A coffee enema - almost, but not quite, totally unlike tea.

A coffee enema – almost, but not quite, totally unlike tea…and some sort of complex analogy involving naturopathy and science.

Those of you in the know recognize the title from the Hitchhikers Guide to the Galaxy, among the funniest and most quotable books of all time. If you have not read the five books in the trilogy, get to work. Consider it a homework assignment.

I bit off more than I can chew for this entry. I usually plan on about 8–10 hours over 4 –5 days to write these entries. So I had this idea. Now that naturopaths have been declared primary care providers by the Oregon legislature I thought it would be good to look over all the websites in Portland to see, in their own words, what naturopaths were offering. I figured there would not be that many sites to review. How many naturopaths could be in Portland?

So I went to the Oregon Board of Naturopathic Medicine Licensee Directory and entered Portland into the search box. And?

578 hits.

There is not enough beer time in the world

Holy Cannoli. I thought there would be 30, which is the number infesting Eugene, the second most naturopathed city in Oregon. There is no way that I could do a comprehensive review of that many websites in the limited time I have to devote to the blog. But my brain is not unlike an oil tanker with blog entries, it takes a long time to change direction and I had nothing else mentally lined up to write about.

I started a spreadsheet and have made it through the first 36 names on the list representing 24 website. Excel is wrong tool, that is for sure. I should have used a database. Sometime in the (hopefully) not too distant future I need to do a comprehensive assessment of ND (and DO and Lac) websites in Oregon as a project for Ore4SBM.org (blatant plug).

Because the breadth (but not depth) of whack-a-loon pseudo-science on display in these websites is truly amazing. That this hodgepodge of providers and therapies are now primary care providers in Oregon would be funny if the topic, health, was not so fundamentally serious.

I will say that every ND does come across as a caring, compassionate provider, committed to their patients. If I were unaware of the content of their practice I would be impressed. They are so relentlessly evangelical I wonder if ND students only travel in pairs wearing white shirts. A good topic for a musical: The Book of Naturopathy?

I also wonder if there is an official template for Naturopathic website as there are remarkable similarities in content. I have often compared Naturopathy to the practice of magic, the Harry Potter kind, i.e. wishful thinking for what is, in reality, impossible. You know, the naturopathic school curriculum.

The naturopathic sleight of hand

However, these websites are masters of modern magic, the Penn & Teller kind. Magic, the kind whose intent is to fool the observer, consists of:

  • Palm: To hold an object in an apparently empty hand.
  • Ditch: To secretly dispose of an unneeded object.
  • Steal: To secretly obtain a needed object.
  • Load: To secretly move a needed object to where it is hidden.
  • Simulation: To give the impression that something that hasn’t happened, has.
  • Misdirection: To lead attention away from a secret move.
  • Switch: To secretly exchange one object for another.

A good template if you need techniques to distract the reader of the website so that they do not notice that, as practiced, there is little in the ND practice that isn’t pseudo-science. Nope. Nothing to see here.

Most sites mention the philosophic principals of naturopathy:

I. The Healing Power Of Nature

II. Identify And Treat The Cause (Tolle Causam)

III. First Do No Harm (Primum Non Nocere)

IV. Treat The Whole Person

V. The Physician As Teacher (Docere)

VI. Prevention

All of which sound great if you did not know the reality behind the application of these principles.

They like to mention that, yes, they are real doctors with training equal to MDs. While naturopathic studies compare favorably in the number of hours in school, however they fail to mention that the bulk of the education is in the pseudo-sciences that comprise the naturopathic education. And, with no post-graduate residency, they lack the experience for real patient care that MD/DO have.

Britt Hermes and the AAFP make it very clear that NDs have barely a whiff of proper medical training. It is all magic.

  • Palm: Mention the ND education hours.
  • Ditch: Ignore the lack of residency.
  • Steal: We can prescribe and do minor surgery.
  • Load: Note that you have a doctorate and a philosophy.
  • Simulation: A medical education.
  • Misdirection: The state says we are primary care providers. And we have a philosophy.
  • Switch: We are real doctors.

You can get a doctorate in other forms of science fiction as well, but at least they have the decency to teach in English Departments.

So the websites use a bit of prestidigitations to try and hide the fact that:

An ND education is almost, but not quite, entirely unlike a real medical education.  But is like a buttfull of coffee.

Now you can see where I was going with the title.

More time ≠ better medicine

Many sites mention that each patient is unique and as a result visits will take an hour or two to evaluate the patient.

The huge time spent on each patient is trumpeted by NDs as a plus, but is further evidence that they really do not know what they are doing.

There are a finite number of diseases in humans and they have patterns. Good, experienced physicians recognize these patterns quickly, especially for common diseases in primary care. Medical students and interns are notorious for taking hours to evaluate patients because they are learning and do not know what they are doing or how to interpret the information they are gathering.

Of course NDs, with an education consisting of pseudo-medicines like homeopathy, acupuncture and hydrotherapy and no post graduate training, never get the opportunity to see and learn these patterns. So it is not a surprise they take hours to see a patient. It is the hallmark of the inexperienced novice.

And it fundamentally disrespects the patient, wasting the patient’s time as the ND flails about trying to come up with a diagnosis and treatment plan.

Hanging with a bad dumb crowd

When mentioned (many sites give no specifics, preferring upbeat platitudes to mentioning the true nature of their particular ND practice) every site offers one or more pseudo-medicine. My father always suggested you can judge a person by the company they keep. And ND’s keep company with the pseudo-medicines.

There are the usual suspects: homeopathy and acupuncture predominate, no surprise, as well as hydrotherapy, reiki, energy therapy, and all the other common SCAMs. Many sites were in the supplement sales racket, being in the pocket of the supplement industry. Pseudo-medicine and unethical sales are the norm on all the sites I visited, two areas where NDs differ from MDs since for physicians:

In-office sale [and I would add internet sales – Ed.] of health-related products by physicians presents a financial conflict of interest, risks placing undue pressure on the patient, and threatens to erode patient trust and undermine the primary obligation of physicians to serve the interests of their patients before their own.

And then there are services that make these supplements seem reasonable by comparison.

There is a female predominance in ND practice on the sites I visited and as a result a focus on female issues. Some services would be creepy if offered by a male, like Holistic Pelvic Care™ and some services are just what the…!?! Like:

The The O-Shot® where:

the platelet rich plasma is injected into an area near the clitoris and upper vagina

And Plant Stem Cell Therapy:

Theory of Action: These same plant growth stimulating factors that can cause the plants to differentiate and produce specialized mature cells may stimulate the immature cells in the tissues of the human body to replace, repair, and regenerate lost tissue, organ, and system function.

And on and on and on.

Cut a naturopath, she will bleed pseudo-medicine. It is their life’s blood.

Look on their works, ye scientifically literate, and despair

This is a further validation of the observation that every practicing naturopath, in the words of their own websites, has a practice often fundamentally divorced from reality and NDs have no qualifications to be primary care providers.

NDs are almost, but not quite, entirely unlike physicians.

And the Oregon Legislature has made them equal to real doctors.

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.