A New Skeptic’s Bibliography

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I did not want to be a skeptic.

I equated skepticism with two character traits I did not like: pessimism and cynicism. As a naturopathic student and then naturopathic doctor, I felt it was important to remain likeable so I didn’t challenge information in ways that could be perceived as a non-believer. For naturopaths, being open-minded to everything is crucial for being well-liked by patients and others in alternative health professions.

Like other alternative practitioners, naturopaths argue that their open-mindedness helps them diagnose the “root cause of disease” with therapies that “treat the whole person.”

This rhetoric is misleading. Any physician always treats the whole person, as the individual patient is the most important subject of analysis in any clinical setting. Alternative practitioners need to stop pretending that their training provides them with special diagnostic abilities and unique treatment plans that are also safe and efficacious.

I think it is important to discuss ongoing professional training as another way in the naturopathic profession where medical beliefs are formed and perpetuated.

Once per year, naturopathic doctors gather at the American Association of Naturopathic Physicians (AANP) conference. On the surface, the conference appears like any other academic or professional conference. Participants gather in a different city each year to attend sessions on various topics and to network. Like other medical conferences, naturopaths earn continuing medical education (CME) credits, which are required for licensure.

One of the most unique aspects of AANP conference lectures is the presenting of “clinical pearls.” A clinical pearl is a naturopathic treatment success story, which is sort of a mutated form of a typical medical case study. To fellow NDs and students, one will describe a case highlighting diagnostic “discoveries” and treatment “victories.” Other NDs can try these same methods with their patients when presented with a case for which they have little experience or when feeling “stuck” when a patient is not improving. In addition to the conference, clinical pearls are frequently discussed on naturopathic social media and internet groups.

Naturopathic students diligently record clinical pearls in their clinic notebook, because their clinical training requires the compilation of “naturopathic treatments” into a cataloged system to use in their practice. Overtime, these notes evolve into a detailed account of a variety of naturopathic practices, which adds to the clinical material covered in school. The treatment catalog seemed most like a collection of experimental protocols. I’ve seen pearls that describe the indications for food allergy or heavy metal testing and pearls that describe treatments using homeopathy, high-dose supplementation, and naturopathic manipulations. Here are a few examples from my clinical notebook:

  • Bacterial Vaginosis: Crab apple flower essences and milk thistle herb. Use black cohosh if there is a black cloud or signs of depression.
  • Orthomolecular schizophrenia: food allergy and heavy metal testing and testing for pyroluria, if high for pyroluria treat with zinc and B6.
  • Chemotherapy immune support: reishe mushroom supplements.
  • Hepatitis C: intravenous myer’s cocktails with alternating alpha lipoic acid and glutathione pushes.
  • There are detailed cooking suggestions and recipes, which is especially useful for patients who are told to follow dietary restrictions.
  • I also have extensive notes on how to market myself as a naturopathic physician and advertising techniques taught in practice/ business management courses.

As a dedicated believer of the naturopathic faith, I enjoyed reading clinical pearls, questions about patients on Facebook, and collecting novel ideas for my clinic notebook. When I was asked to give an online CME lecture for the Pediatric Association of Naturopathic Physicians, I was happy for the opportunity to pass down my clinical pearls.

I lectured on croup, a condition I saw often in practice as a resident naturopathic doctor. Croup is a common respiratory condition usually caused by a viral infection in upper respiratory tract. The prevalence in children is high, one out of eight kids will get croup. Treatment often requires steroids to reduce inflammation. I was prone to prescribe steroids, but I was also eager to prescribe naturopathic therapies concurrently.

Here is a summary of my croup clinical pearl:

Naturopathic Supportive Therapies for Croup:

Herbal Medicine: 2 ounce herbal tincture (for a 20-25 lb child)

  • Echinacea glycerite 20 ml
  • Lemon balm glycerite 20 ml
  • Gallium glycerite 10 ml
  • Lobelia tincture 10 ml (5 drops per ml)

Sig: 1 ml PO q  2 to 3 hours x 2 to 3 days

Nutrients: Vitamin D 10,000 IU QD x 3 days

The evidence I had for these therapies was varied: my observations in patient care, my class notes at Bastyr, and my clinic treatment notebook when I was a student clinician. By using only case studies and personal notes, I was simply reproducing a practice without a critical second look. It was perfectly acceptable to cite justification as “According to Dr. John Doe ND, lobelia is tolerated in drop doses and is an effective bronchodilator.” In the naturopathic profession, lobelia is commonly used to treat acute asthma attacks and respiratory distress because NDs take such rationale as truth.

When I was giving the CME lecture, not a single one of my 20-30 online audience members challenged my lack of research experience nor demanded to be shown better evidence. I remember only being complimented for successfully integrating naturopathic therapies with real medical treatments.

The blind acceptance of bogus treatment protocols by students and practicing naturopaths is yet another example of how the profession exists in a bubble. Such an exclusive transmission of so-called knowledge is not how any other medical or academic community functions, in which ideas are freely exchanged and evaluated for their merit in the face of hard scrutiny and external review.

Suggesting fake and unsubstantiated medical treatments to patients abuses the power differential of the doctor-patient relationship and, ironically, is the antithesis of the core of naturopathic philosophy: do no harm.

Prior to stepping into my new role as a naturopathic apostate, I grappled with starting this blog. I knew telling my story would result in social consequences and personal attacks. Also, I was scared to critically examine my own practices, beliefs, and naturopathic education in a public forum.

This process was incredibly painful and marks one of the most isolating periods of my life. I choose to write this blog, openly share my actions as a naturopathic doctor, and discuss my naturopathic education publicly because of what I have learned from reading several important books on science, medicine, and critical thinking.

For those grappling with making decisions about pursuing a career in alternative medicine; for those aspiring to create change from within the profession; for those naturopaths who think that they practice within the boundaries of evidence, safety, and efficacy; I ask you to please apply your open-mindedness to these books and the information they provide.

  • Carroll, Robert Todd. The Critical Thinker’s Dictionary: Biases, Fallacies, and Illusions and what you can do about them (2013)
  • Homola, Samuel. Inside Chiropractic: A patient’s guide (1999)
  • Ernst, Edzard and Singh, Simon. Trick or Treatment? Alternative medicine on trial (2008)
  • Ernst, Edzard. A Scientist in Wonderland. A memoir of searching for truth and finding trouble. (2015)
  • Kahneman, Daniel. Thinking Fast and Slow (2011)
  • Long, Preston. Chiropractic Abuse: An insider’s lament (2013)
  • Offit, Paul. Do you believe in magic? The Sense and Nonsense of Alternative Medicine (2013)

I’ll update this list as I continue to add to my library.

Image credit: Flickr user domesticat under a CC License
  • Beberman

    I woke this morning from a dream in which I was berating a woman selling raw milk at the farmers’ market for her ignorance of the science involved in pasteurization. I do not have one friend who is informed about the shaky claims behind chiropractics or acupuncture. Most are unaware of the difference between herbal tinctures and homeopathic remedies. And yet, they all use and recommend these products and treatments!

    The anger that my dream brought on has stayed with me all day. The lack of intellectual curiosity among my cohort of left-leaning, back-to-the-landers is beginning to depress me. So, thank you, thank you for pushing back against this tide of delusion – you give me hope!

  • Rosemary Waigh

    I appreciate your honesty and your courage in creating this blog. Thank you.

  • James Dabbagian

    From one Skeptic to another, congratulations on opening your eyes to the BS.

  • Samuel Freedman

    Britt:

    Thank you so much for sharing this and calling attention to the lack of evidence-based practices in naturopathy.

  • http://www.madpenguin.ca Scott Holmes

    Just a quick “thank you” for sharing your story and your journey. I am not involved in healthcare except as a consumer. I do however self-identify as a “Skeptic” and enjoy all the positive learning and personal challenges that entails.

    I see you as an incredibly brave person for many obvious reasons and have been sharing your writings with enthusiasm.

    Be well.

  • Mike

    Phenomenal work!

  • David Killick

    I had little prior knowledge of naturopathy before reading your blog – it has been quite an eye-opener. The shared belief system that you describe reminds me very strongly of a classic work of anthropology – Edward Evans-Pritchard’s “Witchcraft, Oracles and Magic among the Azande” (1937). E-P’s insight, which spawned a whole literature on the nature of rational thought, was that Azande beliefs in witchcraft were rational within their own closed system of thought, and the naturopathy that you describe seems rather similar. Robin Horton later wrote a comment on this called “African traditional thought and western science” in which he contrasted the self-contained rationality of the Azande with the completely open system of science, to which skepticism, criticism and reproducibility are key. It seems to me that such a distinction may apply to naturopathy and conventional medical science. This is not to say that western medicine explains all – acupuncture is an example of a parallel system that western science has ye to explain. But the efficacy of acupuncture can be tested, and has been – for example it is often used instead of anesthesia in surgery in China, and seems to work effectively.

    • JGC

      “But the efficacy of acupuncture can be tested, and has been [found to perform no better than placebo controls or sham acupuncture using retractable needles and/or genuine needles inserted at the wrong meridian points].

      Fixed that for you.

      • Roman

        Point shatteringly well made, with an impressive economy of words. Greater detail may be found at this SBM reference page:
        http://www.sciencebasedmedicine.org/reference/acupuncture/

      • Beth

        The evidence isn’t really in on the efficacy of acupuncture.
        Acupuncture may have anti-inflammatory effects.
        I’ve been curious for example, about acupuncture for allergic rhinitis. A recent overview of the evidence from a non-acupuncture source:

        Aggregate evidence quality: Grade B, based on randomized controlled trials with limitations, observational studies with consistent effects
        Level of confidence in evidence: Low; the randomized trials did not show comparison to traditional medical therapy for allergic rhinitis and had methodological flaws

        And according to a recent review article,

        Compared with control group, acupuncture treatment group exerted a significant reduction in nasal symptom scores, medication scores, and serum IgE.

        Electro-acupuncture seems to work better than acupuncture, and it could be a valuable intervention.
        That’s what I tend to find when I look for impartial evaluations of evidence for plausible alternative treatments – not a definite No, nor a resounding Yes.
        Some of the studies of acupuncture for allergic rhinitis compare it to oral antihistamines. That’s ironic, because oral antihistamines from what I’ve read and from my own experience, are little help with inhalant allergies. They’re comparing it to a weak conventional treatment.

        • JGC

          The first link isn’t to an overview of evidence: it’s to a Clinical Practice Guideline (which explicitly admits that the level of confidence in stuides suggesting acupuncture is efficacious in treating AR is low.

          Unfortunately the review article cited in the second link is behind a pay wall, and without knowing critical details of how the 13 studies the authors considered were concucted–how they were blinded, what interventions the control groups received, etc.–it isn’t possible to assess confidence in the conclusion acupuncture yielded bettter AR outcomes. (If, for example, there was no blinding, or if the control group did not include sham-acupuncture treatments, no conclusion could reasonably be drawn.) The studies in the review article also appear to rely primarily on patient self-reporting as the read out for efficacy:the Rhinitis Quality of Life Questionnaire (RQLQ) and 36-Item Short-Form (SF-36) component score, which only emphasises the importance of proper blinding and appropriate controls.

          Then of course there’s the larger body of evidence (such as PMID:25590322) finding nor efficacy. All in all, not very persuasive support.

          • Beth

            I value the opinion of experts in the Clinical Practice Guideline, and people who aren’t experts in the field need to take their skills at evaluating research with a lot of salt.
            The published commentary by experts on research articles is essential to read for that reason. I’ve found repeatedly that good points were made in those comments that hadn’t occurred to me.
            There’s an interesting article on possible anti-inflammatory mechanisms of acupuncture at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586443/ which discusses a lot of research on acupuncture for allergic rhinitis.

            • JGC

              Well, when the article’s first sentence makes a false claim (“Classical literature indicates that acupuncture has been used for millennia to treat numerous inflammatory conditions, including allergic rhinitis.”) it’s kind of hard to keep an open mind while reading the remainder. The thin needle acupuncture practiced today bears no resemblance to the acupuncture practiced prior to China’s cultural revolution, which was instead a form of blood-letting using lancets. That said, the article fails to make a strong case that acupuncture is an effective treatment for AR.
              McDonald cites a limited number of review papers arguing for acupuncture’s efficacy: he notes two early systematic review studies that fail to demonstrate efficacy before citing two he believes succeed. The third review by Xiao (abstract available only, unless you read Chinese) offers no details regarding the use of controls or study blinding and cautions “no definitive conclusion can be obtained as yet”. The fourth review study (Lee’s) inclusion criteria allows the inclusion of studies where the comparator for the acupuncture arm may be no intervention, a comparator treatment other than sham acupuncture or no treatment at all as well as sham acupuncture, and the authors state that they assume but do not establish studies were adequately blinded if “the control intervention was indistinguishable from acupuncture, even if the word blinding did not occur in the report”. Needless to say for the studies where the comparator was not sham acupuncture no blinding would be possible: those treated (and likely those evaluating as well) would know if they did or did not receive acupuncture.

              to be continued

            • JGC

              Finally McDonald cites Brinkhaus, a study where patients with allergic rhinitis were assigned to either a treatment group receiving acupuncture treatment or to a control group receiving no acupuncture (again no blinding possible) Compounding this error is the fact that assignment to treatment versus control groups was not random: patients who wished to were allowed to reject random assignment and demand they be assigned to the cohort receiving acupuncture treatment instead, effectively front-loading the treatment group with patients seeking a preferred treatment. With the read-out for efficacy again taking the form of self-reporting (the Rhinitis Quality of Life Questionnaire and a general health-related quality of life (36-Item Short-Form Health Survey)) this would appear to be a serious introduction of bias.

              All in all, McDonald offers very little support for acupuncture’s efficacy in AR.

              • Cruz

                Let’s make this real easy: Acupuncture is Bullsh*t… it’s nonsense, meridians are nonsense and Qi or whatever is also Bullsh*t.

              • JGC

                I think an it would be accurate to describe acupuncture as bieng just as good as placebo treatment, but also far less safe than placebo treatment (Adverse events associated with acupuncture, after all, run from infections to pneumothorax).

                Retractable needles, after all, while performing just as well won’t place you at risk of developing a collapsed lung.

  • Mike

    Thanks so much for sharing. I remember during my OTC course during my PharmD years they brought in a BSPharm to teach herbals, he never had any scientific evidence to back up what he was teaching, no well designed double blind, placebo controlled, clinical trials, etc. It was largely anecdotal stories and a few studies that were either with a far too small number of participants, or with serious design flaws or incorrect statistical analyses. So many of my class mates were upset that someone would be teaching, essentially, a faith based belief system versus true medical/pharmacological science that they talked me into lodging a formal complaint with the Dean since I was a much older adult student. I don’t believe he was ever asked back to instruct after that semester.

  • Linda

    Fabulous forum here, Britt! It takes guts and it needs to be said. Beberman, I can totally relate to what you’re saying. I’m a former woo believe who started questioning and reading science last year. After my conversion, I remember sitting at dinner with a bunch of my liberal friends and going nuts; to the left of me was GMO paranoia and to the right of me was a woman giving advice based on what her naturopath said. “Get me out of here!”

    IMO, those of us who aren’t naturopaths should be speaking up too. I have good friends who are into every variety of woo, and have so far kept a low profile on my science conversion. How have any of you handled this?

  • Mike

    My complements on your courage.

  • Travis

    Never a disappointing read. Thanks

  • Beberman

    Linda, yes I also find it difficult to speak up (on some topics, not on vaccines or homeopathy.) We seem to be marinating in a conspiracy theory world which is hostile to investigating competing claims with an open mind. Because I manage a farmers’ market it is assumed that I embrace herbal remedies and anti-GMO propaganda, putting me in a tricky position with some of my customers and other vendors. We even had a psychic set up a booth one week, but she didn’t return because of slow sales. Guess she didn’t see that coming! 🙂

    • Linda

      Ha!

  • ausGeoff

    Excellent blog Britt. May you prosper and continue to expose these sham, pseudo-scientific “therapies” and therapists.

    Unfortunately, here in Australia, the title “naturopath” still carries a lot of weight with inadvertently gullible–and often psychologically vulnerable–people seeking apparently sound medical advice.

    One of the major clinics [sic] here in Melbourne says on its home page “Upon every appointment as a patient, you’ll be greeted by warm, compassionate practitioners who genuinely care about your well being. Our mission is to help get you to your optimum health by stimulating your body’s natural healing process”.

    The negative implications are obvious; medical doctors are cold-hearted, unsympathetic individuals who have little real interest in your well being, and have no aspirations in attempting to optimise your health other than prescribing harmful, unnatural drugs.

    Keep up the good work,
    Geoff.

  • jennifer

    traitor

    • Reasonable Roger

      Insults are a fool’s only tool for replying to arguments they cannot refute.

    • Lynne

      Jennifer, I am curious. Why do you call Britt a traitor? Has she been inacurate in her reporting of naturopathic coursework? Was she wrong about students working on each other, for example being subjects for gynocological exams, for lack of patients while in training? Has she misled us about lack of hard scrutiny and external review when a treatment is put forth by NPs? Or the problem of uncritical acceptance, without question, when natural therapies integrated with medicine are promoted among NPs?

      Or is Britt a traitor because she gave transparency to things that are kept from the public?

    • Suzanne

      This comment is clearly a joke

  • Stefan

    Thank you for saying what needs to be said. As a Registered Dietitian, I am often lumped in with poorly researched, deceptive alternative therapy types. It is increasingly hard to explain how, as a Dietitian I don’t push food as a cure for cancer, or high priced “natural” or “organic” food. Sanity needs a voice, and it is increasingly drowned out by the voices of the modern-day snake oil salesmen.

    • Nutritionprof

      As an RD teaching nutrition at local colleges, it is indeed frustrating telling students how to critically think and to distinguish between RD and nutritionists. Unfortunately there are RDs in practice who subscribe to pseudoscience and it embarrasses me. Nutrition Dimension offers CEUs for Ayurvedic nutrition! If they were describing cultural practices, ok. But this is how to prescribe diet based on vats, pitta kafa voodoo.
      Frustrating

  • http://doctormelgar.com Michael

    Britt I admire your honesty and courage. Its not an easy thing to challenge something into which you have invested so much time and energy.

    For what its worth naturopaths are not the only ones who allow personal beliefs and anecdotes to guide their treatments and recommendations. Even among my own colleagues in traditional medicine I sometimes find myself arguing for rationality against a surprising cadre of fellow physicians that believe in a specific treatment based on very weak evidence or anecdotes. ( The current fad of vitamin D testing comes to mind).

    What you have found in naturopathy is a trait common to all humans, the impulse to trust our instincts. The difference of course is that in allopathic medicine we are at some point forced to align our practice with the evidence even if the evidence is counter intuitive. Best of luck to you.

    Michael Melgar, MD

    • Hawk

      Great comment Michael about the pseudo Vitamin D push. Thank you Brit for being brave and stating the obvious.

  • Veronica Skedd (formerly Veronica Barney)

    Britt, I don’t know where you went to school but I was NEVER taught to use lobelia for acute asthma attacks and respiratory distress. Also, regarding your post “on notice,” using one naturopathic doctor’s poor clinical judgement to bash the profession is misleading and dishonest. I was taught proper treatment for animal bites. As a practicing naturopath, I’ve prescribed oral antibiotics and a tetanus shot on 3 different occasions when a patient presented with an animal bite. Where did I learn that? Well, I didn’t come up with it on my own, which means I learned it at Bastyr. Funny, considering we went to school at the exact same time and graduated at the same time. Sounds like you’re the one suffering from severe cognitive dissonance.

    • https://www.naturopathicdiaries.com Britt Hermes

      Hi Veronica! I remember you. It took about three seconds to find the following references that contradict your claim:

      http://www.naturopathic.org/content.asp?contentid=495 -Written by Bastyr ND
      http://www.drweil.com/drw/u/ART00306/asthma.html -Written by Dr. Weil (speaking history at Bastyr)
      http://life.gaiam.com/article/7-nondrug-asthma-treatments-5-herbal-remedies -Written by NCNM ND
      http://thenaturopathicherbalist.com/herbs/i-l/lobelia-inflata/ -Written by Boucher ND
      http://www.steadyhealth.com/articles/Naturopathinc_Treatment___Natural_Remedies_For_Asthma_a1453.html -Written by NCNM ND

      There many more links…I also have my class notes and BCNH clinic documents on asthma which cites many treatments, like the following: “Acute : TCT [tincture] of Capsicum (1/2 dropperful), Sympylocarpus (or Draconitum) (1 part), Ephedra (1 part), Lobelia (1 part), Yerba (1 part), and Eriodictyon (1 part)
      SIG: 1 tsp Q half hour” There is also a tea: “Lobelia, grindellia, ephedra, 1/2 tsp to cup of water-tea.” There is no listed protocol for rescue inhaler use, but I see lots of homeopathic and dietary treatments.

      Perhaps you were absent in class when this information was taught to us.

      • Beth

        I felt it was important to remain likeable so I didn’t challenge information in ways that could be perceived as a non-believer.

        I took part in a corn allergy forum years ago … One of the people there claimed to be extraordinarily sensitive, so much so that she could get a corn allergy reaction from some non-organic strawberries.
        Corn products are used extensively in many products, so they have traces of corn in them.
        So someone who thinks they have a very sensitive corn allergy can think they’re having a corn reaction almost any time. For example, a pesticide might well be made using some kind of corn product.
        This person had lumps that would appear in her skin, something like that.
        So eventually, I told her that with her extensive and careful precautions, she had eliminated corn a long time ago, and whatever was causing the lumps to appear was not corn.
        I said there were lots of reasons for lumps, and she might be distracting herself from investigating the real reasons for the lumps, by attributing them to corn.
        And I said that maybe she didn’t have a corn allergy at all.
        Then, practically everyone in the forum jumped all over me. “We don’t question each other’s diagnosis”, etc. etc.
        People were very defensive, accused me of questioning their corn allergies (which I hadn’t).
        And the person with the strange “corn reactions” replied to me in a very hostile way.
        It seems like they were so afraid of being called crazy and deluded about their allergies, that they had developed a culture devoid of even reasonable questioning. That’s dangerous.

      • Veronica Skedd (formerly Veronica Barney)

        Your links are irrelevant to what I stated. Links 1, 2, 4, and 5 do not mention lobelia for acute asthma. And what does the Dr. Weil link have to do with anything? Last time I checked I wasn’t trained by Dr. Weil. So every alternative medicine “expert” and every ND who posts online is an accurate representation of your education at Bastyr? I’d have to strongly disagree with your opinion there.

        Here are my notes from Pulmonology Spring 2011; we would’ve taken this course at the same time. I had no problem finding a protocol for rescue inhaler, and found several slides indicating the need to refer for acute asthma. I did see the one slide with the acute asthma tincture you referred to.

        Asthma treatments:
         All patients should have short acting beta agonist (SABA)
         2-4 puffs prn for sx
         Up to 3 tx at 20 minute intervals or single nebulizer tx prn
        Short Acting Beta Agonists (SABA)
         Albuterol (generic)
         ProAir HFA, Proventil HFA, Ventolin HFA, AccuNeb
         Mechanism: Stimulates beta-2 adrenergic receptors. Relaxes airway smooth muscle
         Half-life: 2.7-6hr
         SE: Bronchospasm (paradoxical), HTN, angina, MI, hypokalemia, arrhythmias, throat irriation, URI sx, cough, bad taste, tremor, dizziness, nervousness, nausea, HA, palpitations, tachycardia
         Cost: $20.60 (generic)

        Acute asthma
         Status Asthmaticus = acute, severe asthma attach with risk of respiratory failure
         Refer and transport to ED
         Supplemental oxygen
         High dose inhaled beta-agonists by nebulizer
         IV steroids
         IV magnesium sulfate is favored MD tx but clinical trials have failed to show consistent benefit but meta-analysis shows benefit.

        Naturopathic treatments for acute asthma
         Acute Plan for Asthma
         Patient Safety First – Call 911!!!
         Remember Philosophy:
         Alleviate suffering, therapeutic order, etc.
         ALL treatments can be used in a “naturopathic” manner
         Keep conventional meds on hand (and know how to use them):
         ß-agonists, Epi-pen

        • Ken Hamer

          “Keep conventional meds on hand (and know how to use them)”

          Funny that you never hear the reverse of that.

        • David

          It is such a joke in my mind that naturopaths can even pretend they have the same training. Can I ask you Veronica, during your training, how many patients did you deal with who were in acute respiratory distress! Even more telling, how many has the person teaching you even seen. Reading things in a book even if partially correct does not correspond to the experience an md gets in training. I cannot even count how many patients I saw with respiratory distress and had to work quickly to decide how to treat. I have had to intubate many patients and have followed them through to the Icu in severe cases
          So when a child presents to their primary care doctor who is asthmatic and in distress, do you want a naturopath who will literally crap their pants first, then try to remember, then maybe lead through their old class notes???! Or do you want someone who has been in this situation many times ( knows the differential diagnosis –besides acute gluten overload,)!!!

        • Not convinced Keep Trying

          Veronica, try not to be so offended. Britt is picking and choosing the “juiciest” experiences to share. In the original post, she says “When I was giving the CME lecture, not a single one of my 20-30 online audience members challenged my lack of research experience nor demanded to be shown better evidence.” Wonder why only 20-30 people attended the webinar, when most webinars have over 90 participants? I never attended this webinar because I did not think Britt had the clinical experience and knowledge to teach; but when I asked a colleague how the webinar was, she said “you didn’t miss anything”. Webinar attendees don’t have the option to “challenge” the speaker: we are all in listen only mode. Again, this is misleading and desperate!

          • https://www.naturopathicdiaries.com Britt Hermes

            Ha! Actually, these are not my juiciest. Those are still coming. Also, attendees of webinars can submit questions to the lector. The attendees probably “did not miss anything” because I explicitly refused to cover homeopathic treatments and many other ND treatments. I instead focused on the conventional, evidence-based medical treatments. I would not be surprised if the NDs were disappointed. What exactly am I desperate for, I wonder? And when I am supplying my transcript, course catalog and syllabi for review, I also wonder how this information is misleading?

      • Veronica Skedd (formerly Veronica Barney)

        Asthma treatments from pulmonology taught at Bastyr continued:

        Regarding pulse oximetry:
         Interpretation:
         >95% – generally considered to be normal
         <92% – detects central hypoxia (100% sensitivity, 86% specificity), consider need for oxygen therapy and referral.

        Asthma action plan: if patient < 50% personal best of peak flow:
         Get HELP now!!
         ß-agonists
         Give oxygen
         Acute Tnc and Lobelia Tnc
         Nebulized MgSulfate
         Mg: 500 mg
         Vit. C: 1000 mg
         Breathing/Stress Reduction Exercises

        So yes, you’re correct, there is a recommendation to use lobelia tincture, but it looks to me like you left out the other information we were taught on how to handle acute asthma.

        And as far as the dog bite, it sounds like you knew exactly what to do in that situation as well, even if the ND you worked with did not make the proper clinical decision. Where did you learn how to handle that situation if your education was so inadequate?

        I wholeheartedly agree with you that there are areas of our education and profession that need to be improved, however, some of your claims regarding our training are blatant lies. I was never taught vaccines "do more harm than good." And you know we were never taught "alternative cancer treatments." We were always taught that cancer patients we treat MUST have an oncologist on board, as naturopathic treatments are complimentary, not alternative. It is also illegal for NDs to treat cancer patients without an oncologist and any ND who does so is acting outside the law and our training.

        You have every right to your opinion, and I'm sure you can sift through your notes and provide only the bits and pieces that support your agenda, but in the interest of fair and balanced criticism of naturopathic medicine and education, please don't be dishonest and leave out large chunks of information. I'm done reading your blog and best of luck to you in your new career.

        • Beth

          I posted earlier a death by naturopath horror story, involving asthma.
          This was a Bastyr-trained naturopath.

    • https://www.naturopathicdiaries.com Britt Hermes

      Here is the BCNH clinical document on treating dog bites:

      Bites – dog and cat (EJ except where noted)
      -Homeopathics – Belladonna for painful hot and swollen wound or Lyssin nosode – give 30C everyday for a week and then every week for 6 weeks
      -Rabies – refer for series of shots
      -charcoal poultice
      -wet sock tx or constitutional hydrotx
      -fasting
      -Hp Lachesis and Apis often good (both are > cold,
      lach < heat also) Dog Bite - Wash area with soap and water, H2O2 or mild antiseptic, control bleeding, treat for shock necessary and transport. Get name of owners of dog and have dog penned up till evaluated. (NPLEX) -Dog bite case - cold and sore throats constantly 3 days before menses began for a year after a bite - lasted 2 - 3 weeks and they would have a few days break and it would start again - gave Hp Lac Coninum 30 C TID for 3 days -great for sore throats and they never came back

    • Sheldon

      Interesting how you imply that despite the fact that you were in the same class or school together, you were not taught the same things. Makes me wonder what standards are used to guide course/class content and what assessment methodologies are employed before you are released on the gullible and unsuspecting portion of the community . . . !

      By the way, my 11 year old knows how to treat animal bites so if that’s what you learnt at “Bastyr” then you don’t have any more useful knowledge than someone who has completed basic first aid.

      I have seen many instances where naturopaths have accidently/inadvertently helped people with the advice given. Unfortunately, the rationale and understanding behind the advice given was incorrect and quite misinformed (and the cost of said treatment to be sometimes astoundingly high and inappropriate) but that does not seem to dampen the person’s enthusiasm for their naturopath.

      Heaven help us . . .

      • Ken Hamer

        “Interesting how you imply that despite the fact that you were in the same class or school together, you were not taught the same things. Makes me wonder what standards are used to guide course/class content and what assessment methodologies are employed before you are released on the gullible and unsuspecting portion of the community . . . !”

        Well, according to another “ND” in another post

        “…thats the beauty of this medicine. You take from it what you want…”

        Which leads me to believe that every student scores 100% in every exam, ’cause they can pick and choose whatever answer best suits them — there are no wrong answers.

    • Ken Phelps

      “…I don’t know where you went to school but I was NEVER taught to use lobelia for acute asthma attacks and respiratory distress.”

      Therein lies the problem. Absent evidence based rationales for treatment, there is no reason to expect consistency in either teaching or practice.

  • http://fojap.com fojap

    Hi, I found your website through the Science Based Medicine website.

    Over the weekend I read The Unpersuadables by Will Storr. Like you, I don’t feel my personality is very like the stereotype of a skeptic. In his book, he’s quite harsh on self-proclaimed skeptics, partly because I think he can’t relate to them personally either. However, you might enjoy the book. I did. I’m currently working on a little review of it that I’m hoping to post by the end of the day.

    • https://www.naturopathicdiaries.com Britt Hermes

      I will check it out, thanks for the suggestion.

  • Rachel

    Just as you said you feared before, you are facing attacks from former classmates in the comments on this post. What tremendous courage, honesty, and intellectualism it takes to make the changes you did. By publishing this blog you do a great service to science and medicine. I hope you find that there are many places for optimism and even open mindedness, in the right context, even as a skeptic.

  • http://vset.net John Mayer

    Congratulations and thanks for critically examining your career. It’s one thing to be a skeptic, another to lay your very livelihood on the line to advance science and truth. You have my utmost respect.

    To our credit, the state of Tennessee forbids clinical naturopathy. Unfortunately, the same is not true of homeopathy, as I learned when I called the local office of the FDA to complain about our food co-op selling the especially absurd product Oscillococcinum. It seems that in the early days of drug and medical regulation one of the panelists was a homeopath. That form of quackery has, it seems, been grandfathered into legal commerce nationally.

    • Linda

      (Wish there was a “preview before post” feature.) Again …

      Good for Tennesee! Sadly, here in “progressive” Minnesota, they’ve incorporated naturopathy into our University of Minnesota medical programs. Yes, that’s right, they *teach* it, alongside real medicine and advertise their partnership with Bastyr. When they first started the Center for Spirituality & Healing, the real doctors went nuts when they advertised their teaching of homeopathy. The center doesn’t say the word “homeopathy” on their website anymore, except in the fine print, but I think they still teach it. They do openly promote Reiki, Ayurveda, and other sham treatments.

      The clinics affiliated with the U openly describe and promote homeopathy and other sham treatments, as if they were real medicine. It’s a disgrace.

      • https://www.naturopathicdiaries.com Britt Hermes

        Hi Linda, I think I found the pretty comment for you. I am going to look for a comment preview plug-in today.

        • Linda

          Perfect! Thank you!

  • ketac6

    I quite like this definition of skepticism:

    skepticism n.
    1. A doubting or questioning attitude or state of mind; dubiety. See Synonyms at uncertainty.
    2. Philosophy
    a. The ancient school of Pyrrho of Elis that stressed the uncertainty of our beliefs in order to oppose dogmatism.
    b. The doctrine that absolute knowledge is impossible, either in a particular domain or in general.
    c. A methodology based on an assumption of doubt with the aim of acquiring approximate or relative certainty.
    3. Doubt or disbelief of religious tenets.

    Opposing dogmatism is a very valuable endeavour. Please do keep up the good work.

    • Mitchell

      The mind is powerful and many techniques proven comparable to placebo in controlled studies are still practiced. For benign conditions, we might say, “So what?” But these practices still meet the FDA’s definition of medical fraud which includes doing something for profit that is known to be ineffective, independent of the practitioner’s intent. These methods are misleading to the patient and should not be tolerated by thinking people.

      Why are alternative practitioners not concerned about science and the value of the double-blind, placebo-controlled study? I refer readers to 2 webs sites (www.quackwatch.org and http://www.quackometer.net) that are eye-opening. Unfortunately, I think their blunt names will keep people who most need to look at them from doing so.

    • KelleyB

      ketac6:

      I like it too. What’s your source?

  • JustAThought

    1. The amount of childish disrespect the “SBM team” has demonstrated toward people pursuing natural medicine as a profession is APPALLING. You say you want cold-hard evidence for things, but yet you come across as cold-hearted. This is hardly the type of sentiment needed to truly care for a person’s needs while they are undergoing any type of care. You can push science into people’s veins, but at the end of the day, do you make them feel like you actually care? This matters more than you think to the patients we serve.

    2. A lot of you skeptics dismiss natural remedies as BS, but have you stopped to think about where we get the template/inspiration for our pharmaceuticals in the first place? I met a LLY chemist the other day who told me he was traveling to the East to meet with medicine men to examine some of the remedies they used. He was going to take them back to the lab and isolate their active ingredients. How can you “take from nature”, reverse engineer it and on the next breath, condemn it….?

    • https://www.naturopathicdiaries.com Britt Hermes

      I never stated how the “patient feels” is irrelevant to medicine.

      I do not dismiss ALL natural remedies. “Natural remedies” proven over and over to not work, i.e. homeopathy should be taken out of naturopathic practice, but they are not. Almost all botanicals need much more research to prove efficacy and safety. I am condemning naturopathic medicine for misleading patients into thinking most herbs are safer than Rx, homeopathy works, manipulation is science-based, using IV Vitamin C for cancer treatment, and on and on. I think you need to stop and think about medical ethics and patient safety.

    • Ken Hamer

      The amount of pure rubbish being propagated as “natural medicine” deserves nothing less than outright disdain, as do the people propagating it. If you’re only being shown “child disrespect” you should probably consider it a courtesy of the highest order.

    • Beth

      You say you want cold-hard evidence

      What is cold and hard about evidence?
      “Cold and hard” sounds bad.
      Is it bad to know that something has been tested and shown to usually work, and to know what the risks are?
      To me, it is reassuring!

    • JGC

      “You say you want cold-hard evidence for things, but yet you come across as cold-hearted.”

      Your tone-trolling is acknowledged, JustAThought.

      Other than that, could you explain by what rational argument the medical interventions marketed by naturopath’s should be held to a lesser standard of required proof of safety and efficacy than the medical interventions developed and marketed by pharmaceutical companies like Merck, Glazo Smith Kline, Novartis, etc.? Would you recommend the FDA and EMEA try to come across as a little less “cold hearted” towards the Big Pharma companies submitting new drugs for approval?

      And if not, why not?

  • http://orthorexia.com Steven Bratman

    Of the books mentioned above, I particularly recommend Edzard’s memoir. In the late 1990s, early 2000s, four groups undertook the project of reviewing essentially all published evidence regarding alternative therapies. I led one of these groups, but Edzard’s group produced by far the most academically sound and scientifically complete review. Like most of us involved in this work, Edzard was painfully disillusioned. It was really quite sad. I *wish* alternative medicine could do what it promises. Alas, it cannot. My “Devil’s dictionary” summation is as follows:

    Alternative medicine: That field of medicine most useful for treating illnesses you do not have.

    Conventional medicine: That field of medicine most useful for giving you new illnesses you did not have before.

    But I disagree with one characterization above, regarding treating the whole person. I would say that conventional medicine does NOT in fact treat the whole person, for the simple reason that it is too difficult. We end up with primarily symptomatic treatments because our knowledge is limited and disease is profound. Alternative medicine, insofar as it has any effective treatments at all, similarly treats only symptoms. We are intrinsically unable to treat causes because the fundamental cause of disease is, alas, mortality itself.

    Steven Bratman, MD

  • https://www.naturopathicdiaries.com Britt Hermes

    Hi Dr. Bratman,
    Thank you for reading and posting! Ignoring the issue of trying to figure out the ultimate cause of disease for a moment, there is a significant and important difference between conventional medical treatments and naturopathic treatments. The difference, I think, is that conventional medicine is basing treatments on science that strives to understand the underlying cause of disease, whereas naturopathy is basing treatments on folklore, hearsay, and popular beliefs.

  • Lib Flow

    Gold. I bumped into this website by ‘accident’ or sheer curiosity. Every post you have shared so far shed me new light in understanding the field I’m planning to ruffle.

  • Belinda Lee

    Hi there, appreciate your post I always wanted to study naturopathy since i was in my early 20’s. I still have a passion for it and I’m 33 now. I never studied it as i thought there was limited job opportunities once finished and didn’t wanna spend loads on training and education to end up selling vitamins at GNC. So I suppose a lot of what I thought was somewhat right according to ur article. But I can’t help wonder tho that some of the practices are still of a huge benefit to the public I mean you must of helped a lot of people all the same?? I don’t agree with homeopathy and kinesiology and a lot of these magic practices but let’s face it a lot of herbs can help with general health, herbs are still drugs. So maybe we shouldn’t be calling naturopath’s doctors it does lead us to believe they can cure us but simply as assisting wellbeing for things like blood pressure, diet aid, liver cleanses, anxiety/depression but not serious illnesses etc… A lot of medical professionals don’t treat ppl until they are already sick and severely lacking in hormones or nutrients. I think what is appealing about alternative health is preventive health care… I can’t help but wonder though when these colleges are practising things I don’t believe in like Crystal therapy and astrology that that somehow disputes the overall credibility of the organisation. I know once people are in an institute and taught something people just believe it to be true and don’t challenge what they are being taught.