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Naturopaths as Primary Care Providers: What They Do Not Want You to Know

The author contends that naturopaths do an inferior job at primary care, falling short in cancer screening and vaccinations.
October 21, 2015

OPINION -- Concerning A Win-Win for Oregon: Naturopathic Doctors as Primary Care Providers [1] It is wrong from the opening paragraph. Naturopathic doctors who absolutely meet the standards of care as required by the state are an underutilized resource and diagnose and treat the entire gamut of conditions. Naturopaths may meet the standards required by the state, but they lack virtually all the requirements needed to diagnose and treat the entire gamut of conditions as primary care providers. The opinion piece is filled with half truths and appealing platitudes. But it is what is not mentioned, what THEY do not what you to know, are the facts that reveal NDs should not have been declared primary care providers by the legislature. One constant is that naturopathic medicine is founded in science—NDs are required to study the basic, biomedical and clinical sciences for two years. Although allegedly grounded in science, science is ignored in vast swaths of ND education. Practices divorced from reality - homeopathy, acupuncture, colonics, and energy medicine among others - are the basis of ND education. Pseudo-science is baked into the ND education. And time spent in the pseudo-sciences is time not spent in reality based medicine. For a sobering description of the reality of ND education, I refer you to the Naturopathic Diaries [2], written by an ND, a graduate of Bastyr. As persistent myths are clarified about our practice, licensed states have doubled, active NDs in the field have tripled, and NDs in Oregon are licensed primary care physicians. Less a clarification of persistent myths and more successful advertising. The licensure of NDs by Oregon is, unfortunately, the medical equivalent of legislating astrologers to be the equivalent of astronomers or alchemists to be the equivalent of chemists. Our foundation is anchored in natural healing, including botanical science, nutrition, hydrotherapy, physical medicine among others.

Among others.' As usual they fail to mention all the pseudo-medicines that are the life's blood of the ND practice. A perusal of ND websites finds almost every curious practice imaginable, from homeopathy to craniosacral therapy to plant stem cell therapy to the O-shot to detoxification. There is no ND that avoids pseudo-medicines and no pseudo-medicine not used by some ND in Oregon. In the past 20 years there has been an increasing focus on other therapies our patients require—pharmaceuticals, for example, broad lab testing, and a proliferation of natural research.

Questionable and unvalidated lab tests, from Lyme to saliva tests to hair analysis to live blood analysis to bio-meridian analysis, are also part of the ND pseudo-medical armamentarium. Just as there is no pseudo-medical intervention unused in ND practice, there is no pseudo-scientific test not utilized. NDs know from clinical experience and years of education the interactions that can arise between a prescribed herb and, say, a diabetic medication. Years of education? Compared to their MD/DO counterparts ND education is lacking in reality based practice and few have the extended post-graduate training required by MDs to learn their profession. No medical student has ever been ready for patient care upon graduation; it is why there are residencies. Most NDs go straight from school to practice with a fraction, 15,000 fewer hours [3], of training compared to a Family Practice physician. And many of the ND training hours are not in science-based medicine, making the 6000 hours of ND training a fraction of the realty-based training needed for competent patient care. NDs, unlike their medical counterparts, practice whole-systems medicine. Except that their whole system approach is not based in reality. Part of the appeal of NDs is their philosophy, which is superficially attractive but fails when its implementation is examined. ND’s have excellent advertising, with all the appeal, and reality, of a light beer commercial. Besides being educated in pseudo-science and practicing virtually every pseudo-science imaginable, NDs also treat diseases that do not exist (chronic Lyme, chronic Candida, adrenal fatigue, toxins as examples) with therapies that do not work such as homeopathy and are dangerous, such as chelation and colonics. Naturopaths are generally anti-vaccine and oppose mandatory vaccination laws. As a result, children are significantly more likely to be diagnosed with a vaccine-preventable disease [4] if they receive naturopathic care. When compared to MD’s, naturopaths do an inferior job at primary care, falling short in cancer screening [5] and vaccination. NDs have unethical practice. Many naturopaths sell unneeded supplements and homeopathic nostrums from their clinic or website, a fundamental conflict of interest [6] avoided in the MD practice. MDs are inaccurately accused of being shills for Big Pharma, but it pales in comparison to the sales of Big Supplement for profit in the typical ND office. NDs have no quality improvement. There has never been a change or abandonment of an ND/alternative medical practice because it has been demonstrated to be useless or dangerous. Naturopathic practice, like all alternative practice, is immune to data even when it improves patient safety. Naturopaths claim to stress prevention and consider the whole patient, but that’s only what every good MD does. What NDs do that is good is not special, and what they do that is special is not good. And the author uses, to my ear, the slightly creepy racist term “Western medicine.” There is no Eastern, Western, Alternative or Allopathic Medicine. There is just medicine: interventions that have been demonstrated to be effective in the care of patients. And most of the ND interventions have failed to demonstrate effectiveness or even to be based on scientific reality.

There is little doubt that the court of public opinion is changing in favor of naturopathic medicine. What has changed in recent years to shift the perception of naturopathic medical care from “alternative” to primary” care? It is because ND’s have become very good, as this article demonstrates, at obfuscating the truth about ND practice. Half truths and an appealing natural philosophy in place of an honest, complete description of ND practice. Insurance coverage is another. NDs are covered by Medicaid through the Oregon Health Plan and CareOregon. With the exception of Oregon Health COOP and LifeWise, insurance carriers still balk at covering natural medicine. Aetna, for example, recently served notice to NCNM that it did not recognize our status as primary care providers in Oregon. That company’s logic, despite federal and state legislation to the contrary, stems from recognizing NDs only as “alternative care” practitioners, not as PCPs. For companies like Aetna, this categorization guarantees that naturopathic doctors will continue to be reimbursed significantly less for performing the same services as medical doctors.

It is clear from their education, training, and practice that whatever it is that NDs do, they are not performing the same services as medical doctors and their payment appropriately represents this reality. That premiums are wasted on the practice of pseudo-medicine even at a reduced rates is shameful. We can ameliorate the critical shortage of PCPs. The state of Oregon recognizes us. The Affordable Care Act recognizes us…At the same time, NDs who absolutely meet the standards of care as required by the state, are an underutilized resource. We believe that the rising chronicity rates in America, coupled with an acute shortage of PCPs, is a strong argument that it’s time to remove all the remaining barriers to quality standards of care from all licensed, qualified providers. The team of practitioners at NCNM is ready and able to take action in support of every patient’s health. In every aspect of their education, training, and practice naturopaths are not qualified to be primary care providers, despite the legislature declaring it so. There are enough difficulties getting real, useful care reimbursed. Those limited resources should not be wasted on naturopathic care. There is a shortage of primary care providers in Oregon. The wrong solution is paying providers who are educated in pseudo-science, trained in pseudo-science, and practice pseudo-science. As Simon Singh noted, because there are issues with the airlines does not mean we should use, or pay for. magic carpets. Oregonians deserve better. And now you know. Dr. Mark Crislip is president of the Society for Science-Based Medicine (sfsbm.org and the editor of Oregonians for Science-Based Medicine (ore4sbm.org) (sciencebasedmedicine.org

1]https://www.thelundreport.org/content/win-win-oregon-naturopathic-doctors-primary-care-providers

[2] http://www.naturopathicdiaries.com/category/naturopathic-education/

[3]http://www.aafp.org/dam/AAFP/documents/advocacy/workforce/gme/ES-FPvsNaturopaths-110810.pdf

[4] http://www.ncbi.nlm.nih.gov/pubmed/19760163

[5] http://www.ncbi.nlm.nih.gov/pubmed/19630554

[6]http://www.consumerreports.org/cro/2012/05/your-doctor-as-salesman/index.htm

Comments

Submitted by Allen Knecht on Wed, 10/21/2015 - 13:37 Permalink

The author of this opinion is quite obviously biased and it wouldn't surprise me that he is on the payroll of quack watch, another obviously biased organization come on Lund Report you can do better. Allen Knecht
Submitted by Michael Henderson on Wed, 10/21/2015 - 14:00 Permalink

There are two points I would add to this article. First is that those of us trained in credible, science based healthcare need to SPEAK UP more about the unethical practices eschewed by NDs. I tell patients, when they tell me what happened at the hands of NDs, that malpractice and fraud was committed by that "practitioner" - gross misdiagnosis and associated selling of expensive placebos. Second, we are leaving a vacuum in regards to how we fail to push back against the business of medicine, resulting in too short visits compensated by excess testing, referrals and medications. Patients do recognize we aren't providing what we are capable of and are thus willing to look elsewhere.

Dr. Mike Henderson

Submitted by Margin O'Error on Wed, 10/21/2015 - 17:52 Permalink

Who can disagree with the premise that good scientific evidence is important and desirable, but lacking for much of the health care delivered in the US, or with the assertion that naturopaths may not follow all the generally accepted medical guidelines for medical practice. But there is enormous arrogance in the suggestion that following these guidelines is the answer to good health for everyone, and therefore these so called evidence based guidelines should be the standard (Translation: this is what insurance should cover.)  Just this week, mammography guidelines changed again, and in another year, these will probably change yet again. (How good is that evidence?) An excellent evidence based study (A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care; John T. James, Ph.D., Journal of Patient Safety, September 2013) revealed that hospital related medical errors result in as many as 440,000 avoidable deaths per year, the third leading cause of death behind heart disease and cancer. So even if we follow guidelines, we run very high risks of dying from related mistakes. So should we not factor this in to the risk-benefit analysis of evidence-based medicine? Finally, and what is most important to me, is choice. More and more people want health care that they feel helps them to stay healthy, off drugs, eating better, moving more, and avoiding risky behaviors. Naturopaths evidently pay attention to this, and their patients feel better. Should the people have voice in what care they can access, in what treatments get covered by insurance? Are they all wrong? It is time traditional doctors like Dr. Crislip admit to their arrogance and stop trying to tell all of us what is best for us. There will be about 440,000 people this year who might have wished they'd followed someone else's advice.

Allen Knecht

 

 

 

Submitted by Delores Porch on Thu, 10/22/2015 - 13:24 Permalink

Mr. Crislip uses a broad paintbrush to criticize Naturopathic Doctors which leaves the impression that MDs, by using "infallible science" are therefore perfect primary care providers.  From many personal experiences, I have had the misfortune to partner with primary care providers who treated me like a textbook or research paper instead as an individual.  They could not think outside the box when the "prescribed" method did not work. They would not listen to any reasonable arguement.  They were the experts. I found that medical providers outside of mainstream medicine to be more open to exploring other options. Even though Mr. Crislip thinks MDs are Gods, they are not.

I have a B.S. in Science Education and an A.S. in Respiratory Care.

Delores Porch

Submitted by Adam Rondepierre on Tue, 11/03/2015 - 10:41 Permalink

Hi Mark,

I'm a pre-med student debating which direction to take next and I had a couple thoughts about your letter. I'm assuming you’re an MD protecting your field and that you have spent more time than I have studying medicine. I therefore value your opinion, again, assuming your words are based on experience.

To me, it sounds like you wrote this letter to steer people away from naturopathic medicine because you believe it's harmful compared to the type of healing you're trained in. That's fair, but condemning something because it's not what you believe, or what you were taught doesn’t automatically make it wrong and illogical. Surely there's more than one way of healing, right?

“Part of the appeal of NDs is their philosophy, which is superficially attractive but fails when its implementation is examined.”

Regardless of what your basis is for this statement, are you really arguing that no one has ever been healed by implementing advice from an ND?

I’m also trying to wrap my head around the argument that acupuncture is "divorced on reality." Those kind of statements seem so close-minded, especially considering recent studies (http://annals.org/article.aspx?articleid=2467961).

Does your statement imply that acupuncture can't/hasn't/won't help someone heal because it hasn't stood up to your measurements, or your own research?

To be honest, its negative opinion pieces like this that turn me away from your profession. ND's go through different training than MD's who go through different training than DOs. Isn't there a separation between a ND primary care physician and an MD primary care physician?

Please help me understand if I'm missing something.

Thanks,

Adam Rondepierre