On Notice

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Once, a lawyer gave me astute advice.

He looked at me, with his thirty years of medical malpractice experience, and said, “You are now officially on notice.”

I took his words to mean my ethical and legal obligation to act in light of knowledge about misconduct. His words continue to resonate.

He was referring to a specific dangerous naturopathic practice I had witnessed, for which I sought his legal counsel. His words had a profound impact on me. I now apply my “on notice” duty to the entire profession of naturopathic medicine. The safety and health of millions of Americans are at stake.

In the next few days, Science-Based Medicine will publish an article I wrote that specifically describes the clinical training of naturopathic physicians based on how I earned my ND degree at Bastyr University. I describe a typical clinical rotation at Bastyr’s teaching clinic, the types of patients seen, the number of pharmacology hours I completed, and other testimony. Of course, this post does not cover everything I learned at Bastyr University, but I think it clearly describes why I believe naturopathic physicians are not qualified to practice medicine. The full breadth of my naturopathic education and clinical training will unfurl in forthcoming articles.

I have been accused of not accurately representing the profession or education of naturopathic doctors. In the interest of transparency, I have included my official Bastyr University transcript with my SBM post, which explicitly shows the courses, rotations, and credits completed to earn my degree. I used my course syllabi to translate the credits listed on my transcript into number of hours, which I also included as a chart in the post. My goal was to provide information that has long been withheld from the public, and to let the public and lawmakers understand that naturopaths are not adequately trained to practice any form of medicine.

Additional criticisms of my blog by naturopaths claim that I am misrepresenting the “good” naturopaths who provide “high-quality care” or that I am vilifying naturopathic medicine. The “good” naturopaths like to say, “I practice according to the standards of care in conjunction with what the patient needs.” Let me provide an example of why this reasoning is bollocks.

One day, a patient with “multiple chemical sensitivity disorder” came into the clinic for a regularly scheduled intravenous vitamin C and glutathione injection. The patient was late for the appointment, and the patient’s naturopath was unavailable. I had only a few appointments that day, so I agreed to do the patient’s IV.

The patient arrived holding a bleeding hand. As I was irrigating, examining, and bandaging the wound, I learned the patient’s own dog was responsible. The bite was deep, but I didn’t think the wound needed stitches. However, the patient needed oral antibiotics and a tetanus vaccine. After dressing the wound, I went on to explain the medical necessity of both treatments. I then left the room to get the patient’s IV bag.

The patient’s regular naturopath pulled me aside. This naturopath had overheard me consulting the patient and was furious I had recommended oral antibiotics and a vaccine, due to fears of exacerbating the patient’s “multiple chemical sensitivities.” I maintained that the patient had a deep animal bite, the patient was overdue for a tetanus shot, and the likelihood of an infection was pretty good. We debated for several minutes, and when neither of us agreed to change our minds, we decided to disagree and carried on with our tasks. By the time I had returned with the IV bag, this naturopath had spoken to the patient and made a convincing argument against my medical recommendation.

The patient said, “I don’t want oral antibiotics, and I am very afraid of getting a vaccine. Dr. so-and-so agrees with me.”

I had an idea. I suggested the patient apply a topical antibiotic prescription, take home a prescription for an oral antibiotic, and start taking this medication at the first signs of an infection (along with calling me). The patient would also get a tetanus shot on the way home. I helped arrange the vaccination appointment at a local pharmacy and dispensed a homeopathic remedy.

The only way I could convince the patient to get vaccinated was to recommend the homeopathic remedy Thuja, which is a common remedy prescribed by naturopaths for adverse vaccine reactions. When the patient outright refused to get vaccinated, I came up with the idea of using homeopathy to relax the patient’s fears.

I told this patient, “Take Thuja right after you get vaccinated, and then re-dose yourself every eight hours for the next 72 hours. This will help prevent a reaction, but likely you will have mild tenderness and redness at the vaccination site.” I explained the typical vaccine side effects.

Here’s the catch: homeopathic Thuja would not prevent vaccine side effects. It would do nothing at all. I could have given out any homeopathic remedy and had the same outcome. I specifically dispensed Thuja because I knew the patient would look up online how to mitigate vaccine reactions naturally. I wanted my remedy to be in line with whatever natural health website the patient would find.

The bottom line was that the patient needed appropriate medical care. The patient lived alone, outside of town, and on property with several animals, including a dangerous dog. In my opinion, the risk of a bacterial infection, including tetanus, and subsequent complications was real.

The patient came back the next week and was thrilled to report that the homeopathic remedy had worked. The patient denied a reaction to the vaccine and showed that the bite was healing. I looked at the wound, and indeed, the topical antibiotic seemed to have done it’s job.

Let me state clearly that I do not believe using homeopathy with a patient to get him or her to comply with a standard of care is high-quality care or good doctoring. Yet, I believe that naturopathic recommendations to abstain from sound medical treatment due to unfounded concerns about fake diseases is very dangerous medicine.

Naturopathic standards of care are so loosely defined that they allow naturopaths to invent treatment protocols. While I recognize I worked within this loosely defined realm, the other naturopath had no idea how to treat the dog bite except by rejecting the established standard of care in the interest of providing distinct naturopathic care.  I think it is a shame that I had to use naturopathy and a homeopathic remedy in order to administer medical care to improve someone’s quality of life. Think for a moment about all the “individualized,” “personalized,” and “holistic” naturopathic treatment plans that ignore medical standards of care and endanger patients.

What bothers me the most about this experience is that if I were not already engaged in my new critical thinking journey, I may have acquiesced to the older, “wiser” naturopath and allowed the patient to leave the clinic without appropriate treatment. Naturopaths are notorious for blindly accepting information that fits their world-view and vigorously ignoring information that contradicts. I’ve seen it many times over.

It is easy for naturopaths to ignore information coming from critical websites and insulate themselves with others who think alike. They read the words “pseudoscience,” “quack” and “show the evidence” and run the other direction. For many years, I did the same, but now I know better. Therefore, I will do better.

To all naturopaths: You are officially on notice.

Image credit: Flickr user El Zoid under a CC License