White Coat Underground

Fake medicine to get Ontario’s imprimatur

I live about ten miles due north of “Canada’s automotive capital”. We often look across the straits to the medical system in Ontario, one in which all citizens have a provincial insurance card. We see how everyone has access to care—or at least some care. I’ve treated many Canadian patients who have access to American insurance and prefer to get their care on this side of the border, where there are fewer hassles. Of course if you have no insurance at all, hassles abound, and we’ll leave a discussion of the merits and difficulties of the Canadian system to another day. But one move being considered by the province of Ontario promises to take a modern health care system one step closer to the 19th century.

Ontario wants to license naturopaths to prescribe medications. To see if this is wise, we have to re-examine what naturopathy is. Naturopathy is an approach to health care based on mistaken ideas about disease cause, prevention, and treatment. Naturopaths like to think of themselves as primary care physicians, but their education and training is based on a biology that doesn’t exist in this world. The foundations of modern medicine are compassion, scientific principles, and evidence. When formulating a differential diagnosis, we can only consider what is biologically plausible. Chest pain has many different possible causes, but spiritual possession isn’t one of them. We must also look at evidence: how likely are people with chest pain and a normal EKG to have serious heart disease? Does the evidence support immediate intervention is this case, or can it wait? Once we figure it out, how do we prevent either the onset or progression of heart disease? Knowing the biological basis of heart disease is critical. Most heart attacks occur when an arterial plaque ruptures. Aspirin, for example, helps prevent this, as does a class of medications called statins.  Understanding the pathology of coronary heart disease isn’t a matter of philosophy as much as microscopy.  

Naturopaths often refer to their philosophy of “finding and treating the cause of chronic problems, not just treating symptoms.” It is important to realize that symptoms and cause are not that easily separated. Chest pain, plaque rupture, heart attack—these are the disease. We can treat the “symptoms” of heart disease without treating the disease itself. Nitroglycerin can relieve chest pain but it doesn’t prevent heart attacks the way aspirin, statins, and beta blockers do. But that’s not what we do. We try to intervene early, before symptomatic heart disease develops, and if we cannot, we try to prevent further progression of disease.

Naturopaths like to present themselves as walking a different path to the same destination, but the truth is not so pretty.  If we were to, as the naturopaths put it, help nature heal itself, we would die toothless and miserable before we hit fifty.  Most of us are likely to die of either cancer, heart disease, or stroke.  We are pretty good at catching some of these early, and at preventing development and progression of disease.  The modern, scientific approach to medicine has allowed people with heart disease to live longer, symptom-free lives.  It has allowed us to prevent colon cancer in most people.  But we can’t make people live forever.  

There is no “other path”.  To say that one approach “supports the body’s healing ability” and another does not is just plain wrong.  It is impossible to separate out the intervention from the patient, to separate medicine from nature.  If someone with high blood pressure and high cholesterol (many of whom have very good diets) is left untreated, nature left alone will create inflammation in the blood vessels in an attempt to heal itself.  This inflammation can eventually lead to plaque rupture, heart attack, stroke, kidney failure, impotence, blindness—you get the idea.  When someone gets real medicine for hypertension and high cholesterol, we fight the body’s natural tendency to kill itself, and allow them to live pretty normal lives. 

Naturopaths offer a different path—one based on fantasy.  For a government to legitimize this fantasy is to tell its citizens that science is meaningless.  If naturopaths are treated as doctors, there is no reason that faith healers, shamans, and some dude with a knife should not also be licensed.  Anyone who truly believes that we are infused with magic substances such as qi shouldn’t be trusted to understand how real medicines work, and shouldn’t be allowed to prescribe them.

Comments

  1. #1 William M.
    November 27, 2009

    Excellent post! :D

  2. #2 sac
    November 27, 2009

    PAL- thank you for writing such a thoughtful and educated response. I hope it is read by the Canadian beaurocrats that are contemplating such a terrible decision

  3. #3 Dave Ruddell
    November 27, 2009

    This actually might be enough to goad me to write my MPP about the issue. I wish I could say I can’t believe this is happening, but it’s not surprising in the least.

  4. #4 Denice Walter
    November 27, 2009

    The ND may be “gateway” woo but it can also serve as a means of re-entry for MD’s who have lost certification.Consider the case of Carolyn Dean: a Canadian MD who fell deep into the woo puddle- even co-authoring a *magnum opus* with Gary Null((“Death by Medecine”- an oft-quoted source for examples of “iatrogenic”"data”(sic)))- was deemed unfit to practice and had her registration certificate revoked in Ontario in 1995 (see Quackwatch). She persued an ND (in Ontario), moved to the US(first NY,then CA , now Maui),studied other quackery along the way,and now calls herself the “Doctor of the Future”(see her website).Oddly,the “bio” (at her website)doesn’t mention the action by the Ontario Board( or in CA),and she adds the MD ND after her name.Oh, and she’s a nutrionist as well.

  5. #5 Denice Walter
    November 27, 2009

    That shoild be “nutritionist”.

  6. #6 Abel Pharmboy
    November 27, 2009

    There’s now a weak naturopath rebuttal to criticism of the proposal and their “profession” at the National Post. The NP only keeps comments open for 24 hr after article posting so be sure to stop by soon if you wish to comment.

    It’s more of the same old “we are different, we treat the cause not the symptoms, we individualize therapy,” essentially co-opting the best of fact-based medicine, mixing with an implausible belief system, and calling it naturopathy. Having access to real medicines should fly in the face of their principles, right? But that is the tactic of alternative practitioners: just assume enough of real medicine to show benefit (and maybe some herbs that are laced with prescription medicines) and justify the other magical fake medicine that allows one to appeal to a fearful demographic who pays out-of-pocket.

  7. #7 Interrobang
    November 27, 2009

    This is an incredibly stupid proposal and is about enough to make me wish that Dalton McGuinty would get swept out of office. However, neither of the two alternatives are at all better, and electing the Tories (again) would be considerably worse, given that 99% of what’s wrong with the province at the moment is directly traceable to the neocon policies of our former Tory premier, Mike Effing Harris… I suppose it’s better to just lobby the MPP and hope for the best, assuming my MPP isn’t an idiot about such things. In this burg, composed of 50% Republicanoids and 15% woo-woo newagers (rhymes with “sewage”), that’s unfortunately likely.

    Your facility must be exceptional, if insured patients get care there with “no hassles,” being as all my insured American friends have incredible hassles with healthcare, compared to myself (in the Ontario system), who has approximately zero hassles at all. I needed to go to the doctor’s yesterday because my nose started bleeding in that acute sinusitis flare-up kind of way, was there in the waiting room within 2h. I fell over from the flu three weeks ago, went to the Emerg breathing not at all well, and was triaged immediately. No fuss, no muss, and best of all, no bill. Also, I’ve never had problems problems like my ex from Long Island, who had six different specialists (are there no GPs left in the US?!), none of whom would talk to each other (they seemed to have a very adversarial relationship), which resulted in his being effectively denied care — one of them would say “You need to talk to Dr. 2,” and Dr. 2 would say, “You need to talk to Dr. 3,” all the way around, whereupon Dr. 6 would say, “You need to talk to Dr. 1.”

    I’m definitely in the 95% of Canadians (see the Romanow Report) who would not trade our system for anything — dunno what’s wrong with the other 5%, and they must be your patients. I sure as hell haven’t heard of anyone going from Ontario to Detroit for treatment unless it’s something they can’t get here, and I’m more or less local. Certainly I’m within the Tiger fan base area, anyway, and can get Vernor’s ginger ale in the grocery store.

  8. #8 daijiyobu
    November 27, 2009

    Per: “naturopaths offer a different path — one based on fantasy. For a government to legitimize this fantasy is to tell its citizens that science is meaningless [...]anyone who truly believes that we are infused with magic substances such as qi shouldn’t be trusted to understand how real medicines work, and shouldn’t be allowed to prescribe them.”

    It is to endorse the naturopaTHICK.

    -r.c.

  9. #9 red
    November 27, 2009

    This is news, and really bad news.

    Grr. Not a happy bunny.

  10. #10 WMDKitty
    November 28, 2009

    The only reason I would study naturopathy — and in combination with herbology — is as research for fictional works.

  11. #11 Chester Burton Brown
    November 28, 2009

    But, wait — when you discount the possibilities of alternative paths just because they have no corroborating evidence to support their claims or because they are based on reasoning that is demonstrably flawed, you’re just showing that you are CLOSED MINDED.

    CLOSED MINDED people, like the typical egg-head scientician, simply refuse to enrichen their lives by opening their spirit to the potential awesomeness of being giddily deluded by things that make no sense. Truly, I pity these lost souls.

    Everyone who has COMMON SENSE knows that the manifold interactions of a complex material world isn’t enough to explain the universe or life. That’s why we need the OPEN MINDS of the daring practitioners who are brave enough to talk about the invisible and undetectable things that *actually* make nature go.

    Ever since my naturopath treated me my brain cancer feels much more peaceful.

    Yours,
    CBB

  12. #12 BaldApe
    November 28, 2009

    Open minds are like open doors. If you leave them open all the time, anything at all gets in.

  13. #13 Tanya
    November 28, 2009

    As an Ontarian, I think I’ll be contacting my MPP about this. Any other suggestions to best direct our efforts against this woo-power?

    Also, as a Canadian who lived in Connecticut for over a year, the worst hassles I’ve witnessed with regards to access to health care were in the months I lived in the U.S. Just over 3 months after my return to Canada, encountering some unusual/alarming neurological symptoms, I visited the ER, had a CAT scan and various other tests. I was extremely glad this occurred in Canada – the last thing I needed at that time was a hospital bill, or fight with an insurance company, as I’d witnessed coworkers dealing with in my former workplace. (The worst case there was a girl who shattered a vertebra snow-boarding, which required several surgeries, rehab, etc. When I left, she owed about $25K, though I think she was still wrangling with the insurance company about some of the fees. Our health plan was 80:20, IIRC.) My experiences can be regarded as anecdotal, but like Interrobang, I’m part of the vast majority of Canadians who would never want to give up our system. I don’t think I’d ever risk living in a country without “socialized medicine” again.

  14. #14 Daniel J. Andrews
    November 28, 2009

    Tanya, and others. Steve Thoms at JREF skeptical north blog (link at end) gives out the following info. You can contact

    Ontario Premier, Dalton McGuinty, dmcguinty.mpp.co@liberal.ola.org, and
    Minister of Long-Term Health and Care, Deb Mattews, dmatthews.mpp.co@liberal.ola.org. Steve also recommends CCing the same email to Andrea Horwath, leader of the New Democratic Party (ahorwath-qp@ndp. on.ca) and Tim Hudak, leader of the Progressive Conservative Party (tim.hudakco@pc.ola.org).

    For more info see Steve Thoms’ article.

    h/t to Abel Pharmaboy http://scienceblogs.com/terrasig/2009/11/more_naturopathic_nonsense_in.php for linking to Steve’s site.

    Steve Thoms: http://www.randi.org/site/index.php/swift-blog/786-fake-doctors-with-real-drugs-the-news-from-canada.html

    p.s. also agree I’d not want to live in another country that didn’t have “socialized” medicine

  15. #15 73
    November 29, 2009

    Saskatchewan pioneered medicare under Premier TC Douglas .Our system may not be perfect ,but at least no one loses their home due to medical expenses.The American system is fine if you have lots of money ,but what about the 40 million that have no insurance.There was a doctor in the USA who had a good practice and a big home who got sick and wound up on poor street(TV). There are people (USA) who have never been to a doctor in 10 years .(on American TV).Socialism you say — where do you get your roads and airports,railways etc from..Vets get theirs paid by the good old government of the USA .I don’t want to give up what we have fought so hard to keep. Call it what you may .In Saskatchewan if you reach 65 your prescription cost is $ 15.00 UNLESS it is not covered under the Provincial formulary (Lantus) is an example . Ya gotta like our system unless your dumb . For those of you who take Lipitor or Eprex (their costs) know what I mean and have the right to be envious.//73

  16. #16 clarke
    December 1, 2009

    My My PAL MD,
    Not such a “compassionate” post to say the least. I am sure you are aware of the curriculum of naturopathic medical schools in the U.S. and Canada requiring almost identical hours of instruction in most of the core sciences as allopathic medical schools. So to say that Naturopathy is not science based is a gross over generalization. While allopathic medical training emphasizes diagnosing disease and treating symptoms, Naturopathy emphasizes treating the body as a whole and restoring balance to eliminate disease.

    Both are science based, just a different approach and philosophy. I encourage you to look at the Bastyr curriculum, for example http://www.bastyr.edu/education/naturopath/degree_curriculum/4_year_track.asp
    and tell how Naturopathic medicine is not science based.

  17. #17 Ethan
    January 31, 2010

    “Both are science based”
    Not True.

    One of the ‘pillars of naturopathy’ is homeopathy, which has been *conclusively* proven, both in theory and in multiple peer-reviewed, randomized, double-blind studies, to be outright fraud.
    Homeopathy is not the only nonsensical aspect of naturopathy, make no mistake about it, but it’s the one that sticks out the most and has been the most thoroughly debunked, which is why I use it as an example.

    Furthermore, instruction hours don’t indicate the presence of science in a curriculum – you can teach whatever you want in a course.
    The requirement of study to become an alternative ‘medicine’ practitioner is merely a calculated move on the industry’s part to protect itself from [entirely deserved] charges of illegitimacy; how embarrassing would it be for someone with something to prove [such as myself] to be able to produce a professional certificate of accreditation at the same time as they denounce said profession? Quite embarrassing indeed, as I’m sure you can imagine.

    You, comrade Clarke, don’t know what you’re talking about.