American College of Physicians: Internal Medicine — Doctors for Adults ®

Thursday, June 30, 2016

Naturopaths: fake doctors in white coats?

here is a widely held belief that there is more than 1 kind of medical system. We hear about “mainstream” medicine, traditional Chinese medicine, chiropractic, Ayurvedic, naturopathic medicine. But what is most important to anyone interested in their health is whether or not something works.

The medical system most of us think of when we see our doctors is different from the others in that it is “science-based,” that is it relies on evidence derived from scientific studies for its practices. As a specialist in internal medicine, when I make a recommendation about someone's blood pressure or diabetes, I am relying on decades of scientific studies to guide me in helping my patient.

Sometimes medicine is simple common sense: eat healthy, exercise. Sometimes science turns common sense on its head. A few decades back, patients who had heart attacks were routinely given lidocaine, a drug that prevented the heart rhythm problems seen immediately after the attack. The drug clearly prevented these dangerous rhythms; you could see it right there on the heart monitor. Then someone decided to actually study the practice, and found that patients treated with lidocaine actually fared much worse than those who didn't get the drug. The practice was dropped.

This is the heart of modern medical science: We test out our ideas, and we don't rely only on common sense and things that sound plausible. Most doctors accept that there is no “alternative” medicine; there is only “medicine” and everything else. Any “alternative” medicine that passes scientific muster is adopted and becomes simply “medicine.”

Still, humans are pattern-recognizing machines, always seeking logical explanations for what we observe. For millennia, people have observed what does and does not help us when we are sick. Some of our ancestors found that willow bark helped with pain and fever. Some found that eating peyote cactus gave them visions. Nature is full of medical treasures.

But these treasures, like our lidocaine example, are not just there for the taking. They must be tested, refined, understood and used with caution. Sure, black mamba venom contains a natural painkiller that may be as powerful as morphine. But I'm not about to let 1 bite me when I have a headache.

Which brings us to a popular “system” of alternative medicine: naturopathy. From the headline, you know my bias here: naturopathy is not medicine or science, but more akin to religion. In Colorado and Michigan bills are under consideration to allow naturopaths to have many of the same privileges as doctors. This would be a horrible mistake.

First, we'll see what privileges Michigan wants to give naturopaths, and then why this would be a horrible, dangerous, no-good idea.

Michigan HB 4531 proposes that naturopaths can call themselves “doctor” or “physician” (modified by “naturopathic”), and would allow them to diagnose and treat medical conditions (in other words, be a real doctor).

The bill goes on to list some typical naturopathic procedures that would be allowed in the state, including long-disproved quackery such as homeopathy, hydrotherapy, and electromagnetic therapy (none of which have a consistent definition, but as they are generally understood, make no scientific sense and have been tested and found to be useless or dangerous).

One of my favorite lines from the bill frankly scares me. It would allow naturopaths to:


These fake doctors, without any of the experience or education of real doctors, want the state of Michigan to legally enable them to shove things up your rear end or vagina. That's not good. Equally concerning is their being allowed to prescribe durable medical equipment such as wheelchairs, hospital beds, etc. This is a business neck-deep in fraud, a constant thorn in Medicare's paw. To open it up to more practitioners, especially those without proper training, will needlessly increase costs.

The real problem, though, is that naturopaths are not real doctors. To the extent that they have a coherent belief system (and I'm not conceding that), it is based on outdated ideas about human health. Their official statements try to set them apart from other doctors by claiming to work more “naturally,” whatever that may mean.

The American Association of Naturopathic Physicians describes simply (and damningly) what they are:

Naturopathic medicine is a distinct primary health care profession, emphasizing prevention, treatment, and optimal health through the use of therapeutic methods and substances that encourage individuals' inherent self-healing process. The practice of naturopathic medicine includes modern and traditional, scientific, and empirical methods.

I'm a medical doctor who specializes in internal medicine. That means my work centers on the prevention and treatment of diseases in adults. I use “therapeutic methods and substances that encourage individuals' self-healing,” same as them. Except the way I do it is based on reality and scientific proof. For example, if I prescribe diet and exercise changes to someone at risk for heart disease, and they have a heart attack anyway, 1of the medications I will prescribe them will be an ACEinhibitor. This class of medications helps the heart rebuild and heal itself properly, rather than in a haphazard way that may lead to further damage. Naturopaths can't do that. It's not part of their training.

What naturopathy claims to do is exactly what I am already doing, with 1 exception: what I do is based on over 100 years of science. Their practices are based on imagination. They do not have the proper education or experience to practice anything called “medicine.” In a just world, they wouldn't be licensed but charged with battery.

It would be lovely if we could simply make up medical traditions that somehow magically work and don't have any side effects. We can't. Nature is messy. The only thing that allows us to hold onto the reins at all is science. Remember when you had polio? No? Good. Thank a real scientist and doctor for inventing the vaccine. Does your kid have a tracheotomy scar from epiglottitis? No? Thank a public health official for following the evidence and the science and advising you give your child the Hib vaccine.

Naturopaths are glorified faith-healers trying to put a scientific patina on myth, and worse, legislate trust in their abilities.

They pose no threat to my economic well-being. I'm busy and always will be. But they are a threat to public health. Let's use some sense and not allow them to create more business for me as I clean up the messes they've inflicted on their victims.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog at Forbes. His blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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