Minnesota has recently become the 15th state in the U.S. to formally endorse the claims of a tiny group of naturopaths who portray themselves as physicians.* The bill , like the popular-media “CAM” reports that Steve Novella criticized on Wednesday, merely parrots what these naturopaths claim about themselves. It reveals no attempt to investigate or to judge the tenets of the field. The following excerpts present false assertions as though they were facts. I’ve underlined some of the more obvious examples:
“Naturopathic medicine” means a system of primary health care for the prevention, assessment, and treatment of human health conditions, injuries, and diseases…
“Naturopathic physical medicine” includes, but is not limited to, the therapeutic use of the physical agents of air, water, heat, cold, sound, light, and electromagnetic nonionizing radiation and the physical modalities of electrotherapy, diathermy, ultraviolet light, hydrotherapy, massage, stretching, colon hydrotherapy, frequency specific microcurrent, electrical muscle stimulation, transcutaneous electrical nerve stimulation, and therapeutic exercise.
The practice of naturopathic medicine includes, but is not limited to, the following services: (1) ordering, administering, prescribing, or dispensing for preventive and therapeutic purposes: food, extracts of food, nutraceuticals, vitamins, minerals, amino acids, enzymes, botanicals and their extracts, botanical medicines, herbal remedies, homeopathic medicines, dietary supplements and nonprescription drugs as defined by the federal Food, Drug, and Cosmetic Act, glandulars, protomorphogens, lifestyle counseling, hypnotherapy, biofeedback, dietary therapy, electrotherapy, galvanic therapy, oxygen, therapeutic devices, barrier devices for contraception, and minor office procedures, including obtaining specimens to assess and treat disease…
Unlike the Minnesota leglislators, I have substantial knowledge of the tenets and practices of “naturopathic physicians,” and I am capable of judging those tenets according to standards of reason, science, and modern, science-based medicine. Beginning with my stint on the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners 6-8 years ago, I have spent years listening to “NDs,” reading their literature, and writing about them. I described a bit of my experience on that Commission in a post on Science-Based Medicine several weeks ago. I have continued to observe NDs’ cult-like behavior since then, and have seen no indication that they have begun to awaken from their collective, pseudoscientific stupor.
I won’t reiterate most of what I’ve written elsewhere. I’ll also try not to reiterate material about the Minnesota decision that has already been posted on other worthy blogs (including, and with references to the rest, here). Suffice it to say that I’ve heard every argument favoring licensure or registration of “educated” naturopaths—that is, of graduates of the now 6, on-campus, 4-year schools in North America. I’ve heard every argument claiming that these NDs are “scientifically” trained and that they are qualified to act as “primary care doctors,” which purportedly distinguishes them from “traditional” naturopaths (the matchbook crowd). I’ve heard every argument that they are capable of self-regulation, that their methods are “gentle” and “natural,” that they are experts in “nutrition” and “prevention,” that they “treat the cause, rather than the symptoms,” that they are experts in “natural remedies,” that their methods are supported by “10,000 citations to peer-reviewed literature providing standards of practice for natural medicine,” that their schools have responsible research programs, that they can be expected to make responsible recommendations about immunizations, that they attend responsible continuing education courses, that public demand for them is substantial and can only be satisfied by formal state recognition, and every other argument, ad nauseam. Each of these arguments is specious, as shown in excruciating detail here, here, here, here, here, here , here, and here, among other places.
For now I’ll make a few comments pertinent to the Minnesota bill and discuss a few points that are not likely to be apparent to most people. I’ll also add some information not easily found in the public domain: descriptions of 4-5 catastrophes in the past few years, attributable to “licensed naturopathic physicians” practicing according to their own standards of care; an annotated bibliography of responsible references and of a few irresponsible references; rigorous evidence that NDs are not the experts in “natural remedies” that they claim to be. It will require 2-3 postings to cover the material.
The Minnesota Bill: the Devil’s in the Details
To the uninitiated—including many medical doctors—the practices quoted above from the Minnesota bill probably sound bland and relatively benign, if a little kooky. Even if that were the extent of it, it wouldn’t do for the state to endorse such practices, because they can’t replace effective treatments for real diseases. What isn’t readily apparent are the real meanings of many of the listed methods. References to various “electrical” entities appear several times, for example. To find out what these might be and be used for, it’s necessary to dig a little. The following passage is quoted from a naturopathic treatise on cancer of the prostate. It was written by Thomas Kruzel, the the “former Dean of Clinical Education and Chief Medical Officer at the Southwest College of Naturopathic Medicine in Phoenix, Arizona”:
Electrical current in the form of positive galvanism, applied transrectally, has been used in the treatment of CAP [cancer of the prostate] as well as BPH [benign prostatic hypertrophy]. A steady current of 1 to 5 milliamps for 10 to 15 minutes creates an acidic environment within the prostate gland, oxygenating the tissues and increasing the white blood cell count. This treatment must be coupled with anticoagulant and antioxidant therapy. During and following a series of treatments, protomorphogen therapy helps the growth of healthy prostate tissue.
With natural treatment for CAP it is important to remember that the therapy will have its ups and downs…
Kruzel, according to his biography on the website of the Arizona Naturopathic Medical Association, “is also the past president of the American Association of Naturopathic Physicians and was selected as Physician of the Year by the AANP in 2000.”
Another application to the body, electric, favored by NDs is “electrodiagnostic testing,” also known as “electroacupuncture according to Voll” (EAV), “electrodermal screening” (EDS), “bioelectric functions diagnosis” (BFD), “bio resonance therapy” (BRT), VegaTest, Bio-Path, “bio-energy regulatory technique” (BER), and more. The claims for this method, which consists of using a galvanometer to measure the skin’s (varying) resistance to a tiny electric current, are illustrated in the following listings from the AANP’s “Equipment for Sale” webpage from 2001 (the AANP no longer makes this public):
- Clinic Closing, EAV Screening Device for Sale, A Listen System. Almost new. Complete with manuals, video, and text book. Increase your revenue while better serving your clients. Test for parasites, food and environmental sensitivities, candida, nutritional deficiencies and much more. Call 416-530-5956 for Samantha for more information. Asking $15,000 or best offer.
- Biopath Listen System using electrodermal screening. A great way to test for allergies of all kinds. Excellent practice builder- $2500.
- Vega Machine For Sale. VegaTest II complete with carrying case, extra hand electrode, instruction manual (Short Manual of Vega Test), test kits and 114 food vials. $2,000 for the whole kit and kaboodle. Remember, Vega units are no longer available in the United States. Save yourself the expense and hassle of importing a Vega unit (and avoid the possibility of having the unit confiscated at the border). Contact: Michele Goodwin, N.D. 555 Soquel Ave., Suite 260-H, Santa Cruz, CA 95062; (408) 459-9206 email: firstname.lastname@example.org
- Are you interested in purchasing a relativley new AVITAR EAV diagnostic unit? This machine is state of the art EAV testing and is a good adjunctive source of revenue to a medical practice (We typically charge $100.00 per session). The machine is easy to use and office staff can be trained to use the machine effectively, while the doctor is seeing other patients. We are looking for someone to take over our lease. The monthly payments are about $260.00 (buy out cost is about $11000) We aleady have some equity invested. Contact Geoff at (425)820-4148
The reason that a naturopath might decide to “avoid the possibility of having the unit confiscated at the border” is that the FDA has, for practical purposes, declared such devices illegal.
“Hydrotherapy” sounds harmless and possibly soothing, until you discover some of its uses:
…if you or a family member already has suffered from one or more strokes, a simple hydrotherapy technique may provide relief, and even minimize long term sequelae…One technique is to lower your body temperature, with a cold bath for example, as much as possible without inducing shivering as soon as possible after a stroke has occurred, or is suspected to have occured. The idea here is that if the stroke is ischemic (temporary restriction of oxygenated blood) the body naturally and preferentially preserves blood flow to the brain, so cooling the rest of the body will cause the blood to shunt rapidly to the brain. However, if the stroke is hemorrhagic, cooling the body rapidly will cause vasoconstriction, thereby helping to control the bleed. Another hydrotherapy technique with a similar rationale is to soak the feet in a hot foot bath, as soon as possible after the stroke has occurred, while applying a cold compress to the neck, face and scalp. If this technique can be applied as a stroke is happening, it may even abort the stroke. Make sure the ice-cold compress touches the skin over the carotid arteries under the jaw bone. Mustard paste or powder may be added to the foot bath to increase the heating effect. Make sure to continue this treatment for at least 20 minutes and keep adding hot water to the foot bath and make sure the cold compress stays really cold. Or, you may take a neutral bath that is neither freezing cold, nor warm. Immersion in water of neutral temperature is extremely soothing to the central nervous system.
It is now possible to genuinely abort some ischemic strokes if they are diagnosed and treated promptly. All strokes are potentially life-threatening, and are considered to be medical emergencies that require prompt and expert evaluation and supportive care. The treatments described above will do nothing to improve the outcomes of strokes, but are certain to delay competent diagnosis and treatment. They are recommended by “a graduate of Bastyr University in Seattle (class of 1992)…[who is]…the former senior editor of the Journal of Naturopathic Medicine (1989-96), the scientific, peer-reviewed journal of the American Association of Naturopathic Physicians” (AANP: the national organization of “educated” naturopaths).
Hydrotherapy, garlic, and a version of oxygen, another seemingly benign substance listed in the Minnesota bill, are bases for the following asthma treatments, also recommended by the former senior editor of the Journal of Naturopathic Medicine:
Another useful Physical Medicine technique is that of Hydrotherapy…Placing a hot, wrung out towel over the chest can relax the breathing muscles and restore normal breathing. For an acute asthma attack try a steam inhalation (draping a towel over your head and a bowl of hot water) with a few drops of eucalyptus oil in the water. Be careful that the water is not so hot that the steam burns your face. Some doctors recommend taking baths with a cup or so of 3% hydrogen peroxide in the water to bring extra oxygen to the entire surface of the skin, thus making the lungs somewhat less oxygen hungry. This method can be performed preventively. Another technique for an acute attack is to drink some hot water with the juice of one clove of garlic.
That passage was written by a practitioner held in high esteem by her entire “profession,” and was promoted by the AANP in its “articles written by Naturopathic Physicians for the general public.” Those facts illustrate that NDs are neither scientifically trained nor competent to practice medicine: The amount of oxygen that can be absorbed through the skin is negligible, as anyone with even a passing knowledge of chemistry and physiology ought to know. Asthma is a serious disease, and an acute attack can be life-threatening. A delay caused by such nonsense would be foolish and dangerous. A real-death example, as I’ll discuss, has already occurred.
Another, more lucrative form of oxygen “therapy” has recently become popular among advocates of Implausible Health Claims (IMC): hyperbaric oxygen therapy (HBOT). It is a slippery form of quackery, because there are a few legitimate uses for the method, and most advocates of illegitimate uses hide behind those. As is true for almost any IMC, HBOT is becoming popular among NDs.
“Amino acids” sound benign and nutritious, to denizens of health food stores and veterans of high school biology classes. There is no value in taking them as “medicines,” however, unless one suffers from a frank deficiency, and guess what the term conceals? According to a recent press release from the American College for Advancement in Medicine (ACAM), the most conspicuous organization advocating “chelation therapy,”
Chelation therapy is a process in which a synthetic or man-made amino acid called EDTA is delivered intravenously.
By “EDTA,” the ACAM means disodium ethylenediamine-tetra-acetic acid (Na2EDTA), a dangerous drug that has no place in modern medical therapeutics. Naturopaths at the highest levels recommend “chelation therapy.” In 2003 the Oregon Board of Naturopathic Examiners listed an approved continuing education course taught by the ACAM entitled “Heavy Metal Detoxification,” a euphemism for chelation. The Oregon Naturopathic Formulary Compendium includes “EDTA.” At least one death has resulted, as will be discussed.
“Vitamins” are another category that would make most people yawn, unless they are aware of one of the euphemisms for Laetrile, the greatest health fraud in American history: “vitamin B17.” When I was on the Massachusetts Special Commission, the ND who was president of the Mass. Assoc. of Naturopathic Physicians stated, with an air of accomplishment, that she had worked at the Contreras Clinic in Mexico. She did not add that the clinic is a notorious Laetrile mill.
There is much more hidden agenda in the excerpts from the Minnesota bill, but I trust that the point has been made. I’ll offer a final couple of examples to introduce the next topic. If a doctor ever offers you “glandulars” or “protomorphogens” please turn around and run. Only when you’re safely away should you drop a dime to the state medical board…unless, of course, the “doctor” is a naturopath, because in that case the board will recognize the practice as a standard of care for “naturopathic medicine”—thus demonstrating exactly why there can’t be useful regulation of an irrational “health profession.”
Self-Regulation by Tiny Groups of Sectarians
Almost all trades and professions that are typically regulated—electricians, plumbers, nurses, MDs, etc.—are self-regulated. By that is meant that there is a regulatory board whose members are predominantly members of the relevant profession. If that initially sounds self-defeating, it is also inevitable: who, besides civil engineers, for example, would be qualified to comment on the standards of civil engineering? The Minnesota naturopathy bill is typical in that sense:
REGISTERED NATUROPATHIC DOCTOR ADVISORY COUNCIL.
Subdivision 1. Membership. The board shall appoint a seven-member Registered Naturopathic Doctor Advisory Council consisting of one public member as defined in section 214.02, five registered naturopathic doctors who are residents of the state, and one licensed physician or osteopath with expertise in natural medicine.
The most obvious problem with such a scheme, and what mainly distinguishes it from civil engineering and other boards, is that there can be no objective standards for fields that lack objective data to support their methods. Where are the state boards of astrologers or psychics? Next week I’ll present examples of ND-associated catastrophes that failed to elicit appropriate responses from regulatory boards.
A less-appreciated problem is that of self-regulation of a tiny group. In Minnesota there are barely 25 NDs who qualify for registration, and the state expects 5 of them to pass judgment upon the rest. There’s a good chance that any complaint sent to the Advisory Council will involve an ND that the council members already know, since they are all members of a tiny organization that, until now, was primarily concerned with political activism. How can they avoid conflicting interests? The other reason that self-regulating professions are at least somewhat capable of acting objectively, in addition to the existence of objective standards, is that most are large enough to guarantee independence in their board deliberations. In Massachusetts, for example, there are 30,000 MDs.
Title Protection and Government Handouts
A state board for a tiny group presents a tangential problem that the Minnesota electorate might have overlooked: who pays for it? Most professions pay for their own regulation through licensing fees. How will 25 NDs in Minnesota, each paying $200 for initial registration and $150 for annual renewal, support their board? They won’t, of course:
Sec. 13. APPROPRIATIONS.
(a) $8,000 in fiscal year 2009 is appropriated from the state government special revenue fund to the Board of Medical Practice for the registration of naturopathic doctors under Minnesota Statutes, chapter 147E.
(b) $25,000 in fiscal year 2009 is appropriated from the state government special revenue fund to the commissioner of health for the naturopathy work group. This is a onetime appropriation.
This bill, which is primarily a “title protection” bill (explaining why it has pissed off “traditional naturopaths“), is a real-life example of a government hand-out to a tiny, “special interest” group. What is the alternative? My opinion:
There will always be fanciful health claims that range from the relatively innocuous to the outright dangerous. Most of these will inevitably fall through the regulatory cracks, in spite of the best intentions of government. It would be impossible to regulate all of them, and unwise to try. Existing laws governing consumer fraud, assault, and the illegitimate practice of medicine should be invoked when necessary. Licensure and registration schemes, however well intentioned, tend to encourage illegitimate health practices, rather than to limit them.
The best way for government to help citizens make sense of nonstandard health claims, while respecting freedom of choice, is through education. We recommend that the legislature direct the Department of Public Health and the Office of Consumer Affairs to collaborate on an educational program. We recommend that in doing so, these agencies seek counsel not from advocates, but from experts. There are numerous experts in [Minnesota], covering every medical field, who could help with such a project. There are also organizations of experts who are familiar with nonstandard claims and have already applied scientific scrutiny to many of them…
*The Naturopathy Series:
- “CAL”: a Medico-Legal Parable
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 1
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 2
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 3
- Another State Promotes the Pseudoscientific Cult that is “Naturopathic Medicine.” Part 4
- Colorado is Nearer to Promoting Naturopathic Pseudomedicine—Aided by the Colorado Medical Society
- Naturopathy and Liberal Politics: Strange Bedfellows
- Open Letter to Dr. Josephine Briggs
- Smallpox and Pseudomedicine