First, I’d like to thank everyone who participated in the naturopaty primary care challenge. It was far more successful than I could have hoped. A number of naturopaths and their supporters responded, most of them quite rationally. It takes guts to walk into the fire.
It also takes fanaticism.
I have always rather assumed that most naturopaths and other “alternative” healers are, on the whole, motivated by good. After reading all the comments, I still hold that assumption—most “alternative” healers probably mean well. That does not, however, divorce them from an ethical responsibility to avoid harming people.
Aside from convincing me that they mean well, the commenters cemented my belief that they are terribly wrong. That will come as no surprise to the “other side”, but I was holding out hope that a naturopath would provide regular medical care “plus” (the “plus” being the non-evidence based botanicals, etc.). In fact, the naturopaths who responded (who may or may not be representative of the profession as a whole) were sorely unprepared to provide the most basic screening, prevention, and treatment. Now, I’m leaving out the outliers—those who seem obviously ignorant or crazy (for example, there were a number of “Pharma Shill Gambit” comments—those that assume that real doctors are in the thrall of “Big Pharma”). Just looking at the comments from those who seem to know the most, I’m rather frightened by this movement away from science-based medicine.
The responses fell into a few broad categories. The first was “vagueness”. One response came from “Anonymous” (I encouraged people to post anonymously for freer discourse). His/her response was to “go over everything” and “follow up well” (paraphrased). This type of response is completely inappropriate. Hopefully it was a misunderstanding, but I gave very specific patient information, and if that patient is sitting in front of you, a specific response is required.
The next type of response was the “insufficient” one. A commenter with the ‘nym “ProudND” gave some of the most cogent (and compassionate) responses, but gave rather insufficient advice. For example:
I’d make sure he was following up with a cardiologist (I do mostly women’s health and don’t pretend to be all things to all people and prefer collaboration.
Coronary heart disease is one of the most common afflictions of human beings. Non-interventional management of CHD is essential in primary care. You cannot be a primary care physician without the ability to take care of primary, secondary, and tertiary prevention of CHD. This is not “being all things to all people”; it’s fulfilling the basic requirements of the job. I was also hoping for more specifics, such as, if a statin is to be used, what is the goal LDL (and there can be reasonable disagreement as to whether the goal is 70 or 100, although I think the evidence points more toward 70). I was also hoping for more specifics regarding general health screening, but perhaps s/he knows the answer but did not state it (certainly a possibility).
Where it all comes together though is not in the vagueness or insufficient category, but in the “fanatically wrong” category. This was best exemplified by MM, who, if the other commenters are to be believed, is a rather well-known and respected naturopath.
You see, one of the problems with naturopaths, as opposed to other “alternative” healers, is that their education allows them to sound like they know what they’re doing. They are a lot like 2nd-year medical students—they know a lot, but they don’t yet know the extent of their own ignorance (and I think most doctors can tell you how humbling it is to move on from the pre-clinical to the clinical years). This also allows them to get it partly right, which in medicine can be mostly deadly. For example, MM correctly mentions some of the important screening measures, etc., but fails to understand the gravity of the patient’s condition. For example, she posits the following: “I recheck his vitals and his BP is lower, 140/82, which is okay for now.” That would be entirely correct for someone without CHD or diabetes, but it is almost never appropriate for someone with those conditions. This may, however, be a clarity issue, since at another point she seems to recognize that the BP must come down. It’s not clear.
Since we don’t know how “bad” this patient’s diabetes is, dietary approaches are completely appropriate, but her assumption that she will be successful with her dietary prescription is disturbing. I am always hopeful, but never arrogant enough to believe that I will succeed. Statements like “I am so successful in lowering glucose levels so quickly” are anecdotal, non-science-based, and lure a practitioner into a falsely elevated sense of their own abilities.
And speaking of arrogance (a fault of which I am often accused in this space) this quote is over-the-top:
…there is a risk of worsening of any established diabetic retinopathy. I have figured out a supplement regimen which prevents this worsening…
This is where one of the only Richard Dawkins quotes that I like comes into play:
If you are in possession of this revolutionary secret of science, why not prove it and be hailed as the new Newton? Of course, we know the answer. You can’t do it. You are a fake.
Now, I’m not saying she is a fake, but really, if this lone maverick has discovered some nutritional cure for diabetic retinopathy, how come she hasn’t conducted a real trial and had it published? The funding is certainly out there. No black helicopters from Big Pharma will descend on her lab to take away her secret. The usual answer is that the “Great Discovery” is really and act of great self-deception.
And speaking of shilling, she’s shilling for a dubious diabetes book and sells her prescribed supplements out of her office. Talk about conflict-of-interest!
I’m very impressed with MM, but only with her abilities as a cult leader.
Finally, one of the naturopaths who falls into the well-meaning healer category is someone who goes by the ‘nym “JenND”. She made a very telling statement, one which I’ve heard many times before, so it’s worth mentioning before we close:
And yes, I realize that an abundance of RCT’s would legitimize our treatments, but we’re working on that.
Science—you’re doing it wrong. You don’t work from conclusion to evidence, you work from evidence to conclusion. I find your abundance of faith disturbing.
Look, if you don’t yet have evidence for how to treat a condition, you fall back on what seems logical. If, however, you already have good evidence, that approach becomes your default unless or until new evidence leads us to a better approach.
Oh, and one last thing. MM’s website specifically mentions homeopathy. Mentioning homeopathy is sort of the Godwin’s Law of science-based medicine (perhaps Morstein’s Law?)—once you mention homeopathy without laughing, the argument is over, and you have lost.