Let's not change the eagle into a duck

Let’s not change the eagle into a duck

AMVETS has joined with The American Association of Naturopathic Physicians in seeking to “promote natural, non-pharmacological approaches to treating patients suffering from chronic pain.” They are petitioning Congress and the VA to authorize bringing licensed NDs into the VA system. As a veteran myself, a retired Air Force Colonel and an MD, I find this appalling. During my twenty years service in the U.S. Air Force as a family physician and flight surgeon, I took pride in the high-quality science-based medical care my colleagues and I were able to provide. This proposal would jeopardize the welfare of our veterans by exposing them to substandard care with irrational, untested, and potentially harmful treatments. Letting naturopaths into the VA would be a grave mistake.

Their argument

Many of our veterans suffer from chronic pain, and there have been problems with overdosing and abuse of pain medications. The press release says naturopathic physicians are:

well suited to help our veterans, since they are specially trained in natural, non-pharmacological approaches that facilitate the body’s self-healing ability. Approximately 4,400 NDs are licensed to practice naturopathic medicine, having earned their degree from 4-year postgraduate naturopathic medical schools accredited through the US Department of Education. The approaches studied include nutritional counseling and stress reduction, botanical medicine, therapeutic manipulation, and oriental medicine. A strong emphasis is placed on disease prevention and educating patients on proactive self-care to maintain wellness. Resolutions passed by the US Senate have urged Americans to learn more about this “safe, effective, and affordable form of health care.”

This might sound good to the uninitiated, but it is a very biased, deceptive description of naturopathy. The AANP has bamboozled the AMVETS and now it hopes to bamboozle Congress and the VA. This is a blatant ploy by naturopaths to get a foot in the door. They had to resort to political lobbying because their dubious brand of alternative medicine couldn’t hope to succeed on its own merits.

A rebuttal

  • Yes, the schools are accredited, but accreditation only means that the school has met certain standards of administrative methods. Accreditation does not indicate that what is being taught is valid or even that it has any connection to reality. In fact, naturopaths are in charge of accrediting their own schools.
  • Yes, students of naturopathy learn about science and some valid treatment methods, but they also learn a lot of arrant nonsense. They are taught that homeopathy is valid, that dissolved oxygen can be absorbed through the skin in appreciable quantities, that goldenseal cures strep throat, that a stroke should be treated with wet compresses, and that “craniosacral rhythms” exist and can be altered by pressing on the skull. One of their standard textbooks devotes 2 full pages to describing the physical manifestations of the four humors, a medieval concept that was discarded long ago. It recommends asthma be treated with hydrogen peroxide baths and gems worn as jewelry or placed around the home in special places. For heart disease, it recommends unproven herbs and chelation, and omits any mention of proven treatments known to lower blood pressure and prevent heart attacks. For HIV infection, it recommends naturopathic treatments while admitting there are no clinical studies of effectiveness, and it fails to even mention the effective HAART medications that prevent progression to AIDS and give patients a near-normal life expectancy. The AIDS Research Center at Bastyr, the most prestigious school of naturopathy, recommends over 100 dubious remedies for AIDS, including “acupuncture detoxification auricular program,” cranioelectrical stimulation, and colloidal silver.
  • Naturopaths say they place a strong emphasis on disease prevention, but studies have shown that the patients of naturopaths are actually less likely to get immunizations and preventive screening tests like mammograms.
  • Naturopaths’ education is far inferior to that of medical doctors, physician assistants, and nurse practitioners. Their education does not equip them with the experience needed to treat patients with serious illnesses requiring hospitalization or to recognize the indications and complications of pharmaceuticals, and they have been known to miss crucial diagnoses and to treat patients for diseases that do not exist.
  • They say naturopathy is safe and effective, but that can’t be substantiated. Much of what they do has never been tested for safety and effectiveness, and they continue to use treatments that have been tested and proven not to work, like homeopathy, a mainstay of naturopathy.
  • They say it is affordable, but if any treatment is ineffective, it’s no bargain.

The history of naturopathy

As George Santayana said, “Those who cannot remember the past are condemned to repeat it.” In 1910, the Flexner Report surveyed American medical schools and found that educational standards were sadly lacking, and many schools taught whole bogus systems of medicine. Flexner called for them to adhere strictly to the protocols of mainstream science, and as a result, American medicine was reformed. Nearly half of existing medical schools closed, and the remaining ones were those that were grounded in science.

Naturopathy was the brainchild of Benedict Lust, who became enamored of natural treatment methods after he was treated for TB in Germany with a “water cure.” He advocated massage, hydrotherapy, herbal medicine, nude sun-bathing, and avoidance of caffeine and alcohol. The heyday of naturopathy was in the early 20th century. At its peak of popularity it was licensed in 25 states. By 1958 it was only licensed in 5 states. But with the rise of so-called “alternative medicine,” it has managed to sneak back in. Today it is licensed in 17 states but is still prohibited by law in two states: South Carolina and Tennessee. It was de-licensed in Idaho this year.  Licensing bills that have been brought up in other states have been repeatedly rejected: 10 times in Massachusetts and 8 times in New York. Naturopaths would have us believe there is a public demand for their services, but only a miniscule three tenths of one percent of American adults consulted a naturopath in 2007.

Naturopaths say they reject drugs, but the natural remedies they use meet the definition of drugs, and they have sought and obtained full prescribing rights for prescription drugs in two states (Washington and Oregon), a tacit admission that their natural methods are inadequate. In the 31 states where naturopaths are not licensed, they are subject to prosecution for practicing medicine without a license.

Naturopathy’s basic principles

Naturopathy is a belief system, not a legitimate scientific discipline. It claims to be unique, but most of its avowed principles are no different from those of conventional medicine.

  • First do no harm. This has been a foundational principle of all medicine since the ancient Greeks. Naturopaths interpret it to mean, “don’t use drugs because they might have side effects.” Conventional medicine interprets it to mean, “Make sure the treatment doesn’t do more harm than good.”
  • Physician as teacher. Physicians have always been teachers; they share expert knowledge with patients. Naturopaths teach patients things that are not true.
  • Treat the whole person. That is what every good clinician does. The standard medical history includes a section for social history, reminding the physician to consider everything about the patient that might have an influence on health outcomes, from psychology and lifestyle to family and finances.
  • Healing power of nature. MDs have always known that the body heals itself. Science-based treatments facilitate known physiologic healing processes by rational means, like eliminating harmful bacteria with antibiotics. Naturopaths try to facilitate a mythical vitalistic healing force, the vis medicatrix naturae, by irrational means.
  • Prevention. Conventional doctors invented prevention and have always held that prevention is the best cure. They have always emphasized vaccines, screening tests, and advice about diet, exercise, alcohol, tobacco, etc. And naturopaths have not demonstrated that what they do is effective in preventing disease; in fact their patients are less likely to get effective prevention measures like vaccines and screening tests, and children who receive naturopathic care are more likely to be diagnosed with a vaccine-preventable disease. Their ideas of prevention are often bizarre; here’s how a professor at Bastyr told a patient she could reduce her risk of breast cancer: “Keep your breasts happy and healthy. Love them and yourself. We often develop illnesses because of our own unresolved feelings and lack of love for ourselves…Deal with any unresolved maternal, nurturing, and relationship issues so they’re not lurking in your breasts.”
  • Treat the cause. Doctors have always treated the cause. They don’t just treat symptoms with painkillers for appendicitis or cough syrup for pneumonia. Naturopaths treat bogus causes like dietary sugar/fat/gluten, epidemic candidiasis, intestinal “dysbiosis,” vertebral misalignments, and imbalances of qi.

Health consumer advocate Stephen Barrett says:

I believe that the average naturopath is a muddlehead who combines commonsense health and nutrition measures and rational use of a few herbs with a huge variety of unscientific practices and anti-medical double-talk.

In essence, what naturopaths do that is good is not different from what medical doctors do, and what they do that is different is not good.

AMVETS was hoodwinked

AMVETS is one of America’s leading veterans service organization with over 250,000 members. It has a laudable goal: to put vets first and improve the VA system. But in this case, their misguided proposal would make VA care worse, not better. Unfortunately, with no doctors or scientists on their staff, they were easily misled by the deceptive propaganda of the AANP.

Congressman Mark Pocan said, “Our veterans deserve access to all possible forms of health care.” Really? All possible forms? Including those that have been proven not to work? Including quackery? Bloodletting? Perkins’ tractors? Hulda Clark’s zappers? Psychic surgery? I think not. I think they deserve access to all legitimate, effective forms of health care.

Part of their argument is a fallacious appeal to popularity. They did a survey and found that “nearly two-thirds of veterans (64%) would prefer a doctor who prescribes natural therapies before considering drugs or surgery, and that nearly three-quarters of veterans (73%) would consider seeing a ND if he or she were on staff at a nearby VA facility.” Medical care is not a popularity contest. The patients expressed those preferences without knowing all the pertinent facts. How many patients would prefer a doctor who prescribes natural therapies if they knew that none of those natural therapies had been tested and shown to work, and that some of them had been tested and shown not to work? Calling something “natural” doesn’t justify a double standard: drugs are drugs, whether they come from an herb garden or a pharmaceutical manufacturer. If a new remedy were proposed by a pharmaceutical company, would anyone be clamoring to put it on the market before it had been tested? Do patients know best? Patients may think they know what they want, but they would do well to seek the advice of doctors who have expert knowledge about what will really benefit them.

Scientific medicine has progressed by leaps and bounds. It has had outstanding successes, from antibiotics to organ transplants. Alternative medicine hasn’t. There is really no such thing as “alternative” medicine; there is only medicine that has been tested and proven to work and medicine that hasn’t. There is no evidence that naturopathy is effective in treating chronic pain. If naturopathy had effective treatments to offer and had bothered to properly test them, they would have become part of mainstream medicine and could no longer be called “alternative.”

Naturopaths may offer non-drug treatments for chronic pain that other science-based practitioners already offer, like massage, heat packs, exercise, stretching, and physical therapy. Naturopaths rely heavily on marijuana as a pain management tool, but they could not use it in the VA because it is prohibited by federal law. Other naturopathic specific treatments for chronic pain include herbs like kava that are suspected of causing fatal liver damage and that have yet to be evaluated in populations with chronic health conditions like hepatitis and PTSD.

Naturopathy would have us turn back the clock to the early 1900s. Its vitalistic concepts and its irrational treatment choices have no place in the 21st century.

How about a more rational solution?

The VA has had enough problems with access, long waits for appointments, and bureaucratic snafus. Our vets have enough problems with chronic pain, PTSD, traumatic brain injuries, and other service-related problems. We want to solve those problems, not make things worse. We all want the best for those who have served our country.

Our veterans deserve ready access to cutting edge treatments for chronic pain. Modern medicine offers pain treatment centers that combine rational strategies from various health care specialists working as a team. The VA could work to improve access to the best of those programs for our vets.

It could establish immediate access to care with hotlines and could eliminate waiting for appointments. It could make veterans’ care more personal by providing convenient phone or e-mail access to their own designated patient advocate who would get to know them as individuals and help ensure they got the best, most timely care. It could hire more science-based health care providers and adapt the system so providers could spend more time with patients at each appointment.

Conclusion

Naturopaths do not belong in the VA. As Steven Novella has pointed out,  this proposal appeals to “health care freedom” but goes beyond the issue of health care freedom. It calls for health care irresponsibility and asks for taxpayer dollars to be spent on unproven and pseudoscientific treatments. Our veterans (and our taxpayers) deserve better. This proposal is gravely misguided. It would hold medical care hostage to self-serving lobbyists and misinformed public opinion. Rather than putting veterans first, it would put science last.

Harriet A. Hall, Col, USAF (Ret)

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.

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