 76 citations serves to duplicate the second citation. At that point I lost confidence in the number of citations alone.

    It doesn’t help that the literature on bromelain is inflated by a great deal of what one might call recycling. The same sentences recur across Tochi &c (2008)
    ht_tp://www.pjbs.org/pjnonline/fin975.pdf
    Mondal &c (2011)
    ht_tp://pharmacologyonline.silae.it/files/newsletter/2011/vol3/130.mondal.pdf
    Pavan &c (2012)
    ht_tp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529416/
    Chaktraborty (2015):
    ht_tp://ijapr.in/index.php/ijapr/article/viewFile/169/155
    Gunde &c (2015)
    ht_tp://www.ejpmr.com/admin/assets/article_issue/1441001109.pdf

  21. #21 Panacea
    May 19, 2016

    Well, if naturopaths want licensure so much, they can line up for the malpractice lawsuits to go with it.

    I have a feeling that what it’s going to take to finally stop these people. A few high profile “medical” malpractice lawsuits to expose naturopathy for the fraud it is in a court of law.

  22. #22 Ross Miles
    Barrie ON
    May 19, 2016

    herr doktor bimler

    My first paragraph was parody of the type of silly one has to listen to on occasion from the alties. I thought naming animals, and the magic carpet were indicators. Your right, and that trash of a lying paper just served the purpose that Not a Troll made, about people getting sucked in. The alt believers read without understanding, look at a long list, and surmise it must be good, the authors did their research kind of thing, when what it really is, is writing something up, and then finding some data or paper that might support it, more or less while still looking good.
    Time to give up on the day.

  23. #23 herr doktor bimler
    May 19, 2016

    I thought naming animals, and the magic carpet were indicators
    You’re too good.

  24. #24 Narad
    May 19, 2016

    We are made of meat; swallowing meat tenderiser has side-effects.

    I believe that I’ve already mentioned my childhood fondness for Accent meat tenderizer straight from the canister.

  25. #25 herr doktor bimler
    May 19, 2016

    The whole pineapple thing seems to start out with cancer / multiple-sclerosis scammer Hans Nieper. Nieper and Taussig wrote a paper or two proclaiming the benefits of the humble Ananas (possibly inspired by the nominal similarity to Ananias, patron saint of liars), and Taussig went on to provide the factual basis with a 1980 paper in Medical Hypotheses. Then Taussig and Batkin created a backstory of traditional tribal wisdom, which other less-inventive authors have been recycling ever since.

    Tochi &c (2008)

    It has been used as a medicinal plant in several native cultures and bromelain has been chemically known since 1876 (Peckoldt et al., In: Taussig, 1988)

    Mondal &c (2011):

    It has been used as edible fruit and medicinal plant in several native cultures and its active extract bromelain has been chemically known since 1876 (1).
    Peckoldt, T. and G. Peckoldt., In: Taussig, S.J. and S. Batkin

    Pavan &c (2012):

    It has been used as a medicinal plant in several native cultures [1] and these medicinal qualities of pineapple are attributed to bromelain … Bromelain has been chemically known since 1875 and is used as a phytomedical compound [2].

    Chakraborty (2015)

    It has been used as a medicinal plant in several native cultures Bromelain is a crude extract from pineapple & has been chemically known since 1875 and is used as a phytomedical compound

    Gunde & Amnerkar (2015)

    It has been used as a medicinal plant in several native cultures and bromelain has been chemically known since 1876 [Peckoldt T, Taussig SJ, Batkin S]

  26. #26 herr doktor bimler
    May 19, 2016
  27. #27 Guy Chapman
    United Kingdom
    May 20, 2016

    @prn I think you are mad, bluntly. NDs know less than nothing about human health and physiology, because most of what they think they know is actively wrong. They ave no valid basis of prescribing or treatment, so in fact the ones who use pharmacologically active compounds are arguably *more* dangerous.

  28. #28 Amethyst
    The Crystal Gem
    May 20, 2016

    @Narad

    Likewise hitting us with a meat tenderizer will have the kind of effect you’d expect!

  29. #29 Helianthus
    May 20, 2016

    @ hdb

    proclaiming the benefits of the humble Ananas (possibly inspired by the nominal similarity to Ananias, patron saint of liars),

    **snort**

    Then Taussig and Batkin created a backstory of traditional tribal wisdom

    Tribalism!
    Why couldn’t they be working on achieving world peace?

    It has been used as edible fruit

    Eh, an ounce of truth. A rare bird.

    Either the plants evolved it in order to dissolve any soft-bodied insect larvae attacking the fruit

    More seriously, apropos of how carnivorous plants came to be, there is very interesting post by Greg Laden about a recently published article on the topic. The authors’ thesis is that carnivorous plants recycled and enhanced tools already evolved in non-carnivorous plants, one of them precisely being anti-insect protease and chitinase enzymes.

  30. #30 Helianthus
    May 20, 2016

    @ wes 12

    and especially because they are frequently dead. Is there a legal database of cases full of stories told by their survivors?

    Legal, I don’t know.
    There is a website, What’s the Harm?, with a variety of stories of people who came to harm using some non-scientific procedure.
    There is also The Other Burzynski patient group website, listing a number of patients who tried Burzynski’s treatments and, well, it wasn’t successful.

    @ prn 13

    I don’t berate NDs for their short comings. To do so, would invite scorching some MDs for parity on far greater crimes.

    Suit yourself. Personally, I wouldn’t mind a system which hold people equally to some standard of competence, regardless of their occupation denomination.

  31. #31 prn
    May 20, 2016

    Guy@27
    @prn I think you are mad, bluntly.
    Well, thanks for your concern, that’s your opinion. Since I know you’ve been around a while, if you want to list your areas of concern by weight, I’m morbidly curious.

    NDs know less than nothing about human health and physiology, because most of what they think they know is actively wrong.
    Maybe that’s true in your neck of the woods. I think some of their offerings are fluffy and I haven’t spent much time there. Others might be sub optimal, and vary from either the original papers’ research but still represent improvement over MSM AND nutrition.

    In places I’ve lived, licensed NDs appear to provide a safety valve to many chronic patients unrelieved by MSM. Many of these involve nutrition, digestion, chemo/cancer effects, or some combination.

    The naturopaths’ curricula might not reflect my choices either, but they didn’t ask me. I do think they address real time problems that MSM AND nutrition have failed on.

    • #32 Guy Chapman
      United Kingdom
      May 20, 2016

      @prn:

      Since I know you’ve been around a while, if you want to list your areas of concern by weight, I’m morbidly curious.

      I already did. You expressed a preference for delusional cranks who use potentially active compounds over delusional cranks who don’t. That is wronger than wrong.

      NDs know less than nothing about human health and physiology, because most of what they think they know is actively wrong.
      Maybe that’s true in your neck of the woods.

      No, it’s simply true. For example, every naturopathy school I can find, teaches homeopathy. If you study homeopathy as taught by practitioners and believers, you will become dumber as you learn.
      It’s a Billy Madison moment, genuinely.

      I think some of their offerings are fluffy and I haven’t spent much time there. Others might be sub optimal, and vary from either the original papers’ research but still represent improvement over MSM AND nutrition.

      An irrational view. The core problem here is that naturopaths have no way of self-correcting for error. Their system of study and regulation cannot self-correct because if it did they would have to abandon great chunks of what defines them. Homeopathy, again, is a prime example. And you will know that naturopathy is beginning to get its shit together on the day it abandons all use of homeopathy – and not a minute before. When naturopaths stop advocating hoemopathy and start advocating vaccination then they might begin to earn a modicum of respect: until then they are simply cranks and charlatans and should be avoided. Sure, they might occasionally utter half a sentence that’s not insane. A stopped clock is right twice a day, but it’s still worse than no clock at all.

      In places I’ve lived, licensed NDs appear to provide a safety valve to many chronic patients unrelieved by MSM.

      You have that relationship the wrong way round. The are leeches and the chronically ill are their prey. Mainstream medicine is mainstream because the main stream is where the evidence is. Stuff moves into and out of the mainstream according to the evidence. Naturopaths, and indeed all quacks, cannot learn from new evidence because their entire worldview is founded on a dogmatic rejection of objective evidence as a valid means of telling truth from falsehood.

      It’s like describing the courts as “mainstream justice” and trial by ordeal as a valid alternative based on traditional use over thousands of years. Medicine dropped the crap that naturopaths peddle precisely because it’s crap.

  32. #33 Emma Crew
    May 20, 2016

    @ Not a Troll, I dunno so much about pineapple, but on a trip to Hawaii nearly 20 years ago my husband found papaya helped his digestive issues a lot — I assume from a similar meat tenderizer effect. He took the little papaya tablets for a while and they didn’t seem to worsen his reflux issues; don’t know if it is gentler or if he was just lucky there.

  33. #34 David
    ORAC's fucking COLON
    May 20, 2016

    so, what’s up ORAC? scared of going to jail? You’re going down – and it isn’t “back to Cali” you fucking criminal bitch.

  34. #35 jrkrideau
    At the bottom of the lake (the bottom end that is)
    May 20, 2016

    # 11 Ross Miles

    Oh lord! I sometimes wonder about Ontario civil servants! Surely some of them are competent.

    Still, I suppose it’s like water wearing down stone. Enough naturopaths and a few nutritional funding companies can do a lot of lobbying over time.

    What is the minister thinking about? He is a doctor but, I notice,from McMaster which seems to have a goodly bit of woo in their med school.

  35. #36 Ross Miles
    Barrie ON
    May 20, 2016

    herr doktor bimler

    proclaiming the benefits of the humble Ananas (possibly inspired by the nominal similarity to Ananias, patron saint of liars)

    Good laugh, and note triple play as ananas is the French for pineapple. Also going to borrow that whole thing. Royalties due?

    Should have also noted the animals mentioned @ 19 are actually from the paper where the author took the route directly to humans from animal studies.

    Emma Crew @32

    R&R in a different locale, also works wonders for reflux, especially when mixed with warm sea air, or immersion in said sea.

  36. #37 MI Dawn
    May 20, 2016

    OK. License the NDs. They need to have the same medical insurance as MDs do to protect their patients and take and pass the standard Family Practice boards a FP doctor does. I’m sure, with all their knowledge and wisdom, they won’t have any issues with either proviso. After all, they just want to protect their patients, right?

    Or…we could create new boards for NDs. The standard FP boards (passing this section is required) then fluffy ND sections about reiki, homeopathy, IV vitamins for no indication….

  37. #38 Ross Miles
    Barrie ON
    May 20, 2016

    jrkrideau@33

    The Ontario Health Minister, Dr. Hoskins has several advanced degrees and like our host could arguably legitimately call themselves Dr. …… MD. I have seen nothing from Dr. Hoskins which would indicate any sympathy with woo.

    This is not just an Ontario issue as the Not a Doctor crowd operate their network on a North American basis. It is not just about common sense as look to the Right to Try laws which Orac has written about. It is also political realities. With all the pitfalls of casual observation of N=1, things are more altie in Quèbec, where we have a neurosurgeon for Premier, and a radiologist for Health Minister. Do not forget that the Federal Health Minister is an admired PCP.

  38. #39 Delphine
    May 20, 2016

    Emma Crew, I developed horrific GERD during pregnancy and it still flares several times a year. Mine goes away and comes back and the only thing I’ve found that I can say truly negatively affects it is alcohol, which I don’t do any longer. Positive affect only via medication, but even that doesn’t always help. Sometimes, it just dies down on its own.

  39. #40 Delphine
    May 20, 2016

    Just look at the fancy title: Howat RCL, Lewis GD, THE EFFECT OF BROMELAIN THERAPY ON EPISIOTOMY WOUNDS—A DOUBLE BLIND CONTROLLED CLINICAL TRIAL. Journal of Obstetrics and Gynaecology of the British Commonwealth. 1972;79(10):951–953. and the results:

    NO

  40. #41 Denice Walter
    May 20, 2016

    @ Ross Miles:

    I’ve always enjoyed that *ananas* rhymes with * bananas*
    altho’ I’ve never used it.

  41. #42 sadmar
    May 20, 2016

    Alas, the supplement slingers are the real danger here, and while licensure of naturopathy would help them obviously, they don’t need them. They have the web, brivk-and-mortar ‘nutrition’ outlets, and large displays in chain pharmacies.

    What’s needed is some sort of comprehensive federal legislation prohibiting unproven health claims for any product or service, with real teeth in enforcement. And unless the now-shrugging MDs cowboy up and take a stand, that’s never gonna happen.

  42. #43 Melissa
    May 20, 2016

    I think that the safest herbal teas and infusions are delicious beverages.

  43. #44 JustaTech
    May 20, 2016

    Sadmar 241: speaking of teeth: yesterday I was in a big drugstore (local chain) looking for some braces wax. There, among the dental treatments was something promising 12 hours of relief from mouth pain. Curious, I picked up the box trying to figure out what it was. Not a real drug, not homeopathic, it was a “dietary supplement” and of the two listed “active ingredients” one was labeled as “no known effect”, or something to that effect.

    I almost threw the box.

  44. #45 herr doktor bimler
    May 20, 2016

    I tried bromelain for digestive issues and found that with my GERD it just ended up tearing up my throat

    So far no-one is promoting pineapple-juice enemas. So far.

  45. #46 Science Mom
    http://justthevax.blogspot.com/
    May 20, 2016

    So far no-one is promoting pineapple-juice enemas. So far.

    Doesn’t alternative experimentation involve insertion into different orifices?

  46. #47 Fenella Leigh
    May 20, 2016
  47. #48 Fenella Leigh
    May 20, 2016

    It’s Joseph Mercola, not Eric…

  48. #49 Orac
    May 21, 2016

    Um, no. It’s Eric Merola, a filmmaker, to whom I was referring in that post. Yet your names right.

  49. #50 Sarr
    May 21, 2016

    Helianthus @29

    Wow, thanks for the link to that post. I was recently working on improving Wikipedia’s article on the Venus Flytrap, and that blog post, (and the article it’s about) has a lot of good info on the plant’s evolution.

  50. #51 Fenella Leigh
    May 21, 2016

    I concede….I am extremely confused about the two conflicting sides of these two accounts however…
    My father was a General Practitioner in the UK, however he was very interested in alternative medicine (in the ’60’s onwards)
    I was brought up being exposed to orthodox and alternative medicine. I have watched some of Ty Bollingers ‘documentary’ and maybe I’m just gullible, but it all sounds very convincing…
    I will read your article again and try to think about it all again.
    Sorry for the misunderstanding:-)

  51. #52 Gilbert
    May 21, 2016

    The backdrop of the graphic is hempy-looking cannabis. Carry on.

  52. #53 Mephistopheles O'Brien
    May 21, 2016

    @Fenella Leigh – My only suggestion would be to ask about the quality of the evidence for any treatment you get, should you ever need treatment.

  53. #54 squirrelelite
    May 21, 2016

    @Fenellla Leigh,

    I just watched the 4 minute trailer for Bollingere’s video.

    I’m sure he makes it sound good, but as a counterpoint, I recommend you search this blog for articles about some ot those names.

    Also, look for details about the actual methods discussed and search Pubmed for research on them.

    Please let us know which ones you can find real published trial results on cancer patients for.

  54. #55 herr doktor bimler
    May 21, 2016

    improving Wikipedia’s article on the Venus Flytrap
    The source, needless to say, of yet another naturopathic scam popular with all the usual suspects. The plant, that is, not the Whackypedia.

  55. #56 Fenella Leigh
    May 21, 2016

    Thank you #52 and #53, I will finish the homework I started a few decades ago and be in touch…
    Here’s to health

  56. #57 Amaria
    May 21, 2016

    Sad, but maybe true: perhaps the only way to delegitimize naturopathy in the eyes of the public is actually to allow them licensure, insurance and all the actual responsibility of a medical practitioner – and then watch the fallout… :-/

  57. #58 Not a Troll
    May 21, 2016

    Thanks Emma, I’ve never tried the tablets but I do like papayas when I can find a half way decent one in my geography. It isn’t often enough to tell if it helps my stomach any though.

    Ross and HDB, I appreciate how you took down that paper by examining just one key element. Of course, it was low-hanging fruit after all, wasn’t it?

    🙂

  58. #59 herr doktor bimler
    May 22, 2016

    low-hanging fruit
    Ha.

  59. #60 Not a Troll
    May 22, 2016

    low-hanging fruit
    Ha.

    Yes. I was just being a brat.

    However, the compliment was sincere.

  60. #61 Liz Ditz
    United States
    May 22, 2016

    There’s a petition drive.

    The purpose of this petition is to voice opposition to legitimizing naturopathy through state licensure and mandated insurance reimbursement. Naturopaths are attempting to become legally recognized as “primary care physicians” in all 50 states and become Medicare providers. This is a dangerous future.

    https://www.change.org/p/naturopaths-are-not-doctors

    I am not sure that Change dot org petitions do much good. But they don’t harm, either.

  61. […] and referred to the full House for consideration. It’s all about a renewed push by naturopaths, fueled by supplement industry money, to get laws licensing them as real health care professionals in multiple states, including […]

  62. #63 herr doktor bimler
    May 24, 2016
  63. #64 Michele
    May 25, 2016

    @prn do you have a blog? I find myself scrolling for your comments, more objective and truthful than majority here and I am interested to follow

  64. #65 MI Dawn
    May 25, 2016

    @Michele: if you think prn is objective and truthful, then I hope you’re at least in good health.

    I’d go to a naturopath under the following conditions: they don’t prescribe homeopathy, reiki, any other quackery, they have the same malpractice insurance any similar physician practitioner is required by law to carry, and I’m not really sick and just want someone to talk about the insane world. I probably wouldn’t follow any of their recommendations unless they were in line with my physicians: watch my diet, eat more healthily, exercise more, etc.

  65. #66 MI Dawn
    May 25, 2016

    Oh, and of course, they’d have to be licensed and under the same supervision as any advanced nurse practitioner.

  66. #67 prn
    May 25, 2016

    Michele@63 :
    @prn do you have a blog? I find myself scrolling for your comments…
    Thanks Michele. I’m simply a commenter, on and off here since 2010. I try to intersperse small doses of reality amongst lurid speculations and misinformed assertions about nutritional therapy practices.

  67. #68 prn
    May 25, 2016

    Michele@63 :
    @prn do you have a blog? I find myself scrolling for your comments…
    Thanks Michele. I’m simply a commenter, on and off here since 2010. I try to intersperse small doses of reality amongst lurid speculations and misinformed assertions about nutritional therapy for CAM.

  68. […] a bill to license naturopaths (HB 4531) wending its way through the Michigan legislature supported by supplement manufacturers, its current status being in consideration by the full House of Representatives, periodically I […]

  69. […] by the Michigan Association of Naturopathic Physicians (MANP), who are taking money from the supplement industry to lobby for this bill’s passage. It’s a bill that would grant NDs a wide scope of practice. […]

  70. […] about a bill being considered in the Michigan House of Representatives. The bill, HB 4531, would license naturopaths as health care providers. In fact, it would give them a very broad scope of practice, defined by a […]

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