"Doctors" of Naturopathy in Minnesota? Or: Barbarians at the gate

Well I don't necessarily agree with you and given the responses I have seen from the party faithful on the other science blogs I am waiting for the feeding frenzy to start here.

I will say one response to PalMD who says if ND school is so rigorous then why not go the MD school? Beyond being a VERY conceited statement, it is also disingenuous. By his own admission PalMD doesn't have a clear idea of what the academics is at ND schools. The conceit is in the assumption that what is right for PalMD is right for everyone. I know several MD's who also attended ND schools and their feedback was that it was plenty rigorous. I also know another ND student who should be finishing this summer before starting his residency who was accepted to U of Minnesota and John's Hopkin's before deciding to attend an ND school. It was a choice.

Y'all remember choice. It was what we had before the patriot act and before many well intentioned Americans apparently forgot about manners in conversation.

So OK, let the attacks start. Have at it. Have fun. And try to be nice about it if you remember how.

Naturopathic physicians are trained in the art and science of natural healthcare at accredited medical colleges. Integrative partnerships between conventional medical doctors and licensed NDs are becoming more available. This cooperation makes more effective therapies available to consumers. It increases patient satisfaction in their relationships with their care providers. More people are recovering their health by adding naturopathic medicine to their health care options.

Notice how the first time they refer to the patient, it's as "consumers", even though they're careful to say "patient" later.

I have been calling naturopaths "Witch Doctors" for years. Nice to see that MN is finally catching up.

As for Jeff's comments, there have been naturopaths who dissaude patients from conventional treatments to the detriment of the patient.

As for "rigorous" I hope that their training is rigorously examined, and that the bogus ND schools are not accepted.

Remember, Hulda Clark is a ND, who got her degree from a matchbook cover school.

"I also know another ND student who should be finishing this summer before starting his residency who was accepted to U of Minnesota and John's Hopkin's before deciding to attend an ND school. It was a choice."

A choice based on what? Much cheaper tuition with no enormous debt hanging over you after finishing training?The promise of less oversight and no wrangling with insurance companies? The likelihood of more gullible patients? The siren song of woo?

This is akin to those stories we hear from time to time about supposedly brilliant students who could have their choice of med schools but choose to become chiropractors. Such cases probably exist, but for the most part the people who gravitate to alt med fields are not the brightest bulbs going.

Or maybe they're just too "nice" for "John's Hopkin's". ;)

Not to be technical but DO's legitimately call themselves physicians.

On a similar vein, can chiropractors legitimately call themselves doctors?

Jeff,

What I find curiously lacking from your post is anything resembling a defense of naturopathy itself. Instead, you defend the teaching of naturopathy. But, as Orac points out, that's a strategy which makes science advocates very suspicious. Because it's the exact same tactic used by all manner of crackpot, from Intelligent Design advocates to homeopaths.

jeff friesen: Y'all remember choice. It was what we had before the patriot act and before many well intentioned Americans apparently forgot about manners in conversation.

"Choice" and "manners" don't have much to do with science. Claims are supported by degrees of corroborated evidence, or not. Style of presentation is not generally relevant to substance.

Y'all remember choice. It was what we had before the patriot act and before many well intentioned Americans apparently forgot about manners in conversation.

Were these left-over words? Because they sure as hell don't fit together.

Probe,

I agree that Hulda Clark is a nut job who had to flee to Mexico to continue her "practice." Please don't lump the ND's who will be registered with those who will not be eligible. It is interesting that several of you seem to be against regulating ND's. The reason Ms Clark is able to practice in Mexico is because they are unregulated. I think it is a good thing that we brought the ND's who went to medical school [check out the Princeton Review of top medical schools] into some form of state regulation. The opponents of this bill want ALL medicine to be unregulated. What a nightmare that would be.

Any doctor, ND, MD, DO etc. who convinces a patient to give up care is being irresponsible. I know that my ND has refered me to an MD and to a surgeon as needed. I have no complaints. Are you sure that the "ND" who convinced those people you know to give up good treatment for bad were the real deal?

DBacon [interesting nome de plume - what is it's etiology?]

Most ND's graduate with hundreds of thousands in student loan debt, just like MD's. They go to a real medical school so what else do you expect? Of course, you DO expect something else, but are you sure you aren't confusing ND's with uND's [so to speak]. The bill is to provide oversight to the profession. Gullible patients? Just how insulting do you want to be here. I am a patient and went to a blended approach when a straight allopathic one did not work for me. How does that make me gullible.

As for the rest of your attacks I will not respond to them. My mother, at least, raised me to be polite and I try hard to stick to that. Of course I fail from time to time, but I also say sorry.

Cheers,

Jeff

How does that make me gullible.

Is "susceptible to the placebo effect of quack remedies" better?

Dear Dr. Benway,

May inquire as the field that you degree is in.

As for your comment I would respectfully ask you to reread my comment. The choice I was referring to was about his choice of fields this student chose to study. Much like I am sure you made a choice as a younger person.

Having said that I agree with you completely that science is about theorem and proof with the proof being more important than the theorem.

Do you agree that regulation is a necessary step or do you believe in the free market approach to medical care, which is the stance taken by the opponents of this law?

Thank you,

Jeff

My head explodes!

"inner wisdom" + "science" == contradiction in terms.

crap,

I need to start using a spell checker.

This is "May I inquire as to what field your degree is in?"

Sorry about that.

I know several MD's who also attended ND schools and their feedback was that it was plenty rigorous.

I am told that seminary/theological studies can get pretty rigorous too. That doesn't change the fact that they are studying and thinking about phenomena for which there is zero objective evidence. Put another way: it's a wank-fest, it doesn't matter how hard you're working at wanking.

John's Hopkin's

That's "Johns Hopkins"

Y'all remember choice.

I support choice. Everyone can choose to be stupid - but it's a fairer choice if they understand it. The reason the CAM/woo heads are trying to drape themselves in the mantle of science is to make it harder for their victims - err, patients - to realize that they're getting a "choice" between something that has been forced to justify itself with experiment and cross-examination versus something that is based on some new-age guru's "feelings."

The problem with this kind of "choice" is that things that work may be more expensive, painful, or honest -- an evidence-based oncologist cannot offer h* patient the comfort of a low-cost voodoo doll that'll do nothing but satisfy the patient's need for an "alternative" at a lower cost.

many well intentioned Americans apparently forgot about manners in conversation.

Usually, when people start getting really concerned about keeping the discussion high-toned it's because they don't like being called "fucking idiot" and are trying to preserve a shred of dignity through the inevitable well-deserved shitstorm of scorn headed their way. Does that shoe fit?

mjr.(BA, psychology, Johns Hopkins, 1985)

Jeff said: "Most ND's graduate with hundreds of thousands in student loan debt, just like MD's."

I'm not sure how a naturopath would wind up with hundreds of thousands in student loan debt. According to one site dealing with training of naturopaths, total tuition, fees and supplies runs 15-20K per year (for a four-year program) at residential naturopath colleges. I suspect the Internet/mail order schools are lots cheaper.

Contrast that with the average charges for tuition and fees alone at private medical schools, which currently run $40-45K per year (it's less if you're fortunate enough to get into a public school).

So NDs are subject to less debt, and can make a pretty good living:

"The average income of naturopathic doctors tends to fall in the low to mid-range of family practice doctors, according to a survey done by the AANP. A National College graduate advertising for a partner in his Connecticut practice estimated that an ND in his area could earn $90,000 or more a year."

http://www.naturalhealers.com/qa/naturopathic-medicine.html

Since NDs (one hopes) do not take it on themselves to treat severely injured and/or critically ill patients, they're also far less subject to potential malpractice litigation and don't have to deal with high insurance costs.

Yes, there are good financial reasons to become an ND, apart from one's belief in "patient-centered" care ("allopathic" doctors presumably don't give a crap about patients), "non-toxic" treatments (MDs like to poison their patients) and "letting the body heal itself" (MDs of course have no idea that the human body is capable of any healing whatsoever).

But NDs are such _nice_ people.

Insert rolleyes smilies as needed.

I agree with you completely that science is about theorem and proof with the proof being more important than the theorem.

No, mathematics is about theorem and proof. Science has theories, which are hypotheses backed by large quantities of evidence. Not understanding the difference suggests you lack the knowledge to evaluate whether naturopathy is actually scientific; yet it's the unscientific nature of the field that leads most of us to object to ND's being titled "doctor."

ND education does cost well over 100K:
Average # of CreditsTuition & FeesBooks & Supplies Year Total *
ND 4 year 74.5 $23,515 $2,235 $25,750
ND 5 year 61 $20,545 $1,830 $22,375
This information fresh off Bastyr U. web page.
Factor in living expenses for 4 or 5 years and the cost of additional training in oriental medicine or midwifery which many students undertake.
Considering that tuition costs are comparable to the state owned conventional medical schools, that NDs earn at the bottom range of GP salaries, and that majority of conventional med students choose to be higher-paid specialists, it is clearly less lucrative to obtain a naturopathic medical school degree compared with a conventional one.
Also, the salary range is for NDs practicing in licensed states such as Washington and Oregon. Majority of states do not license NDs and some forbid the practice of naturopathic medicine outright.

Family and friends who have 'Googled' me (and who know of my chronic frustration with all things CAM) love to harangue me with their discovery that there is a naturopath in New England who shares my name.

Jeff Friesen, yours are not the first anecdotes about positive experiences with naturopaths I've heard. Indeed, I have several friends/coworkers who see naturopaths over MDs when seeking general health advice (i.e. in the absence of any acute or chronic illnesses) because of the extra time and warm fuzzy attention that one apparently receives from the ND, in contrast to the comparatively brief and impersonal nature of the typical visit to a managed care physician. At the end of the day, though, this perceived benefit doesn't validate NDs, or any CAM practitioners. It merely points to the gulf that exists between the expectations that patients have regarding their health care experiences and the actual experience that medical doctors can be reasonably expected to provide. it's a real problem, to be sure. However, slapping a thick layer of woo over it is only going to obscure it, as opposed to actually solving it.

jeff,

The problem is not that people are trying to deny choice, however poor that choice may be, to patients. The issue at hand here is that the state is allowing a title to be used that is equivalent to the title used by medical doctors. The practice of medicine and the title of doctor for those skilled in it are something that has had significant meaning for a long time. By allowing this quackery to be honored with a title the public will be confused by the name game, and they will believe that the profession of the "ND" is one that has met some measure of scrutiny. But this is not the case...naturopathic remedies have not been shown to be efficacious.

This clouds the water in an already confusing medical world for the poor patients. As far as the arguments about the rigor of the programs...what does that matter? You can create an 8-year program in anything and make people memorize minutiae. I imagine if alchemy were to make a comeback it would start with a Master's Degree in Transmutational Principles.

How does one evaluate whether naturopathy is scientific?
Would conducting studies and submitting results for publication at a peer-reviewed journal such as JAMA count?
Yes, I've been told by MDs who participate in medical journal discussion groups that JAMA articles are often used as examples of poor scholarships.
Still, I hope the article published in yesterday's JAMA counts for something good:
Hypericum perforatum (St John's Wort) for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Randomized Controlled Trial
Wendy Weber; Ann Vander Stoep; Rachelle L. McCarty; Noel S. Weiss; Joseph Biederman; Jon McClellan
JAMA. 2008; 299(22): 2633-2641.
:^) <--- smiley with eyes rolling up

Hermano I'm not sure what your point is. The first author on that paper has an ND degree, as well as a PhD and a MPH (Masters of Public Heath). Apart from one of the minor authors, who also has ND and MPH, All others are MDs +/- PhDs.

Are you providing this as evidence that some NDs are engaged in scientific research? If so, great! Particularly as the conclusion of this study is that St. Johns Wort is no more effective at treating ADHD symptoms than a placebo.

How does one evaluate whether naturopathy is scientific?

The remedies would need to propose a mechanism (how it works), and would have to be evaluated to do better than placebo.

There is no mechanism for most of the tools in the Naturopath arsenal, and study after study has found they do no better than placebo.

So one has evaluated it already.

I just don't see the point in seeing an ND, apart from a strong desire to be parted with money for no real reason.

I have never seen a non-MD physician. MDs go through a well-documented education and training process where they learn to think about human physiology and pathology. I trust the training they receive, not DOs or NDs. (Sorry but in my experiences the kids who went to DO school did so out of necessity due to low MCATs and GPAs not because of some deep-seated belief in osteopathy). I have no desire to, nor would I want to see a DO or ND.

While it is unfortunate that Minnesota has chosen to give licenses to quacks, it doesn't make them any less of a quack. I can't see this changing to face of healthcare in the slightest, IMO.

Those who think that somehow state 'mandated' woolly NDs to have a title equivalent to MDs: you have no idea how legislatures work.
Without the Minnesota Medical Association's consent this law would have never seen the light of day.
The legislation's most effective proponents were individual medical doctors without whose eloquent testimony the bill would have certainly died in one of its dozen committee hearings.
Do you care to know who actively opposes regulating naturopathic doctors?
If you are curious, google 'miracle devices' and read the Seattle Times investigative report.

Ok,

I give up. You people seem only interested in making points. I hope that makes you feel better about yourselves.

I support any type of regulation that will allow patients to make informed choices and to protect the general public.

The fact that many of you have decided to choose not to "believe" in this without doing any substantive research says loads more about you than about me.

Cheers.

Danio,
The principal author of the recent JAMA article I mentioned is a naturopath, who conducted her research at Bastyr University, a naturopathic medical school in Seattle.
The fact that other authors have MD degrees shows that MDs and NDs collaborated in this research.
The fact that the principal researcher has a PhD and MPH (thank you, I am familiar with public health degrees) attests to the fact that she pursued ND degree as something of value in addition to her other graduate degrees.

Jeff: naturopathy is quackery. Education in quackery does not unquack the mess. Lending legitimacy to quackery does NOT help people make informed choices and does NOT protect the public. On the contrary.

Anyway... here's your ball, you can go home now.

Which part of naturopathic medical training is quackery?
Is it gross anatomy, physiology, biochemistry, pharmacology,
or differential diagnosis?
The science curriculum includes all the courses offered at the conventional medical schools.

I would really like a comment on the following quote from skepdic.com:

"Naturopaths claim to be holistic, which means they believe that the natural body is joined to a supernatural soul and a non-physical mind and the three must be treated as a unit, whatever that means. Naturopathy is fond of such terms as "balance" and "harmony" and "energy." It is often rooted in mysticism and a metaphysical belief in vitalism (Barrett)."

Is this "holistic" claim what makes naturopathy quackery?

Just to emphasize / clarify what naturopathy's central premise is:

that a purposeful life spirit governs physiology, aka vitalism

(if you doubt this, see my compilation, http://thevitalismofnaturopathy.blogspot.com/ ).

This profoundly science-ejected concept is falsely-labeled as able to survive scientific scrutiny (see http://www.oregon.gov/OBNE/Aboutnaturopathy.shtml ), and since the entire edifice of naturopathy is based upon this fraud...

what naturopathy is, essentially, is racketeering.

Jeff:

I give up. You people seem only interested in making points. I hope that makes you feel better about yourselves.

It actually does feel pretty good. You should try it sometime.

The fact that many of you have decided to choose not to "believe" in this without doing any substantive research says loads more about you than about me.

I'm not at all sure what you would classify as "substantive", but your blanket assumption that none of the commenters here have thoroughly researched these topics for professional or personal reasons says quite a bit about you. As does your contention that 'belief' has much weight here, and that it is actually a 'choice'.

Hermano:
I know enough highly educated idiots to be cautious of making judgements about anyone's intelligence (beyond strict academic competence metrics) or motivations based solely on their 'letters'. If your point is "look! An ND doing research!" Ok. I just don't find that impressive in and of itself, especially as it seems to be a rather exceptional to the field.

That said, I'm encouraged that some NDs are science-minded enough to be able to collaborate on research relevant to their training. I hope that this will translate to still more NDs actually heeding the outcome of the study and discontinuing their endorsement of St. John's Wort to treat symptoms upon which it has been shown to have no therapeutic effects. Given that we have yet to see any such adjustments, in the face of numerous other studies with similar outcomes, I'm skeptical that this will actually trickle down into broad, evidence-based changes in the way that naturopathy is practiced. I'd be delighted to be wrong about this, of course, but I'm not holding my breath.

Which part of naturopathic medical training is quackery?

Homeopathy, for starters.

Jeff F. has been spanked at Pharyngula http://scienceblogs.com/pharyngula/2008/06/now_im_embarrassed.php (post #136) and ran away. He seems to have done the same at Denialism, http://scienceblogs.com/denialism/2008/06/thanks_for_playing.php after I asked him to analyze an article at www.naturowatch.com to show how it is wrong.

Hermano asks "Which part of naturopathic medical training is quackery?
Is it gross anatomy, physiology, biochemistry, pharmacology,
or differential diagnosis?"

Those courses teach you "conversational medicine" such that you can say things that sound medical. The real quackery is in the courses on homeopathy, acupuncture, applied kinesiology, iridology, and imaginary detoxification schemes (for starters).

So, Hermano, can you go to www.naturowatch.org and demonstrate any profound errors in the articles by Barry Beyerstein (PhD), Kimball Atwood (MD), or Arnold Relman (MD). Wait, I know- you cannot. Jeff F. cannot, either. And don't tell me they are not nice, i.e., too negative; that is like saying social workers are too opposed to child abuse. "Too negative about quackery" is an oxymoron.

Which part of naturopathic medical training is quackery?

I never said training. Just because the courses have the same name as actual medical education does not mean sanity comes out at the other end.

Because it does not. Homeopathy, acupuncture, energy therapy, quackity-quackity-quack.

Is this "holistic" claim what makes naturopathy quackery?

It's a big, fat warning sign. The complete lack of evidence that anything it does works better than placebo is another.

Like most pseudosciences, Naturopathy likes to point to the more credible areas it includes (such as some of the herbal remedies or diet advice) in order to validate what it really rests on (vitalism and other forms of nonsense.) This can make it a slippery target.

Herbs and nutrition have always been part of mainstream medicine. They're only unique to Naturopathy when they're either untested, or test no better than placebo. So no -- discovering that one of the vitamins or plants naturopaths recommend really does what they say it does will NOT "show us" that Naturopaths are on to something unique.

Reality holds together, and the sciences are consilient. Convince physicists that there is a special kind of "life energy" which helps to balance out the harmonies of the body and allow it to "heal itself," and then we'll think Naturopaths are on to something. Like a Nobel Prize.

People cannot make informed choices if they are misinformed. Patients need to have it explained to them that Naturopathy is a type of religious faith healing, akin to praying that the Holy Spirit takes away your troubles. Only then can they make an informed choice, with their eyes open and the risks accepted.

Hi,

I am new here. Can anyone tell what woo is?

Marcus, as I understand it "woo" is a catchall term used to describe any pseudo-scientific method of treating illness in people or animals. The primary differences between woo and medicine are: 1) woo draws on nonmedical, nonscientific concepts to support it; and 2) woo has no real science -- meaning properly-done formal studies -- to support it.

Orac, you wrote: "Inner wisdom"? Does this remind anyone of "intelligent design"?

Yes, it does. Oddly enough, though, it also reminds me of something I first read about a couple of years ago, a concept called "Darwinian medicine." As I understand it, the idea behind Darwinian medicine is that many illnesses and injuries can be better understood, and better treated, if you inject an understanding of how the human body and its component systems and subsystems and organs evolved.

This "inner wisdom" thing sounds to me like somebody heard about Darwinian medicine and tried to use it as scientific backing for the woo that they already believe in.

So 'woo' is a made up term then. OK, that helps WolfWalker. Thanks.

As a term tho' can't someone smarter than me come up with something that doesn't sound so ... well, fruity. I reminds me of politic blogs I read where the terms "moonbat' and 'wingnut' are used alot to discredit ideas by association.

That is just my 2 cents. Thanks for the lively debate.

So I am wondering one other thing, in the form of a poll, if you will. Does everyone think that the law was a good idea or bad idea. My background in mostly legal in enforcement and corrections so science is not my main area, but it seems to me that some form of legal regulation is needed to rein this in and fold the alternative in and the 'woo' out. What are your thoughts?

Sorry in advance for any spelling or grammar mistakes.

Thanks

It would be nice if there were actually healthcare professionals who actually were what NDs claim to be. Somebody who really knew herbs. Someone who has the knowledge of a qualified nutritionist. Someone skilled in physical therapy. Someone with more time to talk to patients. Someone to deal with the PIA patients who need extra pampering, but no real disease.

Unfortunately once the field becomes woo based this is not what you get. Once you see that the training includes homeopathy and energy therapy the whole thing becomes suspect. From what I have read about the ND schools the science based courses (chemistry, physiology, etc ) are not on a par with other professional schools. Accreditation has been off and on and is more based on record keeping that course content. Can these schools be demanding? Sure- but just because one has to work hard at learning nonsense does not make it real.

Ok, this is trivial, but I fixated on the vacuous phrase "relies on the body's powers to heal itself". Well, duh, so does real medicine. A surgeon cuts, does what is required, sutures/staples/tapes the body back together, and sho' nuf, relies on the body's powers to heal itself in order to heal the incision. Chemo and radiation commit wholesale slaughter of cancer cells, and rely on the body's powers to heal itself of the collateral damage to healthy tissues. Have a cold? Get plenty of fluids and rest and rely on the immune system's ability to ramp up and mount an immune response to the virus and kill it off -- if that's not an example of "the body's powers to heal itself" then what is?

So, yeah, I'm overreacting to your equivalence of "relies on the body's powers to heal itself" with "does nothing." The point of real medicine is that it uses scientific evidence about what the body's properties are (including the body's powers to heal itself) in order to treat people correctly. The problem with woo is that they invent "powers" that they wish the body to have. It's not that the body has no power to heal itself, and, indeed, some of the true powers that the body has are way more freaky and impressive than anything these clowns make up. (Microphages eating bacteria? The brain re-wiring itself after a stroke? Way cool stuff...)

So 'woo' is a made up term then. OK, that helps WolfWalker. Thanks.

Woo is not a new term, nor is it in any way exclusive to this blog. Certainly I can't take credit for it. See: What is woo?

As a term tho' can't someone smarter than me come up with something that doesn't sound so ... well, fruity.

I'm partial to "faith-based treatment".

Does everyone think that the law was a good idea or bad idea.

Bad. The worst thing you can do is give these clowns legitimacy.

marcus welby:

it seems to me that some form of legal regulation is needed to rein this in and fold the alternative in and the 'woo' out.

But regrettably, the legislation in question is not designed to regulate, but to validate. Even if (big IF) this endorsement does somehow result in more oversight for NDs, I still think that the hollow legitimacy it offers is too high a price to pay for this. Count me as another 'no'.

As a term tho' can't someone smarter than me come up with something that doesn't sound so ... well, fruity

I make no claims to being 'smarter that you' (even though I have a science degree) but given the preposterous pronouncements that most CAM purveyors make about their various products/methods, they are hardly deserving of a term with more gravitas, or less 'fruitiness', than 'woo'. I recommend perusing archived "Your Friday Dose of Woo" posts here on Respectful Insolence to become conversant with all that 'woo' encompasses. If, after that, the term still doesn't strike you as appropriate, might I suggest "Bullshit"?

Since NDs (one hopes) do not take it on themselves to treat severely injured and/or critically ill patients, they're also far less subject to potential malpractice litigation and don't have to deal with high insurance costs.

Why shouldn't they?

What liability could they face if they did?

Not following the "standard of care" for homeopathic surgery, which seems to involve making sure the patient has taken vitamins prior to surgery?

I am truly curious regarding the legal limits to the "practice of naturopathic medicine" and conversely what would constitute a violation of a "naturopathic standard of care."

Danio,

I guess we are destined to disagree on some things. I have read the law [link - https://www.revisor.leg.state.mn.us/bin/bldbill.php?bill=H1724.5.html&s… } and it does place the ND board under the direct oversight of the same body that regulates the MD, nurses, etc.. I think that not doing so would give too much of a wild west atmosphere to the alternative health field.

Hiding our heads in the sand and pretending that something is not happening is a good way to get your collective asses handed to you, or at least it is in my profession. I assume it is in yours.

The fact that more and more people in north America are turning to alternative care must be dealt with as the reality it is. I, for one, would prefer some form of oversight. I shudder to think of the alternative. Of course my jaw also dropped to the floor when I found out how many people die in the US every year from taking properly prescribed medicine in a correct manner.

Wow, I have rambled one here. Sorry about that. Time for me to get off my soap box and listen for a while.

Thanks.

Great points, D.C.; the short answer is that naturopaths don't face the same "malpractice as lottery-winning" mindset simply because. . . most (all?) naturopaths do not carry malpractice insurance that most physicians must carry (it is a condition of obtaining privileges at most hospitals: if you want to practice medicine at a hospital, that hospital's credentialing board insists that you carry a certain amount of malpractice insurance).

In other words, litigants seeking a payoff need look no further than the limits of a physician's malpractice insurance policy.....indeed, the first interrogatory question on most med mal discovery requests is: "what are the policy limits on any and all applicable malpractice insurance policies carried by you?" Ka-ching!

As to the "standard of care": even with real physicians, (M.D.s), the SOC can vary widely, especially when you factor in paid experts who will give conflicting opinions on what the SOC is regarding a particular set of facts. Basic principles of negligence mandate that you must have a "breach of duty" to make out a prima facie case, but where that duty is defined by an arbitrary "standard of care" which may well differ from region to region, it becomes pretty slippery. And that is where established medical principles are involved: one can only imagine the kind of "slipperiness" which would be involved in trying to bring a naturopath-malpractice case, and establishing the elements of same:

"Now, Dr. Woo, is it fair to say that the standard of care in this case requires that three amulets be worn when massaging the chakra?"

The absence of any real payoff for the plaintiff's attorney, as well as trying to define a "duty" owed to naturopathic patients, makes me think that naturopaths are reasonably safe from the runaway litigation that hounds physicians these days.

Remember that physician peer-review (a la the AMA, for example, or each state's board of medicine) is separate and apart from civil actions.

Danio, great posts as always: I agree that the designation "Dr." will only validate quackery. Sigh.

marcus, I appreciate your posting the link to the law. I hadn't actually read it and I understand your point about regulation a bit better now.

As I said before, I doubt that anyone here would object to regulation, if that is what it truly is. But the language of the law, at bottom, serves to legitimize and expand the professional realm of the Naturopath in the state of Minnesota. If such a law has to exist at all, I am glad that it at least prohibits some of the highest risk practices (e.g. surgery) that have flown in other states, but the very fact that the legislators are putting Naturopaths on par with Medical Dr.s etc. is not an encouraging development. That Naturopaths will be allowed, by this law, to practice all of the things that are on that list , as ineffectual and wasteful as they may be, if not downright detrimental to the health of the patient, is a blow to evidence-based medicine. The possibility that some practitioners might get busted overstepping these already too-generous boundaries is small consolation, IMO.

oops......never meant to post that three times. really.

[blockquote]A basic assumption is that nature is orderly, and this orderliness is designed to result in ongoing life and well being. This dependable orderliness is believed to be guided by a kind of inner wisdom that everyone has. This inner wisdom can be assisted to return a person to their best balance by naturopathic treatments.[/blockquote]

Anyone who can use the terms 'orderly' and 'inner wisdom' concerning the human body, obviously has never studied anatomy. We have evolved all sorts of weird, inefficient, stupid systems; vestigial crap; 'leftover' bones and muscles.

Are these morons also creationists?

Barbie, I'd love to hear your take on what sort of liability is inherent or implied in the MN law (linked to by Marcus Welby, above). Earlier when I was looking up tuition rates for ND programs I noted that malpractice insurance was a line item in the tuition & fees breakdown at University of Bridgeport. The fee schedule was inclusive of their Chiropractic and Acupuncture programs (!!), as well as the Naturopath degree, though, so it's not clear which students are required to carry the insurance.

Interestingly, the original article from the Minneapolis paper, entitled "A bitter fight over who can be called 'doctor'", says nothing at all about the reaction of the (evidence-based) medical community to this news. The 'bitter fight' is being waged by non-accredited Homeopaths and herbalists who think that the law affording ND undeserved legitimacy will diminish their own equally undeserved legitimacy. Finally, something to laugh about in all this.

Licensure is a license to kill, not a control. It leaves the inmates in charge of the madhouse. Licensed naturopaths have treated eminently-curable cancer with herbs; resulting in death. Since that is within the scope of practice of naturopathy, they aren't even reprimanded by their licensing boards. That is not "regulation" as I would have it. You can read about it at www.naturopathy.org

Danio,

I know what you are saying about the law, but I guess from my paradigm, the law is just what it reads and no more. Sure there are interpretations, but it is what it is. You can't get too far away from the language of the law or there is no law.

This is why I support regulation, as flawed as it may be, because any regulation is better than none. It can be fixed in subsequent legislative sessions or by precedent.

Here's a quote from the Notebooks of RAH. "Beware of strong drink. It can make you shoot at a tax collector.... and miss." I love that one.

Thanks

Danio,
The fight against this law was nothing to laugh at, it was blood and gore till the Governor signed it, and it's not even the end of it.
The last section of the law is a very late amendment to create a work group to draft legislation to protect correspondence school NDs.
The opponents of regulation are extremely well organized on the national level and supremely skilled at suppressing legislations across the country.
Their method is to fabricate controversy by creating maximum chaos, fear, and panic among the general public who flood the legislators with emails and phone calls.
They will pander to whatever any constituency's concerns may be.
If you are a physician, they will tell you all about 'wannabe doctors with substandard training'. If you are socially conservative, you will hear about 'homosexual abortionists', if you are from an ethnic community to has some sort of traditional healing practices, they will tell you that the law will make those practices illegal.
Basically, they deal in pain and pressure and apply it to maximum effect to crash weak naturopathic physician associations in unlicensed states.
Very, very painful for those concerned.

Thank you to those who responded to my earlier question,
please forgive me for quoting myself:
"I would really like a comment on the following quote from skepdic.com:
"Naturopaths claim to be holistic, which means they believe that the natural body is joined to a supernatural soul and a non-physical mind and the three must be treated as a unit, whatever that means. Naturopathy is fond of such terms as "balance" and "harmony" and "energy." It is often rooted in mysticism and a metaphysical belief in vitalism (Barrett)."
Is this "holistic" claim what makes naturopathy quackery?"

Thank you again.

How about the following quote?

"The body is a unit, and the person represents a combination of body, mind, and spirit.
The body is capable of self-regulation, self-healing, and health maintenance.
Structure and function are reciprocally interrelated.
Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function."

Is this also vitalistically suspect?

Marcus Welby,

I salute your genius and I hope I can learn from your example.

Ok, marcus:

Let's imagine a new 'alternative' corrections officer on the scene. These people would have had some training in criminal justice, but would also have studied extensively the application of 'energy fields' to contain prisoners in lieu of steel bars and electronic locks, and would exclusively employ psychic coordinate tracking in lieu of video surveillance. In spite of the fact that there have been no studies supporting their methods as equivalent in efficacy to the traditional means of guarding prisoners, etc., the state decides to grant individuals holding an "ACO" degree the right to practice corrections. They are not allowed to carry tasers or billyclubs, and they are not permitted to work in maximum security prisons, but they will be on the job, relying solely on their alternative means of corrections while guarding real prisoners. Importantly, there are no terms in the law that hold them accountable for any mishaps that occur while they are on duty, as long as they are operating within the guidelines set forth. In other words, they will not be responsible for any breakouts or assaults that occur on their watch as long as they were dutifully employing the energy fields and psychic coordinate tracking prescribed by their training at the time of the incident.

How would you feel about this? Would you be ok with sharing your job description with them? Would it bother you to know that the same body that monitored your training and credentials considered them equivalent in some way? Even if you didn't work alongside them, how would you feel about the potential risk they would pose to the prisoners they were charged with, or to the population at large? What if the inevitable failure of their methods was not attributed to their lack of effectiveness, but to traditional corrections officers undermining their efforts, or to a conspiracy within the corrections system, or to individual prisoners who were unwilling to believe in their abilities?

The analogy breaks down at this point, because the obvious threat to public safety would force the law to be overturned quickly, if it were made in the first place. On the other hand, ND and other CAM practices have gained enough cache and undeserved credibility to have considerable staying power.

Hermano, I don't doubt that it has been indeed bitter. I don't have a personal stake in it, so yes, I find the irony of one group of pseudoscientists lobbying against legislation that will benefit another group of pseudoscientists humorous.

I note that you have chosen to focus on the emotional aspect of this issue rather than address the numerous responses you received to your queries about quackery up-thread.

Hermano,
I spoke too soon, and I apologize. That said, you can keep producing these 'mission statements' if you wish, but it should be pretty clear by now that we think Naturopathy is a pseudoscience, and no amount of woo-rich description you provide and ask for more feedback on will alter that. What will turn us around, you might ask? EVIDENCE. Do rigorous, reproducible experiments. Test your claims. Publish the data. Earn your respect.

Danio, o Danio, wherefore are thou
The Woo statement I produced that you dismissed out hand as representative of Naturopathic pseudoscience is the 2002 revision of the core principles of osteopathic medical philosophy.

It's all about numbers. Here are some more from the article I got the quote from:

From its inception, the osteopathic profession has been smaller than the older MD profession.[13] Currently, there are 25 accredited osteopathic medical schools[14] in 28 locations in the United States and 126 accredited US MD medical schools.[15]

* In 1960, there were 13,708 physicians who were graduates of the 5 osteopathic medical schools.
* In 2002, there were 49,210 physicians from 19 osteopathic schools.
* Between 1980 and 2005, the number of osteopathic graduates per year increased over 250 percent from about 1,000 to 2,800. This number is expected to approach 5,000 by 2015.[16]
* In 2007, there were 25 colleges of osteopathic medicine in 28 locations.[17] One in five medical students in the United States is enrolled in an osteopathic medical school.[18]
* By 2020, the number of osteopathic physicians will grow to 95,400, say expert predictions, according to the American Medical Association.[19]

Read the Wikipedia to learn about reprehensible stunts the AMA pulled on the osteopaths during the late 1960s in California.

Stephen Barrett, who is the idol to some of you here, does not dare to bring up osteopaths on his quackwatch site either. There are too many of them.

The conclusion is that you are a bully and pick on naturopathic doctors because you think they are a soft target.
There are currently 4 naturopathic medical schools in the States with probably between 2,500 and 3,000 graduates.
Have fun bullying while their numbers are still small, monkey boy.

Danio,

I certainly was not looking for your sympathy.
You did say the fight over this legislation was laughably funny, and as someone who observed first hand the pain the
fraudulent mo-fos caused my dear friends I objected and tried
to provide a view of how things actually went down.
Please believe me when I say that the story behind it is much bigger than you imagine, and it is far from being over.

Hermano: "Stephen Barrett, who is the idol to some of you here, does not dare to bring up osteopaths on his quackwatch site either. There are too many of them."

Wrong on a couple of counts. First of all, Quackwatch does in fact question some aspects of osteopathic medicine. For instance:

http://www.quackwatch.com/04ConsumerEducation/QA/osteo.html

Osteopathic physicians in most cases are treated with the same respect in the medical community as physicians educated at standard medical schools. They participate with MDs in accredited residency programs and to my knowledge, overwhelmingly endorse evidence-based medicine. There is no comparison to the blatant woo-ism inherent in naturopathy.

"The conclusion is that you are a bully and pick on naturopathic doctors because you think they are a soft target."

Naturopaths are "picked on" in the same way as other purveyors of quackery. Advocacy for high standards of patient care and the scientific method goes hand in hand with exposing and ridiculing quacks.

This came up elsewhere, and I mentioned then that it does not matter what knowledge you start with if you divert yourself into quackery, crankery or pseudoscience.
How come we almost never hear of Alt-Physics or Complementary and Alternative Chemistry ? Because people who espouse crank theories in those fields are generally seen as such and most often laughed out of the profession.

In the medical/public health community, Doctor has more weight to it than practitioner or therapist, terms previously appropriated by these people.

When Naturopathy produces actual evidence of efficacy, to rigorous scientific standards, then it may be acceptable.
However, having a patient not get well and then claiming that their failure to recover from an illness was due to their lack of belief, or to the lack of belief of those nearby. Sorry, I don't buy that.

DLC,

You have never heard of all the cranks who congregate near major physics departments? Where did you take physics?
And not just disturbed individuals, and those who independently publish their Unified Field Theories.
Cold Fusion anyone?

Come on, Pork.

Setting up my question using the osteopathic core principles as bait was masterful.

You have been exposed as bullies wallowing in the shared smugness of your common prejudice.

That is enough for some, and that is all you apparently care for.

Hermano: Last time I checked, physics and chemistry cranks weren't forming pseudo-professional organizations, succesfully agitating to be legally recognized on equal footing with real physicists and chemists, or inflicting their crank theories on other people as part of a treatment regimen.

N.C.,

Last time I checked (earlier today), trained naturopathic doctors have been prescribing supplements to their patients based on scientific research into the effects of nutrition on their particular medical conditions (M.S. in this case), and educating these same patients that they may need something other than supplements sold them by their chiropractor based on a kinesiology reading.

N.C.,
As far as physics cranks forming pseudo-professional organization, successfully advancing their agenda through legislation, and inflicting their crank theories as part of treatment on the populace: yes, yes, and yes.
Have you heard about William Nelson and Panos Pappas?
If not, you are in for a real treat.
Read http://seattletimes.nwsource.com/html/medicaldevices/.
Whose agenda do you suppose is served by NOT regulating naturopathic medicine? By fighting it tooth and nail?

Last time I checked (earlier today), trained naturopathic doctors have been prescribing supplements to their patients based on scientific research into the effects of nutrition on their particular medical conditions

That would be herbal medicine, which is medicine if the herb is proven to work. If not, it is grade A bullcrap.

But hey, you checked earlier today, so it should be no problem whatsoever to provide a link, right?

Go on, we're waiting.

There is no alternative medicine. There are treatments demonstrated to be effective by well controlled studies, treatments that seem effective on the basis of published case studies, and treatments with no peer reviewed evidence to support them.

That's what we have.

Any "alternative" treatment becomes conventional once it has a sufficient body of evidence demonstrating that it is safe and effective.

Quackery is what we did for thousands of years. Evidenced based medicine is something relatively new. Unfortunately, science is difficult and expensive.

It appears to me that economists and politicians at high levels have determined that low-cost quackery for the masses is simply an economic reality we must accept. Hence the expansion of prescribing privileges for allied health professionals in many states.

Dangerous Bacon: as it happens, my G.P. is a D.O. (alphabet soup, anyone), as was the surgeon who cut the cyst out of my shoulder in 2000. Going by memory, there was a split between the D.O. schools and the D.C. schools sometime in the early 20th century, with the Osteopaths going to a science-based methodology and the Chiropractors either staying where they were or moving toward Woo-ery.

(note: this is not meant as a definitive history of Osteopaths and or Chiropractors. )

Wait, so 2 idiots trying to shoot microwaves into people who are idiotic enough to sit there are equivalent to your organized magic club that is accredited by some what, 10 states? Or was it 13.

Certainly we physicists do something have some people doing crazy stuff, like those good old cold fusion experiments. Their claims were conclusively tested, found to be wrong, and people who still persist in claiming cold fusion is real are ridiculed mercilessly (or would be, if they were still around). Exactly like this naturopathy brand of magic is. Thank FSM.

StuV,

Thank you for waiting.
I do not get ALL my information from online searches.
In this instance, I obtained my information about the latest goings on in naturopathic medicine from a conversation I had today with a practicing naturopathic doctor (who will be eligible for registration under the new MN Statute 147E).
Is this good enough?

Hermano asks:

You have never heard of all the cranks who congregate near major physics departments? Where did you take physics?

I reiterate: Because people who espouse crank theories in those fields are generally seen as such and most often laughed out of the profession.

Coriolis,
All you got out of the Seattle Times report was two people zapping yourself with microwaves?
How about William Nelson selling tens of thousands of his machines in this country for $20K each?
Even more importantly, what did you think of her singing?
I bet there is someone selling sessions on one of Nelson's machines in your town, someone who is NOT a licensed naturopathic doctor. Very likely someone with fake credentials.

Hermano, are you actually saying "I have no proof, but there's this guy I know that says I'm right"?

Really?

Dr. Benway,

You are extremely naive to think that
"It appears to me that economists and politicians at high levels have determined that low-cost quackery for the masses is simply an economic reality we must accept. Hence the expansion of prescribing privileges for allied health professionals in many states."
That is the political process I witnessed.
On a different subject, I really liked the story on your site about the ocean garbage gyre. Is that turtle photo real?

Dr. Benway,

Correction: That is NOT the political process I witnessed firsthand.

You are close about an underlying "economic reality": much of it is about money and its effective application.

StuV,

What proof are you talking about?
I relayed to you the content of the private conversation I had earlier about a patient seen today.
Would you like me to try to get that patient's notes and send them to you?
Not hipaa likely.
It hurts that apparently my word is not good enough for you.

Hermano, I find your 'arguments' less than compelling.
You evidently think that you scored some points by 'baiting' us with the Osteopathic core principles, but I don't recall anyone actually 'biting'.

Many Osteopaths, as has already been noted, practice within the realm of evidence-based medicine, and as such I have no problem with that. I do have a problem when they--or anyone--depart from scientifically vetted treatments. I consider any such practice a 'soft target', because such things have abolutely no grounding in reality. They can be easily dismissed, and should not be given respectful consideration until they have demonstrated that their treatments can withstand objective, repeated scrutiny and testing. It is not at all unreasonable to require that any treatment should undergo such testing before being offered as, and given public respect comparable to, established medical therapies. Yet you think this standard makes me a 'smug, shallow bully'. Ah. You seem to be motivated a great deal by personal investment here, and not at all by rational thought, so I suppose there's really no point in trying to engage you further, lest you hurl more nonsensical insults.

No scientific discipline is immune to quackery. You can continue to name random lunatics in the fields of physics, biology, medicine, and dentistry--I'll even help you find the links, if you want. But these few outliers do not discredit their entire fields, because thes fields do not accept claims presented without convincing evidence. You cannot say the same for Naturopathy, I'm afraid. The ENTIRE field is based on unfounded, untested, and in some cases untestable practices. There is no comparison here. You are a very loyal friend, and I commend you for that. But please endeavor to seek further information from unbiased sources before continuing advocate pseudoscience.

Hi Danio,

The only liability truly inherent in the language of the naturopathic licensing statutes would be administrative action for pursuing treatment specifically "prohibited" by the statutes. The fact that there is a fairly comprehensive list of "no-no's for naturopaths" is pretty telling and also very funny.

One other interesting fact from the statutory language: it appears that the naturopaths of Minnesota would be subject to a standardized 'licensing test' (i.e. analogous to a medical board exam, which most medical specialists must take every ten years to maintain their license). Some crafty lawyer could argue that the applicable 'standard of care' is derived from that test: in other words, rather than relying on expert vs. expert in the (gulp) "field" of naturopathy, one could rely on the standard espoused by the state licensing board. (This is an emerging trend in med. mal cases).

The malpractice coverage issue remains interesting to me because I know from experience that the amount of insurance money available is a key factor in whether (and whom !) to sue. Maybe if naturopaths were required to carry significan malpractice insurance (and without a hospital or other credentialing requirement, they probably won't) and consequently were subject to lawsuits at the same rate as M.D.'s, the 'field' would be revealed for what it is.

Just a thought.

One last comment on the statutory language (and thank you, Marcus Welby, for that link): will registration with the state board be compulsory or voluntary? seems voluntary, especially in light of this catch-all exemption from the provisions of the statutes:

"Subd. 2. Other health care practitioners. Nothing in this chapter may be construed to prohibit or to restrict
. . . .
5) individuals not registered by this chapter from the use of individual modalities which comprise the practice of naturopathic medicine."

Interesting. So any naturopath not licensed or "registered" as such can carry on with his/her "individual modalities" of naturopathic 'medicine'. I guess it should probably be all or nothing . . . otherwise, what is the point?

Jesse: "I have never seen a non-MD physician. MDs go through a well-documented education and training process where they learn to think about human physiology and pathology. I trust the training they receive, not DOs or NDs. (Sorry but in my experiences the kids who went to DO school did so out of necessity due to low MCATs and GPAs not because of some deep-seated belief in osteopathy). I have no desire to, nor would I want to see a DO or ND."

First off I think one of the bigger reasons to chose DO schools is that they are seen as more primary care focused. That and the location, cost, and availability of schools which make up the lion's share of many future physicians' decisions about where to attend medical school.

Secondly you are making the assumption that one's scores on the MCATs or standardized testing indicates capability as a physician. It is certainly true that there is a minimum level of competency that needs to be met and standardized tests are one common way to examine that. However they are not the only way, and just because you do well on a multiple guess exam it doesn't mean that you have the clinical competency or communication skills of a turnip.

The physician who got a 4.0 from an Ivy undergrad, got a 42 on the MCAT, was cut throat enough to crush the competition in medical school and graduate AOA, attended his choice of urology residencies, and who refuses to come see the uninsured teenager with a testicular torsion may be smart as hell, but he's also a flaming asshole who shouldn't be trusted with a plant much less a person's health. The family practice doctor who may have worked hard for a 3.7 and a 33 on the MCAT, and who graduated firmly in the average of her DO program who I call at 2 am to beg to see an uninsured newly diagnosed diabetic in follow-up who tells me of course she'll do it? She's the one I want taking care of me.

My current primary care doctor is exactly that: a DO FP.

Jesse: "I have never seen a non-MD physician. MDs go through a well-documented education and training process where they learn to think about human physiology and pathology. I trust the training they receive, not DOs or NDs. (Sorry but in my experiences the kids who went to DO school did so out of necessity due to low MCATs and GPAs not because of some deep-seated belief in osteopathy). I have no desire to, nor would I want to see a DO or ND."

First off I think one of the bigger reasons to chose DO schools is that they are seen as more primary care focused. That and the location, cost, and availability of schools which make up the lion's share of many future physicians' decisions about where to attend medical school.

Secondly you are making the assumption that one's scores on the MCATs or standardized testing indicates capability as a physician. It is certainly true that there is a minimum level of competency that needs to be met and standardized tests are one common way to examine that. However they are not the only way, and just because you do well on a multiple guess exam it doesn't mean that you have the clinical competency or communication skills of a turnip.

The physician who got a 4.0 from an Ivy undergrad, got a 42 on the MCAT, was cut throat enough to crush the competition in medical school and graduate AOA, attended his choice of urology residencies, and who refuses to come see the uninsured teenager with a testicular torsion may be smart as hell, but he's also a flaming asshole who shouldn't be trusted with a plant much less a person's health. The family practice doctor who may have worked hard for a 3.7 and a 33 on the MCAT, and who graduated firmly in the average of her DO program who I call at 2 am to beg to see an uninsured newly diagnosed diabetic in follow-up who tells me of course she'll do it? She's the one I want taking care of me.

And my current primary care doctor is exactly that: a DO FP.

We ought to license CAM and other anti-science practitioners via state gaming commissions.

All CAM advertising, including business cards, should include the words, "for entertainment purposes only."

So Naturopaths study "Gross Anatomy" (I always that anatomy was gross) - do they learn it hands-on by cutting up actual cadavers? - Certainly those who get their degress by corespondence do not.

Several years ago, a Naturopath in Calgary killed a mentally handicapped girl when a balloon he was inflating in her nasal cavity (this was supposed ot expand the bones in her skull) came loose and suffocated her. He was charged (Criminal Negligence Causing Death?) but got off with a slap on the wrist as I recall. Someone blogged about this case on the Science Based Medicine blog a few months ago.

My point is that restricting naturopaths from doing surgery etc. will not prevent them from finding innovative ways of killing people.

I think this licensing will only serve to increase the impression that naturapaths are almost like medical doctors.

Hermano:

It hurts that apparently my word is not good enough for you.

Nobody's word is good enough. Do you even understand how science works?

Jebus Tapdancing Cripes.

the shared smugness of your common prejudice

Reality is never prejudicial - it's "predictable."

A physicist who points out that a perpetual motion machine can't work is not being "prejudiced" - he's being a good physicist. Etc.

Altie thinking in a nutshell: "I don't like reality because it's too complex/expensive/unpleasant/says something I don't want to hear, therefore I am ignoring it and making up my own."

Danio,
I do appreciate the thought and effort you put into your responses.
I was thought to be very careful with logic questions which include sweeping statements such as "ENTIRE".
My impression is that your opposition to naturopathic medicine has less to do with its actual practice and more with your reaction to the characterization of its philosophy as 'vitalism', etc...
I find that the practitioners are far more pragmatic in their approach then you may imagine.
The analogy with osteopathic medicine is apt, consider the criticism of DOs in previous comments as 'physicians lite'.
It is all relative. I have heard complaints, and no there is no sited article or link, from medical doctors what idiots their fellow MDs are. I am venturing to guess that such complaints are fairly common.
The existence of unlicensable 'traditional (since the rise of correspondence schools in the 1980s) naturopaths' complicate the picture.
What sets apart conventional and osteopathic school graduates from the NDs is that naturopaths often do not go through residencies.
Atwood, as well as 'traditional' naturopath opponents of regulating naturopathic medicine bring this up as a grave deficiency.
Would you allow naturopathic medical school grads into a residency? Highly unlikely. It's a Catch 22 situation.
I read one comment that residencies are becoming more common. I am sure that given a chance qualified NDs would do very well in family practice resident programs.
Could someone please explain the selection process and requirements for residencies?

As a partial aside - to me the whole upsurgence of quackery appears to be a reaction to the way real medicine has grown increasingly impersonal and time-compressed. The last time I went to my doctor for my sit-2-hours-then-5-minute-interview-ok-thanks-bye session, I had a lot of time in the waiting room to observe my fellow patients and how the practice was being run. There was no attempt by the people behind the glass partition to connect with the patients; it was "fill out this insurance form and we'll call you." My doctor was his usual smiling, friendly self, but it was more of the stunned smile of a guy caught in a whirlwind. It's got to be tough on the doctor to be only allowed to ration 1 handshake, 5 minutes, and 2 smiles per patient - but the whole modern medical experience, frankly, sucks. It's impersonal, you know you're going to be on time for your appointment and still have to wait wait wait, and there's the constant theme of insurance money playing in the background.

I contrast that with my friend's accupuncturist. A cheerful charlatan who plays nice new-age music, burns incense, sits down and holds her hand and spends a full hour with her, listening to her current life story. When I challenged my friend about the validity of accupuncture her response was "you know what? He doesn't make me sit in an antiseptic-smelling waiting room for an hour while I worry about getting an antibiotic-resistant staph infection from the junkie next to me." She's pretty realistic. Another point that she made which floored me is that she greatly appreciates the fact that she knows that her accupuncturist is only going to nail her for $250 for the session and that she's not going to walk out the door with some prescription (for something that actually does something) that costs $400 per month to fill.

It's interesting that as our lifespans increase, thanks to science-based medicine - the things that go wrong get more and more expensive and are often impossible to fix. The overall result (for someone who is getting on in years) is a creeping dread that, at the end of your 3 hour wait, you'll be told you're going to a) die and b) be bankrupted first. A quack will just tell you you've got a minor chi problem that they can fix with magic duct tape that cost $10 - costs are kept down because at some level they know that if they started trying to really gouge they'd have to justify it better. I think that the patients of quacks subliminally buy into the cost limitation, to a great extent.

Science-based medicine works on a technical level but it's becoming less and less pleasant - emotionally and financially. The trend-line is downward, too. So, if I'm right, the woo-trend is going to stay on a pretty serious up-ramp for the forseeable future.

I find that the practitioners are far more pragmatic in their approach then you may imagine.

Asked and answered. There is nothing pragmatic about homeopathy or acupuncture. It is shameful quackery.

You've been trolling other threads around here. Are you just entertaining yourself in different ways on different but similar threads? Because you're becoming very repetitive.

Marcus Ranum,
None of the naturopaths I know tell their patients that their chi is out of wack.
They deal with patients who often have chronic or terminal illnesses, e.g. MS, Crohn's, cancer. All sorts of conditions that do not improve under the care of conventional doctors.
Nobody equates cancer with stagnant chi or whatever.
If you want to make a broad generalization, akin to MDs writing a script in 5 minutes, a better one for NDs would
be food allergies, as in 'You may be dairy/gluten/ / intolerant'.

None of the naturopaths I know tell their patients that their chi is out of wack.

Do any of them ever recommend homeopathy? If they do, they are quacks. Period.

Homeopathy is quackery.

They deal with patients who often have chronic or terminal illnesses

So they're hospice counsellors? Why would they need a degree for that?

StuV,

My goal is to find out what people think about regulating
naturopathic medicine.
I am all for civil discourse, and I did react to someone dousing another's comments with expletives in another blog.
Is shouting down others with expletives accepted behavior here?
What do you mean by 'trolling'? Trying to provoke others?
That's not what I want.

I was thought (sic) to be very careful with logic questions which include sweeping statements such as "ENTIRE".
My impression is that your opposition to naturopathic medicine has less to do with its actual practice and more with your reaction to the characterization of its philosophy as 'vitalism', etc...
I find that the practitioners are far more pragmatic in their approach then you may imagine...

No, Hermano. The vitalism is a problem, to be sure, but the practice of using homeopathy and untested herbal supplements is just as big a concern. I don't doubt that there are probably some sensible NDs who don't buy into this, and just like Chiropractors who limit themselves to practicing what is basically a modified form of Physical Therapy, I'm sure there are some NDs who limit their practice to nutritional counseling, more or less. Neither of these particular examples embody any sort of pseudoscience, but they are clearly not representative of either the philosophies or the practices of the field at large, and ergo, there is nothing illogical about branding the ENTIRE field(s) as suspect.

Barbie, thanks again for the legal insights. It is just as I feared. The law apparently does everything it can to legitimize NDs and nothing at all to curtail their application of bogus modalities.

Marcus Ranum, I agree 100%. I'm sure that this is also the reason (oh, and $$$$) why we see more CAM centers popping up at medical schools around the country. The jackpot question is, what can be done about it?

Orac,

The NDs I know do have some of those little homeopathic sugar pills. The kind you find in most drug stores and in better supermarkets.
It's not considered to be a panacea. It was fostered on me several times and I felt no ill effects.
If you are certain they are BS, I suppose they would not have any placebo effect on you.
I am definitely skeptical about their effects, but I really
don't know. So, I can both make fun of them when I am in right mind AND enjoy the placebo effect when I feel really uncomfortable and just want something to soothe me.
And by the way, the main homeopathic advocate in the Twin Cities is an MD.

Barbie,
Regarding
"this catch-all exemption from the provisions of the statutes:

"Subd. 2. Other health care practitioners. Nothing in this chapter may be construed to prohibit or to restrict
. . . .
5) individuals not registered by this chapter from the use of individual modalities which comprise the practice of naturopathic medicine."

Interesting. So any naturopath not licensed or "registered" as such can carry on with his/her "individual modalities" of naturopathic 'medicine'. I guess it should probably be all or nothing . . . otherwise, what is the point?"

The point is the 2001 Minnesota 'Health Freedom' CAM law, Statute 146A, which protects all unlicensed CAM practitioners from the Medical Board.
The qualified naturopathic doctors are asking to come under the jurisdiction of the Medical Board and thus have higher degree of accountability.

Naturopathy isn't medicine. It is either dangerous delusion or willful fraud, depending on how in touch with reality the practitioner is. There are already laws for fraud. Delusion is technically legal, but hardly deserves a degree.

In my latest blog post, I linked to this one, and give deserved credit when a ND school actually did a study debunking itself.

The qualified naturopathic doctors are asking to come under the jurisdiction of the Medical Board and thus have higher degree of accountability.

Sure, that's why they're doing it. Accountability. Uhuh.

Marcus R.,

I think this sentence gives us some insight into your view:

"Science-based medicine works on a technical level but it's becoming less and less pleasant - emotionally and financially"

I don't agree that science-based medicine need be a "pleasant" experience; personally, I have no such expectations and I would rather do anything than go to the doctor or experience a hospital stay.

Could this be part of the whole problem? That people are seeking affirmation, validation, a warm, fuzzy, feel-good experience, and when they don't receive the same from their physician, they are willing to shell out money to someone who will hold their hand and provide such validation? If that is the case (and I truly believe that it is, at least with some percentage of those who visit CAM practitioners) then the problem will continue to exist: physicians are never going to be able to engage in such hand-holding or ego-stroking: I don't believe that was ever the role of a physician in any event.

So if the expectation has become that physicians should take the role of therapist, friend, support group, that expectation is flawed and will only lead to inevitable disappointment with "traditional" medicine.

physicians are never going to be able to engage in such hand-holding or ego-stroking: I don't believe that was ever the role of a physician in any event.

Interesting point, Barbie. Assuming that this in fact has never been the role of a physician, there is at the very least least a prevalant public perception that it was. Many people will wax nostalgic about the good old days when kindly old paternalistic housecall-makin', black bag-totin' Doc White used to stay to supper after tending to Uncle Ned's carbuncles, and lament that the Great Satan that is Managed Care has sucked all the humanity out of modern medicine.

Of course this is a gross distortion of reality, but there is perhaps a nugget of truth in there somewhere. It is easy to imagine a bygone time before modern medical breakthroughs when there wasn't much a physician could actually do for suffering patients, other than to sit at their bedsides and offer comfort as they either got better or died. You'd think people would be pleased, if they thought about it, that doctors today have the benefit of modern science informing them of new, innovative ways to prevent, diagnose, manage and treat disease, in lieu of the hand-patting and lollipop-distributing of old. Alas, the increasing popularity of CAM is evidence to the contrary--while I'm sure that most patients are damn glad to avail themselves of modern medicine when in need, they are turning to the CAM practitioners to fulfill what they perceive as the 'other' role of doctors. The real danger here is that, as we have seen with the antivax loons, buying into the pseudoscience of CAM is ultimately detrimental to the success of *real* medicine.

Recognizing that--right or wrong--today's patients are seeking a more personalized type of care is, I believe, an important step for medical professionals to take in order to encourage patients to exclusively seek evidence-based practitioners/treatments--and to stay away from the soothing charlatans who can do so much harm

Sid Schwab,
If an MD at a med school authored a study showing that a certain prescription drug is not effective, e.g. Vioxx, would
that also qualify as "debunking" his school?

I love the strawmen Hermano flings about (-stops to enjoy image.)

I was trained as a scientist, and I still experimented with every form of available woo when my eczema got so out of control that even predisone (that darling nuclear bomb of a medicine) didn't do the job anymore.

Reflexology, acupuncture, herbology, homeopathy, reiki, colon cleansing, fasting (I was on a spring water fast for 20 days and finally stopped when my friends were freaking out a bit - no, I don't think it was food allergies), shamanic healing, soft-touch chiropractic (now, that's a whole story in itself) - I did it all, meanwhile saying: come on, placebo effect! Do your magic!

Most practitioners basically quit scheduling my next appointment when they saw they couldn't help me. I realized it was time to stop when the next step was (this was from the reiki practitioner) that maybe the reason the "alternative medicine" wasn't working was because for some subconscious reason I actually wanted to have severe, dry, raw skin itching so bad that suicide becomes a viable option eczema. 'cause, you know, if this stuff wasn't working, it had to be me, right?

Well, long story short, I had UVA therapy combined with tacrolimus, and then about a year ago allergy shots for rhinitis also reduced the severity of the eczema (if I had only known!)

BTW, if you like really intense foot massages, I do recommend the reflexology...

Forgot the most basic lesson my freshman calculus teacher taught us: just because it's written down doesn't mean it's true.

NickG, your argument holds no water whatsoever. The hypothetical you just described is not about training but personality. It is entirely possible that a mediocre DO will blow you off but the 'cut-throat' MD would not.

Orac: Excellent post. I hadn't had the time to find out what a N.D. was.

Query to whoever can answer: I haven't taken the time to study the Minn. law or the standards used in award of a N.D., but I was wondering whether the requirements for the N.D. would satisfy the requirements for a Bachelor of Science at an accredited college in Minn.?

About a year ago I reviewed the Logan College of Chiropractic (St . Louis, MO) 2006-07 student handbook on-line (pdf format). A few years ago Logan expanded its educational program so that it now offers a Bachelor of Science degree (I do not know if or who accredits it). Interestingly, there is a section in the handbook describing the procedures for someone with a D.C. to be awarded a B.S. from Logan. The handbook makes clear that while Logan will grant academic credit towards the B.S. for courses taken to receive a DC, the fact that someone has been awarded a D.C. (even by Logan) does not satisfy the requirements for award of the B.S.

I'm curious as to whether the same is true of the N.D. recognition in Minn. -- that is, someone can receive a "doctorate" level degree is what is being represented as a scientifically based discipline, but the doctrate level degree does not meet the requirements for a bachelor's level in biology, organic chemistry or some other related science?

Barbie123-- excellent debunking of the reason for the myths on why D.C.'s aren't sued for mal-practice. Unless you can collect the judgment for your client, you don't get paid, and if there's not going to be a payday there's no reason to pursue a mal-practice case. My ex-brother-in-law (a D.C.) used to boast about how infrequently D.C.'s were sued for mal-practice -- saying it was evidence of the effectiveness of chiropractic care. He didn't like my saying that if D.C.'s in his state were required to carry liability insurance, they'd be sued, too.

@wfjag,

I think you are getting at the question of "accreditation." The basic level, accepted by the US Dep't of Ed (DOE). is minimal. All it means is that the "school" has the facilities and "faculty" that it promises, and it is financially solvent. In other words, the student won't arrive in September to find an abandoned storefront. In the case of chiro and naturo, the DOE accepts the word of their own proponents; which means, the inmates are in charge of the asylum.

Schools (accredited or not) are free to label their degrees (including B.S. or N.D.) as they wish. However, professional societies may not recognize those degrees. If Logan offers a BS in chemistry, it is (doubtless) not accepted by the Chemical Society, and may not be accepted by employers or graduate schools. Lots of diploma mills offer NDs; but the graduates of "real schools" assert they are inferior.

It's like comparing ordinary astrologers with those who graduate from accredited schools (yes, they exist(ed?)), the schooled astrologers are not better.

ildi,
when you refer to me and my 'strawmen', is that because you assume that my anecdotal information is fictitious?

'Anecdotal information' proves nothing, whether it is real or made up. So, your question is moot.

@wfjag,
You would need an A.B. or B.S. degree to APPLY to a naturopathic medical school.
Undergraduate degree is expected for admission, link below
http://www.bastyr.edu/education/naturopath/degree_prerequisites/courses…

@wfjag,
To research accreditation consult http://ope.ed.gov/accreditation/Search.asp
Below is the info for the Logan College of Chiropractic,
As you can tell there is both institutional accreditation and specialized (aka professional) accreditation:

To research accreditation, consult
ACCREDITATION
Institutional Accreditation
Agency NamePeriods of AccreditationAction
North Central Association of Colleges and Schools, The Higher Learning Commission *7/1/1987- Accredited

Specialized Accreditation
Agency Name
Program NamePeriods of AccreditationAction
Council on Chiropractic Education, Commission on Accreditation
-Chiropractic (CHIRO) - Programs leading to the D.C. degree6/1/1978- Accredited

NYTimes inre accrediation http://64.233.169.104/search?q=cache:53OEGhaHbjIJ:query.nytimes.com/gst…
"Judith Eaton, head of the Council for Higher Education Accreditation in Washington, said the accreditation did not validate astrology, but only recognized that the school fulfilled its promises to students." The same is true for naturopathy "schools."

NCAHF Newsletter, May-June 1990 v13 n3 p1(1)

"[We were] informed by USDE that scientific validity was not a consideration for recognizing an accreditation agency for schools training health professionals; their legality is all that matters."

You would need an A.B. or B.S. degree to APPLY to a naturopathic medical school.

An actual, for real, US BS degree?

*swoon*

Well, color me convinced! Wowee! Zowee!

Hermano, are you even remotely aware of how badly you are embarrassing yourself?

Hermano: not any more than I said it was "debunking" Bastyr. I did imply that if they keep doing such studies most of their natural remedies will be shown ineffective; which is in contrast to actual medicines, which have mostly been tested and re-tested. This is clearly not the case with herbs, etc. It remains to be seen whether Bastyr will continue the trend. As has been said: those interventions which can stand up to proper scientific study and be shown effective are not "alternative" medicine. They are medicine. To cling to treatments that have been tested and found ineffective is silly at best. As a physician, my practice has changed much over the years as proper testing leads to new understanding. That's a good thing. WIth "natural medicine," the Bastyr study is entirely exceptional. Most of it is taken on faith, untested. Deliberately so.

@Sid Schwab
Thank you very much for your response.
I hope you will help me understand better your statement about "debunking".
Your initially said:
"a ND school actually did a study debunking itself."
And in your response "not any more than I said it was "debunking" Bastyr".
Do these statements contradict each other?
I beg your indulgence to elaborate, I am not a native speaker of English.
Also, Bastyr issued a press release http://bastyr.edu/news/news.asp?NewsID=1486
which states in part:
"This study is an excellent example of a first-rate scientist and clinician using rigorous scientific methods to explore a treatment commonly used by the public without much evidence to support its effectiveness," says Timothy C. Callahan, PhD, Vice President for Research and Collaboration at Bastyr University in Kenmore, Washington. "The results of this research study will inform the public and stimulate further research to determine the effective, appropriate use of complementary and alternative medicine."

Dr. Weber and the Bastyr University research team will use information gathered from this study to develop and conduct future studies surrounding complementary and alternative medicine. For more information on research studies at Bastyr University, please visit www.bastyr.edu/research."

Is this statement about using the methodology and data from this study to "develop and conduct future studies" into CAM
congruous with your "WIth "natural medicine," the Bastyr study is entirely exceptional. Most of it is taken on faith, untested. Deliberately so."?

Thank you again.

Hermano: How about this one?

"If an MD at a med school authored a study showing that a certain prescription drug is not effective, e.g. Vioxx, would that also qualify as "debunking" his school?"

@idli
I am sorry, I am still struggling to understand what you mean. I have been labeled by other posters here as an idiot, dimwit, and worse, so I totally understand if you consider it below your dignity to grace me with an explanation.
Why have you just reproduced my original question to someone else by the way of explaining what I hope will be that person's further answer?
If you say "prima facie", that will not help me understand you.
I did address a question directly to you yesterday regarding my "strawmen", no answer.

I myself enjoy a good mental image now and then, I only wish I did not read about your eczema while I was eating, no big deal.

Would getting outside and enjoying some sunshine be comparable to using an UVA?

It is a beautiful day here for going outside, I hope it is too wherever you are.
By the way, enjoying sunshine is one of the basic 19th Century "Nature Cures" which led to the development of naturopathy.
Here is a link http://www.hippy.com/php/article-243.html with a racy photo of Benedict Lust, father of naturopathy, showing him enjoying sunshine.
Please be warned, it may not completely safe for work or if you are eating and have a sensitive tummy.

Glad you are doing better!

Hermano:
1. Ildi's last post was the response to your strawman question. The Vioxx scenario you propose IS A STRAWMAN.

2. I just had a glance up this thread. I may have missed it, but see no instances where anyone has 'labelled' you. You, on the other hand, have used a number of derogatory terms, which are very easy to spot--particlarly in your comments addressed to me. In case you were wondering, this is a classic example of projection.

Danio,

I have relieved of duty today after a trying morning and a debriefing. I am glad to have time to even check the blogs.

I must agree with Hermano on this one to a certain degree. There are fewer more dismissive tactics to deal with someone that to ignore them. It is apathy with a passive aggressive twist and interestingly what caused todays [small] riot at the prison [and the not so happy reason that I was sent home early with a bruise on my ribs]. A guard refused to acknowledge a question that would have taken her 2 seconds to answer and that set off an inmate who happened to be a gang member which caused a chain reaction of hard feelings. It didn't have to happen.

Having said that, if you ignore Hermano's vitriol as an understandable [over] reaction to being dismissed and not having his questions answered [by some on here with very dismissive language] in a way he understood, then perhaps you could come to an understanding of his position. I did not say agreement, but understanding.

It is my understanding that most of the 'regulars' here are doctors, researchers or professors, all of whom will have to educate others at some point in their day. Why then not take the opportunity to educate and to dialog.

You don't have to become shower buddies, but it would be nice to see some of the highly educated act with some compassion.

That is just my 2 cents.

As for the meat of his response to an ND school, Bastyr, publishing a study and someone saying that they debunked himself and then pointing to Vioxx ... as far as I know, and I think I am representative, in some ways, of the general public, wasn't the Vioxx thing a case study in research being selectively screened for PR?

If recent history repeats itself here then can I expect to be flamed for my question? Can I expect to be ignored? Of will you decide that I am worth your time and effort to try to get me to understand why you believe what you believe? I know you are all busy people, but isn't understanding better than scoring a point?

Thanks for any replies. And sorry if I sound grumpy, but it hurts to type. I am going to take a short hot soak in some epson salts and then put on a chinese oil blend called Po Sum On [god I love that name] which we use in Tai Chi when someone gets 'schooled' by the Sifu.

Have a great day.

Marcus,
Well, perhaps the application of some statistics will ease us out of this impasse.

There are currently 120 comments in response to this blog entry. Hermano has posted 30 of them (25%) and there have been 30 direct responses (1:1 ratio) in total to his/her questions and comments. Please note that I have not included in this tally the many other excellent posts which, while not addressed to Hermano in particular, made general comments about the validity of Naturopathy that did in fact relate to recent questions/comments posted by Hermano.

Of Hermano's 30 posts, several contain information about the ND program at Basyr, and several contain anecdotal information from his/her experiences with Naturopath acquaintances, and with the MN legislation. There is also a series of posts in which he/she attempts to expose us as "bullies wallowing in the shared smugness of your common prejudice" by posting representative principles from Naturopathy and Osteopathy, and boasts that "Setting up my question using the osteopathic core principles as bait was masterful." Beyond this, several other Hermano-authored comments contain insulting language (objectively speaking, that is. I am personally not bugged by this in the least, but merely pointing it out to illustrate the fallacious arguments in Hermano's most recent post).

In contrast, the vast majority of the 30 responses to Hermano's comments, from a variety of different commenters, directly address Hermano's questions and statements about naturopathy. About midway through these responses, there are two or three comments with what might be construed as a frustrated tone, but given the persistence with which he/she has continued to pepper us with anecdotes irrelevant factoids, and questions which by his/her own admission are designed to hoist us on our own collective petard as opposed to actually seeking answers, This is hardly surprising. I for one think that the group here has shown a great deal of patience and restraint, all things considered. It is clear, if you take the time to read back, that we have, in fact, spent a considerable amount of time and effort directly and specifically engaging Hermano.

I therefore find your charge of 'ignoring' him/her perplexing, and can only conclude that you have not read the responses in this thread very thoroughly.

I am sorry to hear of your injuries, and I hope your day gets better.

P.S. Marcus, Please note that, in the absence of any data on this subject, I have made no assumptions about Hermano's gender. And Hermano, if you are reading this: if you feel the urge to call me names again, I'd really prefer "fish-girl" over "monkey-boy" or "Pork". Thanks!

Danio,

Thank you on elaborating on a STRAWMAN. Your artful use of capitalization gave me an idea and I did find an entry
for "straw man fallacy" on Wikipedia.
I initially thought that ildi's reference to 'strawmen' meant dismissing my first-hand observations of what naturopathic doctors actually do in practice as fabrications and asked for clarification.
I still fail to see how my question about the Bastyr study is logically flawed.
It seems to follow the 'What's good for the goose is good for the gander' paradigm.

I am sorry if I offended your sensibilities earlier.
I've seen others get slugged on this or related blogs,
I apologize for acting badly myself. I do tend to get testy and lose temper.
I'm not a usenet kind of guy, I did not realize I was breaking the "Godwin's law" when I compared a miscreant abusing someone else to a storm trooper on a related blog.

I plead ignorance,
did not know using extreme vulgarity and profanity is kosher, while making fun of Nazis is bad.
Then again I love 'The Producers'.

The thing I do feel good about is that I did keep myself from reacting several times, and I hope I am getting a handle on how things are done here.

Not that you need to care, or I need to explain myself further.

Regards.

For those who still have doubts (and you know who you are), or are seeking an opportunity to make fresh tracks in the ether, please see

http://www.sciencebasedmedicine.org/?p=141#more-141

for a nice deconstruction of the MN ND law.

Hermano,

it's really irrelevant to detail the profanity and other abuses you have allegedly suffered elsewhere when you have been subjected to no such treatment at RI. It may surprise you to learn that Scienceblogs is a big place, with many individual bloggers, and even more individual posters. Please do us the courtesy of treating us as the separate entities that we are, rather than as the uber-rational hive mind you seem to be imagining.

Now that you have discovered the definition of "strawman", I suggest you delve a bit deeper into studying logical fallacies in general. Logic and reason are just as useful in real life as they are on the internet.

Danio,

I appreciate your comment.
I will watch where I am and will not lump all blogs together.
There were several characters who bounced between the blogs mentioned in the first paragraph of Orac's post:
"I know I'm a bit late to this game, but those of you who read ERV, Denialism Blog, and Pharyngula"
This blog was the most congenial of the 4, thank you for making it so.
I will definitely look further into logical fallacies. If you will ever be inclined to explain to me where my arguments are lacking in logic, even in briefest terms, I would appreciate it.
For example, a statement was made: 'an ND researcher at an ND school publishes results in JAMA that a specific herbal preparation is not effective for a specific condition,
thus she debunks her school'. I fail to understand how this research "debunks" the institution that sponsored it and that is proud that the results are published in JAMA.
To make a point a suggested an example with a researcher at a med school who researches a pharmaceutical drug and finds it not effective or harmful. Such research does not debunk the institution, it does debunk the idea about the efficacy of the drug.
How could I have phrased this differently to avoid the straw man fallacy?

Of course more state and local governments are turning to woo. Evidence-based medicine is getting more expensive and insurance companies refuse to cover much if not most of it. Meanwhile, the state and local (not to mention Federal) governments can't take up the slack because that would require things like undoing Bush's massive tax cuts, which would get the rich (such as TV reporters and the billionaires who pay their salaries) on the cases of the politicians daring enough to do this.

Danio,
Thank you for mentioning Atwood's post to the
http://www.sciencebasedmedicine.org/?p=141#more-141
I posted a comment there, reproduced below.
I hope the tone is appropriate.

It would serve the audience much better had the author carefully read the new Minnesota Statute 147E, instead of haranguing against the "hidden agendas" of naturopathic medicine.
Everything said about profession's regulation in Minnesota is false.
The Statute 147E is very clear that the "Board" whose jurisdiction Minnesota registered naturopathic doctors fall under is:
"Subd. 4. Board. "Board" means the Board of Medical Practice or its designee."
The very same Board that governs Minnesota's medical doctors and is described in the Statute 147 of the Minnesota Code.
The "Discipline and Reporting" section of the Statute 147E makes appropriate references:
"Sec. 8. [147E.30] DISCIPLINE; REPORTING.
For purposes of this chapter, registered naturopathic doctors and applicants are
subject to sections 147.091 to 147.162."
Here are the names of the pertinent sections of the Board of Medical Practice Statute:

# 147.091 -- Grounds for disciplinary action.
# 147.092 -- Probable cause hearing; sexual misconduct.
# 147.10 -- Renumbered 147.081
# 147.101 -- Repealed, 1985 c 247 s 26
# 147.11 -- Repealed, 1985 c 247 s 26
# 147.111 -- Reporting obligations.
# 147.12 -- Repealed, 1985 c 247 s 26
# 147.121 -- Immunity.
# 147.13 -- Repealed, 1985 c 247 s 26
# 147.131 -- Physician cooperation.
# 147.141 -- Forms of disciplinary action.
# 147.151 -- Disciplinary record on judicial review.
# 147.155 -- Reports to the commissioner of health.
# 147.16 -- Repealed, 1985 c 247 s 26
# 147.161 -- Physician accountability.
# 147.162 -- Medical care facilities; exclusion.

So much for making "a few comments pertinent to the Minnesota bill"
The post has a section title: "The Minnesota Bill: the Devil's in the Details".
How very ironic.

Hermano, it seems that the self-regulation to which Dr. Atwood was referring is specific to the Advisory Council, detailed in Section 8 of the law. Just as he describes, this is a governing body made up of licensed Naturopaths. It seems fair to assume that the 'Board' would normally accept the judgement of the various Advisory Councils it appoints as to whether disciplinary action, etc. is warranted. It seems reasonable that someone with misgivings about the validity of Naturopathy (e.g. Dr. Atwood, Orac, me...) might worry to some degree about the reliability of this self-regulation. I'm not sure where you think Dr. Atwood got it wrong here, other than that he didn't mention the Board that oversees all ACs. That wasn't really the point of his contention, though, at least not as I read it. Perhaps he will directly address your comment once it is through moderation.

Jesse: "NickG, your argument holds no water whatsoever. The hypothetical you just described is not about training but personality. It is entirely possible that a mediocre DO will blow you off but the 'cut-throat' MD would not."

Actually 'blow me off' isn't the particular characteristic I would be concerned about. Its about a lot of characteristics: compassion, work ethic, ability to appropriately doubt yourself and to consider alternate clinical possibilities, etc.

However, my point that I was illustrating with that anecdote, which you have seemed to miss entirely, is that there is more to being a physician than test scores. Sometimes people who do not do so well on standardized tests have other characteristics that make them excellent physicians. And some people who can do very well on a standardized test shouldn't be practicing medicine. I think Kumar Patel said it best when asked why he didn't want to go to medical school despite perfect MCAT scores: "Just because you are hung like a horse doesn't mean you have to do porn."

p.s. sorry for that posting twice last time. I was on a cell connection that sucks.

Danio,

I somehow missed a post from June 11th that you addressed to me. Whoops.

You talk about a new corrections officer and I have to tell you that we do use alternatively trained and untrained people in some circumstances. What I am thinking about is social workers in minimum to medium security and volunteers at minimum security in some circumstances.

Of course there are always some trained personnel in those places and we watch over the volunteers especially but usually in those cases we have no problems. In max and super max, it is a different story, although we do also have volunteers in to work with the prisoners even in those places. Our supervision is tighter in those situation, of course.

It might interest you to know that many prisoners are essentially unsupervised for most of the day and have the ability to walk away in minimum security prisons. There is one prison that holds a blend of max to min security prisoners that has no walls at all. And yet there are no escapes.

Was your analogies point to compare MD to steel bars and ND to energy fields. IF so I would have to ask if you consider all MD's equal and all ND's equal in terms of ability, training, and professional conduct?

Through no fault of your own I'm afraid that you analogy does not hold water here. Most guards welcome anyone who wants to volunteer and anyone who will work with 'the guys'. It is part of rehabilitation. And it makes my job easier in many ways. Sure, I have to keep an eye on things, but I was doing that anyway.

It may interest you to know that we don't allow any weapons within the prison. Which means that within those walls the officers and other personnel are outnumbered by about 60 to 1 and at the most carry a radio, mace, and handcuffs. Most staff have only a radio.

Danio,

Please read what Atwood said about regulating Registered Naturopathic Doctors in Minnesota again (included below). He is totally wrong on everything pertaining to regulating NDs in Minnesota. It's too bad that when someone so incompetent
opines on regulating naturopathic medicine you immediately call his tirades "a nice deconstruction of the MN ND law".
Atwood presents himself as an expert on what qualifies some one to be an expert (Doctor). A bit more skepticism on your part might be in order.

Statute 147E https://www.revisor.leg.state.mn.us/laws/?id=348&doctype=Chapter&year=2… clearly states which Board has jurisdiction over NDs. I must be breaking a logical fallacy by appealing to your intelligence or common-sense or whatever, but do you not understand what "Advisory" mean? It is absolutely not the "governing body" as you say. The State Board of Medical Practice is the governing body.
The history behind it goes back to 1987 when NDs proposed a legislation which included creating an independent governing Board. The agency which examined that legislation failed to recommend it (with a tied vote) because it felt that the 5 NDs then resident the state could not support the revenue stream required to maintain an independent Board. Since then, the NDs have been working with the Medical Board on drafting their legislation, and were supported by it in pursuing the bill which became Statute 147E. See p.92 of http://www.auditor.leg.state.mn.us/ped/pedrep/9905apb.pdf

Atwood says:

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.

Marcus,
I freely admit that I don't know jack-all about Corrections, and thanks for the insider info. Try another analogy if you like-- Auto Repair via Chi adjustment? Homeopathic Firefighting? Faith-based Law? Sure, at some level the point by point comparisons of most analogies will become unwieldy, but the basic premise of what I was trying to get across still holds: Evidence-based, proven methods + rigorous training in same, vs. some kind of woo that would be preposterously invalid if it were taking place in any other field, but which many people find completely acceptable when it comes to the Medical field.

Are all MDs created equal, you ask? Of course not. But the Medical field is backed by a wealth of scientifically robust methods. No matter how many quack MDs you can dig up on any given day, the validity of the field itself is pretty bullet-proof. This is, as has been pointed out repeatedly, distinctly different from the substantive support for Naturopathy and other CAM. It doesn't matter how 'good' they are at the end of the day. They have been trained in a scientifically impoverished discipline. The research efforts from Bastyr that Hermano has pointed out are encouraging, but by my reckoning not at all representative of the field.

Hermano,
If you are going to charge that Dr. Atwood is 'totally wrong about everything pertaining to NDs in MN' you're going to have to do better than trying to ding him on semantics. Yes, it is clear from reading the law that the State Board passes down the ultimate judgement on these matters, but is it not true that they do so largely based on the recommendations of the advisory councils of every group of professionals they oversee? Otherwise what would be the point of having advisory councils at all? Other than Dr. Atwood's use of the word 'board' in outlining this topic, which at worst introduces some transient ambiguity until he starts specifically talking about the AC, where exactly does he get it 'totally wrong'?

As far as Dr. Atwood's credibility goes, I don't know him personally, but I've been familiar with his tireless efforts to educate and enlighten people of all disciplines about CAM for a number of years. By most standards he is, in fact, an expert in this arena, in addition to being an accomplished and well-respected physician. I suspect you already know this, however, and given your perspective on Naturopathy I'm not surprised at your dismissal of his qualifications. So it goes.

marcus,

I have been tryin to follow your argument and I admit, I am lost...is your point that naturopaths WILL be subject to regulation of some august "medical board" or that they WILL NOT? Sorry to use caps--really, I'm not shouting, I just can't italicize as I would like.

I ask because my impression of the statute at issue is that it allows the naturopaths in the state to essentially have their cake and eat it, too; the regulations are voluntary, not compulsory (unless there is some statutory language I haven't see appended to what you posted)......so no real "teeth" to the statutes. They can simply add the designation of being "licensed" as a naturopath . . . or not; much different than true licensed professions where one MUST be licensed to practice in a particular jurisdiction (and, often, must pay malpractice insurance as a condition of the same, as, for example, lawyers do). Now, if a lawyer chooses to join, for example, the American Bar Association, that provides no oversight nor any type of redress for a disgruntled client.....but you get a nice journal each month and you get to hang a nice certificate in your office and tell potential clients, "Hey, I am a member of the ABA." Meaningless other than some limited marketing value.

So I am not sure what, if any, power is given to disgruntled naturopathic patients vis a vis this set of statutes.

Danio,
I truly appreciate you patience and willingness to discuss this subject, you have my gratitude.
To be precise, I did not say Atwood was "totally wrong about everything pertaining to NDs in MN", I said "totally wrong on everything pertaining to REGULATING NDs in Minnesota".
I am not disputing any other facts, events, or attributions Atwood uses in his article, not being very familiar with them. My issue is with his interpretation of the law REGULATING NDs in Minnesota.
I actually really appreciate that Atwood brings up specific points in his criticism, so that someone who may know differently may dispute them.
This is SO much better than the most common criticism leveled against the bill during the legislative session. What was said hundreds times over "I find the language of the bill unacceptable", without any specific references to whatever is so unacceptable, ever.
I found that infuriating, correct my logical fallacy if any, but that accusation seems equivalent to saying "I do not like English".
I respectfully disagree with you about your enthusiasm for Atwood. I have read some of his writings on sciencebasedmedicine.org and quack/nature/watch.org.
My impression is of someone who is petty, humoreless, dour, and zealous.
The two themes that I see recurring in his writings is
1) the defining moment of glory penning minority opinion for the Mass. committee looking at the pros and cons of legislating NDs and
2) tired repetition of Emily Kane's mention of adding H2O2 to bath water as a method to relieve asthma attack.

Call me ad hominem, I suspect Atwood's vendetta against Kane
has to do with the fact that she graduated from Harvard in 1978. I found a reference in Harvard Magazine for Kimball Atwood '79. Looks like a Harvard College alum tag.
I don't know whether their paths crossed during school years, or whether he simply can not allow that a Harvard grad would engage in a profession he finds so detestable.
I just find his attacks on her really strange.

Barbie123, I hope this is pertinent to your question to Marcus.
To summarize the situation in Minnesota: anybody can be called a naturopath and may practice naturopathy without any restrictions or qualifications, AND when the new naturopathic doctor regulation law, Statute 147E, goes into effect July 2009, there will be very strict requirements for who can hold title 'naturopathic doctor'.
Minnesota is different from other states by being the first one to pass 'Health Freedom' law, Statute 146A, in 2001. https://www.revisor.leg.state.mn.us/bin/getpub.php?pubtype=STAT_CHAP&ye….
This law protects unlicensed CAM practitioners from being hassled by the Board of Medical Practice for practicing medicine without the license.
Trained NDs, who have been trying to get regulated in Minnesota since 1909, had to draft legislative language that would be acceptable to all sides, the Minn. Medical Association, the Board of Medical Practice, many other professional groups, AND the representatives of unlicensed CAM providers covered by the 146A.
For example, naturopathic doctors had to remove title 'naturopathic physician' to placate the MMA, and also removed title protection for 'naturopath' in an ATTEMPT to placate the unlicensed CAM providers.
This good faith attempt absolutely did not placate these opponents who continued to do everything possible to derail the bill, but it did make a favorable impression on the legislators.

My issue is with his interpretation of the law REGULATING NDs in Minnesota.

My apologies for leaving out the word 'regulating'--see how useful 'Caps Lock' can be? ;)

I actually really appreciate that Atwood brings up specific points in his criticism, so that someone who may know differently may dispute them.

Ok, I have addressed your issues on this thread, and Dr. Atwood has responded to your complaint about board vs. AC on the SBM blog. Do you have a rebuttal?

Call me ad hominem

Well spotted. Any personal motivations behind Dr. Atwood's vigilance against the incursions of Naturopathy and other forms of CAM are completely beside the point, and in no way invalidate his position.

@Hermano wrote "This law protects unlicensed CAM practitioners from being hassled by the Board of Medical Practice for practicing medicine without the license."

This begs the question of why they shouldn't CAMs should not be prevented from practicing "medicine" (with or without) a license. You are all over various blogs crowing about the law; but, not one word supporting the utility of n'pathy (hint, it has none; except for enriching its proponents). You cannot argue for n'pathy because the facts are entirely against you. I am intrigued that you seem to realize that.

Naturopaths are the world's foremost quacks because they incorporate every irrational, disproven "health care" notion.

Danio,

Thank you and thank you for the heads up about K. Atwood's response.
My reply to him is below.
I am very tired and I am going to indulge in watching the recording of my favorite TV show, House M.D.! It's about a kick ass, foul mouth, supremely rational, Real Doctor. Yeehaw!

Reply to KAIV.

I am in fact very naive about a great many thing,
including debating, rhetoric, and logical fallacies.
I do believe I have a capacity to learn, so if I err
in any way, I would very much like a reply that
identifies my error in more basic terms suited to
someone new to discussions of this sort.
I do not believe calling attention to the relevant
sections of the Minnesota law K. Atwood completely misinterpreted
is distracting from the subject which is this
particular law, Statute 147E.
I will try to follow the protocol set before me.
First let's get the pleasantries out of the way.
Kimball Atwood is dogmatic, prejudiced, petty, dour, humorless, and a zealot.

Now to elaborate on what I said earlier.
The fact is Advisory Council is an advisory body, the
governance is reserved for the Medical Board.
I sincerely hope the Medical Board considers the input from
the Advisory Council while it deliberates and decides on matters
relevant to registered naturopathic doctors.

Here are some examples regarding advisors. Over at the scienceblogs,
people enjoy watching me flinging strawmen, I don't know if the following
examples qualify as straw man fallacies, if they do, I hope you enjoy them
as much as others have.

I hope the U.S. President listens to his advisors, ultimately
the decisions he or she makes are his or her responsibility.
The U.S. Congresspeople and Senators rely on their legislative
assistants, many of whom yield considerable power, the voting record
is the responsibility of the legislators themselves.
The U.S. Supreme Court Justices have their incredibly bright clerks,
yet these clerks do not cast decisions on cases before the court.

Another example is "Massachusetts Special Commission on Complementary and
Alternative Medical Practitioners, an ad hoc group whose purpose is to
inform state legislators about naturopathy" which I will naively characterize
as an advisory body on licensing NDs in Massachusetts.

This advisory commission makes a recommendation to regulate naturopathic
doctors, and 6 years later the Massachusetts naturopathic doctors are still not regulated
and, I am told, never will be as long as the Mass. Medical Society is set
against allowing them to be regulated.

The truth is, being neither psychic or clairvoyant, I do not know how well the
Medical Board will cooperate with the Advisory Council, only the time will show.

Now, for the "real point: what naturopaths do".
Let me say more about myself, so I can disqualify myself right away.
I am an advocate for regulating naturopathic doctors.
I am neither a health care professional nor a professional scientist.
The highlight of my scientific education has been getting, as an older student,
one of few all "A"s at a challenging physics for engineers university sequence,
not the physics lite gut many premeds take to keep their GPAs up.
I do personally know many of the eligible for regulation naturopathic doctors,
I have paid attention to those who actively opposed this legislation,
watched and read about their tactics in Minnesota and other states,
and I believe I gained an insight into the method behind their madness.

It's not really a compliment, so I hope it does not count against me as a logical fallacy
of pandering to you, but as much as I find the proponents of rational skepticism
irritating and overly zealous, I do not believe you have it in you to be
as plain nasty and fight as dirty in the real world of politics
as I saw the opponents of regulating naturopathic doctors do.
I don't think you have the capacity, or stomach, or whatever they have for inflicting
maximum pain on their opponents.

Having said all this, and mindful that K. Atwood's already "heard every argument"
I will not bore you any more!

Best Regards.

I wrote "This begs the question of why they shouldn't CAMs should not be prevented from practicing "medicine" (with or without) a license."

Of course, I meant "This begs the question of why they shouldn't CAMs should be prevented from practicing "medicine" (with or without a license)."

It is clear that Hermano cannot argue the facts.

but as much as I find the proponents of rational skepticism irritating and overly zealous

Reality can be irritating.

Hermano,
Joe is spot on. You do seem incapable of arguing the facts. A case in point is your last comment, in which, after further ad hominem attacks on Dr. Atwood (why? what purpose does this serve?), and after listing a number of irrelevant non-comparisons, you say, (in 'response' to Dr. Atwood's comment on his own post):

Now, for the "real point: what naturopaths do"

and then spend another 20 lines NOT addressing the 'real point' in any discernible way. Dude, please accept the reality that none of the irritating, overly zealous rational skeptics with whom you are engaged (here, at SBM, Denialism, and Pharyngula) are going to be moved in the slightest by your argument from personal experience. It does not matter how many ways, or on how many blogs, you present your perspectives. Continuing to do so after having been asked repeatedly to cut the BS and get down to evidence just makes you look obtuse. Surely someone who aced 'real' physics is smart enough to realize that you can only talk around the point for so long. If you are ready to discard the protective anecdotal layers and discuss the specific scientific validity of Naturopathic practices, bring it on. Somehow, though, I wonder if all this Naturopath Apologist schtick isn't just another retelling of 'The Emperor's New Clothes' (see Courtier's Reply for the stock answer: http://scienceblogs.com/pharyngula/2006/12/the_courtiers_reply.php)

Danio,
You ask me to drop anecdotes and use evidence to "discuss the specific scientific validity of Naturopathic practices".
First a question,
What do you think naturopathic doctors do?
Now, please help me with one of my favorite examples contrasting ND and MD approaches to patient care.
5 minute visit with an MD who writes a script and sends the patient on his way, and a 90 minute interview NDs conduct during first time patient visit.
I read an article years ago (the NY Times Health Section?) which described a 90 minute patient's lifestyle evaluation by a physician during an "executive physical" at the Mayo Clinic as its highlight.
Would a reference to such article serve as evidence that
this typical "naturopathic practice" is valid?

There are practices I consider bogus, 2 quick examples: applied kinesiology and various machines, such as EAV Atwood mentions.
He uses 'for sale' listings for such from
a 2001 AANP publication as evidence that NDs use these machines.
Some do, not a single one I know, and you don't care I just said that because it's an anecdote.
So for me the best way to prove NDs do not believe in this junk would to reference a study published in an ND peer-approved journal discrediting such machines.
I am not aware of such study.
What I am aware of is the recent Seattle Times investigative report on such machines http://seattletimes.nwsource.com/html/localnews/2004020598_miraclesplit….
I hope you will take a look at this report if you are not already familiar with it. I suspect you will be critical if I use this report as evidence. Please explain why you think it makes for poor evidence.
Washington State has the greatest number of licensed NDs in the country, and, I was told, the Wash. ND association closely cooperated with the reporters.
Is the fact that this report was published in Seattle, and not in NYC or Boston where NDs are not licensed significant?

Now I will mix things a little, there is an argument made against regulation that the number of qualified NDs in unlicensed states is small and thus it only serves the interests of a tiny group to enact regulation. Is this a good argument?
Minnesota with its 5.1m residents only has 20+ qualified NDs. A licensed state such as Oregon with 3.7m residents has nearly 1,000 licensed NDs.

Am I lumping too much staff together?

Thank you again. I am trying to develop arguments you might more persuasive.

I am still thinking about those stupid machines, would a survey completed by Minnesota NDs on whether or not they use these machines and their opinions on their usefulness serve as evidence?

Guys/gals:

I suggest we stop feeding the troll. He's a good one, but really. Didn't things become obvious around the ESL excuse?

Besides, there's a brand new post on naturopathy here. ;-)

I certainly don't want to feed the troll :) but I would like to ask Hermano one question: where is he getting his data that doctors (real doctors) spend only 5 minutes per patient? Does he have a source? Or is this another of his folksy anecdotes to "support" his argument?

If this is the cornerstone of his "nd's can beat up md's nyah nyah" argument, then I know all I need to about Hermano's position.

Barbie123: Please see the 'strawman' (or, rather, 'STRAWMAN') discussion up-thread. Hermano is pretty much a one-hit-wonder troll in this regard.

Hermano, all your questions have been asked and answered, in triplicate. In light of your complete failure to address the questions put to you, I am forced to conclude that there is nothing of substance beneath the froth of your ad hominems, your battalions of strawmen, and your eye-wateringly fetid BS. I'm done with you.

Danio,
Thank you for everything.
I look forward to learning more about logical fallacies, elsewhere.

Barbie123,
In Korean Zen thought, "I don't know" is always the right answer.
Best wishes to you and all your authoritarian pseudo-skeptic brethren.

I am really trying to quit posting to this thread.
It looks like last week's news about the JAMA publication of the Bastyr study was not the only newsworthy child psychoactive substance medical research item.
Just came across http://www.nytimes.com/2008/06/16/opinion/l16drug.html.
'Past coverage' links at the bottom of the linked page.
¡Adios Amigos!

I'm all in favour of regulating naturopaths - it's just that the regulation I'm in favour of is very different from what they're in favour of. Very nearly everything they do should be illegal, on the basis of fraud for worthless treatments, and on the basis of criminality for actively endangering people.

If you are late i dont think that it will be such disaster there is nothing to be afraid.

................
Emma
Addiction Recovery Minnesota