Patients lose when they chose naturopaths over real doctors

I write frequently about naturopathy here because, of all the dubious pseudoscientific medical "disciplines" out there, naturopathy (along with chiropractic) has achieved the most "respectability." Indeed, as I like to point out in my own specialty (breast cancer), the Society for Integrative Oncology (SIO) even admits naturopaths as members. Indeed, the immediate past president of SIO is a naturopath (and, depressingly, faculty at my medical alma mater, the University of Michigan), as was the SIO president in 2014. So entrenched are naturopaths in SIO that they have been prominent co-authors on SIO clinical guidelines papers, like this set of breast cancer guidelines, with two naturopaths as co-authors, one as first author. Basically, in academia at least, naturopaths have certainly surpassed chiropractors in terms of seeming respectability, even though they promote alternative medical treatments that, as I pointed out recently, kill cancer patients dead through lack of effective treatment.

I was reminded of this unfortunate infiltration of naturopaths when I saw a story a week ago from, of all places, New Zealand, "Naturopathy under microscope after cancer sufferers speak from under shadow of death." It tells the story of two cancer patients who relied on naturopaths for treatment and didn't live to regret it, at least not long.

An almost certainly preventable death

Naturopaths sell themselves to cancer patients as offering treatments that are "natural," although I've always been puzzled how many treatments offered by naturopaths (like high dose intravenous vitamin C, "functional medicine, or various diagnostic tests like thermography) are any more "natural" than what "conventional medicine offers. What is really most attractive to patients is the claim that they can treat cancer without the toxicity associated with known effective treatments for cancer, such as radiation, surgery, and, most feared of all, chemotherapy. Unfortunately, when patients with highly treatable cancers believe these claims, the result can be fatal:

It is late July. An Auckland woman sits at her dining room table, frail, cosseted in a wool-knit beanie, brittle wisps of hair poking out.

She knows her time is running out. She doesn't know it, but she will be dead in two weeks.

First, though, she wants to speak out to call for regulation of naturopaths after her bitter experience with alternative therapies.

"From my point of view the naturopath has used people like me as guinea pigs," the Auckland woman told Stuff. "I don't think naturopaths should try to heal cancer. I trusted in naturopathy, I don't trust in it any more."

This is the price patients with treatable cancers can end up paying for trusting naturopaths. This patient, who is not named in the story, didn't even have cancer, but rather a premalignant condition known as ductal carcinoma in situ (DCIS). I've written about DCIS on multiple occasions , because it is a condition whose management is becoming less straightforward as we understand more about the biology of the disease. The reason is that not all DCIS progresses to life-threatening breast cancer in a woman's lifetime; indeed, most probably do not, to the point where watchful waiting is being discussed as a viable treatment option for women with low grade, low risk DCIS. There is a clinical trial, the Low Risk DCIS (LORIS) trial, comparing outcomes between immediate surgery and active monitoring for low-risk DCIS. Close to 100% of women with DCIS women should survive their disease with treatment.

Here is this patient's story. It began in 2013:

In July 2013 she had been diagnosed with ductal carcinoma in situ (DCIS), a pre-cancerous breast condition. Her oncologist told her she had a "50/50" likelihood of contracting breast cancer, and recommended an immediate double-mastectomy.

"I was shocked and scared of surgery, I'd never had surgery. Then you face one breast, both breasts, no breasts, you start looking for alternatives."

Unaware some DCIS strains are more aggressive than others, she believed time was on her side and she could try alternative medicine.

We don't have any information on the features of this woman's DCIS that would allow me to estimate her risk. For instance, we don't know from this story whether it was high or low grade, low grade being much lower risk. We don't know if it had high risk features, like comedo necrosis, which portends a high risk of progression to invasive cancer. I was also puzzled by the recommendation for immediate bilateral mastectomy. Mastectomy is usually not indicated for DCIS. Most DCIS lesions can be treated with breast conserving surgery (lumpectomy) followed by radiation. Mastectomy is reserved for cases of diffuse or extensive DCIS in which all the disease can't be removed by lumpectomy. Bilateral mastectomy is rarely indicated for DCIS, the main exception being when both breasts are involved with extensive DCIS, a very uncommon situation. In fairness, some women with extensive DCIS in one breast and DCIS in the other breast amenable to mastectomy will opt, not necessarily unreasonably, for bilateral mastectomy, but this is usually the woman's choice, and this article states that the oncologist recommended bilateral mastectomy. Again, no reason for this recommendation is provided in this news story; so I don't know whether this patient had any of the indications for a bilateral mastectomy in DCIS. I'd be willing to bet that she probably didn't and that this recommendation was probably a recommendation for massive overtreatment.

I mention this because the aggressiveness of the recommended surgery almost certainly played a role in this Auckland woman's disastrous decision to forego effective treatment. Whatever her reasons, though, this is how her story played out. The woman and her husband found a naturopath, whose name is never mentioned (much to my irritation), having heard stories about her alleged success rate and discovered that she was affiliated with Cape Town University. (Did they mean the University of Cape Town? I wondered.) The naturopath also advertised that she had an MDipNat.Herb from the South African College of Natural Medicines, which is apparently a degree in herbal medicine of some sort. This particular naturopath saw her and then followed up her treatments with Internet consultations:

The naturopath continued treating the Auckland woman over the internet using words such as "tumours" and "cancer". "At this stage there is nothing to worry about," she emailed.

Apart from a grueling regime of daily natural supplements, for a time the naturopath told her to simply apply ointment to her breasts.

The woman emailed the naturopath photos of her bruised breasts: "Hi, those green spots definitely little tumours," the naturopath replied. "It looks like there is just the start of cancer, would most probably have developed into major pictures!!! ... fantastic those come out".

A week later the Auckland woman sent more pictures.

"Wow, girl this looks great," the naturopath replied. "The top one looks at this stage there is nothing to worry about ... you can just apply zambuck ointment to that to draw out the last anger and puss ... do you have that, can I courier you some?"

Now here's something I never figured out. Naturopaths contend that theirs is "natural medicine" that is much less toxic and causes many fewer side effects; sometimes it's claimed that there will be no side effects. Yet their treatment regimens are often quite onerous. For example, read the description of this woman's regimen, which got to the point where she had to get up earlier every morning just to "go through all my stuff." She spent thousands on "myriad pills, drops, powders and ointments the naturopath advised her to take." Then consider other alternative cancer treatments favored by naturopaths, like the Gerson protocol, which requires drinking thirteen organic juices (which have to be prepared fresh hourly) and well over a hundred supplement pills per day, as well as a basic organic whole food plant-based diet plus five coffee enemas per day. I kid you not.

In any case, none of her treatments worked, and in fact the woman became progressively fatigued to the point where she gave up less than a year later and gave the supplements back because she "didn't believe in them any more." Even so, instead of going back to real medicine, she went to another naturopath and didn't finally undergo surgery until January 2016. One thing that bothers me about this story is that the timeline isn't really very clear. As a cancer doctor, I really want to know when this patient was diagnosed with invasive cancer, as that would clarify my discussion a lot. However, I do know how the story ends, and it ends tragically:

Before dying, the woman confronted the naturopath by email about her treatment methods and unavailability.

And with days left to live, the Auckland woman asks one last time, "I don't understand why there are no regulations?"

It's late July. Pale, hunched, shuffling, months after her cancer had spread to her lymph nodes, the woman holds on.

"If we could make a difference there with regulation, that would help everyone – that would help the naturopath," she says.

"I'm starting my chemotherapy, it's quite exciting, the hope is it will shrink the existing cancer but it has spread, I don't know how much hope there is.

"I don't want to lose hope."

It was not to be. This month, she passed away.

When the reporter, Simon Maude, contacts her one last time, instead of expressing regret, the naturopath makes it all about her:

And the naturopath? We give her a final phone call.

She's closing her holistic health practice in September, she says.

"I've just had it. At the end of the day it's a thankless job, I've given my life to people to try and help them, I've had enough".

Selling ineffective supplements that fail to prevent what was almost certainly an eminently preventable death is a "thankless job." I suppose so because this naturopath definitely doesn't deserve anything resembling thanks. I did, of course, try to figure out who this naturopath is, and I think I did. Since I can't be sure, I will not publish my speculation, however. Instead, I will move on to the second case.

Another way naturopaths harm cancer patients

The second patient, a 55-year-old woman named Jane Norcross-Wilkins, had breast cancer and treated by the same naturopath, but her case is quite different otherwise. She had breast cancer in 2001, but it recurred in 2011. By 2015 it was stage IV and incurable. As her husband, Mike Malcolm put it, she just wanted more time, with the rationale, "OK, if I can't beat it, I can work with it and see how far I can go," which is certainly not unreasonable and is the way many patients with terminal cancer think. It's also the approach taken by real oncologists: To slow the progression of the cancer for as long as possible while also balancing the toxicities of therapy with the limited anticipated benefits and taking into account the patient's values (e.g., to fight for as long as possible vs. to be as comfortable as possible for as long as possible). However, such decisions require a dispassionate assessment and communication of the actual prognosis versus the risks and toxicities of therapy. Naturopaths frequently short circuit that necessary discussion with false hope, as in the case of Norcross-Wilkins, who went to see this same naturopath in December 2015:

Upfront with the naturopath about Jane's terminal cancer diagnosis, they listened as the naturopath held court. "She's good at talking herself up, she highlighted how certain parts of the cancer process can be interrupted or changed with processes she used, stopped and reversed.

"You could listen to her all day, she's very knowledgeable, she explains things in layman's terms."

Jane was put on a gruelling regime of expensive natural remedies. She discovered homeopathic melatonin sold to her for $50, retailed elsewhere for $12; vitamin C caplets sold for $140 retailed for $87 over the counter.

As with the first patient – not only was Norcross-Wilkins' regimen expensive, it was brutal:

Mike explains: "It was like a detox, a purge, I've never seen anything like it, the amount of things she had to take. But the naturopath said 'no, no Jane's got to keep on doing it, it's a little bit hard at the start but you're killing the cancer, you're giving the cancer an environment it can't live in'.

"But Jane couldn't live like that."

As it became apparent that the woo wasn't working, the naturopath became progressively more difficult to get a hold of, even after having promised at the beginning that Norcross-Wilkins could call her "any time." Phone calls went unreturned, and e-mails were not answered for days. When Norcross-Wilkins was hospitalized for three weeks in January 2016 the naturopath didn't inquire about her. The end result:

Angry emails sent to the naturopath ended with Jane and Mike dumping her late the following month.

A final March 2016 letter from Jane to the naturopath ended: "I strongly suggest you set up supervision for yourself and a highly experienced practitioner to ensure that you are working ethically ... I also suggest you look into registering with a body such as the NZ Natural Health Council or the NZ Society of Naturopaths Inc.

"I do not wish to continue as your client," Jane concluded.

The naturopath apologised profusely, and promised not to treat cancer sufferers any more. She refunded the cost of some of Jane's medicine's [sic].

Let's just put it this way. Real oncologists don't have the option, ethically, of avoiding their patients who aren't doing well. In any event, Norcross-Wilkins married Malcolm in December 2016 and died on February 8, 2017.

Defenders of naturopaths and other quacks will frequently point to patients like Jane Norcross-Wilkins and ask, "What do they have to lose? Conventional medicine can't save them." The response is simple, if not easy. Patients like Norcross-Wilkins are going to die, but what naturopaths like this one rob them of are effective palliative care, so that they suffer more than they need to, both from their cancer progression and from the quack therapies they undergo; money that could go to their estate that instead is spent on ineffective nostrums; quality time with their families before their condition deteriorates too much; and a chance to put their affairs in order properly before the end.

The naturopath responds

There are usually at least two sides to every story, and this one is no exception. Unfortunately, the naturopath's side of the story comes across as self-serving and very much covering her posterior:

"Cancer IS an exhausting disease," the naturopath tells Stuff. "There's no nice way to treat cancer, you show me a patient who is doing anything that is making them feel better.

"People think because [my treatment is natural] it should feel good. It's not, there's no easy way to treat cancer."

Tumours, cancer – at this point shouldn't the naturopath have stopped and suggested the woman go back to her oncologist?

"It's not my place to refer them to a specialist," she tells us. "I can't do that because I'm a naturopath."

That last bit strikes me a very intentionally legalistic justification. Let's just put it this way. I don't know the law in New Zealand, but whatever it says regarding the regulation of medical practice I'd be willing to bet that there's nothing in it that forbids a naturopath from saying to a patient who is clearly not getting better, "I really think you should see an oncologist."

Be that as it may, it turns out that naturopaths are not regulated in New Zealand. New Zealand Society of Naturopaths vice-president Sharon Erdrich is quoted as saying that New Zealand naturopaths want "tighter regulations." This claim would seem to be belied by the fact reported that a non-regulated health profession can submit an application to the Ministry of Health to be regulated and the observation that the "ministry has not received an application from naturopaths to become regulated under the Health Practitioners Competence Assurance Act 2003."

Beyond cancer and New Zealand

Of course, naturopaths are not just dangerous to cancer patients, as a recent story that I had thought about blogging about but somehow never got to shows. In this incident, which occurred two years ago, an Australian naturopath, using the rationale that a breastfeeding mother needed to "alkaline" her milk and "eliminate the toxins" from the baby's body, recommended a 100% raw vegan diet:

An Australian naturopath who instructed a breastfeeding mother to stick to a "raw food" diet to cure her son's eczema has admitted that her advice endangered the baby's life.

Marilyn Bodnar, 61, was accused of directing the mother, a midwife who cannot be named for legal reasons, to abandon other medical advice and adhere to a strict diet of raw vegetables, fruit and seeds.

By the time the mother took the baby to hospital, he was limp, had sunken eyes and police believe he was just days from death.

According to court documents, Bodnar, from Sydney's south-west, made the mother feel guilty for eating "rubbish" during her pregnancy and using steroid creams for the boy's eczema.

When the baby developed a fever, this naturopath's irresponsible advice went even beyond this. She advised the mother to drink nothing but water, saying, "You're not allowed to drink anything if you want to see him better." When the infant started vomiting, the naturopath went beyond even that and told the mother to continue, saying, "increased temperature meant increased vitality." By the time the baby was taken to the hospital, he was badly emaciated and, at eight months, weighed only 6.39 kg, which placed him in the zero percentile for babies his age.

Nor is this the first time Bodnar endangered a life:

It can now be revealed that Bodnar — who boasts online of being able to help “parents and children’s health and infertility” — faced a manslaughter trial in 1988 over the death of a woman who was on a water only diet for 63 days.
Bodnar was acquitted of the manslaughter of 42-year-old Narelle Niemann, who lost 35 per cent of her body weight while she was under Bodnar’s care.
Prosecutors argued Bodnar failed to get professional help when her condition deteriorated, but the jury found her not guilty. She argued at trial she was helping Ms Niemann as a friend and not as a patient.

So Bodnar's been at this sort of thing for nearly 30 years at least? One wonders why Australian authorities couldn't stop her until now. Not that we in the US have anything to brag about on the score of stopping naturopathic quacks from endangering lives. For instance, four months ago, I wrote about the case of Jade Erick, a young woman with eczema who died of a hypersensitivity reaction when a naturopath named Kim Kelly treated her in his office with intravenous curcumin.

Another case that I've discussed here before involved a woman in Bowling Green named Fikreta Ibrisevic who sought the services of a local naturopath named Juan Sanchez Gonzalez to treat her rhabdomyosarcoma and was quoted in news reports as having told her and her husband Omer Ahmetovic that "chemotherapy is for losers" and that he could "guarantee" that Ibrisevic would be cancer-free with his treatments within three months. Predictably and tragically, Gonzalez's quackery didn't work. Ibrisevic also sought out the care of other naturopaths. Unfortunately, by the time Ibrisevic realized this and sought out conventional medical care it was too late for her. Although she accepted chemotherapy, the cancer was too advanced. She died of it on February 27, 2017. This case is compounded by further tragedy, as well. On a Friday evening after office hours four days after his wife's death, the grieving husband allegedly walked into Gonzalez's office and shot him dead.

There are no "good naturopaths"

I started this article by complaining about the SIO, which will no doubt consider my mentioning of the organization unfair in relationship to discussing these cases of naturopaths leading to the deaths of cancer patients. The reason is that most of the naturopaths I just discussed were not licensed and didn't come from "approved" schools. To some extent, there might be a reasonable point there, but only in that naturopaths who join SIO are usually associated with academia, which (usually, but certainly not always) keeps their worst impulses under control. Usually. Unfortunately, though, organizations like the SIO, as well as most integrative medicine physicians, turn a blind eye to the quackery inherent in naturopathy. To illustrate this, I like to relate an anecdote. (You can skip the next paragraph if you've heard it before, as I do repeat it from time to time.)

Back when I published my Perspective article, "Integrative oncology: Really the best of both worlds?" in Nature Reviews Medicine three years ago, the SIO immediately criticized me for spending so much of it discussing homeopathy, which its leadership properly rejected as being pseudoscience. There were two aspects of this complaint that amused me. First, homeopathy was a far smaller part of the first draft of the article, but reviewers forced me to add more. Second, even more amusing (or disappointing—or both) was that it was clear that the SIO had no clue how integral homeopathy is to naturopathy. I responded by pointing out that naturopathy schools include many hours of homeopathy in their curricula and that naturopaths are tested on homeopathy in the NPLEX, the licensing examination used by states that license naturopaths. I also couldn’t resist twisting the knife a little bit by pointing out that one of the authors of the SIO clinical guidelines for breast cancer was a naturopath who at the time had an open clinical trial of homeopathy listed on Basically, you can't have naturopathy without homeopathy. To reject homeopathy as pseudoscience but still accept naturopaths as co-equal medical colleagues is inherently contradictory, because all naturopaths are trained in homeopathy and most of them use it.

Consider, for example, Kim Kelly, the "naturopathic physician" whose irresponsible use of an unproven treatment like IV curcumin for eczema killed Jade Erick. He graduated from Bastyr University, basically the Harvard or Yale of naturopathy schools, the crème de la crème of naturopathy schools. (Never mind that being the crème de la crème of quack schools is not a good thing.) Any naturopath who looked at his credentials would tell you that he is everything that a good, well-trained naturopath should be, and he is fully licensed by the State of California to practice naturopathy. Yet, as I discussed before, this upstanding naturopath offered a veritable cornucopia of quackery: biopuncture (an unholy union of homeopathy and acupuncture), naturopathic detoxing, hormonal balance treatment, intravenous nutrition, intravenous vitamin C, a dangerous modality like intravenous peroxide, and various “wellness programs.”

Let's just put it this way. I've examined the practices of many naturopaths in my time. Outside the very privileged, cloistered, and protected ivory towers of medical academia, I've been unable to find any detectable difference between the level of quackery offered by the great unwashed unlicensed mass of naturopaths who didn't graduate from schools like Bastyr and the elite group of naturopaths (elite only among naturopaths, that is) who did go to "accredited" naturopathy schools and are licensed. Yes, I acknowledge that I haven't done a systematic study and my views might be affected by confirmation bias, but even if that's true I've found a whole lot of what naturopaths would consider their crème de la crème offering a whole lot of quackery and discussing it in private forums, including some faculty of naturopathy schools and leaders of organized naturopathy, again the crème de la crème.

I tend to focus on cancer when I discuss the quackery in naturopathy because I'm a cancer surgeon. As a cancer doctor, I recognize that naturopaths are dangerous and harmful to cancer patients. No, strike that. They are dangerous and harmful to all patients.


More like this

When people ask, "what's the harm," I point them to stories like this.

Of course, the excuse is, "well, these treatments aren't harmful, are they?" But it ignores that forgoing conventional treatment almost guarantees that the disease will progress naturally & kill the patient.

Untreated Cancer is a horrible, horrible way to die.

Out of curiosity, would a bilateral mastectomy be called for with DCIS in one breast, even localized, but the BRCA1/2 mutated genes? If so, it may explain the oncologists massive over-treatment recommendation, and not be something that would make it into a news article, for fear of confusing the ad viewing public.

By Anonymous Pseudonym (not verified) on 05 Sep 2017 #permalink

That's possible. I do think that it's the sort of thing the woman would have mentioned.

Here's what I think. Medical doctors could stand to be more natural in their approach and naturopaths could be more scientific in theirs. Bashing naturopaths because you don't like them isn't really the best route although it gives you attention that serves a separate need altogether. I wish your articles didn't show up in my Google feed.

By Greg Kevnor (not verified) on 05 Sep 2017 #permalink

@ Orac,

In the post it is written, "Real oncologists don’t have the option, ethically, of avoiding their patients who aren’t doing well".

Q. Is an Oncologist's recommendation for the patient to enter hospice care considered abandoning a patient who isn't doing well.

From cradle to grave, alternative medicine is nothing more than a supplemental treatment to buttress science-based medicine.

I encourage Orac's minions to explore how the dissimilar approaches to medicine may be used in combination for the better good.

By Michael J. Dochniak (not verified) on 05 Sep 2017 #permalink

That you even asked such a question shows that you do not understand hospice. Hospice is NOT about "abandoning the patient." Far from it.

@Greg: could some doctors stand to have a better bedside manner? Sure. Could they be open to some "alternative" therapies? Maybe - if they've been shown to have actual benefit. Orac has many times complained that actual therapies like massage, yoga, relaxation techniques, good diet have been co-opted as "alternative" medicine when they are not.

On the other hand, I lost some faith in my surgeon who recommended (and gave for free) homeopathic arnica to decrease bruising after surgery. On the other hand, he didn't really care if I took it, and DID give prescriptions for real medicines also, which he DID care if I took. I guess as a plastic surgeon, he dealt with a lot of people who wanted the fake stuff.

So, if you can tell me what a naturopath does that is as good or as better as a physician, I'll look into them. However, they can't prescribe homeopathy, Reiki, Theraputic Touch, unnecessary IV treatments, or anything else that they seem to thrive on and which have no known therapeutic use (except prevention of fat wallet syndrome in the patients)

Greg, he's not bashing naturopaths because he doesn't like them. He's critcizing them because they're causing needless suffering and death. Why does it bother you that he calls out such dangerous practices for what they are? You say naturopaths "could be more scientific", so surely you agree their practice is lacking something. Why does it trouble you to see that spelled out in detail?

The biggest problem I have with naturopathy is that it isn't really a discipline at all. It's an umbrella for nearly any unconventional medicine to give it a veneer of science and respectability. A naturopath can appear to be systematic and knowledgeable by going to a naturopathic school and getting the appropriate sheepskin to hang on the wall, and then in most places can also get a license to practice naturopathy to hang alongside it. His or her patients aren't to know that this isn't in any way comparable to the training required of an MD or DO. They aren't to know that naturopaths may use any of a huge arrange of wildly contradictory theories of disease. Seriously, how do cleanses and homeopathy fall under the same umbrella? They are completely contradictory. Anyone who promotes both either really doesn't understand either of them, or is lying. They're either incompetent or frauds. There is really no other possibility, because even a casual examination shows the internal contradictions.

And as Orac pointed out, "define natural". If we are to assume naturopaths are "being natural", then your definition of natural must encompass things like peroxide injection, stem cell therapy, megadosing of synthetic vitamins, and ultraviolet blood irradiation. If that's acceptably natural, why is mainstream medicine not to you, Greg?

Honestly, Greg, I think you may severely underestimate how unscientific and frankly *random* naturopathy is. It's not just unscientific -- to say it needs to be more scientific would be to lie by understatement. It's completely unsystematic. Just whatever a particular naturopath feels like trying, pretty much.

By Calli Arcale (not verified) on 05 Sep 2017 #permalink

@Greg: Just because something is "natural" doesn't mean it's good for the patient. Botulinum toxin is natural. Y. pestis is natural. HIV is natural. Et cetera.

As Orac has repeatedly documented, homeopathy is a major part of naturopathy. Homeopathy can be thought of as a basic intelligence test: if you believe that it can work without most of what we know about physics and chemistry being wrong, you fail. All you need to understand that homeopathy is bunk is high school chemistry.

There are other naturopathic treatments, but none of them has been shown to be effective. In fact, no alternative treatments have been shown to be effective; as soon as one is shown to be effective, it ceases to be alternative.

By Eric Lund (not verified) on 05 Sep 2017 #permalink

The New Zealand article linked to above was pushing the line that regulation of naturopaths would somehow protect patients.

Unfortunately, as alluded to by Orac, such regulation would be highly unlikely to have any practical benefit. In fact, it is likely to make things worse by conferring a wholly unwarranted respectability to egregious quackery. It is also practically impossible to regulate a "profession" which has no standard of care. It would be like trying to regulate magic.

By DrBollocks (not verified) on 05 Sep 2017 #permalink

As a stage 3 prostate cancer survivor, I know where I would be if I had followed an ND or as I call them a Doctor of Nothing. DEAD.

Since vincristine and vinblastine come from the Madagascar periwinkle, they are "natural" too.

Orac (#7) writes,

That you even asked such a question shows that you do not understand hospice.

MJD says,

You may be correct, but, hospice care has been described as a type of care and philosophy of care that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient's pain and symptoms, and attending to their emotional and spiritual needs.

How does science-based medicine attend to their emotional and spiritual needs?

Therein lies my confusion, Orac is often respectfully-insolent towards "natural medicine" even if it satisfies an emotional or spiritual need.

With all due respect Orac, you're complicated.

By Michael J. Dochniak (not verified) on 05 Sep 2017 #permalink

Abandoning a patient to Hospice? @@

Michael, I have recently watched three relatives go through the end of their live under hospice care. After seeing what hospice does, I strongly encourage you to look into it. You clearly do not know what it is they do, and I really think it would warm your heart to see how much good they do for people facing death, and their loved ones.

The one that had the most intensive hospice care was my maternal grandfather, who was in hospice care for just under a week after breaking his femur. He was already in declining health, so doctors did not give him long to live. They did not recommend attempting to repair the bone, as his odds of surviving the surgery were very poor, and then he'd still have to face recovery and physical therapy. So he elected hospice care.

The hospice service sent two people who took alternating shifts essentially living with him. They bathed him, they made sure he had adequate pain relief, they moderated visits with loved ones, they arranged for a hospital bed and helped him take care of his bodily functions while confined to the bed, they cooked for him and helped him eat and drink, and perhaps most importantly of all, they *talked* to him, they held his hand, and they made sure he would never have to be alone.

Dying really isn't easy. And neither is walking alongside a dying person. You need practice to get good at that, and most of us don't get a lot of practice at that. Which is fine; most of us don't *want* any practice at that. That's where the hospice workers come in. They're trained and they're experienced, and they know both that this is hard and that none of us know what to say or do. They help guide both the dying person and their loved ones through a very difficult time, and make it a lot less painful -- both physically and emotionally. And most religious communities have connections to hospice services too, so you can get one of compatible religious doctrine if that is helpful. If not, hospice workers in my experience are the most understanding and open-minded people around -- they'll do what they need to in order to get whatever spiritual counseling you need. And they've got pretty good connections, because they do this a lot.

So yes, hospice care really does tend to emotional and spiritual needs, and in general it does so very well. Mainstream medicine has understood the importance of this for a very long time; it's why hospitals usually have chaplains of multiple faiths on staff. They know this stuff *matters* to people.

By Calli Arcale (not verified) on 05 Sep 2017 #permalink

@16 Of course they do. They did for my mother-in-law. They did for a dear friend. They did for my mother. They did for my sister-in-law. Anyone who says something like "abandoning them to Hospice" is at best, willfully ignorant of how one goes into Hospice care and what happens in a nursing home, hospital, hospice facility, or at home. At worst....just trollin'. I suspect the latter.

You are ignorant and an obvious supporter of insurance plans aha and big pharma. Your article is hillariously transparent and nasty.

By Patricia D Hayden (not verified) on 05 Sep 2017 #permalink

@ Calli Arcale (#16),

Thanks, wonderful comment.

By Michael J. Dochniak (not verified) on 05 Sep 2017 #permalink

From cradle to grave, alternative medicine is nothing more than a supplemental treatment to buttress science-based medicine.

Scroll up. See the part about the dead people? Nothing supplemental about the alternative treatments they received, nor did the quacks describe themselves that way.

You may be correct, but, hospice care has been described as a type of care and philosophy of care that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient’s pain and symptoms, and attending to their emotional and spiritual needs.

Terminally ill only. Chronic and (especially) seriously ill patients should be receiving real medical care from real medical providers, not NDs. Hospice is only for those who real medical care cannot save, *and* no longer wish to receive life prolonging care. They still receive medical care to provide comfort and pain relief.

How does science-based medicine attend to their emotional and spiritual needs?

Speaking only of my own experience in these matters -

When dad was dying, his doctors and the associated nurses ask almost every day if there was any 'emotional or spiritual need' that wasn't being addressed. This continued after he left the hospital and went into hospice. The hospice nurses (and they weren't all nurses, some were real doctors, and some were volunteers as well as other medical professionals) took great pains to do whatever was possible to support not just dad, bet the whole family as well.

Also note that entering hospice care is a voluntary act.

Abandoning patients to hospice? I find that statement to be almost as offensive and anything PGP has ever said.

Therein lies my confusion, Orac is often respectfully-insolent towards “natural medicine” even if it satisfies an emotional or spiritual need.

I have never noted our host being insolent to anyone who only satisfies an emotional or spiritual need, but I'm sure you can provide an example or two. Our host does tend to throw down on those who, in addition to trying to fill emotional or spiritual needs, also give quack medical advice. I believe it is well and proper for him to do so, but while you're providing the examples previously requested, you can tell us why dosing out insolence is wrong in those cases. A quack with a ready ear and a friendly smile may make you feel good, but he will kill you just as dead.

Dayum, I have to learn to type faster.

Calli snuck in while I was typing, and, as usual, said it better.

Greg: Naturopaths will never make their practice more scientific, because to do would virtually eliminate everything they do, especially homeopathy. Science and naturopathy are incompatible, like oil and water. As for medicine being more natural, I agree with the others who have asked you: what do you mean by natural?

MJD: as someone who practiced hospice nursing for seven years, let me add to Orac's "you don't understand hospice" comment (and believe me, he said it nicer than I would have).

Some of the physicians in my community that I knew the best were the oncologists. That was partly because they referred a lot of our patients to our service, but also because they were a caring bunch of people. They never abandoned their patients. They were involved in a different style of treatment to meet a different need: the goal of a dignified and well managed death.

When you enter hospice, you don't give up your primary physician. That physician continues to follow you, and writes the majority of the orders for your health care under hospice. The hospice medical director decides whether or not a medication or treatment is covered by the patient's hospice benefit (usually Medicare), and collaborates with the attending physician on a treatment plan that is in line with the hospice philosophy, the patient's goals for a dignified death, and the patient's medical needs.

Sometimes I would have to communicate with an attending physician who really didn't know much about hospice or what we did. They didn't usually know much about the tools we used to manage symptoms like pain, nausea, or terminal agitation. I would make recommendations based off the hospice standing orders. Some attendings wouldn't sign off on standing orders for their patients, because they wanted the nurses to communicate with them about the problems we would use them for: that is, they wanted to be in the loop regarding what their patients were getting and how they were being managed. But these same physicians were very good about listening to the hospice nurses and what we would recommend. It was extremely rare that a physician would just balk and not authorize appropriate orders, and I can tell you, it was never the cancer docs.

Attending physicians don't abandon their patients when they enter hospice. They are just as involved and caring before the patient became terminal.

Your comeback is pretty pathetic, and further exposes your cluelessness on hospice. There is all kinds of science on psychology, sociology, and nursing that all address emotional and spiritual needs. Hospice care takes the interdisciplinary team approach. Once a week, the hospice medical director will meet with the nurses, social workers, chaplains, the director of the volunteers, hospice aides, and in some cases various therapists (PT, OT) to discuss the patient's case and ongoing care needs. The attending is sometimes invited, and the medical director will coordinate with the attending on the medical aspect of the case.

When I visit a patient and they have an emotional need, I call the social worker. She goes out to see the patient. When I have a patient with a spiritual issue, I call their chaplain or the hospice chaplain . . . who will visit the patient. But more than that. *I* will listen to the patient, or to the family member. I will pray with the patient. It's really not that complicated.

You are ignorant and an obvious supporter of insurance plans aha and big pharma. Your article is hillariously transparent and nasty.

Is this just a coincidence, Patricia?

@ Orac,

What are your thoughts on naturopathic physicians providing their services in hospice care?

Do you lose your discontent for "natural medicine" in this situation?


If a person in hospice care requests acupuncture to relieve emotional and/or physical discomfort is the naturopathic physician a "quack" in your opinion?

Please advise...

By Michael J. Dochniak (not verified) on 05 Sep 2017 #permalink

Johnny: Hey, why are you picking on me?

MJD: "What are your thoughts on naturopathic physicians providing their services in hospice care?"

Throwing the bums out would be my personal inclination. If they're requested, fine, but let's not have them roaming the halls, preying on families. (Something you'd know about.)

Also, ever heard of this thing called research? Maybe you should have done that before spouting off about hospice care. Then again, you have an ongoing record of knowing nothing about anything. I suppose it's important not to break that.

By Politicalguineapig (not verified) on 05 Sep 2017 #permalink

Also, any bets on if Ms. Hayden is one of those annoying people who calls stock 'bone broth?'

By Politicalguineapig (not verified) on 05 Sep 2017 #permalink

Re naturopathy and hospice care

Medicare does not cover naturopathy services, so it is not a part of hospice care. If the patient wanted to pay for it out of pocket, they can, but hospice would not have anything to do with it. It's still quackery, but hospice providers are not interested in creating conflict with patients; as long as there is no danger from the therapy, we wouldn't likely discourage it.

Dangerous "therapies" are another matter. If a patient was insisting on coffee enemas an IDT meeting would be held, and the ethics board would likely get involved because that kind of thing has no palliative benefit and can actually make the patient worse.

However, we've had plenty of patients who took "herbal" remedies for this that and the other. We would review them for contraindications, and mostly had no issues resolving those.

That we accommodate patients doesn't make quackery not be quackery. And while I've talked to patients who see "functional medicine" physicians, or naturopaths in other areas of health care, I've never heard of a patient seeing one who was in hospice.

Panacea (#27) writes,

And while I’ve talked to patients who see “functional medicine” physicians, or naturopaths in other areas of health care, I’ve never heard of a patient seeing one who was in hospice.

MJD says,

That's not good advertising for naturopaths.

By Michael J. Dochniak (not verified) on 05 Sep 2017 #permalink

PGP (#25) writes,

Then again, you have an ongoing record of knowing nothing about anything.

MJD says,

What would happen if someone put PGP in a round room and ask her to sit in the corner?

I don't know but anything's possible.

By Michael J. Dochniak (not verified) on 05 Sep 2017 #permalink


I don’t know but anything’s possible.

Nothing that some trigs and a blacksmith's hammer can't fix.

Now reciprocity ask that you also go sit in the corner of round room number 2.

Always helpful :)


By j a higginbotham (not verified) on 05 Sep 2017 #permalink

@25 (Michael J. Dochniak)

I can't speak for Orac on acupuncture but you can use the search box for this blog to read some of his many posts on the topic.
My post has no doubt disappeared into the unknowable depths of moderation for the links, here truncated.

By j a higginbotham (not verified) on 05 Sep 2017 #permalink

I can't speak for Orac on acupuncture but you can use the search box for this blog to read some of his many posts on the topic.
My post has no doubt disappeared into the unknowable depths of moderation for the links, here truncated.

By j a higginbotham (not verified) on 05 Sep 2017 #permalink

I can't speak for Orac on acupuncture but you can use the search box for this blog to read some of his many posts on the topic.
My post has no doubt disappeared into the unknowable depths of moderation for the links, here removed.

By j a higginbotham (not verified) on 05 Sep 2017 #permalink

@25 (Michael J. Dochniak)
I can't speak for Orac on acupuncture but you can use the search box for this blog to read some of his many posts on the topic.

By j a higginbotham (not verified) on 05 Sep 2017 #permalink

Johnny: Hey, why are you picking on me?

I am NOT picking on you. I thought it was very clear that MJD had offended me by his comment about hospice. To restate what I hope was obvious - in my experience, hospice provides terminally ill patients, and their families, comfort and support in times where comfort is in very short supply. The nice hospice ladies (well, most of them were ladies, and all of them were nice) took great care to see to my dad and his needs, and somehow found the energy to also care for me and the rest of my dad's loved ones. As Calli said - "They help guide both the dying person and their loved ones through a very difficult time, and make it a lot less painful — both physically and emotionally". To say that people in hospice are 'abandon' pisses me right the h3ll off.

Yes, you've said as bad or worse about me and those I love. But while MJD has said some stupid things in the past, this is the first that has made me wish I could ban him outright. This time, it's about him, not you.

If a person in hospice care requests acupuncture to relieve emotional and/or physical discomfort is the naturopathic physician a “quack” in your opinion?

You feel like you're sitting on pins and needles, and need the real thing to calm down?

Presumably if both the acupuncturist and the acupuncturee do not believe that what's being done is medicine and make no claims that this is a medical procedure, then that would take it out of the realm of quackery. This would be similar to having someone pray with you versus going to a faith healer.

By Mephistopheles… (not verified) on 06 Sep 2017 #permalink

Johnny: Agreed on hospice care. My mother's mother spent the last months of her life in hospice, though she had a lot of medical treatment too, and the nurses were very helpful.

I should note that I have nothing against you personally. You seem like a fine human being who deserves better neighbors.

MJD: Could you stop being STUPID for once in your pathetic, parasitic life? You should maybe spend a week, or a month with your mouth shut and your ears pried open. It's not too late to learn stuff, even at your stage of calcification.

By Politicalguineapig (not verified) on 06 Sep 2017 #permalink

It is my understanding that the people that provide hospice care have a high burn out rate because of having to deal with people who have little time left. My hat is off to all the people who can provide hospice service.

As far as acupuncture during hospice, if I was still capable, it would be fun. Throwing the needles at someone trying to poke me with them would make my day.

My dad had hospice at home when he was dying from Parkinson. I can't say enough good things about the nurses, the palliative care specialists, and the social workers who helped us during my dad's last year.

Whenever discussing hospice care, I refrain from mentioning the Spice Girls.

By Mephistopheles… (not verified) on 06 Sep 2017 #permalink

Rich: I worked in hospice for seven years. It wasn't the patients who burned me out, it was administrative nonsense. I teach end of life care now, and I really enjoy taking my students on their hospice rotation.

Many of my colleagues spend that time and more in hospice care. It's definitely a calling.

Panacea, all my praise goes to people that can handle the emotional toll I am sure that goes with being a hospice worker. I am sure there is also another emotion (I can't say joy) of helping people including family members through such a difficult time.

I don't think I could handle this job, so thank you and all the others who can.