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.
109 Replies to “On Notice”
When you say “I think it is a shame that I had to use naturopathy in order to administer medical care to improve someone’s quality of life.” do you mean the homeopathic remedy specifically?
Oh, and I just wanted to say thanks for sharing and I look forward to the SBM article.
Yes, thank you. I see how I was not clear. I edited the post to be specific. I really appreciate your support!
Thanks you very much for your insight and your bravery. I’m sure the more you write about this topic, the more you will attract folks who will not appreciate your efforts … to say the least. Keep on keeping on. Your voice, as someone who has been an insider, is unique and important. I am a Seattleite, and I’ve mentioned before that I can’t believe this city/area is the home of both Bastyr and the Discovery Institute, both of which I consider to be embarrassments. Thanks again.
I just got out of a frustrating discussion involving a chiropractor on another forum online.
I asked, what happens if a patient comes to a chiropractor with back pain from a urinary tract infection?
This person answered, she would do a urine test with a dipstick and refer to an MD if positive / send out for urinalysis (I wasn’t sure quite which or in which order).
Problems are: a dipstick test doesn’t necessarily diagnose a UTI. It’s a crude test. I can buy dipstick tests for UTI’s myself, but the family medical practice (MD’s) that I go to, does a lot more testing than that. They do some kind of panel; they look at the urine under a microscope; they do a culture or send it out for a culture + sensitivity.
There are false negatives with the dipstick test; maybe false positives too, though that would get the patient to an MD.
Also, does a chiropractor even know how to differentiate muscle pain from pain that might be due to an infection? The MD’s I see have sometimes been able to tell the difference.
Also, even if she correctly refers someone with a UTI to an MD, time has been wasted, and UTI’s should be treated quickly – they can turn into kidney infections otherwise.
She thinks she does an excellent job as a primary care physician, and said it’s the patient’s choice who they see.
But I was very unimpressed with that standard of care! It’s very rudimentary.
People do use chiropractors, herbalists, naturopaths etc. as their primary care physicians – but that’s such a bad idea.
At least, they need to see an MD first.
And when “alternative” practitioners do act as primary care physicians, they are deceiving their patients by agreeing to act as primary care physicians when they aren’t really qualified.
Beth I dont know what form of heath provider you are, but your assessment of the Chiropractor is devious at least. Examination of a person does not rest with a dripstick urine test. The Chiropractor has training in diagnosis and management of most disorders they would encounter in general practice of their profession. A thorough history and examination including Musculoskeletal assessment, neurological assessment, abdominal assessment, urinary system assessment, and then a useful office test of dip stick urinalysis brings a clinician to a diagnosis and management plan. Most of the health professions have gained popularity because the medical profession has not been doing a good job. If they were, patients would not be lost to other disciplines. The patient is also now a more ‘well read’ patient thanks to the likes of the internet.
There is room for all of the professions. The patients needs to go to where they feel comfortable, and safe, and just because it has always been funneled through medical practice doesn’t mean its right. … and yes, Beth I do know what Im talking about. I have trained both Chiopractors and Medical doctors, and work as a Medical practitioner.
I made specific criticisms of what this chiropractor told me.
What specifically in what I said, do you disagree with?
And what is a chiropractor going to do once he’s diagnosed a UTI using his astute diagnostic skills? How is he going to treat it?
And please don’t tell me he’ll refer out. Because if someone can’t treat a UTI, they have no business calling themselves a primary care physician.
When I’ve been to my family doctor with a suspected UTI, they do a urine microscopy – looking for red blood cells, white blood cells, bacteria, etc., and also some lab tests, and palpating my abdomen and checking my back for kidney tenderness.
I don’t know if they do that dipstick test or not. I think there’s a check for protein in the urine.
If the results of the microscopy were dubious, they would culture it or send to a lab to be cultured.
The chiropractor wouldn’t have done all that, and claiming that what she would do is adequate, implies that some of this is superfluous.
So what’s the evidence that not all of this is necessary?
I have experienced similar situations in clinic while at SCNM. Situations where proper medical advice is ignored on the grounds of emotional attachment. Situations where certain ‘wise’ doctors have large followings and subsequently students ignore research or go along with what the doc says without question or reason. I can mirror some of your sentiments in many of your posts. I have also experienced the opposite where docs used standards of care in examining and evaluating patients. I have seen and treated patients successfully with naturopathic and pharmaceutical therapies. Successfully meaning biomarkers are reduced and QOL is improved.
Change comes when we are 100% dissatisfied and clearly you had enough and this culminated in you leaving the profession. Naturopathic doctors have always been ‘on notice’ and so your idle threat means nothing. I always find myself defending why I chose this profession over say allopathic/osteopathic medicine. If I had to chose over, I would chose Naturopathic medicine. So many times I find myself lamenting to a colleague about the lack of a standard of care. There needs to be some standard of care. I agree. However, standardization does not automatically ensure safety. Look at the countless pharmaceutical medications and the side effects listed in commercials alone. Fatality is possible with many current medications on the market. This is standardization. Statins carry an increased risk of diabetes. This is standardization. The #1 option in the standard of care for hyperlipidemia is appropriate management with statins.
The Nuremberg Code is a set of ethics for medical research however the Nuremberg Code carries no penalty and is subsequently ignored all together. This is standardization. There is a standard that is to be upheld when it comes to medical research experimentation. However a simple glance through history shows us that the standard doesn’t really matter. Look at Dr Albert Kligman (1950-70s) whom discovered Retin-A/triretinoin. He experimented on Acres of Skin in prison complexes. These men now have chronic disease, cancers, unidentifiable skin disorders. Where was standardization at there? Or accountability?
What about William Osler Abbott (1935) and his intubation experiments, John Hopkins and their Henrietta Lacks thievery?, What about Dan Goosen/Water Basson and the Roodeplant Research Laboratory? What about Maurice Pappworth (1967) and his experiments using medical technology that caused seizures, convulsions and death. Where was standardization there? None of these men have been held accountable. Where was this Nuremberg Code then? This is your biomedical research.
“Change comes when we are 100% dissatisfied and clearly you had enough and this culminated in you leaving the profession.” – Change did not come in because of dissatisfaction with her work as a naturopathic “physician.” Change was necessary for Mrs. Hermes because she could no longer endure cognitive dissonance; to put it bluntly, Mrs. Hermes discovered that Naturopathy and its practice as taught by graduates of Naturopathic ‘medical’ Schools was a crock of ****, pseudoscience, quackery and she did not want to be a part of it anymore.
You state that ” I always find myself defending why I chose this profession over say allopathic/osteopathic medicine. If I had to chose over, I would chose Naturopathic medicine,” Well good for you – it’s a stupid choice, but good for you, hope it works out for you – cognitive dissonance is a mother****** but if you can do it, more power to you!
What do you as a ND have to offer vis a vis Statins – what is your scientific reasoning that it works?
Regarding Nuremberg/Standardization – with your simple example of Kligman – you forget to mention that due to the scandal, Federal regulations restricting experimentation in prisons were enacted (as with all your examples – do you believe that MDs and DOs today would condone the unethical behaviors or the physicians you mentioned? With every scandal, the standards become stricter, are looked at, are improved upon. Your silly examples do not negate in any way the reason why evidence-based and (what would be even better science based) medicine works as practiced by MDs/DOs; it’s just a childish use of the association fallacy… it’s tiresome, but not new with NDs wanting to defend their silliness. BTW, with NDs, the standard seems to be contrived enlightenment… How do you improve on that?
What NDs do so well is create narrative where they are benevolent victims of the ‘patriarchal’ allopathic medical system (and now also osteopathic, although MDs and DOs are basically the same). Western Medicine, despite research and major leaps forward in alleviating (HIV/AIDS) or even curing disease (certain cancers, etc.), is conventional… ‘and does not seek the root of the cause.’ To show your silliness: here is a link with videos from Bastyr, SCNM, NCNM, Bridgeport graduated, practicing NDs and the usual spouting of BS: https://www.youtube.com/playlist?list=PLEE2270DB4377E121
Listen to how NDs are just so much better than ‘conventional’ medicine!!!
Agree wholeheartedly … what you’re correctly implying is that the entirety of Naturopathy is an exercise in Marketing. Pushing FUD (Fear, uncertainty and doubt) about modern medicine. Orac’s post that led me here, is a pretty good one. It’s a great read and lots of great links to other great reads … http://scienceblogs.com/insolence/2015/03/13/a-naturopathic-apostate-confirms-that-naturopathy-is-a-pseudoscientific-belief-system/
This is a classic tu quoque fallacy: instead of answering the numerous criticisms of the pseudoscience that is naturopathy, you change the subject and criticize anything else.
I do believe the Nuremberg code is a real ethical standard and code, as this conversation involves legalities associated with such. There was much more to this post than tu quoque fallacy. There are many criticisms of medicine, not just Naturopathy, and not all of these will be answered on this blog or post. If you have specific questions, there are many a research based conversation we can have. The position of Dr. Hermes does not state specific questions, but presents opinions and personal experiences, of which drive her passion. If there are other specific questions you have, it would be great to understand what information you are looking for to complete further successful conversations.
Exactly. Asia had no counterargument, much less facts in context, against Britt’s post. Though I must give her full marks for doing a world-class job of trying to move the goalposts.
I don’t know what planet you practice on, but around here the first option for hyperlipidemia is management through diet and exercise. Only if that fails are the (very effective) statins pulled out.
What are you talking about? I met Maurice Pappworth and he exposed medical experimentation in his book http://en.wikipedia.org/wiki/Maurice_Henry_Pappworth Human Guinea Pigs. He certainly did not do these experiments.
Also John Money, Johns Hopkins university who “fixed” a botched circumcision by convincing parents to agreed to gender reassignment surgery. The outcome was suicide as an adult.
‘I always find myself defending why I chose this profession over say allopathic/osteopathic medicine.”
If it were me, I think I’d have started wonder why my choice of professions was in such dire need of constant defense.
‘I have just found your page. I very much look forward to your essays on naturopathy. As a trained ND you will give a unique and honest review of the field and give all of us readers ammunition to use with naturopathy fans. I am trying to convince my local drug store to drop naturopathics “meds” but am having a hard time because the margins on them are so good. Anyway, keep up the good work. I will be a follower for sure.
Why are you trying to drop “naturopathic meds” and what is your definition of such? Why do you seek ammunition to destroy Naturopathic medicine?
Because it’s bollocks. It’s probably more useful to go to a voodoo shaman in the Amazon rainforest for treatment than to a naturopath. At least the shaman would never give you plain water and tell you that it is medicine. Naturopathy should be against the law as it is plain fraud.
I, too, came to your blog by SBM. I look forward to more of your posts. I teach nutrition as well as a class called Human Health and Disease at the college level. At the end of the semester I have two classes on “a skeptics guide to complementary and alternative medicine.” My information has come from SBM papers, and I am happy to be able to add you to my list of resources. I wanted to include Naturopathy this semester – so thank you. Stay strong
I had a friend who became a dedicated naturopath. She studied at NCNM in Portland, Oregon. She had a lump in her breast and went to get it diagnosed by someone that her training considered appropriate for such an occasion. This CAM practitioner said that the lump was not cancer.
Even with her naturopathic training and years in the field, this woman could not diagnose her own cancer or know that she needed to see a real doctor. So, she waited and did that which the CAM practitioner advised. I believe it was about a year and a half later, she felt compelled to see a doctor. My friend was absolutely shocked that it took the real doctor less than a second to proclaim that, yes, this lump was a cancerous tumor.
She forsook the advice of her CAM buddies and got some gnarly surgery done. That surgery ended up prolonging her life for almost 20 years with over 15 of those having pretty good quality. She was unable to give birth to children because of her condition. She also pursued parallel non-medical treatments. But these fake “cures” were so invasive to any regular lifestyle that they significantly lowered her quality of life. The compulsive and invasive administration of these magic cures eventually caused her to look into the actual necessity to continue them. As she looked at the data, she realized it was all fraudulent and stopped.
Had this naturopath seen a real doctor at the earliest stages, it is extremely likely that would be that she’d still be around. She’s dead.
Of course, the course of action was of her own choice. But it is the training into the cult of naturopathy that, in my opinion, is the most direct cause of her death.
Thank you for sharing this sad story Marty.
I’m glad she finally came around. Both the “Wellness Warrior” and her mother died thinking they were doing the right thing. Or maybe they couldn’t bear to admit they’d not only killed themselves, but likely led others to do the same.
Britt, I’m so glad that you will never, ever have to face this sort of thing sitting on your conscience. You got out just in time.
I feel like this post is not just for Naturopaths – it is for any practitioner – to not be on notice when someone’s life is in your hands is careless. Though I understand there are NDs that prefer to be very conservative in their approach to medicine, it is not representative of the WHOLE of Naturopathic professionals. You must do what you feel comfortable with and that is your journey. This journey is not so one sided though. As a Naturopathic Doctor, I have been the primary care physician that has diagnosed cancer appropriately, when MDs have shown disregard to a patient’s complaints and shown faulty care, I have appropriately diagnosed endocrine conditions, supported with pharmaceuticals and naturopathy, SAFELY, and effectively, where MDs or specialists would not. In all fairness, it would be best to have both conventional and alternative training to understand both sides of the coin, and the ability to filter research and information appropriately. I wish you the best of luck on your journey, and hope that if, in the future, given the opportunity to work together, your judgment will not be so harsh as to the detriment of our mutual patient or my reputation.
‘In all fairness, it would be best to have both conventional and alternative training to understand both sides of the coin, and ……appropriately’ – well thank God Debbie the ND is here… She has diagnosed cancer appropriately while those conventional MDs failed at it cause they didn’t care; she has appropriately diagnosed endocrine conditions while does god**** MDs could not. Thank God for Debbie, one of the greatest NPDs, I mean NDs out there! Debbie, A Real American Hero!
Perhaps you are overlooking times when you have not diagnosed something that an MD would have.
Also, at least in most states you have far fewer treatment options available than an MD. You can’t prescribe drugs, for example.
Even if you appropriately refer patients to an MD, this would mean a time delay in getting the right treatment. Sometimes time is crucial.
Please look at the formulary for prescription rights for Naturopaths in the state of Oregon.
Since you do primary care, what would your answer be to Dr. Lipson’s primary care challenge?
I fully subscribe to modern medicine and all of its accomplishments, but I will say that when I was incredibly ill and on the (literal) brink of death, it was my mother’s naturopath who – with a fearful look in her eye – said she would not treat me until I’d had a full neurological workup. My PCP thought I was faking brain tumor symptoms (boy did my MRI prove her wrong). So yes, 98% of the time I see “conventional” doctors, and by and large I think naturopathy is a hoax (that has been adopted by all of my immediate family), but I will say there are individual ND practioners who have a better standard of care than my (at the time) PCP had.
Naturopaths do sometimes help people. But how does this imply they have a better standard of care than MD’s?
In that specific example, my PCP thought I was faking my brain tumor symptoms to acquire painkillers while my mother’s naturopath was the only person among 6+ doctors who recognized something was seriously wrong. I could walk you through my entire journey (during which time said neurologist assured us I had no symptoms of a brain tumor……..) but my point was only that sometimes the open mind of a charlatan provides more opportunities for treatment than the preconceived notions of an MD. Not all the time, of course, and I am 110% in favor of legitimate testing and treatment when required, but if actual doctors want to fight this tidal wave they need to understand where it’s coming from. My PCP told me I was faking my symptoms to get painkillers; 22 days later I had a golf-ball-sized tumor removed from my brainstem. I want to convert my family to DR doctors but I’m going to need serious ammo to convert them, so I ask here for the studies and results that can shut the skeptics down.
The “standard of care” is the professional standard for all of the care provided by the practitioner.
It doesn’t mean, what a practitioner does in a particular instance.
One problem with naturopathic practitioners is that they don’t really have a standard of care. If they do something wrong, they can’t be held to the professional standard for naturopathy, because there isn’t one.
Sure, naturopaths help people sometimes. That’s different from naturopathy having a good standard of care.
As for persuading people to see an MD – it would be easy to find horror stories of people who see only naturopaths, and the naturopath misdiagnosed them or missed a diagnosis that an MD normally wouldn’t miss.
Especially for older people who are at risk of developing type 2 diabetes, cancer, etc.
If you do a little actual research on medical school training, you will notice that all the accredited naturopathic medical schools provide MORE hours of medical sciences training than traditional medical schools. And, of course, we also receive more hours of additional training. Like you, I have also been disappointed by clinical training in our schools. And I also don’t always agree with other naturopathic doctors in their recommendations to patients. However, I recommend that you spend a little more time inside traditional medical schools and working with regular doctors before you bash our profession, specifically. Their education and clinical training is also not stellar and I doubt that you would agree with many of their recommendations. The dangerous situations that regular doctors put their patients in – and ignore – easily equals, and usually exceeds, in my observation, anything that I’ve ever witnessed with naturopathic doctors. So, for the good of the public, you may want to at least increase your research quality before continuing your smear compaign. If your goal is to convince people that they will get BETTER care at the hands of regular doctors, you will be doing a lot of people a great dis-service.
Well Ms./Mrs. Tayler, since you have had more hours in medical science training than your average MD/DO you should have no problem passing the USMLE Step I exam!
Theta-healing, your particular brand of healing, could you tell us the biochemistry of that? How does one activate DNA, do we just cut ourselves repeatedly? Please explain to us the medical science underpinnings of Theta-healing, homeopathy, etc. (modalities you use according to your website).
I would love to be Theta-healed! I knew I had phantom strands of DNA hiding in my cells that contain the genetic code for eternal happiness and the pathway to nirvana. Could you please send your divine healing powers in your next reply to my comment. I don’t have the $25 that your website asks, Tevna, but I promise I’ll pay it forward.
Tevnas Tayler NMD website is full of gems such as:
“ThetaHealing can involve healing or general communications with your Angels and/or departed loved ones, or work on non-health-related areas of your life such as Abundance or Love”
“Whenever possible, I provide ThetaHealing remote instant healing sessions for $25 each, with communication by phone, text, Skype, or email […]I will do the session as soon as possible and reply to you after the instant healing session is complete with any information that I receive from the Creator during the session. These sessions are available for people, animals, and locations […]”>
So. Full. of. Medical. Science. (sEE tHat i cAn aLSO bE Creative with CAPS)
Everybody should check this website and post the dumbest thing they find.
Tell me, are all the hours spent mastering homeopathy included when calculating how many hours are spent training in “medical sciences”?
Reading the comments here I feel like I’ve wandered into Storm Front or FreeRepublic.
Talk about a straw man argument…Are you suggesting that the other naturopathic doctor in your anecdote was a “good” naturopath providing “high-quality care”? Any “good” naturopath who provides “high-quality care” would recommend the same thing that you recommended in that situation. Where did you learn that oral antibiotics and a tetanus vaccine was appropriate medical care? Ah…naturopathic medical school. Duh. You are embarrassing yourself Britt.
No John, I learned these standards through Medscape and Up-to-Date.
Did Medscape and Up-to-Date tell you that the wound didn’t need stitches? I’m sure your transcript will show that you took at least one class in pharmacology. And at least one class in minor surgery. NDs are licensed to perform minor surgery in Washington, where you were trained. You learned how to suture a wound while in school, albeit poorly. Are you really suggesting that neither one of those classes covered proper wound care and treatment? Are you suggesting that all you were taught at Bastyr was homeopathy for wound care, infection prevention and everything else? If transparency is your goal, then post your lecture notes from those classes and let us be the judge. Also, are you offering this anecdote as an example of a “good” naturopath providing “high-quality” care? That naturopathic doctor who disagreed with you is a fool. He/she put the patient in harm’s way. They do not represent the entire profession. Neither do the other NDs that you will disparage in future posts. There are plenty of MDs, DOs, DCs, etc. practicing equally irresponsible medicine. You should put them on notice too. This blog started with some valid points (e.g. Response to Matthew Baral), but has since devolved. This latest post is based on a straw man argument and seeded with lies. Your over-generalizations impair your credibility. Your sensationalism and lack of objectivity hurt the strength of your arguments, and expose your immaturity. All you are doing now is pandering to the zealots on SBM, which in reality, are not that different from the naturopathic zealots that you are attempting to defame on this blog. They are simply at different ends of the continuum. Most of the people on both sides of this argument are closer to the center, and they have no use for this blather. Enjoy your 15 minutes of infamy. The clock is ticking…
So you have absolutely no problem with what the “real” naturopaths wanted her to do?
You’re more self-revealing that you realize.
Thanks for this, Britt. You’re doing an amazing job, and keep up the good work.
can you please explain why you are not listed as a graduate/alumnus from Bastyr?
This is her name she graduated under.
Deegan, Britt Doctor of Naturopathic Medicine 6/18/2011
Don’t let the attackers get you down, I think what you’re doing is amazing and brave. I honestly used to have the very pessimistic view that people who use alternative therapy/food/worldviews (that are not rooted in science) wouldn’t and couldn’t change, because admitting the investment (both in time and money) in their alt. med. lifestyle was too big a hit to their egos. Now, I’m slowly changing that view, as I find people like you, who not only changed their minds, but were willing to admit they’d changed their minds to a large audience. Thank you.
I’m really looking forward to your posts here and on SBM. I hope that you will find the experience rewarding and not let the inevitable criticisms by practitioners of non-science get you down.
Britt, your post reminds me of the time I spent working at an Albert Schweitzer Hospital in the Peruvian Amazon. We had a great deal of trouble getting people to take a full course of antibiotics. An ethnobotanist suggested telling the locals that the medicine put to sleep the demon inside them and in order to kill the demon they needed to take the medicine until the demon starved to death in his sleep.
I look forward to reading your SBM essay.
In 2012, I posted the results of my informal survey of Colorado NDs’ websites on SBM:
I thought this information would help keep the NDs from becoming licensed, but alas, it didn’t. But legislators hearing from someone like you could make all the difference.
I recently saw NPLEX Study Guide questions. Two cases involved children described as being in serious respiratory distress. The “correct” answers were to give a homeopathic in one case and acupuncture in the other.
The parents of these children would have done better to stop a person on the street for help who probably would have offered to take the child to the nearest hospital.
Naturopathy’s ideology, as you say, robs people of even their common sense.
An interesting example of the “confessional” medical genre, which of course is not limited to “alternative” medicine (eg Atlantic: “Doctors Tell All—and It’s Bad” )
Intrinsic to the genre is that the convert finally “sees the light” and moves from their former dogma to a new, improved dogma.
Ms. Hermes writes, “Naturopathic standards of care are so loosely defined that they allow naturopaths to invent treatment protocols.” I can think of no better analogy to this than psychiatric medicine during the 90s, where I worked in a various hospital-based settings. SSRIs were not only the panacea of the day, but they also defined the “standard of care” for depression, dysthymia, and a host of other ills, even though the data were sketchy. Today, this “scientific” approach is rightly under attack (e.g. Medscape: “Broad Review of FDA Trials Suggests Antidepressants Only Marginally Better than Placebo”) Personally, if I am going to take a placebo, I would prefer a homeopathic to an expensive pharmaceutical that has the capacity to make me suicidal.
I believe and participate in the endeavor to create an evidence-based medicine. But because I have done intensive reading of the medical literature, as well as the history, philosophy, and cultural underpinnings of medicine, I understand that medicine at its core is an empirical undertaking. It is not and cannot be a science, in part because unlike science it deals with life and death right here, right now. If Ms. Hermes is uncomfortable with that, then it is best that she pass out of medicine’s treatment rooms into a laboratory, where her insecurities will be appropriately coddled.
As to the predictable, requisite clarion call that all such confessionals demand i.e. “You are officially on notice.” Yes, Ms. Hermes, the emperor has no clothes. We’ve know that for centuries. Please return to SnapChat and let physicians of the world deal with the adult realities of medicine that have clearly proven to be too much for you.
Where did she say she’s uncomfortable with empiricism in medicine?
How do the faults of mainstream medicine argue for naturopathy?
I was in psych hospitals in the late 70’s because I “went crazy” – visions, thinking other people were speaking to me in my head.
It was intensely relevant to me, because I had been abused by my parents and my family, and my visions and thoughts were about the abuse.
The antipsychotics squashed my symptoms, brought me out of that visionary state. But they also squashed my thoughts and my emotions and caused involuntary muscle movements.
So I soon quit taking them and left my abusive family. My visions and thoughts during my “crazy” state became a backbone for me. I didn’t go crazy again.
Much later, in my 40’s I found out I had celiac disease and a lot of delayed-reaction food allergies that had been profoundly affecting me emotionally, and also made my vision quasi-hallucinatory.
I feel much MUCH better now, and not crazy at all.
I’m glad I didn’t stay on psychiatric drugs. And maybe I would have permanent brain damage by now if I had.
This is just one of my serious criticisms of mainstream medicine.
But why would someone believe naturopaths offer help, if doctors don’t?
There have been serious advancements in mental health since the 70s. Had you presented with those symptoms now you’d probably be given a far better medication. But medication is still not perfect because there is still much we don’t completly understand. A good example is bi-polar disorder. Treatment is all about finding the right combination and dosage of drugs, which can take a while, but those that stick with it usually do find the right medication to be functional and happy. As we gain knowledge the medicine becomes better, and will continue to do so.
Naturopathy is not about finding those answers or gaining the knowledge needed, it seems to think it already has all the answers.
I’m glad you were able to find the strength to deal with your mental issues without the limited medication that was available in the 70s because it sounds like it wasn’t working well for you. But I’m sure there were those it did work well for, at least until the science advanced and found something better. Naturopathy wouldn’t have found anything better.
There’s current research on gluten/food allergy/mental health connections, but it’s in its infancy. For example, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856786/
The medications might be somewhat better, though last I saw they were still turning people into zombies. But that isn’t the point. Treating the root cause of a problem is much better than medicating it.
I didn’t find out about my food issues via naturopaths, but I’m sure some people did. But there’s also a lot of “alternative” food allergy sham diagnosis.
What’s your evidence for that statement?
I find this blog an interesting read as it has a very polarized viewpoint. I am currently completing my four year education in naturopathic medicine and definitely resonate with a number of the issues outlined. I hope this blog helps to shed light on many of these issues and results in some positive changes. Thought I would share that what pulled me into this particular medical field is an overall love of medicine (both conventional and alternative) and a desire to practice with as much freedom as possible. Is this dangerous for patients? At times I am sure it is. When there is no “strong” standard of care it certainly has risks…though on the other side of that coin it can have rewards as well. Standard of care can be a serious crutch when it is often determined by factors other than what may benefit a patients health the most…such as rigid philosophical beliefs or even capitalistic gains. For example, how often has any physician desired an MRI when an X-ray was considered the most “cost effective” 1st step in the recognized standard of care? Not the best example but there are many. Anyhow, I’m not personally advocating one way or the other just expressing a small part of why I personally enjoy the freedom of being able to help people in anyway “I believe” is most beneficial based on my personal research and study. The system, both in the naturopathic and conventional medical field, is in dire need of repair. I hope for a world where someday a standard of care can be produced that allows for a focus on the best possible health outcomes for individual patients. My feeling is that as technology, unbiased research, and society progress there will only be one medicine and these divisions between various corrupt and inept medical fields will dissipate into nothing but a sad memory.
The idea that any medicine should be based in a belief system puts patients in danger at the hands of unchecked bias and unknown outcomes.
You’ve basically described medicine as it is embedded in an internationally recognised system of consensus based in science.
I’m scared of your ideology. You want “as much freedom as possible”, but this notion is truly terrifying. You are a student at a naturopathic school, for which standards of admission are low, science and clinical education is lacking, and delusions permeate that naturopaths are competent clinicians.
Yes you are correct but sadly belief is a human condition just like your belief that medicine today is embedded in an internationally recognized system based on science. Do you really think that todays medicine really gives the best possible health outcomes for patients? Have you worked in a hospital? Im not surprised by your fear of my ideology. Personal freedom is scary which is often why it becomes more limited by government as scary things occasionally happen. I suppose its a good thing that I have an MD degree as well. That way you can feel more comfortable with my treating people how I deem best clinically. Anyhow, you clearly cherry picked what you wanted out of my previous statements in order to further your personal belief/ agenda regarding all of naturopathic medicine which is why I am paying you the same courtesy. I hope someday you can see past your biased black and white view regarding naturopathic physicians many of whom are competent clinicians. To say the statements you did implies you have experience with naturopathic education at every institution and that you know that every naturopathic doctor is incompetent. I doubt this is true. Of course it could be you extrapolated many BELIEFS about naturopathic education based on your personal experiences. Im sure you will cherry pick this response as well. Have fun as it will be the last I will be writing.
I see you are rambling. I spared deconstructing your entire response in the interest of time. I’d not call it cherry picking; usually that ends with a sweet taste. You will soon have an ND degree to put your cherry on top of your existing MD credential. Now that is cherry picking!
Hi John, out of curiosity, do you have some specific examples of how you were prevented from treating people how you best deemed clinically by the established system? (I ask this seriously and not sarcastically. Also, if it makes a difference, I have worked in a hospital.)
John, it seems that your time would be better spent becoming and medical doctor and then learning when and how to use the placebo effect. Naturopathy is pretty much just placebo effect, which can be very useful because the mind can affect the body. This is why some hospitals are allowing “alternative” medicines like acupuncture, aroma therapy, and massage, because these therapies are generally harmless but the relaxation effect is very powerful and positive. But the placebo effect has its limitations, it will not cure diseases caused by things other than mental stress, like viruses, bacteria, cancer, etc. Positive thinking can always help in dealing with a disease, but it should be backed up by a strong science-based standard of care.
I applaud your honesty but, yikes! You would rather have your “freedom” to practice what you believe, even if it is dangerous to patients? Please, examine these thoughts more deeply. If your standard of care is simply your belief in a certain treatment you may not fully understand your responsibilities in assuming care for a patient.
I have practiced as an ND for over 20 years. My patients with chronic disease get better. They feel better, have better quality of life, are able to go back to work, raise their children, etc. This after seeing doctor after doctor with no improvement. My patients aren’t idealistic hippies. They are sick people with chronic diseases. And they get better. This medicine works. I work in collaboration with MD’s and DO’s. It looks like Britt practiced for, oh, 5 minutes , was unsuccessful financially, perhaps fell under the influence of someone who articulately trashed her profession and dreams and became disgruntled. Well practicing medicine is not for sissies. You deal with real unique people with real unique problems. Perhaps Britt does belong in a laboratory where you can control every variable. One has to be strong and have many skillsets in order to practice medicine successfully and it seems that Britt did not have these abilities.
Nice ad hominem attacks.
You do NOT practice medicine, you practice a hodgepodge of vitalistic nonsense. You have absolutely no criteria to demonstrate that your victims, er..patients get “better”. I’ll take a flawed but well-educated MD any day of the week thank you. If I need my hand held along the way, I’ll get a therapist.
That is your opinion. And you are welcome to go see a flawed MD when you get sick. Nobody really cares what you will do. But my many many patients who were pretty much incapacitated by chronic disease and who now lead productive lives would beg to differ and don’t really care what people like you think.
Then you will have no problem pointing me to the case-control or cohort studies that your profession have undoubtedly conducted to support this claim.
“Well practicing medicine is not for sissies.”
You are absolutely right which is why someone like you isn’t actually practising medicine.
What do you do that you feel helps so much?
Every patient is unique, every condition is unique, but to paint in a very ( very) broad stroke, I identify through various traditional and functional medicine laboratory testing biochemical and nutritional imbalances, and treat accordingly. And I make sure the microbiome is intact. (Look up Harvard’s research on the microbiome – confirming what ND’s have been working with and pioneering for decades. In fact as the research catches up, history will merely show we were ahead of our time).
How do you make sure the microbiome is intact and what would you do if it isn’t?
Do you do primary care, or work by referral from MD’s?
I run laboratory tests to see if the microbiome is intact and treat according to test results. I personally practice as more of a specialist rather than primary care. I work both direct entry from patients referring themselves and also referral/collaboration from MD’s, DO’s and other practitioners.
How would one know if your microbiome treatment is better than simply minimizing antibiotics, eating a good diet, taking a probiotic?
Once again Sue Smith, could you provide citations for this claim? Surely you are aware of the many criticisms of your practice include the lack of scientific rigour.
The fact that the research is just becoming clear about the microbiome doesn’t support the claim that NDs knew the inner-workings of the gut flora or made any pioneering advances. Sounds to me like NDs were just spewing buzzwords and handing out enemas and probiotics.
There’s a lot of research support for various interactions between gut flora and health. However
– I’m not sure of the validity of testing methods for the gut flora that are available to a clinician. I guess they look at a stool sample, but I don’t know that the composition of a stool sample tells you much about the flora in the small intestine.
– It’s not clear what reason there is to think that Sue’s interventions are any better than simply minimizing antibiotic use, a good diet, and probiotics/prebiotics. Sue’s interventions might be dressing up some basic good advice to look more exact and scientific. Perhaps this induces patients to take it more seriously. Also, having invested money in the testing would induce them to take it more seriously.
When alt-med is advocating something sensible, often it’s something people can find with less time and money, in a book.
Speaking of books – I liked Gary Huffnagle’s book The Probiotics Revolution. He’s done research on interactions between the gut microbes and the immune system, and this is his popular book about it. Perhaps dated by now, though.
It’s a popular health book written by a researcher on the area – so it’s worth looking at.
Thanks Beth; I’m very aware of gut flora research/benefits, etc. I would just like to get the naturopath to provide some evidence of her claims regarding treatment, diagnosis, efficacy and also how naturopaths were “pioneers” in this field. The tests are not standardised and some are downright laughable. We also don’t have reference ranges for gut flora. So whatever naturopaths are doing with this information is probably a lot of hand-waving and as you noted some tarted up basic medical advice.
Let’s assume, for the sake of argument, that both statements are true. How have you factually established the improvements seen in the symptoms of their chronic disease is the result of the naturopathic treatments you’ve provided? How have you ruled out the possibility that the improvements are a function of placebo effect, or other confounders (e.g., regression to the mena or simply the passage of two decades time)? I get you believe your treatments have helped these patients–what I don’t get is what you base your belief on.
WOW! This former naturopath really has missed the boat with her entire education at Bastyr. I have been involved in Naturopathy since 2006 as a member of the community and now as student myself. It is offensive to have the intensity, quality and comprehensive nature of my education and profession knocked by someone who clearly has some issues, and who clearly has overlooked the HUGE deficits in mainstream medical school education that our education at Bastyr actually fills in – and that’s not even including all of the “naturopathic” things we learn. This is just referring to the science based curriculum that is more thorough than even most of the top and most well known medical schools. Having a hard time believing that??? Look into it and do a curriculum comparison yourself. Talk to the professors that have taught in those mainstream schools but have come to Bastyr in order to be afforded the opportunity to impart a significantly more comprehensive education upon their students rather than cutting corners. Look at our integrated curriculum for God’s sake! Not only have I witnessed Naturopathy save countless lives, improve quality of life for so many, but I have personally experienced results with my own health issues far beyond what standard treatment protocol in mainstream could EVER accomplish – WITHOUT the use of any pharmaceuticals. I have seen the same in several of my immediate family members. I think this author’s issue was not knowing how to integrate what she learned in school and not having the confidence to impart efficable treatments upon her patients. Her inability to individualize treatment protocols to patients speaks volumes to those of us in the community who actually understand what it is we are doing. It is her inadequacy in the field and her own issues that caused her problems in practice. And threatening an entire profession telling us that we are all on notice because she has been unable to work out her own issues is rediculous!
She wrote a blog post in Science Based Medicine saying in detail why she thinks the training as Bastyr was so inadequate.
And I have personally watched as an ND gave irresponsible and dangerous medical advice- Quackery is endemic to naturopathy, as Ms. Hermes ably describes. What percent of quack medical advice is acceptable?
“has overlooked the HUGE deficits in mainstream medical school education that our education at Bastyr actually fills in”
And what about the HUGE deficits in the Bastyr medical education, including:
– the use of mercury and heroin as natural curatives
– how to drill holes in the skull
– urine injections
And you call yourself a doctor?
That’s a very broad statement.
Can you describe under what circumstances you’ve seen naturopathy save countless lives–what mortal diseases/injuries were treated using what naturopathic regimens?
Could you also explain exactly how have you determined that the results with your own health issues you’re attributing to naturopathy are 1) actually due to the naturopathic protocols you’ve embraced and 2) could not possibly have been matched by means of standard treatment protocols?
People’s opinions on naturopathy are very polarized, as one can see from comments here. Either they tell us that naturopaths help a lot of people; or we’re told that naturopathy is bunk.
There aren’t opinions in between.
To me it looks like a situation created by tribalism and self-interest. The naturopaths promote their profession and have a lot of inducements to delusion and self-delusion. The skeptics only want to talk about the delusion involved in naturopathy. They use a lot pejoratives and give everything a negative slant.
But naturopaths do help some people, and there’s also a lot of delusion and bunk and charlatanry involved.
That very same “help” can also be provide by real doctors without the need to resort to voodoo magic. And contrary to the claims of those trying disparage real doctors, many real doctors (certainly including mine) regularly ask about my life, lifestyle, diet, and so on, and give recommendations based on my replies.
Perhaps naturopaths sometimes help people when MD’s don’t. Having strict standards of evidence can be a limitation.
All well and good but then why not present themselves as the paid companions for the worried well that they are? They are trying to pass themselves off as PCPs and they are simply not.
I think there would be a legitimate role for a consultant on empirical approaches when the science-based approaches don’t work. A MD would refer patients to such a person.
Sometimes, naturopaths probably help people along those lines.
But, their training would be quite different, to actually do well in such a role.
Aren’t all approved science based approaches empirical themselves–i.e., verifiable by observation or experience rather than theory or pure logic? I’m not seeing a real distinction there.
Two questions: What exactly does requiring evidence that a potential course of therapy is safe and effective as a treatment for a specific indication limit,. other than the revenue stream of those interested in marketing it?
Do you believe that the standard of evidence pharmaceutical companies must meet to secure approval of new drug products should be made less rigorous because it is excessively limiting?
For example: in 2003 there was a big epidemiological study that showed that celiac disease was ~45 times more common than had previously been thought.
MD’s were very unlikely to suspect celiac disease, especially since they didn’t know back then that people with CD don’t necessarily have the classic symptoms.
So there were millions of undiagnosed celiacs in the USA, who found no help from MD’s.
But naturopaths commonly recommended a trial of a gluten-free diet back then.
Why would the gf diet have been on their radar screens?
At least partly, because people who had celiac disease would go gf and get dramatically better; this would make a big impression on the naturopath and make them inclined to suggest it more often.
That’s the kind of thing I mean – in the absence of good scientific evidence, some people are helped based on clinical experience.
I’m having a hard time understanding how observing symptomatic improvement following the adoption of a low gluten diet leads to the conclusion that the incidence of celiac disease is greater than previously understood falls outside of the realm of science based medicine and instead within the realm of naturopathy.
For example: in 2003 there was a big epidemiological study that showed celiac disease was ~45 times more common than had previously been thought.
There were millions of people with undiagnosed celiac disease in the USA.
One reason that celiac disease would so often go undiagnosed was that people with CD often didn’t have the classic symptoms. They would be chronically fatigued, maybe joint pains, maybe unexplained anemia …
They would bring vague problems to MD’s for decades without being helped.
So a lot of such people would turn to alt-med; a naturopath or whatever.
Naturopaths would often recommend a trial of a gluten-free diet.
And if the patient had CD, they would dramatically improve, making a big impression on the naturopath, so they’d be likely to recommend a gf diet in the future.
So based on the naturopath’s clinical experience rather than on science, some people were helped, a lot.
“Naturopaths would often recommend a trial of a gluten-free diet.”
Why would they recommend a gluten free diet to patients who didn’t exhibit symptoms indicative of celiac disease? Surely they had some basis to predict that the dietary change would be beneficial and it wasn’t a case of “Might as well try this–it can’t hurt and who knows? Maybe you’ll improve.”
I don’t know about back then, but here are some symptoms of gluten sensitivity from “natural” sites:
– brain fog
– headaches / migraines
– GI issues, like stomach pain, diarrhea, etc.
The list doesn’t answer the question: how was it first determined that celiac disease was causally associated with a panel of symptoms (such as those listed on the various natural sites) that science based medicine were unaware were causally associated? Other than GI issues their listed symptoms are both non-specific and not well defined (and even the GI issues can have multiple causes). Brian ‘fog’? Spaciness? Irritability and fatigue? If these are diagnostic of celiac disease then almost every teenager I know suffers from it.
So far as I know, doctors were quite aware before 2003 that celiac disease could cause those symptoms.
The “brain fog” mentioned understates it a lot. I called the state a “groggy stupor” and I would go lie down when it started. It’s not simply absent-mindedness or confusion.
Back then, researchers weren’t aware that a lot of people had CD without losing a lot of weight, chronic fatty diarrhea, etc. That’s part of the reason why CD was so underdiagnosed. Only if someone had “classic” CD were they likely to get diagnosed.
And perhaps even if they had the classic symptoms, they wouldn’t be diagnosed. I talked with various people back then, who told me things like “I almost died before they figured out what it was”. When a disease is thought to be rare, doctors don’t tend to suspect it.
The symptoms of celiac disease are rather vague, and people can have CD without GI symptoms, or even be asymptomatic.
Sorry it took so long for me to get back to this, I’ve been off doing other things.
I didn’t say those things are diagnostic of celiac disease. Celiac blood tests or intestinal biopsy while on a gluten-loaded diet, are the diagnostic methods.
So was it standard practice prior to 2003 for naturopaths to order blood tests or biopsies to confirm their clients had celiac disease, before recommending they try a gluten free diet? Or did the patients bring those ‘vague problems’ you referred to in a previous post to the naturopaths, who would suggest a gluten free diet on the basis of the presenting symptoms (which were not known to be indiciative of celiac disease)?
I’m trying to why the naturopaths would have concluded going gluten free might benefit their patients.
No, because CD was thought to be rare in the USA – 1/5000. Actually MD’s weren’t testing for it either, and would sometimes recommend an elimination diet / food challenges process, without suggesting getting tested for CD first. This happened to me twice, with allergists.
A small intestine biopsy would be done by a gastroenterologist.
More like that. And if someone improved on a gluten-free diet, they would decide they had a “gluten allergy” ow a “wheat allergy”, not celiac disease.
Probably because some of their patients had big improvements on a gluten-free diet, and those patients made a big impression.
Similarly to other folk remedies – some work. Willow bark for headaches, etc.
Also, there was research on a gluten-free diet – not conclusive, but it might inspire a naturopath to recommend trying it.
Doctors familiar with celiac disease would have known back then that celiac disease could cause those symptoms listed.
What wasn’t known before 2003, was that people could have celiac disease without the “classic” symptoms of weight loss, fatty diarrhea etc.
Only if someone had celiac disease with those “classical” symptoms, were they likely to be diagnosed. And maybe not even then. I talked to several people who told me things like “I almost died before they figured out what was wrong with me”. When a disease is thought to be rare, doctors don’t suspect it.
Celiac disease is still underdiagnosed AFAIK, and it’s a big problem that people with celiac disease find out about their gluten issue through a book like “Wheat Belly” or “Grain Brain”. The problem is that they don’t understand that they have a serious gluten issue, and that if they don’t carefully avoid all gluten, they’re risking colon cancer, lymphoma, etc. etc.
The “brain fog”, spaciness, “fatigue” would often be severe with somebody who has celiac disease – not something “almost every teenager” has.
And “fatigue” is a medical umbrella term, and may describe something much different and more severe than simply being tired.
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