First, thank you for all the wonderful comments on yesterday's post. I never really know which posts are going to rake in the comments---my favorites are usually the quietest, and some of my quickies bring 'em in by the dozen. According to my uber-seekrit data, I've had two unique visitors to my naturopath post. As erv would say, "UR DOING IT RONG!11!!"
Anyway, I would like to thank my commenters on that post. Even those of you who I think are terribly wrong were at least civil.
I'd love to address all of the issues raised in the comments but I'm far too lazy busy at the moment, but I'd like to focus on a few issues.
First, I still haven't found an over-arching authority over naturopathic education and practice equivalent to real doctors. Second, much of what I've read so far follows an new and interesting path---a large number of very intelligent, very well-educated, very well-intentioned shamans.
Anyway, let's examine some of the misconceptions raised in the comments.
From a (presumably) green amphibian:
Today, non-specialist (the GPs that do most treatment) do not "determine what the problem is". You can't possibly do so with 15 minute consults. In engineering, when you troubleshoot, you have the time to go altering one variable after another, attempting to isolate a fault, given systemic conditions. If you just hack away, hoping that a fix will work --- well, you're just not an engineer -- you're a tech (and not a very good one, at that).
That's not what case management is. In case management, you try different solutions without ever trying to isolate the problem. You never have the leisure to actually think about it systematically -- you try treatments in order of success rates until one "works". That's hardly scientific.
I've known quite a few old-timey doctors --- they've all been itching to retire because they don't want to be involved in today's quackish, assembly line medicine. Really, get to know some real doctors. Ask them what they do --- the guys in their fifties and up will repeat exactly this. It's not engineering, and it's not science, it's following a cookbook. They're techs.
And for the idiots out there who will scream "But that's not what I do!", of course there are exception. But this is what the training regime is for pediatricians, GP and other non-specialists. Some folks are smart enough to disregard their crappy training, and find some way to make it work economically.
There is a great deal of unfounded assertion contained in these few sentences. Medicine isn't engineering...it's not even really analogous. We have our own methods and data. I'm not sure what froggie means by "case management", but in my world, that's what specialized nurses and social workers do in the hospital---they help patients arrange safe discharge plans.
I don't know what medical school and residency frog attended, but it seems rather divorced from reality. I spend whatever time I need with a patient. Sometimes I'm rather pressed, but that doesn't really change things all that much. Some patients need a quick check in with me, others need a lot of my time. Square pegs do not get shoved into round holes. I have all the time to think that I want or need, and sometimes ideas come to me later, after conferring with colleagues, reading, or thinking, at which point I can call a patient up for follow up. There is nothing "cookbook" about it except for the part where I rely on evidence to inform my practice.
OK, now that I'm re-reading these comments, I'm finding froggy even more ignorant and offensive.
A great deal of diabetes treatment is a) recognizing it early b) tracking nutritional habits often and explicitly. An decently trained acupuncturist is actually more likely to do a good job of that than an MD. They see their patients more often, they apply old-fashioned diagnoses such as looking at their patients closely and smelling them closely (which is much more likely to id diabetes very early on than waiting for an acute episode), and talk to their patients regularly about their nutritional habits.
Treatment of many chronic conditions doesn't require medical school and residency, but basic training in psychology, nutrition, close observation, and a basic physiological knowledge. Even for some acute conditions, a decent acupuncturist is more likely to pick up on melanomas and such earlier than the GP so they can be referred up the chain.
You have to be kidding. An acupuncturist is likely to do a better job than a real doctor? On what planet? And do they have pizza there?
I know quite a bit about diabetes. There is no evidence that frequent sniffing of patients aids in the diagnosis of diabetes. There is evidence that measuring fasting blood glucose and assessing for typical symptoms of diabetes is useful. We screen for diabetes regularly in the real world of medicine.
I'm still curious to learn what naturopaths think they know that the scientific medicine community is missing. Is there a whole literature out there under the radar?
I don't think so. I think naturopaths are just another kind of snake-oil salesman---they are well-educated, but use unproved techniques, and bizarre ideas to practice medicine. The fact that many of them mean well makes them even more dangerous.
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PalMD,
By what criteria do you consider NDs well-educated? They may learn a lot of things (acupuncture, homeopathy, applied kinesiology, detoxification, ...); but those things are all fake and, most importantly, useless (if not harmful). To me, that does not constitute an "education." There are (were?) two accredited schools of astrology in the US. I don't consider that as an "education" either.
There is a lot of citation of ND lit. at www.naturowatch.org The analysis of their textbook (with 10,000 references!) is a good read. In 2003, Dr. Atwood updated his work in Medscae http://www.medscape.com/viewarticle/465994 In 2004, he published two more articles in Sci Rev Alt Med.
BTW, I don't know if you were kidding about froggy's medical training; but I suspect frog is a lab tech.
I suspect frog is another one of these blokes from the University of Google.
Really enjoying your posts. Glad you "moved in" and hope you are representative of doctors in the US
In reply to Joe, I don't think froggie is even a tech as it doesn't seem to have any clue what they do either - which is gather data, usually with very specific methods, to be used for problem solving/clinical diagnosis.
First of all Froggy probably does not represent the ND's who are going to be registered. I could be wrong, but don't you find "bad apples" in your hospital as well? Let me get this straight ... you are basing your entire understanding of a profession on one blog post that you found. Is that right? My, how scientific of you.
Second of all naturowatch? Talk about an unreliable source of information that specializes in ad hominem attacks. For the scoop on them and their other fun websites like quackwatch go to quackpotwatch.com
Now for the meat of my post.
Holy crap but what a bunch of reactive non-sense. And you people call yourself scientists?
Here's a thought. What if you were to actually research and investigate something before you call it crap. Or is that too easy for you naysayers. Maybe you are right, maybe it is easier to just call anything YOU don't understand stupid or strange or without reason. I rear many of you are the same type of 'academics' who threw Galileo in jail.
OF course I understand your confusion and I am not calling ND's Galileos, but they are doctors. To apply they have to have an undergrad degree and the required science courses. They then attend a 4 year residential medical school complete with clinical training including minor surgery, pharmacology, nutrition etc. That is 8 years of academics.They are trained and qualified to be primary care providers.
To the Ph.D's posting on here about being pissed off and how hard they worked, how does their training in any way take away from your accomplishment? All of the medical boards approved of this law. All of them. This was not the legislature making shit up.
But I can understand your confusion because one of the main benefits of this law is title protection. It is needed because there having been no regulation in Minnesota Diploma Mills have stepped through that loophole and sold a "degree" with the same name.
If you think you have a right to be pissed off imagine how the ND's feel. There ARE hedge doctors out there masquerading as ND's. Imagine how you would feel if someone could just go online and 'purchase' the same degree you had worked YOUR ass off to EARN. That is the place the ND's found themselves and the reason for this law.
Jeff F,
You've been roundly spanked at Pharyngula http://scienceblogs.com/pharyngula/2008/06/now_im_embarrassed.php following your post #136.
A couple points to add.
First, Jeff F.- Naturopaths are quacks, all of them. They sell a non-scientific system of treatment which doesn't work. Any system of medicine which gives support to homeopathy, acupuncture, etc is not real medicine.
Second, to Froggy- some old time doctors have been doing the fifteen minute appointment thing for decades. I suggest that you stop and think for a moment. The majority of things people go to a GP for only take fifteen minutes, a cold, a blood test, the flu, vaccinations, etc. If you go to one of these folks with something worse, you better believe they will spend the time with you. Your complaints are the simplistic and generally anti-establishment rants cult medicine followers use.
Joe,
I think you are mistaking spanking, in the sense of corrective punishment with attacks, in the sense of ad hominem attacks.
I am willing to have a discussion. Are you?
Jeff
Thadd,
To quote many of the people who have replied to me, prove that they don't work.
Just cause you say so is not enough. Of have you completely abandoned scientific methodology?
jeff:
After perusing those replies to you on Pharyngula - your cry of ad hominem is false and a smokescreen to hide the fact that you were indeed roundly spanked. FYI an insult is not, by itself, an ad hominem. It is only ad hominem if the insult is given in the place of arguments refuting your position. An insult as well as refuting your argument is, well just an insult. And the ratio of valid argument to insult was high.
And as for your "prove that they don't work" - Oh give me a break. The burden is firmly upon the naturopaths and their supporters (you) to show they do work, not on everyone else to show they don't.
Having observed in the past thirty years quite a few of my friends and neighbours climb on the naturopath wagon, far too often with unpleasant results (e.g., horrible eye infection, undiagnosed mono, death from untreated breast cancer), I am happy to see PalMD and others speaking out on the issues.
In my experience, people who end up as naturopaths are usually well-meaning individuals who thoroughly buy into the woo they are selling. Their real concern for clients is obvious, and this no doubt increases the placebo effect that encourages people to think naturopathy is a legitimate alternative/adjunct to conventional medicine. That is, for clients who don't end up with serious complications as a result of not getting real treatment for real illnesses.
As for doctors not spending enough time with patients: at least here in socialized medicine territory, I have never experienced this. Most medical problems can be taken care of in a fifteen minute consult, but on any occasion when I or my family have had a more difficult medical problem, doctors have taken plenty of time to thoroughly deal with them.
I think the sniff test works better for diagnosing naturopathy than it does for diabetes.
Jeff wrote "Joe,
I think you are mistaking spanking, in the sense of corrective punishment with attacks, in the sense of ad hominem attacks.
I am willing to have a discussion. Are you?
Jeff"
I think we have established there were few ad hom attacks. Certainly, not in my post. I briefly explained to you why naturopaths are quacks. So far, your responses have not offered any opposing facts, except you think naturowatch is too anti-woo. That is like claiming someone is too anti-child-abuse. How can one go too far in those directions?
You did suggest that naturopathic concern with imaginary toxins is based in fact because there really is such a thing as "toxemia." Naturopaths are not talking about that, nor can they treat it. Quacks regularly salt their nonsense with little bits of (irrelevant) fact.
I really don't know how to have a discussion with someone who doesn't have the requisite knowledge. My neighbor told me she had her tires filled with nitrogen because they hold the pressure better. I told her she had been hoodwinked and asked if she remembers I teach the gas laws in college, introductory chemistry. She knew that; but allowed as how her greasemonster has a different opinion!? It's her money, and his boat payment. She cannot distinguish opinion (with pecuniary interest) from fact.
If you think you can engage on naturopathy, pick an article at naturowatch by Barry L. Beyerstein, PhD, Kimball Atwood, MD, or Arnold Relman, MD, and explain (in your own words) why it is fatally flawed. Can you distinguish opinion (with pecuniary interest) from fact? Note, there are 30,000 doctors in MA, and around 40 naturopaths, there isn't any real competition (pecuniary interest on the part of doctors).
LOL: "smelling them closely (which is much more likely to id diabetes very early on than waiting for an acute episode)"
um, okay, how about, oh, I don't know, a fasting blood sugar analysis? You know, an actualy test ordered by an m.d.? That gives definitive results? Quickly and accurately?
or would you just rather bleed them with leeches and drain their sanguine humors?
unreal.
Today, non-specialist (the GPs that do most treatment) do not "determine what the problem is".
News to me. I've seen specialists twice in the last 10 years, both of them surgeons. I'm actually rather offended by that statement on behalf of two excellent GPs I've had who've diagnosed and treated real "tough nut" problems for me. And I'm a tough case. Granted, I am Canadian, and our GPs up here don't seem quite as willing to refer people to specialists at the drop of a stethoscope, but I've also got a number of chronic conditions and need periodic lookings-after from my medical professionals.
treated real "tough nut" problems
T M I !!!