I'm a primary care physician. What I, other internists, pediatricians, and family medicine docs do is prevent and treat common diseases. When we get to diseases that require more specialized care, we refer to our specialist colleagues. There is a movement afoot to broaden the role of naturopaths to make them primary care doctors. The big difference between naturopaths and real primary care physicians (PCPs) is that naturopaths haven't gone to medical school, completed a post-graduate residency program, and taken their specialty boards. Why is this important? If a naturopath wants to be a PCP, then they must provide the same services as other PCPs. They do not. What, you don't believe me? The thing is, naturopaths have an incorrect understanding of human biology and do not understand how this is applied in a science-based fashion to prevent and treat human disease.
Naturopathic "physicians" claim that "the human body has an innate healing ability" and that they "teach their patients to use diet, exercise, lifestyle changes and cutting edge natural therapies to enhance their bodies' ability to ward off and combat disease."
I must admit that I don't get it. As a primary care physician (the real kind) I talk to my patients every day about diet, exercise, and lifestyle changes. I'm not sure what "natural therapies" are---all of the medications that I prescribe are "natural". What is the opposite of natural? Unnatural? Supernatural?
As a primary care physician, I see a lot of common, serious problems, like diabetes and hypertension, and coronary heart disease. Coronary heart disease (CHD) is the biggest killer of Americans, and hypertension (high blood pressure) and diabetes are two of the primary causes of CHD. The next most common killer of Americans is cancer. If naturopaths want to be allowed to practice primary care medicine, they better be prepared to diagnose and treat these conditions in a way that is proven to help patients.
Let's take a look at the website of their main professional organization, and see what they recommend for, for instance, hypertension. I'm choosing hypertension because their website doesn't have a section on diabetes or on disease prevention.
First I'll tell you a little bit about how doctors approach hypertension. High blood pressure leads to heart attacks, strokes, kidney failure, and blindness. Untreated hypertension is one of the biggest health problems in North America. Because hypertension is so common and has so many disabling and deadly consequences, it has been studied quite well. We have learned over the years which type of patients benefit from which blood pressure goals and from which interventions. For example, the ALLHAT trial was released a few years ago. This study followed tens of thousands of people with hypertension and found that a simple and inexpensive intervention (a thiazide-type diuretic pill) was very effective at preventing serious coronary heart disease.
When I tell a patient that they should start a blood pressure medication, they are often hesitant. They often ask if there is another way to lower blood pressure. This has been studied as well. For example the DASH diet has been found to lower blood pressure significantly (from about 4-7 mmHg for the systolic pressure). If I have a patient with mild hypertension, this may do it, if they can stick to the diet. However, most of my patients don't have stage I hypertension (a systolic BP from 140-159), and even in those who do, the gains from following the DASH diet are minimal. If I get a patient to really stick to it, maybe I can get their BP from 158 down to 152. That's not very good. Most practicing PCPs know that diet and exercise will achieve good blood pressure goals in a minority of patients. Still, when it's safe, and the needed goals are modest, we recommend it as first line therapy, especially for pre-hypertension.
In summary, the evidence tells us that we must lower blood pressures to save lives, and that diet and exercise are good enough in a small percentage of patients. We screen for hypertension and its complications, and then prescribe diet, exercise, and/or medications to lower our patients' risk of becoming ill.
What do naturopaths have to offer? It's not clear to me from reading their literature how they approach screening, but let's say they have identified a patient with hypertension.
The website of their national organization gives some good information about what hypertension is and why we should care. What it doesn't do is explain how they will effectively treat it.
To treat hypertension, naturopaths might counsel patients on eating a healthier diet. Following the DASH (Dietary Approaches to Stop Hypertension) diet includes lowering sodium intake and eating nutrient-rich foods like fresh fruits and vegetables, low-fat dairy, and eating a diet rich in potassium, magnesium, calcium, and fiber. Again, prominent national studies have shown the DASH diet has been shown to be as effective as drugs at reducing blood pressure.
Well, real doctors make those same recommendations. The last sentence is simply false. DASH is not as effective as medication for many hypertensive patients. For some, sure, for others, not at all.
Supplements are also a low-cost and effective way to reduce high blood pressure. Natural diuretics, dandelion and parsley can be used to control blood pressure, although evidence suggests they must be taken in high doses to be effective, (Alternative Medicine Review, 2002). Increasing potassium consumption has shown to reduce the risk of stroke in patients with hypertension by 41 percent (Journal of the American Nutraceutical Association, Houston study, 2002).
Let's review our goal here. Our goal is to treat hypertension in such a way as to reduce the risk of cardiovascular disease and death. This needs to be done in a way that is proven to work, and is tolerable to the patient. Here, rather than recommend medications that have been proven in large, randomized controlled trials to not only lower blood pressure to to actually achieve these goals, they recommend "natural diruetics". I also reviewed the article that is (barely) cited. The article is a review of hypertension and the naturopathic approach to its treatment. It is frankly quite frightening. It reviews the biology, and then makes fantastical claims. For example, it ironically compares various nutrients in their ability to "mimic" various classes of blood pressure medication. Then, rather than comparing the efficacy of the supplement to the known efficacy of the drug, it simply recommends using the supplement. If a real doctor did this it would be called "malpractice".
I can find no naturopathic references that explain what the "doctor" should do when the unproven concoctions fail to control blood pressure. Does this mean that their potions work on everyone, that they have no failures? More likely, they have nothing to offer. Perhaps the good ones refer to a real doctor at this point.
This brings up an important question. If a naturopath wants to be a primary care physician, and yet must refer patients to a real doctor for common problems, what's the point? A PCP must be able to effectively treat common conditions such as diabetes and hypertension. If they can't, they're in the wrong field.
There is no justification for allowing naturopaths to be primary care physicians, and if what they print is accurate, there is no justification for them to treat any patient for any condition. Naturopathy is modern shamanism, and should be banned.
Previous posts on naturopathy here.
A naturopath was invited to my medical school and began his lecture by saying he hoped we would all support his lobbying effort to license naturopaths as PCPs. What followed was an attempted justification (not compelling to me) for the naturopath's focus on diet to treat just about everything. Interestingly, the speaker barely mentioned the "natural" ideology or the implausible modalities (e.g., acupuncture and homeopathy) that are prominently featured on his professional website. Sounds like a bait-and-switch to me...
Man-- wouldn't a naturopathic PCP be legally and ethically required, in the event of REAL disease, to say, "Iunno, go see a real doctor!" ? They sure ought to be.
On a personal note, I am trying so hard to refrain from whining about my cholesterol to the blogging docs I know. (Whine, whine, whine.) I made all these AWESOME lifestyle changes, lost sixteen lbs, and my serum cholesterol only went down 20 points, grrrrrrrahrrr! AND my triglycerides went up ten points!!! (Still only 86, but GAH!!!! UP ten points!!!)
Anyway. Still sticking with eating my greens and exercising. Given a few more months that LDL number could get into the range I want. But now-- with added bitterness!!!! :D
Increasing potassium consumption has shown to reduce the risk of stroke in patients with hypertension by 41 percent
This claim alarms me. What if a patient on spironolactone reads it and decides to start taking potassium supplements? The results could be deadly.
What naturopaths (and the general public) don't seem to understand is that any intervention that is powerful enough to have a real effect is powerful enough to be dangerous. If you alter your body's chemistry it has consequences, whether the alteration is achieved by eating herbs you dug out of the ground yourself or the highest tech pharma product on the market.
One minor quibble: I don't think there's anything particularly 'modern' about their shamanism.
modern, in the sense of "present day"
I'm suffering from acronym collision today: to me, "naturopathic PCP" sounds like, ah, "all-natural, low-fat, high-fiber, extra-crunchy angel dust granola".
as someone who had multiple "chronic" conditions:
Irritable Bowel Syndrome
I was not cured until I turned to alternative and naturopathic medicines. EVERYTHING that I was given by western docs did nothing but mask symptoms and in some cases gave me bad side effects (with endo we're talking REALLY bad side effects) or alternately didn't help at all.
All of those condition have cleared up once I discovered food sensitivities and once I healed my gut in ways they don't even teach in traditional western medicine...
You are being an arrogant fool to not consider that their might be something to learn outside of your discipline.
I spent years giving people like you money and never got results.
I'm flabbergasted at my good health today. And I don't have to take a single pharmaceutical.
And other people became seriously ill or died because they went to naturopaths — hundreds of them, and those are just the ones who got written up in the newspapers. Isn't it important to figure out which medicines work and how and what side effects they have, instead of relying on the say-so of the lucky few who just got, well, lucky?
over 100,000 people die a year as a result of pharmaceuticals a year...you don't really want to go down this road do you??
this is the only citation I can find right now...I'm in the middle of making dinner for guests...but you can look it up in MAINSTREAM media outlets...it was all over the news about a year ago...
it's also real interesting and unfortunately telling that you show no interest in my improved health.
Monica, as someone else who has multiple chronic conditions, I'd probably be disabled or dead if I'd not gone to a "western" doctor. Congratulations on your good health.
Per AANP's "supplements are also a low-cost and effective way",
NDs do love to sell supplements as if they have this 'parallel pharmaceutical arsenal', except 'natural'.
If it's of any interest, here is some personal experience in ND school [I never call it medical school] in terms of the shamanistic and 'theo'-whatever [woven into a naturocrit post about this WCU post]:
Monica, I too have a positive anecdote about a naturopath. A friend's sister was having serious GI trouble. She went to her regular doc. Doc said, hmm, that's not good, I'll send you to this GI specialist. GI specialist runs tests, says, well, to be honest, I'm not sure what you have. If it is X, the only treatment I can recommend is prednisone, and that's not a good thing. They discuss radical diet changes, and she has many test for food allergies, of which she has many.
At some point friend's sister goes to board-certified naturopath (whatever that means). Naturopath recommends specific diet changes. Friend's sister feels better.
What's the point? Rather than replacing the PCP with a naturopath, FS uses the naturopath as a specialist, in coordination with allergist and GI specialist. So while some naturopaths might help with specific conditions, particularly those that aren't well understood scientifically (IBS), they are not real doctors, and I think that there is no reason to bring in the "evil pharma" stuff.
I'm glad you are feeling better.
well good for both of us Donna we both fared well in the end.
...is it possible there is a place for both types of medicine...I'm not claiming western medicine is never an appropriate method...but it seems people here think it always has the answers which is simply untrue and that alternative care is a sham.
western medicine made me very sick. I didn't go into just how sick and I'm not going to.
and now I'm well..
why can't we see the strengths and weaknesses of different systems...us and them thinking is not healthy for anyone.
calling naturopaths and proponents of alterative medicine shamans or witch doctors is not productive and insulting, I've seen immense positive changes in hundreds of people through alternatives.
I did not call all western medicine a sham...all I did was suggest it was arrogant to not consider there might sometimes be answers outside that discipline.
you call what I've seen heal me and many others some sort of hoax.
we cross posted...I hadn't seen your post..thanks.
There's one arithmetic. There are no "alternative" accountants.
Science, like arithmetic is one system involving tests of corroboration, falsification, logic, and parsimony.
I don't get your point...there is nothing unscientific about what cured me. Just because you haven't studied it doesn't mean there isn't a scientific foundation to it...and what's more you don't even know what I did, so you're making assumptions without even finding out what I did...
I'm not anti-science and I've studied this stuff.
In any case...it's clear I'm not going to change any minds here and I've been frustrated enough...
you guys go have fun in your limited world. I'll gladly take what both worlds have to offer when appropriate.
The point is that whatever you believe cured you should be put to the test. We need determine that what you did actually works, and that means scientific study. If it works, then it's evidence-based medicine and will be used by doctors.
As for 'alternative and naturopathic medicine', either it actually works, making it real medicine, or it's just a placebo effect. Given how many different alternative therapies show no statistically significant difference from placebo, the prospect of a naturopath finding some amazing new therapy seems dismal.
Dietary changes are understood to be useful. That's the whole reason why dietitians exist. What annoys me, and probably others here, is how diet is vastly overblown by some naturopaths. Dietary changes are not a cure-all; they work in specific cases.
Also, there's the problem of discerning medicinal effects from placebo effects from the normal remission/relapse cycles of chronic diseases. Your personal experience could fall under any of these headings. Without a proper study, how can we know?
There aren't two worlds here, Monica. It's one world of medicine, and it contains what's shown to work, considers what's unproven, and eschews the disproven.
10), And what does it unfortunately tell you, Monica? That because he didn't immediately congratulate an obnoxious ignoramus on her clear skin and intestinal regularity that he's a selfish prick?
And I'll bet that those naturopaths never even ask hypertensives about sleep patterns, either.
Sleep apnea is a sore subject personally. Doesn't affect me, but probably was high on the list of what killed my father when he was only a bit older than I am now.
The conditions you have - psoriasis, endometriosis, and IBS all have periods of natural remissions and can go from bad to better to worse regardless of therapies.
What are you taking and doing for them - from the naturopath - and how long have you been improved?
yeah they should be put to the test...but you guys and pharma tend to make that very difficult...
also all the docs I went to actually had MDs!! they also all said they thought medical school was systemic brainwashing...but they all HAD YOUR TRAINING!!
I also know they collaborate and work with naturopaths...I'm a social worker...i work with medical professionals all the time and have done my own studies...
the fact is I know what's happened to MY body and how it responded to stuff...how if I eat something my body doesn't like I have a flare...that is not consistent with remission...it's consistent with my doing the right things to keep myself healthy...
so you guys are toast it's so incredibly insulting to be dismissed like this and it was my experience with most trad docs when I was trying to get help...you guys are always right...they didn't give a crap about what helped me they just looked at me as a pathology...not as a holistic being...
anyway...I really need to stay away now...you guys are sad.
Speaking of naturopathy and related issues, have you seen this?
I'm not sure why taking concentrated doses of vitamins--trace elements in food--is any more natural than, say, taking concentrated amounts of sucrose in soft drinks, but naturopaths seem to go for megadose vitamins fairly frequently.
No, Monica. We are nearly always wrong about most things. We are easily fooled, sadly, particularly when it comes to how the body feels.
Nature programmed us to develop strong cause-and-effect convictions concerning our bodies. If we eat something and later feel nauseated, we'll feel in a convincing way that the thing we ate made us sick.
These natural rules of thumb must have helped our ancestors survive. But like most rules of thumb, they don't apply in all situations. In fact, they may only help when we've no better information to guide us.
Because we're wrong so often, we developed the methods of science to check and correct ourselves. Science remains our best hope for seeing reality as it is apart from the distortions introduced by our feelings.
Naturopathy is an anti-science philosophy built around vitalism, or the belief in a life force that prevents disease. So naturopaths are not scientific.
Many MDs for one reason or another are also non-scientific or even anti-science in certain of their practices. But the standard in medicine remains science.
As I understand it, Doctors in the room please sound off, most modern 'western' medicine is developed from organic compounds that originated in a plant (see Herb). Plants are studied, interesting compounds inside them are isolated and tested. If they seem to have some sort of effect on the body that is positive, attempts are made to harvest or synthesize them to create a drug which is then forced to be tested by many different people and organizations before it can be sold as a drug. There is no such thing as an unnatural medicine. The difference between a doctor and a naturopath is that a doctor has to prove his claims. Do you think the big evil pharma companies would reject the idea of being able to sell drugs without bothering with the very costly processes of Proving efficacy?
Also, the reason nobody congratulated you on your health until after you demanded it is simple. You are a relatively anonymous person. For all we know, you could be a guy named bob who is dying as I type this. And as they pointed out, even if we operate on the assumption, which as skeptics, we try to avoid assumptions, we still wouldn't have all the facts about your medical history. Most people don't even know their own history, things go undiagnosed all the time. There are literally, more factors to your story than we can count, let alone name and address. This is why we have the scientific process and massive double-blind experiments. If we relied on anecdotal evidence, we would still think the world was flat.
Irritable Bowel Syndrome
As I recall, not only do those three things wax and wane, but two of them have a psychological component. (I have only had issues with rashes, peeling skin with open cracks, turned out to be a nickel allergy. So I avoid touching nickel, though that is not that easy but I have managed to only get a breakout once every few months, and without the bleeding cracks in my fingers I used to have --- all because my family doc took one look and said "Oh, you are allergic to nickel. First stop wearing the wedding set since nickel is used to harden the gold".)
But to summerize what Mike said: The plural of anecdote is not data.
(and that includes my anecdote)
anyone else do a double-take at "journal of the american nutraceutical association"? maybe it's just me.
I suspect that your research on "naturopaths" and "naturopathic medicine" is as biased, self-serving, and lazy as the approach to research you describe (and attribute to) all naturopaths. While "all" naturopaths are probably not guilty of relying on poor-quality research (or none at all), it seems that you may believe this to be true with a capital "T."
Your statements below demonstrate an extremely polarized, absolutist viewpoint. Unfortunately, I don't believe you've documented your conclusions very well. Where's the research? Where are the interviews, the surveys, the quantitative and qualitative studies you've examined? Where's your meta-review of naturopathy or naturopathic medical practices?
I hear an arrogant, reactionary, and relatively baseless opinion in your blogpost, rather than a reasoned and thoughtful exploration of the issues concerning the relative merits (and demerits) of naturopaths and primary care physicians (in terms of handling the patient populations they both seek to serve).
An excerpt of your blogpost that I find particularly useless (as far as providing incisive, penetrating analysis of the questions you raise), is as follows:
"This brings up an important question. If a naturopath wants to be a primary care physician, and yet must refer patients to a real doctor for common problems, what's the point? A PCP must be able to effectively treat common conditions such as diabetes and hypertension. If they can't, they're in the wrong field.
There is no justification for allowing naturopaths to be primary care physicians, and if what they print is accurate, there is no justification for them to treat any patient for any condition. Naturopathy is modern shamanism, and should be banned."
Given the seemingly casual approach you've taken to examining and exploring naturopathy, I find myself thinking, "Ah fooey! He's just worried about NDs invading his turf and scarfing up some of the money!"
Of course, that may not be your intent at all. Maybe you have some other (unspoken, implicit, opaque) fear that leads you to make brash, unsupported statements about ALL naturopaths and the WHOLE naturopathic medical industry.
Surely you would have done more research on the topic before coming to such quick, absolutist conclusions, if in fact you're primarily and truly concerned about potential harm to the patients that seek treatment from NDs.
Sorry... couldn't resist...
"Conventional medicine is a pathway to many abilities that some consider... unnatural"
Aviva Gabriel wrote:
"I suspect that your research on 'naturopaths' & 'naturopathic medicine' is [...] biased, self-serving, and lazy [...you're] extremely polarized, absolutist [...] absolutist conclusions [...] I don't believe you've documented your conclusions very well [...] where's your meta-review of naturopathy or naturopathic medical practices [...] I hear an arrogant, reactionary, and relatively baseless opinion in your blogpost, rather than a reasoned and thoughtful exploration [...] he's just worried about NDs invading his turf and scarfing up some of the money [...] make brash, unsupported statements about ALL naturopaths and the WHOLE naturopathic medical industry."
Wow. Medicine is not an industry, it is a profession, and is held to the standard "credat emptor" not the lower standard in commerce of "caveat emptor."
There are two great logical constellations that I like to use concerning naturopathy:
i. naturopathy claims that it is a branch of medical science
naturopathy is based upon and requires a belief in vitalsim
vitalism is profoundly science-ejected for, charitably, several decades
ii. naturopathy claims that it is a branch of medical science
naturpathy is based upon and requires a belief in the supernatural
supernaturalism is profoundly science-ejected for, charitably, a couple hundred years
Who is lazy! Who is biased! Who is absolutist?
Science is never absolute.
And I've done the work / documentation, and I cite such just to indicate that critics of naturo. actually know what they're talking about...and NDs don't.
Brash / unsupported?
Why should they get a place at the table when they are so incompetent / unethical about science, and science is the basis for medical knowledge?
As the knights say in Stronghold Crusader: "this is too easy!"
Primary care docs don't worry about competition. They want more colleagues to share the load, which is pretty dire in many areas.
Naturopaths believe in vitalism. Their whole approach is about balancing some unproven "life force" to prevent disease. It's in their core textbook.
Vitalism is religion not science.
"Surely you would have done more research on the topic before coming to such quick, absolutist conclusions, if in fact you're primarily and truly concerned about potential harm to the patients that seek treatment from NDs."
When it comes to absolutism, QUICK, I absolutely want science-based medicine for all my medical treatment needs!!!
I need to get that on a MedAlert bracelet. Or maybe I'll just have it tattooed to my chest. Alongside my DNR. ;)
When it comes to absolutism, QUICK, I absolutely want science-based medicine for all my medical treatment needs!!!
I need to get that on a MedAlert bracelet
Hey, living in Arizona makes for some stress on that front. On the one hand, we have some very decent advance-directive laws and the Secretary of State has a good AD registry complete with wallet cards that allow caregivers to look up the AD online.
On the other hand, we have the University of Arizona, Woopathy as licensed care, and Andrew Weil.
I try not to think about the crapshoot that emergency care involves around here. It's bad enough having to interview potential PCPs to find out if their "medical education" included homeopathy -- and then read between the lines on whether the brainwashing took.
Signs point to Weilâ¢ as patient zero in the present quackademic infestation.
Someone with time should chart a family tree for the IM faculty and where they trained. A number seem to have passed through Arizona. Another variant has indirect connections to Osho.
Sounds like doctors are feeling threatened by naturopaths. My family doctor has done nothing to prevent, alleviate or cure any of my health problems. However, when I turned to alternative therapies and practionners, well lo and behold, my problems have started to disappear. Today's doctors are nothing more than representatives of the pharmaceutical companies that sponsor their numerous luxurious vacations, etc. So of course they will prescribe drugs, drugs and more drugs. I don't want to poison my body with more drugs but rather help it heal itself through natural therapies. Move over MDs and welcome a new generation of naturopaths, chiropractors, etc, etc.