A recent column of mine responded to a question/rant about naturopathic medicine:
A dear friend of mine is about to enter a prestigious program of naturopathic medicine. There—in exchange for hundreds of thousands of dollars and five years of his life—he will study homeopathy, osteopathy, water therapy, etc. Apparently, after gaining his ND credential, he will not only be allowed to practice medicine in Washington, but also to prescribe drugs. Why does state law allow these practitioners to dole out the pills? Can this possibly be safe?
Incredulous Friend
P.S. Is there a polite way to tell someone that everything he passionately believes in is bunk and that he’s throwing his life away?
I disagreed with the questioner; a lot of alternative medicine is worthwhile, and increasingly demonstrated to be so by the scientific method.
Fortunately, not all of naturopathic medicine is bunk….The less a branch of naturopathic medicine defines itself as being in opposition to “allopathic medicine” (i.e., scientific medicine), the more useful it seems to be for patients. Most massage therapists or acupuncturists will gladly admit the limits of their techniques, and the benefits from receiving treatment from either can be scientifically demonstrated. For things like chronic back pain, arguably these practitioners will be of more use to a patient than a doctor armed with pills and surgery. Training in osteopathy is becoming ever closer to the curriculum one would find in a medical school; Science would trust an osteopath as a primary caregiver as much as an MD.
Only when the naturopathic fields refuse to have their claims tested by experimentation does Science find them to be silly or even fraudulent.
This position—that an ND curriculum based upon science is as valid as one taught at a traditional medical school—is a bit out there, a more generous stance in favor than typical for naturopathic medicine.
The response from the local ND community? Emails like these:
First problem: it is an opinion dressed in an article called ‘Science.’ That is shitty science. It is also crappy journalism to advance opinion as fact. Some simple searches on PubMed would have improved the entire article, or maybe call a few people with credentials like Dan Savage does.
Bigger problem: Bastyr University pays the Stranger for ad space. Obviously, you print what you think is important and everybody is better off because censorship creates fear and drones. However, I think taking money from a University for ad space and bashing them in an opinion-laden article passed as Science is low. It is one thing to take ads for cigarettes and then criticize, but Naturopathy is not cigarettes, it leads to health not health problems.
You paper shapes peoples opinions. Do you really want to suggest that current medical practices are ideal? Do you want to discredit the ND’s who heal while not partaking in the fraud that is our current healthcare system and medical practice? I would like you to publish articles on ‘iatrogenic’ disease. There is a story.
Ugh.
Modern medicine works because of a long legacy of scientific inquiry to human health—from peer-reviewed, double-blind, randomized and controlled trials to simple correlations of observations to disease states. After pulling out the horrors of our employer-based private insurance system, for-profit hospitals and other aggravations, this body of knowledge— continually expanded, pruned and refined—is the basis for the dramatic successes of a deeply flawed health care system.
Take Evidenced-Based Physical Diagnosis, written by a Seattle VA doctor Steven McGee, as an exemplar example. Any caregiver (MD, ND, DO, whatever) with this book, or similar, in their mind is skittering on top of a vast and precise body of knowledge that has taken centuries to accumulate. This collection of carefully curated information, that some of my ND readers are ready to call fraudulent, is beautiful and scientific in the deepest sense of the word. To the extent that alternative caregivers are contributing to it—using differing philosophies and point of view to open whole new areas to observation—they deserve a warm embrace. To the extent they are furiously, blindly and stupidly lashing out at it, they are the enemies of health.
Well put. I wish everyone had a functional brain.
I wish everyone had a transgenic mouse brain.
oh, so many problems with that second letter. it seems they didn’t comprehend your article and don’t understand the necessary separation between advertising and editorial.
There is certainly an important distinction to be made between scientific, evidence-and-results-based (“allopathic”) medicine and our current horrendously inefficient and inequitable system for providing it. The writer of the second letter does not see such distinctions, to his cost.
My stepmother is an ND.
… I learned years ago not to mention if I have a headache.
Part of what has the ranter wound up is confusion over the orthogonal question of how health care is paid for versus whether it is alternative health care.
Insurance companies prefer paying for easily-accountable and billable treatments over open-ended practices, some of which are ‘alternative.’ So they would rather have you commit your unruly teenager to inpatient psychiatric care with a lot of drugs and fixed daily costs which will end on a certain date, rather than outpatient talking therapy that could go on for who knows how long. Even if Science says locking bratty teenagers up and pumping them full of drugs doesn’t work.
Mostly he’s reading trigger words in your column and that sets him off attacking his favorite straw man, which today is you.
That said, the Michael Jackson Neverland culture of jet-set living and lavish champagne parties Tim Keck has immersed his reporters in using his billions in advertising profits can’t but compromise the integrity of the Stranger’s writers. Would Science be willing to give up the company paid-for Escalade if Bastyr pulled their ads?
Science based medicine of all forms should be considered valid if it passes the rigorous standards that good science requires. Unfortunately I think there is probably a lot of money based medicine out there that hides behind science that is not so good.
Homeopathy is 100% bunk. Water memory my ass!
That Bastyr teaches homeopathy totally discredits anything good they might otherwise teach.
7
Objective research is getting harder and harder to find.
Outcomes usually favor whomever funded the study.
Lots of researchers have an ax to grind and tailor their studies to reinforce their world view; climate research, homosexuality; etc.
Jonathan, when will you do a post addressing the health implications of (mis)using the rectum as a sex organ?
How dare anyone snipe at naturopathy. It’s cured diseases like Polio, Tuberculosis, Smallpox, Bubonic Plague, etc. Hmm. Wait. Nevermind. That was modern medicine. So what successes can naturopathy point to??? Millenia of it got us almost nowhere and then came Pasteur and the beginnings of science based medicine and voila, all these problems solved in less than a century.
I think you’re giving acupuncture way too much credit. Keep in mind, if an alternative medicine was shown to actually work, it wouldn’t be alternative; it would just be medicine. The totality of studies regarding acupuncture show that it is a very good placebo, really one of the best placebos available. Snake Oil Science by R. Barker Bausell is an excellent primer on the scientific research of acupuncture and other alternative medicine.
Those criticisms aside, I was glad to see such a good concise defense of scientific medicine. Cheers!
Come on – you’re too generous to alternative medicine. To the extent that practitioners engage in proper scientific study of therapies, what they do may be said to have some value. But in general, when alternative medicine is subject to science, it typically doesn’t fare so well – look at the numerous studies debunking homeopathy, or the Bastyr study which discovered that kids’ colds aren’t much impacted by echinacea dosage. These studies are real science, yes, but couldn’t the resources put towards these studies be instead focused on more promising therapies?
You know what we call things that are established by rigorous testing to have a positive benefit for improving health and treating disease? Medicine.
I could care less whats it called if it can be shown to work.
Things like acupuncture, homeopathy, et al generally fail that test. They are not medicine but quackery. Bastyr(d) should not even be allowed to grant degrees that confer a state sanctioned claim to anything approaching knowledge. Nor by the way should the state mandate coverage for this silliness as it does now.
Thread is fact based and not at all p.c.
Noted with favor.
http://whatstheharm.net/index.html
“Modern medicine works because of a long legacy of scientific inquiry to human health—from peer-reviewed, double-blind, randomized and controlled trials to simple correlations of observations to disease states.”
Chinese medicine (including acupuncture and Chinese herbal medicine) has been developed and practiced with great success for far longer than western medicine. I’m talking millennia, motherfuckers. Today, Chinese med students learn traditional healing methods side by side with the most cutting edge techniques from western science and most hospitals offer TCM & western medical diagnoses and treatment in tandem.
@18 Time is not the issue, rigor is. Most Chinese medicine is no better than leaches.
Bravo, Jonathan! I’m saving your statement. It’s the perfect response to the tidal surge of anti-vaccination and anti-fluoridation spam I’ve been receiving.
I’m with @13. The largest trials comparing acupuncture with sham acupuncture have all failed to show a statistically significant difference in response to modality.
Additionally, you write “Training in osteopathy is becoming ever closer to the curriculum one would find in a medical school”. One problem with that is that DO school is medical school. I’m a student at an allopathic school, but DOs receive the same allopathic training as MDs. It’s science-based. They’re accepted to most residency programs nowadays. Lumping them in with NDs and homeopaths is a mistake.
china is a great example for how things should be done. :/
Allopathic medicine has some serious holes and limits in it–particularly with regard to chronic disease/illness. Nearly everything you’ll get from a traditional doctor is reactionary, rather than preventative. Drugs are pushed, while dietary and lifestyle changes aren’t even suggested most of the time. While naturopathic medicine is no panacea, I think many people scoff at it because it takes time and effort, and that’s so un-American. Why would we put a ton of work into something when we could just pop a pill?
As someone with ulcerative colitis, who was told by allopathic doctors that I should be on some seriously f-d up maintenance drugs daily that would not only have “awesome” side effects (hair loss, acne, etc) but would also destroy my liver, I chose to instead pursue natural medicine, which has kept me in remission for years now. Does it take discipline? Hell yes. Going without coffee or alcohol for a year sucked ass. And taking a ton of supplements is annoying and expensive. But am I wayyyy healthier than I would be if I followed the “expert” allopathic advice? Damn right.
I can also testify to the power of acupuncture, which helped me in numerous ways, but homeopathic medicine has never, ever helped me.
Perhaps Jonathan will learn a lesson from this. By all means yes, a rigorusly tested non-traditional treatment is just as good as a rigorusly tested traditional treatment. But people who believe that don’t call themselves “naturopaths” — they called themselves “scientists”. People call temselves “naturopaths” to indicate they believe that eastern, mystical, spiritual shit is inherently better, and for most of them science is a suspiciously Western, corporate, and math-based endeavor. Or at least, they want to sell stuff to people who believe that.
Ancient Chinese Secret.
Nah, it’s Downy.
Naturopathy != homeopathy. Homeopathy is 100% bushwa, beginning and end of story; but naturopathy has some valuable insights and methods.
And allopathy, for all its tremendous successes, does have some serious holes — not so much in the theory, perhaps, but definitely in the practice. When your doc’s first reaction is ALWAYS some shitty medicine that’s no more proven than the most incompotent acupuncturist, there’s a problem — and it frequently is. Just because there’s serious science somewhere behind medicine doesn’t mean your doc knows what it is or how to apply it.
Why, yes, I am a Group Health customer; why do you ask?
It really bothers me that people still think of natural medicine as crap. I have suffered from the worst stomach issues for the past year. My MD couldn’t figure it out, the gastro specialist thought it was all in my head. Then I decided to try an ND and voile, he diagnosed my wheat/fruit allergy and now I am 100% better.
MDs are great for things that need emergency medical and/or serious issues. But don’t discount NDs….mine cured me.
http://www.skepdic.com/natpathy.html
http://whatstheharm.net/
http://www.naturowatch.org/
Fnarf, you can choose your own ND at GHC. Actually, so can any of the people in any of the state-sanctioned medical insurance plans.
@23: there’s no such thing as “allopathic medicine.” It’s just “medicine.”
See also @15’s response.
Naturopaths have been connecting inflammation with chronic disease for more than two decades. You can bet your ass that allopathic doctors scoffed at it for years. Five years ago it finally became accepted fact in the medical community.
Allopathic medicine is sometimes decades behind naturopathic medicine in anything that can’t be taken care of by popping a pill.
Also, allopaths never give a shit about preventive care. NEVER. If you have anything that can’t be easily cured (or more likely managed) with pharmaceuticals, you might as well just roll over and die. If you want to prevent a disease you’re likely to get, you can fuck right off. You’ll be lucky if you can get increased screenings.
@32 so when my otolaryngologist (that’s an ear, nose, and throat doctor, what you would call an “allopath” – but again, there’s no such thing as an “allopath”) tells me to stop drinking so much coffee and soda because it’s giving me acid reflux, that’s not preventive care? He could have given me a prescription for some powerful and expensive antacid, but instead he chose to tell me how to take better care of myself.
This is just one anecdote (and the plural of “anecdote” is not “evidence,” BTW), but your straw man was just begging to be knocked down. Now, if you want an alternative medicine practitioner to cure a real disease, for that you can fuck right off.
Both medical disciplines have their shortcomings; both share common roots and traditions.
The smart choice is not between one or the other, but rather between what works and what does not from both.
If you simply reject one or the other out of hand, you have no respect for real science. Science requires a rigorous method of analysis and proof, and science also requires that you be open to both the possible and the probable.
A closed mind cannot learn or discover. So, what use is it to science?
My primary care physician is an ND at Bastyr. I began going there because I was really sick for 3 months and my Dr. at Polyclinic just kept putting me on rounds of steroids and antibiotics and basically blowing me off when the pain got worse and worse. So I went to Bastyr, where I spoke to my ND for an hour, and we talked about a long list of possible ways for me to feel better, including herbs, dietary changes, and referrals to other specialists who were part of the allopathic community. That’s right folks, my ND willingly sent me to an MD in order to help me resolve my health issues in a whole way. So in tandem with my ND and my new, fabulous MD, we are working shit out. The idea that you can only have one or the other is total bunk. Any health care provider worth their salt would recognize the wide range of treatment options available, and support the patient to take charge of his or her own health needs. Lay off ND’s guys. If it doesn’t work for you, fine. But for the rest of us, Naturopathic Medicine can teach us a lot about how to get healthy and remain healthy.
@keshmeshi:
To this point I can agree: Some MDs are terrible at practicing evidence-based medicine. Much has to do with how health care is socially structured in the US (as a profit-generating enterprise at all levels, with a focus on really short and intermittent office visits and an outright disincentive towards preventive care; most insurers don’t want to pay for things that pay off decades later, when the patient will be someone else’s problem…)
Also, it’s a plain old difficult to keep yourself current on medical science. Only the very talented, time-rich and sharp can do so.
Giffy @ 19: You’re clearly misinformed about TCM (Traditional Chinese Medicine). And you’ve misspelled leeches as well. Tsk, tsk. ; )
There are a number of scholarly journals out there that promote rigorous scientific examination of TCM, including Chinese Medicine (http://www.cmjournal.org/), which is “a peer-reviewed, open access, international, interdisciplinary and scholarly journal in Chinese medicine. CM aims to provide evidence-led force for the advancement of Chinese medicine research.”
Giffy, you said that “Most Chinese medicine is no better than leaches.” (sic)
The World Health Organization’s 2002-2005 Traditional Medicine Strategy says, “… scientific evidence from randomized clinical trials is strong for many uses of acupuncture…” and “the efficacy of
acupuncture in relieving pain and nausea, for instance, has been conclusively demonstrated and is now acknowledged worldwide.”
Link is here: http://whqlibdoc.who.int/hq/2002/WHO_EDM…
From the same WHO report:
* In Tanzania, the WHO collaborates with China in the production of anti-malaria agents extracted from the Chinese herb Artemisia Annua. The local production of this drug should reduce the cost of a dose from US $7 to $2.
* In South Africa, the Medical Research Council is researching the effectiveness of the herb Sutherlandia Microphylla, in the treatment of AIDS patients. This herb, traditionally used as a tonic in TCM, can increase the weight in people affected with HIV, increase appetite and energy.
I think that’s better than leeches.
I used to hang out with a bunch of Bastyr students and at parties I did a little survey. Almost everyone agreed that yes, herbal treatments work, but that it’s all basically placebo effect.
I’m enjoying this discussion. Thanks, Jonathan & sloggers!
i thought you were pretty balanced in your response. and that’s coming from someone who would rather lay in bed for 2 weeks than take antibiotics. It was pretty much all the comments who were off the deep end — in both directions!!
@23
if your doctor is not prescribing non-pill advice/treatments/preventatives than youre seeing a shit doctor.
i had the same deal as you. i did the same deal as you. i saw numerous unrelated g.i.’s (some better than others), an acupuncturist, a dietitian, a naturpath, and several surgeons.
five years of shitting out of my ass with little to no success from any of the people i was paying my whole paychecks to led me to surgery. congratulations on getting the help you did, but after not drinking coffee, not eating dairy, not eating wheat, not eating vegetables, not drinking alcohol, and avoiding everything else normally digestible by humans i can say that the only noticeable help i ever got was from hardcore meds.
Aside from the whole debate, these two sentences are fuckingly beautifully vibrant and powerful: “Any caregiver (MD, ND, DO, whatever) with this book, or similar, in their mind is skittering on top of a vast and precise body of knowledge that has taken centuries to accumulate. This collection of carefully curated information, that some of my ND readers are ready to call fraudulent, is beautiful and scientific in the deepest sense of the word.”
I’m with @34. This is why many practitioners have adopted the tag “complimentary” medicine in place of “alternative” medicine. It’s not either/or — it’s both together allowing each to do what it’s best at.
Fans of non-scientific medicine use “allopath” the same way Republicans talk about the “Democrat Party”.
After I saw the CAM practitioner, I got better.
After I turned my cap inside out and crossed my arms behind my back, Ken Griffey hit a home-run.
What I find frustrating is not the idea of openness to alternative/non-surgical/non-pharmaceutical treatment, but just the complete and utter ignorance of scientific methodology that so many of the advocates of these practices display.
@32 is a good example. “Inflammation” is the kind of thing that the quacks love because it’s so basic, ubiquitous and vague. The idea that “allopaths” have been denying the role of “inflammation” in chronic disease is absurd, but I know that if pressed, I will hear that about an overly-broad and simplistic claim about inflammation was attacked (unfairly, of course) by an actual doctor. Nevermind that “inflammation” itself is one of the most basic and ubiquitous aspects of injury and disease — the fact that this one overly broad claim was debunked proves that science is out to stamp out independent thought and democratic empowerment.
Anyway, my point is: naturopathy seems to thrive on the inborn inability of most people to read carefully and critically.
Did you hear the joke about the doctor who cured a cold? Or long-term stomach pain?
No you didn’t, because they don’t exist. Allopathic medicine is great for some stuff, but it doesn’t have an ancient, centuries-old record. It’s been around for a hundred years or so. The rise of allopathic medicine was tied into power plays and Congressional legislation banning naturopathy and other alternatives.
For most stuff, allopathic is best. But do your homework before posting ignorant BS–either that or stick to economics.
Traditional Chinese Medicine does have a long history BUT—-it is not easily translatable into our ideas about bodies, organs, and diseases. So don’t fool yourself. If you feel you are “cold,” “blocked,” and “dry,” you’re speaking the right words, but if you have a diagnosis and want an alternative treatment, it’s anybody’s guess how a four-thousand year old concept is going to address it. And remember: that compound of imported “herbs” your sweet groovy neighborhood practitioner is handing out is likely to contain ground-up animal glands (yup! that’s part of the tradition!) exposing you to the risk of some emerging virus (lucky you!) and may have high doses of heavy metals. Yum!
Is quackwatch.com still around? They used to be a great resource for debunking alternative therapies. Therapeutic Touch, anyone?
FYI for all of you throwing stones at leeches, they’re not just for the Dark Ages anymore:
1: Am J Nurs. 2009 Apr;109(4):36-42; quiz 43. Links
Leech therapy.Yantis MA, O’Toole KN, Ring P.
Baylor University in Dallas, USA. dr_may@verizon.net
Leech therapy is experiencing a resurgence in health care today, primarily in plastic and reconstructive surgery as a treatment for venous congestion, which can threaten surgical outcomes. Most nurses have had no formal training in administering the therapy or in maintaining Hirudo medicinalis, the species of freshwater worm used therapeutically. Yet nurses may be expected to participate in this therapy in a variety of clinical settings and can use these guidelines for the safe and effective use of the leech in treatment.
PMID: 19325315 [PubMed – indexed for MEDLINE]
1: Microsurgery. 2009 Apr 27. [Epub ahead of print] Links
Preventing infective complications following leech therapy: Is practice keeping pace with current research?Whitaker IS, Kamya C, Azzopardi EA, Graf J, Kon M, Lineaweaver WC.
Department of Molecular and Cell Biology, University of Connecticut, CT.
BACKGROUND:: Despite several publications strongly advocating prophylactic antibiotics during leech therapy, and recent primary articles shedding new light on the microbiota of leeches, many units either do not use antibiotic prophylaxis, or are continuing to use ineffective agents. METHODS:: A 5-year follow-up of plastic surgery units in the United Kingdom and the Republic of Ireland was conducted in 2007 to ascertain current practice regarding the use of prophylactic antibiotics with leech therapy. A comprehensive literature search investigated primary research articles regarding the microbiota of leeches to update the reconstructive surgery community. RESULTS:: Despite published evidence to support the use of prophylactic antibiotics during leech therapy, 24% of units do not use antibiotic prophylaxis and 57% of those using antibiotics are using potentially ineffective agents. Advanced molecular genetic techniques, which allow accurate characterization of both culturable and nonculturable microbiota of the leech digestive tract, show a wider diversity than at first thought, with variable antiobiotic resistance profiles. CONCLUSIONS:: Despite infection due to leech therapy being a well known and relatively common complication, many units are not using appropriate antibiotic prophylaxis. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009.
PMID: 19399888 [PubMed – as supplied by publisher]
I’m the original writer of the letter that you answered in that column. (Thanks for answering!)
It’s funny, when I wrote it, I intended it to be more about how state law chooses which practitioners can prescribe medicines. (How did they decide ND’s can?) I guess it didn’t turn out that way!