ND Confession, Part 1: Naturopathic clinical training inside and out

This post originally appeared on ScienceBasedMedicine.org on March 13, 2015. I am including the article here in its original form to help readers easily discover the truth about naturopathic education.

In 2011, I graduated from Bastyr University with a doctorate in naturopathic medicine. I passed the Naturopathic Physicians Licensing Examination (NPLEX) and landed a competitive, one-year residency in family medicine and pediatrics at an out-patient clinic in Seattle. When I completed my residency, I remained at this clinic for a brief time before moving to Arizona to practice until 2014.

During my time in Arizona, I realized that my profession had severely misled me. Naturopathic medicine is marketed as a “distinct form of primary health care.” This phrase is ubiquitous: it appears on the websites of naturopathic medical schools, on materials published by practicing naturopaths, and on lobbying documents to promote the unfettered licensure of naturopaths and to expand eligibility for federal loan repayment programs. Based on my educational and professional experience as an accomplished member of the naturopathic community, I can say that naturopathic medicine might be a distinct form of something, but it is not any form of primary health care. I am saddened to report that not only was I misled, but so were hundreds of legislators, thousands of students, and tens of thousands of patients.

Patient undergoing hydrotherapy treatment
Historical image of a patient undergoing hydrotherapy treatment. Image from the History of Medicine (NLM).

Given my journey through naturopathic medical school, I can provide strong evidence and testimony of the quality and quantity of training at Bastyr University. I base what follows on my academic transcript, course syllabi, course catalog, and the student clinician’s handbook in addition to my personal experiences. It should come as no surprise to readers of ScienceBasedMedicine.org that naturopathic training is not as the profession presents. I’ll say it anyway: naturopathic education is riddled with pseudoscience, debunked medical theories, and experimental medical practices.

Naturopathic education exists in a bubble without critical oversight

The issue of this deceit boils down to the education and clinical training of naturopaths. The naturopathic profession perpetuates a series of false assertions to justify its advancement, which unfold in a closed-loop system that eschews external criticism. Two examples of this dynamic show that naturopaths are the sole regulators of naturopathic medicine.

First, the NPLEX, the naturopathic licensing exams administered by the North American Board of Naturopathic Examiners (NABNE), is written entirely by naturopaths and does not have the same level of transparency as the USMLE or COMPLEX-USA, which undergo an external audit process to maintain common standards, evidence-based rigor, and high-quality assessment. For more information see Melnick (2009).

Second, the Council on Naturopathic Medical Education (CNME) is an accrediting agency that approves naturopathic medicine programs in North America as designated by the U.S. Department of Education. This accreditation does not apply to what naturopaths were taught in school. It actually means that the CNME meets administrative criteria and conducts its own internal evaluation process of naturopathic programs which it approves. This evaluation is not reviewed or shared outside of the naturopathic community.

I will write a second post detailing the conflicts of interest laden in the widely advertised phrase, “U.S. Department of Education accredited school.” There is a lot to be dissected from the CNME’s Handbook of Accreditation and compared to the breakdown of clinical training hours I present below. I might even write a third post explaining how my clinical sciences coursework at Bastyr cannot possibly prepare a student to practice as a primary care physician. For now, the take home message is that naturopathic education exists in a bubble without critical oversight.

A proximal consequence of this insulated community is that naturopathic education remains mysterious to outside observers, and is falsely presented to the public as being on-par with MDs or DOs and capable of training primary care physicians. The ultimate consequence is that pseudoscience becomes legalized as medicine through political maneuvering.

What do Bastyr (and the others) and the AANP say about themselves?

Bastyr University promotes itself as a leader in natural health care. Bastyr states in its promotional material that the naturopathic medical doctorate is a nationally-recognized degree and that its curricula conveys international prestige as an evidence-based, rigorous, and comprehensive program. Most importantly, Bastyr claims to produce medically competent primary care physicians who are “capable of treating a broad spectrum of patients.”

Without going into much detail on this point, one can survey Bastyr’s website to get a sense of how its programs are advertised. Much of the descriptive information appears to be consistent with how the other “approved” naturopathic programs present themselves (Bastyr University California, National College of Naturopathic Medicine, Southwest College of Naturopathic Medicine, University of Bridgeport, Canadian College of Naturopathic Medicine, Boucher Institute of Naturopathic Medicine, and National University of Health Sciences). The language for their programs is all in striking parallel with how the American Association of Naturopathic Medicine (AANP) presents the profession publicly.

The AANP is the professional association of licensed naturopaths. It issues position papers on various topics, maintains the naturopathic code of ethics, organizes an annual conference, and spearheads legislative efforts. My experience participating in the AANP’s 2011 DC Federal Legislative Initiative (DC FLI) highlights how the profession disseminates misleading information for political advancement and how this information is replicated down the line.

Naturopathic medical students and doctors from all over the country gather annually in Washington D.C. for DC FLI. The three-day long political event includes lectures on topics such as the details of nutritional supplement regulation and the industry’s relationship to naturopathic medicine, how chiropractors gained licensure in all 50 states and what we could learn from them, how to practice naturopathic medicine in an unlicensed state, and how to lobby successfully, complete with mock congressional visits. The last day of DC FLI is spent meeting with congressional aides and group lobbying for our “asks.”

When meeting with congressional aides, our success depended on us having succinct information about our naturopathic training. One of the most disseminated documents was a chart produced by the AANP that compared our educational hours to the educational hours of a student of medicine (MD) and a student of osteopathic medicine (DO). The education chart was part of a series of documents titled “naturopathic education facts” and claimed that because of the sheer number of hours spent in lectures and in clinics, naturopaths were adequately qualified to practice medicine as fully licensed physicians. It is very popular among naturopaths to use such an educational chart in an attempt to justify that naturopaths are well qualified healthcare providers. The charts are often featured on practice websites and on the websites of organizations that promote naturopathic medicine. On my former practice website, I used a chart that was distributed at DC FLI. Different versions of the chart can be found all over the internet.

When I practiced as a naturopath, I never thought to fact check any of these educational comparison charts. I accepted this information as truth and was thrilled that someone else had done the tedious work for me. This was mental laziness on my part, because the charts supported what I already knew at the time to be “true.” Now that I’ve come to a major realization about how I and others have been deceived, I think it is important to put out real data and accurate descriptions of naturopathic education for the purpose of making better “facts.”

Method to count hours and false equivalencies

I’ve found several charts comparing naturopathic education to the education of other health care providers. They are all a bit different in how hours are categorized for comparison, which tipped me off that there was some manipulation of the data. Some charts simply break down hours into two categories: didactic and clinical; while there is usually an accompanying table describing a further break down into other categories. Other charts attempt a more seemingly-detailed accounting of hours, but issues remain. In one chart, NDs are listed as having 100 hours of coursework in pharmacology, while MDs/DOs receive only 70 hours. As Orac and Jann Bellamy have already shown, this wiggle room gives ND training a false upper (or equivalent) hand because dubious coursework is inappropriately lumped into other legitimate categories. Here are some of these charts: 1, 2, 3, and 4.

Yet, what good are such charts and their unknown data inputs when I can show what it took for me to earn my ND degree? Furthermore, what does a credit hour mean for comparative purposes when pseudoscience or experimental therapies are being taught in a supposed clinical science course?

I recently scrutinized my transcript, course syllabi, and student clinician handbook. (Here is a table detailing my coursework into more readable categories based on my transcript; credits were translated to hours based on all of my courses syllabi.) I graduated with 1,224.5 hours of clinical training, of which 1,100 hours were in what Bastyr considers “direct patient contact.”

After breaking down the clinical training hours and assessing the quality of the medical training, I believe the quantity and quality of the training provided by Bastyr University is scant, lacks the application of medical standards of care, and includes pseudoscientific diagnostic methods and treatments of real and fake diseases.

My naturopathic clinical training numbers

The majority of clinical training for ND students at Bastyr is completed in the university’s two teaching clinics: the Bastyr Center for Natural Health located in Seattle, WA and at the small health clinic located on the Bastyr campus in Kenmore, WA. Sometimes temporary community clinics are set-up throughout Seattle for additional training. A clinic rotation is scheduled in 4 hour shifts, once per week, for an 11-week quarter.

My 1,224.5 clinical training hours can be broken down as follows:

  • 1,100 hours of primary care medicine training in “direct patient contact” including
    • 748 clinical training hours on “patient care shifts”
    • 44 hours on counseling shifts
    • 176 hours on physical medicine shifts
    • 132 hours spent shadowing any kind of health practitioner (ND, MD, DO, DC, LAc, homeopath, PT, PA, NP, etc.)
  • 25.5 hours for Clinic Entry 1 and Clinic Entry 2 courses
  • 99 hours for the course clinical laboratory diagnosis, called Lab Rotation

748 clinical training hours in “Primary Care”

To provide a picture of what naturopaths mean when they claim to be primary care physicians, I think a description of a typical patient appointment and how training is structurally organized at the Bastyr teaching clinic is telling.

On a clinic shift, one faculty member (a licensed naturopath) supervised several naturopathic students. Usually, there were at least two “primary” students and one “secondary” student on a shift. The terms primary and secondary refer to how many quarters the student has spent in the teaching clinic. By definition, a secondary student has spent less than four quarters in the clinic and is a novice clinician. A primary student has spent more than four quarters in the clinic and is considered advanced. This amount of time does not equate with clinical skill. I knew many incompetent primary student clinicians. Each clinic shift had a specific structure that included three elements: shift preview, patient appointments, and shift review.

Shift preview and review took place in the first 30 minutes and final 30 minutes of shift. During these periods, primary students roundtabled their patients. The patient’s medical history, previous visits to the clinic, and previous naturopathic assessments were discussed. Patient cases were presented in a standardized S.O.A.P. (subjective, objective, assessment, and plan) format. The supervisor usually asked students about differential diagnoses and treatment protocols. Medical standards of care were almost never discussed on my clinic shifts, with notable exceptions for one or two of my supervisors who insisted on it, to the dismay of many students. I often heard statements such as, “the patient has a strong vital force and it is expected that the patient will heal in 3 to 4 weeks’ time with proper self-care and home hydrotherapy treatments.” Sometimes, the preview and review was attended by first-year students completing their Clinic Entry 1 requirements. These students generally did not contribute to the discussions but their time was considered “direct patient contact.”

Actual patient care accounted for three hours of a clinic shift. Patient care visits were typically attended by two students, a secondary and a primary. Appointments lasted anywhere from one to two hours. During an appointment, the primary student charted the patient’s current medical complaint and relevant history. This charting included a typical medical intake, such as the seven attributes of the medical complaint, a review of systems, past medical history, medications and supplements taken, family history, social history, dietary patterns, and so on. Vital signs, like blood pressure and temperature, were usually taken by a student. The patient intake also included information thought relevant to naturopathic diagnoses, like toxin and heavy metal exposure, use of plasticware in cooking and eating, birth history, pesticide exposure through eating non-organic foods, food intolerances, religious affiliations, and a host of subjective assessments relevant for energy therapies (homeopathy, flower essences, UNDA numbers, etc.).

Diagnosis: naturopathic philosophy required

The diagnosis process in naturopathic medicine is an interesting one. A differential diagnosis was usually reviewed, based on the patient’s history and clinical exam findings. For example, the complaint of heartburn could have included a differential diagnosis of gastroesophageal reflux, H. pylori infection, peptic ulcer disease, angina, and irritable bowel syndrome (amongst other relevant diagnoses).

However, the differential could have also included possible naturopathic diagnoses such as IgG food allergies/intolerances (gluten!) or systemic Candida overgrowth. Lab testing and imaging was also considered during this discussion.

Treatment then encompassed recommendations for the medical and the naturopathic diagnoses as a singular, interwoven diagnostic report. In fact, if a patient’s diagnosis seemed like it was only based in medical science, the students, supervisors, or even the patients themselves would sometimes complain about the lack of naturopathic philosophy.

The treatment plan

The patient care treatment plan is a mainstay of naturopathic medicine. It may include any, or all, of the following: a referral to a medical specialist, homeopath, acupuncturist, nutritionist, another ND or other provider; a medical prescription such as an antibiotic, birth control, or steroid; a botanical formula in the form of a tea, tincture, or poultice; a homeopathic remedy or energy medicine; home or in-office hydrotherapy recommendations such as contrast (hot/cold) showers, enemas, or sitz baths; nutritional and exercise recommendations, and so forth. The options seemed endless. A patient might have received any treatment recommendation!

Many supervisors would limit the number of recommendations in an attempt to rein in plans that seemed to run wild. Other supervisors would have certain requirements to consider, such as if a homeopathic remedy were offered, another therapy must also be included.

To the best of my memory, I was rarely asked about the medical standard of care for a diagnosis and treatment plan. The treatments offered to patients were usually abundant and seemed like a toss-up.

My clinical training included such a small amount of pharmacological experience that it hardly seems worth mentioning. I spent far more time learning how to write a prescription for botanical medicines than how to prescribe appropriate pharmaceutical medications. Once I was in practice, I specifically befriended a pharmacist at a local pharmacy in Seattle so I could ask questions about drugs, dosages, interactions, and protocols. I still am very thankful for her help.

The herb Cheladonium, an infamous cancer quack treatment. Source: Prof. Dr. Otto Wilhelm Thomé Flora von Deutschland, Österreich und der Schweiz, 1885
The herb Cheladonium, the source of an infamous alternative cancer treatment. Source: Prof. Dr. Otto Wilhelm Thomé Flora von Deutschland, Österreich und der Schweiz, 1885

The no-standard standard of care

There are no naturopathic standards of care. Students and residents at Bastyr University have compiled documents explaining the diagnosis and treatments for a variety of diseases, which are available to students and faculty on the university’s online portal. A review of these documents reveals a large degree of untamed variability that is reflected in naturopathic medicine.

For example, the entry on angina includes a variety of treatment options: nutrient therapy with selenium, CoQ10, magnesium, and niacin; limiting fat intake; removing sucrose, alcohol and caffeine from the diet; botanical medicine in the form of doses of ginger, ginkgo biloba, aconite, and bromelain; at home exercises; recommendations to address a type A personality; a detoxification diet; colon hydrotherapy (i.e. enemas); castor oil packs; food allergy elimination; juice fasts; hormone replacement therapy; lifestyle changes; and monitoring of uric acid levels. Of the documents I’ve reviewed, all fail to mention any standard of care, which for some conditions, at a minimum should include an immediate referral to the emergency room or medical specialist. I know it sounds cynical, but naturopathic medical care is like picking treatments out of a magical hat.

I think it is also interesting to note that in lieu of four patient care shifts, a student had the option to take homeopathy shifts instead. This means that 176 hours of the required 748 patient care hours can be spent purely in homeopathic training. But given that very little medicine was actually taught in clinical rotations, perhaps the substitution doesn’t even matter.

44 clinical training hours in naturopathic counseling

Naturopathic counseling included education and training in the basic principles of psychology, counseling, mental illness, substance abuse, and motivational interviewing. Students were required to take 132 lecture hours of counseling-related courses and one clinical rotation that is completely dedicated to naturopathic counseling. On these shifts, no vitals were recorded and no physical health concerns, other than mental health, were covered by the student or the supervisor.

I believe the education and training in counseling for primary care is important, but I do not believe that training in counseling counts as training in primary care.

176 clinical training hours in physical medicine

Naturopathic physical medicine is modeled after the chiropractic theory of vertebral subluxations. Diagnoses are usually based on the invented disease process of a vertebra falling out of alignment with the rest of the spine, causing specific health symptoms, even organ system problems. Naturopathic medicine has repackaged chiropractic theory as “physical medicine and naturopathic manipulation.” We were taught how to assess, diagnosis, and treat vertebral subluxations in our naturopathic manipulation series and hydrotherapy courses. Physical medicine rotations include treatments such as colon hydrotherapy, alternating hot and cold water treatments, or soft tissue massage in addition to what is essentially chiropractic adjustments.

Sometimes patients with chronic diseases, such as fibromyalgia and naturopathic diseases, such as adrenal fatigue, chronic Lyme, and multiple chemical sensitivity, received hydrotherapy treatments in order to help “stimulate the vis” (one’s life force). Naturopaths widely believe that treatments with water, heat, and cold can stimulate the immune system, detoxify, and promote healing.

Bastyr naturopathic students were required to take 198 lecture hours of naturopathic manipulation and physical medicine courses and complete four physical medicine rotations (176 hours). While some primary health care concerns may be covered in a physical medicine shift, the diagnosis and treatment of vertebral subluxations plus the training in hydrotherapy and naturopathic manipulations cannot qualify as primary care training.

132 clinical training hours in preceptorship

In naturopathic education and training, student precepting has a broad definition that can mean anything from the student shadowing, assisting in medical (or naturopathic) diagnosis or treatment, or providing administrative/front desk support. Based on these loose requirements, there is no guarantee that these 132 clinical hours resulted in patient contact or contributed to clinical training. These hours may be spent with a medical doctor, osteopath, naturopathic doctor, homeopath, chiropractor, acupuncturist, or anyone else deemed appropriate by Bastyr University.

Eighty-eight of these 132 hours were required to be spent with a naturopath, and a student was limited to 44 hours of precepting with non-naturopathic providers, including medical doctors.

25.5 clinical training hours for clinic entry 1 and clinic entry 2

The courses Clinic Entry 1 and 2 provided no actual clinical training. The course Clinic Entry 1 required first year naturopathic students to visit the Bastyr Center for Natural Health (BCNH) three times as a patient, and to also attend three patient case preview/reviews. Personal reflection papers for these experiences were required. There was no direct patient contact whatsoever.

The course Clinic Entry 2 covered the structure, organization, and policies of the BCNH. The course was designed to “aid the student’s transition from the classroom, into the clinic,” by introducing the student to personnel, by covering clinical requirements for graduation, and by familiarizing the student with pertinent paperwork such as student timesheets and absence forms. Additionally, professional conduct, HIPPA regulations, and charting were reviewed. At the end of the course, the student was required to complete an exam on a standardized patient. This exam was practiced throughout the year in an entirely separate course, called Physical Clinical Diagnosis Lab. Clinic Entry 2 did not include any clinical training or patient contact. The inclusion of Clinic Entry 1 and 2 in clinical training hours appears to be for the purpose of inflating clinical training hours.

99 clinical training hours in clinical laboratory diagnosis, “lab rotation”

In “Clin/Lab” Diagnosis, we learned laboratory diagnoses of clinical diseases. We were taught methods of lab analysis, testing protocols, interpretation of laboratory results and the clinical application of this information. We were also taught clinical laboratory skills, such as microscopy, KOH prep, vaginal wet mounts, semen analysis, stool analysis, and phlebotomy. While this class was related to primary care training, there was no direct patient contact. We used each other’s arms to learn phlebotomy and practiced analysing each other’s body fluids. I remember feeling more than a little self-conscious as I walked to the bathroom to collect a urine or a vaginal swab. I agree that these hours contribute to training, but they do not contribute to direct patient contact hours.

Nearly any old-timey treatment you can name is still being prescribed by naturopaths today.
Nearly any old-timey treatment you can name is still being prescribed by naturopaths today.

Quality of clinical training and competency evaluation

Our student clinician handbook contained a list of broad medical categories such as cardiovascular disease, hepatobiliary disease, and female gynecological disorders, for which students were required to demonstrate medical competency. Medical competency in these areas was based on the number of appointments a student clinician had with a patient with that category of disease. The number of appointments varied. For example, competency for cardiovascular disease required treating two patients with any type of heart/circulatory disease. Competency for hepatobiliary disease required treating just one patient with any liver or gallbladder disease. Any patient needed to be seen twice to achieve competency.

While students were required to see a variety of primary care conditions in order to graduate, the majority of students never had the opportunity to see an actual patient suffering from such conditions.

Some diseases were very common in the teaching clinic. To the best of my memory, these included irritable bowel syndrome, anxiety, food allergies, fibromyalgia, chronic fatigue, adrenal fatigue, chronic Lyme disease, chronic mononucleosis, chronic back pain, and esophageal reflux.

Less common diseases included hypertension, asthma, hypercholesterolemia, anovulation and menstrual problems, and acute illnesses such as the flu, pneumonia, bronchitis, gastroenteritis, and conjunctivitis. Students used to fight over seeing acutely ill patients as these patients were so rare!

Patients suffering from serious diseases, such as diabetes, cancer, and HIV/AIDS, could only be seen on specific clinic rotations. If students were unable to have direct contact with a mandatory health condition required for competency (due to a lack of patients and a lack of variety of disease in the clinic overall), students could present to fellow students on their clinic shift on the disease/condition to earn competency. A presentation usually lasted about 10 minutes and would cover the basic etiology, differential diagnosis, and naturopathic and/or medical treatments of a condition.

Students were required to achieve physical exam benchmarks, such as a cardiovascular exam, a respiratory exam, a prostate exam, or a neurological exam. Students were only required to complete one exam in each system and may perform the exam on another student if a patient was not available or the student never had the opportunity to perform the exam on a patient. It was not uncommon for students to perform prostate and gynecological exams on each other in order to complete the required examination for competency. And in fact, the instructor of our advanced gynecology class (an elective course) asked the female students taking the course to act as standardized patients. When I learned this, I was happy that I did not register for the weekend elective course. The lack of actual patients to practice examinations significantly hinders naturopathic clinical training.

Sometimes, specific minor medical procedures could be performed in a patient visit. This depended on the available time and the willingness of the supervisor. Procedures I was allowed to perform during visits included: Tb testing, immunizing children and infants, gynecological exams, a prostate exam, sports clearance physicals, well-child exams, intramuscular injections of vitamins and minerals, and an ECG. Minor office procedures, such as suturing, could only be performed on one specific rotation (called Minor Office Procedures) under the supervision of a medical doctor. I was lucky enough to get enrolled in this rotation, and so I had clinical practice performing these procedures. I also took another elective shift, called IV therapy, where I was able to practice formulating, mixing, and administering IV therapies.

There were also clinical competencies for the naturopathic counseling and the physical medicine rotations. The counseling competencies were mostly subjective, such as “student can establish a therapeutic relationship with the patient” or the student can “articulate the therapeutic process.” The physical medicine competencies included demonstrating orthopedic exams and knowledge about physical medicine treatments including: hydrotherapy, electrotherapy, manual therapies, and chiropractic adjustments. It is notable that there were no competency requirements for IV therapies, pharmacology, or minor surgery, and there was no clinical training in emergency medicine (although we were asked basic questions about emergency medicine on the NPLEX). However, there were lengthy competencies for homeopathic medicine!

Lastly, there were graduation requirements that stipulate the number of patient contacts required by each student. Each student needed to have 350 patient contacts, which averaged to about 16 to 17 patients per rotation. Roughly half (176) of these patient contacts must have been as a primary student. Many clinic rotations lacked the necessary patients to reach 350 contacts. I remember students complaining about not having enough patient contacts prior to graduation due to a lack of patients at BCNH. It was possible we might not see any patients during a clinic shift, so we would present on health conditions and complete physical exams on each other for competency.

Conclusion: naturopaths are not qualified to practice primary care

I recognize that it is my opinion, and probably also the opinions of the editors and readers of SBM and other similar venues, that naturopathic “doctors” or “physicians” are not qualified to practice primary care. Yet I hope that my description of the clinical training provided by Bastyr University propels this claim closer to the realm of fact. I find it extremely troubling to have been the victim of so many layers of deceit: the naturopathic medical school promotional material, the education and clinical training, the AANP’s political efforts, and the information promulgated by my former naturopathic peers, colleagues, and elders. (Yes, naturopaths consider some in the older generation who are “influential” to be so-called elders.)

I sincerely hope that I can help shed light on the truth, which is why I decided to start my own blog and recruit others who share my sentiments.

I will continue to write about the many issues in naturopathic medicine. There are gross conflicts of interest in how naturopathic medicine is regulated: the NPLEX exam remains mysterious (though I have submitted exam questions in the past and have some insight to how the exam is put together), the quality of the clinical course work is lacking, and the AANP disseminates false information to lawmakers and naturopaths who don’t think to perform basic fact checking.

In short, naturopathic clinical training is not on par with medical or osteopathic doctors and is in fact far less, in terms of quantity and quality — and also less than nurse practitioners and physician’s assistants. Of the hours that Bastyr provided to me and my classmates in purported primary care training (748 hours), one quarter of this time was spent in case preview and review. The remaining 75% (561 hours) contained dubious diagnostics and experimental treatments that were so embedded within a pseudo-scientific and pseudo-medical practice that the student clinician loses the ability to assess what is truth and what is make-believe. When homeopathic remedies are presented on the same level as antibiotic treatment, the naturopathic student is lost, and I don’t blame them.

I think it is quite apparent that the 561 hours of what I calculated to be “direct patient contact” in clinical training are nothing of the sort that would instill confidence in anyone that naturopathic education can produce competent primary care physicians. There is no way that such training produces better, cheaper or more effective health care than what is currently available. Yet, this is exactly the rhetoric fed to federal and state lawmakers about naturopathic medicine, and it is wrong.

If naturopaths are going to continue to argue that their scope of practice should reflect their training, then they need to accept that their scope of practice should be severely, severely, severely dialed back or they need to conduct a massive overhaul of their training, as the DOs did in the 1970s. Furthermore, naturopaths are not required to complete residencies (except for those practicing in Utah who need one year of residency), which is where any physician will argue the real practice of medicine is learned over the course of multiple-year post-graduate training in a teaching hospital.

Realistically, if I were to practice naturopathic medicine according to my training at Bastyr University, I honestly do not even know what I would be qualified to do.


Melnick, Donald E., 2009. Licensing Examinations in North America: Is external audit valuable? Medical Teacher 31:3, pp. 212-214. DOI: 10.1080/01421590902741163

67 Replies to “ND Confession, Part 1: Naturopathic clinical training inside and out

  1. So you got a doctorate and are now in pursuit of a masters… Why don’t you go to school to become an MD or a DO since you speak so highly of them? I’m trying to understand the purpose of this blog. It seems extremely one-sided and full of anger. A person who talks a lot of crap about something is saying a lot about themselves. How much time do you have on your hands to keep updating this blog spewing so much hate? Naturopaths are no replacement for allopathic medicine, and they say that themselves. The whole point of natural medicine is to be less invasive in treatment. Allopathic medicine isn’t a perfect field either. Chemo and radiation aren’t 100% effective and after all the money poured into cancer research there still is no cure. I think it’s great that bastyr is getting NIH grants for research. When something isn’t working why would you keep doing the same thing over and over? I’m sure you’ve come into contact with incompetent naturopaths, there are incompetent MD’s and DO’s as well. Allopathic doctors receive minimal education in nutrition and I think that’s what sets naturopaths apart. Naturopaths are great for preventative care, and possibly more advanced diseases, we will see as more resarch is being done. Allopathic doctors are great too, I have one in my family and I respect what he does. I just graduated with a bachelors of science in cellular and molecular biology and I am excited to say I’ll be going to ND school. I’m sorry it didn’t work out for you. Good luck in all you do, and I hope you can learn to respect ND’s even if it’s not for you 🙂

    1. Based on your response, I’d conclude that you do not fully understand how science works: advances are made slowly, carefully, and with circumspection. You seem to be unaware of how well medicine deals with cancer, but alas yet there no cure because cancer is not a single disease, despite the umbrella term. Yet, cancer detection and treatment are the best they’ve ever been because of dedicated scientists, science, science, and most importantly more science. Perhaps you’re blaming the pitfalls of capitalism on medical research.

      I’d strongly recommend that you reconsider naturopathic school. It’s expensive, and you could go to medical school for the same price or PA school for far less and help people based in a tradition of real knowledge building, rather than based in mechanical reproduction of obsolete “medical” traditions. If what you learned in molecular biology was developed by the same processes of naturopathy where would you be? What would you know? How would you know that you knew anything?

      1. I don’t want to go to allopathic medical school for many reasons. It’s not for me. I am not interested in treating the symptoms. When I was a kid, I lost my mother at a young age. The first thing they did was put me on three different kinds of antidepressants. I’m sorry but that’s not okay. Drugs are toxic and shouldn’t be used so freely. They are great when they are truly needed but not in a situation like that. I do understand how science works and that’s why I want to go to a school where research is being done. We live in a country where the majority of people die of heart disease yet most MDs continue to prescribe medications instead of helping their patients make a lifestyle change. 10 to 20 minutes is all they have until they are on to the next patient. I am going into the business of helping people. I strongly believe diet and health go hand in hand.

        They are already starting a bunch of cancer research using Chinese herbs which are showing some anti-cancer properties. So there’s your science science and more science. I love science and just because I’m choosing to not be a doctor that perscribes a pharmaceutical drug for everything doesn’t mean what I’ll be doing is bad. We need every kind of doctor out there to provide more options for the patient.. It’s up to the doctor to refer when it’s out of their realm of practice which I will most certanely do. If what naturopaths didn’t work why would they have all these schools teaching naturopathic medicine and why would there be so many successful naturopaths in practice? Not everything an MD does works either! I’ll leave you to your hate blog.. That’s all I’m going to say

        1. There’s not much hate here, but rather distaste for uncritical thinking. Please note that going to a school where research is done is not the same as doing research nor understanding research yourself. Also, just because anything has an institutional system doesn’t mean it’s valid, as you argue is the case with naturopathic schools. Take astrology, for example, or psychics. You would argue that because they exist in society, they must be valid? That’s called a self-satisfied ontology, and that doesn’t work out so nice for getting new information out of nature. Now I’ll be mean: homeopathy is a special kind of stupid thinking, and as an anthropologist I’m sorry to say that, but I make myself feel better by contectualixing it within a huge range of cosmological belief systems around the world that are cool because of how they interface with real sociological phenomenon, not because they are mystical, claim to operate on an esoteric level, or are old.

          1. I didn’t say “if something has an institutional system it’s valid” so I don’t see why you even went there. What I’m trying to say is that there is a market for natural medicine because it WORKS. it works and it does so in the least harmful way possible. You’re an anthropologist and were trying to educate me about cancer?! I received an A in my molecular genetics course where all we did was read papers on cancer research. I know cancer is an umbrella term. I feel like you know very little about medicine and just state random facts to make your argument sound relevant. Call it hate call it “distaste” but you made a whole blog about something you don’t like.

            1. If what naturopaths didn’t work why would they have all these schools teaching naturopathic medicine and why would there be so many successful naturopaths in practice?

              This was the line that inspired the remark about institutional presence justifying its effectiveness. This thinking is also called “begging the question”: For example

            2. A, your evidence that natural medicine all-caps WORKS, and that it does so in the least harmful way possible, would be..what, exactly? Be specific.

              You do have some, don’t you?

        2. “They are already starting a bunch of cancer research using Chinese herbs which are showing some anti-cancer properties.”

          Idnetification of active ingredients from natural sources (such as Chinese herbs) is a branch of science based medicine mnamed pharmacognosy, which has been proven to deliever more effective treatments (there’s a reason why we take aspirin rather than brew and drink willow bark tea, after all–controlled dosage, elimination of contaminatns, etc.)

        3. Actually, cancer has been cured in many cases already; the herbs that were used in these cases are just not popularized here in the states because of all the profits associated with the medical industry. Also, people are and will almost always be driven by incentives, and unfortunately, money is the biggest incentive to most people. So while doctors should take full responsibility for prescribing their patients excessive amounts of drugs (and I have just as much of a distaste for this as you do; I’ve seen so many young kids become addicted to painkillers due to this practice), they are at the end of the day driven by the incentives laid out by the pharmaceutical industry. And it should be noted as well that excessive prescription does not imply the medications do not work. Clearly, they still work and are science-based but just need to be given cautiously and with a particular emphasis on day-to-day health habits. Anyways, I very much appreciate this blog’s deep analysis; I do not think it is a hate blog, but I also see what you’re saying.

          1. Jacqui, whyour evidence that ” cancer has been cured in many cases already” by herbs would be what, exactly? Be specific.
            You do actually have some–right?

          2. Could you tell me how an md profits from prescribing drugs. I know a naturopath actually profits greatly as they sell herbs and supplements at a profit. This is yet another great hypocrisy promoted by naturopaths

    2. “When something isn’t working why would you keep doing the same thing over and over?”

      And yet naturopaths continue to embrace hoemopathy, acupuncture, etc., despite the fact that they perform no better than placebo’s…

    3. To A sorry for the loss of your mother at a young age, no one should go through that. However, don’t throw out the baby with the bath water. I don’t see the author as full of hate, I see disappointment in being deceived. If you go to the author’s “about” section you can see why she’s getting her master’s now, and its in large part due to the reasons she writes this blog. Naturopathy is not evidence based, it seems Ms. Hermes is looking for a career in an evidence based profession with quantifiable results. Science is not about the shotgun approach and seeing what sticks, thats faith based techniques. Science is about observation. Just ask yourself this question how many diseases has any type of alternative medicine eradicated? How many has science? That should be enough to tell you what works and moves humanity forward and what doesn’t.

      Thank you Ms. Hermes for your information and brave decision to question your own former profession, carry on and go forward.

  2. A, I salute you for your courage – as a person very new to the wonders of holistic medicine – in posting on this polluted site. It takes a particularly lovely mind to search outside of the “Box” for solutions to unsolved problems. I wish you the very best on your path. And, I encourage you not to believe the vitriol spewed on this site against homeopathy. Having practiced naturopathic medicine for the last 11 years, I have been consistently awed by the power of homeopathy. It is not the fault of homeopathy that science has not yet figured out how it works. Bastyr does a hideous job of teaching it. But, if you are earnest, you will be able to learn it nonetheless. Best wishes!

    1. It’s not that science hasn’t figured out how homeopathy works. It’s that science suggests that for homeopathy to work, we would require a complete paradigm shift in at least 3 major fields (chem, bio, physics) which is extremely unlikely.

      The other problem is that homeopathy DOESN’T work. The best research done with the biggest sampling sizes and the best controls demonstrate this.

      So not only is it about as inconceivable as it gets, it also demonstrably does NOT work.

      1. I agree Travis; nice one. The person who convinced me that Homeopathy was junk would agree with you but used a different tack. His view was that it was internally incoherent. That is that EVEN if you accepted the major shifts in Physics and so on it STILL couldn’t be right.

        The basic point was really banal but I have confirmed it again and again since. It is the banal difficulty of getting a ‘pure’ starting point. In many cases the ‘starting material’ if I can call it that is so heterogeneous, even in ounce size portions that there is no possiblility of ‘tracking’, if you wish, any dilutions.

        The devil is in the detail you might say, the amount of time spent on large and expensive trials of this nonsense is, in itself a disgrace and needs to be addressed. I spoke once to a person who conducted such a trial, he privately agreed with me. Basically as Britt Hermes says elsewhere, the problem is really sociological, political and indeed legal. Much of the writing and time of the advocates of these things, like Dorothea Cist is actually spent in this ‘second order arena’ and the art of manipulating our political system?

        Back to the technical points. You just can’t achieve the required levels of purity even for plain water; there might be chemists around today who can do it, it is many years since I examined this.

    2. Dorothea, your evidence that homeopathy acheives better outcomes than placebo’s as a treatment for non-self-limiting illnesses or inuries would be…what, exactly? Be specific.

      1. My evidence is massive and amazing personal experience. If I get around to it and get the permission of the mother, I will post an email – with photographs – from the mother of a seven-year-old girl who had a brown recluse spider bite on her neck. This little girl’s enzyme-induced wound – which mostly likely would have killed her without homeopathy, as conventional medicine has no treatment for this bite – resolved completely within one week. I have many other cases of, and letters of testimony from, patients who were treated successfully by naturopathic medicine, and often by homeopathy alone. These magnificent cures, by treatments completely unsupported by any double-blind, placebo-controlled clinical trials, were from pathologies as varied as rheumatoid arthritis, ulcerative colitis, grand mal seizures, interstitial cystitis, bi-polar disorder. But, the closed minds on this site, I imagine, would never believe letters of testimony. This amazing case, with photographs, of a Brown Recluse Spider bite resolving and leaving perfectly clean, smooth skin in its place within a week, since it’s pictorial, might move even the witch-hunters on this site. We”ll see.

        1. “My evidence is massive and amazing personal experience.”
          Dorothy, how have you established what you believe, based on your “massive and amazing personal experience” to be true actually is true? Explain the process.
          “…as conventional medicine has no treatment for this bite”
          You mean, other than local debridement, elevation, local application of cold compresses, surgical excision, administration of steroids, antivenom, etc.?
          “ – resolved completely within one week.”
          Which rather strongly suggests it wasn’t the bite of a brown recluse spider-agreed?
          “I have many other cases of, and letters of testimony from, patients who were treated successfully by naturopathic medicine, and often by homeopathy alone.”
          The plural of ‘anecdote’ isn’t data, Dorothy.

        2. Britt! Let her keep talking
          Beautifully stated Dorothea. You explain perfectly how you practice with no evidence whatsoever and just rely on heresay and testimonials! Moreover, you do not make any of the diagnoses yourself, but rely on md diagnosis of bipolar, seizure, etc and then treat. Great stuff! I wonder if the naturopathic college in your state would be interested to know about your claims of curing all these diseases. Then again the naturopathic colleges are complicit in the deceipt
          Dorothea “evidence” based practice and claims highlight the problems with naturopathic medicine better than Britts articles.

        3. Dorothea. I have thought of an excellent way you can prove to us the extreme power of naturopathy and homeoptathic remedies. You can allow the recluse brown spider to bite you and then cure yourself. We can even allow you to pretreat yourself with this magical concoction.
          More powerful demonstrators then trying to convince us you cured what was probably some common spider bite or more likely a mosquito bite

        4. … a seven-year-old girl who had a brown recluse spider bite on her neck. This little girl’s enzyme-induced wound – which mostly likely would have killed her without homeopathy, as conventional medicine has no treatment for this bite – resolved completely within one week. …

          Actually Brown Recluse Spider bites rarely cause death. You are far more likely to die by being struck by lightning. Most bites heal themselves.

          You might like to read these:
          Brown recluse spider bite death…

          Brown recluse spider bite Wikipedia

          Brown Recluse Spiders: Facts, Bites & Symptoms

          Hope it helped.

        5. I cured a cyst on my face with tea tree cream. pineapple for sinuses, etc… if people would open their minds they would see the truth. I use pharma meds for me and my son but i also use alternative treatments. My mom has been able to stave off uti’s with cranberries. My sister shrunk cancerous liver tumors with an alternative diet. People believe what they want to believe, but I know the truth because i’ve seen it for myself.

          1. Supermon, how exactly did you factually establish that what you beleive cured the cyst on your face–the tea tree cream–actually was responsible for the improvement in the condition you observed? More specifically, how have you ruled out the possibility that it would have improved to the same extent, over the same period of time, if you had not applied tea tree cream to it?

            1. It was on my face for months and looked the same, it was only when I applied the tea tree cream did it shrink.

              1. I cured a cyst in my neck by doing nothing. It went away by itself after a few months.

                Actually, it ocurrs to me that I filled my car with gasoline several times during that period. So maybe it was the gasoline.

  3. Dear A,

    Bill Maher recently quoted Stephen Hawking as saying, “The thing about smart people is that they seem like crazy people to dumb people.” (But, God knows you can find millions of incorrectly attributed quotes, however true, on the internet.)

    This site is filled with the rantings of mediocre minds. If I felt like spending my time that way, I could dismember the “reasoning “ incanted here by, among other things, citing the boundless examples of corruption in the establishment of current “science.” Thankfully, I have better things to do with my time. But, if I have helped encourage one person on this path – with the proviso that you really have to be determined to be true to the principles of this medicine in order to emerge from Bastyr unscathed – then, the time I have spent on this site has been worth it.

    Best wishes and love to you.

    1. “I could dismember the “reasoning “ incanted here by”

      No, you couldn’t.

    2. Thank you for your kind words of encouragement. You are so right. There are some things science has yet to explain but that doesn’t mean that we should stop doing treatment that works because there is no science to explain it. The people who write these blogs have nothing better to do with their time than try to argue circles around people with differing perspectives, and think they can invalidate an entire practice of medicine due to what they think is a lack of scientific backing. Many people would argue otherwise. I am thankful for people like you, Dorothea, that don’t even feed into it. If their goal is to take away medical licenses from naturopathic doctors I first laugh out loud then wish them luck because the trend is moving against their wish. Not everybody wants to chase symptoms. The body has an innate ability to heal itself. If you have an argument against that one you just sound ignorant.

      1. ” lack of scientific backing”

        You are mistaken.

        The reason we know this stuff is nonsense is because of the absolute lack of reliable evidence that it works. In every properly controlled study homeopathy fails to show any more effect than placebos.

      2. ” …The body has an innate ability to heal itself. If you have an argument against that one you just sound ignorant.”

        With an innate ability to heal oneself we won’t need naturopaths. From this statement I am guessing that I just sound ignorant.

        1. Ha! Innate ability of the body to heal itself is any of the following: 1) life; 2) homeostasis; 3) immune function; 4) cellular regeneration. Why are naturopaths stealing these well understood natural phenomenon and rebranding them in pretty sounding phrases?

      3. “The body has an innate ability to heal itself. ”

        Except if you’ve got bacterial or viral meningitis. Or HIV. Type I diabetes. MS. Lupus. Congestive heart failure. COPD. Any number of cancers. Appendicitis. Alzheimers. ALS….

        Well, you get the picture: the body has an innate ability to heal itself, except for all those times it does not.

      4. “Not everybody wants to chase symptoms.”

        Very true. However, Homeopaths do nothing BUT chase symptoms. The entire choice of what ‘remedy’ should be prescribed is based on the symptoms the patient is presenting. Now if or when the symptoms disappear (due to whatever reason) the homeopath claims he has treated the root cause (without ever naming or proving what that purported cause was).
        I really can’t understand why people who believe in homeopathy deride “allopathic” medicine for only treating symptoms… people in glass houses and all…

    3. Let’s assume, for the sake of argument, that there are in fact “boundless examples of corruption in the establishment of current “science.” One must then ask, “Did you have a point?” It does not follow that naturopathic treatments are, or even are more likely than not to be, safe and effective.

      (I’d also caution supporters of naturopathy from throwing the word ‘corruption’ around in light of the practices of the Arizona Naturopathic Physicians Board of Medical Examiners)

  4. The way we perceive cure and health has an immense impact in the way we choose to believe in medicine and health care. Science has proven to us that the body is a complex system in relation to both the internal and external environment we live in. Our internal environment, from our thought patterns and emotions to our fundamental cellular functions, is crucial to our health. Our external environment, from the air we breathe and the water we drink to the food we eat and the people we surround ourselves with, just as well serves a role in our complete health and well-being.

    I am a student of medicine, both allopathic and naturopathic. As health professionals, don’t we all want to find the most effective and least harmful cure to disease and illness? There is a reason why people turn to naturopathy. Something has happened to allopathic medicine over the years that has changed the medical atmosphere. People are afraid of going to hospitals because of the distance they feel between themselves and the health professionals whose care they are under. I am a medical student at UCD, and everyday I see the cold distance between patients and physicians. Where is the human connection? Yes, I believe that medicine would be nothing without the science and clinical research to prove it. Yes, I believe in the work that we physicians strive to achieve with our medical advancements. But over the years I have also come to believe that we have become impersonal and too focused in the disease itself rather than the patient as a human being.

    It is not to say that naturopathic has a long way to go in order to reach the confidence allopathic medicine has achieved. But naturopathy embodies the gentle, holistic, and human connection which allopathy is lacking. Sometimes we look too close into the microscope and lose sight of the being as a whole. Rather than discrediting a discouraging the other, why not try to understand both perspectives and help each other improve in what is wrong?

    1. Beautifully stated. Having not looked back at it in weeks, it’s lovely to see a ray of clear thinking on this site. Thank you, V.

    2. “Rather than discrediting a discouraging the other, why not try to understand both perspectives and help each other improve in what is wrong?”

      I’d like to suggest a way to “improve in what is wrong” with naturopathy: require all medical interventions taught by naturopathic schools and/or practiced by licensed naturopaths meet the same standard of proof for safety and efficacy that science-based medical interventions are required by law to meet.

      This would, of course, require naturopathic schools cease teaching and licensed naturopath’s cease practicing homeopathy, acupuncture, various energy healing modalities, Ayurvedic medicine, etc.

      Do you agree this would represent an improvement, V? If not, can you offer a rational argument why ND interventions should be held to a lesser standard of proof than standard-of-care science based interventions??

  5. And by the way didn’t you move to Germany with your husband that filled your head with all of these horrible things about a profession that you wasted your time on. Oh and by the way I think Germany very highly respects ND professionals as well. So please let them and allow them to be great. Thanks and God bless you and your family.

    1. Sherri, your evidence that any of the modalities which naturopathy offers that are not also standard elements of evidence-based medicine (e.g., hydrotherapy, homeopathy, etc.) are effective as treatments for non-self limiting illnesses or injuries would be…what, exactly?

      I mean, there is some valid reason to believe that naturopaths actually have the potential to ‘be great’, as you put it–right?

    2. Sheri: From what I can gather from an interview she gave (https://www.naturopathicdiaries.com/prism-interview/), her turning point came after reading the book “Trick or Treatment” by Edzard Ernst. In my opinion, as naive as she was at the time of enrolling at a college of naturopathy, she is also blessed with critical thinking.

  6. You never practiced in AZ only received your licence in the state of Washington and became very bitter to the field of Naturopathic Medicine due to the fact that you were not a good doctor period. You had very horrible communication skills and you did not know how to treat your patients because you wanted to be an allopathic doctor but was not “smart enough” to do it. Being a doctor was never your passion nor was it your calling and these are the reasons it may have never worked for you. As stated by others, there are very good MD, DO, DC and ND’s. Before going into the field of becoming a Naturopathic Doctor, you should have done your research about them and clearly it states that they use natural and alternatives ways to help patients and there are many healthcare professionals that work with ND’s as well as going to school to become ND’s. If this is something that is truly so bad, then why would they waste money and time to learn the botanical medicine and other natural approaches that this profession offers????? These stories of you coming across certain patients are seemingly made up and if they are not maybe YOU just did not know what to do with these patients because you could not grasp the concept of being a proficient doctor. You need to pray to God and he will lead you to what you were called to do on this earth, but it clearly was not to be a Naturopathic Doctor.

    1. Sherri, what has lead you to conclude that Britt Hermes “was not a good doctor period” or that she “had very horrible communication skills”? be specific.

      “If this is something that is truly so bad, then why would they waste money and time to learn the botanical medicine and other natural approaches that this profession offers?????”

      Sherri, recall that people are willing to waste money and time to learn any number of things, such as reiki and astrology, that are entirely without evidentiary support.

      The fact people are willing to spend money and time being trained in naturopathy in no way argues naturopaths offer safe or effective treatment for injuries or illnesses.

      1. First of all, I do not have to explain anything to your or be specific to you in any way, but what I can tell you is you need to ask her why she spent all four years in a field that clearly states that they use natural approaches and why make up stories about her working in AZ when she was never licensed in that state. I am not the one with the bashful theory on ND she is, so please do not come for me with anything like you are her advocate. Thanks and Gob bless you and your family.

          1. My point is how about you stop being an advocate for your wife and continue to pursue your degree in archaeology and allow her to think for herself and stop leaching off of your opinions on Naturopathic Medicine. So what is your next point?

            1. I like advocacy. Opinions are her own. I’m just a buff for bravery and critical thinking.

            2. Sherri, what is wrong with being an advocate for the person you love? I most definitely advocate for my wife and she does the same for me. To me that is a part of a good relationship. Instead of telling someone not to advocate for their partner maybe you should thank them for supporting their partner’s endeavor to promote critical thinking and better understand the problems of naturopathy.

              Also, may the Flying Spaghetti Monster bless you and your family with his noodly appendage and take care.

              1. If you say so. My God is not a monster but that is your opinion and may God bless you and your family and bring you peace because clearly you are upset about something.

            3. It is hard to welcome blessings from someone who falsely accuses others of lying and who engages in character assassination. I think the Flying Spaghetti Monster would blast you with marinara covered meatballs for your humanitarian sins.

          1. Ok if you say so. God bless you and your family as well and peace be with you.

        1. “First of all, I do not have to explain anything to your or be specific to you in any way”

          I can only take this as an explicit admission your claims that Britt “was not a good doctor period” and “had very horrible communication skills” was pulled de novo from the distal end of your alimentary canal.

          1. OK if you say so. God bless you and your family and may peace be with you.

            1. ” God bless you and your family as well and peace be with you.”

              How passive aggressive can one be?

              1. Ok if you say so. May God bless you and your family as well and may peace be with you.

    2. There certainly are good naturopaths but fundermentally naturopathy lacks a basis in rigorous science as is expected from evidence based medicine, so it does beg the question, toward what purpose are naturopaths good?

      1. I’m curious, nut–what exactly do you believe distinguishes ‘good’ naturopaths from bad ones?

      2. Hi Nut, I think about this phrase all the time: “good naturopaths.” I like to think I was a “good naturopath” for recognizing all of the bullshit within the profession and then leaving. Sometimes, I think I was a good naturopath for making appropriate and timely referrals and for diagnosing patients correctly. But then I wonder, did that make me a good naturopath, or just a reasonably smart and practical person who studied a great deal on her own?

        At the end of the day, I keep going back to this: Naturopathic medicine is a fake medical profession. Even the “good parts,” such as basic lifestyle and dietary advice, are intertwined with pseudoscience and folklore. I believe the practice of fake medicine, by people with fake medical degrees, is unethical. In no way, not even in the fields of nutrition or counseling, are naturopaths good for anyone.

  7. Thank you Britt for your bravery.

    To the NDs, your fatal misconception is the lack of understanding of cause and effect and the lack of measurement of either.

    Certainly it is plausible that a few tenets of naturopathy have biologically plausible mechanism of action, herbal remedy being the most likely. Allopathic medicine has embraced this as long as anyone, learning organic chemistry to identify the ‘magic’ in nature and studying it for use to ensure safety and effectiveness. But taking this, the most promising of your toolkit, and not learning to identify cause and effect is criminal because where there is benefit there is also harm. Your teaching casts aside an accurate analysis of risk:benefit, or assumes there is no risk which cannot be the case if there is any truth of cause and effect. To wit, over 30 herbal preparations have been associated with acute liver failure and death.


    You not only advise these preparations but the containers contents are often not at all what you say you are prescribing. http://www.documentcloud.org/documents/1532311-supplements.html#document/p1

    And then you make vast profits off of suffering individuals. So much so that this supplement industry is now 75% owned by the Big Pharma you deride so much. It’s great for them, nothing is in it and so it can’t cause harm!

    Another promising field in medicine involves the microbiome. You state you understand this world, but instead ineffectively study or manipulate it. You say you can measure this world, but science has proven that cultures, in fact, are vastly inaccurate. To the tune of misidentifying 2000 organisms in the gut alone based on recent DNA sequencing by population biologists.

    Your allergy testing is flawed, with massively over sensitive results which cannot possibly guide clinical care. Yet you espouse it.

    Because you don’t understand cause and effect, you base your care on anecdotes. You have left the principal of independent and dependent variables on the cutting room floor. You have forgotten that allopaths know that 1/3 of patients will get better, 1/3 will worsen no matter what is done. We can only help the remaining 1/3. You seem to conflate the 1/3 of those that improve with your care effectiveness yet you harm the 1/3 who actually need proven treatments.

    Britt has outlined why you are confused, your training hides from you the sick who don’t just “feel better” when you give them placebo but resolve measurable diseases. You are treating symptoms. If there is any value to your place in care, it is the time you have available to listen and comfort. It’s a part of medicine that has been sadly taken away from allopaths. I warn that your time is now coming to an end too if you amass hundreds of thousands in debt in training and soon will be held accountable for your harm to patients in the form of expensive malpractice policies.

    I’ve treated many patients you have convinced to abandon scientifically proven cures, some of whom have had complicated surgeries, morbidity and even death because they listened to your claims.

    Your time in the limelight has been instructive. Now it is time for you to move on, into science and measurement or instead into the great night.

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