Naturopathy advances in Hawaii

Naturopathy is quackery.

That can't be said often enough. After all, any "discipline" that not only incorporates homeopathy as a major part of its training but also requires that its graduates pass a test with a section on homeopathy certainly can't be considered science-based. Actually, to be more accurate, naturopathy is probably at least 80% quackery and 20% science-based modalities like diet, exercise, and lifestyle changes rebranded and infused with woo. Moreover, whenever naturopaths are misguided enough not to know their limitations, leading them to treat real diseases (rather than made-up naturopathic diseases like "adrenal fatigue"), bad things almost always happen.

None of this has prevented naturopaths and their "professional organizations" (and I use the term loosely in this context) from trying to convince clueless legislators to pass bills in various states, first to license their profession. After they achieve licensure in a state, naturopaths are relentless in pressing for an expansion of their scope of practice, some arguing that they should be considered primary care practitioners, a truly frightening prospect given the pseudoscience at the heart of their "medicine."

Take Hawaii, for instance.

Ever since my wife and I took a vacation to Oahu three years ago, we've been having fantasies about seeing if we can get jobs there. However, I know one thing about Hawaii that would annoy me. Unlike Michigan (where I am now), Hawaii grants naturopaths a broad scope of practice, including prescribing privileges according to the naturopathic formulary. Even in Michigan, I see the occasional patient with locally advanced breast cancer eating through her skin who had been treated by a naturopath; I'm guessing that such occurrences would be more frequent in Hawaii.

Of course, naturopaths are a persistent bunch. If they can't get what they want through the law, they keep at it and, if necessary, get what they want through other means. In this case:

The Hawaii health insurance provider Hawaii Medical Service Association (HMSA) will let you choose a naturopathic doctor as your primary care physician, according to a recent agreement between the insurer and the Hawaii Society of Naturopathic Physicians. This is a big step forward for naturopathic doctors, according to Dr. Karen Frangos, a practicing naturopathic physician on Maui and the President of Hawaii Society of Physicians.

“It allows us all kinds of privileges in terms of being able to be part of a professional physician organization like all other medical doctors do,” says Frangos. “Potentially admission privileges in hospital settings, so it’s a big big deal. It helps close the gap in the shortage of primary care physicians in Hawaii.”

No. It. Does. Not. That's because naturopaths are not primary care physicians. They are not trained to be primary care physicians. They are most certainly not qualified to be primary care physicians, their claims otherwise notwithstanding. What HMSA has done is to make a deal with a bunch of quacks to provide their quackery to its subscribers.

Consider this. Would you want naturopaths to have hospital admitting privileges? (I wouldn't.) What would they do with those privileges anyway? After all, I always thought that the very philosophy of naturopathy precluded the inherently "unnatural" interventions that hospitals excel at. On the other hand, a lot of what naturopaths do isn't exactly that natural, such as intravenous vitamin drips or colon hydrotherapy, the name "naturopathy" notwithstanding.

The funny thing is that naturopaths themselves aren't completely happy with this deal. Witness what Marsha Lowry, a naturopath at Whole Body Wellness in Makawao and Hale Malu in Wailuku, has to say about it:

“On paper I love the idea of PCPs, but what concerns me is if there is a situation that they may choose to not reimburse for the visit if naturopathic treatments are used or recommended,” says Lowry. “I love that people would be able to have coverage. But right now they have been really great to me as an out-of-network provider, and that hasn’t happened. What has happened with other insurance companies is they are auditing our charts and kicking back things like prescribing an herb, and saying it’s not MD standard of care. It’s possible, only because it’s happened recently with UHA [University Health Alliance].”
Things could be different as an in-network provider for HMSA, but the Hawaii Society for Naturopathic Doctors is calling it a success with regard to the Affordable Care Act.

Oh, dear. Other insurance companies are apparently not as misguided as HMSA appears to be. They're actually auditing the charts of naturopaths and flagging items that are not science-based standard of care. The nerve of them! Normally, I'm not a huge fan of health insurance companies, particularly after I've had to argue with a the medical drones belonging to a couple of them over some fairly straightforward and obviously medically indicated tests that I ordered. Really I'm not. But in this case these "other" insurance companies are actually doing what they're supposed to do: Not reimbursing for treatments that are not science-based, as so much of naturopathy is not.

Not that that stops Hawaii naturopaths from spewing the same old propaganda:

“Several meetings over the last month with them in Honolulu–them being some of the management, upper management, and the chief medical officer within HMSA–have culminated in a willingness to comply with the Affordable Care Act,” says Dr. Frangos. “There is a non-discrimination clause in Section 2706 of the Affordable Care Act that states all the insurance companies are to reimburse for services rendered within the state for licensed practitioners practicing within their scope, effective January 2014. But none of the insurance companies have been compliant. So for the last two years, we have been working on this. HMSA has finally agreed to naturopathic physicians in Hawaii to be credentialed as primary care physicians. Hawaii’s licensing law allows us to be primary care physicians yet none of the insurance companies have been allowing us to be participating primary care providers in their plans.”

First of all, this is perhaps the most pernicious effect of naturopathic licensing laws (or laws licensing other quackery, such as homeopathic "physicians" or chiropractic. On the surface, it might not sound so unreasonable for the Affordable Care Act to require that insurance companies reimburse for services provided by health care providers licensed in that state. Unfortunately, states like Hawaii license quacks like naturopaths, which means that the ACA can be leveraged to force insurance companies to pay for quackery.

Actually, Marsha Lowry's practice is an excellent example of this. Just look at some of the quackery she offers her patients, which includes homeopathy and IV nutritional therapy, which usually means "treatments" like intravenous vitamin C and other vitamins.

Meanwhile, naturopaths push for more:

Frangos says the Hawaii Society of Naturopathic Doctors is also involved in other legislation this year, like SB 318, which compels insurers to cover care provided by naturopathic doctors.

She is also working on SB 1034, which will lift the cap on the number of visits related to personal injury protection benefits provided through motor vehicle insurance. And Frangos says the Hawaii Society of Naturopathic Doctors will work on HB 1952, regarding network adequacy, and SB 2332, which allows naturopathic doctors to prescribe controlled substances like Viagra and pain medication.

Again, when I see stories like this, I always wonder why naturopaths would even want to prescribe controlled substances. For instance, why would they want to prescribe opiates, if their methods are so great? The cynic in me thinks that it's because they've come to realize that the "naturopathic" methods they've been taught don't work, while good old-fashioned science-based medicine does work. I mean, seriously. Why would naturopaths want or need to prescribe Viagra? I just don't get it. If you want to prescribe science-based medicines, then you should be trained in how to do it in the same way that physicians are, starting in medical schools and continuing to completion in residency.

Unfortunately, Hawaii is not alone. It is just ahead of the curve in legalizing quackery. After all, according to the article, HMSA is the largest health insurance provider in Hawaii, and where it goes, others will likely follow. In the meantime, reimbursement for naturopathic care as a standard part of their health plans will soon become a reality for large numbers of Hawaiians.

One wonders if this is a harbinger of things to come.

More like this

This might help explain why a recent bill aimed at allowing Hawaii to more rapidly adopt Federal vaccination guidelines was shot down. (Story here).

Why would naturopaths want or need to prescribe Viagra?

Probably so they don't have to worry about running afoul of FDA by selling adulterated "herbal" drugs that actually contain Viagra's active ingredient.

This might help explain why a recent bill aimed at allowing Hawaii to more rapidly adopt Federal vaccination guidelines was shot down. (Story here).

Yeah. I almost linked to that. In retrospective, maybe I should have.

@Todd W. Thanks for the I'm very sad, especially after reading the comments. Guess any plans I have to go to Hawaii won't be until they get a better grip on things.

I always wonder why naturopaths would even want to prescribe controlled substances.

So they can get their hands on some of that filthy Big Pharma lucre. Living in Hawaii is expensive, as anything not produced locally has to be shipped (as in by boat) or flown in, and that's not cheap. What, you're expecting logical consistency from naturopaths?

That's not to mention the short-term attractions of being able to play Dr. Feelgood. I have no basis to assume naturopaths are less likely to succumb to this temptation than MDs.

By Eric Lund (not verified) on 10 Feb 2016 #permalink

Living in the tropics can be nice, but after a while it is rather boring without the seasons and getting certain foods. Plus there is always of chance of getting a more interesting than your average disease.

I have had dengue fever, there is a real and very painful reason why it is called "bone break fever." I am not happy that there have been almost two hundred cases of dengue fever in Hawaii. Note: there are multiple serotypes, so getting it does not make one immune. If you get another serotype the chance of hemorrhagic fever goes up.

Love to see how a naturopath deals with that!

@ Chris:

I agree about the tropics - esp about exotic diseases.
I have also seen some rather awful and frightful swamps as well as grinding poverty in those climes.

It doesn't help that mosquitos appear to consider me a treat.

By Denice Walter (not verified) on 10 Feb 2016 #permalink

It doesn’t help that mosquitos appear to consider me a treat.

Yeah, St. Petersburg (built on a swamp) was where I first started using DEET (or whatever is in the bug spray they sell in Russia) again. I had used it as a kid in Alaska when I was being eaten alive in the summer.

I have always been one to snack on fruit and a beer drinker (vodka rarely, even in Russia), and I hear this makes one more attractive to mosquitos. It's hard to say, though, Russians make a lot of stuff up when they don't know the answer for sure.

Speaking of Russians, my good friend Olga once had dengue fever while she was living in Thailand teaching English. (She has since made a successful segway out of academia and is living very happily in New York.)

I think I had mentioned that I wanted to maybe work "dengue fever" into a poem or something. Haven't quite gotten around to it yet.

I always just liked the sound of the word, is all.

@JP - actually, in Poland they claim that beer makes you _less_ attractive to mosquitos (something something vitamin B something). So it seems each country has its own story.
And I am so happy our mosquitos do not spread anything dangerous. It's enough that I get allergic reaction, meaning I am covered in huge, swollen, itchy red spots afterwards.

"Dengue Fever" is the name of a band I'm very fond of. They based a lot of their work on psychedelic pop from Cambodia in the 60s and 70s. Some member of the band stumbled upon a tape and fell in love with the music.

“Dengue Fever” is the name of a band I’m very fond of. They based a lot of their work on psychedelic pop from Cambodia in the 60s and 70s. Some member of the band stumbled upon a tape and fell in love with the music.

Oh yeeeeah, my friend Vlad has been introducing me to some Cambodian garage rock recently.

Over on Avenue B, which is more or less where he resides.



Naturopathy requires that its graduates pass a test with a section on homeopathy.

It's a hard test. The lower the percentage of correct answers, the higher the grade. There are enough questions that picking responses at random yields a score too high to pass. (6X being the threshold.)

Never let it be said naturopaths don't have standards.

They want to be able to prescribe because Viagra is so incredibly popular. I can see it now: happy, geriatric couple steps off the plane in Honolulu, are greeted with leis and smiles. In the cab to the hotel is an advert for the local naturopath(s), with a sly reference to vacation sex. In the hotel there's a flyer on the nightstand with more naturopath contact, maybe even a particular "doctor" associated with the hotel itself.

And being able to prescribe opiates? They're almost there. Right now in states with medical mj, naturopaths are the pretty much the only ones prescribing it. I know of one locally who had his license temporarily yanked but it was for poor (nonexistent) record keeping for his mmj patients/clients.

By Katatonic (not verified) on 10 Feb 2016 #permalink

For some people, if you want a lei you need Viagra. Not that I speak from experience, as I've never been to Hawaii.

By Mephistopheles… (not verified) on 10 Feb 2016 #permalink

As a registered nurse, I would not take orders from a naturopath in a hospital. I will not administer treatments to a patient that are not evidence based.

I would walk away from such a job in a New York minute. Just as soon as someone could come in to take report from me, so I don't get accused of abandonment.

The part that makes me sad though, is I know nurses who would have no problem with it.

Modern naturopaths often do not use Homeopathy. I agree that some of what is taught at Naturopathic courses is nonsense, but then again that is true of modern medicine. Most of modern medicine is certainly not science-based, just look at how many coi's and fraud charges are levelled at drug companies. Even Dr Marcia Angell has stated that the drug companies virtually own medicine today, which is scandalous. Drugs, drugs, drugs!! Science? Not really.

By James Cooper (not verified) on 10 Feb 2016 #permalink

Most of modern medicine is certainly not science-based, just look at how many coi’s and fraud charges are levelled at drug companies.

Non sequitur duly noted.

I don't doubt in the least that Dr Angell has many justified criticisms of drug companies. But could you give me the source of your quote ?
For example, I know that she criticizes some drugs, but approve of others.
It's not the first time a legitimate critic of Big Pharma is misquoted, in order to justify a caricatural position they wouldn't approve of.
You are also conflating science, research, and business practices.

RE Hospital privileges

That would be a bit like letting your kid drive your car without giving them the keys. I don't know if Hawaii's scope of practice allows NDs (not doctors) to do any type of surgery, but I doubt they can do anything that would require OR level care. And they wont be able to prescribe most of their BS herbals because there will be a hospital pharmacy stocking only meds that have been approved by the hospital Pharmacy and therapeutics committee. That committee will be run by MDs and pharmacists and will be VERY evidenced based if my own experience is any guide.

I think a couple days in the ICU would be very eye opening for most naturopaths. Give them a peek, for the first time, what real disease looks like.

Jaw dropping level shocking that they want to call themselves "physicians" yet can graduate and treat without spending any meaningful time in hospitals managing actually illnesses.

By Captian_A (not verified) on 11 Feb 2016 #permalink

@ MI Dawn:

I’m very sad, especially after reading the comments. Guess any plans I have to go to Hawaii won’t be until they get a better grip on things.

Well, Todd's link hardly represents a valid sample of Hawaii's grip on anything. There are ~15 anti-vaxers posting in that comment thread. If the link to the article was posted on an anti-vax website, we could guess that a number of them are from out-of-state, not residents of Hawaii.

The ABC News blurb offers no background on the politics here, and the reader may come away with the impression that Sen. Rosalyn Baker – the committee chair who pulled the bill from consideration – might be anti-vax. She's not:

a measure by state Sen. Rosalyn Baker of Maui... would make HPV vaccination mandatory for Hawaii youth, with the first of three shots required before beginning seventh grade. The measure also would allow pharmacists to administer the shots to girls and boys between 11 and 18 years of age, making it as easy to access as flu vaccine.

It would seem, then that, some kind of political wrangling is involved in her decision to pull the other broader bill. Perhaps her bill on HPV will benefit from being separately. Perhaps the sponsors want to tweak a few points to make it more 'critique-proof' and/or re-introduce it at some point when it's not as politically 'hot' as it is right now. (???)

I would think decent political journalism would include some mention of how many legislators might actually be opposed to the bill, and what their affiliations and districts might be. If there was "decent political journalism", that is...

In a somewhat related digression, I was looking for some apps for my phone and I came across a free one called "Emergency First Aid - Instant" from the hand of a Dr. Jakob Bargak which offers the assurance that you can "Master emergencies on your own Without Medications using Traditional Chinese Massage Points" (Caps as in the original).
Some of the conditions that it claims to treat are ones that only need time and will respond to a placebo, but among the others are nosebleeds, "massive" menstruation,diabetic coma (!), extremely high blood pressure, and breathing difficulty. It comes in a free and a paid version that look to be identical. He has about another thirty in the Windows phone store, touting acupressure for improvement or relief from everything from playing football to Ebola.
I don't know whether to cackle insanely or vomit (Acupressure for that, too.) when I see this. Once I have some relief from my problems I intend to warn Microsoft about this snake in their garden of apps.

JP, "She has since made a successful segway out of academia and is living very happily in New York." where, I assume, she was offered a job in mall security because she brought her own Segway. (Snark aside, I think and hope you meant "segue").

By Old Rockin' Dave (not verified) on 11 Feb 2016 #permalink

James Cooper. Can you please provide some evidence for your statement that modern naturopaths often don't use homeopathy? could you also clarify what you mean by modern?

Every Naturopathy qualification currently offered in Western Australia and those online offer homeopathy and a quick scan of the local naturopathy websites all include homeopathy.

Your comment regarding modern medicine not being science based is confusing. Do you mean evidence based practice or do you think modern medicine is based on astrology?

By Quokka1969 (not verified) on 11 Feb 2016 #permalink

James Cooper,

Most of modern medicine is certainly not science-based,

That's a common misconception: this study (full text PDF) a few years ago concluded that more than 70% of conventional medical interventions are based on "some form of compelling evidence", with 37% supported by RCTs (a number of interventions are not amenable to RCTs). I think it likely this has improved further since, with further work still to be done, of course.

By Krebiozen (not verified) on 12 Feb 2016 #permalink

JP, “She has since made a successful segway out of academia and is living very happily in New York.” where, I assume, she was offered a job in mall security because she brought her own Segway. (Snark aside, I think and hope you meant “segue”).

Yeah, it's one of those words that I have heard spoken fairly often but rarely seen in print, for some reason. I used to have the opposite problem as a kind (mispronouncing words because I had only ever read them, not heard them used in conversation.)

Anyway, we translate interviews for the same archive. She's probably found other work by now, too, I think she knows people in Brighton or something. Immigrants get along.

@ JP:

Altho' I always hesitate to correct- if it is indeed NY ( not Brighton, UK) it's Brighton BEACH - which is in Brooklyn right next door to Coney Island and a quite a cultural experience- a boardwalk, shops, restaurants, cafes and nightclubs *a la Russe* on the Atlantic. With swimming as well as drinking, And caviar.

Seriously. You should go. Also other parts of Brooklyn have high concentrations of East Europeans as well as being hip-deep in hipsters, new bands and designers.

By Denice Walter (not verified) on 12 Feb 2016 #permalink


Yeah, I know. I have Russian friends who've visited there and didn't like it; they said it was "not really one thing (Russia), not really the other (the US.)"

Plus it was pretty shady back when I was younger. Maybe one of these days I'll visit, though, it seems like it could be a lot of fun.

Modern naturopaths often do not use Homeopathy.

This sentence is subject to multiple interpretations. Are you saying that many modern naturopaths never use homeopathy or that all modern naturopaths use homeopathy but they often don't (when they're sleeping, say, or using some other form of treatment)?

By Mephistopheles… (not verified) on 12 Feb 2016 #permalink

Maybe it will become scientific like DO medicine?

By Francis Wolfe (not verified) on 14 Feb 2016 #permalink

I wonder - is there an inclination in native Hawaiian culture towards "traditional medicine" that makes Hawaii more tolerant towards quackery?

OF COURSE they want to prescribe opiates! Considering what Oxys get on the black market, EVERYBODY wants to prescribe opiates!

By Marc K Mielke (not verified) on 19 Feb 2016 #permalink

Excuse me, but maybe you need to get your facts straight before posting such an ignorant blog about naturopathic medicine. First of all, a licensed, accredited naturopathic program such as the one at Baylor requires two years of basic sciences. The same as any recognized, accredited medical school in the US. Naturopath students have to pass a basic science boards exam, same as medical students. Then, besides all the same medical classes as a allopathic medical student (pulmonolgy, cardiology, immunology, hemeonolgy, pathology, among many others), a naturopath learns nutrition. botanical medicine, physical medicine, acupuncture, minor surgery, and homeopathy. Of all the areas you are criticizing, homeopathy is just one of several healing modalities we have to draw on a a medical practitioner. We also have as many educational hours with pharmacology as allopath doctors. We are required to have take the same continuing education hours as an allopathic doctor in general medicine and pharmacology in the state of Arizona and Hawaii. Ask your family practice allopathic doctor how many hours in nutrition they had in medical school and they will most likely answer: NONE. Licensed naturopathic doctors look at the patient as a whole and treat the whole person. They are trained to get to the root of the cause of their patient's illness and not just throw pharmaceutical medications at an illness. Please, you sound like the quack and also are very ignorant about your knowledge of a licensed naturopathic medical doctor.

By Laura Markison (not verified) on 16 Mar 2016 #permalink

Ms. Markison, Baylor is a very respected medical school in Texas. You must mean Bastyr.

"a naturopath learns nutrition. botanical medicine, physical medicine, acupuncture, minor surgery, and homeopathy."

And that is why it is nonsense, especially the homeopathy. Just use the handy dandy search box at the top of this page the articles about homeopathy.

"They are trained to get to the root of the cause of their patient’s illness and not just throw pharmaceutical medications at an illness."

Cool... do tell us what root causes a naturopath would cure Type 1 diabetes, obstructive hypertrophic cardiomyopathy and meningitis from a haemophilus influenzae infection. The latter is mentioned in more recent articles on this blog.

I suspect that Laura will remain true to earlier hit-and-run form. My best guess is that she bumbled across this while planning a return to Hawaii after graduation.

So she is your standard naturopathic idiot. I should not expect an actual answer to my real medical questions from her. Just like the health insurance health company nurses to call about how I am supposed to prevent my son's obstructive hypertrophic cardiomyopathy.

I really really want them to tell me how I was supposed to prevent the still unknown genetic sequences that caused the abnormal heart muscle growth.

Obviously we all want to know how to prevent de novo mutations Are we to remove ourselves from all radiation, which includes sunlight?.

So she is your standard naturopathic idiot.

Well, it looks to have been an attempt at a career upgrade. Time will tell how incurring that debt burden pans out.

Maybe Laura should try talking to Britt?