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