Greek Whack A Mole.

Greek Whack A Mole.


There is reality and there is perception. Perception usually wins. In trying to win the hearts and minds, pseudomedicine and pseudomedicine is slowly gaining ground

Integrative medicine programs are proliferating in US hospitals, offering everything from acupuncture to reiki to reflexology to homeopathy. The axial rotation of Flexner accelerates.

Naturopathy is growing, unlike the science to support it and other pseudosciences.

Sixteen states and four provinces allow the practice of naturopathic medicine: Alaska, Arizona, British Columbia, California, Connecticut, Hawaii, Idaho, Kansas, Maine, Manitoba, Minnesota, Montana, New Hampshire, North Dakota, Ontario, Oregon, Saskatchewan, Utah, Vermont, and Washington.

Why is there the medical equivalent of astrologists at NASA? Partly it is PR. Pseudomedical providers have a simple and appealing message that they repeat. And repeat. And repeat. Repeat a message enough times and people think it is true. That the message skates up to the edge of truth like Charlie Chaplin in a department store, but never falling in, doesn’t seem to be a problem.

It is more than whack a mole, it resembles Hydra and I ain’t no Hercules. Then again, maybe I am. In my feeds was a press release: “How Naturopathic Doctors Are Educated, Trained, and Licensed.” Time to clean out the Augean Stables.

As “A Service for Consumers”, the American Association of Naturopathic Physicians (AANP) is releasing a series Naturopathic Medicine FAQs, and the first is Naturopathic Medicine FAQs: A Service for Consumers. FAQ. Is that short for False Answers to Questions? Let’s see.

The applicants: What THEY don’t want you to know

What does it take to get into ND school? Applicants must have:

…completed three years of pre-medical training and earned a bachelor of science degree.

A science degree, sadly, that apparently is never applied in ND school. They fail to mention that the average GPA on an ND student is barely over 3.0. The average. So half of students will have a GPA below 3.0. 60 to 100% of ND applicants are accepted. 100% acceptance is not selective. Essentially anyone who can fill out an application is in. Compare that to medical school with a 3.7 average GPA and a 3% acceptance rate. So almost any mediocre applicant can get into ND school. It’s the C students who make it to ND school, not the best and brightest. You want the C students taking care of you?

All sound and fury: The curriculum

But once into ND school, what is the education?

They say:

The general educational structure for naturopathic doctors is comparable to that of conventional medical doctors (MDs) and osteopathic doctors (DOs).

Yes, in the same way a homeless tent and the Burj Khalifa have comparable structures. The difference is in the quality of the material and the expertise of the construction.

Accredited naturopathic medical schools are four-year, in-residence, hands-on medical programs consisting of a minimum of 4,100 hours of class and clinical training. During naturopathic medical school, students are educated in the biomedical sciences as well as the latest advances in science in combination with natural approaches to therapy. They also study disease prevention and clinical techniques.

It is the content of that education that makes NDs unfit for real patient care: the pseudoscience of acupuncture, homeopathy, water therapy, energy therapy. They suggest:

In addition to a standard medical curriculum, schools require their graduates to complete four years of training in disciplines such as clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling.

There is no way a “standard medical curriculum” can coexist in time and content with the pseudosciences taught in ND school. To have time for the pseudoscience, time spent studying the real sciences must go. Time spent on fiction is not the time spent in reality based bioscience.

As Britt Hermes notes:

The basic science courses taught in naturopathic schools are entry-level courses and not on-par with the rigorous science-based courses taught in medical schools.

Then there is the clinical teaching:

For at least the final two years of their medical program, naturopathic medical students intern in clinical settings under the close supervision of licensed professionals.

Those “licensed professionals” are usually other NDs and pseudomedical providers, reinforcing the pseudoscience learned in ND school. And they do not do much clinical medicine. Ms Hermes graduated with 1,224.5 hours of clinical training. Is that a lot? Nope. 153 eight hour work days or about 30 weeks. That’s it. Assuming four weeks off and the mythical eight hour work day, medical students have about 3,800 hours of clinical experience at graduation.

The big difference

Remember:

A major difference between the training of the MDs and naturopathic doctors is medical residencies.

And it is residency where physicians really learn clinical medicine. There has never been an MD/DO medical student, freshly graduated, who is even remotely able to care for patients on their own, and that is with three times the clinical experience that an ND receives. A lack of experience defines NDs, who go from ND school straight to practice. Internal Medicine and Family practice residency are three years each. That is the other main difference between an ND and an MD. The former not only has training in homeopathy but also has homeopathic training. A family practitioner has at least 15,000 more hours of clinical training before starting independent practice.

Why are there no residencies?

Naturopathic medical residencies are not nearly as common because they are not yet required by most states.

And why are residencies for MDs required by states? Because residency is where all the real training to be a physician occurs. If ND schools were interested in actually training their charges they would not wait for the states to mandate residencies. But as I have said many times before, there is no such thing as pseudomedical providers doing their own quality improvement.

They try to make up for the complete lack of adequate post-graduate training by suggesting that the training in ND school is enough:

Third- and fourth-year naturopathic medical students have more opportunities for hands-on clinical training and practice, often at their schools’ teaching clinics and off-site clinics…As a result, naturopathic medical students graduate with experience in diagnosing and treating patients, even before they begin formal practice.

And then contradict themselves by noting that to make up for a lack of training due to no residency:

many new naturopathic doctors choose to practice with or shadow an experienced doctor before setting up their own practices.

They compare the ND school experience with an alternative fact version of what MD medical student clerkships are:

Although MD students see patients during these clerkships, their roles are primarily observational: they are not primarily responsible for patient care.

Medical student clerkships are not observational. They are expected to completely and independently evaluate patients, then present their findings to senior physicians. They are to do everything a physician would do but of course they are not primarily responsible for patient care. Medical students don’t know shit.

They imply that ND students get more primary responsibility:

Third- and fourth-year naturopathic medical students have more opportunities for hands-on clinical training and practice, often at their schools’ teaching clinics and off-site clinics.

To suggest that ND student clinical opportunities are superior to those of an MD student and sufficient training for practice is so Kellyanne Conway. Either ND education is so brain dead simple you can give untrained newbies primary clinical responsibilities or ND schools are uninterested in patients receiving good care by knowledgeable providers. Probably both.

Like MDs, a growing number of naturopathic doctors choose to specialize or focus their practices. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Parenteral Therapies, Pediatrics, Primary Care Physicians, Psychiatry, and Oncology.

Associations do exist, but not real medical training required by those specialties. It takes two or three years of training after a three year residency to become a subspecialist in medicine. An ND just needs to say it is so. And advanced training in pseudoscience is still pseudoscience.

In addition, while practicing Family Medicine, many naturopathic doctors choose an area of focus based on a therapeutic, condition, or population subset.

They do not practice Family Medicine although they do tend to pick a focus of diseases that do not exist (chronic Lyme, adrenal fatigue) and offer unique therapies that do not work. In looking at ND websites in Oregon, I get the sense that each ND tries to differentiate themselves with their own unique offering of pseudoscience.

If you are really interested in the truth THEY don’t want you to know about ND education, training and practice, there is no better site than the Naturopathic Diaries.

But the FAQ is like so much of the ND patter: it appears appealing until you look below the surface and find average students receiving little quality education or training in the real medicine and extensive training in pseudoscience. Just the kind of health care Americans need.

I look forward to the next FAQ.

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.