Sh*t naturopaths say, part 5: Ozone therapy, honey, and attacks on Change.org petitions

Those of us living in Michigan who support science-based medicine have been forced to deal with a bill that, if passed, would grant practitioners of unscientific “medicine” a wide scope of practice—almost as wide as that of primary care practitioners such as pediatricians, internists, and family practice doctors. I’m referring to HB 4531, a bill that would license naturopaths who graduated from “accredited” programs. If this bill were to pass, the only difference between the scope of practice of primary care physicians and naturopaths would be that naturopaths wouldn’t be allowed to prescribe controlled substances and do some minor surgical procedures that MDs can do. My alarm at this prospect has led me to post periodic discussions of the quackery that is naturopathy and why it is quackery.

Over the last couple of years, I’ve been treated to periodic leaks from a closed discussion group known as Naturopathic Chat, or NatChat for short. It’s a series of posts that I like to call Sh*t Naturopaths Say or sometimes “What naturopaths say when they think no one’s listening.” Throughout the series, we’ve seen naturopaths discuss quackery such as intravenous hydrogen peroxide, pseudoscientific defenses of naturopathy, infighting about vaccines in which the rare naturopath who (somewhat) supports vaccines argues with the vast majority who are rabidly antivaccine, and a “naturopathic oncologist” who was reprimanded for treating a cancer patient with unapproved drugs complained bitterly about the injustice of it all.

Well, I’ve just learned of another leak from NatChat, which provides some insight into the latest campaign by naturopaths to obtain licensure in all 50 states by 2025. I learned of the leak from Naturowhat, who Tweeted:

The leaked messages can be found here, and you’ll see that there are several new threads dated June 8. The first order of business on NatChat is to confront a deadly threat, namely a Change.org petition. It comes in the form of a message from Virginia A. Oram ND (the ND to me stands for “not a doctor”), who urges her fellow naturopaths “URGENT, please, let’s all do this!” Basically, she just includes an e-mail from Ryan Cliche, Executive Director, American Association of Naturopathic Physicians.

Ryan Cliche? I tell ya, the jokes write themselves.

In any case, Cliche urged AANP members to complain about a grave danger:

An advocate against our cause has started a Change.org petition at www.change.org/p/naturopaths-are-not-doctors. We need your help to stop this petition.

When on the petition Web page, scroll down to the very bottom where it says, "Report a policy violation."

Click on that link, and include the following within your response:

This petition violates these policies:

Breaks the law - this is defamatory and libelous content Impersonates others; Britt Marie Hermes is not from the United States Terms of service - does not abide by the law or respect the rights of others Thank you in advance for your quick response to this matter. You can also report some of the individual comments found on the page. Our hope is that Change.org reacts to our reports of policy violations in a timely manner.

Thank you for being an AANP member. We appreciate you!

Now this is some seriously funny delusional nonsense. No, I’m not a big fan of Change.org petitions. In general, I think they’re a waste of time. Even though I like this particular petition, I’m not sure that it isn’t a waste of time as well. What it is very, very good for is to use as a concise source of information, a resource if you will, to use to explain to people why naturopathy is quackery and shouldn’t be licensed. For that reason, I like it and think it’s worthwhile for just that purpose. I also admire Britt Hermes, the ex-naturopath who realized that naturopathy is quackery, saw the light, and abandoned it to become its greatest gadfly. (You really do need to read her blog Naturopathic Diaries.) Not surprisingly, naturopaths do not, which is why they are losing their mind over it.

As for the rest about the petition, though, I mean, really? Breaks the law? How on earth does this petition break the law? It doesn’t. It’s defamatory and libelous? How? It’s the expression of an opinion based on facts; that naturopaths don’t like that opinion doesn’t make it defamatory or libelous. It doesn’t “abide by the law or respect the rights of others”? How? What laws are being broken? Just because this Change.org petition says something the AANP doesn’t like doesn’t make it against the law. Apparently naturopathic “reasoning” with respect to criticism is no different than its reasoning with respect to medicine itself!

The funny thing is, though, that in the same dump from NatChat, we learn of just how quacky naturopaths are. For example, there’s a thread. For instance, we learn about the escharotic treatment of the cervix. Michelle Suber, ND of Kamuela, HI asks:

Today I completed the eighth of eight escharotic treatments for a 28 year old woman with CIN1 and high risk HPV. Her cervix has had the appearance, in the last 4 treatments, of one sloughing off epithelial cells. Today, it looked raw and excoriated, even slightly cavitated, not at all what I would expect from the treatment. Now I am worried that the sanguinaria or the ZnCl (and I!) have done harm. I've always been liberal with the calendula succus, but admit that it is sometimes difficult to be sure that all of the bromelain, sanguinaria and ZnCl are completely gone. My patient has ended each session with Wise Woman's Healing Suppositories and is doing immune support supplements and hydrotherapy. The plan now is to follow Dr. Hudson's protocol with alternating suppositories for the next month; then wait one month before repeating pathology studies.

Can anyone reassure me? Does the cervix typically have visible changes with escharotic treatments that heal normally after the following month of soothing treatment? Any suggestions?

CIN1 stands for cervical intraepithelial neoplasia, grade 1. (It's also outdated terminology, but I still hear it used.) Basically, this is a precancerous condition, usually caused by the human papilloma virus (you know, the one we now vaccinate against with Gardasil or Cervarix). Grade 1 means it’s the least serious, the least cancerous-looking. Traditionally, CIN has been treated using various techniques to ablate the abnormal cells, either by excision or destruction. Excisional techniques include cold knife conization, the loop electrosurgical excision procedure (LEEP) as a cone, and CO2 laser conization. The classic technique is the use of a scalpel to excise a cone-shaped piece of tissue. The goals are two-fold: First to make sure there isn't invasive cancer already in the cervix (i.e., biopsy) and, second, to prevent progression to full-on cervical cancer that can threaten the life of the woman affected with CIN by removing all the affected tissue. Alternatively, ablative methods that can be used include, simplistically, freezing (cryotherapy) or burning.

Actually, CIN is a great example of the ambiguity in medicine, as the optimal treatment of low grade CIN is not entirely settled:

Controversy exists over the treatment recommendations for patients with low-grade CIN lesions, primarily because there is controversy regarding the natural history of these lesions. In a review of more than one dozen series including more than 4000 patients with CIN followed-up primarily by biopsy, Mitchell showed that 45% of these lesions regressed, 31% persisted, and 23% progressed. Of those that progressed, 14% progressed to CIS while only 1.4% progressed to invasive carcinoma. In contrast, her review of 353 patients with CIN III/CIS from several series demonstrated that 127 (36%) progressed to invasive carcinoma. While controversy and inconsistently reported results exist, it is generally accepted that low-grade CIN lesions have a high spontaneous remission rate and that most lesions will regress within a 2-year follow-up period.23 Because the time required to progress to invasive cancer is sufficiently long, the risk of invasive cancer occurring during the same 2-year follow-up period is negligible. In the past, it was impossible to determine which low-grade lesions would progress and which ones were more likely to regress. As the technology of HPV detection improves, the use of high-risk HPV testing during observation of low-grade lesions may fill this void.

So, first we have a woman who might not have needed ablative treatment in the first place. Second, this naturopathic quack is using nasty solutions on the cervix to ablate the CIN with sanguinaria (bloodroot). Basically, we’re talking applying the dreaded black salve to the cervix. We know naturopaths like black salve from previous NatChat leaks. As I like to say, black salve is cutting, poisoning, and burning, but naturally. So basically, Suber is applying caustic liquids to this woman’s cervix without knowing what she is doing. In other words, she’s being a typical naturopath.

Next up, persistent vaginal vaginosis, courtesy of Natalie Metz:

I have a patient with persistent bacterial vaginosis (>1 year).

I first saw her for a Pap and pelvic exam last year when I noticed copious discharge, elevated pH, mild odor, and upon questioning, patient reported mild pelvic discomfort with sexual activity. Initial testing showed positive for Gardnerella only.

She continued to test positive for Gardnerella, and negative for Chlamydia, Trich, Gonorrhea, Candida, Mycoplasma and Ureaplasma upon further testing as discharge persisted after a round of Tx with diet, immune boosting herbs, probiotics, and vaginal Boric acid suppositories followed by Lactobacillus suppositories. She later self-treated with a round of Wise Woman #1 suppositories (nightly x 1 month), Diflucan at some point, and eventually did an extended Vaginosis panel from Doctor's Data which revealed clue cells and growth of the following:

2+ Lactobacillus spp.

2+ Enterococcus spp

2+ Gardnerella vaginalis

2+ Staphylococcus spp not aureus

2+ Corynebacterium spp

Possibly Mobiluncus as well per written report....

She has recently done another round of Boric acid and is currently on Lactobacillus suppositories and adding in 1mg estriol this week with Lactobacillus as she is now perimenopausal with some atrophic signs. We just retested this week (there was white foamy discharge with pH ~4.5 upon exam) and are awaiting results. Patient is an ND and we are both a bit stumped after so many attempts, awareness of diet/emotions/ND perspectives/etc....

Or, you could use the standard treatment for bacterial vaginosis, which is antibiotics, specifically metronidazole, clindamycin, or Tinidazole, as described in these CDC recommendations. What I did learn from this is that no condition, no matter how minor, is free from dubious lab panels from Doctors Data and other questionable laboratories. Be that as it may, a fellow naturopath named Heidi Peterson helpfully recommends:

I would recommend vaginal vitamin C ( 250 mg), vitanica bacteria arrest, vaginal colloidal silver or vaginal ozonated olive oil. ( my favorite product phyto-asceptic is back ordered) If she wanted a drug then she would want to consider cleocin ovules. I generally wait to use the estriol until I have cultured and know the bacteria are gone. I have seen the estriol flare bacterial overgrowth.

I’d forget the vaginal vitamin C and use the Cleocin (which is clindamycin).

But what do you do if you’re a naturopath and you have a patient with a staph infection of the hand that recurs after antibiotics? Do you use antibiotics again? Don’t be silly! You use German New Medicine, as Erin Holston Singh suggests:

A staph infection comes when a person has resolved a conflict of separation. The dermatitis is related to the conflict in the active phase (before resolution). Staph is the microbe that is healing/eating up necrotic tissue as a result of this healing. (As the brain makes a new neurological connection because of resolving a conceived 'separation' there is dead tissue that gets cleaned out, hence the necrosis--> staph "infection"). See German New Medicine website for more understanding.

I literally just went through this myself and have put a lifetime of thought and research into it. Consider me your skin expert!

I would treat this as a Staph infection by helping the body chew up this waste....

Allimax minimum 6 caps a day (take as much as she can afford!)
Drainage with Unda's and single homeopathics i.e. 2, 17, 270 + Dulcamara, Sulphur, Mezereum as considerations, or others as you see fit. Sounds like Apis and Belladonna would fit the picture you describe.

Other immune supports:
Vitamin A
Herbal Biotic (Vital Nutrients) or other combo

If she treats this naturally and avoids antibiotics and steroids it will resolve itself within 2-3 weeks completely. IF she takes the meds, it will complicate the healing and take longer because these meds complicate eliminating the waste.

I’ve discussed the utter quackery that is German New Medicine and its bastard offspring, Biologie Totale. So is homeopathy; yet, homeopathy is exactly what naturopaths recommended

Not just naturopathy, though. Heidi Peterson also recommends the quackery that is ozone therapy, either in the form of ozonated olive oil or "bagging" the hand. Another naturopath, Mona Morstein, chimes in, recommending manuka honey and something called Bio-Vegetarian orally, while Sharon Hunter recommended berberine mixed with honey and Vital Nutrients Herbal Biotic.

The AANP and naturopaths talk a good game, particularly to legislators and other lay people who are not in a position to recognize just how pseudoscientific their nostrums are. That’s part of the reason why they’ve had some success in winning laws licensing naturopaths as licensed health care professionals. If HB 4531 passes in Michigan, we’ll see a hell of a lot more patients having CIN1 treated with escharotic treatments wielded by incompetent boobs, with attendant frying of normal tissue. We’ll see a lot more mismanagement of treatable bacterial infections with honey and homeopathic remedies and ozone therapy. Patients will suffer. I am dedicated to preventing that. I hope supporters of science-based medicine in other states where naturopaths are making a major push for licensure feel the same way and act to prevent the ingrowth into their states of the kudzu that is naturopathic licensure.

Our patients deserve no less.

Categories

The cervix comment. Argghhhh!. Insert gif of me vomiting.

Well, regarding the change.org petition:

I think this might not be the right platform for this well-intended goal
https://www.change.org/search?q=GMO
https://www.change.org/search?q=homeopathy

Change.org:
Where a petition named "Save NHS Homeopathy!" received 38000 "signatures".
This site and its supporters do not really care about evidence, as illustrated here:
https://www.change.org/p/costco-stop-selling-toxic-roundup
"Stop selling toxic roundup": ~ 100.000 supporters

There's no shortcut for real-life action, as William MacAskill illustrated during the ALS ice bucket thing:
http://qz.com/250845/this-week-lets-dump-a-few-ice-buckets-to-wipe-out-…

Also there's even some research showing that clicktivism/slacktivism actually leads to people donating and engaging less in the topic (maybe because they already have that good feeling after just sitting in the underpants and signing or liking an online petition)
https://www.washingtonpost.com/news/monkey-cage/wp/2014/03/12/does-slac…
http://www.popsci.com/article/science/just-liking-cause-doesnt-help-int…
http://www.jstor.org/stable/10.1086/674137

TL;DR: Great petition, but sitting in one's underpants and signing change.org petitions is not going to change much (who would have thought?)

ozonated olive oil

Wait, aren't fatty acids oxidized during the preparation of the oil?
*quick wiki search*
Ah, it's apparently the idea. As for effectiveness...
Still, this medication must not improve the smell of the infected tissues.

A staph infection comes when a person has resolved a conflict of separation.

Oh, that's me. I had a staph infection shortly after being born. I guess I was resolving the conflict of being separated from my placenta.

(As the brain makes a new neurological connection because of resolving a conceived ‘separation’ there is dead tissue that gets cleaned out, hence the necrosis–> staph “infection”).

Is this Erin saying that a separation results in necrotic tissue in the brain? I thought it was about skin infection?
I will surmise that the recently divorced mas espouse the first theory.

By Helianthus (not verified) on 09 Jun 2016 #permalink

Naturopathy is a cult. We know how cults handle dissent: with vicious attacks. They have a faith narrative, and the cognitive dissonance caused by reality based commentary is intolerable to them. Deaths caused by substituting delusional practice for medicine are of no importance compared to the damage criticism does to the feels of believers. Their feels are the most important thing in the world. More important than babies' lives, even, as we have seen.

By Guy Chapman (not verified) on 09 Jun 2016 #permalink

Jesus TF Christ. It is an unbelievable level of insanity that people are allowed to pretend to be doctors and there is nothing in place to keep patients safe. Average Joe should not have to delve into any kind of research before selecting a health professional lest they choose one who is pulling everything out of their arse.

There is no other profession in which you can set up shop as an unqualified alternative. There are no alternative lawyers, accountants, mechanics or plumbers. When I take my car to a mechanic, I don't have to know enough about mechanics to challenge him sufficiently to make sure he doesn't subscribe to nonsense theories, he can't call himself a mechanic if he isn't one!

In Australia, complaints about alternative practitioners and their whacky treatments are met with - yeah, but the other quacks say it's standard quack behaviour, so it's ok. Why aren't we asking doctors - the people who actually understand medicine - if what they're doing is ok? If I wanted to set up as an alternative accountant, who should set the standard for practice, me or actual accountants?

It's so nonsensical it makes my nose bleed.

End of rant.

By Can't remember… (not verified) on 09 Jun 2016 #permalink

@ Can't remember my nym

If I wanted to set up as an alternative accountant, who should set the standard for practice, me or actual accountants?

Actually, if you go with the premise that naturopaths and other alt-med practitioners represent a different field than normal doctors, then it's logical that they fix themselves their standard of practice.
It's that is done in about every other field.

That being said;
- a standard of practice is expected to be set; we are still waiting.
- a track of both successes and failures would be nice to support their claims
- naturopaths want their cake and eat it too: they are separate from ordinary doctors, but would like the same prescription privileges. And in this case, it's totally legitimate to ask that they should show an ability to adhere to mainstream medicine's standard of practice, which they don't.

By Helianthus (not verified) on 09 Jun 2016 #permalink

Forgetting for the moment that CIN I is outdated terminology(the current term is low grade squamous intraepithelial lesion, LGSIL), with LGSIL and high risk HPV, there is a risk that this naturopath is treating an invasive cancer with quackery. That patient needs to see a real doctor. Now.

By Michael Finfer, MD (not verified) on 09 Jun 2016 #permalink

Black salve on the cervix??? Oh good LORD.

Staph is a failure of conflict resolution? No wonder community MRSA is spreading like wildfire.

Seriously, though, I shudder to think what will happen the first time some naturoquack diagnoses someone with necrotizing fasciitis with a failure of conflict resolution and the person loses a limb . . . or life.

I sincerely hope that when my primary is unsure of what my symptoms mean, that she does not turn to a chat room for enlightenment. The ignorance on display in the material quoted is shocking, even to a layperson. I trust you are getting this material to Lansing?

By darwinslapdog (not verified) on 09 Jun 2016 #permalink

Having trained in a GUMed Clinic my first diagnosis of someone complaining of a 'foamy discharge' wouldn't be Gardnerella Vaginalis (GVag). It would be Trichomonas Vaginalis (TV).

It's been a few years but, if memory serves, GVag is responsible for a fishy odour and TV is responsible for a foamy discharge (which was memorably described to me as looking like the head of a Guinness).

I'm pretty sure Metronidazole is the drug of choice in treating both conditions (but as I say, it's been a few years since I worked in GUMed).

There are no alternative lawyers, accountants, mechanics or plumbers.

Actually there are alternative accountants. Just ask the people who invested with Bernie Madoff. The catch is that you can go to jail if you are caught practicing alternative accounting.

This might be one approach to take here: to note that naturopaths are to medicine as Bernie Madoff is to investing.

By Eric Lund (not verified) on 09 Jun 2016 #permalink

This might be one approach to take here: to note that naturopaths are to medicine as Bernie Madoff is to investing.

One difference, though, is that Madoff knew he was ripping people off. Most naturopaths really believe their quackery works. To me, that makes naturopaths more dangerous, as true believers are almost always more dangerous than con men.

@Orac:

One difference, though, is that Madoff knew he was ripping people off. Most naturopaths really believe their quackery works.

Yes. A better analogy would be those who engage "freemen on the land" activists as McKenzie friends in divorce courts and the like. FOTL advocates sincerely believe that their bullshit works. Courts absolutely disagree. There is not one single recorded instance where organised pseudolegal commercial arguments (OPCA) have worked.

By a curious coincidence, this is also exactly the same number of times that natural woo has provably cured cancer.

Black salve on the cervix?!?! Good Lord above!!
One of the links I got on Facebook a few days ago was to a post about a woman who used black salve on her nose, with predictable and horrific results. The photos were quite grotesque. I can only imagine what black salve can do to the cervix.

By Julian Frost (not verified) on 09 Jun 2016 #permalink

I literally just went through this myself and have put a lifetime of thought and research into it.

Oh, Erin, why couldn't you have put a lifetime of thought and research into being a bricklayer? You'd do far less harm, and the world will always need bricklayers.

By Rich Woods (not verified) on 09 Jun 2016 #permalink

Oh my lord! I cringed at the salve on the cervix, especially since it's looking "raw". I can't imagine how much that must hurt! As for the vaginal discharge - oh lord. While the Not-a-doc states s/he tested negative for trich, I would wonder how s/he tested for it.

Again, you couldn't pay ME enough to put my health in the hands of these quacks, much less any illness.

My understanding of evidence-based techniques for treating cervical dysplasia (i.e. laser ablation and cryotherapy) is that they are used to specifically treat abnormal areas, not the entire cervix.

I find it hard to believe that naturopaths can precisely apply black salve and other escharotics - meaning that lots of normal tissue is destroyed, with more severe tissue loss and scarring. Consequences could include cervical stenosis and impairment of fertility. The other side of the coin is that smearing on escharotics risks missing areas of serious disease (as in the case of inadequate black salve treatment of skin cancers such as melanoma, where microscopic tumor deposits are left behind to grow and metastasize).

"I’ve always been liberal with the calendula succus"

One hopes this practitioner also uses enough eye of newt.

By Dangerous Bacon (not verified) on 09 Jun 2016 #permalink

Ah, ozone...
Speaking of:

I second your endorsement of Britt Hermes's blog. Wonderfully insightful, and NDs hate her. My kind of place. My only complaint is that she doesn't update it enough. Maybe this new release will prompt something new.

But lack of actiivity aside, one of her more recent posts is about ozone. I didn't see it until a few days after it was up, so my comment didn't get generate any discussion, but the jist was, don't NDs take organic chemistry? Because doctors do, and one thing they might remember is that the effect of ozonolysis is to cleave double (and triple) bonds into aldehydes and ketones (and acids).

So when I hear proposed "treatments" involving ozone, my first question is, ok, what are the olefins that are getting cleaved? And how is that going to provide a benefit? As mentioned above, "ozonated olive oil" is going to be oxygenated (basically, it cleaves the unsaturations in the fatty acids. OK, so what is the effect on pharmocology?

But when it comes to ozonolysis treatments of things like skin (or blood; see Britt's post), the organic chemist in me asks, ok, what are the olefins getting chopped up? Actually, ozone with biological molecules (peptides, nucleotides) just leads to simple oxidation, so is destructive. So what is the pharmocological benefit of doing that?

Ozone is exotic. It's not simple oxygen. It's got three oxygen atoms instead of two, so makes the hyperbaric treatment one better. It must be good, right?

By Marry Me, Mindy (not verified) on 09 Jun 2016 #permalink

<Orac or anyone: Naturopath propaganda alert:

One of the people involved with the new _Holy Hell_ documentary about the Buddhafields cult, is seeking to start a naturopathic TV network:

"Allen, on the verge of his first big film release, and Gleis, who is trying to launch a naturopathic television network, echo similar sentiments."

Source: https://psmag.com/how-to-escape-from-a-cult-in-the-21st-century-d3778a8…

That's all I know about it, but if they're going to try to get a cable TV channel or even a YouTube "channel," it might be worth mobilizing appropriate mass response.

---

Re. honey: It does soothe sore throats and scratchy throats, as I rediscovered during & after a nasty cold, but that's a palliative rather than a treatment. People with zero critical thinking skills probably know honey soothes sore throats, and then translate that to the idea that it's some kind of medicine, and then think it'll cure diseases.

---

Serious impression from reading the NatChat dump: these people are groping around in the darkness, wondering why their medieval remedies do nothing. "I gave the patient Eye of Newt compounded with a dollop of dragon dung dropped while the Moon is in Pisces, and it didn't work! What should I do now?" Eventually the patient's condition resolves and they attribute it to their magic, and become even more committed to magic.

I suspect what's going on there is "intermittent reinforcement." Same mechanism as occurs in bad relationships: Someone is usually emotionally unpleasant to their partner, but occasionally, rarely, they say something nice. The typical outcome is that the partner becomes ferociously loyal to the person who is doing this. Same mechanism as occurs in praying for miracles: Most of the time the deity does nothing (wonder why that would be?;-) but occasionally the deity sends a miracle. The typical outcome is to reinforce belief in the deity.

Same case with naturoquackery: most of the time it does nothing, and occasionally the patient gets better on her/his own, so the naturoquack becomes even more convinced that their magic potions are worthy.

By Gray Squirrel (not verified) on 09 Jun 2016 #permalink

Speaking of Clindamycin: what do you do when the patient says "Last time I took Clindamycin, I came down with C.Diff"...? Seems to me that's a patient who's ripe for the plucking by quacks who claim their potions have "no side effects."

By Gray Squirrel (not verified) on 09 Jun 2016 #permalink

Dear Representative,

While considering HB 4531 please keep in mind that the naturopathic standard of care is to treat severe respiratory distress with homeopathy[1]. When presented with an 8 year old breathing 60 times per minute (over twice the normal range) and gasping, the only correct response should be "call 911", even for a doctor.

It is not just a few bad practitioners that would pose a threat to patients. Irresponsibility is built into the profession at every level: education, licensing, practice. Naturopathy is fundamentally dangerous. By licensing it, the state would be giving tactic approval to practitioners who would harm children by simply following what their own licensing exam says is correct practice.

The state has a duty to protect its citizens and licensing naturopaths would be an abject failure of that duty. Any healthcare profession whose licensing exam features questions where a correct answer would cause harm to a patient, especially a child, should not be allowed anywhere near actual patients.

Sincerely,
C. Krunch

[1] http://www.naturopathicdiaries.com/one-question-nplex-exam/

By capnkrunch (not verified) on 09 Jun 2016 #permalink

Wondering...Are naturopaths required to have malpractice insurance?

Are naturopaths required to have malpractice insurance?

How can you successfully sue someone for malpractice when there is no standard of care?

By Eric Lund (not verified) on 09 Jun 2016 #permalink

Marry Me, Mindy,

If the idea of ozone treatment concerns you, as a chemist, just imagine what they're doing with hydrogen peroxide. Bad enough to imagine their recommendations of drinking it or taking it as an enema -- NDs have also administered it intranvenously. A decade or so ago I seem to recall a wrongful death lawsuit from a guy around here pursuing a quack who gave his wife intravenous H2O2. The resulting embolism killed her.

By Calli Arcale (not verified) on 09 Jun 2016 #permalink

Gosh, do you think post graduate work-like maybe an internship, fellowships, residency, ANYTHING that would be real world experience under an MD's guide-might prevent this guessing game they call practice? I joke about doctors "practicing" their profession, but truly, these folks are practicing, and it's a bad practice at that.

By nutritionprof (not verified) on 09 Jun 2016 #permalink

I joke about doctors “practicing” their profession, but truly, these folks are practicing, and it’s a bad practice at that.

I don't think you can call what these people do "practicing" even in the non-professional sense. When someone practices piano, for example, they have a standard they're measuring themselves against - they know what it's supposed to sound like, and the goal is to get closer and closer to that ideal (only once you've reached at least that level of proficiency can you start to "interpret" pieces.) Naturopaths don't even hold themselves to the standard of someone practicing piano, let alone medicine: they're more like undisciplined kids just banging away on the keys and thinking they're musical savants because they produce the occasional chord by sheer chance.

MSM itself fails to apply current and previous knowledge to problems. Also MSM often fails to acknowledge problems, abandoning patients for decades on end. MSM gets stuck in ruts, whether due to vested interests or not.

The real bottom line here is that the public has systemic problems and failures with MSM and wants more options. The leering OMG and "Dumb and Dumber" routines don't address the underlying problems. If not this bill, what bill will fill the public demaand ? 50+ years of stonewalling is enough.

@prn:
MSM itself fails to apply current and previous knowledge to problems. Also MSM often fails to acknowledge problems, abandoning patients for decades on end. MSM gets stuck in ruts, whether due to vested interests or not.

I'm assuming that by MSM you mean reality-based medicine, rather than the cult of MSM supplementation?

You provide an excellent example fo the Nirvana fallacy. Of course medicine is not perfect, it is a human endeavour. Only idiots and homeopaths think that they are infallible. Medicine has a mechanism for self-correction based on dispassionate analysis of objective data. It is not always perfectly applied, but it is done often enough and well enough that medicine is by now unrecognisably different from what it was 25 years ago, let alone back in the Dark Ages when most naturopathic belief was originated.

Can you give a single concrete example of a practice or treatment that has been abandoned by naturopaths in the last 20 years due to evidence that it does not work, is dangerous, or is demonstrably inferior to another treatment?

By Guy Chapman (not verified) on 12 Jun 2016 #permalink

In reply to by prn (not verified)

@ Eric Lund #24: it depends on what state you're in. In some states you can sue for malpractice if you use the right language: the wanton and reckless act. If the consequences of the act are foreseeable, it doesn't matter if there is no standard of care. In fact, a lack of one supports the wantonness and recklessness of the act.

There is nothing more wanton or reckless in healthcare than quackery.

Thank you once again for this rather horrible report of feelgood quackery and what I can't describe in any other way than learned incompetence and ignorance. I mean, these people took, what, perhaps two years of classes in tooth fairy science, and that causes the sort of damage that is very hard to undo.
Then while reading about the quack ladies discussing their 'treatments', I suddenly had this sensation of familiarity. After a few moments, I realized what it was: when my stepdaughter was seven or eight years old, she and two friends had a 'secret witch club' where they brewed 'witch soup' from garden herbs and orange rinds and honey and coffee grounds and other rather mundane ingredients, albeit in, um, 'exotic' combinations -- and of course the resulting concoctions were meant to work all manner of magic things. The big prize was of course when I or another adult could be persuaded to take a little sip ... oh, the expectation on those little faces ... And sure enough, their charm (pun intended) worked: they got their pizza meal that night, or one of the girls finally mustered enough courage to ask the neighbor boy if they could hang out together. And oh, of course occasionally, I'd start running around making 'argh argh arg' noises and puffing up until red and blue in the face .... hilarious days ....

These women simply haven't grown up. They still think like eight-year-olds withs their secret magic potions. Yet they demand the respect usually reserved for real doctors. It's rather sad, really.

The standard of care for quackery is don't do it. There is real medicine for (fill in condition here).

I would be happy to assist this patient as an expert witness if asked.

By Michael Finfer, MD (not verified) on 09 Jun 2016 #permalink

The real bottom line here is that the public has systemic problems and failures with MSM and wants more options. The leering OMG and “Dumb and Dumber” routines don’t address the underlying problems. If not this bill, what bill will fill the public demaand ? 50+ years of stonewalling is enough.

Unleashing an unqualified, dangerous profession on a medically-ignorant/naive public is the answer? Just because the "public" demands something, doesn't mean they should get it. That's entitlement on steroids.

By Science Mom (not verified) on 09 Jun 2016 #permalink

The real bottom line here is that the public has systemic problems and failures with MSM and wants more options.

Would these be properly researched and understood options, or doesn't that matter? I thought the days of seeking medical relief from hedge-wizards were long gone.

By Rich Woods (not verified) on 09 Jun 2016 #permalink

prn:

First off, your implication is that we should allow the public to pursue naturopathy because mainstream medicine is imperfect. Because something is imperfect is not a reason to completely discard it. (And your comment about "stonewalling" is an extremely disingenuous way to describe a field that has made enormous progress in the past fifty years.)

Secondly, and because we're all polite people who give the benefit of the doubt in debate we tend not to go into this, but most of the public's "problems" with mainstream medicine are actually manufactured by alternative practitioners. The vaccine-autism connection is a prime example, but is by no means an outlier or even particularly unusual. Alternative medicine tends to rely heavily on the principles of Fear, Uncertainty, and Doubt (FUD) in the way they approach their customers, creating the perception of a problem and then conveniently providing solutions for it. "The secret doctors wish you didn't know!" It's very effective marketing. But we cannot assume that because people have fallen prey to this marketing that there is a real problem with mainstream medicine. To put it another way: the rising popularity of charismatic Christian churches does not mean there is a fundamental problem with agonosticism or Judaism or mainstream churches or anything else. It only means the charismatic churches have been doing a good job of marketing. It means absolutely nothing else.

By Calli Arcale (not verified) on 09 Jun 2016 #permalink

I just read the thread titled, "Switching Insulsin (sic)." I couldn't help but grin a bit when the ND asked advice regarding comparable doses suggested the patient was too difficult and they would happily take the patient off their hands. I also wanted to suggest they all look into Dr. Bernstein's Diabetes Solution. For one, it focuses quite a bit on dietary control to manage the numbers, but he also has very specific dosage instructions for insulin. I figured they would like that approach.

They are primary care and don't know how to manage a diabetic patient. That can kill someone rather quickly.

In the pre-cancer treatment thing: granted, they aren't surgeons, so they wouldn't have been part of this, but when my surgeon went over my gall bladder biopsy results she was very excited. It was in the precancerous stage before standard of care recommends you see a liver specialist to evaluate removing part of your liver and lymph nodes.

I wouldn't want these people near that kind of treatment. Naturopathic oncology my eye!

prn @29: But we're not talking about people with complex disorders of unknown eitology. We are talking about people with conditions where the cause is understood (infection with bacteria A, B, C, D) and the treatment is 1) strongly backed by both basic science and clinical trials, 2) well tolerated by most people (and alternative treatments are available for people who do not tolerate the first line treatment), 3) widely available, 4) inexpensive and covered by insurance.

Bacterial infections are one of the things that MSM and SBM have got down pat. And have, for like 50 years.

By JustaTech (not verified) on 09 Jun 2016 #permalink

The real bottom line here is that the public has systemic problems and failures with MSM and wants more options

All together now: "Flaws in aircraft design do not prove the existence of magic carpets" - Ben Goldacre. When the world is mine all alt-med practitioners and apologists will have to write that quote on a blackboard 30C times.

More seriously: the difference between conventional medicine and naturopathy (and all the other forms of "alternative" medicine) isn't that conventional medicine is perfect and alternative medicine isn't; heck, at the most fundamental level it's not even that conventional medicine works and alternative medicine doesn't. The real problem is that alternative medicine doesn't even accept the premise that it needs to "work" by any reasonable definition of the word. There is literally no outcome - including death - that alt-med practitioners will accept as evidence that their treatment doesn't work, so there's no way to separate competent practitioners from incompetent ones, which is what the whole concept of licensure is all about.

Speaking of ozone treatments, when I was a kid, I was taught that ozone in the ozone layer was good, but ozone at ground level was bad. "Ozone therapy" therefore sounds to me rather like "radiation therapy" - conceivably good for you, but definitively scary. I might be convinced to undergo it, but my instinctual stance is hostile.

I mention this because it seems an awful lot of people have entirely different associations with ozone. To them it apparently sounds natural and safe - to me it sounds dangerous and, if not exactly unnatural, then far from its proper place.

By Andreas Johansson (not verified) on 10 Jun 2016 #permalink

And you'd be right. Ozone is considered a pollutant at ground level, and NIOSH sets maximum occupational exposure limits (which I just looked up -- 0.1 parts per million is the limit). Ionizing air purifiers are occasionally recalled for generating too much ozone -- but the quacks will sell you an ozone generator happily. Occupational exposure is a big deal, because ozone is used industrially as a bleach and is produced as a byproduct of many other processes. It can cause respiratory problems if inhaled. It's much more reactive than molecular oxygen.

But hey, maybe if you take a lot of Vitamin C, that offsets it? {snark}

By Calli Arcale (not verified) on 10 Jun 2016 #permalink

The practice of subjecting vulnerable patients to experiments with a toxic plant such as bloodroot (Sanguinaria canadensis) is an excellent example of the antiquated practices of naturopaths who are taught to embrace the romantic notion that so much of what was used in the past just has to be better and safer than the medicines of today. Bloodroot is a lovely ornamental, but as anyone who has study its history would know, internal use is fraught with dangers, including death, and topical use is hardly recommended:

http://www.ncbi.nlm.nih.gov/pubmed/25891030

http://www.ncbi.nlm.nih.gov/pubmed/25046467

By Lighthorse (not verified) on 10 Jun 2016 #permalink

#33 Science Mom
. prn The real bottom line here is that the public has systemic problems and failures with MSM and wants more options. The leering OMG and “Dumb and Dumber” routines don’t address the underlying problems. If not this bill, what bill will fill the public demand ? 50+ years of stonewalling is enough.

SM: Unleashing an unqualified, dangerous profession on a medically-ignorant/naive public is the answer?.
Seems to have worked well for the medical oncologists. I would suggest that you take a good hard look at US oncology practices in the 1960s.

Also there are several parts to this. I don't agree that some disability for part of the population is a legitimate reason to infringe others' rights.

Just because the “public” demands something, doesn’t mean they should get it.That’s entitlement on steroids.
In the limit, a resolution of rights usually means they do. Interference to force an ineffective market competitor isn't acceptable.

#34 Rich Woods
prn The real bottom line...is...systemic problems and failures with MSM and wants more options

RW: Would these be properly researched and understood options, or doesn’t that matter? I thought the days of seeking medical relief from hedge-wizards were long gone.

Degree of required research is an issue. Food based answers are much different creatures than alien new molecular entities.

#35 Calli Arcale
prn: First off, your implication is that we should allow the public to pursue naturopathy because mainstream medicine is imperfect.

Although naturopathy per se is not my first choice, However, I do bridle at this "allow" stuff.

Because something is imperfect is not a reason to completely discard it.

I've never said anything about discarding MSM, but I do think it should have to compete in the marketplaces. I view 'standards of care" more as reference guides, subject to improvement. "Std", fine if that's what you demand, but not necessarily the most up to date or individualized. I wish that practices generally posted more about what standard of care that they project. "truth in labeling".

...your comment about “stonewalling” is an extremely disingenuous way to describe a field that has made enormous progress in the past fifty years.
That MSM still cites lies and misunderstandings that I can punch through on a sick day makes me think otherwise that "stonewall" is reasonably correct.

...most of the public’s “problems” with mainstream medicine are actually manufactured by alternative practitioners.
Our experience is different. Everyone that sought alt med solutions had already struck out on MSM.

Alternative medicine tends to rely heavily on ...FUD
I would have said Hope (desire), warranted or not.
I've gotten the FUD tx and worse mostly from the MDs, RDs and MSM nurses.

#36 Mrs Woo
...Dr. Bernstein’s Diabetes Solution. For one, it focuses quite a bit on dietary control to manage the numbers, but he also has very specific dosage instructions for insulin...
RKB is a former petrochemical researcher and hopeless type I diabetes patient. He makes it clear that he went to med school because of the communication problems with MSM. Even after 40 yrs I don't think he is considered mainstream.

Naturopathic oncology my eye!
A lot of patients use them for natural/nutritional tx in parallel with MSM oncologists to substantially improve their bloodwork and quality of life. Improved QOL and bloodwork ironically often means the ability to take lots more chemo, perhaps with even better interim chemo results. My limited experience is that both systems are often too technically incomplete to work adequately.

#37 JustaTech
prn @29: But we’re not talking about people with complex disorders of unknown eitology. We are talking about people with conditions where the cause is understood (infection with bacteria A, B, C, D) and the treatment is 1) strongly backed by both basic science and clinical trials, 2) well tolerated by most people (and alternative treatments are available for people who do not tolerate the first line treatment), 3) widely available, 4) inexpensive and covered by insurance.
We're actually talking about a lot of pHarmaceutical quackery that goes on, that directly ignores long known medical science and produces unnecessary, extaordinarily visible side effects. Some of it is pretty simple biochem, completely missed by MDs.

Also the minimum infective dose can be greatly changed by health status and malnutrition. Blind dogma has kept MDs from even identifying gross cases of vitamin C and D deficiency.

Bacterial infections are one of the things that MSM and SBM have got down pat. And have, for like 50 years.
That pat sounds a little too self congratulatory in an age of antibiotic resistance and adverse reactions that might have been avoided with cheaper, less dramatic combinations.

#38 Sarah A
All together now: “Flaws in aircraft design do not prove the existence of magic carpets”
Flaws in aircraft design, construction or maintenance lead me to change aircraft or airlines.
Aircraft model affects my choice.

The real problem is that alternative medicine doesn’t even accept the premise that it needs to “work” by any reasonable definition of the word.
Strange, that's like what we've too often seen with MSM practitioners...

....there’s no way to separate competent practitioners from incompetent ones,
speak for yourself

prn said: "That MSM still cites lies and misunderstandings that I can punch through on a sick day makes me think otherwise that “stonewall” is reasonably correct."

No you can't. What you call lies and misunderstandings the rest of us understand as actual medicine. After punching a hole through YOU taking the medical research completely out of context, you have ZERO credibility to complain about modern medicine and how it disseminates, creates and uses medical knowledge.

@prn:

We’re actually talking about a lot of pHarmaceutical quackery that goes on, that directly ignores long known medical science and produces unnecessary, extaordinarily visible side effects. Some of it is pretty simple biochem, completely missed by MDs.

Examples required of this "pharmaceutical quackery".

By Julian Frost (not verified) on 10 Jun 2016 #permalink

Julian, one of the early great examples of medical science was that of digestion, starting almost 200 yrs ago. From this enterprise came acidulents like hydrochloric acid and betaine hydrochloride, and digestive aids like pancrelipase and pancreatin. These days, MDs usually seem unfamiiar with them and maldigestion more generally.

Anyway I had to take care of family matters in a nursing home, a sad state of affairs. One of the first things I noticed was a brand new 3 inch extrapyramidal movement and then vomiting right after dinner started. Really hard to miss.

Being unprepared for the malice and malfeasance of nursing homes, this went on for 3 weeks. After some observation. more failures and growing impatience, I began to suspect digestive problems. I looked up a previous internist with the best conventional pedigree. We reviewed the medications.

"If you choose one script, which is the worst, one that you would remove?"
"That one"
It was Reglan, which had been written for the nausea and vomiting. Reglan was known to cause Parkinson like symptoms and was beginning to attract numerous lawsuits.

So that night we discontinued the Reglan. Also several digestive aids, including the betaine HCl and pancreatin, were added. Overnight the N&V disappeared, all food was eaten with appetite, the N&V didn't recur, and 3 inches of movement became 1 inch in a few days. Later, I requested a test for Helicobacter. Positive, the H. pylori infection was treated with antibiotics but there was no change in the need for digestive aids.

The prescription of Reglan and its continued use was, to me, p-Harmaceutical quackery, another episode.

prn, again you take a personal anecdote and extrapolate that to the entire profession. What naturopathic test and nostrum would have solved your problem?

By Science Mom (not verified) on 11 Jun 2016 #permalink

prn: Reglan increases GI motility. That's how it resolves N/V. And yes, tardive dyskinesia is a common side effect. So what? That doesn't make the nursing home malicious or incompetent. It also doesn't prove that pharmaceuticals are quackery. Reglan is a very effective anti-emetic, anti-migraine medication.

There is no such thing as a medicine that works that is without side effect or adverse reaction. NONE. Even water is lethal in the wrong dose.

It's great you advocated for your family member but your story doesn't mean a thing in the greater scheme of things.

prn, why are you here?  You and your friends have an herbal cure for diabetes (I don't remember if Type I or Type II). You and your friends have cures for numerous forms of cancer, not to mention your relative's GI problems. Why are you here?  Why aren't you out helping your friends to set up clinical trials of all these fabulous cures?

Before you say, "oh, woe, no Big Pharma funding", I will point out that once upon a time I did data entry for an MD in private practice who believed he had a cure for a disease. Not a whole slew of diseases, like you, but just one. He had reviewed all the literature on the disease and, like you, concluded that every researcher in the world had missed the cause of the disease, but he knew wbat it was and therefore could devise an effective treatment. So unlike you he set up and funded out of his own pocket a clinical trial and some other experiments, worked at it for three years, and reported his results.

His trial was neither randomized nor blinded, but his results were so good, and so meticulously documented, that the big guys got involved to do the randomized, blinded trials. You know, I googled his treatment a few years back, and after decades it was still one of the first-line treatments.

I get really annoyed with CAM fans who whine that they have a cure but they can't prove because of wicked Big Pharma. Do what he did. Set up a trial, do it right, and report the results honestly. If you really have a cure for anything that's better than the standard of care, prove it!

SM @47:
What naturopathic test and nostrum would have solved your problem?
A therapeutic trial with digestive aids....

Use of digestive aids is petty rare in MSM these days, like mostly for CF. Even then, the CF patients comment about how hard it is to find experienced GI drs to handle pancrelipase.

Hopefully the anecdotes help those folks that are so ignorant about CAM by illustrating more realsitic treatment differences, and common, widespread problems with MSM. Sort of
"Real CAM for Dummy Doctorates, RDs and nurses"

This Naturopathy = Homeopathy = 200C gets tiresome when so many here are working from a solid foundation between N=0 and -273C.

prn, you didn't answer the question. If medicine is so wrong all the time then what would your precious sCAM practitioner have done to resolve your problem?

By Science Mom (not verified) on 11 Jun 2016 #permalink

prn, so your anecdote was that somebody in Mainstream medicine correctly identified a drug from a shortlist, based on side effects...

...How many CAM practitioners, you feel, would have done that, rather than try to discontinue all of them for whatever they were peddling at the time?

Which, do you think, is the more irresponsible thing to do?

And at least in response to your latest anecdote, nobody has mentioned Homeopathy or that naturopathy is nothing but. So I can only diagnose that as a doing the straw man and deflecting the question.

Andreas Johansson @39: "I mention this because it seems an awful lot of people have entirely different associations with ozone. To them it apparently sounds natural and safe – to me it sounds dangerous and, if not exactly unnatural, then far from its proper place."
It comes from the old myth - common in my childhood - that the sharp, fresh smell you often get at the seaside is the smell of ozone and it's somehow good for you. It's long been debunked, of course, but myths take a long time to die.

By Mrs Grimble (not verified) on 12 Jun 2016 #permalink

#52 Science Mom
#53 gaist

I had two outside licensed physicians. One high end MSM dr and one CAM oriented dr. I had both sign all my paperwork for several months. We were able to reduce the polypharmacy - eliminate some drugs, reduce one drug 2/3rds, and increase one drug for much better performances (all ultimately under the CAM dr's signature).

Mature people address issues based on the resources that they have. At first the MSM dr tried to dominate the CAM dr, laying little traps that the CAM dr could laugh at and politely deflect. The real problems were with the nursing home sr staff doing egrigious stunts.

panacea
Malicious means exactly that, including theft, rts denials and assault.
Incompetent, is being behind on blackboxed drugs, not changing in the face of a tortious adverse reaction for an obviously ineffective drug, Especially with a far superior treatment performance demonstrated without the side effects.

prn, why are you here?  You and your friends have an herbal cure for diabetes (I don’t remember if Type I or Type II). You and your friends have cures for numerous forms of cancer, not to mention your relative’s GI problems. Why are you here?  Why aren’t you out helping your friends to set up clinical trials of all these fabulous cures?

prn,

I am probably one of the most sympathetic ones here to your idea that MDs do not listen to patient complaints of side effects and that their thinking runs in narrow channels but you haven't shown me any reason to think that CAM practices will be not be anything but worse.

It's great that you ran across a CAM practitioner that was able to navigate this particular instance but I see that no different than a friend of a friend who happened to have something similar and advised you on the same. Or even Google which is where I found out about sub-clinical hypothyroidism, but I doubt this is anything but an unusual case as far as CAM goes.

Why would I think that the odds of getting help from a CAM non-doctor would exceed the odds of getting help from an MD when I see how clueless those selling alt med are from the examples cited on this blog. Or even my own experience with one. I went to a Bayster grad and she was as pathetic as the examples here for attempting to treat something I did not want treated, selling the supplements she recommended and experimenting with dosages to exceed anything reasonable or safe.

By Not a Troll (not verified) on 12 Jun 2016 #permalink

#56 LW
LW:prn, why are you here?

First, I'm not a mind reader. Conversations here help me fill in others' thought bubbles IRL. Also, there is a lot of misconception and ignorance about biologically oriented CAM here. Even small improvements here probably yield societal benefits in terms of misery and conflict.

You and your friends have an herbal cure for diabetes (I don’t remember if Type I or Type II).
Mmmmm, that "cure" stuff and that lumping together sounds suspicious, I am not much of an herbalist.

There are potential nutritional treatments for both. Treatments for Type I are likely to center around recovering some function in marginal beta cells, eeking out some trace of insulin. Types II has lots of nutritional treatment recommendations for various aspects.

You and your friends...
There it is again. Yesirreee, massa

...have cures for numerous forms of cancer W
I literally don't even claim one cure for one cancer even though some MSM drs think I am hitting in the miracle leagues.

Why aren’t you out helping your friends to set up clinical trials of all these fabulous cures?

Uh, I'm a little busy learning to keep people alive and supplied as well as clean up the messes of life.

Even if I were to rigorously follow the example of Richard K Bernstein, including his lag times, that means I'll be starting med school in about 10-20 yrs... RKB still hasn't gone mainstream after 50 yrs of effort for one illness.

prn, I apologize if "your friends" is the wrong term. I wasn't sure what to call them -- you don't make clear if they are MDs, NDs, people on the Internet, or what. Would "your acquaintances" or "your correspondents" work better?

As for diabetes, quote:

http://scienceblogs.com/insolence/2016/05/27/yet-another-woman-with-bre…

If you were diabetic or borderline before, and now you are running HgbA1C 4.5 – 5 without medication, maybe you’re doing something right.

That sounds to me like you are claiming that you know or know of someone who has a way to cure diabetes so that the diabetic can be healthy without treatment.

If these effective treatments you constantly reference really exist, it is not necessary for you personally to conduct a clinical trial. Why aren't you pushing those who already have the expertise, and urging them to get to work and prove it.

Please explain where in the story you told us there was theft or assault.

Please explain how malpractice occurred simply because a black boxed drug was used. Please explain WHEN this occurred, since Reglan has been in use for a couple of decades at least. Please explain how a side effect is malpractice.

Your story has a lot of gaps and assumptions in it, and we don't have the other side of the story which might be very different from yours.

As I said earlier, given your history of distortions, you don't exactly have a lot of credibility.

My mistake, prn. It appears that you were referring to two MDs, one of whom leans towards CAM.

Perhaps he is just the better doctor overall. However, what about CAM interests him? Just the nutritional supplements? Off the beaten path research studies?

By Not a Troll (not verified) on 13 Jun 2016 #permalink

Anyone who makes a Change.org petition unironically needs to be shot anyway.

By Under the Bridge (not verified) on 14 Jun 2016 #permalink

@prn - the Dr Bernstein book required and irony font, and for two reasons: one, because his protocol, opinions and books are not mainstream (making him likely to be much more credible to an ND); and two, he has a very detailed discussion regarding insulin and diabetes management in the book.

As a rather recent diabetes patient who disagrees with her doctor about safe post prandial numbers, I am on my own quest for management, because my doctor loves 180 or so for two hours post prandial. I want 140 or below, which seems impossible with the ADA-recommended carbohydrate amounts the dietitian assigned me.-

*an irony font

@ Mrs Woo:

Interestingly, my cousin, a retired nurse, found out that she had diabetes and enrolled in a governmentally sponsored education/ exercise group which advocated extremely low carbs for the first months. She was very happy with her progress and lost quite a bit of weight- her numbers have remained good for a year or more despite upping the carbs.

By Denice Walter (not verified) on 16 Jun 2016 #permalink

Accountants aren't licensed. Anyone can call themselves an accountant. There are plenty of "alternate accountants" ruining other people's finance. It beats ruining their health, I guess. They have an advantage in that unlike nurses, doctors, etc. they can call themselves accountants.

Like many accountants, I am a CPA who does not do any CPA work. That's because CPAs are licensed and everyone knows a CPA has a certain level of education and competency. Every high level accounting job asks for a CPA, and most people don't even know what it is that a licensed CPA is allowed to do that other people can't.

By Christine Rose (not verified) on 19 Jun 2016 #permalink