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:
UTILIZE ROUTES OF ADMINISTRATION THAT INCLUDE, BUT ARE NOT LIMITED TO, ORAL, NASAL, AURICULAR, OCULAR, RECTAL, VAGINAL, TRANSDERMAL, INTRADERMAL, SUBCUTANEOUS, INTRAVENOUS, OR INTRAMUSCULAR CONSISTENT WITH HIS OR HER NATUROPATHIC EDUCATION AND TRAINING.
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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